HEART TRANSPLANTATION

1
HEART TRANSPLANTATION

• Overall

ISHLT
2006

J Heart Lung Transplant 200625869-79
2
NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR
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 hearts
transplanted worldwide has declined in recent
years.
ISHLT
2006

J Heart Lung Transplant 200625869-79
3
AVERAGE CENTER VOLUMEHeart Transplants January
1 1991 - June 30 1995and January 1 2001
June 30 2005
ISHLT
2006

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DISTRIBUTION OF TRANSPLANTS BY CENTER
VOLUMEHeart Transplants January 1 1991 - June
30 1995and January 1 2001 June 30 2005
ISHLT
2006

J Heart Lung Transplant 200625869-79
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HEART TRANSPLANTS Donor Age by Year of
Transplant
ISHLT
2006

J Heart Lung Transplant 200625869-79
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AGE DISTRIBUTIONOF HEART RECIPIENTS
(1/1982-6/2005)
of Transplants
ISHLT
2006

J Heart Lung Transplant 200625869-79
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AGE DISTRIBUTION OF HEART TRANSPLANT RECIPIENTS
BY ERA
P lt 0.0001
ISHLT
2006

J Heart Lung Transplant 200625869-79
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HEART TRANSPLANTATION Kaplan-Meier Survival
(1/1982-6/2004)
N followed at longest time point 28463
ISHLT
2006

J Heart Lung Transplant 200625869-79
9
HEART TRANSPLANTATION

• Adult Recipients

ISHLT
2006

J Heart Lung Transplant 200625869-79
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DIAGNOSIS IN ADULT HEART TRANSPLANTS
ISHLT
2006

J Heart Lung Transplant 200625869-79
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ADULT HEART TRANSPLANTATION Kaplan-Meier
Survival by Era (Transplants 1/1982 6/2004)
Survival ()
ISHLT
2006

J Heart Lung Transplant 200625869-79
12
ADULT HEART TRANSPLANTATION Kaplan-Meier
Survival by Age Group (Transplants
1/1982-6/2004)
ISHLT
2006

J Heart Lung Transplant 200625869-79
13
ADULT HEART TRANSPLANTATION Kaplan-Meier
Survival by Age Group (Transplants
1/1998-6/2004)
ISHLT
2006

J Heart Lung Transplant 200625869-79
14
ADULT HEART TRANSPLANTATION Kaplan-Meier
Survival by Diagnosis (Transplants
1/1982-6/2004)
All pair-wise comparisons with Cardiomyopathy are
significant at p lt 0.05 except for Congenital
Coronary Artery Disease vs. ReTx p lt 0.0001
Coronary Artery Disease vs. Valvular p 0.01
Valvular vs. ReTx p lt 0.0001 Congenital vs.
ReTx p lt 0.0001 ReTx vs. Other p lt 0.0001
ISHLT
2006

J Heart Lung Transplant 200625869-79
15
ADULT HEART TRANSPLANTATION Kaplan-Meier
Survival by Diagnosis Conditional on Survival
to 1 Year (Transplants 1/1982-6/2004)
ISHLT
2006

J Heart Lung Transplant 200625869-79
16
ADULT HEART TRANSPLANTATION Kaplan-Meier
Survival by Diagnosis (Transplants 1/1998-6/2004)
ISHLT
2006

J Heart Lung Transplant 200625869-79
17
ADULT HEART TRANSPLANTATION Kaplan-Meier
Survival by Diagnosis Conditional on Survival to
1 Year (Transplants 1/1998-6/2004)
ISHLT
2006

J Heart Lung Transplant 200625869-79
18
ADULT HEART TRANSPLANTATION Kaplan-Meier
Survival by PVR (Transplants 1/2002-6/2004)
ISHLT
2006

J Heart Lung Transplant 200625869-79
19
ADULT HEART TRANSPLANTATION Kaplan-Meier
Survival by VAD usage (Transplants
1/1999-6/2004)
Note Only 42 transplants involving continuous
flow devices too few to analyze.
ISHLT
2006

J Heart Lung Transplant 200625869-79
20
ADULT HEART TRANSPLANTATION Kaplan-Meier
Survival by VAD usage and Era (Transplants
1/1999-6/2004)
ISHLT
2006

J Heart Lung Transplant 200625869-79
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ADULT HEART TRANSPLANTS5-Year Predicted Survival
Model (Transplants 1/1997-6/2000) Impact of
Pre-Transplant VAD
Recipient 54 y.o. male DxCAD PRA lt 10
weight75 kg height69 in PVR2
volume25/year year of tx99/00 bilirubin0.9
PA diastolic23 creatinine1.2 mg/dl
ischemia180 min Donor 32 y.o. male COD MVA
weight 72 kg height 70 in.
ISHLT
2006

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ADULT HEART RE-TRANSPLANTS1-Year Survival
ISHLT
2006

J Heart Lung Transplant 200625869-79
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ADULT HEART RECIPIENTS Functional Status of
Surviving Recipients (Follow-ups 1995 - June
2005)
ISHLT
2006

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ADULT HEART RECIPIENTSEmployment Status of
Surviving Recipients (Follow-ups 1995 - June
2005)
ISHLT
2006

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ADULT HEART RECIPIENTSRehospitalization
Post-transplant of Surviving Recipients
(Follow-ups 1995 - June 2005)
ISHLT
2006

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ADULT HEART RECIPIENTSInduction
Immunosuppression (Transplants January 2001
June 2005)
ISHLT
2006

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ADULT HEART RECIPIENTSInduction
Immunosuppression (Transplants 1996 2000 and
2004)
ISHLT
2006

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ADULT HEART TRANSPLANTATION Kaplan-Meier
Survival Stratified by Use of Any Induction
(Transplants 1/2000-6/2004 conditional on
survival to 14 days)
ISHLT
2006

J Heart Lung Transplant 200625869-79
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ADULT HEART TRANSPLANTATION Kaplan-Meier
Survival by Induction Type (Transplants
1/2000-6/2004 conditional on survival to 14 days)
ISHLT
2006

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ADULT HEART RECIPIENTS Maintenance
Immunosuppression at Time of Follow-up(Follow-ups
January 2002 - June 2005)
NOTE Different patients are analyzed in Year 1
and Year 5
ISHLT
2006

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31
ADULT HEART RECIPIENTS Maintenance
Immunosuppression at Time of 1 Year Follow-up
NOTE Different patients are analyzed in each
time frame.
ISHLT
2006

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32
ADULT HEART RECIPIENTS Maintenance
Immunosuppression Drug Combinations at Time of
Follow-up(Follow-ups January 2003 - June 2005)
NOTES Different patients are analyzed in Year 1
and Year 5. In the Year 1 cohort 76.5 of
patients were on prednisone in the Year 5 cohort
61 of patients were on prednisone.
ISHLT
2006

J Heart Lung Transplant 200625869-79
33
PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS
TREATED FOR REJECTION IN 1ST YEARStratified by
Type of Induction (Transplants January 1 2000
- June 30 2004)
ISHLT
2006

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NUMBER OF REJECTION EPISODES FOR ADULT HEART
TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN
1ST YEAR Stratified by Type of Induction
(Transplants January 1 2000 - June 30 2004)
Overall no induction vs. OKT3 (p 0.0021)
polyclonal vs. OKT3 (p0.0077) IL2 vs. OKT3
(p0.0003). 18-44 no induction vs. IL2 (p
0.033). 45-62 no induction vs. OKT3 (p
0.0031) IL2 vs. OKT3 (p 0.0034). 63
polyclonal vs. OKT3 (p 0.0228). For females no
induction vs. OKT3 (p 0.0082) IL2 vs. OKT3 (p
0.0493). For males no induction vs. OKT3 (p
0.046) IL2 vs. OKT3 (p 0.0021).
ISHLT
2006

J Heart Lung Transplant 200625869-79
35
PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS
TREATED FOR REJECTION IN 1ST YEARStratified by
Maintenance Immunosuppression (Transplants
January 1 2000 - June 30 2004)
Overall CyA MMF vs. TAC MMF (plt0.0001) CyA
MMF vs. TAC AZA (p0.0102) CyA AZA vs.
TAC MMF (plt0.0001) CyA AZA vs. TAC AZA
(p0.0054). 18-44 CyA MMF vs. TAC MMF
(p0.0085) CyA MMF vs. TAC AZA (p0.0119)
CyA AZA vs. TAC MMF (p0.031) CyA AZA
vs. TAC AZA (p0.0108). 45-62 CyA MMF vs.
TAC MMF (plt0.0001) CyA AZA vs. TAC MMF
(plt0.0001). 63 CyA MMF vs. TAC MMF
(p0.0395) CyA AZA vs. TAC MMF (p0.0027).
For females all comparisons are significant
except TAC MMF vs. TAC AZA. For males CyA
MMF vs. TAC MMF (plt0.0001) CyA AZA vs. TAC
MMF (plt0.0001)
ISHLT
2006

J Heart Lung Transplant 200625869-79
36
NUMBER OF REJECTION EPISODES FOR ADULT HEART
TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN
1ST YEAR Stratified by Maintenance
Immunosuppression (Transplants January 1 2000
- June 30 2004)
ISHLT
2006

J Heart Lung Transplant 200625869-79
37
ADULT HEART TRANSPLANTATION Kaplan-Meier
Survival Stratified by Rejection Within 1st
YearConditional on survival to 1 year for
transplants 1/1995-6/2003
ISHLT
2006

J Heart Lung Transplant 200625869-79
38
ADULT HEART TRANSPLANTATION Kaplan-Meier
Survival Stratified by Rejection between
Transplant Discharge and 1 YearConditional on
survival to 1 year for transplants 1/1995-6/2003
ISHLT
2006

J Heart Lung Transplant 200625869-79
39
POST-HEART TRANSPLANT MORBIDITY FOR ADULTS
Cumulative Prevalence in Survivors at 1 Year
Post-Transplant (Follow-ups April 1994
December 1997 and January 2001 - June 2005)
ISHLT
2006

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40
POST-HEART TRANSPLANT MORBIDITY FOR ADULTS
Cumulative Prevalence in Survivors at 5 and 8
Years Post-Transplant (Follow-ups April 1994 -
June 2005)
ISHLT
2006

J Heart Lung Transplant 200625869-79
41
FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY AND
FREEDOM FROM SEVERE RENAL DYSFUNCTION For
Adult Heart Recipients (Follow-ups April
1994-June 2005)
ISHLT
2006

J Heart Lung Transplant 200625869-79
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FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY
Stratified by Rejection Within 1st Year For
Adult Heart Recipients (Transplants April
1994-June 2003) Conditional on Survival to 1 Year
ISHLT
2006

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PATIENT SURVIVAL AFTER REPORT OF CAV AND PATIENT
SURVIVAL IN PATIENTS WITHOUT CAV (Transplants
April 1994-June 2003)
ISHLT
2006
Patients without CAV conditioned on survival to
median time of CAV development (562 days)

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MALIGNANCY POST-HEART TRANSPLANTATION FOR
ADULTSCumulative Prevalence in Survivors
(Follow-ups April 1994 - June 2005)
Other includes prostate (11 33 23)
adenocarcinoma (7 3 2) lung (5 3 1)
bladder (4 5 4) sarcoma (3 2 1) breast (2
7 4) cervical (2 4 1) colon (2 3 3) and
renal (2 5 2). Numbers in parentheses are
those reported within 1 year 5 years and 8
years respectively.
ISHLT
2006

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FREEDOM FROM MALIGNANCYFor Adult Heart
Recipients (Follow-ups April 1994 - June 2005)
ISHLT
2006

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ADULT HEART TRANSPLANT RECIPIENTS Cause of
Death (Deaths January 1992 - June 2005)
ISHLT
2006

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ADULT HEART TRANSPLANT RECIPIENTS Cause of
Death from Leading Causes by Era (Deaths
January 1992 - June 2005)
ISHLT
2006

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ADULT HEART TRANSPLANT RECIPIENTS Cumulative
Incidence of Leading Causes of Death
(Transplants January 1992 - June 2004)
ISHLT
2006

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ADULT HEART TRANSPLANTS Risk Factors for 1 Year
Mortality
Temporary circulatory support includes ECMO and
Abiomed.
Note All factors were significant at p lt 0.05 in
at least one of the eras.

J Heart Lung Transplant 200625869-79
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ADULT HEART TRANSPLANTS Risk Factors for 1 Year
Mortality
VAD type collected for only part of era. Only
those with known type were included in this group.
Note All factors were significant at p lt 0.05 in
at least one of the eras.

J Heart Lung Transplant 200625869-79
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ADULT HEART TRANSPLANTS Risk Factors for 1 Year
Mortality
Note All factors were significant at p lt 0.05 in
at least one of the eras.

J Heart Lung Transplant 200625869-79
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ADULT HEART TRANSPLANTSBorderline Significant
Risk Factors for 1 Year Mortality
Note All factors were significant at 0.5 lt p lt
0.1 in at least one of the eras.

J Heart Lung Transplant 200625869-79
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ADULT HEART TRANSPLANTSRisk Factors for 1 Year
Mortality

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ADULT HEART TRANSPLANTS Risk Factors for 1 Year
MortalityRecipient Age

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ADULT HEART TRANSPLANTS Risk Factors for 1 Year
MortalityDonor Age

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ADULT HEART TRANSPLANTS Risk Factors for 1 Year
MortalityPre-Transplant Recipient Weight

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ADULT HEART TRANSPLANTS Risk Factors for 1 Year
MortalityDonor Weight

J Heart Lung Transplant 200625869-79
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ADULT HEART TRANSPLANTS Risk Factors for 1 Year
MortalityCenter Volume

J Heart Lung Transplant 200625869-79
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ADULT HEART TRANSPLANTS Risk Factors for 1 Year
MortalityIschemia Time

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ADULT HEART TRANSPLANTS Risk Factors for 1 Year
MortalityPre-Transplant Bilirubin

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ADULT HEART TRANSPLANTS Risk Factors for 1 Year
MortalityPre-Transplant Creatinine

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ADULT HEART TRANSPLANTS Risk Factors for 1 Year
MortalityRecipient PA Diastolic Pressure

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ADULT HEART TRANSPLANTS Factors Not Significant
for 1 Year Mortality
Recipient Factors Pneumothorax sternotomy
thoracotomy ventricular remodeling pulmonary
embolism prior malignancy pulmonary vascular
resistance PCW Donor Factors Clinical
infection history of diabetes
height Transplant Factors Year of transplant

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ADULT HEART TRANSPLANTS Risk Factors for 5 Year
Mortality
Note All factors were significant at p lt 0.05 in
at least one of the eras.

J Heart Lung Transplant 200625869-79
65
ADULT HEART TRANSPLANTS Risk Factors for 5 Year
Mortality
Note All factors were significant at p lt 0.05 in
at least one of the eras.

J Heart Lung Transplant 200625869-79
66
ADULT HEART TRANSPLANTSBorderline Significant
Risk Factors for 5 Year Mortality
Note All factors were significant at 0.5 lt p lt
0.1 in at least one of the eras.

J Heart Lung Transplant 200625869-79
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ADULT HEART TRANSPLANTSRisk Factors for 5 Year
Mortality

J Heart Lung Transplant 200625869-79
68
ADULT HEART TRANSPLANTS Risk Factors for 5 Year
MortalityRecipient Age

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69
ADULT HEART TRANSPLANTS Risk Factors for 5 Year
MortalityDonor Age

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ADULT HEART TRANSPLANTS Risk Factors for 5 Year
MortalityPre-Transplant Recipient BMI

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ADULT HEART TRANSPLANTS Risk Factors for 5 Year
MortalityDonor Weight

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ADULT HEART TRANSPLANTS Risk Factors for 5 Year
MortalityCenter Volume

J Heart Lung Transplant 200625869-79
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ADULT HEART TRANSPLANTS Risk Factors for 5 Year
MortalityIschemia Time

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ADULT HEART TRANSPLANTS Risk Factors for 5 Year
MortalityPre-Transplant Bilirubin

J Heart Lung Transplant 200625869-79
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ADULT HEART TRANSPLANTS Risk Factors for 5 Year
MortalityPre-Transplant Creatinine

J Heart Lung Transplant 200625869-79
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ADULT HEART TRANSPLANTS Risk Factors for 5 Year
MortalityRecipient PA Diastolic Pressure

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ADULT HEART TRANSPLANTS Factors Not Significant
for 5 Year Mortality
Recipient Factors VAD gender pulmonary
vascular resistance thoracotomy pneumothorax
pulmonary embolism Donor FactorsHistory of
cancer clinical infection cause of
death Transplant Factors Year of transplant
CMV mismatch

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ADULT HEART TRANSPLANTS 5-Year Predicted
Survival ModelImpact of Donor Characteristics (I)
Recipient 30 y.o. female PRA lt 10 weight75
kg height65 in center volume25/year year of
tx99/00 bilirubin0.9 PA diastolic23
creatinine1.2 mg/dl ischemia180 min PVR2
ISHLT
2006
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ADULT HEART TRANSPLANTS5-Year Predicted Survival
ModelImpact of Donor Characteristics (II)
Recipient 63 y.o. male DxCAD puls. LVAD PRA
lt 10 weight85 kg height70 in PVR2
volume25/year year of tx99/00 bilirubin0.9
PA diastolic23 creatinine1.3 mg/dl
ischemia180 min
ISHLT
2006
J Heart Lung Transplant 200625869-79
80
ADULT HEART TRANSPLANTS Risk Factors for 5 Year
Mortality Conditional on Survival to 1 Year
Note All factors were significant at p lt 0.05 in
at least one of the eras.

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ADULT HEART TRANSPLANTS Risk Factors for 5 Year
Mortality Conditional on Survival to 1 Year
Note All factors were significant at p lt 0.05 in
at least one of the eras.

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ADULT HEART TRANSPLANTS Borderline Significant
Risk Factors for 5 Year Mortality Conditional on
Survival to 1 Year
Note All factors were significant at p lt 0.05 in
at least one of the eras.

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ADULT HEART TRANSPLANTSRisk Factors for 5 Year
Mortality Conditional on Survival to 1 Year

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84
ADULT HEART TRANSPLANTS Risk Factors for 5 Year
MortalityConditional on Survival to 1
YearRecipient Age

J Heart Lung Transplant 200625869-79
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ADULT HEART TRANSPLANTS Risk Factors for 5 Year
MortalityConditional on Survival to 1 YearDonor
Age

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ADULT HEART TRANSPLANTS Risk Factors for 5 Year
MortalityConditional on Survival to 1 Year
Donor BMI

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ADULT HEART TRANSPLANTS Risk Factors for 5 Year
MortalityConditional on Survival to 1
YearPre-transplant Recipient Weight

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ADULT HEART TRANSPLANTS Risk Factors for 5 Year
MortalityConditional on Survival to 1
YearPre-Transplant Bilirubin

J Heart Lung Transplant 200625869-79
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ADULT HEART TRANSPLANTS Risk Factors for 5 Year
MortalityConditional on Survival to 1
YearPre-Transplant Creatinine

J Heart Lung Transplant 200625869-79
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ADULT HEART TRANSPLANTS Risk Factors for 10
Year Mortality (Transplants 1990-6/1994)
(N16202)

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ADULT HEART TRANSPLANTSBorderline Significant
Risk Factors for 10 Year Mortality (Transplants
1990-6/1994)

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ADULT HEART TRANSPLANTSRisk Factors for 10 Year
Mortality

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ADULT HEART TRANSPLANTS Risk Factors for 10
Year MortalityRecipient Age

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ADULT HEART TRANSPLANTS Risk Factors for 10
Year MortalityDonor Age

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95
ADULT HEART TRANSPLANTS Risk Factors for 10
Year MortalityPre-Transplant Recipient Height

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ADULT HEART TRANSPLANTS Risk Factors for 10
Year MortalityCenter Volume

J Heart Lung Transplant 200625869-79
97
ADULT HEART TRANSPLANTS Risk Factors for 10
Year MortalityIschemia Time

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ADULT HEART TRANSPLANTS10-Year Predicted
Survival ModelImpact of Donor Characteristics (I)
Recipient 30 y.o. female PRA lt 10 weight75
kg height65 in center volume25/year year of
tx1993/94 bilirubin0.9 PA diastolic23
creatinine1.2 mg/dl ischemia180 min PVR2
ISHLT
2006
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ADULT HEART TRANSPLANTS10-Year Predicted
Survival ModelImpact of Donor Characteristics
(II)
Recipient 63 y.o. male DxCAD puls. LVAD PRA
lt 10 weight85 kg height70 in PVR2
volume25/year year of tx93/94 bilirubin 0.9
PA diastolic23 creatinine1.3 mg/dl
ischemia180 min
ISHLT
2006
J Heart Lung Transplant 200625869-79
100
ADULT HEART TRANSPLANTS Risk Factors for 10
Year Mortality Conditional on Survival to 3
Years (Transplants 1990-6/1994)
(N11113)

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101
ADULT HEART TRANSPLANTS Risk Factors for 10
Year Mortality Conditional on 3 Year
SurvivalRecipient Age

J Heart Lung Transplant 200625869-79
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ADULT HEART TRANSPLANTS Risk Factors for 10
Year Mortality Conditional on 3 Year
SurvivalDonor Age

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ADULT HEART TRANSPLANTS Risk Factors for 10
Year Mortality Conditional on 3 Year SurvivalBMI
Ratio

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ADULT HEART TRANSPLANTS (1997-6/2002) Risk
Factors for Developing Cardiac Allograft
Vasculopathy within 3 Years
(N7072)
Note Donor gender was not significant as an
independent risk factor but was significant as an
interaction with donor age.
2006
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ADULT HEART TRANSPLANTS (1997-6/2002) Risk
Factors for Developing Cardiac Allograft
Vasculopathy within 3 Years

Wald Label
Chi-Square DF Pr gt ChiSq
ischtime 11.5639 2
0.0031 bilirubin
4.9749 2 0.0831
volume 7.7569 2
0.0207 recipage
18.1816 2 0.0001
donage 100.0851 2
lt.0001 creatinine
37.8649 2 lt.0001
rec_hgt 30.9831 2
lt.0001 bmi_don
5.9576 2 0.0509
pcw 13.0777 2
0.0014

Wald Label
Chi-Square DF Pr gt ChiSq
ischtime 11.5639 2
0.0031 bilirubin
4.9749 2 0.0831
volume 7.7569 2
0.0207 recipage
18.1816 2 0.0001
donage 100.0851 2
lt.0001 creatinine
37.8649 2 lt.0001
rec_hgt 30.9831 2
lt.0001 bmi_don
5.9576 2 0.0509
pcw 13.0777 2
0.0014
2006
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ADULT HEART TRANSPLANTS (1997-6/2002)Risk
Factors for Developing Cardiac Allograft
Vasculopathy within 3 YearsDonor Age and Donor
Gender
2006
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ADULT HEART TRANSPLANTS (1997-6/2002) Risk
Factors for Developing Cardiac Allograft
Vasculopathy within 3 Years Pre-Transplant
Recipient BMI
2006
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ADULT HEART TRANSPLANTS (1997-6/2002)Risk
Factors for Developing Cardiac Allograft
Vasculopathywithin 3 YearsCenter Volume
2006
J Heart Lung Transplant 200625869-79