Adults with congenital heart disease (CHD) and advanced heart failure have an estimated 1-year mortality risk approaching 40% without transplantation. A cohort study published in the International Journal of Cardiology evaluated clinical characteristics and outcomes among adults with CHD referred for heart transplant evaluation, focusing on those with stage D heart failure (HF).

Adults undergoing multidisciplinary transplant assessment were categorized into three pathways: transplant-listed (eligible stage D HF), transplant-declined (stage D HF with contraindications), and transplant-deferred (no stage D HF). A total of 416 patients were assessed, including 159 (38%) listed for transplant, 101 (24%) declined, and 156 (38%) deferred. Among those listed, 110 underwent heart transplantation. Patients who received a transplant had survival comparable to individuals without stage D HF.

Among patients with stage D HF (n=260), heart transplantation was associated with a 9-fold lower risk of all-cause mortality. In contrast, end-organ dysfunction and clinical congestion were common among patients who were declined for transplant listing or who died while awaiting transplantation and were associated with higher all-cause mortality.

Heart transplantation was associated with improved survival in adults with CHD and stage D HF. Earlier referral for transplant evaluation may improve outcomes in this population.