heart transplantation overall ishlt 2005 j heart lung transplant 2005;24: 945-982
TRANSCRIPT
HEART TRANSPLANTATION
Overall
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR
189 317669
1185
2160
2718
31573383
40314196 4219 4389 4435 4358 4251 4157
38183547 3402 3340 3252 3135
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Nu
mb
er
of
Tra
nsp
lan
ts .
ISHLT 2005
NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of hearts transplanted worldwide has declined in recent years.
J Heart Lung Transplant 2005;24: 945-982
AVERAGE CENTER VOLUMEHeart Transplants: January 1, 1997 - June 30, 2004
62
39
82
45
18
4552
79
22 203 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
of
cen
ters
.
1997-1999
2000-6/2004
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME
Heart Transplants: January 1, 1997 - June 30, 2004
3 6
28 27
15
58 9
310
33
1620
49
60
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
2000-6/2004
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% o
f T
ran
sp
lan
ts .
0-10 11-17 18-34 35-49 50-59 60+
0
5
10
15
20
25
30
35
Mean
do
no
r ag
e (years
)
Mean Age
HEART TRANSPLANTS: Donor Age by Year of Transplant
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
AGE DISTRIBUTIONOF HEART RECIPIENTS (1/1982-6/2004)
% o
f T
r%
of
Tra
ns
pla
nts
ns
pla
nts
0
5
10
15
20
25
30
35
40
0-9 10-19 20-29 30-39 40-49 50-59 60+
Recipient Age
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
AGE DISTRIBUTION OF HEART TRANSPLANT RECIPIENTS BY ERA
0
5
10
15
20
25
30
35
40
0-9 10-19 20-29 30-39 40-49 50-59 60+
Recipient Age
% o
f tr
an
sp
lan
ts
1982-1988 (N = 9,718)1989-1993 (N = 19,602)1994-1998 (N = 20,587)1999-2003 (N = 16,657)
P < 0.0001
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2003)
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 21
Years
Su
rviv
al (%
) .
Half-life = 9.6 yearsConditional Half-life = 12 years
N=66,751
ISHLT 2005
N followed at longest time point: 25,908
J Heart Lung Transplant 2005;24: 945-982
HEART TRANSPLANTATION
Adult Recipients
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
Congenital2%
ReTX2%
Myopathy45%
Misc.1%
Valvular4%
CAD46%
1982-1999
DIAGNOSIS IN ADULT HEART TRANSPLANTS
203040506070
% o
f Cas
es
Myopathy CAD
CAD45%
Valvular3%
Misc.1%
Myopathy47%
ReTX2%
Congenital2%
1/2000-6/2004
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982 – 6/2003)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12
Years
1982-1988 (N=9,148)
1989-1993 (N=17,898)
1994-1998 (N=18,714)
1999-6/2003 (N=13,480)
All comparisons significant at p < 0.01
HALF-LIFE 1982-1988: 8.1 years; 1989-1993: 9.5 years; 1994-1998: 9.8 years
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1982-6/2003)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12
Years
Su
rviv
al (%
) .
18-34 (N= 6,211) 35-49 (N=17,276)50-59 (N=23,589) 60-64 (N=8,808)65-69 (N= 2,812) 70+ (N= 284)
HALF-LIFE 18-34: 11.7 years; 35-49: 10.4 years; 50-59: 9.3 years; 60-64: 8.5 years; 65-69: 8.1 years; 70+: 7.1 years
All pair-wise comparisons are statistically significant at p < 0.05 except 65-69 vs. 70+
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1996-6/2003)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8
Years
Su
rviv
al (%
) .
18-34 (N= 2,267) 35-49 (N= 5,988)50-59 (N=9,520) 60-64 (N=4,446)65-69 (N= 1,845) 70+ (N= 217)
All pair-wise comparisons are statistically significant at p < 0.05 except 18-34 vs. 50-64 and 65-69 vs. 70+
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival for Simultaneous Heart and Kidney
Transplants Compared to Heart-Alone Transplants (Transplants: 1/1982-6/2003)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12
Years
Su
rviv
al (
%)
.
Heart alone (N=58,343) Simultaneous Heart+Kidney (N=336)
HALF-LIFE:Heart alone = 9.5 YearsSimultaneous Heart + Kidney = n.c.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival for Kidney after Heart Transplants Compared to
Heart-Alone Transplants* (Transplants: 1/1982-6/2003)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12
Years from Kidney Transplant Report for Kidney after Heart Transplants and Years from Transplant + Median for Heart-Alone Transplants**
Su
rviv
al (
%)
.
Heart alone (N=12,867) Kidney after Heart (N=499)
HALF-LIFE FOLLOWING KIDNEY TRANSPLANT (KI AFTER HR) OR FROM MEDIAN TIME TO KIDNEY TRANSPLANT REPORT (HEART ALONE):Heart alone* = 7.4 YearsKidney after Heart = 4.9 Years
ISHLT 2005
* For comparison purposes, the heart-alone transplant cohort was limited to those transplants that had survived to the median time to kidney transplant for the kidney after heart transplant (8.0 years).
** Survival time since “kidney transplant” (transplant date not reported, only time point at which kidney transplant has already occurred)
J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival for Kidney after Heart Transplants Compared to
Kidney after Simultaneous Heart and Kidney Transplants (Transplants: 1/1982-6/2003)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12
Years from Kidney Transplant Report*
Su
rviv
al (
%)
.
Kidney after Heart+Kidney (N=62) Kidney after Heart (N=499)
HALF-LIFE FOLLOWING KIDNEY TRANSPLANT:Kidney after Heart+Kidney = 5.1 YearsKidney after Heart = 4.9 Years
ISHLT 2005* Survival time since “kidney transplant” (transplant date not reported, only time point at which kidney transplant has already occurred)
J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1982-6/2003)
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
Su
rviv
al (
%)
.
Cardiomyopathy (N = 25,623) Coronary artery disease (N = 26,065)Congenital diagnosis (N = 971) Retransplant (1,125)Valvular (N= 2,021) Other (N= 804)
HALF-LIFE Cardiomyopathy: 10.6 years; CAD: 8.9 years; Congenital: 11.7 years; Retransplant: 4.4 years; Valvular: 10.2 years; Other: 11.3 years
All pair-wise comparisons with Cardiomyopathy are significant at p < 0.05 except for Congenital; Coronary Artery Disease vs. ReTx: p < 0.0001; Coronary Artery Disease vs. Valvular: p = 0.02; Valvular vs. ReTx: p < 0.0001; Congenital vs. ReTx: p < 0.0001; ReTx vs. Other: p < 0.0001
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis
Conditional on Survival to 1 Year (Transplants: 1/1982-6/2003)
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
Su
rviv
al (
%)
.
Cardiomyopathy (N = 19,185)Coronary artery disease (N = 19,293)Congenital diagnosis (N = 658)Retransplant (659)Valvular (N= 1,369)Other (N= 505)
All pair-wise comparisons are significant except Cardiomyopathy vs. valvular, valvular vs. other, and congenital vs. other
HALF-LIFE Cardiomyopathy: 12.8 years; CAD: 11.0 years; Congenital: 11.5 years; Retransplant: 8.5 years; Valvular: 12.9 years; Other: 14.4 years
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1996-6/2003)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
Su
rviv
al (
%)
.
Cardiomyopathy (N=10,770) Coronary artery disease (N=10,810)Congenital Diagnosis (N=454) Retransplant (N=465)Valvular (N=712) Other (N=456)
All pair-wise comparisons with Cardiomyopathy are significant at p < 0.05 except for Valvular; Coronary Artery Disease vs. ReTX: p < 0.0001
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis Conditional on Survival to 1 Year (Transplants: 1/1996-6/2003)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
Su
rviv
al (
%)
Cardiomyopathy (N=8,080) Coronary artery disease (N=7,949)
Congenital Diagnosis (N=290) Retransplant (N=307)
Valvular (N=475) Other (N=289)
Cardiomyopathy vs. CAD: p = 0.0009; Cardiomyopathy vs. ReTx: p = 0.02; CAD vs. Congenital: p = 0.03; CAD vs. Valvular: p = 0.01; Valvular vs. ReTx: p = 0.006; Congenital vs. ReTx: p = 0.01
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by PVR (Transplants: 1/2000-6/2003)
50
60
70
80
90
100
0 1 2 3 4
Years
Su
rviv
al (
%)
1-<3 Wood units (N= 3,644) 3-<5 Wood units (N= 1,019)
5+ Wood units (N= 342)
1-<3 vs. 3-<5: p = 0.02
1-<3 vs. 5+: p = 0.009
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage (Transplants: 1/1999-6/2003)
50
60
70
80
90
100
0 1 2 3 4 5
Years
Su
rviv
al (
%)
Heartmate/Novacor (N=1,055) No LVAD (N=7,000)
p = 0.022
ISHLT 2005
Note: Only 32 transplants involving continuous flow devices and 33 with ECMO; too few to analyze.
J Heart Lung Transplant 2005;24: 945-982
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
1/1991-12/1998
1/1999-6/2003
Comparison of survival for interval < 12 months vs. > 12 months: p < 0.0001Comparison of survival for interval < 12 months vs. > 12 months for 1/99-6/2003: p < 0.0001
124
143
32 19 2731 66 863722 25 231
50 2 2 81 21 190
ADULT HEART RE-TRANSPLANTS1-Year Survival
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: April 1994 - June 2004)
0%
20%
40%
60%
80%
100%
1 Year (N = 15,901) 3 Years (N = 13,954) 5 Years (N = 11,872) 7 Years (N = 9,144)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART RECIPIENTSEmployment Status of Surviving Recipients
(Follow-ups: April 1994 - June 2004)
0%
20%
40%
60%
80%
100%
1 Year (N = 14,888) 3 Year (N = 12,842) 5 Year (N = 10,848) 7 Year (N = 8,371)
Retired
Not Working
Working Part Time
Working Full Time
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART RECIPIENTSRehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2004)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N = 17,511)
Between 2 and 3 Years (N = 14,928)
Between 4 and 5 Years (N = 12,671)
Between 6 and 7 Years (N = 9,920)
No Hospitalization Hospitalized: Not Rejection/Not InfectionHospitalized: Rejection Only Hospitalized: Infection OnlyHospitalized: Rejection + Infection
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0
10
20
30
40
50
Any Induction (N = 3,607) Polyclonal ALG/ATG (N = 1,699)
OKT3 (N = 427) IL2R-antagonist (N = 1,618)
% o
f p
atien
tsADULT HEART RECIPIENTS
Induction Immunosuppression (Follow-ups: January 2001 – June 2004)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0
10
20
30
40
50
60
Any Induction PolyclonalALG/ATG
OKT3 IL2R-antagonist
% o
f p
ati
en
ts
2001 2002 2003 1/2004-6/2004
ADULT HEART RECIPIENTSInduction Immunosuppression (Follow-ups: January 2001 - June 2004)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
ati
en
ts .
Year 1 (N = 4,015) Year 5 (N = 3,389)
ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2002 - June 2004)
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
atie
nts
.
1998 (N = 216) 2002 (N = 1,648) Jan 2004 - Jun 2004 (N = 809)
ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of 1 Year Follow-up
NOTE: Different patients are analyzed in each time frame.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0%
20%
40%
60%
80%
100%
Year 1 (N = 3,939) Year 5 (N = 3,353)
% o
f P
atie
nts
.
Other
Tacrolimus
Cyclosporine
Rapa + cellcycle
Rapa + calcineurin
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine + MMF
Cyclosporine + AZA
ADULT HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
(Follow-ups: January 2002 - June 2004)
NOTES: Different patients are analyzed in Year 1 and Year 5. In the Year 1 cohort 77.5% of patients were on prednisone; in the Year 5 cohort 62% of patients were on prednisone.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2003)
0
10
20
30
40
50
60
70
Overall 18-34 35-49 50-64 65+ F M
% t
reate
d f
or
reje
cti
on
wit
hin
1 y
ear
.
No induction (N = 4,236) Polyclonal (N = 1,715)IL2R-antagonist (N = 1,376) OKT3 (N = 491)
For females: no induction vs. OKT3 (p = 0.0001); polyclonal vs. OKT3 (p = 0.001); IL2R vs. OKT3 (p = 0.002)For males: no induction vs. OKT3 (p = 0.0002); polyclonal vs. OKT3 (p = 0.0002); IL2R vs. OKT3 (p = 0.002)
Overall: All comparisons with OKT3 were significant at p < 0.0001. 50-64: All comparisons with OKT3 were significant at p < 0.0001. No other comparisons within age groups were statistically significant.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
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, 2003)
0
0.5
1
1.5
2
2.5
3
Overall 18-34 35-49 50-64 65+ F M
Avera
ge n
um
ber
of
reje
cti
on
ep
iso
des .
No induction (N = 4,236) Polyclonal (N = 1,715)IL2R-antagonist (N = 1,376) OKT3 (N = 491)
Overall: No induction vs. OKT3 (p = 0.0026); polyclonal vs. OKT3 (p=0.0065); IL2 vs. OKT3 (p=0.0004).
50-64: No induction vs. OKT3 (p = 0.006); polyclonal vs. OKT3 (p = 0.045); IL2 vs. OKT3 (p = 0.002)
For females: no induction vs. OKT3 (p = 0.008)
For males: polyclonal vs. OKT3 (p =0.04); IL2 vs. OKT3 (p = 0.003)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2003)
0
10
20
30
40
50
60
70
Overall 18-34 35-49 50-64 65+ F M
% t
reate
d f
or
reje
cti
on
wit
hin
1 y
ear
.
Cyclosporin + MMF (N = 1,850) Cyclosporin + AZA (N = 375)Tacrolimus + MMF (N = 400) Tacrolimus + AZA (N = 47)
Overall: CyA + MMF vs. TAC + MMF (p<0.0001); CyA + MMF vs. TAC + AZA (p=0.02); CyA + AZA vs. TAC + MMF (p<0.0001); CyA + AZA vs. TAC + AZA (p=0.0056). 18-34: All comparisons significant except CyA + MMF vs. CyA + AZA. 35-49: CyA + MMF vs. TAC + MMF (p=0.0001); CyA + AZA vs. TAC + MMF (p=0.004). 50-64: CyA + MMF vs. TAC + MMF (p<0.0001); CyA + AZA vs. TAC + MMF (p<0.0001). 65+: CyA + AZA vs. TAC + MMF (p=0.04). For females all comparisons are significant except TAC + MMF vs. TAC + AZA. For males: CyA + MMF vs. TAC + MMF (p<0.0001); CyA + AZA vs. TAC + MMF (p<0.0001)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
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, 2003)
0
0.5
1
1.5
2
2.5
Overall 18-34 35-49 50-64 65+ F M
Avera
ge n
um
ber
of
reje
cti
on
ep
iso
des .
Cyclosporin + MMF (N = 1,850) Cyclosporin + AZA (N = 375)Tacrolimus + MMF (N = 400) Tacrolimus + AZA (N = 47)
Overall: CyA + MMF vs. TAC + MMF (p = 0.04); CyA + AZA vs. TAC + MMF (p = 0.014)35-49: CyA + MMF vs. TAC + MMF (p = 0.04)Male: CyA + AZA vs. TAC + MMF (p = 0.008)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 1 Year Post-Transplant
(Follow-ups: April 1994 - June 2003)
Follow-ups: April 1994-
December 1999 Follow-ups: January 2000 –
June 2003
Outcome Within 1
Years Total N with
known response Within 1
Year Total N with
known response
Hypertension 72.6% (N = 9,659) 76.8% (N = 5,668)
Renal Dysfunction 25.7% (N = 9,534) 31.7% (N = 5,727)
Abnormal Creatinine < 2.5 mg/dl 15.2% 22.1% Creatinine > 2.5 mg/dl 9.1% 7.8% Chronic Dialysis 1.2% 1.5% Renal Transplant 0.2% 0.3%
Hyperlipidemia 49.8% (N = 10,225) 68.7% (N = 6,035)
Diabetes 23.7% (N = 9,634) 30.2% (N = 5,674)
Coronary Artery Vasculopathy 8.7% (N = 8,577) 7.0% (N = 5,125)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 5 and 8 Years Post-Transplant
(Follow-ups: April 1994 - June 2004)
Outcome Within 5
Years Total N with
known response Within 8
Years Total N with
known response
Hypertension 94.0% (N = 6,221) 97.7% (N = 2,103)
Renal Dysfunction 32.4% (N = 6,650) 35.6% (N = 2,348)
Abnormal Creatinine < 2.5 mg/dl 20.5% 19.7% Creatinine > 2.5 mg/dl 9.1% 10.6% Chronic Dialysis 2.5% 4.4% Renal Transplant 0.4% 0.9%
Hyperlipidemia 85.1% (N = 6,927) 91.2% (N = 2,425)
Diabetes 33.2% (N = 6,167) 36.5% (N = 2,108)
Coronary Artery Vasculopathy 32.3% (N = 4,418) 45.7% (N = 1,305)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
FREEDOM FROM CORONARY ARTERY VASCULOPATHY AND FREEDOM FROM SEVERE RENAL DYSFUNCTION*
For Adult Heart Recipients (Follow-ups: April 1994-June 2004)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
% F
ree f
rom
CA
V o
r F
reed
om
fro
m .
Severe
Ren
al D
ysfu
ncti
on
Freedom from CAV
Freedom from Severe Renal Dysfunction
* Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
FREEDOM FROM CORONARY ARTERY VASCULOPATHY Stratified by Diagnosis
For Adult Heart Recipients (Follow-ups: April 1994 - June 2004)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
% F
ree f
rom
CA
V .
Coronary Artery Disease (N = 9,428)
Cardiomyopathy (N = 8,870)
p = 0.0003
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
MALIGNANCY POST-HEART TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2004)
Malignancy/Type 1-Year Survivors
5-Year Survivors
8-Year Survivors
No Malignancy 17250 (96.9%) 5753 (83.9%) 1757 (73.8%)
Malignancy (all types combined) 544 (3.1%) 1108 (16.1%) 625 (26.2%)
Malignancy Type
Skin 249 748 423
Lymph 129 115 40
Other 115 267 123
Type Not Reported 47 39 15
”Other” includes: prostate (11, 34, 21), adenocarcinoma (7, 4, 2), lung (5, 4, 1), bladder (4, 5, 5), sarcoma (3, 3, 1), breast (2, 8, 3), cervical (2, 4, 0), colon (2, 3, 3), and renal (2, 7, 2). Numbers in parentheses are those reported within 1 year, 5 years and 8 years, respectively.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
FREEDOM FROM MALIGNANCYFor Adult Heart Recipients (Follow-ups: April 1994 - June 2004)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
% F
ree f
rom
Malig
nan
cy .
All malignancy Lymph Skin Other
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2004)
CAUSE OF DEATH 0-30 Days
(N = 2,984)31 Days - 1 Year
(N = 2,523)>1 Year - 3 Years
(N = 1,892)>3 Years - 5 Years
(N = 1,631)>5 Years
(N = 4,823)
Coronary Artery Vasculopathy
47 (1.6%) 117 (4.6%) 271 (14.3%) 275 (16.9%) 719 (14.9%)
ACUTE REJECTION 199 (67%) 306 (12.1%) 182 (9.6%) 67 (4.1%) 65 (1.3%)
LYMPHOMA 2 (0.1%) 48 (1.9%) 81 (4.3%) 86 (5.3%) 221 (4.6%)
MALIGNANCY, OTHER 2 (0.1%) 52 (2.1%) 196 (10.3%) 299 (18.3%) 883 (18.3%)
CMV 4 (0.1%) 31 (1.2%) 15 (0.8%) 3 (0.2%) 5 (0.1%)
INFECTION, NON-CMV 386 (12.9%) 826 (32.7%) 252 (13.3%) 153 (9.4%) 481 (10.0%)
PRIMARY FAILURE 786 (26.3%) 190 (7.5%) 125 (6.6%) 68 (4.2%) 208 (4.3%)
GRAFT FAILURE 416 (13.9%) 263 (10.4%) 314 (16.6%) 236 (14.5%) 668 (13.9%)
TECHNICAL 220 (7.4%) 28 (1.1%) 15 (0.8%) 17 (1.0%) 44 (0.9%)
OTHER 175 (5.9%) 200 (7.9%) 172 (9.1%) 158 (9.7%) 453 (9.4%)
MULTIPLE ORGAN FAILURE
417 (14.0%) 254 (10.1%) 97 (5.1%) 94 (5.8%) 396 (8.2%)
RENAL FAILURE 18 (0.6%) 19 (0.8%) 31 (1.6%) 59 (3.6%) 291 (6.0%)
PULMONARY 122 (4.1%) 85 (3.4%) 85 (4.5%) 62 (3.8%) 189 (3.9%)
CEREBROVASCULAR 190 (6.4%) 104 (4.1%) 61 (3.2%) 54 (3.3%) 200 (4.1%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death from Leading Causes by Era
(Deaths: January 1992 - June 2004)
CAUSE OF DEATH
DATE OF DEATH
0-30 Days
(N = 2,984)31 Days - 1 Year
(N = 2,523)>1 Year - 3 Years
(N = 1,892)>3 Years - 5 Years
(N = 1,631)>5 Years
(N = 4,823)
ACUTE REJECTION
1992-1997 118 (6.9%) 221 (13.8%) 111 (9.2%) 37 (4.0%) 19 (1.2%)
1998-6/2004 81 (6.3%) 85 (9.2%) 71 (10.2%) 30 (4.3%) 49 (1.4%)
CORONARY ARTERY VASCULOPATHY
1992-1997 29 (1.7%) 82 (5.1%) 180 (15.0%) 186 (20.1%) 296 (18.6%)
1998-6/2004 18 (1.4%) 35 (3.8%) 91 (13.1%) 89 (12.6%) 423 (13.1%)
GRAFT FAILURE1992-1997
251 (28.0%)
175 (11.0%) 194 (16.1%) 116 (12.5%) 187 (11.7%)
1998-6/2004165
(12.9%)88 (9.5%) 120 (17.3%) 120 (17.0%) 481 (14.9%)
MALIGNANCY, OTHER
1992-1997 2 (0.1%) 38 (2.4%) 116 (9.7%) 177 (19.1%) 281 (17.6%)
1998-6/2004 14 (1.5%) 80 (11.5%) 122 (17.3%) 602 (18.6%)
PRIMARY FAILURE
1992-1997 497
(29.1%)169 (10.6%) 105 (8.7%) 48 (5.2%) 108 (6.8%)
1998-6/2004 289
(22.6%)21 (2.3%) 20 (2.9%) 20 (2.8%) 100 (3.1%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANT RECIPIENTS: Cumulative Incidence of Leading Causes of Death
(Transplants: January 1992 - June 2003)
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
0 1 2 3 4 5 6 7 8
Time (years)
% c
au
se-s
pecif
ic d
eath
s
CAV Acute Rejection Malignancy (non-Lymph/PTLD)Primary Failure Graft Failure CMV
Infection (non-CMV)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/2003) Risk Factors for 1 Year Mortality
1996-1999 (N=13,365)
2000-6/2003 (N=9,743)
Risk Factor N Relative
Risk p-value N
Relative Risk
p-value
Diagnosis: Congenital heart disease 203 1.77 .0001 221 2.51 <0.0001
Temporary circulatory support* 46 2.40 .0001 129 2.07 <0.0001
Ventilator 263 1.59 .0002 244 1.73 .0001
Dialysis 160 1.56 .0018 222 1.69 .0001
Hospitalized at transplant (including ICU) 9494 1.30 <0.0001 6084 1.58 <0.0001
Donor history of cancer 150 1.22 .2719 137 1.58 .0117
Female recipient/male donor 1244 1.11 .2220 971 1.46 .0001
Donor cause of death: cerebrovascular/stroke
3419 0.98 .6972 2658 1.27 .0002
Female recipient/female donor 1549 1.07 .4298 1273 1.25 .0292
Pulsatile chronic VAD 304** 0.99 .9340 1234 1.22 .0394
2005ISHLTNote: All factors were significant at p < 0.05 in at least one of the eras.
* Temporary circulatory support includes ECMO and Abiomed.**VAD type collected for only part of era. Only those with known type were included in this group.
J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/2003) Risk Factors for 1 Year Mortality
1996-1999 (N=13,365)
2000-6/2003 (N=9,743)
Risk Factor N Relative
Risk p-
value N
Relative Risk
p-value
Repeat transplant 306 1.91 <0.0001 225 1.18 .3747
Transplant year = 2000 vs. 2002/2003 . . 2892 1.18 .0101
Diagnosis: Coronary artery disease 6030 1.13 .0120 4324 1.17 .0128
PRA > 10% 606 1.40 .0002 492 1.13 .3018
HLA DR mismatches (per mismatch) 591 0 MM
1.16 .0003 433 0 MM
1.10 .0596
Intra-aortic balloon pump 479 1.41 .0006 427 1.02 .8722
HLA B mismatches (per mismatch) 237 0 MM
1.17 .0015 155 0 MM
1.02 .7367
Infection requiring IV drug therapy within 2 weeks of transplant
691 1.21 .0366 798 0.99 .9348
Prior transfusions 1367 1.20 .0129 1454 0.90 .2329
IV inotropes 4811 0.79 <0.0001 3401 0.75 <0.0001
2005ISHLTNote: All factors were significant at p < 0.05 in at least one of the eras.
J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/2003) Borderline Significant Risk Factors for 1 Year Mortality
1996-1999 (N=13,365)
2000-6/2003 (N=9,743)
Risk Factor N Relative
Risk p-value N
Relative Risk
p-value
Diagnosis: Valvular heart disease 392 1.22 .0975 283 1.24 .1485
Insulin-dependent diabetes 645 1.10 .3040 574 1.21 .0824
Male recipient/female donor 2873 1.10 .0770 1900 1.10 .1779
2005ISHLTNote: All factors were significant at 0.5 < p < 0.1 in at least one of the eras.
J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/2003) Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Recipient age
Recipient weight
Donor age
Donor/recipient weight ratio
Transplant center volume
PA diastolic pressure
Ischemia time
Bilirubin
Serum creatinine
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/2003) 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
Rela
tive R
isk o
f 1 Y
ear
Mo
rtalit
y
1996-1999
2000-6/2003
p < 0.0001p < 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/2003) Risk Factors for 1 Year Mortality
Donor Age
0
0.5
1
1.5
2
15 25 35 45 55
Donor Age
Rela
tive R
isk o
f 1 Y
ear
Mo
rtalit
y
1996-1999
2000-6/2003
p < 0.0001p < 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/2003) Risk Factors for 1 Year MortalityPre-Transplant Recipient Weight
0
0.5
1
1.5
2
50 60 70 80 90 100 110
Recipient Weight (kg)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtalit
y
1996-1999
2000-6/2003
p = 0.0006p = 0.53
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/2003) Risk Factors for 1 Year Mortality
Pre-Transplant Recipient BMI
0
0.5
1
1.5
2
17 21 25 29 33 37
Recipient BMI (kg/m2)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtalit
y
1996-1999
2000-6/2003
p = 0.04p = 0.43
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/2003) Risk Factors for 1 Year MortalityDonor Weight/Recipient Weight
0
0.5
1
1.5
2
0.6 0.7 0.8 0.9 1 1.1 1.2 1.3 1.4 1.5 1.6 1.7
Donor Weight/Recipient Weight
Rela
tive R
isk o
f 1 Y
ear
Mo
rtalit
y
1996-1999
2000-6/2003
p = 0.0002p = 0.11
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/2003) 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)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtalit
y
1996-1999
2000-6/2003
p = 0.0001p < 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/2003) 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)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtalit
y 1996-1999
2000-6/2003
p < 0.0001p < 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/2003) Risk Factors for 1 Year Mortality
Pre-Transplant Bilirubin
0
0.5
1
1.5
2
0.5 1.5 2.5 3.5 4.5
Recipient bilirubin (mg/dl)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtalit
y
1996-1999
2000-6/2003
p = 0.0004p = 0.0004
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/2003) Risk Factors for 1 Year Mortality
Pre-Transplant Creatinine
0
0.5
1
1.5
2
0.6 1.1 1.6 2.1 2.6
Recipient creatinine (mg/dl)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtalit
y
1996-1999
2000-6/2003
p < 0.0001p < 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/2003) Risk Factors for 1 Year MortalityRecipient PA Diastolic Pressure
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40
PA Diastolic Pressure (mm Hg)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtalit
y 1996-1999
2000-6/2003
p = 0.0087p = 0.0073
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/196-6/2003)
Factors Not Significant for 1 Year Mortality
Recipient Factors: Pneumothorax, sternotomy, thoracotomy, ventricular remodeling, pregnancy, pulmonary embolism, prior malignancy, pulmonary vascular resistance, PCW, PA systolic
Donor Factors: Clinical infection, history of diabetes, height, history of hypertension
Transplant Factors: ABO identical/compatible
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1995-6/2003) 1-Year Predicted Survival – Hypothetical Patient 1
50%
60%
70%
80%
90%
100%
0 0.2 0.4 0.6 0.8 1
Time (years)
Pre
dic
ted
Su
rviv
al
.
Recipient: 30 year old female, PRA = 50%, creatinine=1.4, hospitalized on inotropes, weight=80 kg, height=65 in., center volume=22/year, multiple pregnancies, year of transplant=2000
Donor: female, 30 years old
Cohort average
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1995-6/2003) 1-Year Predicted Survival – Hypothetical Patient 2
50%
60%
70%
80%
90%
100%
0 0.2 0.4 0.6 0.8 1
Time (years)
Pre
dic
ted
Su
rviv
al
.
Recipient: 63 year old male with coronary artery disease, PRA < 10%, creatinine=1.8, pulsatile long-term VAD, weight=95 kg, height=70 in., 3 hours ischemia time
Cohort average
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1995-6/2003) 1-Year Predicted Survival – Hypothetical Patient 3
50%
60%
70%
80%
90%
100%
0 0.2 0.4 0.6 0.8 1
Time (years)
Pre
dic
ted
Su
rviv
al .
30 year old donor 55 year old donor
Recipient: 71 year old male with idiopathic DCM, hospitalized on inotropes, creatinine=1.0, PRA < 10%, weight=70 kg, height=70 in., 3 hours ischemia time
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1995-6/2003) 1-Year Predicted Survival – Hypothetical Patient 4
50%
60%
70%
80%
90%
100%
0 0.2 0.4 0.6 0.8 1
Time (years)
Pre
dic
ted
Su
rviv
al
.
Recipient: 24 year old male retransplant recipient, PRA < 10%, creatinine=1.2, weight=85 kg, height=72 in., 2.5 hours ischemia time
Donor: male, 32 years old
Cohort average
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1996-6/1999) Risk Factors for 5 Year Mortality
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Repeat Transplant 271 1.96 <0.0001 1.57 -2.43
Ventilator 210 1.51 .0003 1.21 -1.89
Dialysis 137 1.49 .0027 1.15 -1.92
Diabetes 1268 1.20 .0013 1.07 -1.33
In hospital at time of transplant 8465 1.19 .0003 1.08 -1.30
Infection requiring IV drug therapy within 2 weeks of transplant
576 1.17 .0416 1.01 -1.37
(N=11,794)
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1996-6/1999) Risk Factors for 5 Year Mortality
VARIABLE N Relative
Risk P-
value
95% Confidence
Interval
HLA DR mismatches (per mismatch) 533 0 MM 1.15 .0000 1.08 -1.23
Diagnosis: Coronary artery disease 5314 1.15 .0007 1.06 -1.25
Transplant year 1996 vs. 1998/1999 3565 1.14 .0020 1.05 -1.24
Previous transfusions 1179 1.14 .0323 1.01 -1.28
Female recipient 2443 1.13 .0211 1.02 -1.26
IV inotropes 4312 0.87 .0012 0.79 -0.94
(N=11,794)
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1996-6/1999) Borderline Significant Risk Factors for 5 Year Mortality
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Diagnosis: Congenital heart disease 176 1.29 .0804 0.97 -1.71
PRA > 10% 529 1.16 .0573 1.00 -1.36
Intra-aortic balloon pump 407 1.15 .1225 0.96 -1.39
HLA B mismatches (per mismatch) 212 0 MM 1.07 .0716 0.99 -1.16
(N=11,794)
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) Risk Factors for 5 Year Mortality
Continuous Factors (see figures)
Recipient age
Recipient weight
Donor age
Weight ratio
Ischemia time
Transplant center volume
Serum creatinine
Bilirubin
Wedge pressure
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) 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
Rela
tive R
isk o
f 5 Y
ear
Mo
rtalit
y
p < 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) Risk Factors for 5 Year Mortality
Donor Age
0
0.5
1
1.5
2
15 20 25 30 35 40 45 50 55 60
Donor Age
Rela
tive R
isk o
f 5 Y
ear
Mo
rtalit
y
p < 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) Risk Factors for 5 Year MortalityPre-Transplant Recipient Weight
0
0.5
1
1.5
2
50 60 70 80 90 100 110
Recipient Weight (kg)
Rela
tive R
isk o
f 5 Y
ear
Mo
rtalit
y
p < 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) Risk Factors for 5 Year Mortality
Pre-Transplant Recipient BMI
0
0.5
1
1.5
2
17 19 21 23 25 27 29 31 33 35 37
Recipient BMI (kg/m2)
Rela
tive R
isk o
f 5 Y
ear
Mo
rtalit
y
p = 0.031
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) Risk Factors for 5 Year Mortality
Donor Weight/Recipient Weight Ratio
0
0.5
1
1.5
2
0.6 0.7 0.8 0.9 1 1.1 1.2 1.3 1.4 1.5 1.6 1.7
Donor Weight/Recipient Weight Ratio
Rela
tive R
isk o
f 5 Y
ear
Mo
rtalit
y
p = 0.0015
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) 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)
Rela
tive R
isk o
f 5 Y
ear
Mo
rtalit
y
p = 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) Risk Factors for 5 Year Mortality
Ischemia Time
0
0.5
1
1.5
2
1 2 3 4 5
Ischemia time (hours)
Rela
tive R
isk o
f 5 Y
ear
Mo
rtalit
y
p < 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) Risk Factors for 5 Year Mortality
Pre-Transplant Creatinine
0
0.5
1
1.5
2
0.5 1 1.5 2 2.5
Recipient creatinine (mg/dl)
Rela
tive R
isk o
f 5 Y
ear
Mo
rtalit
y
p < 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) Risk Factors for 5 Year Mortality
Pre-Transplant Bilirubin
0
0.5
1
1.5
2
0.5 1.5 2.5 3.5 4.5 5.5
Recipient bilirubin (mg/dl)
Rela
tive R
isk o
f 5 Y
ear
Mo
rtalit
y
p < 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) Factors Not Significant for 5 Year Mortality
Recipient Factors: VAD, gender, pulmonary vascular resistance, PA systolic, PA diastolic, thoracotomy, sternotomy, pregnancy, history of malignancy, pneumothorax, pulmonary embolism symptomatic cerebrovascular disease/ cerebrovascular event
Donor Factors: Gender, history of diabetes, history of cancer, clinical infection, cause of death, history of hypertension
Transplant Factors: Donor/recipient BMI ratio, ABO identical/compatible
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1995-6/1999) 5-Year Predicted Survival – Hypothetical Patient 1
50%
60%
70%
80%
90%
100%
0 1 2 3 4 5
Time (years)
Pre
dic
ted
Su
rviv
all
Recipient: 30 year old female, PRA = 50%, creatinine=1.4, hospitalized on inotropes, weight=80 kg, height=65 in., center volume=22/year, multiple pregnancies, year of transplant=2000
Donor: female, 30 years old
Cohort average
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1995-6/1999) 5-Year Predicted Survival – Hypothetical Patient 2
50%
60%
70%
80%
90%
100%
0 1 2 3 4 5
Time (years)
Pre
dic
ted
Su
rviv
all
Recipient: 63 year old male with coronary artery disease, PRA < 10%, creatinine=1.8, pulsatile long-term VAD, weight=95 kg, height=70 in., 3 hours ischemia time
Cohort average
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1995-6/1999) 5-Year Predicted Survival – Hypothetical Patient 3
50%
60%
70%
80%
90%
100%
0 1 2 3 4 5
Time (years)
Pre
dic
ted
Su
rviv
all
30 year old donor 55 year old donor
Recipient: 71 year old male with idiopathic DCM, hospitalized on inotropes, creatinine=1.0, PRA < 10%, weight=70 kg, height=70 in., 3 hours ischemia time
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1995-6/1999) 5-Year Predicted Survival – Hypothetical Patient 4
50%
60%
70%
80%
90%
100%
0 1 2 3 4 5
Time (years)
Pre
dic
ted
Su
rviv
all
Recipient: 24 year old male retransplant recipient, PRA < 10%, creatinine=1.2, weight=85 kg, height=72 in., 2.5 hours ischemia time
Donor: male, 32 years old
Cohort average
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1996-6/1999) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
VARIABLE N Relative
Risk P-value 95% Confidence
Interval
Repeat transplant 181 1.70 .0072 1.16 -2.52
Stroke prior to transplant discharge 100 1.66 .0138 1.11 -2.48
Cerebrovascular event prior to transplant 299 1.40 .0094 1.09 -1.81
Coronary Artery Vasculopathy during 1st year 432 1.40 .0025 1.13 -1.74
Diabetes 999 1.35 .0003 1.15 -1.58
Treated for rejection during 1st year 2574 1.30 <0.0001 1.15 -1.47
Treated for infection prior to transplant discharge
1166 1.26 .0023 1.09 -1.47
Transplant year = 1996 vs. 1998/1999 2825 1.24 .0012 1.09 -1.42
HLA DR mismatches (per mismatch) 425 0 MM 1.16 .0047 1.05 -1.28
(N=9,120)
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
Continuous Factors (see figures)
Recipient age
Donor age
Recipient weight
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) 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
Rela
tive R
isk o
f 5 Y
ear
Mo
rtality
.
p = 0.002
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) 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
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0003
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) Risk Factors for 5 Year Mortality Conditional on Survival to 1 YearPre-Transplant Recipient Weight
0
0.5
1
1.5
2
50 60 70 80 90 100 110
Recipient weight (kg)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity p = 0.0014
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
Pre-Transplant Recipient BMI
0
0.5
1
1.5
2
17 19 21 23 25 27 29 31 33 35 37
Recipient BMI (kg/m2)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity p = 0.18
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) Factors Not Significant for 5 Year Mortality
Conditional on Survival to 1 Year
Recipient Factors:Diagnosis, gender, ventilator, VAD, in hospital, IV inotropes, dialysis, infection prior to transplant, transfusions, PRA, balloon, pulmonary embolism, PA pressures, PCW, pulmonary vascular resistance, cardiac output, history of malignancy, height, sternotomy, bilirubin, pregnancy
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1996-6/1999) 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 weight ratio, CMV mismatch, center volume, ischemia time, ABO compatible/identical
Post-transplant Factors:Dialysis, prolonged graft dysfunction, permanent pacemaker
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1990-6/1993) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years
VARIABLE N Relative
Risk P-value 95% Confidence
Interval
Repeat transplant 164 1.37 .0371 1.02 -1.83
Diagnosis: other than cardiomyopathy, coronary artery disease, congenital heart disease, or valvular heart disease
538 1.24 .0378 1.01 -1.52
Diagnosis: Coronary artery disease 4946 1.19 <0.0001 1.10 -1.29
Transplant year: 1990 vs. 1992/1993 2364 1.11 .0299 1.01 -1.21
HLA DR mismatches (per mismatch) 534 0 MM
1.09 .0108 1.02 -1.16
Female/no previous pregnancy 1212 0.83 .0060 0.73 -0.95
(N=10,982)
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1990-6/1993) Borderline Significant Risk Factors for 10 Year Mortality
Conditional on Survival to 3 Years
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
HLA A mismatches (per mismatch) 679 0 MM 1.06 .0821 0.99 -1.13
HLA B mismatches (per mismatch) 229 0 MM 0.94 .0916 0.87 -1.01
(N=10,982)
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1990-6/1993) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years
Continuous Factors (see figures)
Recipient age
Donor age
Recipient BMI
Donor weight
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1990-6/1993) 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
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y p < 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1990-6/1993) 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
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y
p < 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1990-6/1993) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years
Pre-Transplant Recipient BMI
0
0.5
1
1.5
2
18 20 22 24 26 28 30 32 34
Recipient BMI (kg/m2)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y p < 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1990-6/1993) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years
Donor Weight
0
0.5
1
1.5
2
40 50 60 70 80 90 100 110
Donor Weight (kg)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y p = 0.0004
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1990-6/1993) Conditional 10-Year Predicted Survival – Hypothetical Patient 1
50%
60%
70%
80%
90%
100%
3 4 5 6 7 8 9 10
Time (years)
Pre
dic
ted
Su
rviv
all
Recipient: 30 year old female, PRA = 50%, creatinine=1.4, hospitalized on inotropes, weight=80 kg, height=65 in., center volume=22/year, multiple pregnancies, year of transplant=2000
Donor: female, 30 years old
Cohort average
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1990-6/1993) Conditional 10-Year Predicted Survival – Hypothetical Patient 2
50%
60%
70%
80%
90%
100%
3 4 5 6 7 8 9 10
Time (years)
Pre
dic
ted
Su
rviv
all
Recipient: 63 year old male with coronary artery disease, PRA < 10%, creatinine=1.8, pulsatile long-term VAD, weight=95 kg, height=70 in., 3 hours ischemia time
Cohort average
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1990-6/1993) Conditional 10-Year Predicted Survival – Hypothetical Patient 3
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
3 4 5 6 7 8 9 10
Time (years)
Pre
dic
ted
Su
rviv
all
30 year old donor 55 year old donor
Recipient: 71 year old male with idiopathic DCM, hospitalized on inotropes, creatinine=1.0, PRA < 10%, weight=70 kg, height=70 in., 3 hours ischemia time
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1/1990-6/1993) Conditional 10-Year Predicted Survival – Hypothetical Patient 4
50%
60%
70%
80%
90%
100%
3 4 5 6 7 8 9 10
Time (years)
Pre
dic
ted
Su
rviv
all
Recipient: 24 year old male retransplant recipient, PRA < 10%, creatinine=1.2, weight=85 kg, height=72 in., 2.5 hours ischemia time
Donor: male, 32 years old
Cohort average
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1996-6/2001) Risk Factors for Developing Coronary Artery
Vasculopathy within 3 Years
VARIABLE Relative
RIsk P-value
95% Confidence
Interval
Transplant year = 1996 vs. 2000/2001 1.36 .0004 1.14 -1.61
Transplant year = 1997 vs. 2000/2001 1.27 .0055 1.07 -1.49
Infection requiring IV drug therapy within 2 weeks of transplant
1.25 .0240 1.03 -1.52
Donor history of hypertension 1.24 .0089 1.06 -1.45
Transplant year = 1998 vs. 2000/2001 1.20 .0345 1.01 -1.41
Prior transfusions 0.84 .0411 0.71 -0.99
Female recipient 0.82 .0116 0.71 -0.96
Female donor 0.82 .0026 0.72 -0.93
(N=6,730)
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1996-6/2001) Risk Factors for Developing Coronary Artery
Vasculopathy within 3 Years
Continuous Factors (see figures)
Recipient age
Donor age
Recipient BMI
Transplant center volume
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1996-6/2001) Risk Factors for Developing Coronary Artery Vasculopathy within 3 Years
Recipient Age
0
0.5
1
1.5
2
20 25 30 35 40 45 50 55 60 65
Recipient Age
Ris
k o
f C
AV
wit
hin
3 Y
ears
.
p = 0.0057
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1996-6/2001) Risk Factors for Developing Coronary Artery Vasculopathy 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
Ris
k o
f C
AV
wit
hin
3 Y
ears
.
p < 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1996-6/2001) Risk Factors for Developing Coronary Artery Vasculopathy within 3 Years
Pre-Transplant Recipient BMI
0
0.5
1
1.5
2
18 20 22 24 26 28 30 32
Recipient BMI
Ris
k o
f C
AV
wit
hin
3 Y
ears
.
p = 0.0031
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1996-6/2001) Risk Factors for Developing Coronary Artery Vasculopathy 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)
Ris
k o
f C
AV
wit
hin
3 Y
ears
.
p < 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1996-6/1997) Risk Factors for Developing CAV within 7 Years Conditional
on no CAV within 1 Year
VARIABLE Relative
Risk P-value
95% Confidence
Interval
Donor history of diabetes 1.87 0.0287 1.07 -3.28
Donor cause of death: cerebrovascular/stroke
1.37 0.0208 1.05 -1.79
HLA B mismatches (per mismatch) 0.72 0.0004 0.6 -0.86
Female donor 0.66 0.0014 0.51 -0.85
(N=1,461)
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1996-6/1997) Borderline Significant Risk Factors for Developing CAV
within 7 Years Conditional on no CAV within 1 Year
VARIABLE Relative
Risk P-value
95% Confidence
Interval
Diagnosis: Coronary artery disease 1.23 0.0825 0.97 -1.56
(N=1,461)
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1996-6/1997) Risk Factors for Developing CAV within 7 Years Conditional
on no CAV within 1 Year
Continuous Factors (see figures)
Recipient age
Donor age
Recipient BMI
Transplant center volume
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1996-6/1997) Risk Factors for Developing CAV within 7 Years Conditional
on no CAV within 1 Year Recipient Age
0
0.5
1
1.5
2
20 25 30 35 40 45 50 55 60 65
Recipient Age
Ris
k o
f C
AV
wit
hin
7 y
ea
rs
p = 0.014
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1996-6/1997) 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
Ris
k o
f C
AV
wit
hin
7 y
ea
rs
p < 0.0001
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1996-6/1997) Risk Factors for Developing CAV within 7 Years Conditional
on no CAV within 1 Year Pre-Transplant Recipient BMI
0
0.5
1
1.5
2
17 21 25 29 33 37
Recipient BMI (kg/m2)
Ris
k o
f C
AV
wit
hin
7 y
ea
rs
p = 0.029
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982
ADULT HEART TRANSPLANTS (1996-6/1997) Risk Factors for Developing CAV within 7 Years Conditional
on no CAV within 1 Year Center Volume
0
0.5
1
1.5
2
0 10 20 30 40 50 60 70
Center Volume (cases per year)
Ris
k o
f C
AV
wit
hin
7 y
ea
rs
p = 0.042
2005ISHLTJ Heart Lung Transplant 2005;24: 945-982