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THE AUSTRALIA AND NEW ZEALAND CARDIOTHORACIC ORGAN TRANSPLANT REGISTRY EIGHTEENTH ANNUAL REPORT 1984 – 2013 ANZCOTR 2013.

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Presentation on theme: "THE AUSTRALIA AND NEW ZEALAND CARDIOTHORACIC ORGAN TRANSPLANT REGISTRY EIGHTEENTH ANNUAL REPORT 1984 – 2013 ANZCOTR 2013."— Presentation transcript:

1 THE AUSTRALIA AND NEW ZEALAND CARDIOTHORACIC ORGAN TRANSPLANT REGISTRY EIGHTEENTH ANNUAL REPORT 1984 – 2013 ANZCOTR 2013

2 NUMBER OF ALL TRANSPLANT TYPES BY YEAR ANZCOTR 2013

3 NUMBER OF ALL TRANSPLANTS* ANZCOTR 2013 *Includes domino, heterotopic and retransplants

4 ALL HEART TRANSPLANTS BY HOSPITAL

5 HEART LUNG TRANSPLANTS BY HOSPITAL ANZCOTR 2013 Prince Charles 2005 figure includes one retransplant

6 SINGLE LUNG TRANSPLANTS BY HOSPITAL ANZCOTR 2013

7 BILATERAL LUNG TRANSPLANTS BY HOSPITAL ANZCOTR 2013 Includes retransplants

8 COMBINED WAITING LIST ACTIVITY 2013 ANZCOTR 2013 *Contains complete calendar year activity from all Registry Participant Centres. nb lungs column includes heart/lung procedures HEARTS TOTALLUNGS TOTAL Active as at 1 January New Additions during From on hold to Active Jan 2013 Removals from Waiting List (Permanent) W1 - Transplant Performed86188 W2 - Patients condition Improved52 W3 - Too ill, new dev of contraindications etc1210 W4 - Patient declined11 W5 - Transferred to another interstate list10 W6 - Died waiting1514 W7-Removed - unspecified 01 TOTAL at Year end - (Active) 31 December Total at month end inactive - (On HOLD)910

9 PRE TRANSPLANT DIAGNOSIS HEART ISCHAEMIC HEART DISEASE 34% IDIOPATHIC DILATED CARDIOMYOPATHY 40% Viral CM / Myocarditis 3% Congenital HD 6% Other 13% Retransplant 1% Peripartum CM 1% ANZCOTR 2013 Familial CM 2%

10 PRE TRANSPLANT DIAGNOSIS n = 2384 ANZCOTR 2013

11 PRE-TRANSPLANT STATUS HEARTS ANZCOTR 2013

12 PRE-TRANSPLANT STATUS HEARTS ANZCOTR 2013 STATUS - Year n= NYHA III % NYHA IV % Inotropic support % Intra-aortic Balloon Pump % Ventricular Assist Device % Total Artificial Heart %

13 DONOR / RECIPIENT STATE OF ORIGIN HEARTS Number ANZCOTR 2013

14 DONOR / RECIPIENT STATE OF ORIGIN HEARTS ANZCOTR 2013

15 Mean Waiting Time to Transplant HEARTS DAYS YEAR ANZCOTR 2013

16 WAITING DAYS TO HEART TRANSPLANT ANZCOTR 2013

17 Mean Recipient Age at Transplant HEARTS Year Age(yrs) ANZCOTR 2013

18 RECIPIENT AGE AT HEART TRANSPLANT YEARS ANZCOTR 2013

19 Hearts Mean Donor Age Year Age in years ANZCOTR 2013

20 DONOR AGE HEARTS - YEARS ANZCOTR 2013

21 HEARTS - Mean Ischaemic Time Minutes Year ANZCOTR 2013

22 MEAN HEART ISCHAEMIC TIME - MINUTES ANZCOTR 2013

23 ACTUARIAL SURVIVAL - HEART TRANSPLANT n* = Number alive at start of year ANZCOTR 2013

24 ACTUARIAL SURVIVAL - HEART TRANSPLANT Percent Survival YEAR ANZCOTR 2013 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

25 ACTUARIAL SURVIVAL – ORTHOTOPIC v HETEROTOPIC v DOMINO TRANSPLANTS ANZCOTR 2013

26 Actuarial Survival Orthotopic v Heterotopic v Domino Hearts Percent Survival ANZCOTR 2013 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

27 ACTUARIAL SURVIVAL ALL HEARTS PERIOD COMPARISON 1984 – 2013 ANZCOTR 2013 Percent Survival p<0.001 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

28 ACTUARIAL SURVIVAL HEARTS PERIOD COMPARISON ANZCOTR 2013 *N = NUMBER ALIVE AT START OF YEAR

29 ACTUARIAL SURVIVAL PRE TRANSPLANT DIAGNOSIS Percent ANZCOTR 2013 IDCM v IHD p<0.005 IHD v Others p<0.005 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

30 ACTUARIAL SURVIVAL PRE TRANSPLANT DIAGNOSIS HEARTS 1984 – 2013 ANZCOTR 2013

31 ACTUARIAL SURVIVAL PRE-TRANSPLANT STATUS HEARTS ANZCOTR 2013 Percent Survival Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel p=ns

32 ACTUARIAL SURVIVAL PRE-TRANSPLANT STATUS HEARTS ANZCOTR 2013

33 ACTUARIAL SURVIVAL RECIPIENT AGE BY GENDER HEARTS ANZCOTR 2013 *N= NUMBER ALIVE AT START OF YEAR

34 ACTUARIAL SURVIVAL BY RECIPIENT AGE AND GENDER HEARTS ANZCOTR 2013 Percent Survival MALES 0-39 yrsv MALES>39yrs p<0.005 MALES>39yrs v FEMALES>39yrs p <0.05 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

35 ACTUARIAL SURVIVAL DONOR AGE HEARTS ANZCOTR 2013 * * 2 OF THE 16 CASES IN THE GREATER THAN 59 YEARS CATEGORY ARE HETEROTOPIC HEART TRANSPLANTS

36 ACTUARIAL SURVIVAL DONOR AGE HEARTS YEAR Percent Survival ANZCOTR OF THE 11 CASES IN THE GREATER THAN 59 YEARS CATEGORY ARE HETEROTOPIC HEART TRANSPLANTS Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel 0-16yrs v 40-49yrs p< yrs v 50-59yrs p< yrs v 40-49yrs p< yrs v 50-59yrs p<0.009

37 ACTUARIAL SURVIVAL DONOR GENDER HEARTS ANZCOTR 2013

38 ACTUARIAL SURVIVAL DONOR GENDER HEARTS Year Percent Survival ANZCOTR 2013 p=ns Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

39 ACTUARIAL SURVIVAL RECIPIENT GENDER HEARTS ANZCOTR 2013

40 ACTUARIAL SURVIVAL RECIPIENT GENDER HEARTS Year Percent Survival ANZCOTR 2013 p=ns Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

41 ACTUARIAL SURVIVAL ISCHAEMIC TIME HEARTS ANZCOTR 2013

42 ACTUARIAL SURVIVAL ISCHAEMIC TIME HEARTS ANZCOTR 2013 p=ns Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

43 ACTUARIAL SURVIVAL CROSSMATCH HEARTS ANZCOTR 2013

44 ACTUARIAL SURVIVAL CROSSMATCH HEARTS Year Percent Survival ANZCOTR 2013 p < 0.01 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

45 ACTUARIAL SURVIVAL PEAK PANEL REACTIVE ANTIBODIES ALL HEARTS ANZCOTR 2013

46 ACTUARIAL SURVIVAL PEAK PRA ALL HEARTS Year Percent Survival ANZCOTR 2013 p=ns Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

47 ACTUARIAL SURVIVAL CMV STATUS HEARTS ANZCOTR 2013

48 ACTUARIAL SURVIVAL CMV STATUS HEARTS Year Percent Survival ANZCOTR 2013 p=ns R+ve = R+veD+ve or R+veD-ve Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

49 ACTUARIAL SURVIVAL HLA MISMATCH HEARTS ANZCOTR 2013

50 ACTUARIAL SURVIVAL HLA MISMATCH HEARTS Year Percent Survival ANZCOTR 2013 p<0.05 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

51 ACTUARIAL SURVIVAL HLA DR LOCUS MISMATCH HEARTS ANZCOTR 2013

52 ACTUARIAL SURVIVAL HLA DR LOCUS MISMATCH HEARTS Year Percent Survival ANZCOTR 2013 p= ns Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

53 ACTUARIAL SURVIVAL MALIGNANCIES HEART ANZCOTR 2013 *Survival of the group who were defined by having developed a malignancy

54 ACTUARIAL SURVIVAL MALIGNANCIES HEARTS Year Percent Survival ANZCOTR 2013 ptld v other mal p=<0.005 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

55 RECIPIENT CAUSE OF DEATH - HEARTS n = 1114 TxCADMisc InfectionAcute Rejection Other Malignancies PTLDCVAHemorrhage No of Deaths ANZCOTR % 27% 14% 10% 15% 4% 1% NSGF 7%

56 CAUSE OF DEATH HEARTS ANZCOTR 2013

57 CAUSE OF DEATH ALL HEARTS <5 YEARS AFTER TX ANZCOTR 2013 No% Infection10822 Misc (incl 4 no data8717 Rejection8617 Non Specific Graft Failure6714 Graft Atherosclerosis (TxCAD)5611 Non Lymphoid Malignancy306 Lymphoproliferative Disease133 CVA204 Haemorrhage122 Graft Atherosclerosis & Rejection92 Pulmonary Failure61 Pulmonary Hypertension21 Totals

58 CAUSE OF DEATH ALL HEARTS ≥5 YEARS AFTER TX No % Misc (incl data pending)17829 Graft Atherosclerosis (TxCAD)14523 Non Lymphoid Malignancy14123 Infection457 Lymphoproliferative Disease325 Rejection203 CVA224 Non Specific Graft Failure163 Pulmonary Failure61 Haemorrhage30.5 Graft Atherosclerosis & Rejection71 Pulmonary Hypertension10.5 Totals ANZCOTR 2013

59 MALIGNANCIES* - HEART n = PTLD 16 % Other 84 % ANZCOTR 2013 *the count of initial diagnosis only

60 MALIGNANCIES - HEART N= ANZCOTR 2013

61 Reason for Transplant Heart Lung PPH 26% Eisenmenger’s 21% Other PH 3% AAT deficiency 7% Emphysema 3% Congenital Heart Disease 14% Cystic Fibrosis 14% CFA 3% Bronchiectasis 2% Misc 7% ANZCOTR 2013

62 REASON FOR TRANSPLANT HEART LUNG n = ANZCOTR 2013 Primary Pulmonary Hypertension 47 Eisenmenger's Syndrome 37 Congenital Heart Disease 26 Cystic Fibrosis 25 Alpha-1-Antitrypsin Deficiency 13 Emphysema 6 Cryptogenic Fibrosing Alveolitis 5 Other Pulmonary Hypertension 6 Bronchiectasis 4 Miscellaneous 13 Total 182

63 Reason for Transplant Single Lung AAT 16% Emphysema 51% IPF 25% Misc 6% Bronchiectasis 1% Other PH / Eisenmengers / CF 1% ANZCOTR 2013

64 REASON FOR TRANSPLANT SINGLE LUNG n = 476 ANZCOTR 2013

65 Reason for Transplant Bilateral Lung 1992 – 2013 n =1704 Cystic Fibrosis 33% Emphysema 27% IPF 10% Bronchiectasis 8% Misc 9% AAT 7% Other PH 1% PPH 4% ANZCOTR 2013 Eisenmengers 1%

66 REASON FOR TRANSPLANT BILATERAL LUNG n = 1704 ANZCOTR 2013

67 Donor / Recipient State of Origin All Lungs ANZCOTR 2013 Number *Retransplants and unknown state of origins are not included

68 DONOR / RECIPIENT STATE OF ORIGIN ALL LUNGS ANZCOTR 2013 *Retransplants and unknown state of origins are not included

69 Mean Wait to Transplant All Lungs Days Year ANZCOTR 2013

70 MEAN WAITING TIME TO LUNG TRANSPLANT – DAYS ANZCOTR 2013

71 Mean Recipient Age at Transplant LUNGS ANZCOTR 2013 Age in Years

72 MEAN RECIPIENT AGE AT LUNG TRANSPLANT ANZCOTR 2013

73 Mean Donor Age at Transplant ALL LUNGS ANZCOTR 2013 Years of Age

74 MEAN DONOR AGE AT TRANSPLANT LUNGS ANZCOTR 2013

75 LUNGS MEAN ISCHAEMIC TIME ANZCOTR 2013 Minutes

76 LUNGS - MEAN ISCHAEMIC TIME MINUTES ANZCOTR 2013

77 Recipient Gender % Lung Transplants % ANZCOTR 2013

78 Recipient Gender Lung Transplants ANZCOTR 2013

79 ACTUARIAL SURVIVAL ALL LUNGS ANZCOTR 2013

80 ACTUARIAL SURVIVAL ALL LUNG TRANSPLANTS Year Percent Survival ANZCOTR 2013 SL v HL p<0.005 SL v BL p<0.005 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

81 ACTUARIAL SURVIVAL DCD DONORS V DBD DONORS Year Percent Survival ANZCOTR 2013 p=ns Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

82 ACTUARIAL SURVIVAL DCD DONORS v DBD DONORS ANZCOTR 2013

83 ACTUARIAL SURVIVAL DONOR AGE ALL LUNGS YEAR Percent Survival ANZCOTR yrs vs 40-49yrs p< yrs vs 40-49yrs p<0.05 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

84 ACTUARIAL SURVIVAL DONOR AGE ALL LUNGS 1986 – 2013 ANZCOTR 2013

85 ACTUARIAL SURVIVAL ISCHAEMIC TIME ALL LUNGS ANZCOTR 2013

86 ACTUARIAL SURVIVAL ISCHAEMIC TIME ALL LUNGS Year Percent Survival ANZCOTR 2013 p=ns Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

87 ACTUARIAL SURVIVAL CROSSMATCH ALL LUNGS ANZCOTR 2013

88 ACTUARIAL SURVIVAL CROSSMATCH LUNGS Year Percent Survival ANZCOTR 2013 p=ns Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

89 ACTUARIAL SURVIVAL CMV STATUS ALL LUNGS ANZCOTR 2013

90 ACTUARIAL SURVIVAL CMV STATUS LUNGS ANZCOTR 2013 Percent Survival Years R-D+ vs R+ p<0.05 R+ve = R+ve/D+ve or R+ve/D-ve Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

91 ACTUARIAL SURVIVAL HLA MISMATCH ALL LUNGS ANZCOTR 2013

92 ACTUARIAL SURVIVAL HLA MISMATCH ALL LUNGS 1986 – 2013 ANZCOTR 2013 Years Percent Survival MM0-1 v MM5 p<0.05 MM0-1 v MM6 p<0.05 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

93 ACTUARIAL SURVIVAL HLA DR LOCUS MISMATCH ALL LUNGS ANZCOTR 2013 Percent Survival Years p=ns Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

94 ACTUARIAL SURVIVAL HLA DR LOCUS MISMATCH LUNGS 1986 – 2013 ANZCOTR 2013

95 CAUSE OF DEATH - ALL LUNGS ANZCOTR 2012

96 CAUSE OF DEATH - LUNGS n = 1219 ANZCOTR 2013

97 CAUSE OF DEATH ALL LUNGS < 5 YEARS POST TX CAUSE OF DEATH ALL LUNGS ≥ 5 YEARS POST TX ANZCOTR 2013


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