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2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. HEART TRANSPLANTATION Overall.

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Presentation on theme: "2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. HEART TRANSPLANTATION Overall."— Presentation transcript:

1 2003 ISHLT J Heart Lung Transplant 2003; 22: HEART TRANSPLANTATION Overall

2 2003 ISHLT J Heart Lung Transplant 2003; 22: NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR

3 2003 ISHLT J Heart Lung Transplant 2003; 22: NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR AND LOCATION

4 2003 ISHLT J Heart Lung Transplant 2003; 22: AVERAGE CENTER VOLUME Heart Transplants: January 1, June 30, 2002

5 2003 ISHLT J Heart Lung Transplant 2003; 22: HEART TRANSPLANTS: Donor Age by Year of Transplant

6 2003 ISHLT J Heart Lung Transplant 2003; 22: AGE DISTRIBUTION OF HEART RECIPIENTS (1/1982-6/2002) % of Trnsplants % of Transplants

7 2003 ISHLT J Heart Lung Transplant 2003; 22: AGE DISTRIBUTION OF HEART TRANSPLANT RECIPIENTS BY ERA /1997-6/2002

8 2003 ISHLT J Heart Lung Transplant 2003; 22: HEART TRANSPLANTATION Actuarial Survival (1/1982-6/2001) N=59,391 Half-life = 9.3 years Conditional Half-life = 12.0 years

9 2003 ISHLT J Heart Lung Transplant 2003; 22: HEART TRANSPLANTATION Adult Recipients

10 2003 ISHLT J Heart Lung Transplant 2003; 22: DIAGNOSIS IN ADULT HEART TRANSPLANTS

11 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTATION Actuarial Survival by Era (Transplants: 1/1982-6/2001) Survival (%)

12 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTATION Actuarial Survival by Age Group (Transplants: 1/1982-6/2001)

13 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTATION Actuarial Survival by Diagnosis (Transplants: 1/1982-6/2001)

14 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTATION Actuarial Survival by Diagnosis (Transplants: 1/1994-6/2001) Age = Years

15 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTATION Actuarial Survival by Diagnosis (Transplants: 1/1994-6/2001) Age = Years

16 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTATION Actuarial Survival by Diagnosis (Transplants: 1/1994-6/2001) Age = Years

17 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTATION Actuarial Survival by Diagnosis (Transplants: 1/1994-6/2001) Age = Years

18 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTATION Actuarial Survival by Diagnosis (Transplants: 1/1994-6/2001) Age = 70+ Years

19 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTATION Actuarial Survival by PVR (Transplants: 4/1994-6/2001)

20 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTATION Actuarial Survival by PVR (Transplants: 4/1994-6/2001) During first 6 months following transplantation

21 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART RE-TRANSPLANTS 1-Year Survival

22 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality

23 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality

24 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality

25 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality

26 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Recipient Age

27 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Donor Age

28 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Donor Weight

29 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Recipient Height

30 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Center volume

31 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Ischemia time

32 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Bilirubin

33 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Recipient creatinine

34 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Cardiac Output

35 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality PVR

36 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality PA Diastolic

37 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/2001) Factors Not Significant for 1 Year Mortality Recipient Factors: VAD, ABO identical/compatible, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, PCW, history of malignancy, weight

38 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/2001) Factors Not Significant for 1 Year Mortality Donor Factors: Gender, clinical infection, history of cancer, history of hypertension, history of diabetes, height Transplant Factors: Donor/recipient BMI ratio, donor/recipient height ratio, CMV mismatch

39 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1995-6/1997) Risk Factors for 5 Year Mortality (N=8,271)

40 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality

41 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Recipient Age

42 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Donor Age

43 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Donor BMI

44 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Recipient Height

45 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Most Recent PRA

46 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Center volume

47 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Ischemia time

48 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Bilirubin

49 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Recipient creatinine

50 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality PCW

51 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Factors Not Significant for 5 Year Mortality Recipient Factors: VAD, ventilator, in hospital, IV inotropes, balloon, ABO identical/compatible, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, PA diastolic, PVR, history of malignancy, weight, gender, history of malignancy

52 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Factors Not Significant for 5 Year Mortality Donor Factors: Gender, cause of death, clinical infection, history of cancer, history of hypertension, history of diabetes Transplant Factors: Donor/recipient BMI ratio, donor/recipient height ratio, CMV mismatch, HLA mismatch

53 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=6,273)

54 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

55 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year Recipient Age

56 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year Donor Age

57 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year Donor BMI

58 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year Recipient creatinine

59 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Factors Not Significant for 5 Year Mortality Conditional on Survival to 1 Year Recipient Factors: VAD, ventilator, in hospital, IV inotropes, balloon, ABO identical/compatible, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, PA diastolic, PCW, PVR, history of malignancy, height, weight, gender, history of malignancy, PRA, bilirubin

60 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Factors Not Significant for 5 Year Mortality Conditional on Survival to 1 Year Donor Factors: Gender, cause of death, clinical infection, history of cancer, history of hypertension, history of diabetes Transplant Factors: Donor/recipient BMI ratio, donor/recipient height ratio, CMV mismatch, HLA mismatch, center volume, ischemia time Post-transplant Factors: Dialysis, prolonged graft dysfunction, permanent pacemaker

61 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART RECIPIENTS Functional Status (Follow-ups: April 1994-June 2002)

62 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART RECIPIENTS Employment Status (Follow-ups: April 1994-June 2002)

63 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART RECIPIENTS Rehospitalization Post-transplant (Follow-ups: April June 2002)

64 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART RECIPIENTS Induction Immunosuppression (Follow-ups: January 2000 – June 2002)

65 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART RECIPIENTS Induction Immunosuppression (Follow-ups: January June 2002)

66 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART RECIPIENTS Maintenance Immunosuppression at Any Time During Follow-up Period For follow-ups between January 2000 through June 2002 NOTE: Different patients are analyzed in Year 1 and Year 5

67 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2000 through June 2002 NOTE: Different patients are analyzed in Year 1 and Year 5

68 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2000 through June 2002 NOTE: Different patients are analyzed in Year 1 and Year 5

69 2003 ISHLT J Heart Lung Transplant 2003; 22: POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April 1994-June 2002)

70 2003 ISHLT J Heart Lung Transplant 2003; 22: POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant (Follow-ups: April 1994-June 2002)

71 2003 ISHLT J Heart Lung Transplant 2003; 22: Freedom from CAV and Freedom from Severe Renal Dysfunction* For Adult Heart Recipients (Follow-ups: April 1994-June 2002)

72 2003 ISHLT J Heart Lung Transplant 2003; 22: MALIGNANCY POST-HEART TRANSPLANTATION FOR ADULTS Cumulative Prevalence in Survivors (Follow-ups: April 1994-June 2002) Malignancy/Type1-Year Survivors5-Year Survivors No Malignancy (96.7%) 3728 (82.0%) Malignancy (all types combined) 470 (3.3%) 821 (18.0%) Malignancy Type Skin Lymph11372 Other Lymph + Skin12 Lymph + Other13 Skin + Other26 Lymph + Skin + Other2 Type Not Reported4839 Other includes: prostate (11), adenocarcinoma (7), lung (5), bladder (4), breast (2), cervix (2), colon (2), head/neck/throat (2), renal (2).

73 2003 ISHLT J Heart Lung Transplant 2003; 22: Freedom from Malignancy For Adult Heart Recipients (Follow-ups: April 1994-June 2002)

74 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV within 5 Years (N=4,797)

75 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV within 5 Years

76 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV within 5 Years Recipient Age

77 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV within 5 Years Donor Age

78 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV within 5 Years Donor BMI/Recipient BMI

79 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV within 5 Years Center volume

80 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV between 5 and 7 Years (N=839)

81 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV between 5 and 7 Years Donor BMI

82 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for Developing Malignancy within 5 Years (N=4,371)

83 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for Developing Malignancy within 5 Years

84 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for Developing Malignancy within 5 Years Recipient Age

85 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for Developing Malignancy within 5 Years Donor BMI

86 2003 ISHLT J Heart Lung Transplant 2003; 22: ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January June 2002) CAUSE OF DEATH 0-30 Days (N = 2,454) 31 Days - 1 Year (N = 2,155) >1 Year - 3 Years (N = 1,642) >3 Years - 5 Years (N = 1,391) >5 Years (N = 3,454) CAV44 (1.8%)108 (5.0%)243 (14.8%)251 (18.0%)588 (17.0%) ACUTE REJECTION157 (6.4%)264 (12.3%)156 (9.5%)60 (4.3%)39 (1.1%) LYMPHOMA1 (0.0%)44 (2.0%)78 (4.8%)79 (5.7%)181 (5.2%) MALIGNANCY, OTHER2 (0.1%)49 (2.3%)171 (10.4%)269 (19.3%)661 (19.1%) CMV3 (0.1%)27 (1.3%)14 (0.9%)3 (0.2%)4 (0.1%) INFECTION, NON-CMV348 (14.2%)745 (34.6%)216 (13.2%)138 (9.9%)333 (9.6%) PRIMARY FAILURE602 (24.5%)183 (8.5%)118 (7.2%)67 (4.8%)191 (5.5%) GRAFT FAILURE403 (16.4%)226 (10.5%)282 (17.2%)201 (14.5%)466 (13.5%) TECHNICAL183 (7.5%)24 (1.1%)15 (0.9%)17 (1.2%)36 (1.0%) OTHER83 (3.4%)103 (4.8%)114 (6.9%)97 (7.0%)205 (5.9%) MULTIPLE ORGAN FAILURE 342 (13.9%)204 (9.5%)80 (4.9%)73 (5.2%)270 (7.8%) RENAL FAILURE14 (0.6%)16 (0.7%)27 (1.6%)44 (3.2%)203 (5.9%) PULMONARY109 (4.4%)71 (3.3%)72 (4.4%)51 (3.7%)128 (3.7%) CEREBROVASCULAR163 (6.6%)91 (4.2%)56 (3.4%)41 (2.9%)149 (4.3%)


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