heart transplantation overall ishlt 2008 j heart lung transplant 2008;27: 937-983

HEART TRANSPLANTATION

Overall

ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR

189 318665

1182

2159

2713

31363363

40034171 4203

4364 4429 4396 4263 41993864

3581 3433 3390 3283 3226 3065 3185 3205

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Nu

mb

er

of

Tra

ns

pla

nts

ISHLT 2008

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 2008;27: 937-983

AVERAGE CENTER VOLUMEHeart Transplants: January 1, 1992 - June 30, 1996

and January 1, 2002 – June 30, 2006

58 59

81

49

15

4055

80

2515 3 4 3455

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

.

1992-6/1996

2002-6/2006

ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983

DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUMEHeart Transplants: January 1, 1992 - June 30, 1996

and January 1, 2002 – June 30, 2006

28

24 26

129

6

14

2

11

33

18 16

47 9

0

5

10

15

20

25

30

35

1-4 5-9 10-19 20-29 30-39 40-49 50-74 75+

Average number of heart transplants per year

Per

cen

tag

e o

f tr

ansp

lan

ts

1992-6/1996

2002-6/2006


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

Me

an

do

no

r a

ge

(y

ea

rs)

Mean Age

HEART TRANSPLANTS: Donor Age by Year of Transplant


AGE DISTRIBUTIONOF HEART RECIPIENTS (1/1982-6/2006)

% 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


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

1982-1991 (N = 20,991)

1992-2001 (N = 39,801)

2002 - 6/2006 (N = 14,041)

P < 0.0001


HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2005)

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 22

Years

Su

rviv

al

(%)

Half-life = 10.0 yearsConditional Half-life = 13.0 years

N=74,267

ISHLT 2008

N at risk at 22 years: 70

HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2006)


HEART TRANSPLANTATION

Adult Recipients


Congenital2%

ReTX2%

Myopathy45%

Misc.4%

Valvular3%

CAD44%

1/1982-6/2007

DIAGNOSIS IN ADULT HEART TRANSPLANTS

203040506070

% o

f Cas

es

Myopathy CAD

CAD35% Valvular

2%

Misc.14%

Myopathy44%

ReTX2%

Congenital3%

1/2004-6/2007


0%

20%

40%

60%

80%

100%

Europe North America Other

10-19 years 20-29 years 30-39 years 40-49 years50-59 years 60+ years

% o

f T

ran

sp

lan

tsADULT HEART TRANSPLANTS:

RECIPIENT AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006


0%

20%

40%

60%

80%

100%

Europe North America Other

% o

f Don

ors

0-10 years 11-17 years 18-34 years35-49 years 50-59 years 60+ years

ADULT HEART TRANSPLANTS:DONOR AGE DISTRIBUTION BY LOCATION

Transplants between January 2000 and June 2006


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982 – 6/2006)

0

20

40

60

80

100

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

Years

1982-1991 (N=18,854)

1992-2001 (N=35,146)

2002-6/2006 (N=12,369)

All comparisons significant at p < 0.0001

HALF-LIFE 1982-1991: 8.8 years; 1992-2001: 10.5 years; 2002-6/2006: NA

Su

rviv

al (

%)


ADULT HEART TRANSPLANTATION Conditional Kaplan-Meier Survival by Era

(Transplants: 1/1982 – 6/2006)

0

20

40

60

80

100

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

Years

1982-1991 (N=14,381)

1992-2001 (N=27,686)

2002-6/2006 (N=9,326)

1982-1991 vs. 1992-2001: p < 0.0001;1982-1991 vs. 2002-6/2006: p = 0.0004;1992-2001 vs. 2002-6/2006: p = 0.1444.

HALF-LIFE 1982-1991: 11.8 years; 1992-2001: 12.8 years; 2002-6/2005: NA

Su

rviv

al (

%)


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1982-6/2005)

0

20

40

60

80

100

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

Years

Su

rviv

al

(%)

18-34 (N= 6,688) 35-49 (N=17,969)50-59 (N=25,166) 60-64 (N=9,648)65-69 (N= 3,241) 70+ (N= 346)

HALF-LIFE 18-34: 11.9 years; 35-49: 10.8 years; 50-59: 9.7 years; 60-64: 8.8 years; 65-69: 8.1 years; 70+: 6.9 years

All pair-wise comparisons are statistically significant at p < 0.01


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1998-6/2005)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8

Years

Su

rviv

al

(%)

18-34 (N= 2,248) 35-49 (N= 5,244)50-59 (N=8,292) 60-64 (N=4,001)65-69 (N= 1,814) 70+ (N= 235)

All pair-wise comparisons are statistically significant at p < 0.05

except 18-34 vs. 50-64; 18-34 vs. 60-64; and 65-69 vs. 70+

ISHLT 2008

HALF-LIFE 18-34: NA; 35-49: NA; 50-59: NA;

60-64: 8.3 years; 65-69: 8.1 years; 70+: 7.3 years

Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983

ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1982-6/2005)

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 = 27,393) Coronary artery disease (N = 27,846)Congenital diagnosis (N = 1,081) Retransplant (1,255)Valvular (N= 2,027) Other (N= 1,578)

HALF-LIFE Cardiomyopathy: 11.0 years; CAD: 9.1 years; Congenital: 13.4 years; Retransplant: 4.6 years; Valvular: 10.6 years; Other: 11.8 years

All pair-wise comparisons with Cardiomyopathy are significant at p < 0.005 except for Congenital; CAD vs. ReTx: p < 0.0001; CAD vs. Valvular: p = 0.005; Valvular vs. ReTx: p < 0.0001; Congenital vs. ReTx: p < 0.0001; ReTx vs. Other: p < 0.0001


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis

Conditional on Survival to 1 Year (Transplants: 1/1982-6/2005)

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 = 21,707)Coronary artery disease (N = 21,661)Congenital diagnosis (N = 773)Retransplant (766)Valvular (N= 1,506)Other (N= 929)

All pair-wise comparisons are significant at p <.05 except Cardiomyopathy vs. valvular (p = 34), valvular vs. other (p= .14), andCongenital vs. other (p = .12).

HALF-LIFE Cardiomyopathy: 13.3 years; CAD: 11.3 years; Congenital: 17.1 years; Retransplant: 9.3 years; Valvular: 13.4 years; Other: 14.4 years


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/2000-6/2005)

50

60

70

80

90

100

0 1 2 3 4 5 6

Years

Su

rviv

al (

%)

Cardiomyopathy (N=6,722) Coronary artery disease (N=6,520)

Congenital Diagnosis (N=358) Retransplant (N=318)

Valvular (N=405) Other (N=903)

All pair-wise comparisons with Cardiomyopathy are significant at p < 0.001; All pair-wise comparisons with CAD are significant at p < 0.5 except CAD vs. valvular. All other pair-wise comparisons were not statistically significant.


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis Conditional on Survival to 1 Year

(Transplants: 1/2000-6/2005)

50

60

70

80

90

100

0 1 2 3 4 5 6

Years

Su

rviv

al (%

)

Cardiomyopathy (N=5,344) Coronary artery disease (N=5.096)

Congenital Diagnosis (N=251) Retransplant (N=230)

Valvular (N=305) Other (N=449)

ISHLT 2008

Cardiomyopathy vs. Re-TX: p = .006; Cardiomyopathy vs. Other: p = .02; CAD vs. Re-TX: p = .03; Congenital vs. Re-TX: p = .01; Valvular vs. Other: = .01; Re-TX vs. Other: p = .0003

Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983

ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by PVR (Transplants: 1/2002-6/2006)

50

60

70

80

90

100

0 1 2 3 4 5

Years

Su

rviv

al (

%)

1-<3 Wood units (N = 4,383) 3-<5 Wood units (N = 1,287)

5+ Wood units (N= 457)

1-<3 vs. 3-<5: p = 0.0005; 1-<3 vs. 5+: p = 0.0133; 3-<5 vs. 5+: p = 0.8661


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage (Transplants: 4/1994-6/2006)

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

VAD (N=3,757) No VAD / No Inotropes (N=9,435)

No VAD / Inotropes (N=11,576)

VAD vs. no VAD/no inotropes: p < 0.0001VAD vs. no VAD/inotropes: p < 0.0001No VAD/no inotropes vs No VAD/inotropes: p = 0.0008



50

60

70

80

90

100

0 1 2 3 4 5

Years

Su

rviv

al (

%)

Pulsatile flow (N=2,563) No LVAD / No Inotropes (N=5,638)

No LVAD / Inotropes (N=6,173)

Pulsatile vs. No LVAD/Inotropes: p < 0.0001;Pulsatile vs. No LVAD/No inotropes: p < 0.0001; No LVAD/No inotropes vs. No LVAD/Inotropes: p = 0.0510

NOTE: There were 206 transplants with continuous flow VADs



50

60

70

80

90

100

0 1 2 3 4 5

Years

Su

rviv

al (

%)

Pulsatile flow (N=2,563) Continuous flow (N=206)

No LVAD / No Inotropes (N=5,638) No LVAD / Inotropes (N=6,173)

Pulsatile vs. No LVAD/Inotropes: p < 0.0001;Pulsatile vs. No LVAD/No inotropes: p < 0.0001; No LVAD/Inotropes vs. No LVAD/No inotropes : p = 0.0510No LVAD/Inotropes vs. Continuous: p = 0.0852No LVAD/No Inotropes vs. Continuous: p = 0.0149


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage and Era (Transplants: 1/1999-6/2006)

50

60

70

80

90

100

0 1 2 3 4 5

Years

Su

rviv

al (

%)

Pulsatile, 1999-2002 (N=1,328) No LVAD/Inotrope, 1999-2002 (N=3,583)

Pulsatile, 2003-6/2006 (N=1,235) No LVAD/Inotrope, 2003-6/2006 (N=2,590)

Pulsatile vs. no LVAD/Inotropes (1999-2002): p = 0.0028Pulsatile vs. no LVAD/Inotropes (2003-6/2006): p < 0.0001


ADULT HEART TRANSPLANTS1-Year Predicted Survival Model (Transplants: 1/2002-6/2006)

Impact of Pre-Transplant VAD

ISHLT 2008

75%

80%

85%

90%

95%

100%

0 30 60 90 120 150 180 210 240 270 300 330 360

Time (days)

Pre

dic

ted

Su

rviv

al

No Pre-op VAD

Pre-op pulsatile VAD

Recipient: 54 y.o., Dx=cardiomyopathy, height=175 cm, volume=22/year, bilirubin=0.8, PA systolic=40, creatinine=1.2 mg/dl, ischemia=180 min, transplant year = 2005/2006

Donor: 30 y.o., BMI = 25 kg/m2


0

20

40

60

80

100

0-2months

>2-6months

>6-12months

>12-36months

>36-60months

>60months

Primarytransplant

Time between previous and current transplant

1 Y

ear

Pat

ien

t S

urv

ival

(%

) 1/1982-12/19911/1992-12/20011/2002-6/2006

Comparison of survival for interval < 12 months vs. > 12 months: p < 0.0001Comparison of survival for interval < 12 months vs. > 12 months for 1/02-6/2006: p < 0.0001

85

16

91

72

43 2

2 22 83

20

18

,91

53

5,2

17

43

84

49

35

1

12

,16

4

N=17 N=5 N=7

40 94

21

4

ADULT HEART RE-TRANSPLANTS1-Year Survival


ADULT HEART RECIPIENTS Functional Status of Surviving Recipients

(Follow-ups: 1995 - June 2006)

0%

20%

40%

60%

80%

100%

1 Year (N = 15,388) 3 Years (N = 13,600) 5 Years (N = 11,698) 7 Years (N = 9,306)

No Activity Limitations Performs with Some Assistance Requires Total Assistance


ADULT HEART RECIPIENTSEmployment Status of Surviving Recipients


0%

20%

40%

60%

80%

100%

1 Year (N = 16,161) 3 Year (N = 14,165) 5 Year (N = 12,175) 7 Year (N = 9,910)

Retired

Not Working

Working Part Time

Working Full Time

Working (FT/PTstatus unknown)


ADULT HEART RECIPIENTSRehospitalization Post-transplant of Surviving Recipients


0%

20%

40%

60%

80%

100%

Up to 1 Year (N = 19,425)

Between 2 and 3 Years (N = 16,781)



No Hospitalization Hospitalized: Not Rejection/Not InfectionHospitalized: Rejection Only Hospitalized: Infection OnlyHospitalized: Rejection + Infection


0

10

20

30

40

50

Any Induction (N = 5,529) Polyclonal ALG/ATG (N =2,458)

OKT3 (N = 374) IL2R-antagonist (N =2,851)

% o

f p

ati

en

tsADULT HEART RECIPIENTS

Induction Immunosuppression (Transplants: January 2002 – June 2007)

ISHLT 2008

Analysis is limited to patients who were alive at the time of the follow-up


0

10

20

30

40

50

60

Any Induction PolyclonalALG/ATG

OKT3 IL2R-antagonist

% o

f p

ati

en

ts

1997 2002 1/2007-6/2007

ADULT HEART RECIPIENTSInduction Immunosuppression

(Transplants: 1997, 2002 and 1/2007-6/2007)

ISHLT 2008



ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Type

(Transplants: 1/2000-6/2006, conditional on survival to 14 days)

50

60

70

80

90

100

0 1 2 3 4 5 6

Years

Su

rviv

al (

%)

No induction (N = 6,274) Polyclonal induction (N = 2,859)

IL2-R antagonist (N = 2,875) OKT3 (N = 594)


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

ati

en

ts

Year 1 (N = 3,973) Year 5 (N = 3,084)

ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up

(Follow-ups: January 2005 - June 2007)

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

ISHLT 2008



0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

atie

nts

2000 (N = 2,796) 2003 (N = 2,940) July 2006 - June 2007 (N = 2,829)

ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of 1 Year Follow-up

NOTE: Different patients are analyzed in each time frame.

ISHLT 2008



0%

20%

40%

60%

80%

100%

Year 1 (N = 3,973) Year 5 (N = 3,084)

None

Other

Tacrolimus

Cyclosporine

Rapa + cellcycle

Rapa + calcineurin

Tacrolimus + MMF

Tacrolimus + AZA

Cyclosporine + MMF

Cyclosporine + AZA

% o

f P

ati

en

tsADULT HEART RECIPIENTS

Maintenance Immunosuppression Drug Combinations at Time of Follow-up(Follow-ups: January 2005 - June 2007)

NOTES: Different patients are analyzed in Year 1 and Year 5. In the Year 1 cohort 73.40% of patients were on prednisone; in the Year 5 cohort 54.12% of patients were on prednisone.ISHLT 2008

Analysis is limited to patients who were alive at the time of the follow-upJ Heart Lung Transplant 2008;27: 937-983

0%

20%

40%

60%

80%

100%

Year 1 (N = 4,089) Year 5 (N = 4,089)

% o

f P

atie

nts

None

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

For the Same Patients(Follow-ups: January 2000 - June 2007)

ISHLT 2008



PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS EXPERIENCING REJECTION IN 1ST YEAR

Stratified by Type of Induction (Follow-ups: July 1, 2004 - June 30, 2007)

0

10

20

30

40

50

60

% e

xp

eri

en

cin

g r

eje

cti

on

wit

hin

1 y

ea

r.

No induction, Treatment No induction, No TreatmentPolyclonal, Treatment Polyclonal, No TreatmentIL2R-antagonist, Treatment IL2R-antagonist, No Treatment OKT3, Treatment OKT3, No Treatment

ISHLT 2008

Overall 18-44 45-62 63+ Female Male

No induction: N=2,580Polyclonal: 1,137IL2R-antagonist: N=1,461OKT3: N=126

Overall: no induct vs. poly (p<0.0001); no induct vs. IL2 (p<0.0001), no induct vs. OKT3 (p=0.019) 18-44: no induct vs. poly (p=0.018); no induct vs. IL2 (p=0.002)45-62: no induct vs. poly (p=0.008); no induct vs. IL2 (p<0.0001) 63+: no induct vs. poly (p=0.004); no induct vs. IL2 (p<0.0001); no induct vs. OKT3 (p=0.044)F: no induct vs. poly (p=0.001); no induct vs. IL2 (p=0.0004)M: all comparisons were statistically significant at 0.05 except poly vs. OKT3 and IL2 vs. OKT3



PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS EXPERIENCING REJECTION IN 1ST YEAR

Stratified by Maintenance Immunosuppression (Follow-ups: July 1, 2004 - June 30, 2007)

0

10

20

30

40

50

60 Cyclosporine + MMF, Treatment Cyclosporine + MMF, No TreatmentTacrolimus + MMF, Treatment Tacrolimus + MMF, No Treatment

% e

xp

eri

en

cin

g r

eje

cti

on

wit

hin

1 y

ea

r

Overall: p<0.000118-44: p<0.000145-62: p<0.0001Female: p<0.001Male: p<0.0001

ISHLT 2008

NOTE: There were 257 patients with cyclosporine+AZA and 42 with tacrolimus+AZA. These groups were excluded due to small numbers.

Cyclosporine + MMF: N = 1,981Tacrolimus + MMF: N = 2,249

18-44 45-62 63+ MaleFemaleOverall

Analysis is limited to patients who were alive at the time of the follow-upJ Heart Lung Transplant 2008;27: 937-983

ADULT HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Rejection Within 1st Year

Conditional on survival to 1 year (follow-ups: 7/2004-6/2006)

50

60

70

80

90

100

0 1 2

Years

Su

rviv

al (

%)

No rejection (N=1,164) Rejection (N=713)

p <0.0001


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

(Follow-ups: April 1994 – December 1997 and January 2002 - June 2006)

Follow-ups: April 1994-

December 1997 Follow-ups: January 2002 –

June 2006

Outcome Within 1

Year Total N with

known response Within 1

Year Total N with

known response

Hypertension 68.9% (N = 6,425) 74.4% (N = 7,099)

Renal Dysfunction 20.4% (N = 6,378) 30.4% (N = 7.247)

Abnormal Creatinine < 2.5 mg/dl 11.3% 22.4% Creatinine > 2.5 mg/dl 8.1% 5.9% Chronic Dialysis 1.0% 1.6% Renal Transplant 0.1% 0.4%

Hyperlipidemia 33.3% (N = 6,816) 67.8% (N = 7,640)

Diabetes 20.9% (N = 6,433) 31.5% (N = 7,199)

Cardiac Allograft Vasculopathy 7.9% (N = 5,847) 7.1% (N = 6,556)


POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 5 and 10 Years Post-Transplant

(Follow-ups: April 1994 - June 2006)

Outcome Within 5

Years Total N with

known response Within 10

Years Total N with

known response

Hypertension 93.8% (N = 8,266) 98.5% (N = 1,586)

Renal Dysfunction 32.6% (N = 8,859) 38.7% (N = 1,829)

Abnormal Creatinine < 2.5 mg/dl 21.2% 24.4% Creatinine > 2.5 mg/dl 8.4% 8.2% Chronic Dialysis 2.5% 4.9% Renal Transplant 0.5% 1.2%

Hyperlipidemia 87.1% (N = 9,237) 93.3% (N = 1,890)

Diabetes 34.8% (N = 8,219) 36.7% (N = 1,601)

Cardiac Allograft Vasculopathy 31.5% (N = 5,944) 52.7% (N = 896)


FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY AND FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Adult Heart Recipients (Follow-ups: April 1994-June 2007)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

Freedom from CAV (N = 19,897)

Freedom from Severe Renal Dysfunction (N = 21,867)

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

% F

ree

do

m f

rom

CA

V o

r F

ree

do

m

fro

m S

ev

ere

Re

na

l D

ys

fuc

nti

on


FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY AND FREEDOM FROM SEVERE RENAL DYSFUNCTION BY ERA*

For Adult Heart Recipients (Transplants: April 1994-June 2006)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

Freedom from CAV 4/1994-1999 (N = 8,610)Freedom from Severe Renal Dysfunction 4/1994-1999 (N = 9,559)Freedom from CAV 2000-6/2006 (N = 9,583)Freedom from Severe Renal Dysfunction 2000-6/2006 (N = 10,599)

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

% F

ree

do

m f

rom

CA

V o

r F

ree

do

m

fro

m S

ev

ere

Re

na

l D

ys

fuc

nti

on

Freedom from CAV 4/1994-1999 vs 2000-6/2006: p < 0.0001;Freedom from Severe Renal Dysfunction 4/1994-1999 vs. 2000-6/2006: p < 0.0001

ISHLT 2008

This slide is based on the date of transplant. As a result sample sizes are different from ones on the previous slide


PATIENT SURVIVAL AFTER REPORT OF CAV AND PATIENT SURVIVAL IN PATIENTS WITHOUT CAV*

(Transplants: April 1994-June 2006)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Time after Report of CAV* (Years)

Su

rviv

al

(%)

No CAV (N = 13,244)

CAV (N = 3,104)

p < 0.0001

ISHLT 2008

* Patients without CAV conditioned on survival to median time of CAV development (504 days)


PATIENT SURVIVAL AFTER REPORT OF CAV AND PATIENT SURVIVAL IN PATIENTS WITHOUT CAV* BY ERA

(Transplants: April 1994-June 2006)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Time after Report of CAV* (Years)

Su

rviv

al

(%)

No CAV 4/1994-1999 (N = 6,490)CAV 4/1994-1999 (N = 1,668)No CAV 2000-6/2006 (N = 6,754)CAV 2000-6/2006 (N = 1,436)

No CAV 4/1994-1999 vs. 2000-6/2006: p = 0.0903CAV 4/1994-1999 vs. 2000-6/2006: p = 0.1889

ISHLT 2008

* Patients without CAV conditioned on survival to median time of CAV development (504 days)


MALIGNANCY POST-HEART TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2006)

Malignancy/Type 1-Year Survivors

5-Year Survivors

10-Year Survivors

No Malignancy 20441 (97.1%) 7780 (84.9%) 1264 (68.1%)

Malignancy (all types combined) 612 (2.9%) 1389 (15.1%) 592 (31.9%)

Malignancy Type

Skin 282 937 360

Lymph 142 127 38

Other 132 359 108

Type Not Reported 56 39 126

”Other” includes: prostate (11, 34, 17), adenocarcinoma (7, 4, 2), lung (5, 4, 1), bladder (4, 5, 4), sarcoma (3, 3, 1), breast (2, 8, 3), cervical (2, 4, 0), colon (2, 3, 1), and renal (2, 7, 2). Numbers in parentheses are those reported within 1 year, 5 years and 10 years, respectively.


FREEDOM FROM MALIGNANCYFor Adult Heart Recipients (Follow-ups: April 1994 - June 2006)

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

All malignancy Lymph Skin Other

% F

ree f

rom

Malig

nan

cy


ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2006)

CAUSE OF DEATH 0-30 Days

(N = 3,006)

31 Days –

1 Year

(N = 2,722)

>1 Year –

3 Years

(N = 2,135)

>3 Years –

5 Years

(N = 1,857)

>5 Years –

10 Years

(N = 4,054)

>10 Years

(N = 2,107)

CARDIAC ALLOGRAFT VASCULOPATHY

52 (1.7%) 127 (4.7%) 298 (14.0%) 299 (16.1%) 581 (14.3%) 309 (14.7%)

ACUTE REJECTION 193 (6.4%) 338 (12.4%) 220 (10.3%) 82 (4.4%) 69 (1.7%) 26 (1.2%)

LYMPHOMA 2 (0.1%) 54 (2.0%) 85 (4.0%) 96 (5.2%) 195 (4.8%) 73 (3.5%)

MALIGNANCY, OTHER 1 (0.0%) 57 (2.1%) 218 (10.2%) 340 (18.3%) 749 (18.5%) 392 (18.6%)

CMV 4 (0.1%) 34 (1.2%) 16 (0.7%) 3 (0.2%) 5 (0.1%) 1 (0.0%)

INFECTION, NON-CMV 393 (13.1%) 896 (32.9%) 276 (12.9%) 180 (9.7%) 442 (10.9%) 213 (10.1%)

GRAFT FAILURE 1,257 (41.8%) 500 (18.4%) 499 (23.4%) 379 (20.4%) 765 (18.9%) 353 (16.8%)

TECHNICAL 233 (7.8%) 28 (1.0%) 17 (0.8%) 17 (0.9%) 36 (0.9%) 20 (0.9%)

OTHER 162 (5.4%) 175 (6.4%) 187 (8.8%) 147 (7.9%) 339 (8.4%) 175 (8.3%)

MULTIPLE ORGAN FAILURE

356 (11.8%) 268 (9.8%) 117 (5.5%) 102 (5.5%) 309 (7.6%) 190 (9.0%)

RENAL FAILURE 20 (0.7%) 25 (0.9%) 36 (1.7%) 65 (3.5%) 225 (5.6%) 173 (8.2%)

PULMONARY 133 (4.4%) 108 (4.0%) 96 (4.5%) 85 (4.6%) 172 (4.2%) 99 (4.7%)

CEREBROVASCULAR 200 (6.7%) 112 (4.1%) 70 (3.3%) 62 (3.3%) 167 (4.1%) 83 (3.9%)

ISHLTLast updated based on data as of December 2006

2008J Heart Lung Transplant 2008;27: 937-983

ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death from Leading Causes by Era

(Deaths: January 1992 - June 2006)

CAUSE OF DEATH

DATE OF DEATH

0-30 Days

(N = 3,005)

31 Days –

1 Year

(N = 2,722)

>1 Year –

3 Years

(N = 2,135)

>3 Years –

5 Years

(N = 1,857)

>5 Years – 10 Years

(N = 4,054)>10 Years

(N = 2,107)

ACUTE REJECTION

1992-1997 122 (7.1%) 231 (14.3%) 113 (9.3%) 41 (4.4%) 16 (1.1%) 3 (1.7%)

1998-6/2006 71 (5.5%) 107 (9.7%) 107 (11.7%) 41 (4.5%) 53 (2.0%) 23 (1.2%)

CARDIAC ALLOGRAFT VASCULOPATHY

1992-1997 32 (1.9%) 83 (5.1%) 184 (15.1%) 189 (20.1%) 262 (18.3%) 40 (22.6%)

1998-6/2006 20 (1.6%) 44 (4.0%) 114 (12.4%) 110 (12.0%) 319 (12.2%) 269 (13.9%)

GRAFT FAILURE1992-1997 766 (44.5%) 347 (21.4%) 305 (25.0%) 168 (17.9%) 273 (19.0%) 30 (16.9%)

1998-6/2006 491 (38.3%) 153 (13.9%) 194 (21.2%) 211 (23.0%) 492 (18.8%) 323 (16.7%)

MALIGNANCY, OTHER

1992-1997 1 (0.1%) 40 (2.5%) 118 (9.7%) 177 (18.8%) 257 (17.9%) 25 (14.1%)

1998-6/2006 0 (0.0%) 17 (1.5%) 100 (10.9%) 163 (17.8%) 492 (18.8%) 367 (19.0%)


ADULT HEART TRANSPLANT RECIPIENTS: Cumulative Incidence of Leading Causes of Death

(Transplants: January 1992 - June 2005)

0%

1%

2%

3%

4%

5%

6%

0 1 2 3 4 5 6 7 8 9 10

Time (years)

CAV Acute Rejection

Malignancy (non-Lymph/PTLD) Primary Failure

Graft Failure CMV

Infection (non-CMV)

Incid

en

ce o

f C

au

se-S

pecif

ic D

eath

s


ADULT HEART TRANSPLANTS (1/2002-6/2006) Risk Factors for 1 Year Mortality

2008ISHLT (N=8,823)

VARIABLE N

Relative Risk

P-value 95% Confidence

Interval

Temporary circulatory support* 137 3.19 <0.0001 2.32 -4.37

Diagnosis: Congenital vs. cardiomyopathy 228 1.89 0.0002 1.35 -2.64

Recipient on ventilator at time of transplant 248 1.50 0.0044 1.13 -1.98

Recipient history of dialysis 273 1.48 0.0021 1.15 -1.91

Recipient with infection requiring IV drug therapy within 2 weeks prior to transplant

923 1.30 0.0047 1.08 -1.56

Chronic pulsatile device 1456 1.26 0.0205 1.04 -1.53

Not ABO identical 1288 1.25 0.0067 1.06 -1.46

Prior transfusion 1749 1.19 0.0432 1.01 -1.41

Diagnosis: coronary artery disease vs. cardiomyopathy

3939 1.16 0.0431 1.00 -1.35

Recipient on inotropes at time of transplant 3673 0.85 0.0282 0.73 -0.98

* Temporary circulatory support includes ECMO and Abiomed.

NOTE: There were too few continuous flow devices to analyze.



Continuous Factors (see figures)

Recipient age

Recipient height

Donor age

Donor BMI

Transplant center volume

Ischemia time

PA systolic pressure

Bilirubin

Serum creatinine

2008ISHLT J Heart Lung Transplant 2008;27: 937-983

ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits

Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

2008ISHLT (N=8,823)J Heart Lung Transplant 2008;27: 937-983


Donor Age

0

0.5

1

1.5

2

2.5

15 20 25 30 35 40 45 50 55 60

Donor Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity



Recipient Height

0

0.5

1

1.5

2

155 160 165 170 175 180 185 190

Recipient height (cm)

p < 0.0001

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity



Donor BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30 32 34

Donor BMI (kg/m2)

p = 0.0288

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity



Ischemia Time

0

0.5

1

1.5

2

2.5

3

30 60 90 120 150 180 210 240 270 300 330 360

Ischemia Time (minutes)

p = 0.0060Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity



Center Volume

0

0.5

1

1.5

2

5 10 15 20 25 30 35 40 45 50 55 60 65 70

Center Volume (cases per year)

p = 0.0032

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity



Pre-Transplant Bilirubin

0

0.5

1

1.5

2

0.2 1.2 2.2 3.2

Bilirubin (mg/dl)

p = 0.0006

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity



Pre-Transplant Creatinine

0

0.5

1

1.5

2

2.5

3

3.5

0.5 1 1.5 2 2.5 3

Recipient Creatinine (mg/dl)

p < 0.0001

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity



Recipient PA Systolic Pressure

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65 70 75

PA Systolic (mm Hg)

p = 0.0004Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity


ADULT HEART TRANSPLANTS (1/2002-6/2006)

Factors Not Significant for 1 Year Mortality

Recipient Factors: Prior malignancy, gender, hospitalized, prior pregnancy, balloon pump, diabetes, PRA

Donor Factors: Clinical infection, history of diabetes, gender, history of hypertension, cause of death, history of malignancy

Transplant Factors: HLA mismatch, CMV mismatch, prior transplant


ADULT HEART TRANSPLANTS (1/2002-6/2006) 1-Year Predicted Survival Model

75%

80%

85%

90%

95%

100%

0 30 60 90 120 150 180 210 240 270 300 330 360

Time (days)

Cohort average

Recipient: Creatinine=1.7 mg/dl; inotropes; bilirubin=1.1 mg/dl. Donor: 60 y.o.

Recipient: Creatinine=1.3 mg/dl; pulsatile chronic VAD; bilirubin=0.8 mg/dl. Donor: 30 y.o.

Pre

dic

ted

Su

rviv

al

ISHLT 2008

Recipient: 55 y.o., Dx=CAD, height=175 cm, volume=22/year, PA systolic=40, ischemia=180 min

Donor: BMI = 25 kg/m2



2008ISHLT (N=5,131)

VARIABLE N

Relative Risk


Interval

Temporary circulatory support* 91 2.26 0.0004 1.44 -3.55

Diagnosis: Congenital vs. cardiomyopathy 117 2.00 <0.0001 1.43 -2.78

Ventilator 149 1.97 <0.0001 1.50 -2.57

Recipient on dialysis 136 1.74 <0.0001 1.33 -2.26

Diagnosis: Other** vs cardiomyopathy 162 1.52 0.0035 1.15 -2.02

Chronic pulsatile device 836 1.51 0.0188 1.07 -2.12

Previous pregnancy 723 1.46 <0.0001 1.22 -1.74

Diagnosis: Valvular heart disease vs. cardiomyopathy

153 1.41 0.025 1.04 -1.91

Recipient history of diabetes 968 1.26 0.0007 1.10 -1.45

Diagnosis: Coronary artery disease vs. cardiomyopathy

2438 1.23 0.0018 1.08 -1.40

Hospitalized (including ICU) 2648 1.19 0.0056 1.05 -1.34

Total number of HLA mismatches 0-3 MM (N= 621) 4-6 MM (N= 4510)

1.08 0.0127 1.02 -1.14

o ** Other = not cardiomyopathy, coronary artery disease, valvular

heart disease, or congenital heart disease

* Temporary circulatory support includes ECMO and Abiomed

NOTE: There were too few continuous flow devices to analyze.




Recipient age

Donor age

Bilirubin (+ interaction with VAD)


Ischemia time

Serum creatinine

PVR

Recipient BMI


ADULT HEART TRANSPLANTS (1/2000-6/2002)

Relative Risk of 5 Year Mortality with 95% Confidence Limits

Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity



Donor Age

0

0.5

1

1.5

2

15 20 25 30 35 40 45 50 55 60

Donor Age

p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity



Ischemia Time

0

0.5

1

1.5

2

2.5

30 60 90 120 150 180 210 240 270 300 330 360

Ischemia time (minutes)

p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity



Center Volume

0

0.5

1

1.5

2

5 10 15 20 25 30 35 40 45 50 55 60 65 70

Center volume (cases per year)

p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity


ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence

LimitsRecipient Pre-Transplant BMI

0

0.5

1

1.5

2

15 20 25 30 35

Recipient BMI (kg/m2)

p = 0.025

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity


ADULT HEART TRANSPLANTS (1/2000-6/2002)Relative Risk of 5 Year Mortality with 95% Confidence Limits

Recipient Pre-Transplant Bilirubin

0

0.5

1

1.5

2

0.2 1.2 2.2 3.2

Bilirubin (mg/dl)

No VAD VAD

p = 0.0002

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity



Recipient Pre-Transplant Creatinine

0

0.5

1

1.5

2

0.5 1 1.5 2 2.5 3

Creatinine (mg/dl)

p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity



Recipient Pre-Transplant PVR

0

0.5

1

1.5

2

0 1 2 3 4 5 6 7

PVR (Wood units)

p = 0.0127

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity


ADULT HEART TRANSPLANTS (1/2000-6/2002) Factors Not Significant for 5 Year Mortality

Recipient Factors: Sternotomy, gender, pulmonary embolism, IV inotropes, transfusions, prior malignancy, PRA, balloon pump, infection requiring IV antibiotics prior to transplant

Donor Factors: History of cancer, clinical infection, cause of death, history of hypertension, height, weight

Transplant Factors: CMV mismatch, ABO match, prior transplant


ADULT HEART TRANSPLANTS (1/2000-6/2002) 5-Year Predicted Survival Model

50%

60%

70%

80%

90%

100%

0 1 2 3 4 5

Time (years)

Cohort average

Recipient: Creatinine = 1.7 mg/dl; bilirubin = 1.1 mg/dl; balloon pump; in hospitalDonor: 60 y.o.

Recipient: Creatinine = 1.3 mg/dl; bilirubin = 0.8 mg/dl; pulsatile chronic VAD; not hospitalizedDonor: 30 y.o.

Pre

dic

ted

Su

rviv

al

ISHLT 2008

Recipient: 55 y.o.; Dx=CAD; BMI = 26 kg/m2; PVR=2.2; volume=24/year; ischemia=180 min; HLA mismatch = 5, transplant year = 2001/2002

Donor: BSA = 1.9 m2


ADULT HEART TRANSPLANTS (1/2000-6/2002) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year

2008ISHLT (N=4,144)

VARIABLE N

Relative Risk


Interval

Ventilator at time of transplant 86 2.00 0.0023 1.28 -3.13

CAV within 1st year 210 1.94 <0.0001 1.45 -2.58

Diagnosis: other* vs. cardiomyopathy 112 1.79 0.008 1.16 -2.75

Rejection between discharge and 1st year 1415 1.39 0.0002 1.17 -1.65

Recipient history of diabetes 779 1.38 0.0016 1.13 -1.69

Drug-treated rejection prior to discharge 732 1.35 0.0038 1.10 -1.65

Other surgical procedures (excl. cardiac re-operation) prior to discharge

457 1.30 0.0394 1.01 -1.66


1986 1.28 0.0122 1.06 -1.55

Drug-treated infection prior to discharge 884 1.21 0.0624 0.99 -1.47

* Other = not cardiomyopathy, coronary artery disease, valvular heart disease, or congenital heart disease


ADULT HEART TRANSPLANTS (1/2000-6/2002) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year


Recipient age

Donor age

PVR

Donor BMI

Donor/recipient weight ratio



Conditional on Survival to 1 Year Recipient Age

0

0.5

1

1.5

2

2.5

3

3.5

4

20 25 30 35 40 45 50 55 60 65

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity



Conditional on Survival to 1 Year Donor Age

0

0.5

1

1.5

2

15 20 25 30 35 40 45 50 55 60

Donor Age

p = 0.0006

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity



Conditional on Survival to 1 Year Donor BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30 32 34

Donor BMI (kg/m2)

p = 0.0062

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

2008ISHLT (N=4,144)

NOTE: These results should be considered in the context of donor/recipient weight ratio (next slide)



Conditional on Survival to 1 Year Donor/Recipient Weight Ratio

0

0.5

1

1.5

2

0.5 0.7 0.9 1.1 1.3 1.5

Donor Weight/Recipient Weight

p = 0.0106

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

2008ISHLT (N=4,144)

NOTE: These results should be considered in the context of donor BMI (previous slide)



Conditional on Survival to 1 Year Recipient Pre-Transplant PVR

0

0.5

1

1.5

2

0 1 2 3 4 5 6 7

PVR (Wood units)

p = 0.0057

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity


ADULT HEART TRANSPLANTS (1993-6/1996) Risk Factors for 10 Year Mortality

2008ISHLT

(N=8,298)

VARIABLE N

Relative Risk

P-value 95% Conf. Interval

Repeat transplant 175 1.67 0.0013 1.22 -2.29

Ventilator at time of transplant 230 1.51 <0.0001 1.27 -1.80

Diagnosis: congenital vs. cardiomyopathy 153 1.29 0.046 1.00 -1.66

Female recipient/female donor 695 1.24 0.0122 1.05 -1.46

Female recipient/male donor 831 1.21 0.0107 1.05 -1.41

On VAD at time of transplant 473 1.19 0.0168 1.03 -1.36

Male recipient/female donor 1795 1.17 0.0008 1.07 -1.28

Diagnosis: coronary artery disease vs. cardiomyopathy 4146 1.14 0.0004 1.06 -1.23

On inotropes at time of transplant 3569 1.10 0.0371 1.01 -1.21

Year of transplant: 1993 vs. 1995/1996 2381 1.09 0.0403 1.00 -1.18

Number of HLA mismatches at the B locus 0 B MM (N=183)

1 B MM (N=1968) 2 B MM (N=6147)

1.08 0.0264 1.01 -1.15

Number of HLA mismatches at the DR locus 0 DR MM (N=390)

1 DR MM (N=4239) 2 DR MM (N=3669)

1.06 0.0393 1.00 -1.12




Recipient age

Recipient BMI

Donor age

PRA

Ischemia time

2008ISHLT

(N=8,298)


ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits

Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

2008ISHLT

(N=8,298)



Donor Age

0

0.5

1

1.5

2

15 25 35 45 55

Donor Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

2008ISHLT

(N=8,298)



Pre-Transplant Recipient BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30 32 34


p = 0.0003

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

2008ISHLT

(N=8,298)



Ischemia Time

0

0.5

1

1.5

2

30 60 90 120 150 180 210 240 270 300 330 360


p = 0.0028

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

2008ISHLT

(N=8,298)



Pre-transplant PRA

0

0.5

1

1.5

2

2.5

0 20 40 60 80 100

Most recent PRA prior to transplant (%)

p = 0.0176

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

2008ISHLT

(N=8,298)J Heart Lung Transplant 2008;27: 937-983

ADULT HEART TRANSPLANTS (1993-6/1996) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years

2008ISHLT

(N=5,869)

VARIABLE N

Relative Risk

P-value 95%

Confidence Interval


2893 1.15 .0121 1.03 -1.27

Female recipient 1098 1.12 .0836 0.99 -1.27

Number of HLA mismatches at the DR locus

0 DR MM (N=289) 1 DR MM (N=3164) 2 DR MM (N=2416)

1.08 .0529 1.00 -1.17


ADULT HEART TRANSPLANTSRisk Factors for 10 Year MortalityConditional on Survival to 3 Years


Recipient age

Recipient BMI

Donor age

Donor BMI

2008ISHLT

(N=5,869)



Conditional on Survival to 3 YearsRecipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

2008ISHLT

(N=5,869)



Conditional on Survival to 3 YearsDonor Age

0

0.5

1

1.5

2

15 25 35 45 55

Donor Age

p = 0.016

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

2008ISHLT

(N=5,869)



Conditional on Survival to 3 YearsPre-Transplant Recipient BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30 32 34


p = 0.0321

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

2008ISHLT

(N=5,869)



Conditional on Survival to 3 YearsDonor Weight

0

0.5

1

1.5

2

18 20 22 24 26 28 30 32 34

Donor BMI (kg/m2)

p = 0.0029

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

2008ISHLT

(N=5,869)



2008ISHLT

(N=5,605)

VARIABLE N

Relative Risk


Interval

Repeat transplant 156 1.96 0.0001 1.39 -2.76

Ventilator at time of transplant 142 1.23 0.0468 1.00 -1.51


2821 1.14 0.0005 1.06 -1.23


0 DR MM (N=338) 1 DR MM (N=2983) 2 DR MM (N=2284)

1.13 <0.0001 1.07 -1.20


ADULT HEART TRANSPLANTSRisk Factors for 15 Year Mortality


Recipient age

Donor age

Ischemia time

PRA

Center volume (borderline)

2008ISHLT

(N=5,605)



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty

2008ISHLT

(N=5,605)



Donor Age

0

0.5

1

1.5

2

15 25 35 45 55

Donor Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty

2008ISHLT

(N=5,605)



Ischemia Time

0

0.5

1

1.5

2

30 60 90 120 150 180 210 240 270 300 330 360


p = 0.005

Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty

2008ISHLT

(N=5,605)



Recipient Pre-Transplant PRA

0

0.5

1

1.5

2

0 10 20 30 40

PRA

p = 0.0223

Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty

2008ISHLT

(N=5,605)



Center Volume

0

0.5

1

1.5

2

5 10 15 20 25 30 35 40 45 50 55 60 65 70


p = 0.0642

Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty

2008ISHLT

(N=5,605)


ADULT HEART TRANSPLANTS (1989-6/1992) Risk Factors for 15 Year MortalityConditional on Survival to 5 Years

2008ISHLT

(N=3,647)

VARIABLE N Relative

Risk P-value

95% Confidence

Interval


1849 1.29 <0.0001 1.16 -1.43

Number of HLA mismatches at the A locus

0 A MM (N=261) 1 A MM (N = 1792) 2 A MM (N=1594)

1.08 0.0495 1.00 -1.17

Number of HLA mismatches at the B locus

0 B MM (N=99) 1 B MM (N=964)

2 B MM (N=2584) 0.91 0.0389 0.84 -1.00

Previous transplant 60 1.61 0.0802 0.94 -2.75


0 DR MM (N=242) 1 DR MM (N=1986) 2DR MM (N=1419)

1.08 0.0637 1.00 -1.17


ADULT HEART TRANSPLANTSRisk Factors for 15 Year Mortality Conditional on Survival to 5 Years


Recipient age

Donor age

PRA prior to transplant

2008ISHLT

(N=3,647)



Conditional on Survival to 5 Years Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty

2008ISHLT

(N=3,647)



Conditional on Survival to 5 Years Donor Age

0

0.5

1

1.5

2

15 20 25 30 35 40 45 50

Donor Age

p = 0.0011Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty

2008ISHLT

(N=3,647)



Conditional on Survival to 5 Years Recipient Pre-Transplant PRA (%)

0

0.5

1

1.5

2

0 10 20 30 40


p = 0.029Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty

2008ISHLT

(N=3,647)


ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Cardiac Allograft Vasculopathy

after 5 Years (with no CAV prior to 5 years)

VARIABLE N Relative

risk P-value

95% Confidence

Interval

Diagnosis: Congenital vs. cardiomyopathy 52 1.77 0.0434 1.02 -3.10

Diagnosis: Coronary artery disease vs. cardiomyopathy

1703 1.23 0.0289 1.02 -1.48

Other surgical procedures (excl. cardiac re-operation) prior to transplant discharge

282 0.66 0.0270 0.46 -0.95

Transplant year = 2000 vs. 2001/2002 472 0.50 0.0084 0.30 -0.84

Recipient history of diabetes prior to transplant 505 1.24 0.0691 0.98 -1.57

Recipient on dialysis prior to transplant 502 0.39 0.0625 0.14 -1.05

(N=3,610)ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983


Recipient age

Donor age

Donor age*donor gender interaction

Transplant center volume (borderline)

ISHLT 2008

(N=3,610)

ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Cardiac Allograft Vasculopathy

after 5 Years (with no CAV prior to 5 years)


ADULT HEART TRANSPLANTS (4/1994-6/2002)Relative Risk of Developing Cardiac Allograft Vasculopathy after 5 Years

Donor Age, Donor Gender and Recipient Gender

0

0.5

1

1.5

2

2.5

3

3.5

15 20 25 30 35 40 45 50 55

Donor Age

Male Recip/Male Donor Male Recip/Female Donor

Female Recip/Male Donor Female Recip/Female Donor

p < 0.0001Re

lati

ve

Ris

k o

f C

AV

aft

er

5 Y

ea

rs

ISHLT 2008

(N=3,610)

Relative risk includes impact of donor gender, recipient gender and donor age.


ADULT HEART TRANSPLANTS (4/1994-6/2002) Relative Risk of Developing Cardiac Allograft Vasculopathy after 5 Years

with 95% Confidence Limits Recipient Age

0

0.5

1

1.5

2

2.5

20 25 30 35 40 45 50 55 60 65

Recipient Age

p = 0.0052

Re

lati

ve

Ris

k o

f C

AV

aft

er

5 Y

ea

rs

ISHLT 2008


ADULT HEART TRANSPLANTS (4/1994-6/2002) Relative Risk of Developing Cardiac Allograft Vasculopathy after 5 Years

with 95% Confidence Limits Center Volume

0

0.5

1

1.5

2

5 10 15 20 25 30 35 40 45 50 55 60 65 70

Center Volume (cases per year)

p = 0.067

Re

lati

ve

Ris

k o

f C

AV

aft

er

5 Y

ea

rs

ISHLT 2008


ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction within 7 Years

Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant

VARIABLE N Relative

Risk P-value

95% Confidence

Interval

Recipient diabetes pre-transplant 1381 1.48 <0.0001 1.34 -1.64

Donor history of malignancy 139 1.36 0.0412 1.01 -1.82

Donor history of hypertension 907 1.20 0.0089 1.05 -1.37

Infection requiring IV antibiotics within 2 weeks prior to transplant

692 1.17 0.0325 1.01 -1.36

Inotropes at transplant 4960 1.15 0.001 1.06 -1.24

Recipient treated for hypertension pre-transplant

2954 1.15 0.0017 1.05 -1.25

Diagnosis: congenital vs. cardiomyopathy

119 0.52 0.0305 0.28 -0.94

(N=9,161)ISHLT 2008

*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis



Limited to Recipients without Severe Renal Dysfunction Pre-Transplant


Recipient age

Recipient creatinine

Recipient weight

Recipient PRA

Ischemia time (borderline)

PVR

Bilirubin

ISHLT 2008

(N=9,161)




Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Pre-Transplant Creatinine

0

0.5

1

1.5

2

2.5

3

0.5 1 1.5 2 2.5

Creatinine (mg/dl)

p < 0.0001

Re

lati

ve

Ris

k o

f R

en

al

Dy

sfu

nc

tio

n w

ith

in 7

Ye

ars

ISHLT 2008

(N=9,161)




Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Age

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

25 30 35 40 45 50 55 60 65

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f R

en

al

Dy

sfu

nc

tio

n w

ith

in 7

Ye

ars

ISHLT 2008

(N=9,161)




Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Weight

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

50 60 70 80 90 100 110

Recipient Weight (kg)

p < 0.0001

Re

lati

ve

Ris

k o

f R

en

al

Dy

sfu

nc

tio

n w

ith

in 7

Ye

ars

ISHLT 2008

(N=9,161)




Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Pre-Transplant Bilirubin

0

0.5

1

1.5

2

0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2 2.2 2.4 2.6 2.8

Bilirubin (mg/dl)

p = 0.0032

Re

lati

ve

Ris

k o

f R

en

al

Dy

sfu

nc

tio

n w

ith

in 7

Ye

ars

ISHLT 2008

(N=9,161)




Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Pre-Transplant PVR

0

0.5

1

1.5

2

0 1 2 3 4 5 6 7 8

PVR (Wood units)

p = 0.046

Re

lati

ve

Ris

k o

f R

en

al

Dy

sfu

nc

tio

n w

ith

in 7

Ye

ars

ISHLT 2008

(N=9,161)




Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient PRA

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

0 5 10 15 20 25 30 35 40

Recipient PRA (%)

p = 0.043

Re

lati

ve

Ris

k o

f R

en

al

Dy

sfu

nc

tio

n w

ith

in 7

Ye

ars

ISHLT 2008

(N=9,161)



ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction after 7 Years

Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant or Renal Dysfunction within 7 Years

VARIABLE N Relative

Risk P-value 95% Confidence

Interval

Recipient diabetes pre-transplant 296 1.81 0.0005 1.29 -2.53

Pre-transplant transfusions 374 1.42 0.04 1.02 -1.99

Donor clinical infection 474 1.39 0.0284 1.04 -1.85

Recipient treated for rejection prior to transplant hospitalization discharge

524 1.33 0.0572 0.99 -1.78

(N=2,775)ISHLT 2008




Limited to Recipients without Severe Renal Dysfunction Pre-Transplant or Renal Dysfunction within 7 Years

Continuous Factors (see figures) Recipient creatinine

Donor age

Bilirubin

Recipient PRA (borderline)

Donor/recipient BMI ratio (borderline)

ISHLT 2008

(N=2,775)





Recipient Pre-Transplant Creatinine

0

1

2

3

4

5

0.5 1 1.5 2 2.5

Creatinine (mg/dl)

p < 0.0001

Re

lati

ve

Ris

k o

f R

en

al

Dy

sfu

nc

tio

n b

ey

on

d 7

Ye

ars

ISHLT 2008

(N=2,775)





Donor Age

0

0.25

0.5

0.75

1

1.25

1.5

1.75

2

15 25 35 45 55

Donor Age (years)

p = 0.0017Re

lati

ve

Ris

k o

f R

en

al

Dy

sfu

nc

tio

n b

ey

on

d 7

Ye

ars

ISHLT 2008

(N=2,775)





Donor/Recipient BMI Ratio

0

0.25

0.5

0.75

1

1.25

1.5

0.8 0.9 1 1.1 1.2 1.3

Donor BMI/Recipient BMI

p = 0.0636

Re

lati

ve

Ris

k o

f R

en

al

Dy

sfu

nc

tio

n b

ey

on

d 7

Ye

ars

ISHLT 2008

(N=2,775)





Recipient Pre-Transplant Bilirubin

0

0.5

1

1.5

2

0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2 2.2 2.4 2.6 2.8

Bilirubin (mg/dl)

p = 0.0032

Re

lati

ve

Ris

k o

f R

en

al

Dy

sfu

nc

tio

n b

ey

on

d 7

Ye

ars

ISHLT 2008

(N=2,775)



ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy within 5 Years

Limited to Recipients without History of Malignancy Pre-Transplant

VARIABLE N Relative

Risk P-value

95% Confidence

Interval

Year of transplant: 1994/1995 vs. 2000-2002 2077 2.00 <0.0001 1.72 -2.32

Year of transplant: 1996/1997 vs. 2000-2002 2208 1.56 <0.0001 1.34 -1.82

Donor cause of death: anoxia 643 1.23 0.0417 1.01 -1.51

Year of transplant: 1998/1999 vs. 2000-2002 2469 1.21 0.0157 1.04 -1.41

Donor and recipient not ABO identical 1411 0.84 0.0436 0.72 -1.00

Recipient PRA > 10% 658 0.74 0.0199 0.57 -0.95

Recipient female 2288 0.63 <0.0001 0.52 -0.75



Limited to Recipients without History of Malignancy Pre-Transplant

Continuous Factors (see figures) Recipient age

Donor weight Center volume

ISHLT 2008



Limited to Recipients without History of Malignancy Pre-Transplant Recipient Age

0

0.25

0.5

0.75

1

1.25

1.5

1.75

2

25 35 45 55 65

Age (years)

p < 0.0001

Re

lati

ve

Ris

k o

f M

ali

gn

an

cy

w

ith

in 5

Ye

ars

ISHLT 2008



Limited to Recipients without History of Malignancy Pre-Transplant Donor Weight

0

0.25

0.5

0.75

1

1.25

1.5

50 60 70 80 90 100 110

Donor Weight (kg)

p = 0.0145

Re

lati

ve

Ris

k o

f M

ali

gn

an

cy

w

ith

in 5

Ye

ars

ISHLT 2008



Limited to Recipients without History of Malignancy Pre-Transplant Center Volume

0

0.25

0.5

0.75

1

1.25

1.5

5 10 15 20 25 30 35 40 45 50 55 60 65 70


p < 0.0001

Re

lati

ve

Ris

k o

f M

ali

gn

an

cy

w

ith

in 5

Ye

ars

ISHLT 2008


ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy after 5 Years

Limited to Recipients without Malignancy within 5 Years

VARIABLE N Relative

Risk P-value 95% Confidence

Interval

Donor history of diabetes 89 1.65 0.043 1.02 -2.69

Drug-treated hypertension prior to transplant 1690 0.84 0.0463 0.70 -1.00

Female recipient 1226 0.64 0.0363 0.42 -0.97


ADULT HEART TRANSPLANTS (4/1994-6/2002)Risk Factors for Developing Malignancy after 5 Years

Limited to Recipients without Malignancy within 5 Years

Continuous Factors (see figures) Recipient age

Center volume

Bilirubin

Donor BSA

Recipient BSA (borderline)

ISHLT 2008



Limited to Recipients without Malignancy within 5 Years Recipient Age

0

0.25

0.5

0.75

1

1.25

1.5

1.75

2

25 35 45 55 65

Recipient Age (years)

p < 0.0001

Re

lati

ve

Ris

k o

f M

ali

gn

an

cy

b

ey

on

d 5

Ye

ars

ISHLT 2008


ADULT HEART TRANSPLANTS (4/1994-6/2002)Risk Factors for Developing Malignancy after 5 Years

Limited to Recipients without Malignancy within 5 Years Donor Body Surface Area (BSA)

0

0.25

0.5

0.75

1

1.25

1.5

1.6 1.8 2 2.2

Donor BSA

p = 0.0086

Re

lati

ve

Ris

k o

f M

ali

gn

an

cy

b

ey

on

d 5

Ye

ars

ISHLT 2008



Limited to Recipients without Malignancy within 5 Years Recipient Pre-Transplant Bilirubin

0

0.25

0.5

0.75

1

1.25

1.5

0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2 2.2 2.4 2.6 2.8

Bilirubin (mg/dl)

p = 0.0367

Re

lati

ve

Ris

k o

f M

ali

gn

an

cy

b

ey

on

d 5

Ye

ars

ISHLT 2008



Limited to Recipients without Malignancy within 5 Years Center Volume

0

0.25

0.5

0.75

1

1.25

1.5

5 10 15 20 25 30 35 40 45 50 55 60 65 70


p = 0.0147

Re

lati

ve

Ris

k o

f M

ali

gn

an

cy

b

ey

on

d 5

Ye

ars

ISHLT 2008


ERA ANALYSIS:ADULT HEART TRANSPLANTS (1/1988-6/2002)

Risk Factors for 5 Year Mortality

2008ISHLT (N=27,596)

VARIABLE N

Relative Risk


Interval

On ventilator at transplant 818 1.88 <0.0001 1.68 -2.10

Year of transplant 1989 (vs. 2002) 1314 1.57 <0.0001 1.34 -1.84



Previous transplant 701 1.50 0.0003 1.21 -1.87



Other diagnosis* vs. cardiomyopathy 900 1.38 0.0018 1.13 -1.68

Year of transplant 1990 (vs. 2002) 1530 1.38 0.0001 1.18 -1.61

Congenital diagnosis vs. cardiomyopathy 456 1.30 0.0027 1.10 -1.55



o * Other = not cardiomyopathy, coronary artery disease, valvular

heart disease, or congenital heart disease




2008ISHLT (N=27,596)

VARIABLE N

Relative Risk


Interval

Year of transplant 1994 (vs. 2002) 2098 1.26 0.0022 1.09 1.47

Female recipient/male donor 3028 1.20 <0.0001 1.11 1.29

On VAD at time of transplant 2486 1.19 <0.0001 1.10 1.29



Number of HLA mismatches at DR locus 1.11 <0.0001 1.07 1.15

Female recipient/female donor 2890 1.10 0.0135 1.02 1.19

Coronary artery disease vs. cardiomyopathy 13749 1.10 0.0005 1.04 1.15

Male recipient/female donor 5380 1.10 0.002 1.03 1.16

Number of HLA mismatches at B locus 1.09 0.0003 1.04 1.14

In hospital prior to transplant (incl. ICU) 15883 1.08 0.0024 1.03 1.13

o




Continuous Factors

Recipient age

Donor age


Ischemia time

PRA


ERA ANALYSIS:ADULT HEART TRANSPLANTS (1/1988-6/2002) 5-Year Predicted Survival Model by Year of Transplant

50%

60%

70%

80%

90%

100%

0 1 2 3 4 5

Time (years)

2002 1998 1993 1988

Pre

dic

ted

Su

rviv

al

ISHLT 2008

Recipient: 54 y.o., Dx=cardiomyopathy, primary transplant, male, PRA = 0, volume=23/year, ischemia=180 min; HLA A mismatches = 1; HLA B mismatches = 2; HLA DR mismatches = 1; in hospital; not on VAD or ventilator or balloon pump

Donor: 28 y.o. male



Mortality within 5 YearsRecipient Age

0

0.25

0.5

0.75

1

1.25

1.5

1.75

2

25 35 45 55 65

Recipient Age (years)

p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

P < 0.0001

ISHLT 2008



Mortality within 5 YearsDonor Age

0

0.5

1

1.5

2

2.5

15 25 35 45 55

Donor Age (years)

p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

2008ISHLT



Mortality within 5 YearsIschemia Time

0

0.25

0.5

0.75

1

1.25

1.5

1.75

30 60 90 120 150 180 210 240 270 300 330 360


p = 0.0147

Rel

ativ

e R

isk

of

5 Y

ear

Mo

rtal

ity

P < 0.0001

ISHLT 2008



Mortality within 5 YearsCenter Volume

0

0.25

0.5

0.75

1

1.25

1.5

5 10 15 20 25 30 35 40 45 50 55 60 65 70


p = 0.0147

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity P < 0.0001

ISHLT 2008



Mortality within 5 YearsPre-transplant PRA

0

0.5

1

1.5

2

2.5

0 20 40 60 80 100


p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

2008ISHLT



Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

2008ISHLT (N=22,901)

VARIABLE N

Relative Risk


Interval








Number of mismatches at the DR locus 1.12 0.0001 1.06 -1.18

Female recipient/male donor 2485 1.12 0.0443 1.00 -1.25

Congenital diagnosis vs. cardiomyopathy 343 0.71 0.0296 0.53 -0.97

o



Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

2008ISHLT (N=22,901)

VARIABLE N Relative

Risk P-value

95% Confidence Interval

Repeat transplant 473 1.40 .0578 0.99 -1.98

Year of transplant 1996 (vs. 2002) 1728 1.24 .0501 1.00 -1.54

Year of transplant 1994 (vs. 2002) 1777 1.23 .0577 0.99 -1.53

Coronary artery disease vs. cardiomyopathy

11354 1.08 .0537 1.00 -1.16

In hospital prior to transplant (incl. ICU) 13006 1.06 .0985 0.99 -1.14

o


ERA ANALYSIS:ADULT HEART TRANSPLANTS (1/1988-6/2002) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

Continuous Factors

Recipient age

Donor age


Ischemia time


ERA ANALYSIS:ADULT HEART TRANSPLANTS (1/1988-6/2002) 5-Year Predicted Survival Model by Year of Transplant

Conditional on Survival to 1 Year

50%

60%

70%

80%

90%

100%

0 1 2 3 4 5

Time (years)

2002 1998 1993 1988

Pre

dic

ted

Su

rviv

al

ISHLT 2008

Recipient: 54 y.o., Dx=cardiomyopathy, primary transplant, male, PRA = 0, volume=23/year, ischemia=180 min; HLA A mismatches = 1; HLA B mismatches = 2; HLA DR mismatches = 1; in hospital; not on VAD or ventilator or balloon pump

Donor: 28 y.o. male


heart transplantation overall ishlt 2008 j heart lung transplant 2008;27: 937-983

Documents

j heart lung transplant

adult heart transplants

number of heart transplants

adult heart retransplants

year of transplant ishlt

ishlt transplant registry

transplant year

year transplants