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HEART TRANSPLANTATION Overall ISHLT 2007 J Heart Lung Transplant 2007;26: 769-781.

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Presentation on theme: "HEART TRANSPLANTATION Overall ISHLT 2007 J Heart Lung Transplant 2007;26: 769-781."— Presentation transcript:

1 HEART TRANSPLANTATION Overall ISHLT 2007 J Heart Lung Transplant 2007;26:

2 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:

3 AVERAGE CENTER VOLUME Heart Transplants: January 1, June 30, 1996 and January 1, 2002 – June 30, 2006 ISHLT 2007 J Heart Lung Transplant 2007;26:

4 DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Heart Transplants : January 1, June 30, 1996 and January 1, 2002 – June 30, 2006 ISHLT 2007 J Heart Lung Transplant 2007;26:

5 HEART TRANSPLANTS: Donor Age by Year of Transplant ISHLT 2007 J Heart Lung Transplant 2007;26:

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

7 AGE DISTRIBUTION OF HEART TRANSPLANT RECIPIENTS BY ERA P < ISHLT 2007 J Heart Lung Transplant 2007;26:

8 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:

9 HEART TRANSPLANTATION Adult Recipients ISHLT 2007 J Heart Lung Transplant 2007;26:

10 DIAGNOSIS IN ADULT HEART TRANSPLANTS ISHLT 2007 J Heart Lung Transplant 2007;26:

11 ADULT HEART TRANSPLANTS: RECIPIENT AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT 2007 J Heart Lung Transplant 2007;26:

12 ADULT HEART TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT 2007 J Heart Lung Transplant 2007;26:

13 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982 – 6/2005) Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

14 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1982-6/2005) ISHLT 2007 J Heart Lung Transplant 2007;26:

15 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1998-6/2005) ISHLT 2007 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 J Heart Lung Transplant 2007;26:

16 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1982-6/2005) ISHLT 2007 J Heart Lung Transplant 2007;26:

17 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis Conditional on Survival to 1 Year (Transplants: 1/1982-6/2005) ISHLT 2007 J Heart Lung Transplant 2007;26:

18 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/2000-6/2005) ISHLT 2007 J Heart Lung Transplant 2007;26:

19 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis Conditional on Survival to 1 Year (Transplants: 1/2000-6/2005) ISHLT 2007 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 J Heart Lung Transplant 2007;26:

20 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by PVR (Transplants: 1/2002-6/2005) ISHLT 2007 J Heart Lung Transplant 2007;26:

21 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage (Transplants: 1/1999-6/2005) ISHLT 2007 J Heart Lung Transplant 2007;26:

22 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage and Era (Transplants: 1/1999-6/2005) ISHLT 2007 J Heart Lung Transplant 2007;26:

23 ADULT HEART TRANSPLANTS 1-Year Predicted Survival Model (Transplants: 1/2002-6/2005) Impact of Pre-Transplant VAD ISHLT 2007 Recipient: 54 y.o., Dx=cardiomyopathy, weight=78 kg, PVR=2.2, volume=22/year, bilirubin=0.8, PA systolic=40, creatinine=1.3 mg/dl, ischemia=180 min Donor: 30 y.o., weight = 77 kg J Heart Lung Transplant 2007;26:

24 ADULT HEART RE-TRANSPLANTS 1-Year Survival ISHLT 2007 J Heart Lung Transplant 2007;26:

25 ADULT HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

26 ADULT HEART RECIPIENTS Employment Status of Surviving Recipients (Follow-ups: June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

27 ADULT HEART RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

28 ADULT HEART RECIPIENTS Induction Immunosuppression (Transplants: January 2001 – June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

29 ADULT HEART RECIPIENTS Induction Immunosuppression (Transplants: 1995, 2000 and 2005) ISHLT 2007 J Heart Lung Transplant 2007;26:

30 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Type (Transplants: 1/2000-6/2005, conditional on survival to 14 days) ISHLT 2007 J Heart Lung Transplant 2007;26:

31 ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January June 2006) NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT 2007 J Heart Lung Transplant 2007;26:

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:

33 ADULT HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up (Follow-ups: January June 2006) NOTES: Different patients are analyzed in Year 1 and Year 5. In the Year 1 cohort 73.9% of patients were on prednisone; in the Year 5 cohort 56.8% of patients were on prednisone. ISHLT 2007 J Heart Lung Transplant 2007;26:

34 ADULT HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up (Follow-ups: January June 2006) NOTES: Different patients are analyzed in Year 1 and Year 5. ISHLT 2007 J Heart Lung Transplant 2007;26:

35 ADULT HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For the Same Patients (Follow-ups: January June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

36 PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January 1, June 30, 2005) ISHLT 2007 J Heart Lung Transplant 2007;26:

37 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, 2005) Overall: no induction vs. OKT3 (p = ); polyclonal vs. OKT3 (p=0.0065); IL2 vs. OKT3 (p=0.0003) : no induction vs. IL2 (p = 0.037) : 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 =0.040); polyclonal vs. OKT3 (p=0.045); IL2 vs. OKT3 (p = ). ISHLT 2007 J Heart Lung Transplant 2007;26:

38 PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, June 30, 2005) Overall: p< : p< Male: p< ISHLT 2007 NOTE: There were 1,119 patients with cyclosporine+AZA and 138 with tacrolimus+AZA. These groups were excluded due to small numbers. J Heart Lung Transplant 2007;26:

39 NUMBER OF REJECTION EPISODES FOR ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, June 30, 2005) ISHLT 2007 NOTE: Cyclosporine+AZA and tacrolimus+AZA were excluded due to small numbers. J Heart Lung Transplant 2007;26:

40 ADULT HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Rejection Within 1 st Year Conditional on survival to 1 year for transplants: 1/1999-6/2004 ISHLT 2007 J Heart Lung Transplant 2007;26:

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 2007 J Heart Lung Transplant 2007;26:

42 POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 5 and 10 Years Post-Transplant (Follow-ups: April June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

43 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:

44 PATIENT SURVIVAL AFTER REPORT OF CAV AND PATIENT SURVIVAL IN PATIENTS WITHOUT CAV* (Transplants: April 1994-June 2004) ISHLT 2007 * Patients without CAV conditioned on survival to median time of CAV development (514 days) J Heart Lung Transplant 2007;26:

45 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 2007 J Heart Lung Transplant 2007;26:

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

47 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%) PRIMARY FAILURE804 (26.7%)196 (7.2%)134 (6.3%)81 (4.4%)186 (4.6%)43 (2.0%) GRAFT FAILURE453 (15.1%)304 (11.2%)365 (17.1%)298 (16.0%)579 (14.3%)310 (14.7%) 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%) J Heart Lung Transplant 2007;26: ISHLT

48 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%) / (5.5%)107 (9.7%)107 (11.7%)41 (4.4%)53 (2.0%) CARDIAC ALLOGRAFT VASCULOPATHY (1.9%)83 (5.1%)184 (15.1%)189 (20.1%)262 (18.3%) / (1.6%)44 (4.0%)114 (12.4%)110 (12.0%)319 (12.2%) GRAFT FAILURE (15.0%)179 (11.0%)200 (16.4%)119 (12.7%)174 (12.1%) / (15.2%)125 (11.4%)165 (18.0%)179 (18.8%)405 (15.5%) MALIGNANCY, OTHER (0.1%)40 (2.5%)118 (9.7%)177 (18.8%)257 (17.9%) /20060 (0.0%)17 (1.5%)100 (10.9%)163 (17.8%)492 (18.8%) PRIMARY FAILURE (29.5%)168 (10.4%)105 (8.6%)49 (5.2%)99 (6.9%) / (23.1%)28 (2.5%)29 (3.2%)32 (3.5%)87 (3.3%) ISHLT 2007 J Heart Lung Transplant 2007;26:

49 ADULT HEART TRANSPLANT RECIPIENTS: Cumulative Incidence of Leading Causes of Death (Transplants: January June 2005) ISHLT 2007 J Heart Lung Transplant 2007;26:

50 ADULT HEART TRANSPLANTS (1/2002-6/2005) Risk Factors for 1 Year Mortality 2007 ISHLT (N=7,024) * Temporary circulatory support includes ECMO and Abiomed. J Heart Lung Transplant 2007;26:

51 ADULT HEART TRANSPLANTS (1/2002-6/2005) Risk Factors for 1 Year Mortality 2007 ISHLT (N=7,024) J Heart Lung Transplant 2007;26:

52 ADULT HEART TRANSPLANTS (1/2002-6/2005) Risk Factors for 1 Year Mortality 2007 ISHLT J Heart Lung Transplant 2007;26:

53 ADULT HEART TRANSPLANTS (1/2002-6/2005) Relative Risk of 1 Year Mortality with 95% Confidence Limits Recipient Age 2007 ISHLT (N=7,024) J Heart Lung Transplant 2007;26:

54 ADULT HEART TRANSPLANTS (1/2002-6/2005) Relative Risk of 1 Year Mortality with 95% Confidence Limits Donor Age 2007 ISHLT (N=7,024) J Heart Lung Transplant 2007;26:

55 ADULT HEART TRANSPLANTS (1/2002-6/2005) Relative Risk of 1 Year Mortality with 95% Confidence Limits Recipient Weight 2007 ISHLT (N=7,024) J Heart Lung Transplant 2007;26:

56 ADULT HEART TRANSPLANTS (1/2002-6/2005) Relative Risk of 1 Year Mortality with 95% Confidence Limits Ischemia Time 2007 ISHLT (N=7,024) J Heart Lung Transplant 2007;26:

57 ADULT HEART TRANSPLANTS (1/2002-6/2005) Relative Risk of 1 Year Mortality with 95% Confidence Limits Center Volume 2007 ISHLT (N=7,024) J Heart Lung Transplant 2007;26:

58 ADULT HEART TRANSPLANTS (1/2002-6/2005) Relative Risk of 1 Year Mortality with 95% Confidence Limits Pre-Transplant Bilirubin 2007 ISHLT (N=7,024) J Heart Lung Transplant 2007;26:

59 ADULT HEART TRANSPLANTS (1/2002-6/2005) Relative Risk of 1 Year Mortality with 95% Confidence Limits Pre-Transplant Creatinine 2007 ISHLT (N=7,024) J Heart Lung Transplant 2007;26:

60 ADULT HEART TRANSPLANTS (1/2002-6/2005) Relative Risk of 1 Year Mortality with 95% Confidence Limits Recipient PA Systolic Pressure 2007 ISHLT (N=7,024) J Heart Lung Transplant 2007;26:

61 ADULT HEART TRANSPLANTS (1/2002-6/2005) Relative Risk of 1 Year Mortality with 95% Confidence Limits Recipient PVR 2007 ISHLT (N=7,024) J Heart Lung Transplant 2007;26:

62 ADULT HEART TRANSPLANTS (1/2002-6/2005) Factors Not Significant for 1 Year Mortality Recipient Factors: Prior malignancy, PCW, gender, hospitalized, prior transfusions Donor Factors: Clinical infection, history of diabetes, height, weight, gender, history of hypertension, cause of death, history of malignancy 2007 ISHLT J Heart Lung Transplant 2007;26:

63 ADULT HEART TRANSPLANTS (1/2002-6/2005) 1-Year Predicted Survival Model ISHLT 2007 Recipient: 55 y.o., Dx=CAD, weight=78 kg, PVR=2.2, volume=22/year, PA systolic=40, ischemia=180 min Donor: Weight = 77 kg J Heart Lung Transplant 2007;26:

64 ADULT HEART TRANSPLANTS (1/1999-6/2001) Risk Factors for 5 Year Mortality 2007 ISHLT (N=5,147) * Other = not cardiomyopathy, coronary artery disease, valvular heart disease, or congenital heart disease J Heart Lung Transplant 2007;26:

65 ADULT HEART TRANSPLANTS (1/1999-6/2001) Risk Factors for 5 Year Mortality 2007 ISHLT (N=5,147) J Heart Lung Transplant 2007;26:

66 ADULT HEART TRANSPLANTS (1/1999-6/2001) Relative Risk of 5 Year Mortality with 95% Confidence Limits Recipient Age 2007 ISHLT (N=5,147) J Heart Lung Transplant 2007;26:

67 ADULT HEART TRANSPLANTS (1/1999-6/2001) Relative Risk of 5 Year Mortality with 95% Confidence Limits Donor Age 2007 ISHLT (N=5,147) J Heart Lung Transplant 2007;26:

68 ADULT HEART TRANSPLANTS (1/1999-6/2001) Relative Risk of 5 Year Mortality with 95% Confidence Limits Ischemia Time 2007 ISHLT (N=5,147) J Heart Lung Transplant 2007;26:

69 ADULT HEART TRANSPLANTS (1/1999-6/2001) Relative Risk of 5 Year Mortality with 95% Confidence Limits Center Volume 2007 ISHLT (N=5,147) J Heart Lung Transplant 2007;26:

70 ADULT HEART TRANSPLANTS (1/1999-6/2001) Relative Risk of 5 Year Mortality with 95% Confidence Limits BMI Ratio 2007 ISHLT (N=5,147) J Heart Lung Transplant 2007;26:

71 ADULT HEART TRANSPLANTS (1/1999-6/2001) Relative Risk of 5 Year Mortality with 95% Confidence Limits Pre-Transplant Bilirubin 2007 ISHLT (N=5,147) J Heart Lung Transplant 2007;26:

72 ADULT HEART TRANSPLANTS (1/1999-6/2001) Relative Risk of 5 Year Mortality with 95% Confidence Limits Pre-Transplant Creatinine 2007 ISHLT (N=5,147) J Heart Lung Transplant 2007;26:

73 ADULT HEART TRANSPLANTS (1/1999-6/2001) Factors Not Significant for 5 Year Mortality Recipient Factors: VAD, thoracotomy, sternotomy, pulmonary embolism, IV inotropes, prior malignancy, PRA Donor Factors: History of cancer, clinical infection, cause of death, history of hypertension Transplant Factors: CMV mismatch, ABO match 2007 ISHLT J Heart Lung Transplant 2007;26:

74 ADULT HEART TRANSPLANTS (1/1999-6/2001) 5-Year Predicted Survival Model ISHLT 2007 Recipient: 55 y.o., Dx=CAD, weight=78 kg, PVR=2.2, volume=24/year, PA systolic=42, ischemia=180 min; BMI ratio = 1; HLA mismatch = 5 Donor: Weight = 75 kg J Heart Lung Transplant 2007;26:

75 ADULT HEART TRANSPLANTS (1/1999-6/2001) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year 2007 ISHLT (N=4,079) J Heart Lung Transplant 2007;26:

76 ADULT HEART TRANSPLANTS (1/1999-6/2001) Borderline Significant Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year 2007 ISHLT (N=4,079) J Heart Lung Transplant 2007;26:

77 ADULT HEART TRANSPLANTS (1/1999-6/2001) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year 2007 ISHLT (N=4,079) J Heart Lung Transplant 2007;26:

78 ADULT HEART TRANSPLANTS (1/1999-6/2001) Relative Risk of 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year Recipient Age 2007 ISHLT (N=4,079) J Heart Lung Transplant 2007;26:

79 ADULT HEART TRANSPLANTS (1/1999-6/2001) Relative Risk of 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year Donor Age 2007 ISHLT (N=4,079) J Heart Lung Transplant 2007;26:

80 ADULT HEART TRANSPLANTS (1/1999-6/2001) Relative Risk of 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year BMI Ratio 2007 ISHLT (N=4,079) J Heart Lung Transplant 2007;26:

81 ADULT HEART TRANSPLANTS (1991-6/1995) Risk Factors for 10 Year Mortality 2007 ISHLT (N=11,870) * Other = not cardiomyopathy, coronary artery disease, valvular heart disease, or congenital heart disease J Heart Lung Transplant 2007;26:

82 ADULT HEART TRANSPLANTS (1991-6/1995) Risk Factors for 10 Year Mortality 2007 ISHLT (N=11,870) J Heart Lung Transplant 2007;26:

83 ADULT HEART TRANSPLANTS (1991-6/1995) Relative Risk of 10 Year Mortality with 95% Confidence Limits Recipient Age 2007 ISHLT (N=11,870) J Heart Lung Transplant 2007;26:

84 ADULT HEART TRANSPLANTS (1991-6/1995) Relative Risk of 10 Year Mortality with 95% Confidence Limits Donor Age 2007 ISHLT (N=11,870) J Heart Lung Transplant 2007;26:

85 ADULT HEART TRANSPLANTS (1991-6/1995) Relative Risk of 10 Year Mortality with 95% Confidence Limits Pre-Transplant Recipient Height 2007 ISHLT (N=11,870) J Heart Lung Transplant 2007;26:

86 ADULT HEART TRANSPLANTS (1991-6/1995) Relative Risk of 10 Year Mortality with 95% Confidence Limits Center Volume 2007 ISHLT (N=11,870) J Heart Lung Transplant 2007;26:

87 ADULT HEART TRANSPLANTS (1991-6/1995) Relative Risk of 10 Year Mortality with 95% Confidence Limits Ischemia Time 2007 ISHLT (N=11,870) J Heart Lung Transplant 2007;26:

88 ADULT HEART TRANSPLANTS (1991-6/1995) Relative Risk of 10 Year Mortality with 95% Confidence Limits Pre-transplant PRA 2007 ISHLT (N=11,870) J Heart Lung Transplant 2007;26:

89 ADULT HEART TRANSPLANTS (1991-6/1995) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years 2007 ISHLT (N=8,426) J Heart Lung Transplant 2007;26:

90 ADULT HEART TRANSPLANTS Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years 2007 ISHLT (N=8,426) J Heart Lung Transplant 2007;26:

91 ADULT HEART TRANSPLANTS (1991-6/1995) Relative Risk of 10 Year Mortality with 95% Confidence Limits Conditional on Survival to 3 Years Recipient Age 2007 ISHLT (N=8,426) J Heart Lung Transplant 2007;26:

92 ADULT HEART TRANSPLANTS (1991-6/1995) Relative Risk of 10 Year Mortality with 95% Confidence Limits Conditional on Survival to 3 Years Donor Age 2007 ISHLT (N=8,426) J Heart Lung Transplant 2007;26:

93 ADULT HEART TRANSPLANTS (1991-6/1995) Relative Risk of 10 Year Mortality with 95% Confidence Limits Conditional on Survival to 3 Years Pre-Transplant Recipient Weight 2007 ISHLT (N=8,426) J Heart Lung Transplant 2007;26:

94 ADULT HEART TRANSPLANTS (1991-6/1995) Relative Risk of 10 Year Mortality with 95% Confidence Limits Conditional on Survival to 3 Years Donor Weight 2007 ISHLT (N=8,426) J Heart Lung Transplant 2007;26:

95 ADULT HEART TRANSPLANTS (1988-6/1991) Risk Factors for 15 Year Mortality 2007 ISHLT (N=3,500) J Heart Lung Transplant 2007;26:

96 ADULT HEART TRANSPLANTS Risk Factors for 15 Year Mortality 2007 ISHLT (N=3,500) J Heart Lung Transplant 2007;26:

97 ADULT HEART TRANSPLANTS (1988-6/1991) Relative Risk of 15 Year Mortality with 95% Confidence Limits Recipient Age 2007 ISHLT (N=3,500) J Heart Lung Transplant 2007;26:

98 ADULT HEART TRANSPLANTS (1988-6/1991) Relative Risk of 15 Year Mortality with 95% Confidence Limits Donor Age 2007 ISHLT (N=3,500) J Heart Lung Transplant 2007;26:

99 ADULT HEART TRANSPLANTS (1988-6/1991) Risk Factors for 15 Year Mortality Conditional on Survival to 5 Years 2007 ISHLT (N=2,322) * Other = not cardiomyopathy, coronary artery disease, valvular heart disease, or congenital heart disease J Heart Lung Transplant 2007;26:

100 ADULT HEART TRANSPLANTS Risk Factors for 15 Year Mortality Conditional on Survival to 5 Years 2007 ISHLT (N=2,322) J Heart Lung Transplant 2007;26:

101 ADULT HEART TRANSPLANTS (1988-6/1991) Relative Risk of 15 Year Mortality with 95% Confidence Limits Conditional on Survival to 5 Years Recipient Age 2007 ISHLT (N=2,322) J Heart Lung Transplant 2007;26:

102 ADULT HEART TRANSPLANTS (1988-6/1991) Relative Risk of 15 Year Mortality with 95% Confidence Limits Conditional on Survival to 5 Years Donor Age 2007 ISHLT (N=2,322) J Heart Lung Transplant 2007;26:

103 ADULT HEART TRANSPLANTS (1995-6/2001) Risk Factors for Developing Cardiac Allograft Vasculopathy within 5 Years (N=7,711) ISHLT * Due to the statistically significant interaction of donor gender and donor age, the relative risk for donor gender must be considered in the context of donor age rather than independently J Heart Lung Transplant 2007;26:

104 ADULT HEART TRANSPLANTS (1995-6/2001) Risk Factors for Developing Cardiac Allograft Vasculopathy within 5 Years ISHLT 2007 (N=7,711) J Heart Lung Transplant 2007;26:

105 ADULT HEART TRANSPLANTS (1995-6/2001) Relative Risk of Developing Cardiac Allograft Vasculopathy within 5 Years with 95% Confidence Limits Donor Age, Donor Gender and Recipient Gender ISHLT 2007 (N=7,711) Relative risk includes impact of donor gender, recipient gender and donor age. J Heart Lung Transplant 2007;26:

106 ADULT HEART TRANSPLANTS (1995-6/2001) Relative Risk of Developing Cardiac Allograft Vasculopathy within 5 Years with 95% Confidence Limits Recipient Age ISHLT 2007 (N=7,711) J Heart Lung Transplant 2007;26:

107 ADULT HEART TRANSPLANTS (1995-6/2001) Relative Risk of Developing Cardiac Allograft Vasculopathy within 5 Years with 95% Confidence Limits Center Volume ISHLT 2007 (N=7,711) J Heart Lung Transplant 2007;26:

108 ADULT HEART TRANSPLANTS (4/1994-6/2001) Risk Factors for Developing Renal Dysfunction within 5 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant (N=11,145) ISHLT 2007 *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2007;26:

109 ADULT HEART TRANSPLANTS (4/1994-6/2001) Risk Factors for Developing Renal Dysfunction within 5 Years Limited to Recipients without Severe Renal Dysfunction Pre-Transplant ISHLT 2007 (N=11,145) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2007;26:

110 ADULT HEART TRANSPLANTS (4/1994-6/2001) Risk Factors for Developing Renal Dysfunction within 5 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Pre-Transplant Creatinine ISHLT 2007 (N=11,145) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2007;26:

111 ADULT HEART TRANSPLANTS (4/1994-6/2001) Risk Factors for Developing Renal Dysfunction within 5 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Age ISHLT 2007 (N=11,145) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2007;26:

112 ADULT HEART TRANSPLANTS (4/1994-6/2001) Risk Factors for Developing Renal Dysfunction within 5 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Weight ISHLT 2007 (N=11,145) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2007;26:

113 ADULT HEART TRANSPLANTS (4/1994-6/2001) Risk Factors for Developing Renal Dysfunction within 5 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Donor Weight ISHLT 2007 (N=11,145) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2007;26:

114 ADULT HEART TRANSPLANTS (4/1994-6/2001) Risk Factors for Developing Renal Dysfunction within 5 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient PRA ISHLT 2007 (N=11,145) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis J Heart Lung Transplant 2007;26:


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