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Lookup NU author(s): Dr Louise Coats, Dr Louise Kenny
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2026 The AuthorsBackground: 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.
Author(s): Roque MAR, Erturk E, Rushton S, Ranasinghe A, Spencer H, Ball A, Thomas D, Parmar J, Gerovasili V, Coats L, Fisher AJ, Kenny LA
Publication type: Article
Publication status: Published
Journal: JHLT Open
Year: 2026
Volume: 13
Print publication date: 01/08/2026
Online publication date: 18/06/2026
Acceptance date: 02/04/2018
Date deposited: 29/06/2026
ISSN (electronic): 2950-1334
Publisher: Elsevier
URL: https://doi.org/10.1016/j.jhlto.2026.100572
DOI: 10.1016/j.jhlto.2026.100572
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