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2004 ISHLT J Heart Lung Transplant 2004; 23: 796-803 HEART TRANSPLANTATION Overall.

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Presentation on theme: "2004 ISHLT J Heart Lung Transplant 2004; 23: 796-803 HEART TRANSPLANTATION Overall."— Presentation transcript:

1 2004 ISHLT J Heart Lung Transplant 2004; 23: HEART TRANSPLANTATION Overall

2 2004 ISHLT J Heart Lung Transplant 2004; 23: NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR

3 2004 ISHLT J Heart Lung Transplant 2004; 23: AVERAGE CENTER VOLUME Heart Transplants: January 1, June 30, 2003

4 2004 ISHLT J Heart Lung Transplant 2004; 23: DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Heart Transplants: January 1, June 30, 2003

5 2004 ISHLT J Heart Lung Transplant 2004; 23: HEART TRANSPLANTS: Donor Age by Year of Transplant

6 2004 ISHLT J Heart Lung Transplant 2004; 23: AGE DISTRIBUTION OF HEART RECIPIENTS (1/1982-6/2003) % of Trnsplants % of Transplants

7 2004 ISHLT J Heart Lung Transplant 2004; 23: AGE DISTRIBUTION OF HEART TRANSPLANT RECIPIENTS BY ERA

8 2004 ISHLT J Heart Lung Transplant 2004; 23: HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2002)

9 2004 ISHLT J Heart Lung Transplant 2004; 23: HEART TRANSPLANTATION Adult Recipients

10 2004 ISHLT J Heart Lung Transplant 2004; 23: DIAGNOSIS IN ADULT HEART TRANSPLANTS

11 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2002) Survival (%)

12 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1982-6/2002)

13 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1996-6/2002)

14 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: 1/1982-6/2002)

15 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1982-6/2002)

16 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1996-6/2002)

17 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by PVR (Transplants: 1/1996-6/2002)

18 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART RE-TRANSPLANTS 1-Year Survival

19 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality

20 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality

21 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality

22 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality

23 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality

24 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality Recipient Age

25 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality Donor Age

26 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality Recipient Height

27 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality Center volume

28 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality Ischemia time

29 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality Recipient Bilirubin

30 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality Recipient creatinine

31 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/2002) Factors Not Significant for 1 Year Mortality Recipient Factors: VAD, ABO identical/compatible, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, cardiac output, weight

32 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/2002) Factors Not Significant for 1 Year Mortality Donor Factors: Clinical infection, history of cancer, history of hypertension, history of diabetes, height, weight, cause of death Transplant Factors: Donor/recipient BMI ratio, donor/recipient weight ratio

33 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1995-6/1998) Risk Factors for 5 Year Mortality (N=11,963)

34 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1995-6/1998) Risk Factors for 5 Year Mortality (N=11,963)

35 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1995-6/1998) Risk Factors for 5 Year Mortality (N=11,963)

36 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality 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

37 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Recipient Age

38 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Donor Age

39 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Donor BMI

40 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Recipient Height

41 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Center volume

42 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Ischemia time

43 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Recipient creatinine

44 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/1998) Factors Not Significant for 5 Year Mortality Recipient Factors: VAD, in hospital, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, PA diastolic, PVR, history of malignancy, weight, gender, history of malignancy, bilirubin, PCW

45 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/1998) 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, ABO identical/compatible

46 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1995-6/1998) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=9,182)

47 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

48 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year Recipient Age

49 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year Donor Age

50 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year Donor BMI

51 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year Recipient creatinine

52 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/1998) 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, diabetes, PRA, bilirubin

53 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1995-6/1998) 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

54 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years (N=5,952)

55 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years

56 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years Recipient Age

57 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years Donor Age

58 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years Donor BMI

59 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1/1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years Center volume

60 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART RECIPIENTS Functional Status (Follow-ups: January June 2003)

61 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART RECIPIENTS Employment Status (Follow-ups: January 1996-June 2003)

62 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART RECIPIENTS Rehospitalization Post-transplant (Follow-ups: January June 2003)

63 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART RECIPIENTS Induction Immunosuppression (Follow-ups: January 2001 – June 2003)

64 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART RECIPIENTS Induction Immunosuppression (Follow-ups: January June 2003)

65 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2001 through June 2003 NOTE: Different patients are analyzed in Year 1 and Year 5

66 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2001 through June 2003 NOTE: Different patients are analyzed in Year 1 and Year 5

67 2004 ISHLT J Heart Lung Transplant 2004; 23: PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January 1, June 30, 2002)

68 2004 ISHLT J Heart Lung Transplant 2004; 23: 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, 2002)

69 2004 ISHLT J Heart Lung Transplant 2004; 23: PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, June 30, 2002)

70 2004 ISHLT J Heart Lung Transplant 2004; 23: NUMBER OF REJECTION EPISODES FOR ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, June 30, 2002)

71 2004 ISHLT J Heart Lung Transplant 2004; 23: POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April June 2003)

72 2004 ISHLT J Heart Lung Transplant 2004; 23: POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant (Follow-ups: April June 2003)

73 2004 ISHLT J Heart Lung Transplant 2004; 23: POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 7 Years Post-Transplant (Follow-ups: April June 2003)

74 2004 ISHLT J Heart Lung Transplant 2004; 23: FREEDOM FROM CAV AND FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Adult Heart Recipients (Follow-ups: January 1996-June 2003)

75 2004 ISHLT J Heart Lung Transplant 2004; 23: FREEDOM FROM CAV Stratified by Diagnosis For Adult Heart Recipients (Follow-ups: January 1996-June 2003)

76 2004 ISHLT J Heart Lung Transplant 2004; 23: MALIGNANCY POST-HEART TRANSPLANTATION FOR ADULTS Cumulative Prevalence in Survivors (Follow-ups: April 1994-June 2003) Malignancy/Type1-Year Survivors 5-Year Survivors 7-Year Survivors No Malignancy15396 (96.8%)4697 (83.1%)1994 (75.9%) Malignancy (all types combined)502 (3.2%)957 (16.9%)633 (24.1%) Malignancy Type Skin Lymph Other Type Not Reported Other includes: prostate (11, 33, 25), adenocarcinoma (7, 4, 2), lung (5, 3, 2), bladder (4, 5, 5), sarcoma (3, 3, 1), breast (2, 8, 6), cervical (2, 4, 1), colon (2, 2, 3), and renal (2, 7, 3). Numbers in parentheses are those reported within 1 year, 5 years and 7 years, respectively.

77 2004 ISHLT J Heart Lung Transplant 2004; 23: FREEDOM FROM MALIGNANCY For Adult Heart Recipients (Follow-ups: April June 2003)

78 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1996-6/2000) Risk Factors for Developing CAV within 3 Years (N=5,787)

79 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1996-6/2000) Risk Factors for Developing CAV 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

80 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1996-6/2000) Risk Factors for Developing CAV within 3 Years Recipient Age

81 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1996-6/2000) Risk Factors for Developing CAV within 3 Years Donor Age

82 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1996-6/2000) Risk Factors for Developing CAV within 3 Years Recipient BMI

83 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1996-6/2000) Risk Factors for Developing CAV within 3 Years Center Volume

84 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1996-6/2000) Risk Factors for Developing CAV within 3 Years Recipient Diastolic PA Pressure

85 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1995-6/1996) Risk Factors for Developing CAV within 7 Years Conditional on no CAV within 1 Year (N=1,414)

86 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1995-6/1996) Risk Factors for Developing CAV within 7 Years Conditional on no CAV within 1 Year 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

87 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1995-6/1996) Risk Factors for Developing CAV within 7 Years Conditional on no CAV within 1 Year Recipient Age

88 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANTS (1995-6/1997) Risk Factors for Developing CAV within 7 Years Conditional on no CAV within 1 Year Donor Age

89 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January June 2003) CAUSE OF DEATH0-30 Days (N = 2,759 ) 31 Days - 1 Year (N = 2,310 ) >1 Year - 3 Years (N = 1,737 ) >3 Years - 5 Years (N = 1,492 ) >5 Years (N = 4,009 ) CAV 43 (1.6%)111 (4.8%)257 (14.8%)268 (18.0%)651 (16.2%) ACUTE REJECTION 188 (6.8%)288 (12.5%)165 (9.5%)63 (4.2%)43 (1.1%) LYMPHOMA 2 (0.1%)46 (2.0%)77 (4.4%)80 (5.4%)201 (5.0%) MALIGNANCY, OTHER 2 (0.1%)49 (2.1%)181 (10.4%)281 (18.8%)763 (19.0%) CMV 4 (0.1%)29 (1.3%)15 (0.9%)3 (0.2%)4 (0.1%) INFECTION, NON-CMV 370 (13.4%)784 (33.9%)234 (13.5%)145 (9.7%)393 (9.8%) PRIMARY FAILURE 747 (27.1%)186 (8.1%)119 (6.9%)68 (4.6%)200 (5.0%) GRAFT FAILURE 400 (14.5%)245 (10.6%)298 (17.2%)218 (14.6%)567 (14.1%) TECHNICAL 208 (7.5%)28 (1.2%)15 (0.9%)17 (1.1%)43 (1.1%) OTHER 101 (3.7%)122 (5.3%)123 (7.1%)104 (7.0%)240 (6.0%) MULTIPLE ORGAN FAILURE 382 (13.8%)228 (9.9%)86 (5.0%)83 (5.6%)335 (8.4%) RENAL FAILURE 17 (0.6%)19 (0.8%)31 (1.8%)51 (3.4%)238 (5.9%) PULMONARY 116 (4.2%)77 (3.3%)77 (4.4%)60 (4.0%)163 (4.1%) CEREBROVASCULAR 179 (6.5%)98 (4.2%)59 (3.4%)51 (3.4%)168 (4.2%)


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