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HEART-LUNG TRANSPLANTATION Overall ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095.

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Presentation on theme: "HEART-LUNG TRANSPLANTATION Overall ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095."— Presentation transcript:

1 HEART-LUNG TRANSPLANTATION Overall ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

2 NUMBER OF HEART-LUNG TRANSPLANTS REPORTED BY YEAR ISHLT 2012 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. 2012 Oct; 31(10): 1045-1095

3 AVERAGE CENTER VOLUME Heart-Lung Transplants: January 1, 2000 - June 30, 2011 ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

4 DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME Heart-Lung Transplants: January 1, 2000 - June 30, 2011 ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

5 HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival for All Ages (Transplants: January 1982 - June 2010) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

6 HEART-LUNG TRANSPLANTATION Adult Recipients ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

7 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2011) ISHLT 2012 “Other” includes cancer, LAM, OB, bronchiectasis J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

8 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2011) ISHLT 2012 Diagnosis N (%) Congenital Heart Disease1,134 (35.7%) Idiopathic Pulmonary Arterial Hypertension877 (27.6%) Cystic Fibrosis448 (14.1%) Acquired Heart Disease160 (5.0%) COPD/Emphysema133 (4.2%) Idiopathic Pulmonary Fibrosis115 (3.6%) Alpha-161 (1.9%) Sarcoidosis52 (1.6%) Re-Transplant: Not Obliterative Bronchiolitis36 (1.1%) Re-Transplant: Obliterative Bronchiolitis22 (0.7%) Bronchiectasis30 (0.9%) Obliterative Bronchiolitis (not Re-Transplant)24 (0.8%) Other88 (2.8%) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

9 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA (Transplants: January 1982 - June 2011) ISHLT 2012 “Other” includes OB (non-ReTX) and Bronchiectasis J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

10 ADULT HEART-LUNG TRANSPLANTS Major Indications By Year (%) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

11 ADULT HEART-LUNG TRANSPLANTS Major Indications By Year (Number) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

12 ADULT HEART-LUNG TRANSPLANTS Age Distribution By Location (Transplants: January 2000 - June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

13 ADULT HEART-LUNG TRANSPLANTS Diagnosis Distribution By Location (Transplants: January 2000 - June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

14 ADULT HEART-LUNG TRANSPLANTS Donor Age Distribution By Location (Transplants: January 2000 - June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

15 ADULT HEART-LUNG TRANSPLANTS Kaplan-Meier Survival (Transplants: January 1982 - June 2010) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

16 ADULT HEART-LUNG TRANSPLANTS Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2010) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

17 ADULT HEART-LUNG TRANSPLANTS Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 - June 2010) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

18 ADULT HEART-LUNG TRANSPLANTS Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 - June 2010) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

19 ADULT HEART-LUNG RECIPIENTS Cross-Sectional Analysis Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

20 ADULT HEART-LUNG RECIPIENTS Functional Status of Surviving Recipients US Recipients Only (Follow-ups: March 2005 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

21 ADULT HEART-LUNG RECIPIENTS Employment Status of Surviving Recipients (Follow-ups: April 1994 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

22 ADULT HEART-LUNG RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April 1994 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

23 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2001 – June 2011) ISHLT 2012 Analysis is limited to patients who were alive at the time of the discharge J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

24 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2000 – December 2010) ISHLT 2012 Analysis is limited to patients who were alive at the time of the discharge J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

25 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2000 – December 2010) ISHLT 2012 Analysis is limited to patients who were alive at the time of the discharge J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

26 ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January 2001 – June 2011) ISHLT 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 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

27 ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up (Follow-ups: January 2001 – June 2011) ISHLT 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 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

28 POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Morbidity Rates in Survivors within 1 Year Post-Transplant (Follow-ups: April 1994 - June 2011) ISHLT 2012 Outcome Within 1 Year Total number with known response Hypertension59.0%(N = 405) Renal Dysfunction18.7%(N = 439) Abnormal Creatinine < 2.5 mg/dl11.8% Creatinine > 2.5 mg/dl3.0% Chronic Dialysis3.6% Renal Transplant0.2% Hyperlipidemia26.7%(N = 427) Diabetes19.0%(N = 441) Coronary Artery Vasculopathy3.2%(N = 348) Bronchiolitis Obliterans Syndrome8.4%(N = 415) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

29 POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Morbidity Rates in Survivors within 5 Years Post-Transplant (Follow-ups: April 1994 - June 2011) ISHLT 2012 Outcome Within 5 Years Total number with known response Hypertension88.1%(N = 143) Renal Dysfunction46.2%(N = 169) Abnormal Creatinine < 2.5 mg/dl32.5% Creatinine > 2.5 mg/dl10.1% Chronic Dialysis2.4% Renal Transplant1.2% Hyperlipidemia69.3%(N = 150) Diabetes28.1%(N = 167) Coronary Artery Vasculopathy8.0%(N = 87) Bronchiolitis Obliterans Syndrome26.4%(N = 140) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

30 Freedom from Coronary Artery Vasculopathy and Bronchiolitis Obliterans Syndrome For Adult Heart-Lung Recipients (Follow-ups: April 1994 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

31 Freedom from Coronary Artery Vasculopathy For Adult Heart-Lung Recipients By Diagnosis Type (Follow-ups: April 1994 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

32 Freedom from Bronchiolitis Obliterans Syndrome For Adult Heart-Lung Recipients By Diagnosis Type (Follow-ups: April 1994 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

33 Freedom from Severe Renal Dysfunction* For Adult Heart-Lung Recipients (Follow-ups: April 1994 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

34 MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTS Cumulative Morbidity Rates in Survivors (Follow-ups: April 1994 – June 2011) ISHLT 2012 Malignancy/Type 1-Year Survivors 5-Year Survivors 10-Year Survivors No Malignancy 421 (94.2%)155 (88.6%)50 (83.3%) Malignancy (all types combined) 26 (5.8%)20 (11.4%)10 (16.7%) Malignancy Type* Skin 279 Lymphoma 1860 Other 452 Type Not Reported 220 * 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. 2012 Oct; 31(10): 1045-1095

35 Freedom from Malignancy For Adult Heart-Lung Recipients (Follow-ups: April 1994 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

36 ADULT HEART-LUNG TRANSPLANT RECIPIENTS Cause of Death (Deaths: January 1992 – June 2011) ISHLT 2012 CAUSE OF DEATH 0-30 Days (N = 385) 31 Days - 1 Year (N = 311) >1 Year - 3 Years (N = 250) >3 Years - 5 Years (N = 160) >5 Years (N = 393) BRONCHIOLITIS011 (3.5%)62 (24.8%)36 (22.5%)80 (20.4%) ACUTE REJECTION7 (1.8%)9 (2.9%)5 (2.0%)2 (1.3%)3 (0.8%) LYMPHOMA011 (3.5%)15 (6.0%)8 (5.0%)11 (2.8%) MALIGNANCY, OTHER1 (0.3%)4 (1.3%)10 (4.0%)5 (3.1%)23 (5.9%) CMV02 (0.6%)01 (0.6%)1 (0.3%) INFECTION, NON-CMV68 (17.7%)109 (35.0%)74 (29.6%)44 (27.5%)97 (24.7%) GRAFT FAILURE109 (28.3%)67 (21.5%)34 (13.6%)26 (16.3%)54 (13.7%) CARDIOVASCULAR28 (7.3%)12 (3.9%)19 (7.6%)14 (8.8%)34 (8.7%) TECHNICAL86 (22.3%)10 (3.2%)3 (1.2%)3 (1.9%)3 (0.8%) OTHER86 (22.3%)76 (24.4%)28 (11.2%)21 (13.1%)87 (22.1%) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

37 ADULT HEART-LUNG TRANSPLANT RECIPIENTS Relative Incidence of Leading Causes of Death (Deaths: January 1992 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

38 HEART-LUNG TRANSPLANTATION Pediatric Recipients ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

39 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January 1982 - June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

40 AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART-LUNG RECIPIENTS Transplants: January 1982 - June 2011 ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

41 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS BY YEAR ISHLT 2012 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 pediatric heart-lung transplants worldwide has declined in recent years. J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

42 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS BY ERA OF TRANSPLANT ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

43 NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

44 NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS Stratified by center volume ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

45 DIAGNOSIS IN PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS (Transplants: 1986-2010) ISHLT 2012 NOTE: Unknown diagnoses were excluded from this tabulation. “Other” includes Bronchiectasis, Alpha-1, and OB (non-ReTX) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

46 PEDIATRIC HEART-LUNG TRANSPLANTS Age Distribution By Location ( Transplants: January 2000 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

47 PEDIATRIC HEART-LUNG TRANSPLANTS Diagnosis Distribution By Location ( Transplants: January 2000 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

48 PEDIATRIC HEART-LUNG TRANSPLANTS Donor Age Distribution By Location ( Transplants: January 2000 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

49 PEDIATRIC HEART-LUNG TRANSPLANTS Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 - June 2010) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

50 PEDIATRIC HEART-LUNG TRANSPLANTS Kaplan-Meier Survival (Transplants: January 1982 - June 2010) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

51 PEDIATRIC HEART-LUNG TRANSPLANTS Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2010) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

52 PEDIATRIC HEART-LUNG TRANSPLANTS Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2010) Conditional on Survival to 1 Year ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

53 PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS Cause of Death (Deaths: January 1992 – June 2011) ISHLT 2012 CAUSE OF DEATH 0-30 Days (N = 48) 31 Days - 1 Year (N = 59) >1 Year - 3 Years (N = 55) >3 Years - 5 Years (N = 39) >5 Years (N = 62) BRONCHIOLITIS03 (5.1%)27 (49.1%)16 (41.0%)18 (29.0%) ACUTE REJECTION02 (3.4%)1 (1.8%)2 (5.1%)1 (1.6%) LYMPHOMA03 (5.1%)2 (3.6%)1 (2.6%)2 (3.2%) MALIGNANCY, OTHER01 (1.7%)01 (2.6%)0 CMV02 (3.4%)000 INFECTION, NON-CMV8 (16.7%)18 (30.5%)4 (7.3%)1 (2.6%)16 (25.8%) GRAFT FAILURE18 (37.5%)12 (20.3%)13 (23.6%)12 (30.8%)12 (19.4%) CARDIOVASCULAR3 (6.3%)3 (5.1%)2 (3.6%)2 (5.1%)3 (4.8%) TECHNICAL11 (22.9%)03 (5.5%)2 (5.1%)0 OTHER8 (16.7%)15 (25.4%)3 (5.5%)2 (5.1%)10 (16.1%) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

54 PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS Cause of Death (Deaths: April 1994 – June 2011) ISHLT 2012 CAUSE OF DEATH 0-30 Days (N = 39) 31 Days - 1 Year (N = 44) >1 Year - 3 Years (N = 44) >3 Years - 5 Years (N = 34) >5 Years (N = 62) BRONCHIOLITIS01 (2.3%)21 (47.7%)14 (41.2%)18 (29.0%) ACUTE REJECTION01 (2.3%) 2 (5.9%)1 (1.6%) LYMPHOMA03 (6.8%)2 (4.5%)1 (2.9%)2 (3.2%) MALIGNANCY, OTHER01 (2.3%)01 (2.9%)0 CMV01 (2.3%)000 INFECTION, NON-CMV4 (10.3%)15 (34.1%)4 (9.1%)1 (2.9%)16 (25.8%) GRAFT FAILURE15 (38.5%)9 (20.5%)10 (22.7%)11 (32.4%)12 (19.4%) CARDIOVASCULAR3 (7.7%)2 (4.5%) 1 (2.9%)3 (4.8%) TECHNICAL9 (23.1%)01 (2.3%)1 (2.9%)0 OTHER8 (20.5%)11 (25.0%)3 (6.8%)2 (5.9%)10 (16.1%) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

55 PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS Relative Incidence of Leading Causes of Death (Deaths: April 1994 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095


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