HEART TRANSPLANTATION Overall ISHLT 2006 J Heart Lung Transplant 2006;25:869-79.

HEART TRANSPLANTATION

Overall

ISHLT 2006 J Heart Lung Transplant 2006;25:869-79

NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR

189 316661

1179

2145

2701

31143330

3980 4148 4187 4346 4428 4409 4242 41443820

3536 3396 3345 3283 31872954

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Nu

mb

er

of

Tra

ns

pla

nts

ISHLT 2006

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 2006;25:869-79

AVERAGE CENTER VOLUMEHeart Transplants: January 1, 1991 - June 30, 1995

and January 1, 2001 – June 30, 2005

61 55

81

44

15

47 51

74

2914 3 6 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

.

1991-6/1995

2001-6/2005


DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUMEHeart Transplants: January 1, 1991 - June 30, 1995

and January 1, 2001 – June 30, 2005

28

25 23

128 9

13

310

30

21

15

4

116

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

1991-6/1995

2001-6/2005


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 (1/1982-6/2005)

% 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

1982-1988 (N = 9,672)1989-1993 (N = 19,386)1994-1998 (N = 20,624)1999-2004 (N = 19,679)

P < 0.0001


HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2004)

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 = 9.9 yearsConditional Half-life = 13 years

N=69,536

ISHLT 2006

N followed at longest time point: 28,463


HEART TRANSPLANTATION

Adult Recipients


Congenital2%

ReTX2%

Myopathy45%

Misc.1%

Valvular4%

CAD46%

1982-1999

DIAGNOSIS IN ADULT HEART TRANSPLANTS

203040506070

% o

f Cas

es

Myopathy CAD

CAD42%

Valvular3%

Misc.5%

Myopathy46%

ReTX2%

Congenital2%

1/2001-6/2005


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982 – 6/2004)

0

20

40

60

80

100

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

Years

1982-1988 (N=9,071)

1989-1993 (N=17,685)

1994-1998 (N=18,758)

1999-6/2004 (N=16,227)

All comparisons significant at p < 0.0001

HALF-LIFE 1982-1988: 8.2 years; 1989-1993: 9.7 years; 1994-1998: 10.2 years

Su

rviv

al (

%)


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1982-6/2004)

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= 6,485) 35-49 (N=17,962)50-59 (N=24,430) 60-64 (N=9,263)65-69 (N= 3,036) 70+ (N= 318)

HALF-LIFE 18-34: 12.0 years; 35-49: 10.7 years; 50-59: 9.6 years; 60-64: 8.7 years; 65-69: 8.0 years; 70+: 7.0 years

All pair-wise comparisons are statistically significant at p < 0.005 except 65-69 vs. 70+


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1998-6/2004)

0

20

40

60

80

100

0 1 2 3 4 5 6 7

Years

Su

rviv

al (%

) .

18-34 (N= 1,911) 35-49 (N= 4,956)50-59 (N=7,370) 60-64 (N=3,545)65-69 (N= 1,598) 70+ (N= 205)

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+


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1982-6/2004)

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 = 25,637) Coronary artery disease (N = 25,952)Congenital diagnosis (N = 955) Retransplant (1,181)Valvular (N= 1,931) Other (N= 788)

HALF-LIFE Cardiomyopathy: 10.7 years; CAD: 9.0 years; Congenital: 11.7 years; Retransplant: 4.6 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 = 0.01; 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: 1/1982-6/2004)

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 = 19,654)Coronary artery disease (N = 19,611)Congenital diagnosis (N = 658)Retransplant (703)Valvular (N= 1,353)Other (N= 449)

All pair-wise comparisons are significant except Cardiomyopathy vs. valvular, valvular vs. other, and congenital vs. other

HALF-LIFE Cardiomyopathy: 12.9 years; CAD: 11.1 years; Congenital: 11.5 years; Retransplant: 9.0 years; Valvular: 13.2 years; Other: 14.2 years


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1998-6/2004)

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

Su

rviv

al (

%)

Cardiomyopathy (N=8,399) Coronary artery disease (N=8,197)

Congenital Diagnosis (N=383) Retransplant (N=407)

Valvular (N=501) Other (N=410)

All pair-wise comparisons with Cardiomyopathy are significant at p < 0.05; Coronary Artery Disease vs. ReTX: p < 0.0001


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis Conditional on Survival to 1 Year (Transplants: 1/1998-6/2004)

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

Su

rviv

al (

%)

Cardiomyopathy (N=6,559) Coronary artery disease (N=6,264)

Congenital Diagnosis (N=252) Retransplant (N=273)

Valvular (N=354) Other (N=210)

Cardiomyopathy vs. CAD: p = 0.009; Cardiomyopathy vs. ReTx: p = 0.0005; CAD vs. Congenital: p = 0.07; CAD vs. Valvular: p = 0.16; Valvular vs. ReTx: p = 0.005; Congenital vs. ReTx: p = 0.003


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by PVR (Transplants: 1/2002-6/2004)

50

60

70

80

90

100

0 1 2 3

Years

Su

rviv

al (

%)

1-<3 Wood units (N= 2,421) 3-<5 Wood units (N= 719)

5+ Wood units (N= 266)

1-<3 vs. 3-<5: p = 0.0002


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage (Transplants: 1/1999-6/2004)

50

60

70

80

90

100

0 1 2 3 4 5

Years

Su

rviv

al (

%)

Pulsatile flow (N=1,813) No LVAD (N=14,154)

p < 0.0001

ISHLT 2006

Note: Only 42 transplants involving continuous flow devices; too few to analyze.


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage and Era (Transplants: 1/1999-6/2004)

50

60

70

80

90

100

0 1 2 3 4 5

Years

Su

rviv

al (

%)

Pulsatile, 1999-2001 (N = 825) No LVAD, 1999-2001 (N=8,130)

Pulsatile, 2002-6/2004 (N=859) No LVAD, 2002-6/2004 (N=6,024)

p < 0.0001


ADULT HEART TRANSPLANTS5-Year Predicted Survival Model (Transplants: 1/1997-6/2000)

Impact of Pre-Transplant VAD

ISHLT 2006

50%

60%

70%

80%

90%

100%

0 1 2 3 4 5

Time (years)

Pre

dic

ted

Su

rviv

al No Pre-op VAD

Pre-op pulsatile VAD

Recipient: 54 y.o. male, Dx=CAD, PRA < 10%, weight=75 kg, height=69 in, PVR=2, volume=25/year, year of tx=99/00, bilirubin=0.9, PA diastolic=23, creatinine=1.2 mg/dl, ischemia=180 min;

Donor: 32 y.o. male, COD = MVA, weight = 72 kg, height = 70 in.


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

(%

) 1/1982-12/19901/1991-12/19991/2000-6/2004

Comparison of survival for interval < 12 months vs. > 12 months: p < 0.0001Comparison of survival for interval < 12 months vs. > 12 months for 1/00-6/2004: p < 0.0001

124

143

32 19 2731 66 863722 25 231

50 2 2 81 21 19015

ADULT HEART RE-TRANSPLANTS1-Year Survival


ADULT HEART RECIPIENTS Functional Status of Surviving Recipients

(Follow-ups: 1995 - June 2005)

0%

20%

40%

60%

80%

100%

1 Year (N = 15,406) 3 Years (N = 13,612) 5 Years (N = 11,872) 7 Years (N = 9,313)

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 = 15,030) 3 Year (N = 13,133) 5 Year (N = 11,279) 7 Year (N = 9,077)

Retired

Not Working

Working Part Time

Working Full Time


ADULT HEART RECIPIENTSRehospitalization Post-transplant of Surviving Recipients


0%

20%

40%

60%

80%

100%

Up to 1 Year (N = 17,817)

Between 2 and 3 Years (N = 15,349)



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


0

10

20

30

40

50

Polyclonal ALG/ATG (N = 2,242) OKT3 (N = 510) IL2R-antagonist (N = 2,253)

% o

f p

ati

en

tsADULT HEART RECIPIENTS

Induction Immunosuppression (Transplants: January 2001 – June 2005)


0

10

20

30

40

50

60

Any Induction PolyclonalALG/ATG

OKT3 IL2R-antagonist

% o

f p

atien

ts

1996 2000 2004

ADULT HEART RECIPIENTSInduction Immunosuppression (Transplants: 1996, 2000 and 2004)


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Use of Any Induction

(Transplants: 1/2000-6/2004, conditional on survival to 14 days)

50

60

70

80

90

100

0 1 2 3 4

Years

Su

rviv

al (

%)

No induction (N= 4,573) Any induction (N= 4,473)


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Type

(Transplants: 1/2000-6/2004, conditional on survival to 14 days)

50

60

70

80

90

100

0 1 2 3 4

Years

Su

rviv

al (

%)

No induction (N= 4,573) Polyclonal induction (N= 2,055)

IL2-R antagonist (N= 1,876) OKT3 (N= 542)


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

ati

en

ts .

Year 1 (N = 5,558) Year 5 (N = 4,577)

ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up

(Follow-ups: January 2002 - June 2005)

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


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

atie

nts

.

1999 (N=685) 2003 (N = 2,949) Jan 2005 - Jun 2005 (N = 1,411)

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

NOTE: Different patients are analyzed in each time frame.


0%

20%

40%

60%

80%

100%

Year 1 (N = 5,558) Year 5 (N = 4,577)

% 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 2003 - June 2005)

NOTES: Different patients are analyzed in Year 1 and Year 5. In the Year 1 cohort 76.5% of patients were on prednisone; in the Year 5 cohort 61% of patients were on prednisone.


PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR

Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2004)

0

10

20

30

40

50

60

70

Overall 18-44 45-62 63+ F M% t

rea

ted

fo

r re

jec

tio

n w

ith

in 1

ye

ar

.

No induction (N = 4,455) Polyclonal (N = 2,045)IL2R-antagonist (N = 1,872) OKT3 (N = 540)

For females: no induction vs. OKT3 (p = 0.0003); polyclonal vs. OKT3 (p = 0.0011); IL2R vs. OKT3 (p = 0.0048)For males: no induction vs. OKT3 (p = 0.0015); polyclonal vs. OKT3 (p = 0.0007); IL2R vs. OKT3 (p = 0.0365)

Overall: no induction vs. OKT3 (p < 0.0001); polyclonal vs. OKT3 (p < 0.0001); IL2R vs. OKT3 (p = 0.0017).45-62: All comparisons with OKT3 were significant at p < 0.0001. No other comparisons within age groups were statistically significant.


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, 2004)

0

0.5

1

1.5

2

2.5

3

Overall 18-44 45-62 63+ F M

Ave

rag

e n

um

ber

of

reje

ctio

n e

pis

od

es

No induction (N = 4,455) Polyclonal (N = 2,045)IL2R-antagonist (N = 1,872) OKT3 (N = 540)

Overall: no induction vs. OKT3 (p = 0.0021); polyclonal vs. OKT3 (p=0.0077); IL2 vs. OKT3 (p=0.0003). 18-44: no induction vs. IL2 (p = 0.033).45-62: no induction vs. OKT3 (p = 0.0031); IL2 vs. OKT3 (p = 0.0034).63+: polyclonal vs. OKT3 (p = 0.0228).For females: no induction vs. OKT3 (p = 0.0082); IL2 vs. OKT3 (p = 0.0493). For males: no induction vs. OKT3 (p =0.046); IL2 vs. OKT3 (p = 0.0021).


PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR

Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2004)

0

10

20

30

40

50

60

70

Overall 18-44 45-62 63+ F M

% t

reat

ed f

or

reje

ctio

n w

ith

in 1

yea

r

Cyclosporine + MMF (N = 2,906) Cyclosporine + AZA (N = 587)Tacrolimus + MMF (N = 973) Tacrolimus + AZA (N = 78)

Overall: CyA + MMF vs. TAC + MMF (p<0.0001); CyA + MMF vs. TAC + AZA (p=0.0102); CyA + AZA vs. TAC + MMF (p<0.0001); CyA + AZA vs. TAC + AZA (p=0.0054).

18-44: CyA + MMF vs. TAC + MMF (p=0.0085); CyA + MMF vs. TAC + AZA (p=0.0119); CyA + AZA vs. TAC + MMF (p=0.031); CyA + AZA vs. TAC + AZA (p=0.0108).

45-62: CyA + MMF vs. TAC + MMF (p<0.0001); CyA + AZA vs. TAC + MMF (p<0.0001). 63+: CyA + MMF vs. TAC + MMF (p=0.0395); CyA + AZA vs. TAC + MMF (p=0.0027). 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)


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, 2004)

0

0.5

1

1.5

2

2.5

Overall 18-44 45-62 63+ F M

Ave

rag

e n

um

ber

of

reje

ctio

n e

pis

od

es

Cyclosporine + MMF (N = 2,906) Cyclosporine + AZA (N = 587)Tacrolimus + MMF (N = 973) Tacrolimus + AZA (N = 78)

Overall: CyA + MMF vs. TAC + MMF (p = 0.0391); CyA + AZA vs. TAC + MMF (p = 0.0067)18-44: CyA + MMF vs. TAC + MMF (p = 0.0474); CyA + TAC + MMF (p = 0.0434)Male: CyA + MMF vs. CyA + AZA (p = 0.0493); CyA + AZA vs. TAC + MMF (p = 0.0033)


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

Conditional on survival to 1 year for transplants: 1/1995-6/2003

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

No rejection (N=7,032) Rejection (N=6,336)

p < 0.0001


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Rejection between Transplant

Discharge and 1 YearConditional on survival to 1 year for transplants: 1/1995-6/2003

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

No rejection (N=4,697) Rejection (N=4,613)

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 2001 - June 2005)

Follow-ups: April 1994-

December 1997 Follow-ups: January 2001 –

June 2005

Outcome Within 1

Years Total N with

known response Within 1

Year Total N with

known response

Hypertension 68.9% (N = 6,428) 75.9% (N = 7,174)

Renal Dysfunction 20.4% (N = 6,381) 31.7% (N = 7,267)

Abnormal Creatinine < 2.5 mg/dl 11.3% 22.4% Creatinine > 2.5 mg/dl 8.1% 7.3% Chronic Dialysis 1.0% 1.5% Renal Transplant 0.1% 0.4%

Hyperlipidemia 33.3% (N = 6,816) 68.6% (N = 7,689)

Diabetes 20.9% (N = 6,436) 30.8% (N = 7,208)

Cardiac Allograft Vasculopathy 7.9% (N = 5,950) 7.9% (N = 6,515)


POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 5 and 8 Years Post-Transplant

(Follow-ups: April 1994 - June 2005)

Outcome Within 5

Years Total N with

known response Within 8

Years Total N with

known response

Hypertension 94.1% (N = 7,298) 97.4% (N = 3,232)

Renal Dysfunction 33.2% (N = 7,785) 35.9% (N = 3,114)

Abnormal Creatinine < 2.5 mg/dl 21.4% 20.6% Creatinine > 2.5 mg/dl 8.7% 10.0% Chronic Dialysis 2.6% 4.3% Renal Transplant 0.5% 0.9%

Hyperlipidemia 86.3% (N = 8,123) 91.4% (N = 3,232)

Diabetes 34.3% (N = 7,244) 37.2% (N = 2,798)

Cardiac Allograft Vasculopathy 32.1% (N = 5,207) 44.3% (N = 1,723)


FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY AND FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Adult Heart Recipients (Follow-ups: April 1994-June 2005)

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

fro

m C

AV

or

Fre

ed

om

fro

m

Se

ve

re R

en

al

Dy

sfu

nc

tio

n

Freedom from CAV

Freedom from Severe Renal Dysfunction

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


FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY Stratified by Rejection Within 1st Year

For Adult Heart Recipients (Transplants: April 1994-June 2003) Conditional on Survival to 1 Year

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8

Years

% F

ree

fro

m C

AV

No rejection (N = 5,250) Rejection (N = 4,456)

p = 0.0001


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

(Transplants: April 1994-June 2003)

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8

Time after Report of CAV (Years)

Su

rviv

al

(%)

CAV (N = 3,349)

No CAV (N = 9,946)

p < 0.0001

ISHLT 2006

* Patients without CAV conditioned on survival to median time of CAV development (562 days)


MALIGNANCY POST-HEART TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2005)

Malignancy/Type 1-Year Survivors

5-Year Survivors

8-Year Survivors

No Malignancy 18851 (97.1%) 6802 (84.4%) 2360 (74.0%)

Malignancy (all types combined) 572 (2.9%) 1257 (15.6%) 830 (26.0%)

Malignancy Type

Skin 262 843 552

Lymph 136 121 55

Other 123 321 165

Type Not Reported 51 38 115

”Other” includes: prostate (11, 33, 23), adenocarcinoma (7, 3, 2), lung (5, 3, 1), bladder (4, 5, 4), sarcoma (3, 2, 1), breast (2, 7, 4), cervical (2, 4, 1), colon (2, 3, 3), and renal (2, 5, 2). Numbers in parentheses are those reported within 1 year, 5 years and 8 years, respectively.


FREEDOM FROM MALIGNANCYFor Adult Heart Recipients (Follow-ups: April 1994 - June 2005)

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

% F

ree

fro

m M

ali

gn

an

cy

All malignancy Lymph Skin Other


ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2005)

CAUSE OF DEATH 0-30 Days

(N = 3,198)31 Days - 1 Year

(N = 2,635)>1 Year - 3 Years

(N = 1,985)>3 Years - 5 Years

(N = 1,724)>5 Years

(N = 5,364)

CARDIAC ALLOGRAFT VASCULOPATHY

54 (1.7%) 116 (4.4%) 272 (13.7%) 279 (16.2%) 767 (14.3%)

ACUTE REJECTION 208 (6.5%) 316 (12.0%) 195 (9.8%) 72 (4.2%) 76 (1.4%)

LYMPHOMA 2 (0.1%) 48 (1.8%) 81 (4.1%) 89 (5.2%) 236 (4.4%)

MALIGNANCY, OTHER 2 (0.1%) 55 (2.1%) 206 (10.4%) 312 (18.1%) 994 (18.5%)

CMV 4 (0.1%) 32 (1.2%) 16 (0.8%) 3 (0.2%) 5 (0.1%)

INFECTION, NON-CMV 414 (12.9%) 866 (32.9%) 260 (13.1%) 164 (9.5%) 554 (10.3%)

PRIMARY FAILURE 831 (26.0%) 194 (7.4%) 132 (6.6%) 73 (4.2%) 217 (4.0%)

GRAFT FAILURE 445 (13.9%) 287 (10.9%) 337 (17.0%) 272 (15.8%) 790 (14.7%)

TECHNICAL 237 (7.4%) 27 (1.0%) 16 (0.8%) 17 (1.0%) 49 (0.9%)

OTHER 213 (6.7%) 185 (7.0%) 175 (8.8%) 146 (8.5%) 447 (8.3%)

MULTIPLE ORGAN FAILURE

431 (13.5%) 276 (10.5%) 104 (5.2%) 101 (5.9%) 447 (8.3%)

RENAL FAILURE 18 (0.6%) 12 (0.9%) 35 (1.8%) 63 (3.7%) 341 (6.4%)

PULMONARY 134 (4.2%) 97 (3.4%) 89 (4.5%) 76 (4.4%) 223 (4.2%)

CEREBROVASCULAR 205 (6.4%) 113 (4.3%) 67 (3.4%) 57 (3.3%) 218 (4.1%)


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

(Deaths: January 1992 - June 2005)

CAUSE OF DEATH

DATE OF DEATH

0-30 Days

(N = 3,198)31 Days - 1 Year

(N = 2,635)>1 Year - 3 Years

(N = 1,985)>3 Years - 5 Years

(N = 1,724)>5 Years

(N = 5,364)

ACUTE REJECTION

1992-1997 117 (6.7%) 217 (13.8%) 106 (8.9%) 36 (4.0%) 18 (1.2%)

1998-6/2005 91 (6.2%) 99 (9.4%) 89 (11.1%) 36 (4.4%) 58 (1.5%)

CARDIAC ALLOGRAFT VASCULOPATHY

1992-1997 33 (1.9%) 78 (4.9%) 175 (14.8%) 179 (19.8%) 281 (18.1%)

1998-6/2005 21 (1.4%) 38 (3.6%) 97 (12.1%) 100 (12.2%) 486 (12.8%)

GRAFT FAILURE1992-1997

261 (15.0%)

177 (11.2%) 194 (16.4%) 119 (13.1%) 192 (12.3%)

1998-6/2005184

(12.6%)110 (10.4%) 143 (17.9%) 153 (18.7%) 598 (15.7%)

MALIGNANCY, OTHER

1992-1997 2 (0.1%) 39 (2.5%) 115 (9.7%) 168 (18.5%) 267 (17.2%)

1998-6/2005 16 (1.5%) 91 (11.4%) 144 (17.6%) 727 (19.1%)

PRIMARY FAILURE

1992-1997 500

(28.8%)169 (10.7%) 105 (8.9%) 48 (5.3%) 108 (6.6%)

1998-6/2005 331

(22.7%)25 (2.4%) 27 (3.4%) 25 (3.1%) 109 (2.9%)


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

(Transplants: January 1992 - June 2004)

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

0 1 2 3 4 5 6 7 8 9 10

Time (years)

% c

au

se

-sp

ec

ific

de

ath

s

CAV Acute Rejection

Malignancy (non-Lymph/PTLD) Primary Failure

Graft Failure CMV

Infection (non-CMV)


ADULT HEART TRANSPLANTS Risk Factors for 1 Year Mortality

4/1994-1998 (N=16,838)

2001-6/2004 (N=9,511)

Risk Factor N Relative

Risk p-value N

Relative Risk

p-value

Temporary circulatory support* 35 2.22 .0034 110 2.76 <.0001

Diagnosis: Congenital heart disease 257 1.77 <.0001 220 2.32 <.0001

Dialysis 161 1.87 <.0001 209 1.71 .0001

Female recipient 3353 1.18 .0394 2229 1.40 .0015

Diagnosis: Valvular heart disease 499 1.17 .1316 247 1.40 .0352

Donor cause of death: cerebrovascular/stroke

4037 1.09 .0077 2300 1.36 <.0001

Recipient cerebrovascular event prior to transplant

449 0.90 .4053 421 1.31 .0278

Hospitalized at transplant (including ICU) 12352 1.01 .8082 5845 1.31 .0003

2006ISHLTNote: All factors were significant at p < 0.05 in at least one of the eras.

* Temporary circulatory support includes ECMO and Abiomed.



4/1994-1998 (N=16,838)

2001-6/2004 (N=9,511)

Risk Factor N Relative Risk

p-value

N Relative Risk

p-value

Ventilator 272 1.81 <.0001 235 1.29 .0953

Repeat transplant 378 2.33 <.0001 230 1.29 .1598

Pulsatile chronic device** 197 1.41 .0415 1237 1.28 .0166

Not ABO identical vs. ABO identical 2719 1.01 .8473 1221 1.27 .0018

Diagnosis: Coronary artery disease 7311 1.24 <.0001 3883 1.26 .0009

Infection requiring IV drug therapy within 2 weeks prior to transplant

778 1.22 .0305 808 1.18 .093

PRA > 10% 765 1.39 .0001 517 1.13 .3058

HLA DR mismatches (per mismatch) 1 DR MM –

5041 2 DR MM –

11089 1.09 .0136

1 DR MM – 2870

2 DR MM – 6219

1.12 .0342


**VAD type collected for only part of era. Only those with known type were included in this group.



4/1994-1998 (N=16,838)

2001-6/2004 (N=9,511)


p-value

N Relative Risk

p-value

Female donor 5446 1.19 .0006 3057 1.11 .1590

Intra-aortic balloon pump 594 1.23 .03 433 0.98 .8757

HLA B mismatches (per mismatch) 1 B MM – 3340 2 B MM – 13197 1.15 .0021 1 B MM 1825

2 B MM – 7522 0.98 .7216

Diagnosis: Other 1770 0.77 .0004 1039 0.97 .8186

Recipient previous transfusions 1466 1.19 .0134 1412 0.96 .6687

Donor history of hypertension 1030 1.2 0.0239 701 0.87 0.2125

Recipient IV inotropes 5941 1.14 .0256 3303 0.85 .0359

Donor CMV +/Recipient CMV - 2966 1.00 .9468 1754 0.85 .0302



ADULT HEART TRANSPLANTSBorderline Significant Risk Factors for 1 Year Mortality

4/1994-1998 (N=16,838)

2001-6/2004 (N=9,511)


Risk p-value N

Relative Risk

p-value

Female donor, female recipient 1790 0.87 .1579 1239 0.77 .0587

2006ISHLTNote: All factors were significant at 0.5 < p < 0.1 in at least one of the eras.


ADULT HEART TRANSPLANTSRisk Factors for 1 Year Mortality

Continuous Factors (see figures)

Recipient age

Recipient weight

Donor age

Donor weight (borderline)

Transplant center volume

PA diastolic pressure

Ischemia time

Bilirubin

Serum creatinine

2006ISHLT J Heart Lung Transplant 2006;25:869-79


Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

4/1994-1998

2001-6/2004

p = 0.0001p < 0.0001



Donor Age

0

0.5

1

1.5

2

15 25 35 45 55

Donor Age

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

4/1994-1998

2001-6/2004

p < 0.0001p = 0.0011


ADULT HEART TRANSPLANTS 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)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

4/1994-1998

2001-6/2004

p = 0.0022p = 0.125



Donor Weight

0

0.5

1

1.5

2

50 60 70 80 90 100 110

Donor Weight (kg)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

4/1994-1998

2001-6/2004

p = 0.12p = 0.06



Center Volume

0

0.5

1

1.5

2

0 10 20 30 40 50 60 70

Center Volume (cases per year)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity 4/1994-1998

2001-6/2004

p < 0.0001p = 0.0006



Ischemia Time

0

0.5

1

1.5

2

1 2 3 4 5

Ischemia time (hours)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity 4/1994-1998

2001-6/2004

p < 0.0001p = 0.0004



Pre-Transplant Bilirubin

0

0.5

1

1.5

2

0.5 1.5 2.5 3.5 4.5

Recipient bilirubin (mg/dl)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

4/1994-1998

2001-6/2004

p = 0.024p = 0.0067



Pre-Transplant Creatinine

0

0.5

1

1.5

2

2.5

0.6 1.1 1.6 2.1 2.6

Recipient creatinine (mg/dl)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

4/1994-1998

2001-6/2004

p < 0.0001p < 0.0001


ADULT HEART TRANSPLANTS 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)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity 4/1994-1998

2001-6/2004

p = 0.16p = 0.006


ADULT HEART TRANSPLANTS Factors Not Significant for 1 Year Mortality

Recipient Factors: Pneumothorax, sternotomy, thoracotomy, ventricular remodeling, pulmonary embolism, prior malignancy, pulmonary vascular resistance, PCW

Donor Factors: Clinical infection, history of diabetes, height

Transplant Factors: Year of transplant



4/1994-1996 (N=10,048)

1997-6/2000 (N=11,363)


p-value

N Relative Risk

p-value

Repeat transplant 225 2.05 .0000 262 1.94 .0000

Ventilator 176 1.39 .0112 239 1.65 .0000

Diagnosis: congenital disease 150 1.24 .1470 168 1.55 .0019

Recipient dialysis 86 2.37 .0000 154 1.31 .0397

Recipient history of diabetes 733 1.03 .6435 1297 1.26 .0000

Intra-aortic balloon pump 352 1.04 .6975 443 1.25 .0116

Prior transfusion 764 1.08 .3080 1284 1.20 .0032

Hospitalized (including ICU) 7344 0.94 .3058 8044 1.20 .0003

Previous pregnancy 777 0.91 .3242 1064 1.20 .0226

Donor history of diabetes 81 0.58 .0299 132 1.18 .2843

HLA DR mismatches (per mismatch) 1 DR MM – 5659 2 DR MM – 3983 1.02 .5721

1 DR MM 2289 2 DR MM –

8893 1.14 .0001




4/1994-1996 (N=10,048)

1997-6/2000 (N=11,363)


p-value

N Relative Risk

p-value

Donor history of hypertension 564 1.14 .0985 811 1.14 .0488


455 1.23 .0210 628 1.14 .0838

PRA > 10% 436 1.25 .0097 545 1.14 .1123

Prior sternotomy 2124 0.98 .6850 2855 1.12 .0288

Female recipient 1917 1.15 .0358 2494 1.11 .1070

Diagnosis: coronary artery disease 4324 1.21 .0000 4969 1.09 .0572

HLA B mismatches (per mismatch) 1 B MM – 1972 2 B MM – 7884 1.10 .0199 1 B MM – 2289

2 B MM – 8893 1.08 .0584

Female donor 3223 1.16 .0016 3808 0.99 .7753

Defibrillator 549 0.82 .0296 1483 0.95 .3834

Recipient prior malignancy 149 1.37 .0247 264 0.91 .4707

Diagnosis: Other 1077 0.77 .0006 1148 0.87 .0658




4/1994-1996 (N=10,048)

1997-6/2000 (N=11,363)


Risk p-value N

Relative Risk

p-value

Recipient on IV inotropes 3385 1.12 .0772 4074 0.94 .2558

Not ABO identical vs. ABO identical 1775 0.98 .7268 1537 0.90 .0689

2006ISHLTNote: All factors were significant at 0.5 < p < 0.1 in at least one of the eras.




Recipient age

Recipient BMI

Donor age

Donor weight


PA diastolic pressure (borderline)

Ischemia time

Bilirubin

Serum creatinine



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

4/1994-1996

1997-6/2000

p = 0.0022p < 0.0001



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

4/1994-1996

1997-6/2000

p < 0.0001p < 0.0001



Pre-Transplant Recipient BMI

0

0.5

1

1.5

2

17 23 29 35

Recipient BMI (kg/m2)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

4/1994-1996

1997-6/2000

p < 0.0001p < 0.0001



Donor Weight

0

0.5

1

1.5

2

50 60 70 80 90 100 110

Donor Weight (kg)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

4/1994-1996

1997-6/2000

p = 0.68p = 0.008



Center Volume

0

0.5

1

1.5

2

0 10 20 30 40 50 60 70


Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity 4/1994-1996

1997-6/2000

p = 0.0001p < 0.0001



Ischemia Time

0

0.5

1

1.5

2

1 2 3 4 5


Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity 4/1994-1996

1997-6/2000

p = 0.0028p = 0.0014




0

0.5

1

1.5

2

0.5 1.5 2.5 3.5 4.5


Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

4/1994-1996

1997-6/2000

p = 0.078p < 0.0001




0

0.5

1

1.5

2

0.6 1.1 1.6 2.1 2.6


Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity 4/1994-1996

1997-6/2000

p < 0.0001p < 0.0001


ADULT HEART TRANSPLANTS Risk Factors for 5 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)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity 4/1994-1996

1997-6/2000

p = 0.089p = 0.36


ADULT HEART TRANSPLANTS Factors Not Significant for 5 Year Mortality

Recipient Factors: VAD, gender, pulmonary vascular resistance, thoracotomy, pneumothorax, pulmonary embolism

Donor Factors:History of cancer, clinical infection, cause of death

Transplant Factors: Year of transplant, CMV mismatch


ADULT HEART TRANSPLANTS 5-Year Predicted Survival Model

Impact of Donor Characteristics (I)

50%

60%

70%

80%

90%

100%

0 1 2 3 4 5

Time (years)

Pre

dic

ted

Su

rviv

all

Cohort average

Donor: 50 y.o. female, COD = CVA, weight = 70 kg, height = 65 in.


ISHLT 2006

Recipient: 30 y.o. female, PRA < 10%, weight=75 kg, height=65 in, center volume=25/year, year of tx=99/00, bilirubin=0.9, PA diastolic=23, creatinine=1.2 mg/dl, ischemia=180 min, PVR=2


ADULT HEART TRANSPLANTS5-Year Predicted Survival Model

Impact of Donor Characteristics (II)

50%

60%

70%

80%

90%

100%

0 1 2 3 4 5

Time (years)

Pre

dic

ted

Su

rviv

all Cohort average



ISHLT 2006

Recipient: 63 y.o. male, Dx=CAD, puls. LVAD, PRA < 10%, weight=85 kg, height=70 in, PVR=2, volume=25/year, year of tx=99/00, bilirubin=0.9, PA diastolic=23, creatinine=1.3 mg/dl, ischemia=180 min


ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

4/1994-1996 (N=5736)

1997-6/2000 (N=8799) Risk Factors

N Relative Risk

p-value

N Relative Risk

p-value

Stroke prior to discharge 61 1.37 .2542 96 1.81 .0040

Repeat transplant 108 1.42 .1204 173 1.53 .0254

CAV within 1st year 219 1.85 <.0001 423 1.45 .0011

Drug-treated infection prior to discharge 614 1.12 .3032 1222 1.45 <.0001

Recipient cerebrovascular event prior to transplant

162 1.26 .1904 335 1.33 .0241

Recipient history of diabetes 486 1.07 .5945 1008 1.33 .0007



ADULT HEART TRANSPLANTS Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

Risk Factor 4/1994-1996 (N=5736)

1997-6/2000 (N=8799)

N Relative Risk

p-value

N Relative Risk

p-value

Treated for rejection during 1st year 1486 1.19 .0232 2705 1.32 <.0001

Recipient female 1109 1.20 .1030 1928 1.21 .0243

Diagnosis: coronary artery disease vs. cardiomyopathy

2455 1.28 .0034 3831 1.02 .7787


243 1.34 .0437 470 0.95 .6960

3 or 4 total HLA mismatches vs. 5 or 6 1684 1.13 .0963 2606 0.82 .0030



ADULT HEART TRANSPLANTS Borderline Significant Risk Factors for 5 Year Mortality

Conditional on Survival to 1 Year

4/1994-1996 (N=5736)

1997-6/2000 (N=8799) Post-Transplant Risk Factor

N Relative Risk

p-value

N Relative Risk

p-value

Additional surgery required prior to discharge

220 1.34 .0574 534 1.12 .3193

0, 1 or 2 total HLA mismatches vs. 5 or 6 mismatches

177 0.62 .0648 277 0.93 .6519

Diagnosis = valvular heart disease vs. cardiomyopathy

160 0.60 .0883 197 0.65 .0635



ADULT HEART TRANSPLANTSRisk Factors for 5 Year Mortality Conditional on Survival to 1 Year


Recipient age

Recipient weight

Donor age

Donor BMI

Bilirubin

Serum creatinine


ADULT HEART TRANSPLANTS Risk Factors for 5 Year MortalityConditional 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

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

4/1994-1996

1997-6/2000

p < 0.0001p = 0.0036



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

4/1994-1996

1997-6/2000

p < 0.0001p < 0.0001



Donor BMI

0

0.5

1

1.5

2

17 23 29 35

Donor BMI (kg/m2)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

4/1994-1996

1997-6/2000

p = 0.035p = 0.5


ADULT HEART TRANSPLANTS Risk Factors for 5 Year MortalityConditional 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

4/1994-1996

1997-6/2000

p = 0.9p < 0.0001




0

0.5

1

1.5

2

0.5 1.5 2.5 3.5 4.5


Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

4/1994-1996

1997-6/2000

p = 0.2p = 0.008




0

0.5

1

1.5

2

0.6 1.1 1.6 2.1 2.6


Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity 4/1994-1996

1997-6/2000

p = 0.010p = 0.26


ADULT HEART TRANSPLANTS Risk Factors for 10 Year Mortality (Transplants: 1990-6/1994)

Risk Factor N p-value Relative

Risk

Repeat transplant 382 <.0001 2.45

Recipient on VAD 29 0.0003 2.31

Recipient on ventilator 251 <.0001 1.55

Recipient on IV inotropes 2073 0.0016 1.12

Number of HLA DR mismatches (RR per mismatch) 690 0 DR MM

9331 1 DR MM 6181 2 DR MM

<.0001 1.12


6824 0.0002 1.11

Number of HLA B mismatches (RR per mismatch 301 0 B MM: 3274 1 B MM

12627 2 B MM 0.0422 1.05

ABO identical 12811 0.0018 0.91

Diagnosis: other vs. cardiomyopathy 1850 0.0223 0.90

Female donor/female recipient 1336 0.0064 0.86

2006ISHLT

(N=16,202)



(Transplants: 1990-6/1994)


Risk p-value

Female donor 4539 1.06 .0582




Recipient age

Recipient height

Donor age


Ischemia time



Recipient Age

0

0.5

1

1.5

2

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



Donor Age

0

0.5

1

1.5

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


ADULT HEART TRANSPLANTS Risk Factors for 10 Year MortalityPre-Transplant Recipient Height

0

0.5

1

1.5

2

150 160 170 180 190

Recipient height (cm)

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

alit

y

p < 0.0001



Center Volume

0

0.5

1

1.5

2

0 10 20 30 40 50 60 70


Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

alit

y

p < 0.0001



Ischemia Time

0

0.5

1

1.5

2

1 2 3 4 5


Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

alit

y

p = 0.0005



Impact of Donor Characteristics (I)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 1 2 3 4 5 6 7 8 9 10

Time (years)

Pre

dic

ted

Su

rviv

all


Cohort average

Donor: 30 y.o. male, COD = MVA, weight = 80 kg, height =70 in.

ISHLT 2006

Recipient: 30 y.o. female, PRA < 10%, weight=75 kg, height=65 in, center volume=25/year, year of tx=1993/94, bilirubin=0.9, PA diastolic=23, creatinine=1.2 mg/dl, ischemia=180 min, PVR=2



Impact of Donor Characteristics (II)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 1 2 3 4 5 6 7 8 9 10

Time (years)

Pre

dic

ted

Su

rviv

all

Cohort average



ISHLT 2006

Recipient: 63 y.o. male, Dx=CAD, puls. LVAD, PRA < 10%, weight=85 kg, height=70 in, PVR=2, volume=25/year, year of tx=93/94, bilirubin =0.9, PA diastolic=23, creatinine=1.3 mg/dl, ischemia=180 min



Conditional on Survival to 3 Years (Transplants: 1990-6/1994)

Risk Factor N p-value Relative

Risk

Repeat transplant 165 .0005 1.61


4738 <.0001 1.18

2006ISHLT

(N=11,113)


ADULT HEART TRANSPLANTS Risk Factors for 10 Year Mortality Conditional on 3 Year Survival

Recipient Age

0

0.5

1

1.5

2

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

ali

ty

p < 0.0001



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



BMI Ratio

0

0.5

1

1.5

2

0.5 0.6 0.7 0.8 0.9 1 1.1 1.2 1.3 1.4 1.5

Donor BMI/Recipient BMI

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

alit

y

p < 0.0001


ADULT HEART TRANSPLANTS (1997-6/2002) Risk Factors for Developing Cardiac Allograft Vasculopathy

within 3 Years

VARIABLE Relative

RIsk P-value

95% Confidence

Interval

Transplant year = 1997 vs. 2001/2002 1.31 .0012 1.11 -1.55

Transplant year = 1998 vs. 2001/2002 1.25 .0083 1.06 -1.47

Donor history of hypertension 1.23 .0099 1.05 -1.45

Infection requiring IV drug therapy within 2 weeks of transplant

1.22 .0324 1.02 -1.46

(N=7,072)

ISHLT

Note: Donor gender was not significant as an independent risk factor but was significant as an interaction with donor age.

2006J Heart Lung Transplant 2006;25:869-79


within 3 Years


Donor age

Donor age*donor gender interaction

Recipient BMI


ISHLT 2006J Heart Lung Transplant 2006;25:869-79

ADULT HEART TRANSPLANTS (1997-6/2002)Risk Factors for Developing Cardiac Allograft Vasculopathy

within 3 YearsDonor Age and Donor Gender

0

0.5

1

1.5

2

2.5

3

15 20 25 30 35 40 45 50 55

Donor Age

Ris

k o

f C

AV

wit

hin

3 Y

ears

.

Male DonorFemale Donor

p < 0.0001



within 3 Years Pre-Transplant Recipient BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30 32 34 36

Recipient BMI

Ris

k o

f C

AV

wit

hin

3 Y

ears

.

p = 0.0005


ADULT HEART TRANSPLANTS (1997-6/2002)Risk Factors for Developing Cardiac Allograft Vasculopathy

within 3 YearsCenter Volume

0

0.5

1

1.5

2

0 10 20 30 40 50 60 70


Ris

k o

f C

AV

wit

hin

3 Y

ears

.

p < 0.0001


HEART TRANSPLANTATION Overall ISHLT 2006 J Heart Lung Transplant 2006;25:869-79.

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Transcript of HEART TRANSPLANTATION Overall ISHLT 2006 J Heart Lung Transplant 2006;25:869-79.