2004 ISHLT J Heart Lung Transplant 2004; 23: 804-15 HEART-LUNG TRANSPLANTATION Overall.

2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15

HEART-LUNG TRANSPLANTATION

Overall


0

50

100

150

200

25019

82

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

Num

ber

of T

rans

plan

tsNUMBER OF HEART-LUNG

TRANSPLANTS REPORTED BY YEAR


AVERAGE CENTER VOLUMEHeart-Lung Transplants: January 1, 1998 - June 30, 2003

75

2 20

25

50

75

1-4 5-9 10-19

Average number of heart-lung transplants per year

Nu

mb

er o

f ce

nte

rs


DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME

Heart-Lung Transplants: January 1, 1998 - June 30, 2003

0

25

50

75

1-4 5-9 10-19

Average number of lung transplants per year

Per

cen

tag

e o

f tr

ansp

lan

ts


HEART-LUNG TRANSPLANTATIONKaplan-Meier SURVIVAL (Transplants: January 1982 - June 2002)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Years

N=2,973

Half-life = 2.8 yearsConditional Half-life = 8.3 years

Su

rviv

al (

%)



Adult Recipients


Congenital heart disease

32%

COPD6%

PPH24%

IPF3%

CF15%

Other 12%

Acquired heart disease

4%

Alpha-12%

Retransplant2%

DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (1/1982-6/2003)

“Other” includes cancer, LAM, OB, sarcoidosis, bronchiectasis


DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2003)

Diagnosis N (%)

Congenital Heart Disease 726 (32.1%)

PPH 550 (24.3%)

CF 355 (15.7%)

Acquired Heart Disease 98 ( 4.3%)

COPD/Emphysema 89 ( 3.9%)

IPF 63 ( 2.8%)

Alpha-1 57 ( 2.5%)

Re-TX: Non-OB 30 ( 1.3%)

Sarcoidosis 26 ( 1.1%)

Re-TX: OB 24 ( 1.1%)

Bronchiectasis 14 ( 0.6%)

OB (not Re-TX) 8 ( 0.4%)

Other 225 ( 9.9%)


DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA

36%

1%

3%

17%

2%

19%6%

13%

3%

COPD/Alpha-1 Congenital Heart Disease Acquired Heart Disease

Alpha-1 CF IPF

PPH Re-TX Other

8%29%

4%

3% 26%

3%

12%

15%

1982-1995 1/1996-6/2003“Other” includes OB (non-ReTX), Bronchiectasis, Sarcoidosis


HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for Adult Recipients

(Transplants: January 1982 - June 2002)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Years

N=2,389

Half-life = 3.1 yearsConditional Half-life = 8.8 years

Su

rviv

al (

%)


ADULT HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2002)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10Years

Su

rviv

al (

%)

Other Congenital (N = 169)Eisenmenger's Syndrome (N = 405)PPH (N=334)

Congenital vs. Eisenmenger's: p < 0.0001Congenital vs. PPH: p = 0.003Eisenmenger's vs. PPH: p = 0.07

HALF-LIFE Congenital: 1.0 Years; Eisenmenger's: 5.1 Years; PPH: 3.2 Years


ADULT HEART-LUNG RECIPIENTSFunctional Status (Follow-ups: April 1994 – June 2003)

0%

20%

40%

60%

80%

100%

1 Year (N = 238) 3 Years (N = 178) 5 Years (N = 160) 7 Years (N = 128)

No Activity Limitations Performs with Some Assistance Requires Total Assistance


ADULT HEART-LUNG RECIPIENTSEmployment Status (Follow-ups: April 1994 – June 2003)

0%

20%

40%

60%

80%

100%

1 Year (N = 227) 3 Years (N = 168) 5 Years (N = 156) 7 Years (N = 114)

Working Full Time Working Part Time Not Working Retired


ADULT HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant (Follow-ups: April 1994 - June 2003)

0%

20%

40%

60%

80%

100%

Up to 1 Year (N =271)

Between 2 and 3Years (N = 191)



No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Only Hospitalized, Infection OnlyHospitalized, Rejection and Infection


0

10

20

30

40

50

Any Induction (N = 51) Polyclonal ALG/ATG (N= 23)

OKT3 (N = 4) IL2R-antagonist (N =26)

% o

f p

ati

en

tsADULT HEART-LUNG RECIPIENTS

Induction ImmunosuppressionFor follow-ups between January 2001 through June 2003


0

10

20

30

40

50

60

Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist

% o

f p

atie

nts

2000 2001 2002

ADULT HEART-LUNG RECIPIENTSInduction Immunosuppression (Follow-ups: January 2000 - June 2003)


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

atie

nts

Year 1 (N = 47) Year 5 (N = 38)

ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up

For follow-ups between January 2001 through June 2003

NOTE: Different patients are analyzed in Year 1 and Year 5


0%

20%

40%

60%

80%

100%

Year 1 (N = 47) Year 5 (N = 38)

% o

f P

atie

nts

Other

Tacrolimus + MMF

Tacrolimus + AZA

Cyclosporine + MMF

Cyclosporine + AZA

ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression Drug Combinations at Time of Follow-up

For follow-ups between January 2001 through June 2003

NOTE: Different patients are analyzed in Year 1 and Year 5


POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant

(Follow-ups: April 1994 - June 2003)

Outcome Within 1

Year Total number with known response

Hypertension 55.6% (N = 270)

Renal Dysfunction 12.5% (N = 278)

Abnormal Creatinine < 2.5 mg/dl 9.5% Creatinine > 2.5 mg/dl 3.0%

Hyperlipidemia 18.3% (N = 278)

Diabetes 13.1% (N = 268)

CAV 2.2% (N = 227)

Bronchiolitis Obliterans 9.8% (N = 255)


POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant

(Follow-ups: April 1994 - June 2003)

Outcome Within 5

Years Total number with known response

Hypertension 85.5% (N = 76)

Renal Dysfunction 28.8% (N = 80)

Abnormal Creatinine < 2.5 mg/dl 18.8% Creatinine > 2.5 mg/dl 10.0%

Hyperlipidemia 60.0% (N = 80)

Diabetes 19.5% (N = 77)

CAV 9.5% (N = 42)

Bronchiolitis Obliterans 27.6% (N = 58)


Freedom from CAV For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2003)

50

60

70

80

90

100

0 1 2 3 4 5

Years

% F

ree

fro

m C

AV


Freedom from Bronchiolitis Obliterans For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2003)

50

60

70

80

90

100

0 1 2 3 4 5

Years

% F

ree

fro

m B

ron

chio

liti

s O

bli

tera

ns


Freedom from Severe Renal Dysfunction*For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2003)

50

60

70

80

90

100

0 1 2 3 4 5

Years

% F

ree

fro

m S

ev

ere

Re

na

l D

ys

fun

cti

on

*Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant


MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994-June 2003)

Malignancy/Type 1-Year Survivors 5-Year Survivors

No Malignancy 245 (91.4%) 68 (86.1%)

Malignancy (all types combined) 23 (8.6%) 11 (13.9%)

Malignancy Type

Skin 2 3

Lymph 16 5

Other 1 1

Type Not Reported 4 2


Freedom from MalignancyFor Adult Heart-Lung Recipients (Follow-ups: April 1994- June 2003)

50

60

70

80

90

100

0 1 2 3 4 5

Years

% F

ree

from

Mal

igna

ncy

All malignancy

Lymph

Skin

Other


ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2003)

CAUSE OF DEATH 0-30 Days

(N = 181)

31 Days - 1 Year (N = 117)

>1 Year - 3 Years (N = 96)

>3 Years - 5 Years (N = 56)

>5 Years

(N = 82)

BRONCHIOLITIS . (.%) 4 (3.4%) 25 (26.0%) 21 (37.5%) 17 (20.7%)

ACUTE REJECTION 3 (1.7%) 3 (2.6%) 1 (1.0%) 1 (1.8%) 1 (1.2%)

LYMPHOMA . (.%) 3 (2.6%) 4 (4.2%) 3 (5.4%) 1 (1.2%)

MALIGNANCY, OTHER . (.%) 1 (0.9%) 6 (6.3%) 2 (3.6%) 5 (6.1%)

CMV . (.%) 1 (0.9%) . (.%) 1 (1.8%) . (.%)

INFECTION, NON-CMV 37 (20.4%) 52 (44.4%) 31 (32.3%) 3 (5.4%) 11 (13.4%)

GRAFT FAILURE 57 (31.5%) 23 (19.7%) 17 (17.7%) 8 (14.3%) 20 (24.4%)

CARDIOVASCULAR 17 (9.4%) 7 (6.0%) 5 (5.2%) 8 (14.3%) 7 (8.5%)

TECHNICAL 35 (19.3%) 2 (1.7%) 1 (1.0%) . (.%) . (.%)

OTHER 32 (17.7%) 21 (17.9%) 6 (6.3%) 9 (16.1%) 20 (24.4%)



Pediatric Recipients


AGE DISTRIBUTION OF PEDIATRIC HEART-LUNGRECIPIENTS (Transplants: January 1982 - June 2003)

0

10

20

30

40

50

60

70

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Recipient Age (Years)

Nu

mb

er o

f T

ran

spla

nts


AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January 1982 - June 2003)

0

10

20

30

40

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

18-2

5

25-3

030

+

Donor Age (Years)

Nu

mb

er o

f T

ran

spla

nts


AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS

By Year of Transplant

0

5

10

15

20

25

30

35

40

4511-17 Years1-10 Years

<1 Year

Nu

mb

er o

f T

ran

spla

nts


NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS

0

5

10

15

20

25

301

98

4

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

Transplant Year

Nu

mb

er

of

Pe

dia

tric

Tra

ns

pla

nt

Ce

nte

rs


37%2%

24%

5%

19%

13%Congenital

Acquired heart disease

Cystic Fibrosis

ReTX

PPH

Other

DIAGNOSIS IN PEDIATRIC HEART –LUNG TRANSPLANT RECIPIENTS (Age: 11-17 Years)

0

25

50

75

100

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

% o

f Cas

es

Cystic Fibrosis Congenital PPH

“Other” includes Alpha-1, Bronchiectasis, IPF and OB (non-ReTX)


PEDIATRIC HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2002)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10Years

Su

rviv

al

(%)

Other Congenital (N = 169)Eisenmenger's Syndrome (N = 39)PPH (N=55)

Congenital vs. Eisenmenger's: p= 0.5Congenital vs. PPH: p = 0.8Eisenmenger's vs. PPH: p = 0.6


PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1982 - June 2002)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11

Years

Sur

viva

l (%

)

1-10 (N = 110)

11-17 (N = 185)

Overall (N = 305)

HALF-LIFE 1-10: 2.0 Years; 11-17: 3.3 Years

1-10 years vs. 11-17 years p = 0.9


PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2002)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11Years

1982-1987 (N=70)

1989-1993 (N=177)

1994-1998 (N=129)

1999-6/2002 (N=52)

HALF-LIFE Unconditional 1982-1988: 1.7 Years; 1989-1993: 3.0 Years; 1994-1998: 3.0 Years; 1999-6/2002: 3.0 YearsConditional 1982-1988: 8.0 Years; 1989-1993: 7.2 Years; 1994-1998: 5.9 Years; 1999-6/2002: n.c.

No comparisons are statistically significant

Su

rviv

al (

%)


PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2003)

CAUSE OF DEATH 0-30 Days (N = 25)

31 Days - 1 Year (N = 27)

>1 Year - 3 Years (N = 25)

>3 Years - 5 Years (N = 16)

>5 Years

(N = 17)

BRONCHIOLITIS 1 (3.7%) 13 (52.0%) 8 (50.0%) 5 (29.4%)

ACUTE REJECTION 2 (7.4%)

INFECTION, NON-CMV 5 (20.0%) 9 (33.3%) 5 (20.0%) 1 (6.3%) 5 (29.4%)

GRAFT FAILURE 12 (48.0%) 2 (7.4%) 5 (20.0%) 4 (25.0%) 3 (17.6%)

CARDIOVASCULAR 1 (4.0%) 3 (11.1%) 1 (6.3%) 2 (11.8%)

TECHNICAL 3 (12.0%) 1 (3.7%)

OTHER 4 (16.0%) 9 (33.3%) 2 (8.0%) 2 (12.5%) 2 (11.8%)

2004 ISHLT J Heart Lung Transplant 2004; 23: 804-15 HEART-LUNG TRANSPLANTATION Overall.

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Transcript of 2004 ISHLT J Heart Lung Transplant 2004; 23: 804-15 HEART-LUNG TRANSPLANTATION Overall.