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HEART TRANSPLANTATION Overall ISHLT 2006 J Heart Lung Transplant 2006;25:869-79.

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Presentation on theme: "HEART TRANSPLANTATION Overall ISHLT 2006 J Heart Lung Transplant 2006;25:869-79."— Presentation transcript:

1 HEART TRANSPLANTATION Overall ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

2 NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR 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 hearts transplanted worldwide has declined in recent years. J Heart Lung Transplant 2006;25:869-79

3 AVERAGE CENTER VOLUME Heart Transplants: January 1, June 30, 1995 and January 1, 2001 – June 30, 2005 ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

4 DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Heart Transplants : January 1, June 30, 1995 and January 1, 2001 – June 30, 2005 ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

5 HEART TRANSPLANTS: Donor Age by Year of Transplant ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

6 AGE DISTRIBUTION OF HEART RECIPIENTS (1/1982-6/2005) % of Trnsplants % of Transplants ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

7 AGE DISTRIBUTION OF HEART TRANSPLANT RECIPIENTS BY ERA P < ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

8 HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2004) ISHLT 2006 N followed at longest time point: 28,463 J Heart Lung Transplant 2006;25:869-79

9 HEART TRANSPLANTATION Adult Recipients ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

10 DIAGNOSIS IN ADULT HEART TRANSPLANTS ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

11 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982 – 6/2004) Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

12 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1982-6/2004) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

13 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1998-6/2004) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

14 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1982-6/2004) All pair-wise comparisons with Cardiomyopathy are significant at p < 0.05 except for Congenital; Coronary Artery Disease vs. ReTx: p < ; Coronary Artery Disease vs. Valvular: p = 0.01; Valvular vs. ReTx: p < ; Congenital vs. ReTx: p < ; ReTx vs. Other: p < ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

15 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis Conditional on Survival to 1 Year (Transplants: 1/1982-6/2004) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

16 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1998-6/2004) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

17 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis Conditional on Survival to 1 Year (Transplants: 1/1998-6/2004) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

18 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by PVR (Transplants: 1/2002-6/2004) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

19 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage (Transplants: 1/1999-6/2004) ISHLT 2006 Note: Only 42 transplants involving continuous flow devices; too few to analyze. J Heart Lung Transplant 2006;25:869-79

20 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage and Era (Transplants: 1/1999-6/2004) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

21 ADULT HEART TRANSPLANTS 5-Year Predicted Survival Model (Transplants: 1/1997-6/2000) Impact of Pre-Transplant VAD ISHLT 2006 Recipient: 54 y.o. male, Dx=CAD, PRA < 10%, weight=75 kg, height=69 in, PVR=2, volume=25/year, year of tx=99/00, bilirubin=0.9, PA diastolic=23, creatinine=1.2 mg/dl, ischemia=180 min; Donor: 32 y.o. male, COD = MVA, weight = 72 kg, height = 70 in. J Heart Lung Transplant 2006;25:869-79

22 ADULT HEART RE-TRANSPLANTS 1-Year Survival ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

23 ADULT HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

24 ADULT HEART RECIPIENTS Employment Status of Surviving Recipients (Follow-ups: June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

25 ADULT HEART RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

26 ADULT HEART RECIPIENTS Induction Immunosuppression (Transplants: January 2001 – June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

27 ADULT HEART RECIPIENTS Induction Immunosuppression (Transplants: 1996, 2000 and 2004) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

28 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Use of Any Induction (Transplants: 1/2000-6/2004, conditional on survival to 14 days) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

29 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Type (Transplants: 1/2000-6/2004, conditional on survival to 14 days) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

30 ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January June 2005) NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

31 ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of 1 Year Follow-up NOTE: Different patients are analyzed in each time frame. ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

32 ADULT HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up (Follow-ups: January June 2005) NOTES: Different patients are analyzed in Year 1 and Year 5. In the Year 1 cohort 76.5% of patients were on prednisone; in the Year 5 cohort 61% of patients were on prednisone. ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

33 PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January 1, June 30, 2004) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

34 NUMBER OF REJECTION EPISODES FOR ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January 1, June 30, 2004) Overall: no induction vs. OKT3 (p = ); polyclonal vs. OKT3 (p=0.0077); IL2 vs. OKT3 (p=0.0003) : no induction vs. IL2 (p = 0.033) : no induction vs. OKT3 (p = ); IL2 vs. OKT3 (p = ). 63+: polyclonal vs. OKT3 (p = ). For females: no induction vs. OKT3 (p = ); IL2 vs. OKT3 (p = ). For males: no induction vs. OKT3 (p =0.046); IL2 vs. OKT3 (p = ). ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

35 PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, June 30, 2004) Overall: CyA + MMF vs. TAC + MMF (p<0.0001); CyA + MMF vs. TAC + AZA (p=0.0102); CyA + AZA vs. TAC + MMF (p<0.0001); CyA + AZA vs. TAC + AZA (p=0.0054) : CyA + MMF vs. TAC + MMF (p=0.0085); CyA + MMF vs. TAC + AZA (p=0.0119); CyA + AZA vs. TAC + MMF (p=0.031); CyA + AZA vs. TAC + AZA (p=0.0108) : CyA + MMF vs. TAC + MMF (p<0.0001); CyA + AZA vs. TAC + MMF (p<0.0001). 63+: CyA + MMF vs. TAC + MMF (p=0.0395); CyA + AZA vs. TAC + MMF (p=0.0027). For females all comparisons are significant except TAC + MMF vs. TAC + AZA. For males: CyA + MMF vs. TAC + MMF (p<0.0001); CyA + AZA vs. TAC + MMF (p<0.0001) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

36 NUMBER OF REJECTION EPISODES FOR ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, June 30, 2004) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

37 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Rejection Within 1 st Year Conditional on survival to 1 year for transplants: 1/1995-6/2003 ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

38 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Rejection between Transplant Discharge and 1 Year Conditional on survival to 1 year for transplants: 1/1995-6/2003 ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

39 POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 1 Year Post-Transplant (Follow-ups: April 1994 – December 1997 and January June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

40 POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 5 and 8 Years Post-Transplant (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

41 FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY AND FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Adult Heart Recipients (Follow-ups: April 1994-June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

42 FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY Stratified by Rejection Within 1 st Year For Adult Heart Recipients (Transplants: April 1994-June 2003) Conditional on Survival to 1 Year ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

43 PATIENT SURVIVAL AFTER REPORT OF CAV AND PATIENT SURVIVAL IN PATIENTS WITHOUT CAV* (Transplants: April 1994-June 2003) ISHLT 2006 * Patients without CAV conditioned on survival to median time of CAV development (562 days) J Heart Lung Transplant 2006;25:869-79

44 MALIGNANCY POST-HEART TRANSPLANTATION FOR ADULTS Cumulative Prevalence in Survivors (Follow-ups: April June 2005) Malignancy/Type1-Year Survivors 5-Year Survivors 8-Year Survivors No Malignancy18851 (97.1%)6802 (84.4%)2360 (74.0%) Malignancy (all types combined)572 (2.9%)1257 (15.6%)830 (26.0%) Malignancy Type Skin Lymph Other Type Not Reported Other includes: prostate (11, 33, 23), adenocarcinoma (7, 3, 2), lung (5, 3, 1), bladder (4, 5, 4), sarcoma (3, 2, 1), breast (2, 7, 4), cervical (2, 4, 1), colon (2, 3, 3), and renal (2, 5, 2). Numbers in parentheses are those reported within 1 year, 5 years and 8 years, respectively. ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

45 FREEDOM FROM MALIGNANCY For Adult Heart Recipients (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

46 ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January June 2005) CAUSE OF DEATH0-30 Days (N = 3,198) 31 Days - 1 Year (N = 2,635) >1 Year - 3 Years (N = 1,985) >3 Years - 5 Years (N = 1,724) >5 Years (N = 5,364) CARDIAC ALLOGRAFT VASCULOPATHY 54 (1.7%)116 (4.4%)272 (13.7%)279 (16.2%)767 (14.3%) ACUTE REJECTION 208 (6.5%)316 (12.0%)195 (9.8%)72 (4.2%)76 (1.4%) LYMPHOMA 2 (0.1%)48 (1.8%)81 (4.1%)89 (5.2%)236 (4.4%) MALIGNANCY, OTHER 2 (0.1%)55 (2.1%)206 (10.4%)312 (18.1%)994 (18.5%) CMV 4 (0.1%)32 (1.2%)16 (0.8%)3 (0.2%)5 (0.1%) INFECTION, NON-CMV 414 (12.9%)866 (32.9%)260 (13.1%)164 (9.5%)554 (10.3%) PRIMARY FAILURE 831 (26.0%)194 (7.4%)132 (6.6%)73 (4.2%)217 (4.0%) GRAFT FAILURE 445 (13.9%)287 (10.9%)337 (17.0%)272 (15.8%)790 (14.7%) TECHNICAL 237 (7.4%)27 (1.0%)16 (0.8%)17 (1.0%)49 (0.9%) OTHER 213 (6.7%)185 (7.0%)175 (8.8%)146 (8.5%)447 (8.3%) MULTIPLE ORGAN FAILURE 431 (13.5%)276 (10.5%)104 (5.2%)101 (5.9%)447 (8.3%) RENAL FAILURE 18 (0.6%)12 (0.9%)35 (1.8%)63 (3.7%)341 (6.4%) PULMONARY 134 (4.2%)97 (3.4%)89 (4.5%)76 (4.4%)223 (4.2%) CEREBROVASCULAR 205 (6.4%)113 (4.3%)67 (3.4%)57 (3.3%)218 (4.1%) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

47 ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death from Leading Causes by Era (Deaths: January June 2005) CAUSE OF DEATH DATE OF DEATH 0-30 Days (N = 3,198) 31 Days - 1 Year (N = 2,635) >1 Year - 3 Years (N = 1,985) >3 Years - 5 Years (N = 1,724) >5 Years (N = 5,364) ACUTE REJECTION (6.7%)217 (13.8%)106 (8.9%)36 (4.0%)18 (1.2%) / (6.2%)99 (9.4%)89 (11.1%)36 (4.4%)58 (1.5%) CARDIAC ALLOGRAFT VASCULOPATHY (1.9%)78 (4.9%)175 (14.8%)179 (19.8%)281 (18.1%) / (1.4%)38 (3.6%)97 (12.1%)100 (12.2%)486 (12.8%) GRAFT FAILURE (15.0%) 177 (11.2%)194 (16.4%)119 (13.1%)192 (12.3%) / (12.6%) 110 (10.4%)143 (17.9%)153 (18.7%)598 (15.7%) MALIGNANCY, OTHER (0.1%)39 (2.5%)115 (9.7%)168 (18.5%)267 (17.2%) / (1.5%)91 (11.4%)144 (17.6%)727 (19.1%) PRIMARY FAILURE (28.8%) 169 (10.7%)105 (8.9%)48 (5.3%)108 (6.6%) / (22.7%) 25 (2.4%)27 (3.4%)25 (3.1%)109 (2.9%) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

48 ADULT HEART TRANSPLANT RECIPIENTS: Cumulative Incidence of Leading Causes of Death (Transplants: January June 2004) ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

49 ADULT HEART TRANSPLANTS Risk Factors for 1 Year Mortality 2006 ISHLT Note: All factors were significant at p < 0.05 in at least one of the eras. * Temporary circulatory support includes ECMO and Abiomed. J Heart Lung Transplant 2006;25:869-79

50 ADULT HEART TRANSPLANTS Risk Factors for 1 Year Mortality 2006 ISHLT Note: All factors were significant at p < 0.05 in at least one of the eras. **VAD type collected for only part of era. Only those with known type were included in this group. J Heart Lung Transplant 2006;25:869-79

51 ADULT HEART TRANSPLANTS Risk Factors for 1 Year Mortality 2006 ISHLT Note: All factors were significant at p < 0.05 in at least one of the eras. J Heart Lung Transplant 2006;25:869-79

52 ADULT HEART TRANSPLANTS Borderline Significant Risk Factors for 1 Year Mortality 2006 ISHLT Note: All factors were significant at 0.5 < p < 0.1 in at least one of the eras. J Heart Lung Transplant 2006;25:869-79

53 ADULT HEART TRANSPLANTS Risk Factors for 1 Year Mortality 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

54 ADULT HEART TRANSPLANTS Risk Factors for 1 Year Mortality Recipient Age 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

55 ADULT HEART TRANSPLANTS Risk Factors for 1 Year Mortality Donor Age 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

56 ADULT HEART TRANSPLANTS Risk Factors for 1 Year Mortality Pre-Transplant Recipient Weight 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

57 ADULT HEART TRANSPLANTS Risk Factors for 1 Year Mortality Donor Weight 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

58 ADULT HEART TRANSPLANTS Risk Factors for 1 Year Mortality Center Volume 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

59 ADULT HEART TRANSPLANTS Risk Factors for 1 Year Mortality Ischemia Time 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

60 ADULT HEART TRANSPLANTS Risk Factors for 1 Year Mortality Pre-Transplant Bilirubin 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

61 ADULT HEART TRANSPLANTS Risk Factors for 1 Year Mortality Pre-Transplant Creatinine 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

62 ADULT HEART TRANSPLANTS Risk Factors for 1 Year Mortality Recipient PA Diastolic Pressure 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

63 ADULT HEART TRANSPLANTS Factors Not Significant for 1 Year Mortality Recipient Factors: Pneumothorax, sternotomy, thoracotomy, ventricular remodeling, pulmonary embolism, prior malignancy, pulmonary vascular resistance, PCW Donor Factors: Clinical infection, history of diabetes, height Transplant Factors: Year of transplant 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

64 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality 2006 ISHLT Note: All factors were significant at p < 0.05 in at least one of the eras. J Heart Lung Transplant 2006;25:869-79

65 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality 2006 ISHLT Note: All factors were significant at p < 0.05 in at least one of the eras. J Heart Lung Transplant 2006;25:869-79

66 ADULT HEART TRANSPLANTS Borderline Significant Risk Factors for 5 Year Mortality 2006 ISHLT Note: All factors were significant at 0.5 < p < 0.1 in at least one of the eras. J Heart Lung Transplant 2006;25:869-79

67 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

68 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Recipient Age 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

69 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Donor Age 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

70 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Pre-Transplant Recipient BMI 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

71 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Donor Weight 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

72 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Center Volume 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

73 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Ischemia Time 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

74 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Pre-Transplant Bilirubin 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

75 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Pre-Transplant Creatinine 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

76 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Recipient PA Diastolic Pressure 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

77 ADULT HEART TRANSPLANTS Factors Not Significant for 5 Year Mortality Recipient Factors: VAD, gender, pulmonary vascular resistance, thoracotomy, pneumothorax, pulmonary embolism Donor Factors:History of cancer, clinical infection, cause of death Transplant Factors: Year of transplant, CMV mismatch 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

78 ADULT HEART TRANSPLANTS 5-Year Predicted Survival Model Impact of Donor Characteristics (I) ISHLT 2006 Recipient: 30 y.o. female, PRA < 10%, weight=75 kg, height=65 in, center volume=25/year, year of tx=99/00, bilirubin=0.9, PA diastolic=23, creatinine=1.2 mg/dl, ischemia=180 min, PVR=2 J Heart Lung Transplant 2006;25:869-79

79 ADULT HEART TRANSPLANTS 5-Year Predicted Survival Model Impact of Donor Characteristics (II) ISHLT 2006 Recipient: 63 y.o. male, Dx=CAD, puls. LVAD, PRA < 10%, weight=85 kg, height=70 in, PVR=2, volume=25/year, year of tx=99/00, bilirubin=0.9, PA diastolic=23, creatinine=1.3 mg/dl, ischemia=180 min J Heart Lung Transplant 2006;25:869-79

80 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year 2006 ISHLT Note: All factors were significant at p < 0.05 in at least one of the eras. J Heart Lung Transplant 2006;25:869-79

81 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year 2006 ISHLT Note: All factors were significant at p < 0.05 in at least one of the eras. J Heart Lung Transplant 2006;25:869-79

82 ADULT HEART TRANSPLANTS Borderline Significant Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year 2006 ISHLT Note: All factors were significant at p < 0.05 in at least one of the eras. J Heart Lung Transplant 2006;25:869-79

83 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

84 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year Recipient Age 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

85 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year Donor Age 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

86 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year Donor BMI 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

87 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year Pre-transplant Recipient Weight 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

88 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year Pre-Transplant Bilirubin 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

89 ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year Pre-Transplant Creatinine 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

90 ADULT HEART TRANSPLANTS Risk Factors for 10 Year Mortality (Transplants: /1994) 2006 ISHLT (N=16,202) J Heart Lung Transplant 2006;25:869-79

91 ADULT HEART TRANSPLANTS Borderline Significant Risk Factors for 10 Year Mortality (Transplants: /1994) 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

92 ADULT HEART TRANSPLANTS Risk Factors for 10 Year Mortality 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

93 ADULT HEART TRANSPLANTS Risk Factors for 10 Year Mortality Recipient Age 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

94 ADULT HEART TRANSPLANTS Risk Factors for 10 Year Mortality Donor Age 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

95 ADULT HEART TRANSPLANTS Risk Factors for 10 Year Mortality Pre-Transplant Recipient Height 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

96 ADULT HEART TRANSPLANTS Risk Factors for 10 Year Mortality Center Volume 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

97 ADULT HEART TRANSPLANTS Risk Factors for 10 Year Mortality Ischemia Time 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

98 ADULT HEART TRANSPLANTS 10-Year Predicted Survival Model Impact of Donor Characteristics (I) ISHLT 2006 Recipient: 30 y.o. female, PRA < 10%, weight=75 kg, height=65 in, center volume=25/year, year of tx=1993/94, bilirubin=0.9, PA diastolic=23, creatinine=1.2 mg/dl, ischemia=180 min, PVR=2 J Heart Lung Transplant 2006;25:869-79

99 ADULT HEART TRANSPLANTS 10-Year Predicted Survival Model Impact of Donor Characteristics (II) ISHLT 2006 Recipient: 63 y.o. male, Dx=CAD, puls. LVAD, PRA < 10%, weight=85 kg, height=70 in, PVR=2, volume=25/year, year of tx=93/94, bilirubin =0.9, PA diastolic=23, creatinine=1.3 mg/dl, ischemia=180 min J Heart Lung Transplant 2006;25:869-79

100 ADULT HEART TRANSPLANTS Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years (Transplants: /1994) 2006 ISHLT (N=11,113) J Heart Lung Transplant 2006;25:869-79

101 ADULT HEART TRANSPLANTS Risk Factors for 10 Year Mortality Conditional on 3 Year Survival Recipient Age 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

102 ADULT HEART TRANSPLANTS Risk Factors for 10 Year Mortality Conditional on 3 Year Survival Donor Age 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

103 ADULT HEART TRANSPLANTS Risk Factors for 10 Year Mortality Conditional on 3 Year Survival BMI Ratio 2006 ISHLT J Heart Lung Transplant 2006;25:869-79

104 ADULT HEART TRANSPLANTS (1997-6/2002) Risk Factors for Developing Cardiac Allograft Vasculopathy within 3 Years (N=7,072) ISHLT Note: Donor gender was not significant as an independent risk factor but was significant as an interaction with donor age J Heart Lung Transplant 2006;25:869-79

105 ADULT HEART TRANSPLANTS (1997-6/2002) Risk Factors for Developing Cardiac Allograft Vasculopathy within 3 Years Wald Label Chi-Square DF Pr > ChiSq ischtime bilirubin volume recipage donage <.0001 creatinine <.0001 rec_hgt <.0001 bmi_don pcw Wald Label Chi-Square DF Pr > ChiSq ischtime bilirubin volume recipage donage <.0001 creatinine <.0001 rec_hgt <.0001 bmi_don pcw ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

106 ADULT HEART TRANSPLANTS (1997-6/2002) Risk Factors for Developing Cardiac Allograft Vasculopathy within 3 Years Donor Age and Donor Gender ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

107 ADULT HEART TRANSPLANTS (1997-6/2002) Risk Factors for Developing Cardiac Allograft Vasculopathy within 3 Years Pre-Transplant Recipient BMI ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

108 ADULT HEART TRANSPLANTS (1997-6/2002) Risk Factors for Developing Cardiac Allograft Vasculopathy within 3 Years Center Volume ISHLT 2006 J Heart Lung Transplant 2006;25:869-79


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