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

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

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

2 NUMBER OF HEART-LUNG TRANSPLANTS REPORTED BY YEAR ISHLT 2008 NOTE: This figure includes only the heart-lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of heart-lung transplants worldwide has declined in recent years. J Heart Lung Transplant 2008;27:

3 AVERAGE CENTER VOLUME Heart-Lung Transplants: January 1, June 30, 2007 ISHLT 2008 J Heart Lung Transplant 2008;27:

4 DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY CENTER VOLUME Heart-Lung Transplants: January 1, June 30, 2007 ISHLT 2008 J Heart Lung Transplant 2008;27:

5 DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME Lung Transplants: January 1, June 30, 2007 ISHLT 2008 J Heart Lung Transplant 2008;27:

6 HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January June 2006) N=3,272 Half-life = 3.1 years Conditional Half-life = 8.9 years Survival (%) ISHLT 2008 N at risk at 20 years = 18 J Heart Lung Transplant 2008;27:

7 HEART-LUNG TRANSPLANTATION Adult Recipients ISHLT 2008 J Heart Lung Transplant 2008;27:

8 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (January June 2007) Other includes cancer, LAM, OB, sarcoidosis, bronchiectasis ISHLT 2008 J Heart Lung Transplant 2008;27:

9 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January June 2007) Diagnosis N (%) Congenital Heart Disease869 (34.4%) Primary Pulmonary Hypertension633 (25.0%) Cystic Fibrosis354 (14.0%) Acquired Heart Disease91 ( 3.6%) COPD/Emphysema96 ( 3.8%) Idiopathic Pulmonary Fibrosis72 ( 2.8%) Alpha-152 ( 2.1%) Re-Transplant: Not Obliterative Bronchiolitis31 ( 1.2%) Sarcoidosis35 ( 1.4%) Re-Transplant: Obliterative Bronchiolitis24 ( 0.9%) Bronchiectasis20 ( 0.8%) Obliterative Bronchiolitis (not Re-Transplant)8 ( 0.3%) Other243 ( 9.6%) ISHLT 2008 J Heart Lung Transplant 2008;27:

10 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA Other includes OB (non-ReTX), Bronchiectasis, Sarcoidosis ISHLT 2008 J Heart Lung Transplant 2008;27:

11 ADULT HEART-LUNG TRANSPLANTATION Indications By Year (%) ISHLT 2008 J Heart Lung Transplant 2008;27:

12 ADULT HEART-LUNG TRANSPLANTATION Indications By Year (Number) ISHLT 2008 J Heart Lung Transplant 2008;27:

13 ADULT HEART-LUNG TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2007 ISHLT 2008 J Heart Lung Transplant 2008;27:

14 ADULT HEART-LUNG TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2007 ISHLT 2008 J Heart Lung Transplant 2008;27:

15 ADULT HEART-LUNG TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2007 ISHLT 2008 J Heart Lung Transplant 2008;27:

16 HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival for Adult Recipients (Transplants: January June 2006) N=2,639 Half-life = 3.5 Years Conditional Half-life = 9.1 Years Survival (%) ISHLT 2008 J Heart Lung Transplant 2008;27:

17 HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival for Adult Recipients by Era (Transplants: January June 2006) Half-life (Years): = 3.0; = 3.5; /2006 =6.0 Conditional Half-life (Years): = 8.7; = 9.7; /2006 = n/a Survival (%) ISHLT 2008 P-value comparing all: J Heart Lung Transplant 2008;27:

18 ADULT HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2006) ISHLT 2008 J Heart Lung Transplant 2008;27:

19 ADULT HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2006) ISHLT 2008 J Heart Lung Transplant 2008;27:

20 ADULT HEART-LUNG RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27:

21 ADULT HEART-LUNG RECIPIENTS Employment Status of Surviving Recipients (Follow-ups: April 1994 – June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27:

22 ADULT HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27:

23 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression For transplants between January 2001 through 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:

24 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression (Transplants: January December 2006) ISHLT 2008 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27:

25 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression (Transplants: January December 2006) ISHLT 2008 Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27:

26 ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2001 through 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:

27 ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2001 through 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:

28 POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27:

29 POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant (Follow-ups: April June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27:

30 Freedom from Coronary Artery Vasculopathy For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27:

31 Freedom from Bronchiolitis Obliterans For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27:

32 Freedom from Severe Renal Dysfunction* For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2007) *Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant ISHLT 2008 J Heart Lung Transplant 2008;27:

33 MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTS Cumulative Prevalence in Survivors (Follow-ups: April 1994-June 2007) Malignancy/Type1-Year Survivors 5-Year Survivors 10-Year Survivors No Malignancy 330 (92.7%)114 (88.4%)22 (84.6%) Malignancy (all types combined) 26 (7.3%)15 (11.6%)4 (15.4%) Malignancy Type* Skin244 Lymph1861 Other233 Type Not Reported420 ISHLT 2008 * Recipients may have experienced more than one type of malignancy so sum of individual malignancy types may be greater than total number with malignancy. J Heart Lung Transplant 2008;27:

34 Freedom from Malignancy For Adult Heart-Lung Recipients (Follow-ups: April June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27:

35 ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January June 2007) CAUSE OF DEATH 0-30 Days (N = 269) 31 Days - 1 Year (N = 209) >1 Year - 3 Years (N = 181) >3 Years - 5 Years (N = 130) >5 Years (N = 249) BRONCHIOLITIS 04 (1.9%)39 (21.5%)25 (19.2%)38 (15.3%) ACUTE REJECTION 3 (1.1%)6 (2.9%)2 (1.1%)01 (0.4%) LYMPHOMA 09 (4.3%)11 (6.1%)5 (3.8%)4 (1.6%) MALIGNANCY, OTHER 02 (1.0%)6 (3.3%)3 (2.3%)12 (4.8%) CMV 01 (0.5%)01 (0.8%)0 INFECTION, NON-CMV 51 (19.0%)76 (36.4%)61 (33.7%)42 (32.3%)76 (30.5%) GRAFT FAILURE 79 (29.4%)49 (23.4%)29 (16.0%)25 (19.2%)50 (20.1%) CARDIOVASCULAR 23 (8.6%)9 (4.3%)10 (5.5%)9 (6.9%)14 (5.6%) TECHNICAL 53 (19.7%)6 (2.9%)1 (0.6%)1 (0.8%)0 OTHER 60 (22.3%)47 (22.5%)22 (12.2%)19 (14.6%)54 (21.7%) ISHLT 2008 J Heart Lung Transplant 2008;27:

36 HEART-LUNG TRANSPLANTATION Pediatric Recipients ISHLT 2008 J Heart Lung Transplant 2008;27:

37 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27:

38 AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART- LUNG RECIPIENTS (Transplants: January June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27:

39 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS By Year of Transplant Number of Transplants 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 pediatric heart- lung transplants worldwide has declined in recent years. Transplants between January 1984 and June 2007 J Heart Lung Transplant 2008;27:

40 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS By Era of Transplant Percentage of Transplants ISHLT 2008 J Heart Lung Transplant 2008;27:

41 NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS ISHLT 2008 NEED TO UPDATE Transplants between January 1984 and June 2007 J Heart Lung Transplant 2008;27:

42 NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS Stratified by center volume ISHLT 2008 Transplants between January 1984 and June 2007 J Heart Lung Transplant 2008;27:

43 DIAGNOSIS IN PEDIATRIC HEART –LUNG TRANSPLANT RECIPIENTS (Age: Years) Other includes Bronchiectasis, Alpha-1, and OB (non-ReTX) ISHLT 2008 J Heart Lung Transplant 2008;27:

44 PEDIATRIC HEART-LUNG TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2007 ISHLT 2008 J Heart Lung Transplant 2008;27:

45 PEDIATRIC HEART-LUNG TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2007 ISHLT 2008 J Heart Lung Transplant 2008;27:

46 PEDIATRIC HEART-LUNG TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2007 ISHLT 2008 J Heart Lung Transplant 2008;27:

47 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2006) ISHLT 2008 J Heart Lung Transplant 2008;27:

48 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January June 2006) ISHLT 2008 J Heart Lung Transplant 2008;27:

49 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January June 2006) Survival (%) ISHLT 2008 J Heart Lung Transplant 2008;27:

50 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January June 2006) Conditional on Survival to 1 Year Survival (%) ISHLT 2008 J Heart Lung Transplant 2008;27:

51 PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January June 2007) CAUSE OF DEATH 0-30 Days (N = 37) 31 Days - 1 Year (N = 48 ) >1 Year - 3 Years (N = 41 ) >3 Years - 5 Years (N = 30 ) >5 Years (N = 39) BRONCHIOLITIS 2 (4.2%)20 (48.8%)10 (33.3%)8 (20.5%) ACUTE REJECTION 2 (4.2%)1 (2.4%) MALIGNANCY, OTHER 1 (3.3%) INFECTION, NON-CMV 6 (16.2%)16 (33.3%)4 (9.8%)1 (3.3%) 13 (33.3%) GRAFT FAILURE 16 (43.2%)9 (18.8%)13 (31.7%)14 (46.7%)9 (23.1%) CARDIOVASCULAR 2 (5.4%)3 (6.3%)2 (6.7%)2 (5.1%) TECHNICAL 6 (16.2%) ISHLT 2008 J Heart Lung Transplant 2008;27:

52 PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: April June 2007) CAUSE OF DEATH0-30 Days (N = 31) 31 Days - 1 Year (N = 34) >1 Year - 3 Years (N = 35) >3 Years - 5 Years (N = 26) >5 Years (N = 39) BRONCHIOLITIS1 (2.9%)17 (48.6%)9 (34.6%)8 (20.5%) ACUTE REJECTION1 (2.9%) MALIGNANCY, OTHER1 (3.8%) INFECTION, NON-CMV4 (12.9%)12 (35.3%)4 (11.4%)1 (3.8%)13 (33.3%) GRAFT FAILURE14 (45.2%)6 (17.6%)10 (28.6%)12 (46.2%)9 (23.1%) CARDIOVASCULAR2 (6.5%)2 (5.9%)1 (3.8%)2 (5.1%) TECHNICAL4 (12.9%) ISHLT 2008 J Heart Lung Transplant 2008;27:


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