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HEART-LUNG TRANSPLANTATION Overall 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141.

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Presentation on theme: "HEART-LUNG TRANSPLANTATION Overall 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141."— Presentation transcript:

1 HEART-LUNG TRANSPLANTATION Overall 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

2 NUMBER OF HEART-LUNG TRANSPLANTS REPORTED BY YEAR 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

3 AVERAGE CENTER VOLUME Heart-Lung Transplants: January 1, 1998 - June 30, 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

4 DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY CENTER VOLUME Heart-Lung Transplants: January 1, 1998 - June 30, 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

5 DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME Lung Transplants: January 1, 1998 - June 30, 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

6 HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival for All Ages (Transplants: January 1990 - June 2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

7 HEART-LUNG TRANSPLANTATION Adult Recipients 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

8 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (January 1982 - June 2009) Other includes cancer, LAM, OB, sarcoidosis, bronchiectasis 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

9 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2009) Diagnosis N (%) Congenital Heart Disease972 (36.5%) Idiopathic Pulmonary Arterial Hypertension731 (27.5%) Cystic Fibrosis374 (14.0%) Acquired Heart Disease133 ( 5.0%) COPD/Emphysema101 ( 3.8%) Idiopathic Pulmonary Fibrosis82 ( 3.1%) Alpha-153 ( 2.0%) Sarcoidosis37 ( 1.4%) Re-Transplant: Not Obliterative Bronchiolitis32 ( 1.2%) Re-Transplant: Obliterative Bronchiolitis24 ( 0.9%) Bronchiectasis21 ( 0.8%) Obliterative Bronchiolitis (not Re-Transplant)14 ( 0.5%) Other88 ( 3.3%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

10 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA (Transplants: January 1982 - June 2009) Other includes OB (non-ReTX), Bronchiectasis, Sarcoidosis 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

11 ADULT HEART-LUNG TRANSPLANTATION Major Indications By Year (%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

12 ADULT HEART-LUNG TRANSPLANTATION Major Indications By Year (Number) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

13 ADULT HEART-LUNG TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

14 ADULT HEART-LUNG TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

15 ADULT HEART-LUNG TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

16 HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival for Adult Recipients (Transplants: January 1982 - June 2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

17 HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival for Adult Recipients by Era (Transplants: January 1982 - June 2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

18 ADULT HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

19 ADULT HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

20 ADULT HEART-LUNG RECIPIENTS Cross-Sectional Analysis Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

21 ADULT HEART-LUNG RECIPIENTS Longitudinal Analysis Functional Status of Surviving Recipients For the Same Patients (Follow-ups: April 1994 – June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

22 ADULT HEART-LUNG RECIPIENTS Functional Status of Surviving Recipients US Recipients Only (Follow-ups: March 2005 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

23 ADULT HEART-LUNG RECIPIENTS Employment Status of Surviving Recipients (Follow-ups: April 1994 – June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

24 ADULT HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

25 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression For transplants between January 2001 through June 2009 Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

26 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2000 - December 2008) Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

27 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2000 - December 2008) Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

28 ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2001 through June 2009 NOTE: Different patients are analyzed in Year 1 and Year 5 Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

29 ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2001 through June 2009 NOTE: Different patients are analyzed in Year 1 and Year 5 Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

30 POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

31 POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant (Follow-ups: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

32 Freedom from Coronary Artery Vasculopathy For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

33 Freedom from Coronary Artery Vasculopathy For Adult Heart-Lung Recipients By Diagnosis Type (Follow-ups: April 1994-June 2009) P-value comparing all = 0.2078 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

34 Freedom from Bronchiolitis Obliterans Syndrome For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

35 Freedom from Bronchiolitis Obliterans Syndrome For Adult Heart-Lung Recipients By Diagnosis Type (Follow-ups: April 1994-June 2009) P-value comparing all = 0.7771 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

36 Freedom from Severe Renal Dysfunction* For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

37 MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTS Cumulative Prevalence in Survivors (Follow-ups: April 1994-June 2009) Malignancy/Type1-Year Survivors 5-Year Survivors 10-Year Survivors No Malignancy 369 (93.4%)129 (89.6%)36 (85.7%) Malignancy (all types combined) 26 (6.6%)15 (10.4%)6 (14.3%) Malignancy Type* Skin246 Lymph1860 Other430 Type Not Reported220 * Recipients may have experienced more than one type of malignancy so sum of individual malignancy types may be greater than total number with malignancy. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

38 Freedom from Malignancy For Adult Heart-Lung Recipients (Follow-ups: April 1994- June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

39 ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2009) CAUSE OF DEATH 0-30 Days (N = 289) 31 Days - 1 Year (N = 226) >1 Year - 3 Years (N = 195) >3 Years - 5 Years (N = 137) >5 Years (N = 290) BRONCHIOLITIS 05 (2.2%)41 (21.0%)28 (20.4%)48 (16.6%) ACUTE REJECTION 3 (1.0%)6 (2.7%)2 (1.0%)1 (0.7%)1 (0.3%) LYMPHOMA 08 (3.5%)11 (5.6%)5 (3.6%)5 (1.7%) MALIGNANCY, OTHER 03 (1.3%)7 (3.6%)4 (2.9%)17 (5.9%) CMV 01 (0.4%)01 (0.7%)0 INFECTION, NON-CMV 51 (17.6%)76 (33.6%)62 (31.8%)42 (30.7%)83 (28.6%) GRAFT FAILURE 83 (28.7%)50 (22.1%)32 (16.4%)25 (18.2%)51 (17.6%) CARDIOVASCULAR 24 (8.3%)10 (4.4%)16 (8.2%)10 (7.3%)21 (7.2%) TECHNICAL 58 (20.1%)6 (2.7%)1 (0.5%)1 (0.7%)0 OTHER 70 (24.2%)61 (27.0%)23 (11.8%)20 (14.6%)64 (22.1%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

40 ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death (Deaths: January 1992 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

41 HEART-LUNG TRANSPLANTATION Pediatric Recipients 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

42 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January 1982 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

43 AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART- LUNG RECIPIENTS (Transplants: January 1982 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

44 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS By Year of Transplant Number of Transplants NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of pediatric heart-lung transplants worldwide has declined in recent years. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

45 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS By Era of Transplant Percentage of Transplants 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

46 NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS NEED TO UPDATE 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

47 NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS Stratified by center volume 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

48 DIAGNOSIS IN PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS (Transplants: 1986-2008) Other includes Bronchiectasis, Alpha-1, and OB (non-ReTX) NOTE: Unknown diagnoses were excluded from this tabulation. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

49 PEDIATRIC HEART-LUNG TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

50 PEDIATRIC HEART-LUNG TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

51 PEDIATRIC HEART-LUNG TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

52 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

53 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1982 - June 2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

54 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

55 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2008) Conditional on Survival to 1 Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

56 PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2009) CAUSE OF DEATH 0-30 Days (N = 39) 31 Days - 1 Year (N = 49 ) >1 Year - 3 Years (N = 48 ) >3 Years - 5 Years (N = 27 ) >5 Years (N = 48) BRONCHIOLITIS 02 (4.1%)23 (47.9%)10 (37.0%)10 (20.8%) ACUTE REJECTION 02 (4.1%)1 (2.1%)00 LYMPHOMA 02 (4.1%)2 (4.2%)1 (3.7%)2 (4.2%) MALIGNANCY, OTHER 0001 (3.7%)0 CMV 02 (4.1%)000 INFECTION, NON-CMV 7 (17.9%)16 (32.7%)4 (8.3%)015 (31.3%) GRAFT FAILURE 17 (43.6%)9 (18.4%)14 (29.2%)12 (44.4%)11 (22.9%) CARDIOVASCULAR 2 (5.1%)3 (6.1%)1 (2.1%)2 (7.4%)3 (6.3%) TECHNICAL 6 (15.4%)0000 OTHER 7 (17.9%)13 (26.5%)3 (6.3%)1 (3.7%)7 (14.6%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

57 PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: April 1994 - June 2009) CAUSE OF DEATH 0-30 Days (N = 32) 31 Days - 1 Year (N = 36) >1 Year - 3 Years (N = 41) >3 Years - 5 Years (N = 25) >5 Years (N = 48) BRONCHIOLITIS 01 (2.8%)19 (46.3%)9 (37.5%)10 (20.8%) ACUTE REJECTION 01 (2.8%)1 (2.4%)00 LYMPHOMA 02 (5.6%)2 (4.9%)1 (4.2%)2 (4.2%) MALIGNANCY, OTHER 0001 (4.2%)0 CMV 01 (2.8%)000 INFECTION, NON-CMV 4 (12.5%)13 (36.1%)4 (9.8%)015 (31.3%) GRAFT FAILURE 15 (46.9%)6 (16.7%)11 (26.8%)11 (45.8%)11 (22.9%) CARDIOVASCULAR 2 (6.3%)2 (5.6%)1 (2.4%)1 (4.2%)3 (6.3%) TECHNICAL 4 (12.5%)0000 OTHER 7 (21.9%)10 (27.8%)3 (7.3%)1 (4.2%)7 (14.6%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

58 PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death (Deaths: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141


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