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HEART-LUNG TRANSPLANTATION Overall ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892.

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Presentation on theme: "HEART-LUNG TRANSPLANTATION Overall ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892."— Presentation transcript:

1 HEART-LUNG TRANSPLANTATION Overall ISHLT 2006 J Heart Lung Transplant 2006;25:

2 NUMBER OF HEART-LUNG TRANSPLANTS REPORTED BY YEAR ISHLT 2006 NOTE: This figure includes only the heart-lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of heart-lung transplants worldwide has declined in recent years. J Heart Lung Transplant 2006;25:

3 AVERAGE CENTER VOLUME Heart-Lung Transplants: January 1, June 30, 2005 ISHLT 2006 J Heart Lung Transplant 2006;25:

4 DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY CENTER VOLUME Heart-Lung Transplants: January 1, June 30, 2005 ISHLT 2006 J Heart Lung Transplant 2006;25:

5 DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME Lung Transplants: January 1, June 30, 2005 ISHLT 2006 J Heart Lung Transplant 2006;25:

6 HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January June 2004) N=3,086 Half-life = 3.1 years Conditional Half-life = 8.7 years Survival (%) ISHLT 2006 N alive at 18 years = 18 J Heart Lung Transplant 2006;25:

7 HEART-LUNG TRANSPLANTATION Adult Recipients ISHLT 2006 J Heart Lung Transplant 2006;25:

8 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (1/1982-6/2005) Other includes cancer, LAM, OB, sarcoidosis, bronchiectasis ISHLT 2006 J Heart Lung Transplant 2006;25:

9 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January June 2005) Diagnosis N (%) Congenital Heart Disease702 (32.2%) Primary Pulmonary Hypertension531 (24.4%) Cystic Fibrosis342 (15.7%) Acquired Heart Disease97 ( 4.5%) COPD/Emphysema83 ( 3.8%) Idiopathic Pulmonary Fibrosis62 ( 2.8%) Alpha-138 ( 1.7%) Re-Transplant: Not Obliterative Bronchiolitis29 ( 1.3%) Sarcoidosis28 ( 1.3%) Re-Transplant: Obliterative Bronchiolitis23 ( 1.1%) Bronchiectasis14 ( 0.6%) Obliterative Bronchiolitis (not Re-Transplant) 9 ( 0.4%) Other221 (10.1%) ISHLT 2006 J Heart Lung Transplant 2006;25:

10 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA Other includes OB (non-ReTX), Bronchiectasis, Sarcoidosis ISHLT 2006 J Heart Lung Transplant 2006;25:

11 ADULT HEART-LUNG TRANSPLANTATION Indications By Year (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

12 ADULT HEART-LUNG TRANSPLANTATION Indications By Year (Number) ISHLT 2006 J Heart Lung Transplant 2006;25:

13 HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival for Adult Recipients (Transplants: January June 2004) N=2,496 Half-life = 3.5 years Conditional Half-life = 9.0 years Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

14 HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival for Adult Recipients by Era (Transplants: January June 2004) Half-life: = 3.1 years; = 3.6 years; /2005 = 5 years Conditional Half-life: = 8.9 years Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

15 ADULT HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2004) ISHLT 2006 J Heart Lung Transplant 2006;25:

16 ADULT HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2004) ISHLT 2006 J Heart Lung Transplant 2006;25:

17 ADULT HEART-LUNG RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

18 ADULT HEART-LUNG RECIPIENTS Employment Status of Surviving Recipients (Follow-ups: April 1994 – June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

19 ADULT HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

20 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression For transplants between January 2001 through June 2005 ISHLT 2006 J Heart Lung Transplant 2006;25:

21 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression (Transplants: January December 2004) ISHLT 2006 J Heart Lung Transplant 2006;25:

22 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression (Transplants: January December 2004) ISHLT 2006 Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist J Heart Lung Transplant 2006;25:

23 ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2001 through June 2005 NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT 2006 J Heart Lung Transplant 2006;25:

24 ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2001 through June 2005 NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT 2006 J Heart Lung Transplant 2006;25:

25 POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

26 POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

27 Freedom from Coronary Artery Vasculopathy For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

28 Freedom from Bronchiolitis Obliterans For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

29 Freedom from Severe Renal Dysfunction* For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2005) *Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant ISHLT 2006 J Heart Lung Transplant 2006;25:

30 MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTS Cumulative Prevalence in Survivors (Follow-ups: April 1994-June 2005) Malignancy/Type1-Year Survivors 5-Year Survivors 10-Year Survivors No Malignancy 278 (91.7%)90 (89.1%)47 (83.9%) Malignancy (all types combined) 25 (8.3%)11 (10.9%)9 (16.1%) Malignancy Type Skin235 Lymph1852 Other111 Type Not Reported421 ISHLT 2006 J Heart Lung Transplant 2006;25:

31 Freedom from Malignancy For Adult Heart-Lung Recipients (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

32 ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January June 2005) CAUSE OF DEATH 0-30 Days (N = 205) 31 Days - 1 Year (N = 127) >1 Year - 3 Years (N = 100) >3 Years - 5 Years (N = 59) >5 Years (N = 106) BRONCHIOLITIS 05 (3.9%)26 (26.0%)23 (39.0%)21 (19.8%) ACUTE REJECTION 2 (1.0%)3 (2.4%)1 (1.0%)01 (0.9%) LYMPHOMA 04 (3.1%)4 (4.0%)3 (5.1%)1 (0.9%) MALIGNANCY, OTHER 01 (0.8%)6 (6.0%)2 (3.4%)5 (4.7%) CMV 01 (0.8%)01 (1.7%)0 INFECTION, NON-CMV 39 (19.0%)52 (40.9%)31 (31.0%)3 (5.1%)16 (15.1%) GRAFT FAILURE 64 (31.2%)26 (20.5%)17 (17.0%)10 (16.9%)27 (25.5%) CARDIOVASCULAR 19 (9.3%)7 (5.5%)5 (5.0%)7 (11.9%)8 (7.5%) TECHNICAL 39 (19.0%)2 (1.6%)1 (1.0%)1 (1.7%)0 OTHER 42 (20.5%)26 (20.5%) 9 (9.0%)9 (15.3%)27 (25.5%) ISHLT 2006 J Heart Lung Transplant 2006;25:

33 HEART-LUNG TRANSPLANTATION Pediatric Recipients ISHLT 2006 J Heart Lung Transplant 2006;25:

34 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

35 AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART- LUNG RECIPIENTS (Transplants: January June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

36 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS By Year of Transplant Number of Transplants ISHLT 2006 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 pediatric heart- lung transplants worldwide has declined in recent years. J Heart Lung Transplant 2006;25:

37 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS By Era of Transplant Percentage of Transplants ISHLT 2006 J Heart Lung Transplant 2006;25:

38 NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS ISHLT 2006 J Heart Lung Transplant 2006;25:

39 DIAGNOSIS IN PEDIATRIC HEART –LUNG TRANSPLANT RECIPIENTS (Age: Years) Other includes Bronchiectasis, Alpha-1, and OB (non-ReTX) ISHLT 2006 J Heart Lung Transplant 2006;25:

40 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2004) ISHLT 2006 J Heart Lung Transplant 2006;25:

41 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January June 2004) ISHLT 2006 J Heart Lung Transplant 2006;25:

42 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January June 2004) Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

43 PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January June 2005) CAUSE OF DEATH0-30 Days (N = 27) 31 Days - 1 Year (N = 28) >1 Year - 3 Years (N = 25) >3 Years - 5 Years (N = 17) >5 Years (N = 18) BRONCHIOLITIS 1 (3.6%)14 (53.8%)8 (47.1%)7 (35.0%) ACUTE REJECTION 2 (7.1%) INFECTION, NON-CMV 5 (19.2%)9 (32.1%)5 (19.2%)1 (5.9%)5 (25.0%) GRAFT FAILURE 13 (50.0%)2 (7.1%)5 (19.2%)5 (29.4%)3 (15.0%) CARDIOVASCULAR 2 (7.7%)3 (10.7%)1 (5.9%)2 (10.0%) TECHNICAL 3 (11.5%)1 (3.6%) OTHER 3 (11.5%)10 (35.7%)2 (7.7%)2 (11.8%)3 (15.0%) ISHLT 2006 J Heart Lung Transplant 2006;25:


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