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HEART-LUNG TRANSPLANTATION Overall ISHLT 2007 J Heart Lung Transplant 2007;26.

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

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

2 NUMBER OF HEART-LUNG TRANSPLANTS REPORTED BY YEAR ISHLT 2007 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 2007;26

3 AVERAGE CENTER VOLUME Heart-Lung Transplants: January 1, 1998 - June 30, 2006 ISHLT 2007 J Heart Lung Transplant 2007;26

4 DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY CENTER VOLUME Heart-Lung Transplants: January 1, 1998 - June 30, 2006 ISHLT 2007 J Heart Lung Transplant 2007;26

5 DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME Lung Transplants: January 1, 1998 - June 30, 2006 ISHLT 2007 J Heart Lung Transplant 2007;26

6 HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1982 - June 2005) N=3,184 Half-life = 3.1 years Conditional Half-life = 8.8 years Survival (%) ISHLT 2007 N at risk at 20 years = 7 J Heart Lung Transplant 2007;26

7 HEART-LUNG TRANSPLANTATION Adult Recipients ISHLT 2007 J Heart Lung Transplant 2007;26

8 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (January 1982 - June 2006) Other includes cancer, LAM, OB, sarcoidosis, bronchiectasis ISHLT 2007 J Heart Lung Transplant 2007;26

9 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2006) Diagnosis N (%) Congenital Heart Disease841 (33.9%) Primary Pulmonary Hypertension601 (24.2%) Cystic Fibrosis352 (14.2%) Acquired Heart Disease110 ( 4.4%) COPD/Emphysema92 ( 3.7%) Idiopathic Pulmonary Fibrosis71 ( 2.9%) Alpha-153 ( 2.1%) Re-Transplant: Not Obliterative Bronchiolitis31 ( 1.2%) Sarcoidosis30 ( 1.2%) Re-Transplant: Obliterative Bronchiolitis24 ( 1.0%) Bronchiectasis18 ( 0.7%) Obliterative Bronchiolitis (not Re-Transplant)8 ( 0.3%) Other251 (10.1%) ISHLT 2007 J Heart Lung Transplant 2007;26

10 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA Other includes OB (non-ReTX), Bronchiectasis, Sarcoidosis ISHLT 2007 J Heart Lung Transplant 2007;26

11 ADULT HEART-LUNG TRANSPLANTATION Indications By Year (%) ISHLT 2007 J Heart Lung Transplant 2007;26

12 ADULT HEART-LUNG TRANSPLANTATION Indications By Year (Number) ISHLT 2007 J Heart Lung Transplant 2007;26

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

14 ADULT HEART-LUNG TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT 2007 J Heart Lung Transplant 2007;26

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

16 HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival for Adult Recipients (Transplants: January 1982 - June 2005) N=2,571 Half-life = 3.4 Years Conditional Half-life = 9.0 Years Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26

17 HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival for Adult Recipients by Era (Transplants: January 1982 - June 2005) Half-life (Years): 1982-1995 = 3.0; 1996-1999 = 3.4; 2000-6/2005 = 5.2 Conditional Half-life (Years): 1982-1995 = 8.9; 1996-1999 = 9.5; 2000-6/2005 = n/a Survival (%) ISHLT 2007 P-value comparing all: 0.0082 J Heart Lung Transplant 2007;26

18 ADULT HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2005) ISHLT 2007 J Heart Lung Transplant 2007;26

19 ADULT HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2005) ISHLT 2007 J Heart Lung Transplant 2007;26

20 ADULT HEART-LUNG RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26

21 ADULT HEART-LUNG RECIPIENTS Employment Status of Surviving Recipients (Follow-ups: April 1994 – June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26

22 ADULT HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April 1994 - June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26

23 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression For transplants between January 2001 through June 2006 ISHLT 2007 J Heart Lung Transplant 2007;26

24 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2000 - December 2005) ISHLT 2007 J Heart Lung Transplant 2007;26

25 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2000 - December 2005) ISHLT 2007 Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist J Heart Lung Transplant 2007;26

26 ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2001 through June 2006 NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT 2007 J Heart Lung Transplant 2007;26

27 ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2001 through June 2006 NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT 2007 J Heart Lung Transplant 2007;26

28 POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April 1994 - June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26

29 POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant (Follow-ups: April 1994 - June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26

30 Freedom from Coronary Artery Vasculopathy For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26

31 Freedom from Bronchiolitis Obliterans For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26

32 Freedom from Severe Renal Dysfunction* For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2006) *Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant ISHLT 2007 J Heart Lung Transplant 2007;26

33 MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTS Cumulative Prevalence in Survivors (Follow-ups: April 1994-June 2006) Malignancy/Type1-Year Survivors 5-Year Survivors 10-Year Survivors No Malignancy 308 (92.2%)106 (88.3%)51 (85%) Malignancy (all types combined) 26 (7.8%)14 (11.7%)9 (15%) Malignancy Type* Skin249 Lymph1862 Other221 Type Not Reported420 ISHLT 2007 * 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 2007;26

34 Freedom from Malignancy For Adult Heart-Lung Recipients (Follow-ups: April 1994- June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26

35 ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2006) CAUSE OF DEATH 0-30 Days (N = 225) 31 Days - 1 Year (N = 145) >1 Year - 3 Years (N = 124) >3 Years - 5 Years (N = 70) >5 Years (N = 129) BRONCHIOLITIS 04 (2.8%)34 (27.4%)28 (40.0%)31 (24.0%) ACUTE REJECTION 3 (1.3%)4 (2.8%)2 (1.6%)01 (0.8%) LYMPHOMA 05 (3.4%)9 (7.3%)3 (4.3%)1 (0.8%) MALIGNANCY, OTHER 01 (0.7%)6 (4.8%)2 (2.9%)6 (4.7%) CMV 01 (0.7%)01 (1.4%)0 INFECTION, NON-CMV 40 (17.8%)58 (40.0%)34 (27.4%)7 (10.0%)22 (17.1%) GRAFT FAILURE 69 (30.7%)32 (22.1%)21 (16.9%)11 (15.7%)31 (24.0%) CARDIOVASCULAR 21 (9.3%)6 (4.1%)6 (4.8%)8 (11.4%)8 (6.2%) TECHNICAL 47 (20.9%)3 (2.1%)1 (0.8%)1 (1.4%)0 OTHER 45 (20.0%)31 (21.4%)11 (8.9%)9 (12.9%)29 (22.5%) ISHLT 2007 J Heart Lung Transplant 2007;26

36 HEART-LUNG TRANSPLANTATION Pediatric Recipients ISHLT 2007 J Heart Lung Transplant 2007;26

37 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January 1982 - June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26

38 AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART- LUNG RECIPIENTS (Transplants: January 1982 - June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26

39 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS By Year of Transplant Number of Transplants 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 pediatric heart- lung transplants worldwide has declined in recent years. J Heart Lung Transplant 2007;26

40 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS By Era of Transplant Percentage of Transplants ISHLT 2007 J Heart Lung Transplant 2007;26

41 NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS ISHLT 2007 NEED TO UPDATE J Heart Lung Transplant 2007;26

42 NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS Stratified by center volume ISHLT 2007 J Heart Lung Transplant 2007;26

43 DIAGNOSIS IN PEDIATRIC HEART –LUNG TRANSPLANT RECIPIENTS (Age: 11-17 Years) Other includes Bronchiectasis, Alpha-1, and OB (non-ReTX) ISHLT 2007 J Heart Lung Transplant 2007;26

44 PEDIATRIC HEART-LUNG TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT 2007 J Heart Lung Transplant 2007;26

45 PEDIATRIC HEART-LUNG TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT 2007 J Heart Lung Transplant 2007;26

46 PEDIATRIC HEART-LUNG TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT 2007 J Heart Lung Transplant 2007;26

47 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2005) ISHLT 2007 J Heart Lung Transplant 2007;26

48 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1982 - June 2005) ISHLT 2007 J Heart Lung Transplant 2007;26

49 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2005) Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26

50 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2005) Conditional on Survival to 1 Year Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26

51 PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2006) CAUSE OF DEATH 0-30 Days (N = 30) 31 Days - 1 Year (N= 28 ) >1 Year - 3 Years (N= 26 ) >3 Years - 5 Years (N = 19 ) >5 Years (N = 19) BRONCHIOLITIS 1 (3.6%)14 (53.8%)9 (47.4%)7 (36.8%) ACUTE REJECTION 2 (7.1%) MALIGNANCY, OTHER 1 (5.3%) INFECTION, NON-CMV 6 (20.0%)9 (32.1%)5 (19.2%)1 (5.3%)5 (26.3%) GRAFT FAILURE 12 (40.0%)2 (7.1%)5 (19.2%)5 (26.3%)3 (15.8%) CARDIOVASCULAR 2 (6.7%)3 (10.7%)1 (5.3%)2 (10.5%) TECHNICAL 4 (13.3%)1 (3.6%) ISHLT 2007 J Heart Lung Transplant 2007;26

52 PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: April 1994 - June 2006) CAUSE OF DEATH0-30 Days (N = 26) 31 Days - 1 Year (N = 22) >1 Year - 3 Years (N = 20) >3 Years - 5 Years (N = 17) >5 Years (N = 19) BRONCHIOLITIS1 (4.5%)11 (55.0%)8 (47.1%)7 (36.8%) ACUTE REJECTION1 (4.5%) MALIGNANCY, OTHER1 (5.9%) INFECTION, NON-CMV4 (15.4%)7 (31.8%)4 (20.0%)1 (5.9%)5 (26.3%) GRAFT FAILURE12 (46.2%)2 (9.1%)3 (15.0%)5 (29.4%)3 (15.8%) CARDIOVASCULAR2 (7.7%)2 (9.1%)2 (10.5%) TECHNICAL2 (7.7%)1 (4.5%) ISHLT 2007 J Heart Lung Transplant 2007;26


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