HEART TRANSPLANTATION Adult Recipients JHLT. 2013 Oct; 32(10): 951-964 2013.

HEART TRANSPLANTATION Adult Recipients JHLT. 2013 Oct; 32(10): 951-964 2013

Table of Contents  Donor and recipient characteristics: slides 3-24  Survival slides: slides 25-61  Immunosuppression: slides 62-80  Morbidity: slides 81-106  Multivariable analyses: slides 107-195  2013 focus theme: age: slides 196-237 JHLT. 2013 Oct; 32(10): 951-964 2013

 Diagnosis: slides 4-6  Recipient and donor characteristics: slides 7-24 Donor and Recipient Characteristics: JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Diagnosis JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Diagnosis: Cardiomyopathy vs. CAD by Location JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Diagnosis by Location (Transplants: January 2006 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Donor and Recipient Characteristics 1992-2000 (N = 37,146) 2001-2005 (N = 17,183) 2006-6/2012 (N = 22,318) p-value Recipient age (years) 54.0 (28.0 - 65.0)54.0 (26.0 - 66.0)54.0 (24.0 - 67.0)<0.0001 Donor age (years) 31.0 (15.0 - 54.0)33.0 (16.0 - 55.0)34.0 (17.0 - 56.0)<0.0001 Donor and recipient age difference (years) -19.0 (-44.0 - 7.0)-17.0 (-43.0 - 10.0)-16.0 (-43.0 - 12.0)<0.0001 Recipient weight (kg) 75.0 (51.0 - 102.0)77.6 (53.0 - 106.6)79.4 (53.1 - 110.0)<0.0001 Recipient height (cm) 173.0 (157.0 - 188.0)174.0 (157.5 - 188.0)175.0 (157.4 - 188.0)0.0042 Recipient BMI 22.7 (19.5 - 31.7)24.2 (19.6 - 33.1)24.4 (19.6 - 34.3)<0.0001 Donor weight (kg) 75.0 (52.0 - 103.3) 1 76.8 (55.0 - 108.8)79.4 (56.7 - 113.0)<0.0001 Donor height (cm) 175.0 (155.0 - 188.0) 1 175.3 (158.0 - 189.0)175.0 (158.0 - 190.0)<0.0001 Donor BMI 24.2 (18.8 - 32.9) 1 24.8 (19.5 - 34.4)25.5 (19.9 - 36.4)<0.0001 Continuous factors are expressed as median (5 th -95 th percentiles) 1 Based on 4/1994-2000 transplants. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Donor and Recipient Characteristics 1992-2000 (N = 37,146) 2001-2005 (N = 17,183) 2006-6/2012 (N = 22,318) p-value Recipient/donor gender (% male) 80.7%/ 68.4%77.9%/ 69.1%75.9%/ 69.2%<0.0001/ 0.1103 Male recipient/ female donor 21.3%18.5%16.7%<0.0001 Female recipient/ male donor 9.2%9.7%9.9%0.0055 Recipient/donor diabetes mellitus 13.1%*/ 1.6% 1 19.8%/ 2.0%25.3%/ 3.0%<0.0001/ <0.0001 Recipient prior history of dialysis 3.0% 1 4.3%4.2%<0.0001 Recipient amiodarone use (US only) 21.7% 1 29.0%30.5%<0.0001 Recipient/donor cigarette history -/ 38.0% 1 46.6% 2 / 29.1%46.4%/ 18.6%0.8536/ <0.0001 Recipient/donor hypertension 34.5% 1 / 10.8% 1 38.1%/ 11.4%45.3%/ 13.8%<0.0001/ <0.0001 Recipient prior cardiac surgery -39.1% 2 46.4%<0.0001 Recipient Peripheral Vascular Disease 3.8% 1 3.2%2.9%0.0002 Recipient previous malignancy 3.3% 1 4.5%6.6%<0.0001 Recipient COPD 3.2% 1 3.2%4.3%<0.0001 Ischemic time (hours) 2.9 (1.3 - 4.8)3.1 (1.5 - 5.0)3.3 (1.6 - 5.1)<0.0001 Continuous factors are expressed as median (5 th -95 th percentiles) 1 Based on 4/1994-2000 transplants. 2 Based on 7/2004-2005 transplants. (Cont’d) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Donor and Recipient Characteristics 1992-2000 (N = 37,146) 2001-2005 (N = 17,183) 2006-6/2012 (N = 22,318) p-value Most recent PRA > 10% 1 Overall 7.7%8.9% 2 13.8% 3 <0.0001 Class I --14.4% 4 - Class II --9.6% 4 - Creatinine at time of transplant (mg/dL) 1.2 (0.7 - 2.5)1.2 (0.7 - 2.4)1.2 (0.7 - 2.3)<0.0001 Pulmonary vascular resistance (Wood units) 2.2 (0.4 - 6.1) 5 2.0 (0.3 - 5.6)2.1 (0.3 - 5.5)<0.0001 HLA Mismatches 4.3%4.4%3.8% 0-2 40.2%40.1%38.4% 0.0003 3-4 55.5% 57.8% 5-6 7.7%8.9%13.8% Continuous factors are expressed as median (5 th -95 th percentiles) 2 Based on US 2001-6/2004 transplants and non US 2001 - 2005 transplants. 3 Based on non US transplants. 4 Based on US transplants. 5 Based on 4/1994-2000 transplants. 1 PRA was collected as a single percentage outside of US. Until mid-2004 PRA was collected in US as a single percentage. After this date, PRA was collected separately for Class I and Class II. (Cont’d) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Donor and Recipient Characteristics 1992-2000 (N = 37,146) 2001-2005 (N = 17,183) 2006-6/2012 (N = 22,318) p-value Diagnosis Cardiomyopathy 46.2%48.2%54.0% <0.0001 Coronary artery disease 45.8%42.7%36.8% Valvular 3.9%3.5%2.8% Retransplant 1.9%2.2%2.5% Congenital 1.8%2.7%2.9% Other causes 0.4%0.6%0.9% Donor cause of death Head trauma 45.9%54.6%45.8% <0.0001 Stroke 29.0%32.9%24.4% Other 25.0%12.5%29.8% (Cont’d) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Donor and Recipient Characteristics 1992-2000 (N = 37,146) 2001-2005 (N = 17,183) 2006-6/2012 (N = 22,318) p-value Pre-operative support (multiple items may be reported) Hospitalized at time of transplant 60.8%47.9%44.3%<0.0001 On IV inotropes 55.7% 1 47.2%42.4%<0.0001 LVAD 12.1% 2 17.0%28.5%<0.0001 IABP 6.4%6.7%6.1%0.1650 RVAD -5.0% 3 3.7%0.0055 Ventilator 3.3%3.2%2.7%0.0092 TAH 0.1% 2 0.1%1.0%<0.0001 ECMO 0.3% 4 0.5%1.1%<0.0001 1 Based on 4/1994-2000 transplants. 2 Based on 11/1999-2000 transplants. 3 Based on 2005 transplants. 4 Based on 5/1995-2000 transplants. (Cont’d) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Recipient Gender By Location (Transplants: January 2006 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Donor Gender By Location (Transplants: January 2006 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants PRA Distribution (Transplants: January 2006 – June 2012) If Class I and Class II values were reported separately, the higher of the two values was used. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants % of Patients Bridged with Mechanical Circulatory Support* (Transplants: January 2000 – December 2011) * LVAD, RVAD, TAH. ECMO is excluded. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants % of Patients Bridged with Mechanical Circulatory Support* by Year and Device Type * LVAD, RVAD, TAH. ECMO is excluded. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Number and % of Combined Organ Transplants Reported By Year and Type of Transplant JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Recipient BMI Distribution By Location (Transplants: January 2006 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Recipient BMI Distribution By Diagnosis (Transplants: January 2006 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Recipient Diabetes Mellitus Distribution By Location (Transplants: January 2006 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Recipient Diabetes Mellitus Distribution By Diagnosis (Transplants: January 2006 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Recipient Cigarette History By Location (Transplants: January 2006 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Recipient Cigarette and COPD History By Diagnosis (Transplants: January 2006 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Ischemic time Distribution By Location (Transplants: January 2006 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Survival Analyses:  by era: slides 26-27 and 37-41  by gender: slides 28-31  by diagnosis: slides 32-41  by PVR: slides 42-45  by BMI: slide 46  by comorbidities: slides 47-49  by VAD usage: slides 50-53  by re-transplant: slide 54  by employment status at 1 year post transplant: slide 55  by age: see slides 210-217 in the age theme section  by immunosuppression: see slides 66, 72 and 79 in the immunosuppression section  Cause of death: slides 56-61 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Era (Transplants: January 1982 – June 2011) All pair-wise comparisons were significant at p < 0.0001 except 2002-2005 vs. 2006-6/2011 (p = 0.9749) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Era Conditional on Survival to 1 Year (Transplants: January 1982 – June 2011) All pair-wise comparisons were significant at p < 0.001 except 1992-2001 vs. 2006-6/2011 (p=0.9440) and 2002- 2005 vs. 2006-6/2011 (p=0.0569) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Recipient Gender (Transplants: January 1982 – June 2011) p < 0.0001 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Recipient Gender Conditional on Survival to 1 Year (Transplants: January 1982 – June 2011) p < 0.0001 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Donor/Recipient Gender (Transplants: January 1982 – June 2011) All pair-wise comparisons with male/female were significant at p < 0.0001. No other pair-wise comparisons were significant at p < 0.05 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Donor/Recipient Gender Conditional on Survival to 1 Year (Transplants: January 1982 – June 2011) All pair-wise comparisons were significant at p < 0.05 except male/male vs. female/male and female/male vs. female/female JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Diagnosis (Transplants: January 1982 – June 2011) All pair-wise comparisons were significant at p < 0.01 except cardiomyopathy vs. congenital (p=0.9113). Median survival (years): Cardiomyopathy= 11.6; CAD=9.4; Congenital=14.4; Retransplant=6.3; Valvular=10.9 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Diagnosis Conditional on Survival to 1 Year (Transplants: January 1982 – June 2011) All pair-wise comparisons were significant at p < 0.0001 except cardiomyopathy vs. valvular (p = 0.9665) and CAD vs. retransplant (p = 0.0659) Median survival (years): Cardiomyopathy=14.2; CAD=11.9; Congenital=21.2; Retransplant=10.8; Valvular=14.6 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival Within 1 Year by Diagnosis (Transplants: January 2006 – June 2011) All pair-wise comparisons were significant at p < 0.05 except cardiomyopathy vs. CAD, congenital vs. retransplant, congenital vs. valvular, retransplant vs. valvular JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Diagnosis (Transplants: January 2003 – June 2011) All pair-wise comparisons with cardiomyopathy are significant at p < 0.02. No other pair-wise comparisons were significant at p < 0.05. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Diagnosis Conditional on Survival to 1 Year (Transplants: January 2003 – June 2011) No pair-wise comparisons are significant at p < 0.05 except cardiomyopathy vs. CAD, CAD vs. congenital and congenital vs. retransplant JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Era (Transplants: January 1982 – June 2011) Diagnosis: Cardiomyopath y All comparisons were significant at p < 0.0001 except 2002-2005 vs. 2006-6/2011 (p=0.9689) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Era (Transplants: January 1982 – June 2011) Diagnosis: Coronary Artery Disease JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Era (Transplants: January 1982 – June 2011) Diagnosis: Congenital No pair-wise comparisons were significant at p < 0.05 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Era (Transplants: January 1982 – June 2011) Diagnosis: Retransplant JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Era (Transplants: January 1982 – June 2011) Diagnosis: Valvular No pair-wise comparisons were significant at p < 0.05 except 1982-1991 vs. 1992-2001 (p = 0.0197) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by PVR (Transplants: January 2003 – June 2011) 1-<3 vs. 3-<5: p = 0.0006 No other pair-wise comparisons were significant at p < 0.05 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Donor/Recipient Weight Ratio (Transplants: January 2003 – June 2011) For recipients with PVR: 1–<3 wood units No pair-wise comparisons were significant at p < 0.05 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Donor/Recipient Weight Ratio (Transplants: January 2003 – June 2011) For recipients with PVR: 3–<5 wood units No pair-wise comparisons were significant at p < 0.05 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Donor/Recipient Weight Ratio (Transplants: January 2003 – June 2011) For recipients with PVR: 5+ wood units No pair-wise comparisons were significant at p < 0.05 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by BMI Group (Transplants: January 2006 – June 2011) No pair-wise comparisons were significant at p < 0.05 except 18.5<25 vs. 25-<30 (p < 0.0001) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Recipient Diabetes Mellitus (Transplants: January 2003 – June 2011) p < 0.0001 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Recipient Cigarette History (Transplants: July 2004 – June 2011) p = 0.2024 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Recipient COPD History (Transplants: January 2003 – June 2011) p = 0.7302 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by VAD usage (Transplants: April 1994 – June 2011) Pulsatile vs. Continuous: p=0.0127 Pulsatile vs. No LVAD/No Inotropes: p = 0.0032 No other pair-wise comparisons were significant at p < 0.05 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by VAD usage (Transplants: January 2003 – June 2011) Pulsatile vs. No LVAD/No Inotropes: p = 0.0077 Pulsatile vs. No LVAD/Inotropes: p = 0.0061 Continuous vs. No LVAD/Inotropes: p = 0.0229 No other pair-wise comparisons were significant at p < 0.05 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by VAD usage Conditional on Survival to 6 Months (Transplants: January 1999 – June 2011) Continuous vs. No LVAD/No Inotropes: p = 0.0297 No other pair-wise comparisons were significant at p < 0.05 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by VAD usage (Transplants: January 2005 – June 2011) All pair-wise comparisons with LVAD+RVAD Pulsatile were significant at p < 0.05 except LVAD Pulsatile vs. LVAD+RVAD Pulsatile No other pair-wise comparisons were significant at p < 0.05. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Re-Transplants 1 Year Survival Time between previous and current transplant Comparison of survival for interval ≤ 12 months vs. > 12 months: p < 0.0001 Comparison of survival for interval ≤ 12 months vs. > 12 months for 1/2003-6/2011: p < 0.0001 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Employment Status at 1 Year Conditional on Survival to 1 Year (1 Year Follow-ups: January 2000 – June 2011) p < 0.0001 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Cause of Death (Deaths: January 1994 – June 2012) CAUSE OF DEATH 0-30 Days (N = 5,297) 31 Days – 1 Year (N = 4,547) >1 Year – 3 Years (N = 3,307) >3 Years – 5 Years (N = 2,890) >5 Years – 10 Years (N = 7,315) >10 Years – 15 Years (N = 4,774) >15 Years (N = 3,436) Cardiac Allograft Vasculopathy 77 (1.5%)172 (3.8%)413 (12.5%)406 (14.0%)1,020 (13.9%)675 (14.1%)299 (12.3%) Acute Rejection251 (4.7%)442 (9.7%)334 (10.1%)140 (4.8%)139 (1.9%)47 (1.0%)17 (0.7%) Lymphoma3 (0.1%)56 (1.2%)78 (2.4%)98 (3.4%)275 (3.8%)149 (3.1%)69 (2.8%) Malignancy, Other4 (0.1%)111 (2.4%)408 (12.3%)563 (19.5%)1,542 (21.1%)1,002 (21.0%)459 (18.8%) CMV3 (0.1%)51 (1.1%)15 (0.5%)6 (0.2%)6 (0.1%)3 (0.1%)0 Infection, Non-CMV690 (13.0%)1,402 (30.8%)412 (12.5%)283 (9.8%)781 (10.7%)497 (10.4%)277 (11.4%) Graft Failure2,063 (38.9%)780 (17.2%)845 (25.6%)641 (22.2%)1,323 (18.1%)796 (16.7%)405 (16.6%) Technical382 (7.2%)72 (1.6%)23 (0.7%)25 (0.9%)90 (1.2%)61 (1.3%)31 (1.3%) Other304 (5.7%)319 (7.0%)268 (8.1%)227 (7.9%)577 (7.9%)326 (6.8%)197 (8.1%) Multiple Organ Failure938 (17.7%)688 (15.1%)198 (6.0%)179 (6.2%)505 (6.9%)385 (8.1%)230 (9.4%) Renal Failure29 (0.5%)45 (1.0%)48 (1.5%)91 (3.1%)414 (5.7%)396 (8.3%)221 (9.1%) Pulmonary160 (3.0%)176 (3.9%)134 (4.1%)130 (4.5%)313 (4.3%)195 (4.1%)108 (4.4%) Cerebrovascular393 (7.4%)233 (5.1%)131 (4.0%)101 (3.5%)330 (4.5%)242 (5.1%)123 (5.0%) Total N of Deaths5,9855,1473,9553,5289,0256,1393,186 Percentages represent % of deaths in the respective time period. Total number of deaths includes deaths with unknown causes. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Cause of Death from Leading Causes by Time since Transplant and Era (Deaths: January 1994 – June 2012) Deaths 1994 – 2001Deaths 2002 – 6/2012 Since only leading causes of death are shown, sum of percentages for each time period is less than 100% JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Relative Incidence of Leading Causes of Death (Deaths: January 1994 – June 2012) Since only leading causes of death are shown, sum of percentages for each time period is less than 100% JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Cumulative Incidence of Leading Causes of Death (Transplants: January 1994 – June 2011) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Relative Incidence of Leading Causes of Death (Deaths: January 2006 – June 2012) Since only leading causes of death are shown, sum of percentages for each time period is less than 100% JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Cumulative Incidence of Leading Causes of Death (Transplants: January 2005 – June 2011) JHLT. 2013 Oct; 32(10): 951-964 2013

 Induction: slides 63-66 and 75-76  Maintenance: slides 67-72 and 77-78  Rejection: slides 73-80 Immunosuppression: JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Induction Immunosuppression (Transplants: January 2005 – June 2012) Analysis is limited to patients who were alive at the time of the discharge JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Induction Immunosuppression by Location (Transplants: January 2005 – June 2012) Analysis is limited to patients who were alive at the time of the discharge JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Induction Immunosuppression (Transplants: 2002, 2007 and 1/2012–6/2012) Analysis is limited to patients who were alive at the time of the discharge JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Induction Type Conditional on Survival to 14 Days (Transplants: January 2001 – June 2011) No induction vs. IL-2R: p = 0.0031 Polyclonal vs. IL-2R: p = 0.0303 No other pair-wise comparisons were significant at p < 0.05 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January 2008 – June 2012) Analysis is limited to patients who were alive at the time of the follow-up JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Maintenance Immunosuppression at Time of 1 Year Follow-up by Year Analysis is limited to patients who were alive at the time of the follow-up NOTE: Different patients are analyzed in each time frame JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Maintenance Immunosuppression Drug Combinations at Time of Follow-up (Follow-ups: January 2006 – June 2012) Analysis is limited to patients who were alive at the time of the follow-up NOTE: Different patients are analyzed in Year 1 and Year 5 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Maintenance Immunosuppression Drug Combinations at Time of Follow-up (Follow-ups: January 2001 – June 2012) For the Same Patients at Year 1 and 5 Analysis is limited to patients who were alive at the time of the follow-up JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Maintenance Immunosuppression Drug Combinations at Time of Follow-up by Location (Follow-ups: January 2006 – June 2012) Analysis is limited to patients who were alive at the time of the follow-up NOTE: Different patients are analyzed in Year 1 and Year 5 Year 1Year 5 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Maintenance Immunosuppression at 1 year (Transplants: January 2001 – June 2011) Conditional on Survival to 1 Year p = 0.1388 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants % of Recipients Experiencing Treated Rejection Between Transplant Discharge and 1-Year Follow-Up by Year Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants % of Recipients Experiencing Any Rejection Between Transplant Discharge and 1-Year Follow-Up by Year Any rejection = Recipient was reported to (1) have at least one acute rejection episode; or (2) have been hospitalized for rejection. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants % of Recipients Experiencing Treated Rejection between Transplant Discharge and 1-Year Follow-Up by Type of Induction (Follow-ups: January 2005 – June 2012) Analysis is limited to patients who were alive at the time of the follow-up Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants % of Recipients Experiencing Any Rejection between Transplant Discharge and 1-Year Follow-Up by Type of Induction (Follow-ups: January 2005 – June 2012) Analysis is limited to patients who were alive at the time of the follow-up Any rejection = Recipient was reported to (1) have at least one acute rejection episode; or (2) have been hospitalized for rejection. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants % of Recipients Experiencing Treated Rejection between Transplant Discharge and 1-Year Follow-Up by Maintenance Immunosuppression (Follow-ups: January 2005 – June 2012) Analysis is limited to patients who were alive at the time of the follow-up Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants % of Recipients Experiencing Any Rejection between Transplant Discharge and 1-Year Follow-Up by Maintenance Immunosuppression (Follow-ups: January 2005 – June 2012) Analysis is limited to patients who were alive at the time of the follow-up Any rejection = Recipient was reported to (1) have at least one acute rejection episode; or (2) have been hospitalized for rejection. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Treatment for Rejection Within 1 st Year (1 Year Follow-ups: January 2005 – June 2011) Conditional on survival to 1 year All pair-wise comparisons were significant at p < 0.0001 except No rejection vs. Untreated rejection (p = 0.8528) Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection. No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom from Hospitalization for Rejection by Era (Transplants: April 1994 – June 2011) All pair-wise comparisons were statistically significant at p < 0.0001 JHLT. 2013 Oct; 32(10): 951-964 2013

 Functional status: slide 82  Employment: slides 83-84  Hospitalization: slide 85  CAV: slides 86-93  Renal dysfunction: slides 86-88 and 94-96  Malignancy: slides 97-106 Morbidity: JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Functional Status of Surviving Recipients by Karnofsky Score ( Follow-ups: January 2006 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Employment Status of Surviving Recipients (Follow-ups: January 2000 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Employment Status of Surviving Recipients Age at Follow-up: 25-60 Years (Follow-ups: January 2000 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: January 2000 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Cumulative Morbidity Rates in Survivors within 1, 5 and 10 Years Post-Transplant (Follow-ups: January 1995 – June 2012) Outcome Within 1 Year Total N with known response Within 5 Years Total N with known response Within 10 Years Total N with known response Hypertension*72.3%(N = 26,852)92.2%(N = 12,534)- Renal Dysfunction26.3%(N = 29,301)52.5%(N = 14,680)68.4%(N = 4,879) Abnormal Creatinine ≤ 2.5 mg/dl18.1% 33.3% 38.3% Creatinine > 2.5 mg/dl6.4% 15.1% 20.5% Chronic Dialysis1.5% 2.9% 6.0% Renal Transplant0.3% 1.2% 3.6% Hyperlipidemia*60.0%(N = 28,102)87.8%(N = 13,876)- Diabetes*25.7%(N = 29,289)38.1%(N = 14,470)- Cardiac Allograft Vasculopathy7.8%(N = 26,480)30.2%(N = 10,651)50.1%(N = 2,815) * Data are not available 10 years post transplant JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Cumulative Morbidity Rates in Survivors within 1, 5 and 10 Years Post-Transplant (Follow-ups: January 1995 – June 2002) For the Same Patients Outcome Within 1 Year Total N with known response Within 5 Years Total N with known response Within 10 Years Total N with known response Renal Dysfunction22.8%(N = 2,233)49.4%(N = 2,233)65.9%(N = 2,233) Abnormal Creatinine ≤ 2.5 mg/dl16.5% 34.6% 40.3% Creatinine > 2.5 mg/dl6.0% 13.0% 17.9% Chronic Dialysis0.1% 0.9% 4.3% Renal Transplant0.2% 0.9% 3.4% Cardiac Allograft Vasculopathy6.8%(N = 2,233)29.6%(N = 2,233)49.0%(N = 2,233) Only patients with known responses reported on every annual follow-up through the 10-year follow- up were included. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Cumulative Morbidity Rates in Survivors within 1 and 5 Years Post-Transplant (Follow-ups: January 2001 – June 2007) For the Same Patients OutcomeWithin 1 Year Total N with known response Within 5 Years Total N with known response Hypertension73.2%(N = 3,439)88.5%(N = 3,439) Renal Dysfunction26.4%(N = 3,439)50.1%(N = 3,439) Abnormal Creatinine ≤ 2.5 mg/dl22.2% 37.7% Creatinine > 2.5 mg/dl3.5% 9.5% Chronic Dialysis0.5% 1.9% Renal Transplant0.3% 1.0% Hyperlipidemia72.6%(N = 3,439)89.5%(N = 3,439) Diabetes29.7%(N = 3,439)40.6%(N = 3,439) Cardiac Allograft Vasculopathy5.7%(N = 3,439)27.0%(N = 3,439) Only patients with known responses reported on every annual follow-up through the 5-year follow- up were included. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom from Cardiac Allograft Vasculopathy by Era (Transplants: April 1994 – June 2011) p < 0.0001 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom from Cardiac Allograft Vasculopathy by Ischemia Time (Transplants: April 1994 – June 2011) p = 0.2240 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom from Cardiac Allograft Vasculopathy by Gender (Transplants: April 1994 – June 2011) p < 0.0001 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Survival After Report of CAV Within 3 Years of Transplant and Survival In Patients Without CAV* (Transplants: April 1994 – June 2011) p < 0.0001 * Patient survival for those without CAV within 3 years after transplant was conditioned on survival to median time of CAV development (512 days). Median time to CAV development is based on patients who developed CAV within 3 years of transplant. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Survival After Report of CAV Within 3 Years of Transplant and Survival In Patients Without CAV* by Era (Transplants: April 1994 – June 2011) 4/1994-2002: No CAV vs. CAV p < 0.0001 2003-6/2011: No CAV vs. CAV p < 0.0001 No CAV: 4/1994-2002 vs. 2003-6/2011 p = 0.9999 CAV: 4/1994-2002 vs. 2003-6/2011 p = 0.0028 * Patient survival for those without CAV within 3 years after transplant was conditioned on survival to median time of CAV development (512 days). Median time to CAV development is based on patients who developed CAV within 3 years of transplant. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom from Severe Renal Dysfunction by Era* (Transplants: April 1994 – June 2011) p < 0.0001 * Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom from Severe Renal Dysfunction* Stratified by Ischemia Time (Transplants: April 1994 – June 2011) p = 0.6270 * Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Renal Dysfunction Within 1 st Year Conditional on Survival to 1 Year (1 year follow-ups: April 1994 – June 2011) p < 0.0001 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Post Transplant Malignancy (Follow-ups: April 1994 – June 2012) Cumulative Morbidity Rates in Survivors Malignancy/Type 1-Year Survivors 5-Year Survivors 10-Year Survivors No Malignancy 30,892 (97.4%)13,813 (85.9%)4,073 (72.1%) Malignancy (all types combined) 827 (2.6%)2,264 (14.1%)1,578 (27.9%) Malignancy Type* Skin 409 (1.3%)1,493 (9.3%)1,119 (19.8%) Lymphoma 170 (0.5%)174 (1.1%)102 (1.8%) Other 190 (0.6%)667 (4.1%)496 (8.8%) Type Not Reported 58 (0.2%)46 (0.3%)18 (0.3%) * Recipients may have experienced more than one type of malignancy so sum of individual malignancy types may be greater than total number with malignancy. “Other” includes: prostate (11, 35, 21), adenocarcinoma (7, 7, 4), lung (6, 4, 1), bladder (4, 5, 4), Kaposi's sarcoma (0, 3, 1), breast (2, 7, 2), cervical (2, 5, 2), colon (2, 4, 2), and renal (2, 7, 2). Numbers in parentheses are those reported within 1 year, 5 years and 10 years, respectively. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom from Malignancy by Type (Follow-ups: April 1994 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom from Malignancy by Maintenance Immunosuppression Combinations at Discharge Conditional on Survival to 14 days (Transplants: January 2001 – June 2011) p = 0.0027 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom from Malignancy by Era (Transplants: April 1994 – June 2011) p < 0.0001 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom from Malignancy by Era and Gender (Transplants: April 1994 – June 2011) All pair-wise comparisons were significant at p < 0.05 except Female 4/1994-202 vs. Female 2003-06/2011 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom from Skin Malignancy by Era (Transplants: April 1994 – June 2011) p < 0.0001 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom from Lymphoma by Era (Transplants: April 1994 – June 2011) p < 0.0001 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom from Other* Malignancy by Era (Transplants: April 1994 – June 2011) p < 0.0001 * Other malignancy includes all types of malignancy except skin and lymphoma JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Survival After Report of Malignancy Within 3 Years of Transplant and Survival In Patients Without Malignancy* (Transplants: April 1994 – June 2011) p < 0.0001 * Patient survival for those without malignancy within 3 years after transplant was conditioned on survival to median time of malignancy development (545 days). Median time to malignancy development is based on patients who developed malignancy within 3 years of transplant. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Survival After Report of Skin Malignancy or Lymphoma Within 3 Years of Transplant and Survival In Patients Without Malignancy * (Transplants: April 1994 – June 2011) All pair-wise comparisons were significant at p < 0.0001 * Patient survival for those without malignancy within 3 years after transplant was conditioned on survival to median time of malignancy development (545 days). Median time to malignancy development is based on patients who developed malignancy within 3 years of transplant. JHLT. 2013 Oct; 32(10): 951-964 2013

 1 year mortality: slides 108-122  5 year mortality: slides 123-135  5 year mortality conditional on survival to 1 year: slides 136- 145  10 year mortality: slides 146-155  15 year mortality: slides 156-165  20 year mortality: slides 166-170  Developing severe renal dysfunction within 1 year: slides 171-175  Developing severe renal dysfunction within 5 years: slides 176-182  Developing non-skin malignancy within 8 years: slides 183- 189  Developing CAV within 5 years: slides 190-195 Multivariable Analyses: JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors For 1 Year Mortality VARIABLE NHazard Ratio P-value95% Confidence Interval Temporary circulatory support*1632.80<.00012.04-3.83 Total artificial heart982.260.00041.43-3.55 Diagnosis: Congenital vs. cardiomyopathy2662.21<.00011.62-3.02 Recipient history of dialysis2741.78<.00011.39-2.28 Recipient on ventilator at time of transplant 3021.660.00011.29-2.15 Chronic pulsatile flow device9521.56<.00011.27-1.92 Chronic continuous flow device18461.50<.00011.24-1.81 Previous transplant3111.460.01251.08-1.96 N = 10,473 * Temporary circulatory support includes ECMO and temporary pulsatile flow devices. JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors For 1 Year Mortality (continued) VARIABLE NHazard Ratio P-value95% Confidence Interval Male recipient/female donor vs. male recipient/male donor 15691.320.00091.12-1.55 Recipient with infection requiring IV drug therapy within 2 weeks prior to transplant 10631.280.00431.08-1.52 Previous transfusion22681.250.00341.08-1.45 Not hospitalized just prior to transplant57420.870.03720.77-0.99 Ventricular remodeling18350.800.01070.67-0.95 Transplant year: 2006 vs. 2010/201119131.400.00021.17-1.68 Transplant year: 2007 vs. 2010/201118821.320.00311.10-1.58 Transplant year: 2008 vs. 2010/201117991.260.01461.05-1.51 N = 10,473 * Temporary circulatory support includes ECMO and temporary pulsatile flow devices. JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors For 1 Year Mortality Continuous Factors (see figures) Recipient ageIschemia time Recipient heightRecipient pre-transplant bilirubin BMI ratioRecipient pre-transplant creatinine Donor agePRA Class II Transplant center volumeRecipient pulmonary artery systolic pressure JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Age p < 0.0001 (N = 10,473) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS Risk Factors For 1, 5, 10 and 20 Year Mortality Recipient Age JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors For 1 Year Mortality with 95% Confidence Limits Donor Age p < 0.0001 (N = 10,473) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS Risk Factors For 1, 5, 10 and 20 Year Mortality Donor Age JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Height p = 0.0016 (N = 10,473) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors For 1 Year Mortality with 95% Confidence Limits Donor BMI/Recipient BMI ratio p = 0.0029 (N = 10,473) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors For 1 Year Mortality with 95% Confidence Limits Ischemia Time p < 0.0001 (N = 10,473) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors For 1 Year Mortality with 95% Confidence Limits Center Volume p = 0.0002 (N = 10,473) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Bilirubin p < 0.0001 (N = 10,473) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Creatinine p < 0.0001 (N = 10,473) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors For 1 Year Mortality with 95% Confidence Limits PRA Class II (%) p = 0.0188 (N = 10,473) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors For 1 Year Mortality with 95% Confidence Limits Pulmonary Artery Systolic Pressure p = 0.0001 (N = 10,473) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality VARIABLE NHazard Ratio P-value95% Confidence Interval Temporary circulatory support*1602.23<.00011.72-2.90 Total artificial heart371.770.04421.01-3.08 Continuous flow device or VAD with type unknown 3491.710.00651.16-2.52 Recipient history of dialysis3261.70<.00011.43-2.03 Diagnosis: Congenital vs. cardiomyopathy2841.460.00121.16-1.83 Recipient on ventilator at time of transplant 3011.370.00341.11-1.68 Female recipient with prior pregnancy/ male donor vs. male recipient/male donor 7521.330.00171.11-1.58 PRA > 10%6851.250.0031.08-1.45 N = 10,332 * Temporary circulatory support includes ECMO and temporary pulsatile flow devices. JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality (continued) VARIABLE NHazard Ratio P-value95% Confidence Interval Recipient Hep B core (+)4041.220.03881.01-1.47 Recipient with infection requiring IV drug therapy within 2 weeks prior to transplant 11171.220.00181.08-1.37 Number of HLA mismatches at A locus (per locus) 0 A MM (N=677) 1 A MM (N=4910) 2 A MM (N=4745) 1.180.01961.03-1.35 Donor cause of death: anoxia vs. head trauma 9561.170.02431.02-1.33 Recipient history of diabetes22751.150.00491.04-1.26 Chronic pulsatile flow device17301.150.02131.02-1.29 Diagnosis: coronary artery disease vs. cardiomyopathy 45871.120.02061.02-1.23 Ventricular remodeling9280.850.04150.73-0.99 N = 10,332 JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality Continuous Factors (see figures) Recipient ageIschemia time Recipient heightRecipient pre-transplant bilirubin Recipient BMIRecipient pre-transplant creatinine Donor ageRecipient PVR Donor BMIRecipient diastolic PA pressure Transplant center volume JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient Height p = 0.0022 (N = 10,332) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient and Donor BMI Recipient BMI: p < 0.0001 Donor BMI: p = 0.012 (N = 10,332) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Bilirubin p = 0.0029 (N = 10,332) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality with 95% Confidence Limits Pulmonary Vascular Resistance p = 0.0002 (N = 10,332) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient Pulmonary Artery Diastolic Pressure p = 0.0112 (N = 10,332) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality Conditional on Survival to 1 Year VARIABLE NHazard Ratio P-value95% Confidence Interval No Cyclo, TAC or Sirolimus at 1 year1362.02<.00011.44-2.84 No AZA, MMF/MPA or Sirolimus at 1 year4151.75<.00011.47-2.08 Rejection between discharge and 1 st year21531.65<.00011.46-1.86 Polyclonal agent and IL-2R antagonist used for induction 1131.570.02071.07-2.29 Recipient history of dialysis prior to transplant 2201.440.01681.07-1.95 Recipient Hep B core (+) and Hep B surface antigen not positive 3171.400.01151.08-1.83 Dialysis prior to discharge5311.350.0061.09-1.67 Female recipient with prior pregnancy/ male donor vs. male recipient/male donor 6351.320.031.03-1.68 N = 8,873 JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality Conditional on Survival to 1 Year (continued) VARIABLE NHazard Ratio P-value95% Confidence Interval Donor cause of death: anoxia vs. head trauma 8111.260.01341.05-1.52 Treated for infection prior to discharge18791.240.0021.08-1.42 IL-2R antagonist used for induction (no polyclonal agent) 22541.190.01041.04-1.36 Recipient history of diabetes19301.170.02681.02-1.34 2 mismatches at the A locus40611.160.01111.03-1.30 Defibrillator prior to transplant52210.890.04890.78 Ventricular remodeling prior to transplant 7990.790.04670.63 AZA vs. MMF/MPA4420.670.01740.490.93 N = 8,873 JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality Conditional on Survival to 1 Year Continuous Factors (see figures) Recipient ageRecipient pre-transplant creatinine Recipient heightDonor/recipient height ratio Recipient BMIRecipient TPG Donor age JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year Recipient Age p < 0.0001 (N = 8,873) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year Recipient Height p = 0.0134 (N = 8,873) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year Recipient BMI p = 0.048 (N = 8,873) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year Donor Age p = 0.0087 (N = 8,873) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year Donor Height/Recipient Height Ratio P = 0.0300 (N = 8,873) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year Recipient Pre-Transplant Creatinine P = 0.0496 (N = 8,873) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors For 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year Transpulmonary Pressure Gradient p = 0.0025 (N = 8,873) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (1997-6/2002) Risk Factors For 10 Year Mortality VARIABLE NHazard Ratio P-value95% Confidence Interval ECMO322.180.00031.43-3.33 Ventilator at time of transplant3531.65<.00011.42-1.91 Recipient on dialysis2591.45<.00011.23-1.72 Repeat transplant2831.42<.00011.19-1.68 Recipient history of diabetes20371.31<.00011.22-1.41 PRA > 20%6101.30<.00011.16-1.46 Female recipient with prior pregnancy16451.29<.00011.18-1.41 Diagnosis: congenital vs. CM2351.280.02331.03-1.58 Transplant year: 1997 vs. 2001/200220641.20<.00011.09-1.31 N = 11,531 JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (1997-6/2002) Risk Factors For 10 Year Mortality (continued) VARIABLE NHazard Ratio P-value95% Confidence Interval Year of transplant: 1998 vs. 2001/200221631.190.00011.09-1.30 Prior cerebrovascular event6271.170.00911.04-1.31 Diagnosis: coronary artery disease vs. CM56991.16<.00011.09-1.24 Year of transplant: 1999 vs. 2001/200220341.140.00271.05-1.25 Year of transplant: 2000 vs. 2001/200221321.120.00891.03-1.22 Donor history of hypertension13141.110.01891.02-1.22 On VAD at time of transplant18111.110.01151.02-1.20 Not hospitalized at transplant46660.930.02690.88-0.99 0-4 HLA mismatches (A + B + DR) vs. 5-639630.87<.00010.82-0.93 N = 11,531 JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (1997-6/2002) Risk Factors For 10 Year Mortality Continuous Factors (see figures) Recipient ageIschemia time Recipient weightRecipient pre-transplant bilirubin Donor ageRecipient pre-transplant creatinine Transplant center volume JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (1997-6/2002) Risk Factors For 10 Year Mortality with 95% Confidence Limits Recipient Weight p = 0.0137 (N = 11,531) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (1997-6/2002) Risk Factors For 10 Year Mortality with 95% Confidence Limits Center Volume p < 0.0001 (N = 11,531) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (1997-6/2002) Risk Factors For 10 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Bilirubin p = 0.0004 (N = 11,531) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (1992-6/1997) Risk Factors For 15 Year Mortality VARIABLE NHazard Ratio P-value95% Confidence Interval Retransplant2681.67<.00011.44-1.94 Diagnosis: not cardiomyopathy, coronary artery disease, congenital heart disease, valvular heart disease or retransplant vs. CM 731.660.00061.25-2.22 On ventilator3381.33<.00011.16-1.52 Recipient Hep B Core (+)2651.270.00241.09-1.47 PR A> 20%5341.210.00061.08-1.34 Transplant year: 1992 vs. 1996/199718811.17<.00011.08-1.27 Female recipient/male donor vs. male recipient/male donor 12181.160.0041.05-1.28 N = 11,055 JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (1992-6/1997) Risk Factors For 15 Year Mortality (continued) VARIABLE NHazard Ratio P-value95% Confidence Interval On VAD at transplant7771.160.00391.05-1.27 Diagnosis: Coronary artery disease vs. cardiomyopathy 55061.15<.00011.09-1.22 Transplant year: 1993 vs. 1996/199720171.150.00051.06-1.24 Male recipient/female donor vs. male recipient/male donor 22601.140.0021.05-1.24 2 mismatches at DR locus67741.11<.00011.06-1.17 Transplant year: 1994 vs. 1996/199720721.080.04171.00-1.16 N = 11,055 JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (1992-6/1997) Risk Factors For 15 Year Mortality Continuous Factors (see figures) Recipient ageTransplant center volume Difference in recipient and donor ageIschemia time Recipient BMIRecipient pre-transplant creatinine Donor height JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (1992-6/1997) Risk Factors For 15 Year Mortality with 95% Confidence Limits Donor Age – Recipient Age p < 0.0001 (N = 11,055) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (1992-6/1997) Risk Factors For 15 Year Mortality with 95% Confidence Limits Recipient BMI p = 0.0002 (N = 11,055) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (1992-6/1997) Risk Factors For 15 Year Mortality with 95% Confidence Limits Donor Height p = 0.0461 (N = 11,055) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (1987-6/1992) Risk Factors For 20 Year Mortality VARIABLE NHazard Ratio P-value95% Confidence Interval Retransplant3342.27<.00012.02-2.56 Diagnosis: not cardiomyopathy, coronary artery disease, congenital heart disease, valvular heart disease or retransplant vs. cardiomopathy 11961.22<.00011.13-1.31 Transplant year: 1987 vs. 1991/199226481.20<.00011.13-1.26 Transplant year: 1988 vs. 1991/199231001.15<.00011.09-1.21 Diagnosis: Coronary artery disease vs. cardiomyopathy 84501.12<.00011.07-1.16 Transplant year: 1989 vs. 1991/199233081.110.00011.05-1.16 Female recipient vs. male recipient31060.940.01610.90-0.99 N = 18,951 JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (1987-6/1992) Risk Factors For 20 Year Mortality Continuous Factors (see figures) Recipient ageTransplant center volume Donor age JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (1987-6/1992) Risk Factors For 20 Year Mortality with 95% Confidence Limits Center Volume p < 0.0001 (N = 18,951) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors for Developing Severe Renal Dysfunction within 1 Year Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge VARIABLE NHazard Ratio P-value95% Confidence Interval Dialysis prior to discharge 4704.56<.00013.60-5.79 Female recipient/female donor vs. male recipient/male donor 11262.07<.00011.44-2.97 Infection requiring IV antibiotics within 2 weeks prior to transplant 8231.560.00161.18-2.06 Rejection prior to discharge 8081.480.00731.11-1.98 Cyclosporine vs. Tacrolimus at discharge 24871.470.00061.18-1.84 Post-transplant cardiac re-operation prior to discharge 7721.470.00361.13-1.90 Ventilatory support at transplant 5641.470.02621.05-2.06 Continuous chronic device 15911.440.00391.12-1.84 Male recipient/female donor vs. male recipient/male donor 12821.330.03841.02-1.74 Hospitalized (inc. ICU) at transplant 38851.250.02771.02-1.53 Diagnosis: Valvular disease vs. cardiomyopathy 2120.380.03350.16-0.93 N = 8,861 *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors for Developing Severe Renal Dysfunction within 1 Year Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge Continuous Factors (see figures) Recipient ageRecipient pre-transplant creatinine Recipient BSA *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors for Developing Severe Renal Dysfunction within 1 Year Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge Recipient Age p = 0.008 (N = 8,861) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors for Developing Severe Renal Dysfunction within 1 Year Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge Recipient BSA p = 0.0103 (N = 8,861) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2006-6/2011) Risk Factors for Developing Severe Renal Dysfunction within 1 Year Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge Recipient Pre-Transplant Creatinine p < 0.0001 (N = 8,861) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors for Developing Severe Renal Dysfunction within 5 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge VARIABLE NHazard Ratio P-value95% Confidence Interval Dialysis prior to discharge4312.55<.00012.12-3.06 Multiple induction agents reported vs. none 1471.780.00131.25-2.54 Transplant year: 2002 vs. 2005/200614671.61<.00011.35-1.93 Continuous chronic device2511.430.02631.04-1.97 Female recipient19211.390.00261.12-1.71 Transplant year: 2003 vs. 2006/200713991.380.00051.15-1.65 N = 8,182 *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors for Developing Severe Renal Dysfunction within 5 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge (continued) VARIABLE NHazard Ratio P-value95% Confidence Interval Pulsatile chronic device13051.36<.00011.17-1.58 Recipient history of diabetes18031.35<.00011.18-1.54 IL-2R antagonist used for induction21031.30.00031.13-1.49 Cyclosporine vs. Tacrolimus at discharge38951.250.00061.10-1.42 Rejection prior to discharge10471.240.0131.05-1.47 HLA mismatch (per mismatch)1.070.03451.00-1.13 N = 8,182 *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors for Developing Severe Renal Dysfunction within 5 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge Continuous Factors (see figures) Recipient ageRecipient pulmonary artery systolic pressure Recipient weightRecipient pre-transplant creatinine *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors for Developing Severe Renal Dysfunction within 5 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge Recipient Age p = 0.0077 (N = 8,182) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors for Developing Severe Renal Dysfunction within 5 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge Recipient Weight p = 0.0061 (N = 8,182) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors for Developing Severe Renal Dysfunction within 5 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge Recipient Pre-Transplant Creatinine p < 0.0001 (N = 8,182) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors for Developing Severe Renal Dysfunction within 5 Years Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge Recipient Pulmonary Artery Systolic Pressure p < 0.0001 (N = 8,182) *Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2000-6/2004) Risk Factors for Developing Non-Skin Malignancy within 8 Years Limited to Recipients without Malignancy Pre-Transplant Conditional on Survival to Transplant Discharge VARIABLE NHazard Ratio P-value95% Confidence Interval Multiple induction agents reported972.380.00151.40-4.07 Donor history of cancer841.950.02421.09-3.48 Female recipient/female donor vs. male recipient/male donor 6081.870.00181.26-2.78 Pacemaker prior to discharge1781.810.00741.17-2.80 Transplant year: 2000 vs. 2003/200411001.81<.00011.37-2.39 Transplant year: 2001 vs. 2003/200411421.490.0061.12-1.99 Implantable defibrillator prior to transplant21781.280.01941.04-1.57 N = 5,179 JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2000-6/2004) Risk Factors for Developing Non-Skin Malignancy within 8 Years Limited to Recipients without Malignancy Pre-Transplant Conditional on Survival to Transplant Discharge Continuous Factors (see figures) Recipient ageRecipient PVR Ischemia timeRecipient PA systolic Transplant center volume JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2000-6/2004) Risk Factors for Developing Non-Skin Malignancy within 8 Years Limited to Recipients without Malignancy Pre-Transplant Conditional on Survival to Transplant Discharge Recipient Age p < 0.0001 (N = 5,179) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2000-6/2004) Risk Factors for Developing Non-Skin Malignancy within 8 Years Limited to Recipients without Malignancy Pre-Transplant Conditional on Survival to Transplant Discharge Ischemia Time p = 0.0409 (N = 5,179) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2000-6/2004) Risk Factors for Developing Non-Skin Malignancy within 8 Years Limited to Recipients without Malignancy Pre-Transplant Conditional on Survival to Transplant Discharge Center Volume p = 0.0007 (N = 5,179) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2000-6/2004) Risk Factors for Developing Non-Skin Malignancy within 8 Years Limited to Recipients without Malignancy Pre-Transplant Conditional on Survival to Transplant Discharge Pulmonary Vascular Resistance p = 0.0109 (N = 5,179) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2000-6/2004) Risk Factors for Developing Non-Skin Malignancy within 8 Years Limited to Recipients without Malignancy Pre-Transplant Conditional on Survival to Transplant Discharge Pre-Transplant PA Mean Pressure p = 0.036 (N = 5,179) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors for Developing CAV within 5 Years Conditional on Survival to Transplant Discharge VARIABLE NHazard Ratio P-value95% Confidence Interval OTK3 used for induction2391.90<.00011.52-2.39 AZA vs. MMF/MPA at discharge3441.360.00381.11-1.68 Pacemaker prior to discharge2661.320.02011.04-1.67 Rejection prior to discharge9871.290.00041.12-1.48 Cyclosporine vs. Tacrolimus at discharge37741.29<.00011.16-1.42 Donor history of hypertension8771.190.01291.04-1.37 N = 7,778 JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors for Developing CAV within 5 Years Conditional on Survival to Transplant Discharge (continued) VARIABLE NHazard Ratio P-value95% Confidence Interval Female recipient/female donor with prior pregnancy vs. male recipient/male donor 5810.800.02040.66-0.97 Male recipient/female donor vs. male recipient/male donor 12360.800.0020.69-0.92 Recipient history of malignancy3540.750.02270.59-0.96 Female recipient without prior pregnancy/ female donor vs. male recipient/male donor 3270.600.00030.46-0.79 Diagnosis: Congenital vs. cardiomyopathy2010.520.00150.35-0.78 N = 7,778 JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors for Developing CAV within 5 Years Conditional on Survival to Transplant Discharge Continuous Factors (see figures) Recipient BMIDonor age Donor/recipient BSA ratio JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors for Developing CAV within 5 Years Conditional on Survival to Transplant Discharge Recipient BMI p = 0.0026 (N = 7,778) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors for Developing CAV within 5 Years Conditional on Survival to Transplant Discharge Donor BSA/Recipient BSA p = 0.0108 (N = 7,778) JHLT. 2013 Oct; 32(10): 951-964 2013

ADULT HEART TRANSPLANTS (2002-6/2007) Risk Factors for Developing CAV within 5 Years Conditional on Survival to Transplant Discharge Donor Age p < 0.0001 (N = 7,778) JHLT. 2013 Oct; 32(10): 951-964 2013

2013 Focus Theme: Age  Age distribution: slides 197-201 and 208  Recipient characteristics by age: slides 202-207  Age mismatch: slides 208-209  Survival by age: slides 210-217  Age and immunosuppression: slides 218-219  Age and complications: slides 220-229  Age and cause of death: slides 230-237 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Donor and Recipient Age (Transplants: January 2006 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Diagnosis by Age Group (Transplants: January 2006 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Recipient Age Distribution by Location (Transplants: January 2006 – June 2012) Mean/median recipient age: Europe = 50.2/53.0 North America = 52.2/55.0 Other = 47.2/50.0 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Donor Age Distribution by Location (Transplants: January 2006 – June 2012) Mean/median donor age: Europe = 40.4/43.0 North America = 31.7/29.0 Other = 31.7/29.0 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Donor and Recipient Characteristics by Recipient Age Group (Transplants: January 2006 – June 2012) 18-39 (N = 4,053) 40-59 (N = 11,632) 60-69 (N = 6,287) 70+ (N = 346) p- value Donor age (years) 30.0 (16.0 - 53.0)35.0 (17.0 - 56.0)36.0 (17.0 - 58.0)36.0 (18.0 - 59.0)<0.0001 Donor and recipient age difference (years) 2.0 (-18.0 - 25.0)-17.0 (-37.0 - 7.0)-28.0 (-47.0 - -5.0)-35.0 (-53.0 - -13.0)<0.0001 Recipient BMI 22.6 (18.2 - 34.3)24.6 (20.1 - 34.6)25.0 (20.3 - 33.7)24.9 (20.1 - 32.0)<0.0001 Donor BMI 24.8 (19.4 - 35.9)25.7 (20.0 - 36.5)25.7 (20.1 - 36.6)26.3 (21.0 - 37.9)<0.0001 Recipient/donor gender (% male) 65.5%/ 67.1%76.5%/ 69.7%81.0%/ 69.5%89.9%/ 68.1% <0.0001/ 0.0153 Male recipient/ female donor 13.7%16.4%18.5%25.5%<0.0001 Female recipient/ male donor 15.4%9.7%7.1%3.8%<0.0001 Recipient prior cardiac surgery 38.7%44.6%52.9%53.8%<0.0001 Continuous factors are expressed as median (5 th -95 th percentiles) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Donor and Recipient Characteristics by Recipient Age Group (Transplants: January 2006 – June 2012) 18-39 (N = 4,053) 40-59 (N = 11,632) 60-69 (N = 6,287) 70+ (N = 346) p- value Recipient previous malignancy 4.3%5.3%9.6%11.0%<0.0001 Creatinine at time of transplant 1.0 (0.6 - 2.1)1.2 (0.7 - 2.4)1.3 (0.8 - 2.3)1.3 (0.8 - 2.1)<0.0001 Pulmonary vascular resistance (Wood units) 2.0 (0.2 - 5.6)2.1 (0.3 - 5.4) 2.1 (0.3 - 5.8)0.0505 Diagnosis Cardiomyopathy 74.3%54.8%40.5%36.7% < 0.0001 Coronary artery disease 7.3%37.4%53.4%57.1% Valvular 1.7%3.0%3.3%2.6% Retransplant 5.3%2.0%1.6%3.2% Congenital 9.9%1.9%0.5%0.0% Other causes 1.4%0.8%0.6%0.3% Continuous factors are expressed as median (5 th -95 th percentiles) (Cont’d) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Donor and Recipient Characteristics by Recipient Age Group (Transplants: January 2006 – June 2012) 18-39 (N = 4,053) 40-59 (N = 11,632) 60-69 (N = 6,287) 70+ (N = 346) p- value Pre-operative support (multiple items may be reported) Hospitalized at time of transplant 51.3%44.2%41.1%39.7%<0.0001 On IV inotropes 45.6%41.6%42.1%39.9%0.0083 LVAD 29.7%29.6%26.6%18.0%<0.0001 IABP 6.5% 5.1%7.5%0.0214 RVAD 5.7%4.0%2.3%1.3%<0.0001 Ventilator 3.5%2.7%2.3%3.7%0.0258 TAH 1.1% 0.6%0.0%0.0140 ECMO 2.1%1.1%0.7%0.0%<0.0001 (Cont’d) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Recipient Age Distribution by Gender (Transplants: January 2006 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants % of Patients Bridged with Mechanical Circulatory Support* by Year, Age Group and Device Type * LVAD, RVAD, TAH. ECMO is excluded. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Number of Combined Organ Transplants Reported by Year, Age and Type of Transplant JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Donor and Recipient Age (Transplants: January 2006 – June 2012) R 2 = 0.01, p < 0.0001 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Donor and Recipient Age Difference (Transplants: January 2006 – June 2012) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Age Group (Transplants: January 1982 – June 2011) All pair-wise comparisons were significant at p < 0.01 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Age Group (Transplants: January 2006 – June 2011) No pair-wise comparisons were significant at p < 0.05 except 18-39 vs. 60-69: p = 0.0199 40-59 vs. 60-69: p= 0.0013 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Age Group (Transplants: January 1982 – June 2011) No pair-wise comparisons with 75+ were significant at p < 0.05. All other pair-wise comparisons were significant at p < 0.05 except 60-64 vs. 65-69 and 65-69 vs. 70-74 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Donor Age Group (Transplants: January 1982 – June 2011) All pair-wise comparisons were significant at p < 0.05 except 0-10 vs. 11-39 and 0-10 vs. 40-59 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Donor and Recipient Age Difference Recipient Age = 18-39 years (Transplants: January 1982 – June 2011) All pair-wise comparisons with 0+ were significant at p < 0.05. No other pair-wise comparisons were significant at p < 0.05. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Donor and Recipient Age Difference Recipient Age = 40-59 years (Transplants: January 1982 – June 2011) All pair-wise comparisons were significant at p < 0.05 except <-30 vs. -30 - <-20 and -10 - <0 vs. 0+ JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Donor and Recipient Age Difference Recipient Age = 60-69 years (Transplants: January 1982 – June 2011) All pair-wise comparisons were significant at p < 0.05 except -30 - <-20 vs. -20 - <-10, -20 - <-10 vs. 0+ and -10 - <0 vs. 0+ JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Kaplan-Meier Survival by Donor and Recipient Age Difference Recipient Age = 70+ years (Transplants: January 1982 – June 2011) No pair-wise comparisons were significant at p < 0.05 except <-10 vs. -30 - <-20 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Induction Immunosuppression by Age Group (Transplants: January 2005 – June 2012) Analysis is limited to patients who were alive at the time of the discharge JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Maintenance Immunosuppression at Time of 1 Year Follow-up by Age Group (Follow-ups: January 2006 – June 2012) Analysis is limited to patients who were alive at the time of the follow-up JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants % of Recipients Experiencing Treated Rejection between Transplant Discharge and 1-Year Follow-Up by Type of Induction (Follow-ups: January 2005 – June 2012) Analysis is limited to patients who were alive at the time of the follow-up Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants % of Recipients Experiencing Any Rejection between Transplant Discharge and 1-Year Follow-Up by Type of Induction (Follow-ups: January 2005 – June 2012) Analysis is limited to patients who were alive at the time of the follow-up Any rejection = Recipient was reported to (1) have at least one acute rejection episode; or (2) have been hospitalized for rejection. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants % of Recipients Experiencing Treated Rejection between Transplant Discharge and 1-Year Follow-Up by Maintenance Immunosuppression (Follow-ups: January 2005 – June 2012) Analysis is limited to patients who were alive at the time of the follow-up Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants % of Recipients Experiencing Any Rejection between Transplant Discharge and 1-Year Follow-Up by Maintenance Immunosuppression (Follow-ups: January 2005 – June 2012) Analysis is limited to patients who were alive at the time of the follow-up Any rejection = Recipient was reported to (1) have at least one acute rejection episode; or (2) have been hospitalized for rejection. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom from Cardiac Allograft Vasculopathy by Age Group (Transplants: April 1994 – June 2011) No pair-wise comparisons were significant at p < 0.05 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom From Severe Renal Dysfunction* by Age Group (Transplants: April 1994 – June 2011) All pair-wise comparisons were significant at p < 0.05 except 40-59 vs. 70+ and 60-69 vs. 70+ * Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom from Malignancy by Age Group (Follow-ups: April 1994 – June 2012) All pair-wise comparisons were significant at p < 0.0001 except 60-69 vs. 70+ (p=0.9554) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom from Skin Malignancy by Age Group (Follow-ups: April 1994 – June 2012) All pair-wise comparisons were significant at p < 0.0001 except 60-69 vs. 70+ (p=0.9999) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom from Lymphoma by Age Group (Follow-ups: April 1994 – June 2012) No pair-wise comparisons were significant at p < 0.05 except 18-39 vs. 60-69: p = 0.0188 40-49 vs. 60-69: p = 0.0227 JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Freedom From Non Skin Malignancy by Age Group (Follow-ups: April 1994 – June 2012) All pair-wise comparisons were significant at p < 0.05 except 40-49 vs. 70+ and 60-69 vs. 70+ JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Cause of Death for Age = 18-39 (Deaths: January 1994 – June 2012) CAUSE OF DEATH 0-30 Days (N = 749) 31 Days – 1 Year (N = 639) >1 Year – 3 Years (N = 614) >3 Years – 5 Years (N = 448) >5 Years – 10 Years (N = 867) >10 Years – 15 Years (N = 555) >15 Years (N = 372) Cardiac Allograft Vasculopathy 9 (1.2%)36 (5.6%)86 (14.0%)83 (18.5%)195 (22.5%)141 (25.4%)73 (19.6%) Acute Rejection52 (6.9%)129 (20.2%)130 (21.2%)55 (12.3%)37 (4.3%)13 (2.3%)8 (2.2%) Lymphoma08 (1.3%)6 (1.0%)12 (2.7%)35 (4.0%)23 (4.1%)12 (3.2%) Malignancy, Other09 (1.4%)8 (1.3%)18 (4.0%)65 (7.5%)53 (9.5%)42 (11.3%) CMV07 (1.1%)1 (0.2%) 000 Infection, Non-CMV69 (9.2%)120 (18.8%)45 (7.3%)31 (6.9%)52 (6.0%)43 (7.7%)30 (8.1%) Graft Failure302 (40.3%)153 (23.9%)199 (32.4%)163 (36.4%)271 (31.3%)151 (27.2%)95 (25.5%) Technical63 (8.4%)14 (2.2%)3 (0.5%)2 (0.4%)16 (1.8%)7 (1.3%)1 (0.3%) Other49 (6.5%)62 (9.7%)68 (11.1%)35 (7.8%)77 (8.9%)38 (6.8%)31 (8.3%) Multiple Organ Failure111 (14.8%)58 (9.1%)31 (5.0%)23 (5.1%)48 (5.5%)39 (7.0%)30 (8.1%) Renal Failure2 (0.3%)4 (0.6%)2 (0.3%)8 (1.8%)24 (2.8%)19 (3.4%)26 (7.0%) Pulmonary26 (3.5%)18 (2.8%)24 (3.9%)10 (2.2%)21 (2.4%)10 (1.8%)12 (3.2%) Cerebrovascular66 (8.8%)21 (3.3%)11 (1.8%)7 (1.6%)26 (3.0%)18 (3.2%)12 (3.2%) Total N of Deaths8497177305601,089698500 Percentages represent % of deaths in the respective time period. Total number of deaths includes deaths with unknown causes. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Cause of Death for Age = 40-59 (Deaths: January 1994 – June 2012) CAUSE OF DEATH 0-30 Days (N = 2,995) 31 Days – 1 Year (N = 2,458) >1 Year – 3 Years (N = 1,816) >3 Years – 5 Years (N =1,682) >5 Years – 10 Years (N = 4,587) >10 Years – 15 Years (N = 3,182) >15 Years (N = 1,700) Cardiac Allograft Vasculopathy 48 (1.6%)106 (4.3%)248 (13.7%)259 (15.4%)671 (14.6%)453 (14.2%)202 (11.9%) Acute Rejection147 (4.9%)233 (9.5%)163 (9.0%)65 (3.9%)76 (1.7%)29 (0.9%)9 (0.5%) Lymphoma2 (0.1%)32 (1.3%)47 (2.6%)56 (3.3%)176 (3.8%)108 (3.4%)50 (2.9%) Malignancy, Other4 (0.1%)59 (2.4%)224 (12.3%)331 (19.7%)998 (21.8%)689 (21.7%)346 (20.4%) CMV1 (0.0%)31 (1.3%)9 (0.5%)4 (0.2%)3 (0.1%)2 (0.1%)0 Infection, Non-CMV382 (12.8%)757 (30.8%)221 (12.2%)165 (9.8%)489 (10.7%)332 (10.4%)211 (12.4%) Graft Failure1,160 (38.7%)412 (16.8%)492 (27.1%)357 (21.2%)794 (17.3%)524 (16.5%)255 (15.0%) Technical221 (7.4%)33 (1.3%)15 (0.8%)17 (1.0%)57 (1.2%)47 (1.5%)26 (1.5%) Other183 (6.1%)182 (7.4%)140 (7.7%)128 (7.6%)370 (8.1%)213 (6.7%)143 (8.4%) Multiple Organ Failure538 (18.0%)376 (15.3%)102 (5.6%)105 (6.2%)292 (6.4%)247 (7.8%)155 (9.1%) Renal Failure17 (0.6%)23 (0.9%)28 (1.5%)57 (3.4%)268 (5.8%)256 (8.0%)137 (8.1%) Pulmonary83 (2.8%)83 (3.4%)56 (3.1%)81 (4.8%)194 (4.2%)135 (4.2%)80 (4.7%) Cerebrovascular209 (7.0%)131 (5.3%)71 (3.9%)57 (3.4%)199 (4.3%)147 (4.6%)86 (5.1%) Total N of Deaths3,4052,7852,1882,0465,6474,0932,200 Percentages represent % of deaths in the respective time period. Total number of deaths includes deaths with unknown causes. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Cause of Death for Age = 60-69 (Deaths: January 1994 – June 2012) CAUSE OF DEATH 0-30 Days (N = 1,501) 31 Days – 1 Year (N = 1,385) >1 Year – 3 Years (N = 838) >3 Years – 5 Years (N = 734) >5 Years – 10 Years (N = 1,803) >10 Years – 15 Years (N = 1,014) >15 Years (N = 362) Cardiac Allograft Vasculopathy 19 (1.3%)28 (2.0%)74 (8.8%)62 (8.4%)153 (8.5%)80 (7.9%)24 (6.6%) Acute Rejection51 (3.4%)77 (5.6%)37 (4.4%)20 (2.7%)26 (1.4%)5 (0.5%)0 Lymphoma1 (0.1%)16 (1.2%)25 (3.0%)30 (4.1%)64 (3.5%)18 (1.8%)7 (1.9%) Malignancy, Other041 (3.0%)170 (20.3%)205 (27.9%)463 (25.7%)254 (25.0%)71 (19.6%) CMV2 (0.1%)13 (0.9%)5 (0.6%)1 (0.1%)3 (0.2%)1 (0.1%)0 Infection, Non-CMV230 (15.3%)503 (36.3%)139 (16.6%)83 (11.3%)235 (13.0%)120 (11.8%)36 (9.9%) Graft Failure583 (38.8%)203 (14.7%)151 (18.0%)116 (15.8%)249 (13.8%)117 (11.5%)54 (14.9%) Technical93 (6.2%)25 (1.8%)5 (0.6%)6 (0.8%)13 (0.7%)5 (0.5%)4 (1.1%) Other70 (4.7%)73 (5.3%)56 (6.7%)63 (8.6%)124 (6.9%)74 (7.3%)23 (6.4%) Multiple Organ Failure278 (18.5%)239 (17.3%)59 (7.0%)49 (6.7%)161 (8.9%)99 (9.8%)44 (12.2%) Renal Failure10 (0.7%)16 (1.2%)18 (2.1%)26 (3.5%)115 (6.4%)116 (11.4%)58 (16.0%) Pulmonary49 (3.3%)72 (5.2%)52 (6.2%)38 (5.2%)96 (5.3%)49 (4.8%)16 (4.4%) Cerebrovascular115 (7.7%)79 (5.7%)47 (5.6%)35 (4.8%)101 (5.6%)76 (7.5%)25 (6.9%) Total N of Deaths1,6721,5749938922,2171,321484 Percentages represent % of deaths in the respective time period. Total number of deaths includes deaths with unknown causes. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Cause of Death for Age = 70+ (Deaths: January 1994 – June 2012) CAUSE OF DEATH 0-30 Days (N = 52) 31 Days – 1 Year (N = 65) >1 Year – 3 Years (N = 39) >3 Years – 5 Years (N = 26) >5 Years – 10 Years (N = 58) >10 Years (N = 25) Cardiac Allograft Vasculopathy 1 (1.9%)2 (3.1%)5 (12.8%)2 (7.7%)1 (1.7%)1 (4.0%) Acute Rejection1 (1.9%)3 (4.6%)4 (10.3%)000 Malignancy, non Lymphoma 02 (3.1%)6 (15.4%)9 (34.6%)16 (27.6%)6 (24.0%) Infection, Non-CMV9 (17.3%)22 (33.8%)7 (17.9%)4 (15.4%)5 (8.6%)2 (8.0%) Graft Failure18 (34.6%)12 (18.5%)3 (7.7%)5 (19.2%)9 (15.5%)5 (20.0%) Technical5 (9.6%)0004 (6.9%)2 (8.0%) Other2 (3.8%)2 (3.1%)4 (10.3%)1 (3.8%)6 (10.3%)1 (4.0%) Multiple Organ Failure11 (21.2%)15 (23.1%)6 (15.4%)2 (7.7%)4 (6.9%)1 (4.0%) Renal Failure02 (3.1%)007 (12.1%)5 (20.0%) Pulmonary2 (3.8%)3 (4.6%)2 (5.1%)1 (3.8%)2 (3.4%)1 (4.0%) Cerebrovascular3 (5.8%)2 (3.1%)2 (5.1%)2 (7.7%)4 (6.9%)1 (4.0%) Total N of Deaths597144307229 Percentages represent % of deaths in the respective time period. Total number of deaths includes deaths with unknown causes. JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Cumulative Incidence of Leading Causes of Death Age Group = 18-39 Years (Transplants: January 2005 – June 2011) JHLT. 2013 Oct; 32(10): 951-964 2013

Adult Heart Transplants Cumulative Incidence of Leading Causes of Death Age Group = 70+ Years (Transplants: January 2005 – June 2011) JHLT. 2013 Oct; 32(10): 951-964 2013

HEART TRANSPLANTATION Adult Recipients JHLT. 2013 Oct; 32(10): 951-964 2013.

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HEART TRANSPLANTATION Adult Recipients JHLT. 2013 Oct; 32(10): 951-964 2013.

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Presentation on theme: "HEART TRANSPLANTATION Adult Recipients JHLT. 2013 Oct; 32(10): 951-964 2013."— Presentation transcript:

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