2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
HEART TRANSPLANTATION
Overall
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR
189 318669
1185
2165
27203156
3380
4024 4186 4219 4382 4438 4356 4206 40873769
3436 3314 3219 3107
0
500
1000
1500
2000
2500
3000
3500
4000
45001
98
2
19
83
19
84
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
Nu
mb
er o
f T
ran
spla
nts
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
AVERAGE CENTER VOLUMEHeart Transplants: January 1, 1997 - June 30, 2003
63
37
83
42
18
4350
79
2314 5 5 2455
0
10
20
30
40
50
60
70
80
90
1-4 5-9 10-19 20-29 30-39 40-49 50-74 75+
Average number of heart transplants per year
Nu
mb
er o
f ce
nte
rs
1997-1999
2000-6/2003
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME
Heart Transplants: January 1, 1997 - June 30, 2003
0
5
10
15
20
25
30
35
1-4 5-9 10-19 20-29 30-39 40-49 50-74 75+
Average number of heart transplants per year
Per
cen
tag
e o
f tr
ansp
lan
ts 1997-1999
2000-6/2003
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%1
98
2
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
% o
f T
ran
sp
lan
ts
0-10 11-17 18-35 36-49 50-59 60+
0
5
10
15
20
25
30
35
Me
an
do
no
r a
ge
(y
ea
rs)
Mean Age
HEART TRANSPLANTS: Donor Age by Year of Transplant
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
AGE DISTRIBUTIONOF HEART RECIPIENTS (1/1982-6/2003)
% o
f T
r%
of
Tra
ns
pla
nts
ns
pla
nts
0
10
20
30
40
50
60
<1 1-5 6-10 11-17 18-34 35-49 50-64 65+
Recipient Age
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
AGE DISTRIBUTION OF HEART TRANSPLANT RECIPIENTS BY ERA
0
10
20
30
40
50
60
<1 1-5 6-10 11-17 18-34 35-49 50-64 65+
Recipient age
% o
f tr
an
sp
lan
ts
1997-19992000-6/2003
p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2002)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years
Sur
viva
l (%
)
Half-life = 9.4 yearsConditional Half-life = 12.0 years
N=62,952
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
HEART TRANSPLANTATION
Adult Recipients
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
Congenital2%
ReTX2%
Myopathy45%
Misc.1%
Valvular4%
CAD46%
1982-1999
DIAGNOSIS IN ADULT HEART TRANSPLANTS
203040506070
% o
f Cas
es
Myopathy CAD
Congenital2%
ReTX2%
Myopathy46%
Misc.2%
Valvular3%
CAD45%
1/2000-6/2003
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2002)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11
Years
1982-1988 (N=9,143)
1989-1993 (N=17,869)
1994-1998 (N=18,557)
1999-6/2002 (N=10,234)
All comparisons significant at p < 0.01
HALF-LIFE 1982-1988: 8.1 years; 1989-1993: 9.5 years; 1994-1998: 9.1 years
Su
rviv
al (
%)
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1982-6/2002)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11
Years
Su
rviv
al
(%)
18-34 (N= 5,858) 35-49 (N=16,337)50-64 (N=30,600) 65-69 (N= 2,511)70+ (N= 250)
HALF-LIFE 18-34: 11.5 years; 35-49: 10.1 years; 50-64: 8.9 years; 65-69: 8.1 years; 70+: 5.9 years
All pair-wise comparisons are statistically significant at p < 0.001 except 18-34 vs. 35-49 and 65-69 vs. 70+
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1996-6/2002)
0
20
40
60
80
100
0 1 2 3 4 5 6 7
Years
Su
rviv
al
(%)
18-34 (N= 1,916) 35-49 (N= 5,066)50-64 (N=12,182) 65-69 (N= 1,543)70+ (N= 183)
All pair-wise comparisons are statistically significant at p < 0.05 except 18-34 vs. 50-64, 18-34 vs. 70+ and 65-69 vs. 70+
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: 1/1982-6/2002)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Years
Su
rviv
al
(%)
Male (N=45,017) Female (N=10,427)
HALF-LIFE Male: 9.3 years; Female: 9.7 years
p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1982-6/2002)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al
(%)
Cardiomyopathy (N = 24,147) Coronary artery disease (N = 24,663)Congenital diagnosis (N = 899) Retransplant (1,070)Valvular (N= 1,929) Other (N= 610)
All pair-wise comparisons with Cardiomyopathy are significant at p < 0.05 except for Congenital and Other; Coronary Artery Disease vs. ReTX: p < 0.0001; Valvular vs. ReTX: p < 0.0001; Congenital vs. ReTX: p < 0.0001; Other vs. ReTX: p < 0.0001
HALF-LIFE Cardiomyopathy: 10.5 years; CAD: 8.7 years; Congenital: 11.5 years; Retransplant: 4.2 years; Valvular: 10.0 years; Other: 10.9 years
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1996-6/2002)
0
20
40
60
80
100
0 1 2 3 4 5 6
Years
Su
rviv
al
(%)
Cardiomyopathy (N=9,310) Coronary artery disease (N=9,427)Congenital Diagnosis (N=379) Retransplant (N=408)Valvular (N=619) Other (N=273)
All pair-wise comparisons with Cardiomyopathy are significant at p < 0.05 except for Valvular; Coronary Artery Disease vs. ReTX: p = 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by PVR (Transplants: 1/1996-6/2002)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
Su
rviv
al (
%)
1-<3 (N= 6,571) 3-<5 (N= 2,200) 5+ (N= 869)
1-3 vs. 3-5: p = 0.091-3 vs. 5+: p = 0.023-5 vs. 5+: p = 0.3
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
0
20
40
60
80
100
0-2 months >2-6 months >6-12months
>12-36months
>36-60months
>60 months
Time between previous and current transplant
1 Y
ear
Pat
ien
t S
urv
ival
(%
)
1/1982-12/1990
1/1991-12/1995
1/1996-6/2002
Comparison of survival for interval < 12 months vs. > 12 months: p < 0.000112
610
6
32 19 2231 66 483736 25 109
74 18
7 62 56 269
ADULT HEART RE-TRANSPLANTS1-Year Survival
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
1995-1998 (N=13,523)
1999-6/2002 (N=7,067)
Factor Odds Ratio
p-value Odds Ratio
p-value
Dialysis 2.11 0.0001 2.52 <.0001
Diagnosis: Congenital heart disease 1.97 0.0002 2.66 <.0001
Ventilator 1.85 0.0002 2.47 <.0001
Repeat transplant 1.76 <.0001 1.08 0.7
Intra-aortic balloon pump 1.46 0.002 1.23 0.2
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
1995-1998 (N=13,523)
1999-6/2002 (N=7,067)
Factor Odds Ratio
p-value Odds Ratio
p-value
Diagnosis: Other (excluding Cardiomyopathy)
1.35 0.0011 1.42 0.0105
Donor history of cancer 1.33 0.21 1.78 0.0124
Diagnosis: Coronary artery disease 1.31 <.0001 1.05 0.5
In hospital (including ICU) 1.26 0.0009 1.42 <.0001
Infection requiring IV drug therapy within 2 weeks of transplant
1.25 0.05 1.02 0.8576
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
1995-1998 (N=13,523)
1999-6/2002 (N=7,067)
Factor Odds Ratio
p-value
Odds Ratio
p-value
HLA B mismatches (per mismatch) 1.22 0.0002 1.13 0.1102
Prior transfusions 1.21 0.046 1.25 0.06
Donor CMV+/Recipient CMV - 1.20 0.0011 1.34 0.0003
PRA > 10% 1.19 0.13 1.43 0.02
HLA DR mismatches (per mismatch) 1.15 0.0013 1.1 0.1336
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
1995-1998 (N=13,523)
1999-6/2002 (N=7,067)
Factor Odds Ratio
p-value
Odds Ratio
p-value
Insulin dependent diabetes 1.13 0.3 1.41 0.02
Female donor 1.11 0.0433 1.07 0.3736
Sternotomy 0.86 0.03 1.01 0.8948
IV inotropes 0.83 0.005 0.83 0.04
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Recipient age
Recipient height
Donor age
Ischemia time
Transplant center volume
Bilirubin
Serum creatinine
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
Recipient Age
0
0.5
1
1.5
2
20 25 30 35 40 45 50 55 60 65
Recipient Age
Od
ds
of
1 Y
ear
Mo
rtal
ity
1995-1998
1999-6/2002
p = 0.01p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
Donor Age
0
0.5
1
1.5
2
15 25 35 45 55
Donor Age
Od
ds
of
1 Y
ear
Mo
rtal
ity
1995-1998
1999-6/2002
p < 0.0001p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
Recipient Height
0
0.5
1
1.5
2
150 160 170 180 190
Recipient Height (cm)
Od
ds
of
1 Y
ear
Mo
rtal
ity
1995-1998
1999-6/2002
p < 0.0001p = 0.14
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
Center volume
0
0.5
1
1.5
2
0 10 20 30 40 50 60 70
Center Volume (cases per year)
Od
ds
of
1 Y
ea
r M
ort
alit
y
1995-1998
1999-6/2002
p = 0.003p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
Ischemia time
0
0.25
0.5
0.75
1
1.25
1.5
1 2 3 4 5
Ischemia time (hours)
Od
ds
of
1 Y
ear
Mo
rtal
ity
1995-1998
1999-6/2002
p < 0.0001p = 0.004
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
Recipient Bilirubin
0
0.5
1
1.5
2
0.5 1.5 2.5 3.5 4.5
Recipient bilirubin (mg/dl)
Od
ds
of
1 Y
ear
Mo
rtal
ity
1995-1998
1999-6/2002
p = 0.03p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
Recipient creatinine
0
0.5
1
1.5
2
0.5 1 1.5 2
Recipient creatinine (mg/dl)
Od
ds
of
1 Y
ear
Mo
rtal
ity
1995-1998
1999-6/2002
p < 0.0001p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/2002) Factors Not Significant for 1 Year Mortality
Recipient Factors:VAD, ABO identical/compatible, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, cardiac output, weight
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/2002) Factors Not Significant for 1 Year Mortality
Donor Factors:Clinical infection, history of cancer, history of hypertension, history of diabetes, height, weight, cause of death
Transplant Factors:Donor/recipient BMI ratio, donor/recipient weight ratio
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1995-6/1998) Risk Factors for 5 Year Mortality
VARIABLE Odds Ratio P-value
95% Confidence
Interval
Repeat Transplant 1.93 <.0001 1.46 2.55
Dialysis 1.80 0.004 1.21 2.68
Intra-aortic balloon pump 1.66 0.02 1.07 2.55
Ventilator 1.62 0.008 1.14 2.32
(N=11,963)
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1995-6/1998) Risk Factors for 5 Year Mortality
VARIABLE Odds Ratio P-value
95% Confidence
Interval
Diagnosis: Congenital heart disease 1.51 0.02 1.07 2.13
Infection requiring IV drug therapy within 2 weeks of transplant
1.37 0.002 1.12 1.68
Diagnosis: Coronary artery disease 1.29 <.0001 1.16 1.42
Diagnosis: Other (excluding Cardiomyopathy)
1.19 0.04 1.01 1.41
Diabetes 1.19 0.02 1.03 1.37
(N=11,963)
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1995-6/1998) Risk Factors for 5 Year Mortality
VARIABLE Odds Ratio P-value
95% Confidence
Interval
HLA DR Mismatches (per mismatch) 1.12 0.006 1.03 1.21
HLA B Mismatches (per mismatch) 1.11 0.03 1.01 1.22
IV inotropes 0.87 0.02 0.77 0.98
Sternotomy 0.85 0.005 0.75 0.95
(N=11,963)
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality
Continuous Factors (see figures) Recipient age
Recipient height
Donor age
Donor BMI
Ischemia time
Transplant center volume
Serum creatinine
Wedge pressure
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality
Recipient Age
0
0.5
1
1.5
2
20 25 30 35 40 45 50 55 60 65
Recipient Age
Od
ds
of
5 Y
ear
Mo
rtal
ity
p = 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality
Donor Age
0
0.5
1
1.5
2
10 15 20 25 30 35 40 45 50 55 60
Donor Age
Od
ds
of
5 Y
ear
Mo
rtal
ity
p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality
Donor BMI
0
0.5
1
1.5
2
18 20 22 24 26 28 30 32
Donor BMI (kg/m2)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p = 0.05
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality
Recipient Height
0
0.5
1
1.5
2
150 160 170 180 190
Recipient Height (cm)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality
Center volume
0
0.5
1
1.5
2
0 10 20 30 40 50 60 70
Center Volume (cases per year)
Od
ds
of
5 Y
ea
r M
ort
alit
y
p = 0.02
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality
Ischemia time
0
0.25
0.5
0.75
1
1.25
1.5
1 2 3 4 5
Ischemia time (hours)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p = 0.003
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality
Recipient creatinine
0
0.5
1
1.5
2
0.5 1 1.5 2 2.5
Recipient creatinine (mg/dl)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/1998) Factors Not Significant for 5 Year Mortality
Recipient Factors:VAD, in hospital, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, PA diastolic, PVR, history of malignancy, weight, gender, history of malignancy, bilirubin, PCW
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/1998) Factors Not Significant for 5 Year Mortality
Donor Factors:Gender, cause of death, clinical infection, history of cancer, history of hypertension, history of diabetes
Transplant Factors:Donor/recipient BMI ratio, donor/recipient height ratio, CMV mismatch, ABO identical/compatible
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1995-6/1998) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
VARIABLE Odds Ratio P-value
95% Confidence Interval
Previous transplant 2.19 0.0002 1.45 -3.28
CAV during 1st year 1.62 0.0001 1.25 -2.08
Cerebrovascular disease at transplant 1.59 0.002 1.19 -2.14
Treated for rejection during 1st year 1.44 <0.0001 1.22 -1.71
Treated for infection prior to transplant discharge
1.37 0.004 1.15 -1.64
Diagnosis: Coronary Artery Disease 1.25 0.003 1.08 -1.44
CMV mismatch (Donor+/Recipient-) 0.83 0.009 0.72 -0.95
(N=9,182)
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
Continuous Factors (see figures)
Recipient age
Donor age
Donor BMI
Serum creatinine
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
Recipient Age
0
0.5
1
1.5
2
2.5
20 25 30 35 40 45 50 55 60 65
Recipient Age
Od
ds
of
5 Y
ear
Mo
rtal
ity
p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
Donor Age
0
0.5
1
1.5
2
15 25 35 45 55
Donor Age
Od
ds
of
5 Y
ear
Mo
rtal
ity
p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
Donor BMI
0
0.5
1
1.5
2
18 20 22 24 26 28 30 32
Donor BMI (kg/m2)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p = 0.003
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
Recipient creatinine
0
0.5
1
1.5
0.6 0.8 1 1.2 1.4 1.6 1.8 2 2.2 2.4
Creatinine (mg/dl)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p = 0.005
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/1998) Factors Not Significant for 5 Year Mortality
Conditional on Survival to 1 Year
Recipient Factors:VAD, ventilator, in hospital, IV inotropes, balloon, ABO identical/compatible, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, PA diastolic, PCW, PVR, history of malignancy, height, weight, gender, diabetes, PRA, bilirubin
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1995-6/1998) Factors Not Significant for 5 Year Mortality Conditional on
Survival to 1 Year
Donor Factors:Gender, cause of death, clinical infection, history of cancer, history of hypertension, history of diabetes
Transplant Factors:Donor/recipient BMI ratio, donor/recipient height ratio, CMV mismatch, HLA mismatch, center volume, ischemia time
Post-transplant Factors:Dialysis, prolonged graft dysfunction, permanent pacemaker
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years
VARIABLE Odds Ratio P-value
95% Confidence Interval
Previous transplant 1.76 0.012 1.13 -2.74
Previous pregnancy 1.39 0.03 1.03 -1.86
Diagnosis: Coronary artery disease 1.34 <0.0001 1.18 -1.52
Female recipient 0.73 0.015 0.56 -0.94
Diagnosis: Congenital heart disease 0.39 0.01 0.19 -0.81
(N=5,952)
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years
Continuous Factors (see figures)
Recipient age
Donor age
Donor BMI
Center volume
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years
Recipient Age
0
0.5
1
1.5
2
2.5
20 25 30 35 40 45 50 55 60 65
Recipient Age
Od
ds
of
10 Y
ear
Mo
rtal
ity
p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years
Donor Age
0
0.5
1
1.5
2
15 25 35 45 55
Donor Age
Od
ds
of
10 Y
ear
Mo
rtal
ity
p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years
Donor BMI
0
0.5
1
1.5
2
18 20 22 24 26 28 30
Donor BMI (kg/m2)
Od
ds
of
10 Y
ear
Mo
rtal
ity
p = 0.0006
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1/1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years
Center volume
0
0.5
1
1.5
2
0 20 40 60 80 100
Center Volume (cases per year)
Od
ds
of
10
Ye
ar
Mo
rta
lity
p = 0.007
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART RECIPIENTS Functional Status (Follow-ups: January 1996 - June 2003)
0%
20%
40%
60%
80%
100%
1 Year (N = 14,353) 3 Years (N =12,6286)
5 Years (N =10,668)
7 Years (N = 8,054)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART RECIPIENTSEmployment Status (Follow-ups: January 1996-June 2003)
0%
20%
40%
60%
80%
100%
1 Year (N = 13,542) 3 Year (N = 11,741) 5 Year (N = 9,831) 7 Year (N = 7,490)
Retired
Not Working
Working Part Time
Working Full Time
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART RECIPIENTSRehospitalization Post-transplant (Follow-ups: January 1996 - June 2003)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N =15,704)
Between 2 and 3 Years (N = 13,392)
Between 4 and 5 Years (N = 11,265)
Between 6 and 7 Years (N = 8,685)
No Hospitalization Hospitalized: Not Rejection/Not InfectionHospitalized: Rejection Only Hospitalized: Infection OnlyHospitalized: Rejection + Infection
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
0
10
20
30
40
50
Any Induction (N =2,391)
Polyclonal ALG/ATG (N= 1,181)
OKT3 (N = 318) IL2R-antagonist (N =974)
% o
f p
ati
en
ts
ADULT HEART RECIPIENTSInduction Immunosuppression (Follow-ups: January 2001 – June 2003)
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
0
10
20
30
40
50
Any Induction PolyclonalALG/ATG
OKT3 IL2R-antagonist
% o
f p
atie
nts
2001 2002 1/2003-6/2003
ADULT HEART RECIPIENTSInduction Immunosuppression (Follow-ups: January 2001 - June 2003)
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
ati
en
ts
Year 1 (N = 3,888) Year 5 (N = 3,271)
ADULT HEART RECIPIENTS Maintenance 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
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
0%
20%
40%
60%
80%
100%
Year 1 (N = 3,967) Year 5 (N = 3,351)
% o
f P
ati
en
ts
Other
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine + MMF
Cyclosporine + AZA
ADULT HEART RECIPIENTS Maintenance 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
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEARStratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2002)
0
10
20
30
40
50
60
70
Overall 18-34 35-49 50-64 65+ F M
% t
reat
ed f
or
reje
ctio
n w
ith
in 1
yea
r
No induction PolyclonalIL2R-antagonist OKT3
For female: no induction vs. OKT3 (p = 0.006); polyclonal vs. OKT3 (p = 0.005); IL2R vs. OKT3 (p = 0.016)For male: no induction vs. OKT3 (p = 0.002); polyclonal vs. OKT3 (p = 0.002); IL2R vs. OKT3 (p = 0.003)
For the 50-64 age group: all comparisons with OKT3 were significant at p < 0.0001. No other comparisons within age groups were statistically significant.
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
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, 2002)
0
0.5
1
1.5
2
2.5
3
Overall 18-34 35-49 50-64 65+ F M
Av
era
ge
nu
mb
er
of
reje
cti
on
ep
iso
de
s
No induction Polyclonal IL2R-antagonist OKT3
35-49: IL2R vs. OKT3 (p = 0.03); 50-64: No induction vs. OKT3 (p = 0.04); polyclonal vs. OKT3 (p = 0.02)Male: Polyclonal vs. OKT3 (p = 0.02); IL2R vs. OKT3 (p = 0.004)
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS
TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2002)
0
10
20
30
40
50
60
Overall 18-34 35-49 50-64 65+ F M
% t
reat
ed f
or
reje
ctio
n w
ith
in 1
yea
r
Cyclosporin + MMF Cyclosporin + AZATacrolimus + MMF Tacrolimus + AZA
35-49: CyA + MMF vs. TAC + MMF (p = 0.0001); CyA + AZA vs. TAC + MMF (p = 0.03)50-64: CyA + MMF vs. TAC + MMF and CyA + AZA vs. TAC + MMF p < 0.0001Male: CyA + MMF vs. TAC + MMF and CyA + AZA vs. TAC + MMF p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
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, 2002)
0
0.5
1
1.5
2
2.5
Overall 18-34 35-49 50-64 65+ F M
Av
era
ge
nu
mb
er
of
reje
cti
on
ep
iso
de
s Cyclosporin + MMF Cyclosporin + AZATacrolimus + MMF Tacrolimus + AZA
No within-age group comparisons were statistically significant.Male: CyA + AZA vs. TAC + MMF (p = 0.009)
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
POST-HEART 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 73.2% (N = 15,305)
Renal Dysfunction 26.2% (N = 15,249) Abnormal Creatinine < 2.5 mg/dl 16.2% Creatinine > 2.5 mg/dl 8.6% Chronic Dialysis 1.3% Renal Transplant 0.2%
Hyperlipidemia 52.0% (N = 16,178)
Diabetes 25.0% (N = 15,300)
CAV 7.9% (N = 13,812)
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
POST-HEART 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 94.2% (N = 5,172)
Renal Dysfunction 31.8% (N = 5,571)
Abnormal Creatinine < 2.5 mg/dl 19.6% Creatinine > 2.5 mg/dl 9.4% Chronic Dialysis 2.4% Renal Transplant 0.4%
Hyperlipidemia 84.0% (N = 5,753)
Diabetes 32.8% (N = 5,128)
CAV 32.9% (N = 3,644)
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 7 Years Post-Transplant
(Follow-ups: April 1994 - June 2003)
Outcome Within 7
Years Total number with known response
Hypertension 97.0% (N = 2,366)
Renal Dysfunction 35.5% (N = 2,657)
Abnormal Creatinine < 2.5 mg/dl 20.2% Creatinine > 2.5 mg/dl 10.4% Chronic Dialysis 4.0% Renal Transplant 0.9%
Hyperlipidemia 89.1% (N = 2,701)
Diabetes 35.0% (N = 2,362)
CAV 43.0% (N = 1,510)
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
FREEDOM FROM CAV AND FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Adult Heart Recipients (Follow-ups: January 1996-June 2003)
0
10
20
30
40
50
60
70
80
90
100
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5
Years
% F
ree
fro
m C
AV
or
Fre
ed
om
fro
m S
ev
ere
Re
na
l D
ys
fun
cti
on
Freedom from CAV
Freedom from Severe Renal Dysfunction
* Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
FREEDOM FROM CAV Stratified by Diagnosis
For Adult Heart Recipients (Follow-ups: January 1996-June 2003)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
% F
ree
fro
m C
AV
Coronary Artery Disease (N = 8,195)
Cardiomyopathy (N = 7,924)
p = 0.005
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
MALIGNANCY POST-HEART TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994-June 2003)
Malignancy/Type 1-Year Survivors
5-Year Survivors
7-Year Survivors
No Malignancy 15396 (96.8%) 4697 (83.1%) 1994 (75.9%)
Malignancy (all types combined) 502 (3.2%) 957 (16.9%) 633 (24.1%)
Malignancy Type
Skin 228 639 462
Lymph 119 105 57
Other 109 228 157
Type Not Reported 46 39 15
”Other” includes: prostate (11, 33, 25), adenocarcinoma (7, 4, 2), lung (5, 3, 2), bladder (4, 5, 5), sarcoma (3, 3, 1), breast (2, 8, 6), cervical (2, 4, 1), colon (2, 2, 3), and renal (2, 7, 3). Numbers in parentheses are those reported within 1 year, 5 years and 7 years, respectively.
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
FREEDOM FROM MALIGNANCYFor Adult Heart Recipients (Follow-ups: April 1994 - June 2003)
0
10
20
30
40
50
60
70
80
90
100
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5
Years
% F
ree
fro
m M
alig
nan
cy
All malignancy Lymph Skin Other
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1996-6/2000) Risk Factors for Developing CAV within 3 Years
VARIABLE Odds Ratio P-value
95% Confidence
Interval
Donor history of hypertension 1.47 0.0002 1.20 -1.80
Diagnosis: Coronary artery disease 1.17 0.03 1.01 -1.36
Female recipient 0.81 0.048 0.66 -1.00
Female donor 0.72 0.0002 0.60 -0.86
(N=5,787)
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1996-6/2000) Risk Factors for Developing CAV within 3 Years
Continuous Factors (see figures)
Recipient age
Donor age
Recipient BMI
Transplant center volume
Diastolic PA pressure
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1996-6/2000) Risk Factors for Developing CAV within 3 Years
Recipient Age
0
0.5
1
1.5
2
20 25 30 35 40 45 50 55 60 65
Recipient Age
Od
ds
of
CA
V b
y 3
Yea
rs
p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1996-6/2000) Risk Factors for Developing CAV within 3 Years
Donor Age
0
0.5
1
1.5
2
2.5
15 20 25 30 35 40 45 50 55
Donor Age
Od
ds
of
CA
V b
y 3
Yea
rs
p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1996-6/2000) Risk Factors for Developing CAV within 3 Years
Recipient BMI
0
0.5
1
1.5
2
18 20 22 24 26 28 30 32
Recipient BMI
Od
ds
of
CA
V b
y 3
Yea
rs
p = 0.005
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1996-6/2000) Risk Factors for Developing CAV within 3 Years
Center Volume
0
0.5
1
1.5
2
0 10 20 30 40 50 60 70
Center Volume (cases per year)
Od
ds
of
CA
V b
y 3
Yea
rs
p < 0.0001
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1996-6/2000) Risk Factors for Developing CAV within 3 Years
Recipient Diastolic PA Pressure
0
0.5
1
1.5
2
10 15 20 25 30 35 40
Recipient Diastolic PA Pressure
Od
ds
of
CA
V b
y 3
Yea
rs
p = 0.04
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1995-6/1996) Risk Factors for Developing CAV within 7 Years Conditional
on no CAV within 1 Year
VARIABLE Odds Ratio P-value
95% Confidence
Interval
Donor history of hypertension 1.72 0.02 1.08 -2.73
Recipient rejection during 1st year 1.45 0.02 1.05 -2.00
Diagnosis: coronary artery disease 1.39 0.03 1.04 -1.87
DR mismatches (per mismatch) 1.34 0.03 1.02 -1.75
(N=1,414)
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1995-6/1996) Risk Factors for Developing CAV within 7 Years Conditional
on no CAV within 1 Year
Continuous Factors (see figures)
Recipient age
Donor age
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1995-6/1996) Risk Factors for Developing CAV within 7 Years Conditional
on no CAV within 1 Year Recipient Age
0
0.5
1
1.5
2
2.5
20 25 30 35 40 45 50 55 60 65
Recipient Age
Od
ds
of
CA
V b
y 7
Yea
rs
p = 0.007
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANTS (1995-6/1997) Risk Factors for Developing CAV within 7 Years Conditional
on no CAV within 1 Year Donor Age
0
0.5
1
1.5
2
15 20 25 30 35 40 45 50 55
Donor Age
Od
ds
of
CA
V b
y 7
Yea
rs
p = 0.0009
2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803
ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2003)
CAUSE OF DEATH 0-30 Days
(N = 2,759 )31 Days - 1 Year
(N = 2,310 )>1 Year - 3 Years
(N = 1,737 )>3 Years - 5 Years
(N = 1,492 )>5 Years
(N = 4,009 )
CAV 43 (1.6%) 111 (4.8%) 257 (14.8%) 268 (18.0%) 651 (16.2%)
ACUTE REJECTION 188 (6.8%) 288 (12.5%) 165 (9.5%) 63 (4.2%) 43 (1.1%)
LYMPHOMA 2 (0.1%) 46 (2.0%) 77 (4.4%) 80 (5.4%) 201 (5.0%)
MALIGNANCY, OTHER 2 (0.1%) 49 (2.1%) 181 (10.4%) 281 (18.8%) 763 (19.0%)
CMV 4 (0.1%) 29 (1.3%) 15 (0.9%) 3 (0.2%) 4 (0.1%)
INFECTION, NON-CMV 370 (13.4%) 784 (33.9%) 234 (13.5%) 145 (9.7%) 393 (9.8%)
PRIMARY FAILURE 747 (27.1%) 186 (8.1%) 119 (6.9%) 68 (4.6%) 200 (5.0%)
GRAFT FAILURE 400 (14.5%) 245 (10.6%) 298 (17.2%) 218 (14.6%) 567 (14.1%)
TECHNICAL 208 (7.5%) 28 (1.2%) 15 (0.9%) 17 (1.1%) 43 (1.1%)
OTHER 101 (3.7%) 122 (5.3%) 123 (7.1%) 104 (7.0%) 240 (6.0%)
MULTIPLE ORGAN FAILURE
382 (13.8%) 228 (9.9%) 86 (5.0%) 83 (5.6%) 335 (8.4%)
RENAL FAILURE 17 (0.6%) 19 (0.8%) 31 (1.8%) 51 (3.4%) 238 (5.9%)
PULMONARY 116 (4.2%) 77 (3.3%) 77 (4.4%) 60 (4.0%) 163 (4.1%)
CEREBROVASCULAR 179 (6.5%) 98 (4.2%) 59 (3.4%) 51 (3.4%) 168 (4.2%)
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