The Registry of the International Society for Heart and Lung Transplantation: Twenty- seventh official adult heart transplant report—2010  Josef Stehlik, MD, MPH, Leah B. Edwards, PhD, Anna Y. Kucheryavaya, MS, Paul Aurora, PhD, MRCP, Jason D. Christie, MD, MS, Richard Kirk, MA, FRCP, FRCPCH, Fabienne Dobbels, PhD, Axel O. Rahmel, MD, Marshall I. Hertz, MD  The Journal of Heart and Lung Transplantation  Volume 29, Issue 10, Pages 1089-1103 (October 2010) DOI: 10.1016/j.healun.2010.08.007 Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 1 Number of heart transplant procedures reported to the International Society for Heart and Lung Transplantation (ISHLT) Registry by year and stratified by geographic location. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 2 Etiology of heart disease resulting in adult heart transplantation stratified by geographic location. CAD, ischemic cardiomyopathy; myopathy, non-ischemic cardiomyopathy. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 3 Adult patients bridged to heart transplantation with mechanical circulatory support, including left ventricular assist device (LVAD), right ventricular assist device (RVAD), or biventricular support (LVAD plus RVAD, total artificial heart). The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 4 Changes in the age distribution of heart donors over time. Colored areas represent proportion of donors in the appropriate age group; corresponding y-axis is on the left. The red line represents mean donor age; corresponding y-axis is on the right. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 5 Age distribution of donor hearts in different geographic locations for adult heart transplants performed between January 2000 and June 2009. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 6 Allograft ischemic time distribution in different geographic locations for adult heart transplants performed between January 2000 and June 2009. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 7 Immunosuppressive induction therapy for adult heart transplants performed between January 2002 and June 2009. ALG, anti-lymphocyte globulin; ATG, anti-thymocyte globulin; IL-2R, interleukin-2 receptor. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 8 Maintenance immunosuppressive agents at the 1- and 5-year post-transplant follow-up. This includes adult heart recipients with follow-up between January 2007 and June 2009. MMF, mycophenolate mofetil; MPA, mycophenolic acid. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 9 Survival for adult and pediatric heart transplants performed between January 1982 and June 2008. Conditional median survival is the time to 50% survival for those recipients surviving the first post-transplantation year. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 10 Survival for adult heart transplants performed between January 1982 and June 2008, stratified by era of transplant. NA, not available. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 11 Survival for adult heart transplants performed between January 1982 and June 2008 and surviving to 1 year after transplant, stratified by era of transplant. NA, not available. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 12 Survival at 1 year after adult heart retransplant, stratified by era and time elapsed between original transplant and retransplant. The absolute number of retransplants performed is shown in vertical bars. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 13 Recipient age and relative risk of mortality at 1 year after transplant, for transplants performed January 2003—June 2008. The dashed lines show the 95% confidence intervals. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 14 Survival after adult heart transplants performed between January 2002 and June 2008 in patients bridged with left ventricular assist devices (LVAD). The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 15 Survival in patients bridged with ventricular assist devices (LVAD), for adult heart transplants performed between January 1999 and June 2008, conditional on survival to 6 months. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 16 Recipient age and relative risk of mortality at 5 years after transplant, for adult heart transplants performed between January 2001 and June 2004 and surviving to 1 year. The dashed lines show the 95% confidence intervals. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 17 Cumulative incidence of the leading causes of death for adult heart transplants performed between January 1992 and June 2008. CAV, coronary allograft vasculopathy; CMV, cytomegalovirus; lymph/PTLD, lymphoma or post-transplant lymphoproliferative disease. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 18 Relative incidence of leading causes of death by time since adult heart transplant, for deaths occurring January 1998—June 2009. CAV, coronary allograft vasculopathy; CMV, cytomegalovirus. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 19 Relative risk of cardiac allograft vasculopathy (CAV) development within 8 years of adult heart transplant, according to donor age, donor gender, and recipient gender. Includes transplants performed July 1997 to June 2001, conditional on survival to transplant discharge. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 20 Freedom from severe renal dysfunction, stratified by era, for transplants performed between April 1994 and June 2008. Severe renal dysfunction is defined as creatinine > 2.5 mg/dl, dialysis, or renal transplant. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 21 Functional status of adult heart recipients transplanted in the United States, expressed as the Karnofsky score. Follow-ups submitted from March 2005 to June 2009. The Journal of Heart and Lung Transplantation 2010 29, 1089-1103DOI: (10.1016/j.healun.2010.08.007) Copyright © 2010 International Society for Heart and Lung Transplantation Terms and Conditions