1. CHAPTER 3 HEART AND LUNG TRANSPLANTATION Editors: Mr Mohamed Ezani Md. Taib Dato’ Dr David Chew Soon Ping Dr Ashari Yunus Expert Panel: Mr Mohamed Ezani Md. Taib (Chairperson) Dr Abdul Rais Sanusi Datuk Dr Aizai Azan Abdul Rahim Dr Ashari Yunus Dato’ Dr David Chew Soon Ping

2. Table 3.1.1a: Stock and Flow of Heart Transplantation, 1997-2008 Year 199719981999200020012002200320042005200620072008 New transplant patients 132340201110 Deaths 010313100100 Retransplanted 000000000010 Lost to follow up 000000000000 Alive at 31 st December 135585667788 Figure 3.1.1a: Stock and Flow of Heart Transplantation, 1997-2008 Number of patients Year 0 1 2 3 4 5 6 7 8 9 New transplant patients Alive at 31st December 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

3. Table 3.2.1a: Distribution of Patients by Gender, 1997-2008 Year 979899000102030405060708TOTAL Gender No. Male 13022020110012 Female 0021200000106 TOTAL 13234020111018 Table 3.2.2a: Distribution of Patients by Ethnic Group, 1997-2008 Year 979899000102030405060708TOTAL Ethnic group No. Malay 0011200010005 Chinese 0001001000103 Indian 13112010010010 TOTAL13234020111018 Table 3.2.3a: Distribution of Patients by Age, 1997-2008 Year 979899000102030405060708TOTAL Age, years No. 0-19 0021100010106 20-39 0200000000002 40-59 11023020010010 ≥60 0000000000000 TOTAL 13234020111018 Mean 5140163738-46-154415-35 SD -912217-8-----16 Median 5137164443-46-154415-40 Minimum 5133151314-40-154415-13 Maximum 5150165554-52-154415-55

4. Table 3.2.4a: Distribution of Patients by Primary Diagnosis, 1997-2008 Table 3.3.1a: Distribution of Patients by Heart Procedure, 1997-2008 Year 979899000102030405060708TOTAL Primary diagnosis No. Ischaemic Cardiomyopathy 1301102001009 Idiopathic Dilated Cardiomyopathy 0021200010006 Restrictive Cardiomyopathy 0000000000000 End Stage Valvular Heart Disease 0000100000001 Hypertrophic Cardiomyopathy 0001000000001 Others 0000000000101 TOTAL 13234020111018 Year979899000102030405060708TOTAL Heart ProcedureNo. Orthotopic Bicaval 1100000000002 Orthotopic Traditional 02234020112017 Heterotopic0000000000000 TOTAL13234020112019

5. Table 3.3.2a: Distribution of Patients by Immunosuppressive Used, 1997-2008 Year979899000102030405060708Total Type of immunosuppressiveNo. Steroids Prednisolone 13234010101016 Methylprednisolone 13234020112019 Calcineurin Inhibitors Cyclosporin A 0000001001002 Neoral ® 13234000100014 Tacrolimus (FK506) 0000000000101 Antimetabolites Azathioprine (AZA) 13234020010016 Mycophenolate Mofetil (MMF) 0000100010103 Anti-lymphocyte Receptor Antibodies Anti-thymocyte globulin (ATG) 0000000000202 TOTAL patients at notification 13234020112019 Table 3.3.3a: Immunosuppressive Used at Time of Last Follow-up up to 2008 Year of follow up* 20042005200620072008 Type of immunosuppressiveNo. Steroids Prednisolone 13222 Methylprednisolone 00000 Calcineurin Inhibitors Cyclosporin A Neoral ® 16757 Tacrolimus (FK506) 1 Antimetabolites Azathioprine (AZA) 13211 Mycophenolate Mofetil (MMF) 33546 TOTAL patients at follow-up 66778

6. Table 3.3.4a: Duration of Waiting Time on Waiting List, 1997-2008 Year 979899000102030405060708TOTAL Duration (months)* No. <5 0210101000005 5 ≤ 10 1010100010004 10 ≤ 15 0001000001204 15 ≤ 20 0001000000001 20 ≤ 25 0000000000000 25 ≤ 30 0000000000000 30 ≤ 35 0000000000000 35 ≤ 40 0000001000001 TOTAL 12222020112015 Mean 624155-20-91013-9 SD -0165-25---0-9 Median 624155-20-91013-8 Minimum 623101-2-9 13-1 Maximum 625198-37-91013-37

7. Table 3.4.1a: Post Transplant Events at Last Follow-up up to 2008 Year of transplant* 979899000102030405060708TOTAL Type of post transplant events No. Drug Treated Hypertension 12213010000010 Bone Disease (Symptomatic) 1000100000002 Chronic Liver Disease 0000000000000 Cataracts 0000000000000 Diabetes 1200001000004 Renal Dysfunction 1100100000003 Stroke 0000000000000 Drug-Treated Hyperlipidaemia 12213010100011 TOTAL patients at follow-up 12213010101012

8. Table 3.4.2a: Post Transplant Malignancies at Follow-up up to 2008 Year of transplant* 979899000102030405060708TOTAL Type of post transplant malignancies No. Recurrence of pre- transplant tumour 0000000000000 De Novo solid tumour 1000000000001 De Novo lymphoproliferative disorder 0000000000000 Skin 0000000000000 TOTAL patients at follow-up 12213010101012 Table 3.4.3a: Non-compliance at Follow-up up to 2008 Year of transplant* 979899000102030405060708TOTAL Non-compliance during follow- up No.  Yes 0020001000003  No 1201300010109 TOTAL patients at follow-up12213010101012 Areas of non-compliance:  Immunosuppression medication 0010001000002  Patient unable to afford immunosuppression medications 0000000000000  Other medication 0000000000000  Other therapeutic regimen 0010000000001 TOTAL patients with noncompliance 0020001000003

9. Table 3.4.4a: Patient Treated for Rejection at Follow-up up to 2008 Year of transplant* 979899000102030405060708TOTAL Patient treated for rejection No.  Yes 0110100010004  No 1111201000108 TOTAL patients at follow-up 12213010101012 Number of rejection events 11 0100100010003 22 0000000000000 33 0010000000001 TOTAL patients with rejection 0110100010004 Table 3.4.5a: Distribution of Patients by Time of Deaths, 1997-2008 Year of discharge 9798990001020304050607TOTAL Time of deaths* No. <3 months (at discharge) 010201100106 3-<6 months 000000000000 6 months-1 year 000001000001 >1 year 000111000003 TOTAL patients who died0103131001010

10. Figure 3.4.6a: Patient Survival, 1997-2008 Table 3.4.6a: Patient Survival, 1997-2008 Year of Transplant1997-2008 Interval% SurvivalSE 6 months6811 1 year6311 2 year5012 3 year4412 4 year4412 5 year4412 6 year4412 7 year4412 8 year4412 9 year4412 10 year4412 0.00 0.25 0.50 0.75 1.00 0.512345678910 Cumulative survival Duration in years Kaplan-Meier survival estimate

11. Table 3.4.7a: Cause of Death at Discharge, 1997-2008 Table 3.4.8a: Cause of Death at Follow-up, 1997-2008 Year979899000102030405060708TOTAL Cause of deathNo. Hyperacute rejection0000001000001 Multi organ failure0001000000001 Respiratory failure secondary to septicaemia 0000010000001 Respiratory failure, renal function and liver failure, ARDS, septicaemia 0001000000001 Septicaemia, multiorgan failure 0100000000001 Graft failure0000000001001 TOTAL patients who died at discharge 0102011001006 Year979899000102030405060708TOTAL Cause of deathNo. Severe bleeding0000010000001 Lung cancer, small cell type, septicaemia, bronchopneumonia 0001000000001 Rejection due to non- compliance 0000100000001 Unknown0000010000001 TOTAL patients who died at follow-up 0001120000004

12. LUNG TRANSPLANTATION & HEART-LUNG TRANSPLANTATION Table 3.1.1b: Stock and Flow of Lung Transplantation, 2005-2008 Year2005200620072008 New transplant patients 1120 Deaths 0110 Retransplanted 0000 Lost to follow up 0000 Alive at 31 st December 1122 Figure 3.1.1b: Stock and Flow of Lung Transplantation, 2005-2008

13. Table 3.2.1b: Distribution of Patients by Gender, 2005-2008 Year2005200620072008 GenderNo. Male1110 Female0010 TOTAL1120 Table 3.2.2b: Distribution of Patients by Ethnic Group, 2005-2008 Table 3.2.3b: Distribution of Patients by Age, 2005-2008 Year2005200620072008 RaceNo. Malay0010 Chinese0000 Indian1100 Iban0010 TOTAL1120 Year2005200620072008 Age(years)No. 0-190010 20-390110 40-591000 ≥ 600000 TOTAL1120

14. Year2005200620072008 DiagnosisNo. Idiopathic pulmonary fibrosis 1110 Idiopathic pulmonary arterial hypertension 0010 Chronic obstructive pulmonary disease 0000 Bronchiectasis0000 TOTAL1120 Table 3.2.4b: Distribution of Patients by Primary Diagnosis, 2005 -2008 Table 3.3.1b: Distribution of Patients by Lung Procedure, 2005-2008 Year200520062008 ProcedureNo. Single Lung Transplant1000 Double Lung Transplant0110 Heart – Lung Transplant0010 TOTAL1120 Table 3.3.3b: Immunosuppressive Used at Time Follow-up to 2008 Year2005200620072008 Immunosuppresive drugsNo. Steroids: Prednisolone Methylprednisolone 1111 2121 2222 1010 Antimetabolites: Azathioprine(AZA) Mycophenolate (MMF) 0101 0202 0303 0202 Neoral1230 Tacrolimus0002 TOTAL patients at follow -up1232

15. Table 3.4.5b: Distribution of patients by time of deaths, 2005-2008 Year2005200620072008 DeathNo. < 3 months0110 3 - < 6 months0000 6 – 12 months0000 > 12 months0000 TOTAL0110