2003 ishlt j heart lung transplant 2003; 22: 610-72. heart transplantation overall
TRANSCRIPT
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
HEART TRANSPLANTATION
Overall
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR
189 318669
1189
2167
27203157
3378
4016 4186 4199 4346 4402 43144128 4039
37443419 3246 3122
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
Nu
mb
er o
f T
ran
spla
nts
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR AND LOCATION
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
Nu
mb
er o
f T
ran
spla
nts
South America
North America
Europe
Australia/Oceania
Asia
Africa
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
AVERAGE CENTER VOLUMEHeart Transplants: January 1, 1998 - June 30, 2002
6049
79
29
136 5 30
10
20
30
40
50
60
70
80
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
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
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
% 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
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
AGE DISTRIBUTIONOF HEART RECIPIENTS (1/1982-6/2002)
% 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
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
AGE DISTRIBUTION OF HEART TRANSPLANT RECIPIENTS BY ERA
0
10
20
30
40
50
60
<11-
56-
10
11-1
7
18-3
4
35-4
9
50-6
465
+ <11-
56-
10
11-1
7
18-3
4
35-4
9
50-6
465
+
% o
f tr
an
sp
lan
ts
p < 0.0001
1985-1996 1/1997-6/2002
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
HEART TRANSPLANTATION Actuarial Survival (1/1982-6/2001)
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
Years
Sur
viva
l (%
)
N=59,391
Half-life = 9.3 yearsConditional Half-life = 12.0 years
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
HEART TRANSPLANTATION
Adult Recipients
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
Congenital2%
ReTX2%
Myopathy45%
Misc.1%
Valvular4%
CAD46%
DIAGNOSIS IN ADULT HEART TRANSPLANTS
20
3040
5060
70
1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
% o
f Cas
es
Myopathy CAD
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTATION Actuarial Survival by Era (Transplants: 1/1982-6/2001)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
1982-1987 (N=6,367)
1988-1992 (N=16,621)
1993-1997 (N=18,743)
1/1998-6/2001 (N=10,678)
All comparisons significant at p < 0.03 except for 1993-1997 vs. 1998-6/2001.
HALF-LIFE 1982-1987: 7.7 years; 1988-1992: 9.3 years; 1993-1997: 9.1 years
Su
rviv
al (
%)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTATION Actuarial Survival by Age Group (Transplants: 1/1982-6/2001)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al
(%)
18-34 (N=5,492) 35-49 (N=15,478)50-64 (N=28,681) 65-69 (N=2,294)70+ (N = 220)
HALF-LIFE 18-34: 11.1 years; 35-49: 9.9 years; 50-64: 8.7 years; 65-69: 7.9 years; 70+: 5.8 years
All pair-wise comparisons are statistically significant at p < 0.001 except: 18-34 vs. 35-49 and 65-69 vs. 70+
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTATION Actuarial Survival by Diagnosis (Transplants: 1/1982-6/2001)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al
(%)
Coronary Artery Disease (N=23,682) Cardiomyopathy (N=25,543)Congenital Diagnosis (N=2,933) Retransplant (N=1,227)Valvular (N=1,917) Other (N=962)
All pair-wise comparisons with Retransplant and Cardiomyopathy are statistically significant at p < 0.05 except Cardiomyopathy vs. Other
HALF-LIFE Cardiomyopathy: 10.3 years; CAD: 8.6 years; Congenital: 12.2 years; Retransplant: 4.2 years; Valvular: 9.7 years; Other: 10.9 years
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTATION Actuarial Survival by Diagnosis (Transplants: 1/1994-6/2001)
Age = 18-34 Years
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8
Years
Su
rviv
al (
%)
Coronary Artery Disease (N=146) Cardiomyopathy (N=1,600)
Congenital Diagnosis (N=246) Retransplant (N=88)
Valvular (N=64) Other (N=54)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTATION Actuarial Survival by Diagnosis (Transplants: 1/1994-6/2001)
Age = 35-49 Years
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8
Years
Su
rviv
al (
%)
Coronary Artery Disease (N=2,130) Cardiomyopathy (N=3,484)
Congenital Diagnosis (N=117) Retransplant (N=134)
Valvular (N=210) Other (N=82)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTATION Actuarial Survival by Diagnosis (Transplants: 1/1994-6/2001)
Age = 50-64 Years
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8
Years
Su
rviv
al (
%)
Coronary Artery Disease (N=8,057) Cardiomyopathy (N=5,701)
Congenital Diagnosis (N=53) Retransplant (N=243)
Valvular (N=468) Other (N=137)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTATION Actuarial Survival by Diagnosis (Transplants: 1/1994-6/2001)
Age = 65-69 Years
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8
Years
Su
rviv
al (
%)
Coronary Artery Disease (N=1,036) Cardiomyopathy (N=560)Retransplant (N=23) Valvular (N=41)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTATION Actuarial Survival by Diagnosis (Transplants: 1/1994-6/2001)
Age = 70+ Years
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8
Years
Su
rviv
al (
%)
Coronary Artery Disease (N=121) Cardiomyopathy (N=53)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTATION Actuarial Survival by PVR (Transplants: 4/1994-6/2001)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
Su
rviv
al (
%)
1-3 (N=7,386) 3-5 (N=2,651) 5 (N=1,037)
1-3 vs. 3-5: p = 0.0021-3 vs. 5+: p = 0.0063-5 vs. 5+: p = 0.6
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTATION Actuarial Survival by PVR (Transplants: 4/1994-6/2001)
During first 6 months following transplantation
50
60
70
80
90
100
0.0 0.1 0.2 0.3 0.4 0.5
Years
Su
rviv
al (
%)
1-<3 (N=7,386) 3-<5 (N=2,651) 5+ (N=1,037)
1-<3 vs 3-<5: p = 0.0021-<3 vs. 5+: p = 0.0063-<5 vs. 5+: p = 0.6
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
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
1/1991-6/2001
Comparison of survival for interval < 12 months vs. > 12 months: p < 0.0001
ADULT HEART RE-TRANSPLANTS1-Year Survival
123
172
32 18
29
31
64 98
3591
22 286
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
1995-1998 (N=12,353)
1999-6/2001 (N=5,923)
Factor Odds Ratio
p-value Odds Ratio
p-value
Diagnosis: Coronary artery disease 1.25 <.0001 1.00 0.9
Diagnosis: Congenital heart disease 1.74 0.003 2.42 0.0004
Diagnosis: Other (excluding Cardiomyopathy)
1.33 0.003 1.37 0.04
Repeat transplant 1.67 0.0005 0.98 0.9
In hospital (including ICU) 1.7 <.0001 2.51 <.0001
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
1995-1998 (N=12,353)
1999-6/2001 (N=5,923)
Factor Odds Ratio
p-value
Odds Ratio
p-value
Ventilator 1.97 <.0001 2.53 <.0001
Intra-aortic balloon pump 1.47 0.001 1.09 0.6
IV inotropes 0.6 <.0001 0.54 <.0001
Infection requiring IV drug therapy within 2 weeks of transplant
1.25 0.04 0.97 0.8
PRA > 10% 1.25 0.03 1.26 0.1
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
1995-1998 (N=12,353)
1999-6/2001 (N=5,923)
Factor Odds Ratio
p-value Odds Ratio
p-value
History of malignancy 1.27 0.1 0.61 0.04
Dialysis 1.90 0.0008 2.58 <.0001
Sternotomy 0.86 0.02 0.91 0.3
0-4 HLA Mismatches 0.93 0.2 0.98 0.8
Male recipient/female donor 1.13 0.04 1.11 0.3
Donor COD: Stroke 1.07 0.2 1.21 0.04
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
Continuous Factors (see figures) Recipient age
Recipient height
Donor age
Donor weight
Ischemia time
Transplant center volume
Cardiac output
PVR
PA diastolic pressure
Bilirubin
Serum creatinine
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/2001) 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
1999-6/2001
p = 0.02p < 0.0001
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 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
1 Y
ear
Mo
rtal
ity
1995-1998
1999-6/2001
p < 0.0001p < 0.0001
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
Donor Weight
0
0.5
1
1.5
2
40 50 60 70 80 90 100 110
Donor Weight (kg)
Od
ds
of
1 Y
ear
Mo
rtal
ity
1995-1998
1999-6/2001
p = 0.0064p = 0.05
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
Recipient Height
0
0.5
1
1.5
2
140 150 160 170 180 190
Recipient Height (cm)
Od
ds
of
1 Y
ear
Mo
rtal
ity
1995-1998
1999-6/2001
p < 0.0001p = 0.04
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/2001) 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
1999-6/2001
p = 0.003p < 0.0001
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
Ischemia time
0
0.5
1
1.5
2
2.5
3
0 1 2 3 4 5 6
Ischemia time (hours)
Od
ds
of
1 Y
ear
Mo
rtal
ity
1995-1998
1999-6/2001
p < 0.0001p < 0.0001
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
Bilirubin
0
0.5
1
1.5
2
2.5
0 2 4 6 8 10 12 14 16 18 20
Bilirubin (mg/dl)
Od
ds
of
1 Y
ear
Mo
rtal
ity
1995-1998
1999-6/2001
p < 0.0001p < 0.0001
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
Recipient creatinine
0
1
2
3
4
0 0.5 1 1.5 2 2.5 3 3.5 4
Creatinine (mg/dl)
Od
ds
of
1 Y
ear
Mo
rtal
ity
1995-1998
1999-6/2001
p < 0.0001p < 0.0001
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
Cardiac Output
0
0.5
1
1.5
2
0 1 2 3 4 5 6 7 8 9 10
Cardiac output (L/min)
Od
ds
of
1 Y
ear
Mo
rtal
ity
1995-1998
1/1999-6/2001
p = 0.03p = 0.06
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
PVR
0
0.5
1
1.5
2
1 2 3 4 5 6 7 8 9 10
PVR (Wood units)
Od
ds
of
1 Y
ear
Mo
rtal
ity 1995-1998
1/1999-6/2001
p = 0.2p = 0.003
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
PA Diastolic
0
0.5
1
1.5
2
0 5 10 15 20 25 30 35 40
PA Diastolic (mm Hg)
Od
ds
of
1 Y
ear
Mo
rtal
ity 1995-1998
1/1999-6/2001
p=0.001p=0.09
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/2001) Factors Not Significant for 1 Year Mortality
Recipient Factors:VAD, ABO identical/compatible, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, PCW, history of malignancy, weight
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/2001) Factors Not Significant for 1 Year Mortality
Donor Factors:Gender, clinical infection, history of cancer, history of hypertension, history of diabetes, height
Transplant Factors:Donor/recipient BMI ratio, donor/recipient height ratio, CMV mismatch
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1995-6/1997) Risk Factors for 5 Year Mortality
VARIABLE Odds Ratio P-value
95% Confidence
Interval
Diagnosis: Coronary artery disease 1.28 <.0001 1.15 - 1.43
Repeat transplant 1.71 0.001 1.24 - 2.36
Infection requiring IV drug therapy within 2 weeks of transplant
1.46 0.001 1.16 - 1.82
Dialysis 2.31 0.0005 1.44 - 3.70
Prior sternotomy 0.85 0.02 0.74 - 0.97
(N=8,271)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality
Continuous Factors (see figures) Recipient age
Recipient height
Donor age
Donor BMI
Ischemia time
Transplant center volume
Bilirubin
Serum creatinine
Most recent PRA
Wedge pressure
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) 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 = 0.002
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) 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
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality
Donor BMI
0
0.5
1
1.5
2
17 21 25 29 33
Donor BMI (kg/m2)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p = 0.05
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality
Recipient Height
0
0.5
1
1.5
2
140 150 160 170 180 190
Recipient Height (cm)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p < 0.0001
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality
Most Recent PRA
0
0.5
1
1.5
2
0 10 20 30 40 50 60 70 80 90 100
Most recent PRA
Od
ds
of
5 Y
ear
Mo
rtal
ity
p < 0.0001
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) 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 = 0.007
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality
Ischemia time
0
0.5
1
1.5
2
2.5
0 1 2 3 4 5 6
Ischemia time (hours)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p < 0.0001
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality
Bilirubin
0
1
2
3
4
0 2 4 6 8 10 12 14 16 18 20
Bilirubin (mg/dl)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p = 0.003
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality
Recipient creatinine
0
1
2
3
0 0.5 1 1.5 2 2.5 3 3.5 4
Creatinine (mg/dl)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p < 0.0001
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality
PCW
0
0.5
1
1.5
2
0 5 10 15 20 25 30 35 40
PCW (mm Hg)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p = 0.0009
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Factors Not Significant for 5 Year Mortality
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, PVR, history of malignancy, weight, gender, history of malignancy
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) 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, HLA mismatch
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
VARIABLE Odds Ratio P-value
95% Confidence Interval
Diagnosis: Coronary Artery Disease 1.25 0.005 1.07 -1.46
Treated for infection prior to transplant discharge 1.31 0.009 1.07 -1.60
Treated for infection during 1st year 1.28 0.002 1.10 -1.50
CAV during 1st year 1.80 <.0001 1.35 -2.41
Cerebrovascular disease at transplant 1.55 0.01 1.10 -2.20
Insulin dependent diabetes 1.40 0.04 1.01 -1.94
(N=6,273)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
Continuous Factors (see figures)
Recipient age
Donor age
Donor BMI
Serum creatinine
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
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
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
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 = 0.001
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
Donor BMI
0
0.5
1
1.5
2
17 21 25 29 33
Donor BMI (kg/m2)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p = 0.005
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
Recipient creatinine
0
0.5
1
1.5
0 0.5 1 1.5 2 2.5 3 3.5 4
Creatinine (mg/dl)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p = 0.03
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) 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, history of malignancy, PRA, bilirubin
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) 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
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART RECIPIENTS Functional Status (Follow-ups: April 1994-June 2002)
0%
20%
40%
60%
80%
100%
1 Year (N = 12,811) 3 Years (N = 11,249) 5 Years (N = 9,532)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART RECIPIENTSEmployment Status (Follow-ups: April 1994-June 2002)
0%
20%
40%
60%
80%
100%
1 Year (N = 12,023) 3 Years (N = 10,396) 5 Years (N = 8,716)
Retired
Not Working
Working Part Time
Working Full Time
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART RECIPIENTSRehospitalization Post-transplant (Follow-ups: April 1994 - June 2002)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N = 13,930) Between 2 and 3 Years (N = 11,880)
Between 4 and 5 Years (N = 10,052)
No Hospitalization Hospitalized: Not Rejection/Not InfectionHospitalized: Rejection Only Hospitalized: Infection OnlyHospitalized: Rejection + Infection
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
0
10
20
30
40
50
Any Induction (N =2,441)
PolyclonalALG/ATG (N =
1,220)
OKT3 (N = 617) IL2R-antagonist (N= 904)
% o
f p
ati
en
ts
ADULT HEART RECIPIENTSInduction Immunosuppression (Follow-ups: January 2000 – June 2002)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
0
10
20
30
40
50
Any Induction (N = 1,036)
Polyclonal ALG/ATG (N = 581)
OKT3 (N = 382)
IL2R-antagonist (N = 321)
Any Induction (N = 987)
Polyclonal ALG/ATG (N = 439)
OKT3 (N = 176)
IL2R-antagonist (N = 407)
Any Induction (N = 418)
Polyclonal ALG/ATG (N = 200)
OKT3 (N = 59)
IL2R-antagonist (N = 176)
% o
f p
ati
en
ts 2000 2001 2002(6 months)
ADULT HEART RECIPIENTSInduction Immunosuppression (Follow-ups: January 2000 - June 2002)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
ati
en
ts
Year 1 (N = 3,916) Year 5 (N = 3,364)
ADULT HEART RECIPIENTS Maintenance Immunosuppression at Any Time During Follow-up Period
For follow-ups between January 2000 through June 2002
NOTE: Different patients are analyzed in Year 1 and Year 5
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
ati
en
ts
Year 1 (N = 3,793) Year 5 (N = 3,103)
ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2000 through June 2002
NOTE: Different patients are analyzed in Year 1 and Year 5
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
0%
20%
40%
60%
80%
100%
Year 1 (N = 3,793) Year 5 (N = 3,103)
% 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 2000 through June 2002
NOTE: Different patients are analyzed in Year 1 and Year 5
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994-June 2002)
Outcome Within 1 Year
Hypertension 72.8% (N = 13,507)
Renal Dysfunction 25.6% (N = 16,533)
Abnormal Creatinine < 2.5 mg/dl 15.3% Creatinine > 2.5 mg/dl 8.9% Chronic Dialysis 1.3% Renal Transplant 0.2%
Hyperlipidemia
50.3% (N = 14,245)
Diabetes 24.4% (N = 13,479)
CAV 8.1% (N = 12,174)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant
(Follow-ups: April 1994-June 2002)
Outcome Within 5 Years
Hypertension 94.6% (N = 4,042)
Renal Dysfunction 31.0% (N = 4,579)
Abnormal Creatinine < 2.5 mg/dl 18.5% Creatinine > 2.5 mg/dl 9.8% Chronic Dialysis 2.4% Renal Transplant 0.4%
Hyperlipidemia
82.4% (N = 4,539)
Diabetes 32.3% (N = 4,012)
CAV 32.5% (N = 2,797)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
Freedom from CAV and Freedom from Severe Renal Dysfunction*
For Adult Heart Recipients (Follow-ups: April 1994-June 2002)
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
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
MALIGNANCY POST-HEART TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994-June 2002)
Malignancy/Type 1-Year Survivors 5-Year Survivors
No Malignancy 13699 (96.7%) 3728 (82.0%)
Malignancy (all types combined) 470 (3.3%) 821 (18.0%)
Malignancy Type
Skin 206 499
Lymph 113 72
Other 103 158
Lymph + Skin 12
Lymph + Other 13
Skin + Other 26
Lymph + Skin + Other 2
Type Not Reported 48 39
”Other” includes: prostate (11), adenocarcinoma (7), lung (5), bladder (4), breast (2), cervix (2), colon (2), head/neck/throat (2), renal (2).
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
Freedom from MalignancyFor Adult Heart Recipients (Follow-ups: April 1994-June 2002)
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
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV within 5 Years
VARIABLE Odds Ratio P-value
95% Confidence
Interval
Diagnosis: Coronary Artery Disease 1.17 0.05 1.00 - 1.38
PRA > 20% 1.74 0.0009 1.25 - 2.42
Donor history of hypertension 1.30 0.04 1.01 - 1.66
Female donor 0.83 0.03 0.70 - 0.98
(N=4,797)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV within 5 Years
Continuous Factors (see figures) Recipient age
Donor age
Transplant center volume
Donor BMI/Recipient BMI
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV within 5 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 w
ith
in 5
Yea
rs
p = 0.006
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV within 5 Years
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
CA
V w
ith
in 5
Yea
rs
p < 0.0001
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV within 5 Years
Donor BMI/Recipient BMI
0
0.5
1
1.5
2
0.6 0.8 1 1.2 1.4 1.6 1.8
Donor BMI/Recipient BMI
Od
ds
of
CA
V w
ith
in 5
Yea
rs
p = 0.09
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV within 5 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 w
ith
in 5
Yea
rs
p = 0.02
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV between 5 and 7 Years
VARIABLE Odds Ratio P-value
95% Confidence
Interval Hospitalized for rejection within 5 years of transplant
1.93 0.005 1.23 - 3.05
Donor history of hypertension 2.23 0.01 1.19 - 4.17
(N=839)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV between 5 and 7 Years
Donor BMI
0
0.5
1
1.5
2
2.5
3
17 19 21 23 25 27 29 31 33
Donor BMI (kg/m2)
Od
ds
of
CA
V w
ith
in 5
Yea
rs
p = 0.03
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for Developing Malignancy within 5 Years
VARIABLE Odds Ratio P-value
95% Confidence
Interval
MMF at discharge 0.57 0.0004 0.42 - 0.78
Tacrolimus at discharge 0.48 0.007 0.29 - 0.82
Diagnosis: Coronary artery disease 1.29 0.01 1.06 - 1.56
Malignancy prior to transplant 1.93 0.006 1.20 - 3.11
Female 0.7 0.008 0.54 - 0.91
(N=4,371)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for Developing Malignancy within 5 Years
Continuous Factors (see figures)
Recipient age Donor BMI
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for Developing Malignancy within 5 Years
Recipient Age
0
1
2
3
4
20 25 30 35 40 45 50 55 60 65
Recipient Age
Od
ds
of
Mal
ign
ancy
wit
hin
5 Y
ears
p < 0.0001
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for Developing Malignancy within 5 Years
Donor BMI
0
0.5
1
1.5
2
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
Donor BMI (kg/m2)
Od
ds
of
Mal
ign
ancy
wit
hin
5 Y
ears
p = 0.007
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2002)
CAUSE OF DEATH 0-30 Days (N = 2,454)
31 Days - 1 Year (N = 2,155)
>1 Year - 3 Years (N = 1,642)
>3 Years - 5 Years (N = 1,391)
>5 Years (N = 3,454)
CAV 44 (1.8%) 108 (5.0%) 243 (14.8%) 251 (18.0%) 588 (17.0%)
ACUTE REJECTION 157 (6.4%) 264 (12.3%) 156 (9.5%) 60 (4.3%) 39 (1.1%)
LYMPHOMA 1 (0.0%) 44 (2.0%) 78 (4.8%) 79 (5.7%) 181 (5.2%)
MALIGNANCY, OTHER 2 (0.1%) 49 (2.3%) 171 (10.4%) 269 (19.3%) 661 (19.1%)
CMV 3 (0.1%) 27 (1.3%) 14 (0.9%) 3 (0.2%) 4 (0.1%)
INFECTION, NON-CMV 348 (14.2%) 745 (34.6%) 216 (13.2%) 138 (9.9%) 333 (9.6%)
PRIMARY FAILURE 602 (24.5%) 183 (8.5%) 118 (7.2%) 67 (4.8%) 191 (5.5%)
GRAFT FAILURE 403 (16.4%) 226 (10.5%) 282 (17.2%) 201 (14.5%) 466 (13.5%)
TECHNICAL 183 (7.5%) 24 (1.1%) 15 (0.9%) 17 (1.2%) 36 (1.0%)
OTHER 83 (3.4%) 103 (4.8%) 114 (6.9%) 97 (7.0%) 205 (5.9%)
MULTIPLE ORGAN FAILURE
342 (13.9%) 204 (9.5%) 80 (4.9%) 73 (5.2%) 270 (7.8%)
RENAL FAILURE 14 (0.6%) 16 (0.7%) 27 (1.6%) 44 (3.2%) 203 (5.9%)
PULMONARY 109 (4.4%) 71 (3.3%) 72 (4.4%) 51 (3.7%) 128 (3.7%)
CEREBROVASCULAR 163 (6.6%) 91 (4.2%) 56 (3.4%) 41 (2.9%) 149 (4.3%)