Miguel Angel Reyes Roque, Emre Erturk, Sally Rushton, Aaron Ranasinghe, Helen Spencer, Alexandra Ball, Debra Thomas, Jasvir Parmar, Vasiliki Gerovasili, Louise Coats, Andrew J. Fisher, Louise A. Kenny
NHS Blood and Transplant. Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust and Newcastle University. Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust. Great Ormond Street Hospital. University of Manchester NHS Foundation Trust and Manchester Academic Health Science Centre. Royal Papworth Hospital NHS Foundation Trust. Royal Brompton and Harefield Hospitals Guy’s and St. Thomas’ NHS Foundation Trust. Imperial College London.
United Kingdom
Journal of Heart and Lung Transplantation Open
JHLT Open 2026; 13:
DOI: 10.1016/j.jhlto.2026.100572
Abstract
Background: Combined en-bloc heart-lung transplantation (HLT) remains the optimal treatment for selected patients with end-stage cardiopulmonary disease. The indications for and utilization of HLT have changed significantly over time. We report the changing landscape of HLT in the UK over recent decades, identifying factors that may inform future organization of services.
Methods: Data were extracted from the UK Transplant Registry spanning 1984 to December 2023. All patients who were registered for and/or underwent HLT were included in our analysis. Baseline characteristics and outcomes from listing and transplantation were compared between 2 eras: pre-2000 and post-2000.
Results: Pre-2000, 1,199 patients were registered for HLT, and 915 received HLT, post-2000, there were 473 registrations and 200 transplantations, reflecting a significant decline in the use of this procedure. Those listed post-2000 were older, more symptomatic, and with more prior cardiac surgeries. Cystic fibrosis, the leading indication pre-2000, declined substantially in the later era. For patients requiring HLT in the later era, the risk of dying on the waiting list exceeded the chance of receiving a transplant. Median post-transplant survival improved from 4.07 (IQR 0.2, 12.3) to 7.9 (IQR 0.8, 21.6) years.
Conclusion: Although HLT activity has declined, a considerable need remains, particularly among patients with congenital heart disease and pulmonary hypertension. The changes in patient demographics and high waiting list mortality highlight systemic inefficiencies in organ allocation and underscore the need for a revised system to ensure timely and equitable access for this high-risk population.
Category
Lung Transplantation for Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease or Adult Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes