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HEART TRANSPLANTATION Overall ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983.

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Presentation on theme: "HEART TRANSPLANTATION Overall ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983."— Presentation transcript:

1 HEART TRANSPLANTATION Overall ISHLT 2008 J Heart Lung Transplant 2008;27:

2 NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR ISHLT 2008 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 2008;27:

3 AVERAGE CENTER VOLUME Heart Transplants: January 1, June 30, 1996 and January 1, 2002 – June 30, 2006 ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

4 DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Heart Transplants : January 1, June 30, 1996 and January 1, 2002 – June 30, 2006 ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

5 HEART TRANSPLANTS: Donor Age by Year of Transplant ISHLT 2008 J Heart Lung Transplant 2008;27:

6 AGE DISTRIBUTION OF HEART RECIPIENTS (1/1982-6/2006) % of Trnsplants % of Transplants ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

7 AGE DISTRIBUTION OF HEART TRANSPLANT RECIPIENTS BY ERA P < ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

8 HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2005) ISHLT 2008 N at risk at 22 years: 70 HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2006) J Heart Lung Transplant 2008;27:

9 HEART TRANSPLANTATION Adult Recipients ISHLT 2008 J Heart Lung Transplant 2008;27:

10 DIAGNOSIS IN ADULT HEART TRANSPLANTS ISHLT 2008 J Heart Lung Transplant 2008;27:

11 ADULT HEART TRANSPLANTS: RECIPIENT AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

12 ADULT HEART TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

13 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982 – 6/2006) Survival (%) ISHLT 2008 J Heart Lung Transplant 2008;27:

14 ADULT HEART TRANSPLANTATION Conditional Kaplan-Meier Survival by Era (Transplants: 1/1982 – 6/2006) Survival (%) ISHLT 2008 J Heart Lung Transplant 2008;27:

15 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1982-6/2005) ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

16 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1998-6/2005) ISHLT 2008 HALF-LIFE 18-34: NA; 35-49: NA; 50-59: NA; 60-64: 8.3 years; 65-69: 8.1 years; 70+: 7.3 years Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

17 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1982-6/2005) ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

18 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis Conditional on Survival to 1 Year (Transplants: 1/1982-6/2005) ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

19 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/2000-6/2005) ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

20 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis Conditional on Survival to 1 Year (Transplants: 1/2000-6/2005) ISHLT 2008 Cardiomyopathy vs. Re-TX: p =.006; Cardiomyopathy vs. Other: p =.02; CAD vs. Re-TX: p =.03; Congenital vs. Re-TX: p =.01; Valvular vs. Other: =.01; Re-TX vs. Other: p =.0003 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

21 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by PVR (Transplants: 1/2002-6/2006) ISHLT 2008 J Heart Lung Transplant 2008;27:

22 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage (Transplants: 4/1994-6/2006) ISHLT 2008 J Heart Lung Transplant 2008;27:

23 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage (Transplants: 1/1999-6/2006) ISHLT 2008 J Heart Lung Transplant 2008;27:

24 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage (Transplants: 1/1999-6/2006) ISHLT 2008 J Heart Lung Transplant 2008;27:

25 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage and Era (Transplants: 1/1999-6/2006) ISHLT 2008 J Heart Lung Transplant 2008;27:

26 ADULT HEART TRANSPLANTS 1-Year Predicted Survival Model (Transplants: 1/2002-6/2006) Impact of Pre-Transplant VAD ISHLT 2008 Recipient: 54 y.o., Dx=cardiomyopathy, height=175 cm, volume=22/year, bilirubin=0.8, PA systolic=40, creatinine=1.2 mg/dl, ischemia=180 min, transplant year = 2005/2006 Donor: 30 y.o., BMI = 25 kg/m 2 J Heart Lung Transplant 2008;27:

27 ADULT HEART RE-TRANSPLANTS 1-Year Survival ISHLT 2008 J Heart Lung Transplant 2008;27:

28 ADULT HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: June 2006) ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

29 ADULT HEART RECIPIENTS Employment Status of Surviving Recipients (Follow-ups: June 2006) ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

30 ADULT HEART RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: June 2006) ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

31 ADULT HEART RECIPIENTS Induction Immunosuppression (Transplants: January 2002 – June 2007) ISHLT 2008 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27:

32 ADULT HEART RECIPIENTS Induction Immunosuppression (Transplants: 1997, 2002 and 1/2007-6/2007) ISHLT 2008 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27:

33 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Type (Transplants: 1/2000-6/2006, conditional on survival to 14 days) ISHLT 2008 J Heart Lung Transplant 2008;27:

34 ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January June 2007) NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT 2008 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27:

35 ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of 1 Year Follow-up NOTE: Different patients are analyzed in each time frame. ISHLT 2008 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27:

36 ADULT HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up (Follow-ups: January June 2007) NOTES: Different patients are analyzed in Year 1 and Year 5. In the Year 1 cohort 73.40% of patients were on prednisone; in the Year 5 cohort 54.12% of patients were on prednisone. ISHLT 2008 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27:

37 ADULT HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For the Same Patients (Follow-ups: January June 2007) ISHLT 2008 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27:

38 PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS EXPERIENCING REJECTION IN 1ST YEAR Stratified by Type of Induction (Follow-ups: July 1, June 30, 2007) ISHLT 2008 Overall FemaleMale No induction: N=2,580 Polyclonal: 1,137 IL2R-antagonist: N=1,461 OKT3: N=126 Overall: no induct vs. poly (p<0.0001); no induct vs. IL2 (p<0.0001), no induct vs. OKT3 (p=0.019) 18-44: no induct vs. poly (p=0.018); no induct vs. IL2 (p=0.002) 45-62: no induct vs. poly (p=0.008); no induct vs. IL2 (p<0.0001) 63+: no induct vs. poly (p=0.004); no induct vs. IL2 (p<0.0001); no induct vs. OKT3 (p=0.044) F: no induct vs. poly (p=0.001); no induct vs. IL2 (p=0.0004) M: all comparisons were statistically significant at 0.05 except poly vs. OKT3 and IL2 vs. OKT3 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27:

39 PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS EXPERIENCING REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Follow-ups: July 1, June 30, 2007 ) Overall: p< : p< : p< Female: p<0.001 Male: p< ISHLT 2008 NOTE: There were 257 patients with cyclosporine+AZA and 42 with tacrolimus+AZA. These groups were excluded due to small numbers. Cyclosporine + MMF: N = 1,981 Tacrolimus + MMF: N = 2, MaleFemaleOverall Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27:

40 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Rejection Within 1 st Year Conditional on survival to 1 year (follow-ups: 7/2004-6/2006) ISHLT 2008 J Heart Lung Transplant 2008;27:

41 POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 1 Year Post-Transplant (Follow-ups: April 1994 – December 1997 and January June 2006) ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

42 POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 5 and 10 Years Post-Transplant (Follow-ups: April June 2006) ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

43 FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY AND FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Adult Heart Recipients (Follow-ups: April 1994-June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27:

44 FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY AND FREEDOM FROM SEVERE RENAL DYSFUNCTION BY ERA* For Adult Heart Recipients (Transplants: April 1994-June 2006) ISHLT 2008 This slide is based on the date of transplant. As a result sample sizes are different from ones on the previous slide J Heart Lung Transplant 2008;27:

45 PATIENT SURVIVAL AFTER REPORT OF CAV AND PATIENT SURVIVAL IN PATIENTS WITHOUT CAV* (Transplants: April 1994-June 2006) ISHLT 2008 * Patients without CAV conditioned on survival to median time of CAV development (504 days) J Heart Lung Transplant 2008;27:

46 PATIENT SURVIVAL AFTER REPORT OF CAV AND PATIENT SURVIVAL IN PATIENTS WITHOUT CAV* BY ERA (Transplants: April 1994-June 2006) ISHLT 2008 * Patients without CAV conditioned on survival to median time of CAV development (504 days) J Heart Lung Transplant 2008;27:

47 MALIGNANCY POST-HEART TRANSPLANTATION FOR ADULTS Cumulative Prevalence in Survivors (Follow-ups: April June 2006) Malignancy/Type1-Year Survivors 5-Year Survivors 10-Year Survivors No Malignancy20441 (97.1%)7780 (84.9%)1264 (68.1%) Malignancy (all types combined)612 (2.9%)1389 (15.1%)592 (31.9%) Malignancy Type Skin Lymph Other Type Not Reported Other includes: prostate (11, 34, 17), adenocarcinoma (7, 4, 2), lung (5, 4, 1), bladder (4, 5, 4), sarcoma (3, 3, 1), breast (2, 8, 3), cervical (2, 4, 0), colon (2, 3, 1), and renal (2, 7, 2). Numbers in parentheses are those reported within 1 year, 5 years and 10 years, respectively. ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

48 FREEDOM FROM MALIGNANCY For Adult Heart Recipients (Follow-ups: April June 2006) ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

49 ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January June 2006) CAUSE OF DEATH 0-30 Days (N = 3,006) 31 Days – 1 Year (N = 2,722) >1 Year – 3 Years (N = 2,135) >3 Years – 5 Years (N = 1,857) >5 Years – 10 Years (N = 4,054) >10 Years (N = 2,107) CARDIAC ALLOGRAFT VASCULOPATHY 52 (1.7%)127 (4.7%)298 (14.0%)299 (16.1%)581 (14.3%)309 (14.7%) ACUTE REJECTION193 (6.4%)338 (12.4%)220 (10.3%)82 (4.4%)69 (1.7%)26 (1.2%) LYMPHOMA2 (0.1%)54 (2.0%)85 (4.0%)96 (5.2%)195 (4.8%)73 (3.5%) MALIGNANCY, OTHER1 (0.0%)57 (2.1%)218 (10.2%)340 (18.3%)749 (18.5%)392 (18.6%) CMV4 (0.1%)34 (1.2%)16 (0.7%)3 (0.2%)5 (0.1%)1 (0.0%) INFECTION, NON-CMV393 (13.1%)896 (32.9%)276 (12.9%)180 (9.7%)442 (10.9%)213 (10.1%) GRAFT FAILURE1,257 (41.8%)500 (18.4%)499 (23.4%)379 (20.4%)765 (18.9%)353 (16.8%) TECHNICAL233 (7.8%)28 (1.0%)17 (0.8%)17 (0.9%)36 (0.9%)20 (0.9%) OTHER162 (5.4%)175 (6.4%)187 (8.8%)147 (7.9%)339 (8.4%)175 (8.3%) MULTIPLE ORGAN FAILURE 356 (11.8%)268 (9.8%)117 (5.5%)102 (5.5%)309 (7.6%)190 (9.0%) RENAL FAILURE20 (0.7%)25 (0.9%)36 (1.7%)65 (3.5%)225 (5.6%)173 (8.2%) PULMONARY133 (4.4%)108 (4.0%)96 (4.5%)85 (4.6%)172 (4.2%)99 (4.7%) CEREBROVASCULAR 200 (6.7%)112 (4.1%)70 (3.3%)62 (3.3%)167 (4.1%)83 (3.9%) ISHLT Last updated based on data as of December J Heart Lung Transplant 2008;27:

50 ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death from Leading Causes by Era (Deaths: January June 2006) CAUSE OF DEATH DATE OF DEATH 0-30 Days (N = 3,005) 31 Days – 1 Year (N = 2,722) >1 Year – 3 Years (N = 2,135) >3 Years – 5 Years (N = 1,857) >5 Years – 10 Years (N = 4,054) >10 Years (N = 2,107) ACUTE REJECTION (7.1%)231 (14.3%)113 (9.3%)41 (4.4%)16 (1.1%)3 (1.7%) / (5.5%)107 (9.7%)107 (11.7%)41 (4.5%)53 (2.0%)23 (1.2%) CARDIAC ALLOGRAFT VASCULOPATHY (1.9%)83 (5.1%)184 (15.1%)189 (20.1%)262 (18.3%)40 (22.6%) / (1.6%)44 (4.0%)114 (12.4%)110 (12.0%)319 (12.2%)269 (13.9%) GRAFT FAILURE (44.5%)347 (21.4%)305 (25.0%)168 (17.9%)273 (19.0%)30 (16.9%) / (38.3%)153 (13.9%)194 (21.2%)211 (23.0%)492 (18.8%)323 (16.7%) MALIGNANCY, OTHER (0.1%)40 (2.5%)118 (9.7%)177 (18.8%)257 (17.9%)25 (14.1%) /20060 (0.0%)17 (1.5%)100 (10.9%)163 (17.8%)492 (18.8%)367 (19.0%) ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

51 ADULT HEART TRANSPLANT RECIPIENTS: Cumulative Incidence of Leading Causes of Death (Transplants: January June 2005) ISHLT 2008 Last updated based on data as of December 2006J Heart Lung Transplant 2008;27:

52 ADULT HEART TRANSPLANTS (1/2002-6/2006) Risk Factors for 1 Year Mortality 2008 ISHLT (N=8,823) * Temporary circulatory support includes ECMO and Abiomed. NOTE: There were too few continuous flow devices to analyze. J Heart Lung Transplant 2008;27:

53 ADULT HEART TRANSPLANTS (1/2002-6/2006) Risk Factors for 1 Year Mortality 2008 ISHLT J Heart Lung Transplant 2008;27:

54 ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits Recipient Age 2008 ISHLT (N=8,823) J Heart Lung Transplant 2008;27:

55 ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits Donor Age 2008 ISHLT (N=8,823) J Heart Lung Transplant 2008;27:

56 ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits Recipient Height 2008 ISHLT (N=8,823) J Heart Lung Transplant 2008;27:

57 ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits Donor BMI 2008 ISHLT (N=8,823) J Heart Lung Transplant 2008;27:

58 ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits Ischemia Time 2008 ISHLT (N=8,823) J Heart Lung Transplant 2008;27:

59 ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits Center Volume 2008 ISHLT (N=8,823) J Heart Lung Transplant 2008;27:

60 ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits Pre-Transplant Bilirubin 2008 ISHLT (N=8,823) J Heart Lung Transplant 2008;27:

61 ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits Pre-Transplant Creatinine 2008 ISHLT (N=8,823) J Heart Lung Transplant 2008;27:

62 ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits Recipient PA Systolic Pressure 2008 ISHLT (N=8,823) J Heart Lung Transplant 2008;27:

63 ADULT HEART TRANSPLANTS (1/2002-6/2006) Factors Not Significant for 1 Year Mortality Recipient Factors: Prior malignancy, gender, hospitalized, prior pregnancy, balloon pump, diabetes, PRA Donor Factors: Clinical infection, history of diabetes, gender, history of hypertension, cause of death, history of malignancy Transplant Factors: HLA mismatch, CMV mismatch, prior transplant 2008 ISHLT J Heart Lung Transplant 2008;27:

64 ADULT HEART TRANSPLANTS (1/2002-6/2006) 1-Year Predicted Survival Model ISHLT 2008 Recipient: 55 y.o., Dx=CAD, height=175 cm, volume=22/year, PA systolic=40, ischemia=180 min Donor: BMI = 25 kg/m 2 J Heart Lung Transplant 2008;27:

65 ADULT HEART TRANSPLANTS (1/2000-6/2002) Risk Factors for 5 Year Mortality 2008 ISHLT (N=5,131) ** Other = not cardiomyopathy, coronary artery disease, valvular heart disease, or congenital heart disease * Temporary circulatory support includes ECMO and Abiomed NOTE: There were too few continuous flow devices to analyze. J Heart Lung Transplant 2008;27:

66 ADULT HEART TRANSPLANTS (1/2000-6/2002) Risk Factors for 5 Year Mortality 2008 ISHLT (N=5,131) J Heart Lung Transplant 2008;27:

67 ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits Recipient Age 2008 ISHLT (N=5,131) J Heart Lung Transplant 2008;27:

68 ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits Donor Age 2008 ISHLT (N=5,131) J Heart Lung Transplant 2008;27:

69 ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits Ischemia Time 2008 ISHLT (N=5,131) J Heart Lung Transplant 2008;27:

70 ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits Center Volume 2008 ISHLT (N=5,131) J Heart Lung Transplant 2008;27:

71 ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant BMI 2008 ISHLT (N=5,131) J Heart Lung Transplant 2008;27:

72 ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Bilirubin 2008 ISHLT (N=5,131) J Heart Lung Transplant 2008;27:

73 ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Creatinine 2008 ISHLT (N=5,131) J Heart Lung Transplant 2008;27:

74 ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant PVR 2008 ISHLT (N=5,131) J Heart Lung Transplant 2008;27:

75 ADULT HEART TRANSPLANTS (1/2000-6/2002) Factors Not Significant for 5 Year Mortality Recipient Factors: Sternotomy, gender, pulmonary embolism, IV inotropes, transfusions, prior malignancy, PRA, balloon pump, infection requiring IV antibiotics prior to transplant Donor Factors: History of cancer, clinical infection, cause of death, history of hypertension, height, weight Transplant Factors: CMV mismatch, ABO match, prior transplant 2008 ISHLT J Heart Lung Transplant 2008;27:

76 ADULT HEART TRANSPLANTS (1/2000-6/2002) 5-Year Predicted Survival Model ISHLT 2008 Recipient: 55 y.o.; Dx=CAD; BMI = 26 kg/m 2 ; PVR=2.2; volume=24/year; ischemia=180 min; HLA mismatch = 5, transplant year = 2001/2002 Donor: BSA = 1.9 m 2 J Heart Lung Transplant 2008;27:

77 ADULT HEART TRANSPLANTS (1/2000-6/2002) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year 2008 ISHLT (N=4,144) * Other = not cardiomyopathy, coronary artery disease, valvular heart disease, or congenital heart disease J Heart Lung Transplant 2008;27:

78 ADULT HEART TRANSPLANTS (1/2000-6/2002) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year 2008 ISHLT (N=4,144) J Heart Lung Transplant 2008;27:

79 ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year Recipient Age 2008 ISHLT (N=4,144) J Heart Lung Transplant 2008;27:

80 ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year Donor Age 2008 ISHLT (N=4,144) J Heart Lung Transplant 2008;27:

81 ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year Donor BMI 2008 ISHLT (N=4,144) NOTE: These results should be considered in the context of donor/recipient weight ratio (next slide) J Heart Lung Transplant 2008;27:

82 ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year Donor/Recipient Weight Ratio 2008 ISHLT (N=4,144) NOTE: These results should be considered in the context of donor BMI (previous slide) J Heart Lung Transplant 2008;27:

83 ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year Recipient Pre-Transplant PVR 2008 ISHLT (N=4,144) J Heart Lung Transplant 2008;27:

84 ADULT HEART TRANSPLANTS (1993-6/1996) Risk Factors for 10 Year Mortality 2008 ISHLT (N=8,298) J Heart Lung Transplant 2008;27:

85 ADULT HEART TRANSPLANTS (1993-6/1996) Risk Factors for 10 Year Mortality 2008 ISHLT (N=8,298) J Heart Lung Transplant 2008;27:

86 ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits Recipient Age 2008 ISHLT (N=8,298) J Heart Lung Transplant 2008;27:

87 ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits Donor Age 2008 ISHLT (N=8,298) J Heart Lung Transplant 2008;27:

88 ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits Pre-Transplant Recipient BMI 2008 ISHLT (N=8,298) J Heart Lung Transplant 2008;27:

89 ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits Ischemia Time 2008 ISHLT (N=8,298) J Heart Lung Transplant 2008;27:

90 ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits Pre-transplant PRA 2008 ISHLT (N=8,298) J Heart Lung Transplant 2008;27:

91 ADULT HEART TRANSPLANTS (1993-6/1996) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years 2008 ISHLT (N=5,869) J Heart Lung Transplant 2008;27:

92 ADULT HEART TRANSPLANTS Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years 2008 ISHLT (N=5,869) J Heart Lung Transplant 2008;27:

93 ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits Conditional on Survival to 3 Years Recipient Age 2008 ISHLT (N=5,869) J Heart Lung Transplant 2008;27:

94 ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits Conditional on Survival to 3 Years Donor Age 2008 ISHLT (N=5,869) J Heart Lung Transplant 2008;27:

95 ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits Conditional on Survival to 3 Years Pre-Transplant Recipient BMI 2008 ISHLT (N=5,869) J Heart Lung Transplant 2008;27:

96 ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits Conditional on Survival to 3 Years Donor Weight 2008 ISHLT (N=5,869) J Heart Lung Transplant 2008;27:

97 ADULT HEART TRANSPLANTS (1989-6/1992) Risk Factors for 15 Year Mortality 2008 ISHLT (N=5,605) J Heart Lung Transplant 2008;27:

98 ADULT HEART TRANSPLANTS Risk Factors for 15 Year Mortality 2008 ISHLT (N=5,605) J Heart Lung Transplant 2008;27:

99 ADULT HEART TRANSPLANTS (1989-6/1992) Relative Risk of 15 Year Mortality with 95% Confidence Limits Recipient Age 2008 ISHLT (N=5,605) J Heart Lung Transplant 2008;27:

100 ADULT HEART TRANSPLANTS (1989-6/1992) Relative Risk of 15 Year Mortality with 95% Confidence Limits Donor Age 2008 ISHLT (N=5,605) J Heart Lung Transplant 2008;27:

101 ADULT HEART TRANSPLANTS (1989-6/1992) Relative Risk of 15 Year Mortality with 95% Confidence Limits Ischemia Time 2008 ISHLT (N=5,605) J Heart Lung Transplant 2008;27:

102 ADULT HEART TRANSPLANTS (1989-6/1992) Relative Risk of 15 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant PRA 2008 ISHLT (N=5,605) J Heart Lung Transplant 2008;27:

103 ADULT HEART TRANSPLANTS (1989-6/1992) Relative Risk of 15 Year Mortality with 95% Confidence Limits Center Volume 2008 ISHLT (N=5,605) J Heart Lung Transplant 2008;27:

104 ADULT HEART TRANSPLANTS (1989-6/1992) Risk Factors for 15 Year Mortality Conditional on Survival to 5 Years 2008 ISHLT (N=3,647) J Heart Lung Transplant 2008;27:

105 ADULT HEART TRANSPLANTS Risk Factors for 15 Year Mortality Conditional on Survival to 5 Years 2008 ISHLT (N=3,647) J Heart Lung Transplant 2008;27:

106 ADULT HEART TRANSPLANTS (1989-6/1992) Relative Risk of 15 Year Mortality with 95% Confidence Limits Conditional on Survival to 5 Years Recipient Age 2008 ISHLT (N=3,647) J Heart Lung Transplant 2008;27:

107 ADULT HEART TRANSPLANTS (1989-6/1992) Relative Risk of 15 Year Mortality with 95% Confidence Limits Conditional on Survival to 5 Years Donor Age 2008 ISHLT (N=3,647) J Heart Lung Transplant 2008;27:

108 ADULT HEART TRANSPLANTS (1989-6/1992) Relative Risk of 15 Year Mortality with 95% Confidence Limits Conditional on Survival to 5 Years Recipient Pre-Transplant PRA (%) 2008 ISHLT (N=3,647) J Heart Lung Transplant 2008;27:

109 ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Cardiac Allograft Vasculopathy after 5 Years (with no CAV prior to 5 years) (N=3,610) ISHLT 2008 J Heart Lung Transplant 2008;27:

110 ISHLT 2008 (N=3,610) ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Cardiac Allograft Vasculopathy after 5 Years (with no CAV prior to 5 years) J Heart Lung Transplant 2008;27:

111 ADULT HEART TRANSPLANTS (4/1994-6/2002) Relative Risk of Developing Cardiac Allograft Vasculopathy after 5 Years Donor Age, Donor Gender and Recipient Gender ISHLT 2008 (N=3,610) Relative risk includes impact of donor gender, recipient gender and donor age. J Heart Lung Transplant 2008;27:

112 ADULT HEART TRANSPLANTS (4/1994-6/2002) Relative Risk of Developing Cardiac Allograft Vasculopathy after 5 Years with 95% Confidence Limits Recipient Age ISHLT 2008 (N=3,610) J Heart Lung Transplant 2008;27:

113 ADULT HEART TRANSPLANTS (4/1994-6/2002) Relative Risk of Developing Cardiac Allograft Vasculopathy after 5 Years with 95% Confidence Limits Center Volume ISHLT 2008 (N=3,610) J Heart Lung Transplant 2008;27:

114 ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction within 7 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant (N=9,161) ISHLT 2008 *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2008;27:

115 ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction within 7 Years Limited to Recipients without Severe Renal Dysfunction Pre-Transplant ISHLT 2008 (N=9,161) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2008;27:

116 ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction within 7 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Pre-Transplant Creatinine ISHLT 2008 (N=9,161) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2008;27:

117 ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction within 7 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Age ISHLT 2008 (N=9,161) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2008;27:

118 ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction within 7 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Weight ISHLT 2008 (N=9,161) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2008;27:

119 ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction within 7 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Pre-Transplant Bilirubin ISHLT 2008 (N=9,161) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2008;27:

120 ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction within 7 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Pre-Transplant PVR ISHLT 2008 (N=9,161) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2008;27:

121 ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction within 7 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient PRA ISHLT 2008 (N=9,161) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2008;27:

122 ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction after 7 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant or Renal Dysfunction within 7 Years (N=2,775) ISHLT 2008 *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2008;27:

123 ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction after 7 Years Limited to Recipients without Severe Renal Dysfunction Pre-Transplant or Renal Dysfunction within 7 Years ISHLT 2008 (N=2,775) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2008;27:

124 ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction after 7 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant or Renal Dysfunction within 7 Years Recipient Pre-Transplant Creatinine ISHLT 2008 (N=2,775) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2008;27:

125 ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction after 7 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant or Renal Dysfunction within 7 Years Donor Age ISHLT 2008 (N=2,775) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2008;27:

126 ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction after 7 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant or Renal Dysfunction within 7 Years Donor/Recipient BMI Ratio ISHLT 2008 (N=2,775) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2008;27:

127 ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction after 7 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant or Renal Dysfunction within 7 Years Recipient Pre-Transplant Bilirubin ISHLT 2008 (N=2,775) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2008;27:

128 ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy within 5 Years Limited to Recipients without History of Malignancy Pre-Transplant (N=10,054) ISHLT 2008 J Heart Lung Transplant 2008;27:

129 ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy within 5 Years Limited to Recipients without History of Malignancy Pre-Transplant ISHLT 2008 (N=10,054) J Heart Lung Transplant 2008;27:

130 ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy within 5 Years Limited to Recipients without History of Malignancy Pre-Transplant Recipient Age ISHLT 2008 (N=10,054) J Heart Lung Transplant 2008;27:

131 ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy within 5 Years Limited to Recipients without History of Malignancy Pre-Transplant Donor Weight ISHLT 2008 (N=10,054) J Heart Lung Transplant 2008;27:

132 ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy within 5 Years Limited to Recipients without History of Malignancy Pre-Transplant Center Volume ISHLT 2008 (N=10,054) J Heart Lung Transplant 2008;27:

133 ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy after 5 Years Limited to Recipients without Malignancy within 5 Years (N=5,041) ISHLT 2008 J Heart Lung Transplant 2008;27:

134 ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy after 5 Years Limited to Recipients without Malignancy within 5 Years ISHLT 2008 (N=5,041) J Heart Lung Transplant 2008;27:

135 ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy after 5 Years Limited to Recipients without Malignancy within 5 Years Recipient Age ISHLT 2008 (N=5,041) J Heart Lung Transplant 2008;27:

136 ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy after 5 Years Limited to Recipients without Malignancy within 5 Years Donor Body Surface Area (BSA) ISHLT 2008 (N=5,041) J Heart Lung Transplant 2008;27:

137 ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy after 5 Years Limited to Recipients without Malignancy within 5 Years Recipient Pre-Transplant Bilirubin ISHLT 2008 (N=5,041) J Heart Lung Transplant 2008;27:

138 ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy after 5 Years Limited to Recipients without Malignancy within 5 Years Center Volume ISHLT 2008 (N=5,041) J Heart Lung Transplant 2008;27:

139 ERA ANALYSIS: ADULT HEART TRANSPLANTS (1/1988-6/2002) Risk Factors for 5 Year Mortality 2008 ISHLT (N=27,596) * Other = not cardiomyopathy, coronary artery disease, valvular heart disease, or congenital heart disease J Heart Lung Transplant 2008;27:

140 ERA ANALYSIS: ADULT HEART TRANSPLANTS (1/1988-6/2002) Risk Factors for 5 Year Mortality 2008 ISHLT (N=27,596) J Heart Lung Transplant 2008;27:

141 ERA ANALYSIS: ADULT HEART TRANSPLANTS (1/1988-6/2002) Risk Factors for 5 Year Mortality 2008 ISHLT (N=27,596) J Heart Lung Transplant 2008;27:

142 ERA ANALYSIS: ADULT HEART TRANSPLANTS (1/1988-6/2002) 5-Year Predicted Survival Model by Year of Transplant ISHLT 2008 Recipient: 54 y.o., Dx=cardiomyopathy, primary transplant, male, PRA = 0, volume=23/year, ischemia=180 min; HLA A mismatches = 1; HLA B mismatches = 2; HLA DR mismatches = 1; in hospital; not on VAD or ventilator or balloon pump Donor: 28 y.o. male J Heart Lung Transplant 2008;27:

143 ERA ANALYSIS: ADULT HEART TRANSPLANTS (1/1988-6/2002) Mortality within 5 Years Recipient Age ISHLT 2008 (N=27,596) J Heart Lung Transplant 2008;27:

144 ERA ANALYSIS: ADULT HEART TRANSPLANTS (1/1988-6/2002) Mortality within 5 Years Donor Age 2008 ISHLT (N=27,596) J Heart Lung Transplant 2008;27:

145 ERA ANALYSIS: ADULT HEART TRANSPLANTS (1/1988-6/2002) Mortality within 5 Years Ischemia Time ISHLT 2008 (N=27,596) J Heart Lung Transplant 2008;27:

146 ERA ANALYSIS: ADULT HEART TRANSPLANTS (1/1988-6/2002) Mortality within 5 Years Center Volume ISHLT 2008 (N=27,596) J Heart Lung Transplant 2008;27:

147 ERA ANALYSIS: ADULT HEART TRANSPLANTS (1/1988-6/2002) Mortality within 5 Years Pre-transplant PRA 2008 ISHLT (N=27,596) J Heart Lung Transplant 2008;27:

148 ERA ANALYSIS: ADULT HEART TRANSPLANTS (1/1988-6/2002) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year 2008 ISHLT (N=22,901) J Heart Lung Transplant 2008;27:

149 ERA ANALYSIS: ADULT HEART TRANSPLANTS (1/1988-6/2002) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year 2008 ISHLT (N=22,901) J Heart Lung Transplant 2008;27:

150 ERA ANALYSIS: ADULT HEART TRANSPLANTS (1/1988-6/2002) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year 2008 ISHLT (N=22,901) J Heart Lung Transplant 2008;27:

151 ERA ANALYSIS: ADULT HEART TRANSPLANTS (1/1988-6/2002) 5-Year Predicted Survival Model by Year of Transplant Conditional on Survival to 1 Year ISHLT 2008 Recipient: 54 y.o., Dx=cardiomyopathy, primary transplant, male, PRA = 0, volume=23/year, ischemia=180 min; HLA A mismatches = 1; HLA B mismatches = 2; HLA DR mismatches = 1; in hospital; not on VAD or ventilator or balloon pump Donor: 28 y.o. male J Heart Lung Transplant 2008;27:


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