2001 j heart lung transplant 2001; 20: 805-815; 2002: 21: 827-840 the registry of the international...
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2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
THE REGISTRY OF THE INTERNATIONAL SOCIETY
FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL
REPORT
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ACKNOWLEDGMENTS:We wish to extend our sincere thanksto the many thoracic transplant surgeons, physicians and data coordinators in transplant programsthroughout the world whose timely and accurate submission of data hasmade these analyses possible.
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
REGISTRY DATABASENUMBER OF CENTERS
PERFORMING TRANSPLANTS:ORGAN
1993 1999 TOTAL
Heart 227 211 321
Heart-Lung 60 44 126
Single Lung 91 91 161
Bilateral/Double Lung 67 91 148
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
REGISTRY DATABASENUMBER OF TRANSPLANTS
PERFORMEDORGAN
Through 1993 In 2000
Heart 30882 3175
Heart-Lung 1751 104
Single Lung 2181 673
Bilateral/ Double Lung 1158 739
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
HEART TRANSPLANTATION
* Numbers may be low due to incomplete reporting.
475910
11931433 1637
1879 1999 1976 2002 2002 1890 1688 17411390 1190 978354
721
1305
1496
16761706
21062126 2171 2297 2340
23592343 2294
23452179
2197
78 143 316111 174
0
1000
2000
3000
4000
5000
Non-US US
Nu
mb
er o
f T
ran
spla
nts
*
*
12%
9%
6%
3%
% donors 50-55% donors 50+ P
ercent o
f Do
no
rs by A
ge
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
AGE DISTRIBUTIONOF HEART RECIPIENTS (1982-2000)
% o
f T
r%
of
Tra
ns
pla
nts
ns
pla
nts
0
10
20
30
40
50
<1 1-5 6-10 11-17 18-34 35-49 50-64 65+
Recipient Age
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
Congenital1.6%
ReTX2.1%
CAD46.1%
Valvular3.6%
Misc.1.3%
Myopathy45.3%
ADULT HEART TRANSPLANTATIONINDICATIONS
20
3040
5060
70
1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
% o
f C
as
es
Myopathy CAD
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS
0
100
200
300
400
11-17 Years1-10 Years
<1 Year
Nu
mb
er o
f T
ran
spla
nts
11 942
75
111 128
194
255
326365 363
386362 374
346375 352
332347
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
PEDIATRIC HEART TRANSPLANTATIONINDICATIONS BY AGE (1982-1999)
52.4%37.3%
5.0%5.3%
Myopathy Congenital Other ReTX
25.0%
6.3%3.4%
65.4%
2.6%76.5%
1.2%
19.7%
< 1 Year 1-10 Years 11-17 Years
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
HEART TRANSPLANTATIONACTUARIAL SURVIVAL (1982-2000)
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 Post-Transplantation
Su
rviv
al (
%)
N=52,195
Half-life =9.1 yearsConditional Half-life = 11.6 years
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT HEART TRANSPLANTATION ACTUARIAL SURVIVAL
50
60
70
80
90
100
0 6 12 18 24 30 36 42 48 54 60
Months Post Transplantation
1980-1987 (N=5,674) 1988-1992 (N=15,278)1993-1996 (N=13,622) 1997-2000 (N=11,639)
All comparisons with 1980-1987are significant at p < 0.0001
Su
rviv
al (
%)
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
0
20
40
60
80
100
0-1month
>1-2months
>2-6months
>6-12months
>12-24months
>24-36months
>36-48months
>48-60months
>60-84months
>84months
Inter-transplant interval
ADULT HEART RE-TRANSPLANTATION(1982-1999)
1 Y
ea
r P
atie
nt
Su
rviv
al (
%)
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT HEART TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY
N=38,943
VARIABLEOddsRatio P-value
95%Confidence
Interval
Ventilator 2.45 <.0001 2.05 -2.93
Repeat Transplant 2.39 <.0001 2.05 -2.80
Diagnosis: Congenital 1.67 <.0001 1.38 -2.02
VAD 1.29 0.0005 1.12 -1.49
Balloon Pump 1.26 0.002 1.09 -1.47
TX Year: 1988-1989 1.26 <.0001 1.16 -1.37
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT HEART TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY
N=38,943
VARIABLE Odds Ratio
P-value 95%
Confidence Interval
Diagnosis: Not CAD, Myopathy or Congenital 1.24 <.0001 1.13 -1.37
Female Donor/ Male Recipient 1.18 <.0001 1.11 -1.26
Pre-transplant Transfusions 1.18 0.01 1.04 -1.33
Donor CMV+/ Recipient CMV- 1.17 0.003 1.06 -1.29
Diagnosis: CAD 1.10 0.002 1.04 -1.17
TX Year: 1996-1999 0.93 0.02 0.87 -0.99
*
* Latest period in cohort
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT HEART TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY
N=38,943
VARIABLE ODDS RATIO P-VALUERecipient Age - linear <0.0001Recipient Age - quadratic <0.0001
20 years 0.91
35 years 0.86
50 years 0.99
65 years 1.37
Donor Age - linear <0.000120 years 0.83
35 years 1.07
50 years 1.40
65 years 1.81
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT HEART TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY
N=38,943
VARIABLE ODDS RATIO P-VALUEPeak PRA - linear <0.0001
0% 0.96
25% 1.15
50% 1.37
75% 1.64
100% 1.97
Recipient BMI - quadratic 0.0009Recipient Height - linear <0.0001
150 cm 1.34
175 cm 0.98
BMI: 25
200 cm 0.72
150 cm 1.77
175 cm 1.29
BMI: 33
200 cm 0.95
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT HEART TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY
N=38,943
VARIABLE ODDS RATIO P-VALUECenter Volume - linear <0.0001Center Volume - quadratic <0.0001
5 transplants/year 1.33
10 transplants/year 1.24
50 transplants/year 0.96
100 transplants/year 1.46
Ischemia Time - linear <0.00011 hour 0.84
3 hours 1.02
5 hours 1.24
7 hours 1.50
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT HEART TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY
N=26,250
VARIABLE Odds Ratio P-value
95% Confidence Interval
Repeat Transplant 2.645 <.0001 2.19 -3.17
Ventilator 1.65 <.0001 1.36 -2.00
Diagnosis: Congenital 1.28 0.02 1.04 -1.58 Diagnosis: Not CAD, Myopathy or Congenital 1.22 0.0001 1.10 -1.35
Female Donor/ Male Recipient 1.12 0.002 1.04 -1.20
Diagnosis: CAD 1.10 0.002 1.03 -1.17
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT HEART TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY
N=26,250
VARIABLE ODDS RATIO P-VALUERecipient Age - linear <0.0001Recipient Age - quadratic <0.0001
20 years 1.12
35 years 0.93
50 years 0.99
65 years 1.37
Donor Age - linear <0.000120 years 0.83
35 years 1.07
50 years 1.38
65 years 1.77
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT HEART TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY
N=26,250
VARIABLE ODDS RATIO P-VALUEPeak PRA - linear 0.0002
0% 0.97
25% 1.09
50% 1.22
75% 1.37
100% 1.53
Recipient BMI - quadratic 0.03Recipient Height - linear <0.0001
150 cm 1.30
175 cm 0.98
BMI: 25
200 cm 0.74
150 cm 1.57
175 cm 1.19
BMI: 33
200 cm 0.90
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT HEART TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY
N=26,250
VARIABLE ODDS RATIO P-VALUECenter Volume - linear <0.0001Center Volume - quadratic <0.0001
5 transplants/year 1.26
10 transplants/year 1.19
50 transplants/year 0.97
100 transplants/year 1.40
Ischemia Time - linear 0.00021 hour 0.90
3 hours 1.01
5 hours 1.14
7 hours 1.29
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
PEDIATRIC HEART TRANSPLANTATIONACTUARIAL SURVIVAL (1982-2000)
50
60
70
80
90
100
0 6 12 18 24 30 36 42 48 54 60
Months Post Transplantation
Su
rviv
al
(%)
<1 Year (N=1,099) 1-10 Years (N=1,642)11-17 Years (N=1,678) Overall (N=4,419)
All comparisons with <1 year significant at p < 0.0001
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
PEDIATRIC HEART TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY
N=3,760
VARIABLEOddsRatio P-value
95%Confidence
Interval
Balloon or VAD 2.23 0.0001 1.47 -3.37
Repeat Transplant 2.17 0.0005 1.40 -3.35
Ventilator 1.60 <.0001 1.27 -2.01
Diagnosis: Congenital 1.59 <.0001 1.32 -1.91
TX Year: 1988-1995 1.54 <.0001 1.28 -1.86
* Earliest period in cohort
*
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
PEDIATRIC HEART TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY
N=3,760
VARIABLE ODDS RATIO P-VALUERecipient Age - linear <.0001Recipient Age - quadratic 0.004
0 years 1.90
6 years 1.05
12 years 0.86
18 years 1.03
Donor Age - quadratic 0.002
0 years 1.06
10 years 1.00
20 years 1.06
30 years 1.24
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
PEDIATRIC HEART TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY
N=2,465
VARIABLEOddsRatio P-value
95%Confidence
Interval
Repeat Transplant 2.04 0.006 1.23 -3.41
Ventilator 1.49 0.002 1.16 -1.91
Female Recipient 1.28 0.008 1.07 -1.53
Diagnosis: Cardiomyopathy 0.79 0.02 0.65 -0.96
TX Year: 1995 0.70 0.01 0.53 -0.92
* Latest year in cohort
*
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
PEDIATRIC HEART TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY
N=2,465
VARIABLE ODDS RATIO P-VALUERecipient Age - linear <.0001Recipient Age - quadratic 0.0003
0 years 1.88
6 years 1.04
12 years 0.94
18 years 1.41
Donor Age - linear 0.005
0 years 1.06
10 years 1.00
20 years 1.06
30 years 1.24
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
PEDIATRIC HEART TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY
N=2,465
VARIABLE ODDSRATIO
P-VALUE
Donor BMI/Recipient BMI - linear 0.02
0.75 (donor size < recipient size) 1.29
1.00 (donor size = recipient size) 1.02
1.50 (donor size > recipient size) 0.65
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
FUNCTIONAL STATUS
0%
20%
40%
60%
80%
100%
1 Year 3 Years 5 Years
No Activity Limitations Performs with Assistance Total Assistance
Heart (April 1994-Dec. 2000)
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
EMPLOYMENT STATUS
0%
20%
40%
60%
80%
100%
1 Year 3 Years 5 Years
Working Full Time Working Part Time Not Working Retired
Heart (US Data: April 1994-Dec. 2000)
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
REHOSPITALIZATION POST HEARTTRANSPLANTATION (April 1994 - Dec. 2000)
0%
20%
40%
60%
80%
100%
1 Year 3 Years 5 Years
No Hospitalization Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection Hospitalized, Infection Only
Hospitalized, Rejection + Infection
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
0
20
40
60
80
100
Cyclosporine Tacrolimus MMF/Cellcept Azathioprine Prednisone
Year 1 Year 5
HEART TRANSPLANT MAINTENANCEIMMUNOSUPPRESSION
% o
f P
atie
nts
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
HEART TRANSPLANTATIONDonor age versus Ejection Fraction yr 1 to yr 2
-10%
-5%
0%
5%
10%
<20n=1326
20-29n=1291
30-39n=992
40-49n=764
50-59n=359
60-69n=41
Donor Age (Years)
% C
ha
ng
e i
n E
F
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
POST-HEART TRANSPLANT MORBIDITY (April 1994-December 2000)
Outcome 1-year Follow-up 5-year Follow-up
Hypertension 68.1% 68.0%
Renal Function None 78.1% 75.1% Renal Dysfunction 12.8% 14.0% Creatinine>5 mg/dl 7.8% 8.6% Chronic Dialysis 1.2% 1.9% Renal Transplant 0.1% 0.4%
Hyperlipidemia 40.6% 43.8%
Diabetes 20.8% 16.2%
CAV 7.8% 20.8%
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT HEART TRANSPLANTATION RISK FACTORS FOR CAV WITHIN 3 YEARS
N=7,691
VARIABLE Odds Ratio P-value95% Confidence
Interval
Diagnosis: CAD 1.15 0.02 1.03 - 1.30
TX Year: 1997 0.83 0.008 0.72 - 0.95
Female Donor 0.82 0.002 0.72 - 0.93
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT HEART TRANSPLANTATION RISK FACTORS FOR CAV WITHIN 3 YEARS
N=7,691
VARIABLE ODDS RATIO P-VALUERecipient Age - linear 0.005Recipient Age - quadratic 0.008
20 years 0.81
35 years 1.02
50 years 1.01
65 years 0.80
Donor Age - linear <.0001
Donor Age - quadratic 0.03
20 years 0.73
35 years 1.19
50 years 2.31
65 years 5.40
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
MALIGNANCY POST-HEART TRANSPLANTATION (April 1994-December 2000)
Yes3.5%
No96.5%
Not Reported13.5%
Skin37.3%
Other20.2%
Lymph29.0%
1-Year Followup
Yes8.8%
No91.2%
Not Reported13.1%
Skin52.1%
Other22.3%
Lymph12.5%
5-Year Followup
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
HEART TRANSPLANTS: CAUSE OF DEATH (1982-2000)
0
20
40
60
80
100
0-30 Days 31 Days - 1 Year >1 - 3 Years >3 - 5 Years
CAV Lymphoma Malignancy, OtherCMV Acute Rejection Infection, Non-CMV1°/NS Graft Failure
Timing of Death
Cau
se o
f D
eath
(%
)
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
1319
35
83
119
159
213
240 232221 217
194
221 218
145161
130131
104
0
50
100
150
200
250
No
. o
f T
ran
spla
nts
19
82
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
HEART-LUNG TRANSPLANTATION
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ReTX2.6%
Congenital32.4%
A1A3.1%
IPF2.8%
Misc.12.8%
PPH25.4%
COPD4.4% CF
16.3%
ADULT HEART-LUNG TRANSPLANTATIONINDICATIONS (1982-2000)
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
HEART-LUNG TRANSPLANTATIONACTUARIAL SURVIVAL (1982-2000)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Years Post Transplantation
N=2,550
Half-life = 2.8 yearsConditional Half-life = 8.2 years
Su
rviv
al (
%)
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
LUNG TRANSPLANTATION
0
200
400
600
800
1000
1200
1400
1600
1800
Nu
mb
er
of
Tra
ns
pla
nts
Bilateral/Double LungSingle Lung
18
20
22
24
26
28
30
32
34
36
38
Mean
Do
no
r Ag
e
4 7 38 74184
404
675
887
10621176
13311284
138613851325
1412
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
AGE DISTRIBUTION OF LUNG TRANSPLANTATION
0
10
20
30
40
50
% o
f tr
an
sp
lan
ts
<1 1-5 6-10 11-17 18-34 35-49 50-64 65+
Recipient Age
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
PPH4%
COPD47%
CF3%A1A
11%ReTX
3%
IPF21%
Misc.11%
ADULT LUNG TRANSPLANTATIONINDICATIONS (1983-2000)
Single Lung Bilateral/Double Lung
IPF7.8%
PPH9.0%
Misc.17.7%
COPD20.1%
CF33.3%ReTX
2.2%
A1A9.8%
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
PEDIATRIC LUNG TRANSPLANTATION
AGE DISTRIBUTION (1986-2000)
0
20
40
60
80
100
11-17 Years1-10 Years
<1 Year
Nu
mb
er o
f T
ran
spla
nts
1 3 4 6
19
4750
4541
80
68
85 86
64 65
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
CF51%
PPH12%
ReTX8%
Congenital
7%
Misc.18%
IPF4%
PEDIATRIC LUNG TRANSPLANTATIONINDICATIONS (1986-2000)
0
25
50
75
100
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
% o
f C
as
es PPH CF
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
LUNG TRANSPLANTATIONACTUARIAL SURVIVAL (1983-2000)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10 11 12
Years Post Transplantation
Su
rviv
al (
%)
Bilateral/Double Lung (N=4,908)
Single Lung (N=6,375)
All Lungs (N=11,283)
Double lung: 1/2-life = 4.5 Years; Conditional 1/2-life = 7.9 YearsSingle lung: 1/2-life = 3.6 Years; Conditional 1/2-life = 5.7 YearsAll lungs: 1/2-life = 3.8 Years; Conditional 1/2-life = 6.3 Years
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT LUNG TRANSPLANTATIONACTUARIAL SURVIVAL (1988-2000)
0
25
50
75
100
0 1 2 3 4 5
Years Post-Transplantation
Su
rviv
al (
%)
1988-1992 (N=1,955)1993-1996 (N=4,115)1997-2000 (N=4,500)
Comparison of 1988-1992 vs. 1997-2000 was significant at p = 0.002
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
PEDIATRIC LUNG/HRT-LUNG TRANSPLANTATION
ACTUARIAL SURVIVAL (1984-2000)
0
25
50
75
100
0 1 2 3 4 5 6 7
Years Post Transplantation
Su
rviv
al (
%)
Single Lung (N=115)
Bilateral/Double Lung (N=484)
Heart-Lung (N=417)
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY
N=9,653
VARIABLEOddsRatio P-value
95%Confidence
Interval
Ventilator 3.48 <.0001 2.51 - 4.81
Diagnosis: Congenital 2.04 <.0001 1.50 - 2.78
Diagnosis: PPH 1.50 <.0001 1.23 - 1.83
Donor CMV+/ Recipient CMV- 1.44 <.0001 1.25 - 1.67
TX Year: 1988-1991 1.37 <.0001 1.19 - 1.58
* Earliest period in cohort
*
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY
N=9,653
VARIABLE Odds Ratio P-value
95% Confidence
Interval
Repeat Transplant 1.35 0.002 1.11 - 1.64
Female Recipient 0.85 0.002 0.77 - 0.94
Diagnosis: Alpha-1 Antitrypsin 0.83 0.04 0.70 - 0.99
Diagnosis: Emphysema/COPD 0.56 <.0001 0.49 - 0.63
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY
N=9,653
VARIABLE ODDS RATIO P-VALUERecipient Age - linear <.0001Recipient Age - quadratic 0.0002
20 years 0.82
35 years 0.83
50 years 1.09
65 years 1.86
Recipient BMI - linear <0.000117 0.83
22 0.97
27 1.13
32 1.32
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY
N=9,653
VARIABLE ODDS RATIO P-VALUEDonor Height - linear 0.0052
140 cm 1.41
160 cm 1.15
180 cm 0.94
200 cm 0.76
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY
N=9,653
VARIABLE ODDSRATIO
P-VALUE
Donor Age - quadratic 0.002Center Volume - linear <.0001
Interaction of Donor Age and Volume 0.02
5 transplant/year 1.17
30 transplant/year 0.88
30 year
55 transplant/year 0.66
5 transplant/year 1.52
30 transplant/year 1.42
60 years
55 transplant/year 1.32
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY
N=5,050
VARIABLEOddsRatio P-value
95%Confidence
Interval
Ventilator 3.01 <.0001 1.79 - 5.06
Donor CMV +/Recipient CMV - 1.42 0.0007 1.16 - 1.74
TX Year: 1988-1991 1.21 0.01 1.04 - 1.41
Female Recipient 0.87 0.02 0.77 - 0.98
Double Lung Transplant 0.84 0.02 0.73 - 0.97
Diagnosis: Emphysema/COPD 0.76 0.0005 0.65 - 0.89
Diagnosis: Alpha-1 Antitrypsin 0.70 0.0005 0.57 - 0.86
* Earliest period in cohort
*
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY
N=5,050
VARIABLE ODDS RATIO P-VALUERecipient Age - linear <.0001Recipient Age - quadratic <.0001
20 years 1.22
35 years 0.91
50 years 1.08
65 years 2.10
Recipient BMI - linear 0.002
17 0.83
22 0.97
27 1.13
32 1.31
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY
N=5,050
VARIABLE ODDSRATIO
P-VALUE
Donor Age - quadratic 0.01Center Volume - linear 0.003Interaction of Donor Age and Volume 0.01
5 Transplants/Year 1.12
30 Transplants/Year 0.91
30 Years
55 Transplants/Year 0.74
5 Transplants/Year 2.37
30 Transplants/Year 1.16
60 Years
55 Transplants/Year 0.57
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY
N=5,050
VARIABLE ODDSRATIO
P-VALUE
Interaction of Donor Age and Ischemia Time 0.03
1 Hour 1.01
4 Hours 1.00
30 Years
7 Hours 0.99
1 Hours 1.12
4 Hours 1.55
60 Years
7 Hours 2.14
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
FUNCTIONAL STATUS
0%
20%
40%
60%
80%
100%
1 Year 3 Years 5 Years
No Activity Limitations Performs with Assistance Total Assistance
Lung (April 1994-December 2000)
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
EMPLOYMENT STATUS
0%
20%
40%
60%
80%
100%
1 Year 3 Years 5 Years
Working Full Time Working Part Time Not Working Retired
Lung (US: April 1994-December 2000)
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
REHOSPITALIZATION POST LUNGTRANSPLANTATION (April 1994 - December 2000)
0%
20%
40%
60%
80%
100%
1 Year 3 Years 5 Years
No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Only Hospitalized, Infection OnlyHospitalized, Rejection and Infection
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
POST-LUNG TRANSPLANT MORBIDITY (April 1994-December 2000)
Outcome 1-year Follow-up 5-year Follow-up
Hypertension 48.0% 62.5%
Renal Function None 77.8% 64.0% Renal Dysfunction 12.6% 17.6% Creatinine>5 mg/dl 8.0% 14.4% Chronic Dialysis 1.6% 3.2% Renal Transplant 0.0% 0.7%
Hyperlipidemia 12.5% 20.5%
Diabetes 16.5% 16.1%
Bronchiolitis Obliterans 10.7% 29.5%
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT LUNG TRANSPLANTATION RISK FACTORS FOR BRONCHIOLITIS WITHIN 3 YEARS
N=2,756
VARIABLEOddsRatio P-value
95% ConfidenceInterval
Repeat Transplant 2.68 0.001 1.47 - 4.87
TX Year: 1993 1.41 0.003 1.13 - 1.77
Female Donor 0.79 0.01 0.66 - 0.95
TX Year: 1997 0.66 0.0001 0.53 - 0.81
** Latest year in cohort
* Earliest year in cohort
*
**
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT LUNG TRANSPLANTATION RISK FACTORS FOR BRONCHIOLITIS WITHIN 3 YEARS
N=2,756
VARIABLE ODDS RATIO P-VALUERecipient Age - quadratic 0.01
20 years 1.52
35 years 1.09
50 years 1.00
65 years 1.20
Recipient BMI - linear 0.05
17 0.86
22 0.97
27 1.10
32 1.25
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
ADULT LUNG TRANSPLANTATION RISK FACTORS FOR BRONCHIOLITIS WITHIN 3 YEARS
N=2,756
VARIABLE ODDS RATIO P-VALUEIschemia Time - linear 0.002
1 Hour 0.773 Hours 0.905 Hours 1.047 Hours 1.21
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
MALIGNANCY POST-LUNG TRANSPLANTATION (April 1994-December 2000)
Yes4.4%
No95.6%
Not Reported12.4%
Skin15.3%
Other19.2% Lymph
53.1%
1-Year Followup
Yes5.8%
No94.2%
Not Reported9.7%
Skin55.6%
Other18.1%
Lymph16.7%
5-Year Followup
2001J Heart Lung Transplant 2001; 20: 805-815; 2002: 21: 827-840
LUNG TRANSPLANTS: CAUSE OF DEATH (1982-2000)
0
20
40
60
80
100
0-30 Days 31 Days - 1 Year >1 - 3 Years >3 - 5 Years
CAD Cardiac Malignancy, OtherLymphoma CMV Acute RejectionInfection, Non-CMV Bronchiolitis 1°/NS Graft FailureTechnical
Timing of Death
Cau
se o
f D
eath
(%
)
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