HEART-LUNG TRANSPLANTATION

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J Heart Lung Transplant 2002; 21: 950-970.

HEART-LUNG TRANSPLANTATION

Overall

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0

50

100

150

200

25019

82

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

*

Num

ber

of T

rans

plan

tsNUMBER OF HEART-LUNG

TRANSPLANTS REPORTED BY YEAR

* Numbers may be low due to delayed reporting

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HEART-LUNG TRANSPLANTATIONACTUARIAL SURVIVAL (1982-2001)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Years Post Transplantation

N=2,928

Half-life = 2.8 yearsConditional Half-life = 8.2 years

Su

rviv

al (

%)

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HEART-LUNG RECIPIENTSFunctional Status (April 1994 – December 2001)

0%

20%

40%

60%

80%

100%

1 Year (N=240) 3 Years (N=180) 5 Years (N=164)

No Activity Limitations Performs with Some Assistance Requires Total Assistance

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HEART-LUNG RECIPIENTSEmployment Status (U.S.: April 1994 – December 2001)

0%

20%

40%

60%

80%

100%

1 Year (N = 196) 3 Years (N = 140) 5 Years (N = 134)

Working Full Time Working Part Time Not Working Retired

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HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant (April 1994 - December 2001)

0%

20%

40%

60%

80%

100%

Up to 1 Year (N = 281)

Between 2 and 3 Years (N = 197)

Between 4 and 5 Years (N = 168)

No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Only Hospitalized, Infection OnlyHospitalized, Rejection and Infection

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Adult Recipients

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Other 8%

Alpha-13%

Acquired heart disease

4%

CF17%

IPF3%

PPH26%

COPD4%

Congenital heart disease

35%

DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (1982-2001)

“Other” includes cancer, LAM, OB, bronchiectasis, retransplant, sarcoidosis

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DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (1982-2001)

Diagnosis N %

Congenital Heart Disease 693 36.4

PPH 520 27.3

CF 340 17.8

Acquired Heart Disease 90 4.7

COPD/Emphysema 87 4.6

IPF 59 3.1

Alpha-1 58 3.0

Re-TX: Non-OB 31 1.6

Sarcoidosis 27 1.4

Re-TX: OB 22 1.2

Bronchiectasis 13 0.7

OB (not Re-TX) 9 0.5

Other 52 2.7

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3%

4%

16%3% 4%

35%

25%

6%

2%

2%

DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA

1982-1990

38%

22%

1%

4%

1%4%

5%4%17%

4%

COPD Congenital Heart Disease Acquired Heart DiseaseAlpha-1 CF IPFOther PPH Re-TX: Non-OBRe-TX: OB

3%41%

7%

1%

19%2%

6%

20%

1%

0%

1991-1995 1996-2001

“Other” includes OB (non-ReTX), Bronchiectasis, Sarcoidosis

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0

10

20

30

40

50

Any Induction (N = 48)

Polyclonal ATG/ALG (N = 34)

OKT3 (N = 5) IL2-R Antagonist (N=12)

% o

f p

ati

en

tsADULT HEART-LUNG RECIPIENTS

Induction ImmunosuppressionFor follow-ups between October 1999 and December 2001

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0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

atie

nts

Year 1 (N = 47)

Year 5 (N = 53)

ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression at Any Time During Follow-up

For follow-ups between October 1999 and December 2001

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0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

atie

nts

Year 1 (N = 41) Year 5 (N = 41)

ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up


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0%

20%

40%

60%

80%

100%

Year 1 (N = 41) Year 5 (N = 41)

% o

f P

atie

nts

Other

Tacrolimus + MMF

Tacrolimus + AZA

Cyclosporine + MMF

Cyclosporine + AZA

ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up


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ADULT POST-HEART-LUNG TRANSPLANT MORBIDITYCumulative Incidence of Survivors (April 1994-December 2001)

Outcome By 1 Year By 5 Years

Hypertension 53.0% (N=234) 84.2% (N=57)

Renal Function (N=227) (N=59) Normal 84.6% 81.4% Renal Dysfunction 7.9% 11.9% Creatinine>2.5 mg/dl 3.1% 6.8% Chronic Dialysis 4.4% 0.0% Renal Transplant 0.0% 0.0%

Hyperlipidemia 17.0% (N=241) 56.9% (N=58)

Diabetes 11.7% (N=231) 18.2% (N=55)

Bronchiolitis Obliterans 10.0% (N=221) 25.6% (N=43)

CAV 1.0% (N=194) 10.0% (N=30)

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Freedom from CAV For Adult Heart-Lung Recipients (April 1994-December 2000)

50

60

70

80

90

100

0 12 24 36 48 60

Months

% F

ree

from

CA

V

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Freedom from Bronchiolitis Obliterans For Adult Heart-Lung Recipients (April 1994-December 2000)

50

60

70

80

90

100

0 12 24 36 48 60

Months

% F

ree

fro

m B

ron

chio

litis

O

blit

eran

s

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Freedom from Renal DysfunctionFor Adult Heart-Lung Recipients (April 1994-December 2000)

50

60

70

80

90

100

0 12 24 36 48 60

Months

% F

reed

om fr

om R

enal

D

ysfu

nctio

n

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

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MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTSCumulative Incidence for Survivors (April 1994-December 2001)

Malignancy/Type 1-Year Survivors 5-Year Survivors

No Malignancy 211 (90.9%) 53 90.8%)

Malignancy (all types combined) 21 (9.1%) 6 (9.2%)

Malignancy Type

Skin 1

Lymph 14 2

Other 2 2

Type Not Reported 4 2

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Freedom from MalignancyFor Adult Heart-Lung Recipients (April 1994-December 2000)

50

60

70

80

90

100

0 12 24 36 48 60

Months

% F

ree

from

Mal

igna

ncy

All malignancy

Lymph

Skin

Other

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ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (1987-2001)

0%

20%

40%

60%

80%

100%

0-30 Days (N = 235)

31 Days - 1 Year (N = 184)

>1 Year - 3 Years(N = 112)

>3 Years - 5Years (N = 58)

>5 Years (N = 52)

Timing of Death

Per

cen

tag

e o

f D

eath

s

Other

Malignancy, Other

Lymphoma

CMV

CAV

Graft Failure - Other

Primary Graft Failure

Infection, Non-CMV

Acute Rejection

Bronchiolitis

Technical

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Pediatric Recipients

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AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS (1982-2001)

0

10

20

30

40

50

60

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Recipient Age (Years)

Nu

mb

er o

f T

ran

spla

nts

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AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART-LUNG RECIPIENTS (1982-2001)

0

10

20

30

40

50

60

70

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18+

Donor Age (Years)

Nu

mb

er o

f T

ran

spla

nts

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AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS

By Year of Transplant

0

5

10

15

20

25

30

35

40

4511-17 Years1-10 Years

<1 Year

Nu

mb

er o

f T

ran

spla

nts

* Numbers may be low due to delayed reporting.

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NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS

0

5

10

15

20

2519

84

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

*

Transplant Year

Num

ber

of P

edia

tric

Tra

nspl

ant C

ente

rs

* Numbers may be low due to delayed reporting.

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39%2%

27%

3%

2% 21%

6%

Congenital

Acquired heart disease

Cystic Fibrosis

ReTX: OB

ReTX: Non-OB

PPH

Other

DIAGNOSIS IN PEDIATRIC HEART –LUNG TRANSPLANT RECIPIENTS (Age: 11-17 Years)

0

25

50

75

100

1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

% o

f Cas

es

PPH Cystic Fibrosis Congenital

“Other” includes Alpha-1, Bronchiectasis, IPF and OB (non-ReTX)

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PEDIATRIC HEART-LUNG TRANSPLANTATION Actuarial Survival (1982-2001)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Years Post-Transplantation

Sur

viva

l (%

)

1-10 (N = 112)

11-17 (N = 189)

Overall (N = 311)

Comparison between 1-10 years and 11-17 years not significant

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PEDIATRIC HEART-LUNG TRANSPLANTATION Actuarial Survival by Era (1982-2001)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Years Post-Transplantation

1982-1987 (N=70)

1988-1992 (N=191)

1993-1997 (N=133)

1998-2001 (N=72)

Su

rviv

al (

%)

No comparisons are statistically significant

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PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (1987-2001)

0%

20%

40%

60%

80%

100%

0-30 Days (N = 30)

31 Days - 1 Year (N = 37)

>1 Year - 3 Years(N = 27)

>3 Year - 5 Years(N = 13)

>5 Years (N = 11)

Timing of Death

Pe

rce

nta

ge

of

De

ath

s Other

Graft Failure - Other

Primary Graft Failure

Infection, Non-CMV

Acute Rejection

Bronchiolitis

Technical

HEART-LUNG TRANSPLANTATION

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