1. 13-09-2008BWGHF Liège Heart transplantation 2008

2. Evolution of life expectancy at birth in Belgium source: NIS

3. l number of procedures and donor shortage l current results l cost l remaining problems l perspectives

4. NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR ISHLT 2007 NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of hearts transplanted worldwide has declined in recent years. J Heart Lung Transplant 2007;26: 769-781

5. U.S. Waiting List Registrations 1998-2007 Source: OPTN and UNOS

6. U.S. Wait List Death Rates 1998-2007 Percent Source: OPTN and UNOS

7. heart transplantation in Belgium 1 34567 N active centers

8. Eurotransplant region 1967 2007 2000

9. Donor and Transplant Statistics 2007 Eurotransplant annual donor rate pmp

10. ET waiting list for HTx

11. ET HTx waiting list mortality

12. Mortality on the heart waiting list source: www.optn.org and Eurotransplant Annual Reportswww.optn.org USA ET 538479432387327 194222213263214 0.92 →0.47 pmp ~1.23 pmp the expert help of Jacqueline Smits is gratefully acknowledged

13. reporting of potential donors in Belgium Donor and Transplant Statistics 2007 - 20/03/2008

14. national waiting list 31/12/2007: non-renal +219% -34%

15. patient and donor age %

16. ♀♂ patientsdonors

17. DIAGNOSIS IN ADULT HEART TRANSPLANTS ISHLT 2007 J Heart Lung Transplant 2007;26: 769-781

18. reason for transplantation ‘87-’93‘94-’00 ’01-’07

19. HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2005) ISHLT 2007 N at risk at 22 years: 33 HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2005) J Heart Lung Transplant 2007;26: 769-781

20. 01/01/08 survival % years the expert help of A. Belmans and of H. Ector, MD, PhD is gratefully acknowledged

21. Overall graft survival rates by country, corrected for local vs non-local donor, urgency status, CIT and VAD Adults, first heart only transplants in ET, in 1997 (N=665) Crude ratesCorrected rates P=0.0007P=0.004 Post-transplant time (m) ET meeting’99_JS.31 - Belgium - The Neth. - Austria - Germany

22. Mortality rates after heart transplantation. How to compare centre-specific outcome data ? Crude centre effects, case-mix adjusted (with 95% CI). Centres sorted by transplant volume Ln(RR ) Smits JMA et al. Transplantation 2003;75:90-6.

23. cost/QALY currencyamountsourceyear HTx - adults - children US $ 1992 US $ 2004 ~45,000 ~50,000 NL US 2003 2006 dialysis US $ 2003 CAN $ € 84 – 108,000 71 – 125,000 54 – 60,000 US CA Greece 2000 2003 2007 LVAD US $ ₤ 36 – 86,000 40,000 UK 2008 2005 ICD US $ 2005 34 – 70,000US2005 CRT-P -D ₤₤₤₤ ~17,000 ~24,000 UK 2007 statins- 2° - 1° ₤₤₤₤ 10 – 17,000 20 – 48,000 UK 2007

24. 01/01/08 acute rejection year 1 % pts 17.4%

25. FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY AND FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Adult Heart Recipients (Follow-ups: April 1994-June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26: 769-781

26. FREEDOM FROM MALIGNANCY For Adult Heart Recipients (Follow-ups: April 1994 - June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26: 769-781

27. perspectives l xenotransplantation l improved mechanical support systems (BTT, destination therapy, bridge to recovery ?) l new drugs n PSI (sirolimus, everolimus) l monitoring through gene expression profiling n rejection (acute and chronic) n tailored immunosuppression

29. ET region: 2007 deceased donors pmp 28.2 22.3 16.9 15.9 11.4 13.1 2.1

30. age trends recipientsdonors mean age

31. Mortality rates after heart transplantation. How to compare centre-specific outcome data ? Patient survival rate at 1 yr (with 95% CI). Centres sorted by transplant volume Smits JMA et al. Transplantation 2003;75:90

32. ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of 1 Year Follow-up NOTE: Different patients are analyzed in each time frame. ISHLT 2007 J Heart Lung Transplant 2007;26: 769-781

33. 01/01/08 patient survival % years the expert help of H. Ector, MD, PhD is gratefully acknowledged

34. 01/01/08 patient survival 92 92 87 76 54 the expert help of H. Ector, MD, PhD is gratefully acknowledged

35. AGE DISTRIBUTION OF HEART RECIPIENTS (1/1982-6/2006) % of Trnsplants % of Transplants ISHLT 2007 J Heart Lung Transplant 2007;26: 769-781

36. U.S. Waiting List Additions 1998-2007 Source: OPTN and UNOS