Analysis of UNOS: Trends in Heart Transplantation for Adults With Congenital Heart Disease in the United States Over 35 Years - A Comparison of Two Eras

<b>Background:</b> The purpose of this study is to identify 35-year trends in adult congenital heart disease (ACHD) heart transplant volume, transplant centers, patient characteristics, and longitudinal survival up to ten years. <b>Methods:</b> We performed a retrospective review of ACHD patients (≥18 years) who underwent heart transplantation (N = 2,297 transplants) between January 1, 1988, and December 31, 2022, using the United Network for Organ Sharing Database. Trends in transplant volume, transplant centers, patient characteristics, and longitudinal survival were analyzed. To allow for distinct comparisons between contemporary and historical outcomes, two eras were created (Era 1[N = 1,202 transplants]: January 1, 1988-December 31, 2011; Era 2[N = 1,095 transplants]: January 1, 2012-December 31, 2022). <b>Results:</b> Over a 35-year period, 2,297 heart transplants were performed in ACHD patients. During this time, ACHD heart transplant volume steadily increased. In 1988, 26 heart transplants were performed in ACHD patients nationally, while in 2022, 165 heart transplants were performed in ACHD patients nationally. Simultaneously, the number of transplant centers also increased, but at a slower pace. Era 2 transplants were performed in patients with increased rates of pretransplant cerebrovascular disease, inotropic support, and mechanical circulatory support; nevertheless, patients transplanted in Era 2 had improved longitudinal survival through ten years (log-rank <i>P</i> < .001). <b>Conclusions:</b> Our analysis of ACHD patients undergoing cardiac transplantation over 35 years (January 1, 1988-December 31, 2022) demonstrates that in the more recent era, ACHD transplant patients have increased pretransplant rates of cerebrovascular disease, inotropic support, and mechanical circulatory support; nevertheless, patients transplanted in the most recent ten years of our analysis had improved longitudinal posttransplant survival through ten years in comparison with those transplanted earlier.