HEART TRANSPLANTATION Pediatric Recipients ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983.
HEART TRANSPLANTATION Overall ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10):...
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Transcript of HEART TRANSPLANTATION Overall ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10):...
HEART TRANSPLANTATION
Overall
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR
32
2 67
0 1,2
54
2,3
49 2,9
89
3,5
04
3,7
96 4,4
56
4,6
69
4,6
39
4,8
41
4,7
47
4,7
41
4,6
14
4,5
16
4,2
58
3,9
92
3,8
55
3,8
30
3,7
25
3,6
50
3,6
08
3,7
08
3,7
64
3,7
65
3,7
20
3,7
42
18
7
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Nu
mb
er
of
Tra
ns
pla
nts
NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, the presented data may not mirror the changes in the number of heart transplants performed worldwide
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Nu
mb
er
of
Tra
ns
pla
nts
Other
EuropeNorth America
NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, the presented data may not mirror the changes in the number of heart transplants performed worldwide
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
AVERAGE CENTER VOLUMEHeart Transplants: January 1, 2003 – June 30, 2010
45
103
3013 24
6
62
0
10
20
30
40
50
60
70
80
90
100
110
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
ce
nte
rs
0
5
10
15
20
25
30
35
40
45
50
55
Number of centers Percentage of transplants
Pe
rce
nta
ge
of
tra
ns
pla
nts
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
% o
f T
ran
spla
nts
0
5
10
15
20
25
30
35
0-10 11-17 18-34 35-49 50-59 60+ Median Age
Med
ian
do
no
r ag
e (y
ears
)
HEART TRANSPLANTS: Donor Age by Year of Transplant
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
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 60-69 70+
Recipient Age
% o
f tr
an
sp
lan
ts
1982-1991 (N = 23,929)
1992-2001 (N =43,912)
2002-6/2010 (N = 31,398)
p < 0.0001
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
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 23 24 25
Years
Su
rviv
al (
%)
Half-life = 11.0 yearsConditional Half-life = 14.0 years
N=89,006
N at risk at 25 years = 98
HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2009)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
HEART TRANSPLANTATION
Adult Recipients
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Congenital2%
ReTX2%
Myopathy48%
Misc.0%
Valvular4%
CAD44%
1/1982-6/2010
DIAGNOSIS IN ADULT HEART TRANSPLANTS
CAD38%
Valvular3%
Misc.1%
Myopathy53%
ReTX3%
Congenital3%
1/2005-6/2010
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
DIAGNOSIS IN ADULT HEART TRANSPLANTSCardiomyopathy vs. CAD by Location
20
30
40
50
60
70
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
% o
f C
ases Myopathy CADNorth America
20
30
40
50
60
70
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
% o
f C
ases
Myopathy CADEurope
20
30
40
50
60
70
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
% o
f C
ases Myopathy CADAll Locations
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Congenital3%
ReTX1%
Myopathy58%
Misc.0%
Valvular4%
CAD33%
Europe
ADULT HEART TRANSPLANTS:DIAGNOSIS BY LOCATION
Transplants between January 2005 and June 2010
Congenital2%
ReTX1%
Myopathy58%
Misc.7%
Valvular1%
CAD30%
Other
Congenital3%
ReTX3%
Myopathy50%
Misc.1%
Valvular2%
CAD41%
North America
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
1992-2001(N=39,812 )
2002-6/2010 (N=27,387)
p-value
Recipient age (years) 54.0 ± 11.0 (28.0 - 65.0) 54.0 ± 12.4 (25.0 - 67.0) 0.5756
Donor age (years) 31.0 ± 12.8 (15.0 - 54.0) 34.0 ± 13.1 (16.0 - 56.0) <0.0001
Recipient/donor gender (% male) 80.5%/ 68.4% 77.2%/ 69.5% <0.0001/ 0.0030
Recipient weight (kg) 75.0 ± 16.7 (51.7 - 102.1) 78.0 ± 17.2 (53.0 - 108.8) <0.0001
Recipient height (cm) 173.0 ± 11.3 (157.0 - 188.0) 175.0 ± 10.7 (157.5 - 188.0) <0.0001
Recipient BMI 25.0 ± 4.3 (18.9 - 32.8) 25.8 ± 4.7 (19.2 - 34.4) <0.0001
Donor weight (kg) 75.0 ± 17.6 (52.0 - 103.9)* 78.0 ± 17.1 (55.6 - 110.0) <0.0001
Donor height (cm) 175.0 ± 18.9 (155.0 - 188.0)* 175.0 ± 10.3 (159.0 - 190.0) <0.0001
Donor BMI 24.2 ± 4.5 (18.8 - 33.0)* 25.2 ± 4.9 (19.7 - 35.4) <0.0001
Recipient/donor diabetes mellitus 14.5%*/ 1.6%* 22.7%/ 2.5% <0.0001/ <0.0001
Recipient amiodarone use (US only)
22.6%* 29.4% <0.0001
Recipient/donor cigarette history -/ 37.5%* 46.9%**/ 23.6% -/ <0.0001
Recipient/donor hypertension 34.6%*/ 10.8%* 40.9%/ 12.4% <0.0001/ <0.0001
Recipient prior cardiac surgery - 43.0%** -
Continuous factors are expressed as median ± standard deviation (5th-95th percentiles)
* Based on 4/1994-2001 transplants.
** Based on 7/2004-6/2010 transplants.
ADULT HEART TRANSPLANTATION Donor and Recipient Characteristics
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
1992-2001(N=39,812 )
2002-6/2010 (N=27,387)
p-value
Recipient Peripheral Vascular Disease
3.9%* 3.0% <0.0001
Recipient previous malignancy 3.5%* 5.3% <0.0001
Recipient COPD 3.2%* 3.6% 0.0601
Ischemic time (hours) 2.6 ± 1.5 (0.0 - 4.6) 3.0 ± 1.5 (0.0 - 5.0) <0.0001
Most recent PRA > 10%
Overall 7.8% 9.2%** 0.0016
Class I 13.3%***
Class II 9.0%***
Creatinine at time of transplant 1.2 ± 9.7 (0.7 - 2.5) 1.2 ± 0.9 (0.7 - 2.3) 0.0001
Pulmonary vascular resistance (Wood units)
2.1 ± 2.2 (0.4 - 6.0)* 2.1 ± 2.0 (0.3 - 5.6) <0.0001
Continuous factors are expressed as median ± standard deviation (5th-95th percentiles)
* Based on 4/1994-2001 transplants.
** Based on US 2002-6/2004 transplants and non US 2002 - 6/2010 transplants
*** Based on US 7/2004-6/2010 transplants. Until mid-2004 PRA was collected in US as a single percentage. After this date, PRA was collected separately for Class I and Class II.
(Cont’d)
ADULT HEART TRANSPLANTATIONDonor and Recipient Characteristics
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
1992-2001(N=39,812 )
2002-6/2010 (N=27,387)
p-value
HLA Mismatches
0.0003 0-2 4.8% 4.2%
3-4 41.6% 40.4%
5-6 53.6% 55.4%
Diagnosis
<0.0001
Coronary artery disease 45.7% 39.5%
Cardiomyopathy 46.4% 51.6%
Valvular 3.7% 3.0%
Retransplant 1.9% 2.4%
Congenital 1.9% 2.8%
Other causes 0.4% 0.7%
ADULT HEART TRANSPLANTATION Donor and Recipient Characteristics
(Cont’d)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
1992-2001(N=39,812 )
2002-6/2010 (N=27,387)
p-value
Donor cause of death
<0.0001 Head trauma 45.7% 50.2%
Stroke 28.5% 28.8%
Other 25.8% 21.1%
Pre-operative support (multiple items may be reported)
Hospitalized at time of transplant 58.7% 46.0% <0.0001
On IV inotropes 55.3%* 44.8% <0.0001
LVAD 1.7%*** 19.0% <0.0001
IABP 6.7% 6.7% 0.7815
RVAD - 4.1%**** -
Ventilator 3.5% 3.0% 0.0065
TAH 0.1%*** 0.5% <0.0001
ECMO 0.3%** 0.8% <0.0001
(Cont’d)
ADULT HEART TRANSPLANTATION Donor and Recipient Characteristics
* Based on 4/1994-2001 transplants.
** Based on 5/1995-2001 transplants.
*** Based on 11/1999-2001 transplants.
**** Based on 2005-6/2010 transplants.
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION PRA DISTRIBUTION
Transplants between July 2004 and June 2010
0
10
20
30
40
50
60
70
80
0 1-9 10-39 40-79 80+
PRA
% o
f tr
an
sp
lan
ts
If Class I and Class II values were reported separately Class I PRA value was used
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION % OF PATIENTS BRIDGED WITH MECHANICAL
CIRCULATORY SUPPORT* (Transplants: 1/2000 – 12/2009)
0
10
20
30
40
50
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
% o
f p
ati
en
ts
* LVAD, RVAD, TAHISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION % OF PATIENTS BRIDGED WITH RVAD*
(Transplants: 1/2005 – 12/2009)
0
1
2
3
4
5
6
7
8
9
10
2005 2006 2007 2008 2009
Year
% o
f p
ati
en
ts
* RVAD, RVAD+LVADISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATIONNumber of Combined Organ Transplants Reported
By Year and Type of Transplant
ISHLT 2011
0
10
20
30
40
50
60
70
80
90
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Nu
mb
er
of
Tra
ns
pla
nts
Other Combined Organ TransplantsHeart-Kidney-PancreasHeart-Kidney-LiverHeart-LiverHeart-Kidney
ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f D
on
ors
0-10 years 11-17 years 18-34 years35-49 years 50-59 years 60+ years
ADULT HEART TRANSPLANTSDONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2010
Mean/median donor age: Europe = 38.3/40.0 North America = 31.7/29.0 Other = 32.9/31.0
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0%
20%
40%
60%
80%
100%
Europe North America Other
18-19 years 20-29 years 30-39 years 40-49 years50-59 years 60-69 years 70+ years
% o
f T
ran
sp
lan
tsADULT HEART TRANSPLANTS
RECIPIENT AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010
Mean/median recipient age: Europe = 50.1/53.0 North America = 51.8/55.0 Other = 48.3/51.0
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0%
20%
40%
60%
80%
100%
Europe North America Other
<18.5 18.5-<25 25-<30 30-<40 40+
% o
f T
ran
sp
lan
tsADULT HEART TRANSPLANTS
RECIPIENT BMI DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0%
20%
40%
60%
80%
100%
Europe North America Other
Diabetes No diabetes
% o
f T
ran
sp
lan
tsADULT HEART TRANSPLANTS
RECIPIENT DIABETES MELLITUS BY LOCATION Transplants between January 2000 and June 2010
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0%
20%
40%
60%
80%
100%
Europe North America Other
Cigarette history No cigarette history
% o
f T
ran
sp
lan
tsADULT HEART TRANSPLANTS
RECIPIENT CIGARETTE HISTORY BY LOCATION Transplants between July 2004 and June 2010
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era
(Transplants: 1/1982 – 6/2009)
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=20,504)
1992-2001 (N=36,879)
2002-6/2009 (N=22,477)
1982-1991 vs. 1992-2001: p = 0.84601982-1991 vs. 2002-6/2009: p < 0.00011992-2001 vs. 2002-6/2009: p < 0.0001
HALF-LIFE 1982-1991: 10.2 years; 1992-2001: 10.7 years; 2002-6/2009: NA
Su
rviv
al (
%)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Conditional Kaplan-Meier Survival by Era
(Transplants: 1/1982 – 6/2009)
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=16,059)
1992-2001 (N=29,287)
2002-6/2009 (N=16,686)
1982-1991 vs. 1992-2001: p = 0.00021982-1991 vs. 2002-6/2009: p = 0.00131992-2001 vs. 2002-6/2009: p = 0.2327
HALF-LIFE 1982-1991: 13.9 years; 1992-2001: 13.2 years; 2002-6/2009: NA
Su
rviv
al (
%)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group
(Transplants: 1/1982-6/2009)
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 (
%)
18-29 (N=5,580) 30-39 (N=7,898)40-49 (N=17,714) 50-59 (N=30,967)60-69 (N=17,187) 70+ (N=514)
HALF-LIFE 18-29: 12.3 years; 30-39: 13.2 years; 40-49: 11.7 years; 50-59: 10.5 years; 60-69: 9.5 years; 70+: 7.5 years
All pair-wise comparisons are statistically significant at p < 0.02 except 18-29 vs. 40-49 (p=0.2807)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group
(Transplants: 1/2002-6/2009)
0
20
40
60
80
100
0 1 2 3 4 5 6 7
Years
Su
rviv
al (
%)
18-29 (N=1,860) 30-39 (N=2,223)40-49 (N=4,214) 50-59 (N=7,902)60-69 (N=6,010) 70+ (N=268)
All pair-wise comparisons are statistically significant at p < 0.05 except 18-29 vs. 60-69; 18-29 vs. 70+, 30-39 vs. 40-49; 30-39 vs. 50-59 and 60-69 vs. 70+
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1982-6/2009)
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 = 35,912) Coronary artery disease (N = 34,220)Congenital diagnosis (N = 1,511) Retransplant (N = 1,628)Valvular (N = 2,788) Other (N = 351)
HALF-LIFE Cardiomyopathy: 11.9 years; CAD: 9.8 years; Congenital: 13.1 years; Retransplant: 5.8 years;Valvular: 12.1 years; Other: 11.8 years
All pair-wise comparisons with coronary artery disease and retransplant are significant at p = 0.001 except CAD vs. other (p=0.1541). All other pair-wise comparisons were not statistically significant.
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis
Conditional on Survival to 1 Year (Transplants: 1/1982-6/2009)
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=28,336) Coronary artery disease (N=26,762)
Congenital diagnosis (N=1,085) Retransplant (N=1,071)
Valvular (N=2,122)
All pair-wise comparisons are significant at p < 0.05
HALF-LIFE Cardiomyopathy: 14.7 years; CAD: 12.2 years; Congenital: 18.7 years; Retransplant: 10.1 years; Valvular: 16.3 years
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982 – 6/2009)
Diagnosis: Cardiomyopathy
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=8,564)
1992-2001 (N=16,147)
2002-6/2009 (N=11,201)
1982-1991 vs. 1992-2001: p = 0.15181982-1991 vs. 2002-6/2009: p < 0.00011992-2001 vs. 2002-6/2009: p < 0.0001
HALF-LIFE 1982-1991: 11.7 years; 1992-2001: 11.7 years; 2002-6/2009: NA
Su
rviv
al (
%)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982 – 6/2009)
Diagnosis: Coronary Artery Disease
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=8,937)
1992-2001 (N=16,486)
2002-6/2009 (N=8,797)
1982-1991 vs. 1992-2001: p = 0.39161982-1991 vs. 2002-6/2009: p < 0.00011992-2001 vs. 2002-6/2009: p < 0.0001
HALF-LIFE 1982-1991: 9.3 years; 1992-2001: 9.9 years; 2002-6/2009: NA
Su
rviv
al (
%)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982 – 6/2009)
Diagnosis: Congenital
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=249)
1992-2001 (N=675)
2002-6/2009 (N=587)
No comparisons are significant at 0.05
HALF-LIFE 1982-1991: 15.3 years; 1992-2001: 12.4 years; 2002-6/2009: NA
Su
rviv
al (
%)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982 – 6/2009)
Diagnosis: Retransplant
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=389)
1992-2001 (N=696)
2002-6/2009 (N=543)
All comparisons are significant at p < 0.001
HALF-LIFE 1982-1991: 1.9 years; 1992-2001: 6.2 years; 2002-6/2009: NA
Su
rviv
al (
%)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982 – 6/2009)
Diagnosis: Valvular
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=845)
1992-2001 (N=1,296)
2002-6/2009 (N=647)
No comparisons are significant at p < 0.05 except 1982-1991 vs. 1992-2001 (p = 0.0041)
HALF-LIFE 1982-1991: 13.7 years; 1992-2001: 11.5 years; 2002-6/2009: NA
Su
rviv
al (
%)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/2002-6/2009)
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
Su
rviv
al (
%)
Cardiomyopathy (N=11,201) Coronary artery disease (N=8,797)
Congenital Diagnosis (N=587) Retransplant (N=543)
Valvular (N=647)
All pair-wise comparisons are significant at p < 0.05 except valvular vs. congenital, valvular vs. retransplant and congenital vs. retransplant
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis Conditional on Survival to 1 Year
(Transplants: 1/2002-6/2009)
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
Su
rviv
al (
%)
Cardiomyopathy (N=8,404) Coronary artery disease (N=6,644)
Congenital Diagnosis (N=402) Retransplant (N=394)Valvular (N=457) Other (N=141)
No comparisons are significant at p < 0.05 exceptCongenital vs. Retransplant p=0.0209
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by PVR (Transplants: 1/2002-6/2009)
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
Su
rviv
al (
%)
1-<3 Wood units (N = 7,269) 3-<5 Wood units (N = 2,277)
5+ Wood units (N = 776)
1-<3 vs. 3-<5: p = 0.00061-<3 vs. 5+: p = 0.08933-<5 vs. 5+: p = 0.6820
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATIONKaplan-Meier Survival by Donor/Recipient Weight Ratio
(Transplants: 1/2002-6/2009)
For Recipients with PVR: 1- < 3 Wood units
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
Su
rviv
al (
%)
<0.8 Weight ratio (N=1,044) 0.8-<0.9 Weight ratio (N= 1,444)0.9-<1.1 Weight ratio (N=2,734) 1.1-<1.2 Weight ratio (N=805)1.2+ Weight ratio (N=1,242)
No pair-wise comparisons are statistically significant at p < 0.05 except <0.8 vs. 1.1 - <1.2: p = 0.0230
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION
Kaplan-Meier Survival by Donor/Recipient Weight Ratio (Transplants: 1/2002-6/2009)
For Recipients with PVR: 3- < 5 Wood units
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
Su
rviv
al (
%)
<0.8 Weight ratio (N=218) 0.8-<0.9 Weight ratio (N=397)0.9-<1.1 Weight ratio (N=834) 1.1-<1.2 Weight ratio (N=301)1.2+ Weight ratio (N=527)
No pair-wise comparisons are statistically significant at p < 0.05
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Donor/Recipient Weight Ratio
(Transplants: 1/2002-6/2009)
For Recipients with PVR: 5+ Wood units
50
60
70
80
90
100
0 1 2 3 4 5
Years
Su
rviv
al (
%)
<0.8 Weight ratio (N=81) 0.8-<0.9 Weight ratio (N=106)
0.9-<1.1 Weight ratio (N=268) 1.1-<1.2 Weight ratio (N=113)
1.2+ Weight ratio (N=208)
No pair-wise comparisons are statistically significant at p < 0.05
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage (Transplants: 4/1994-6/2009)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Years
Su
rviv
al (
%)
Pulsatile flow (N=3,540) Continuous flow (N=891)
No LVAD / No Inotropes (N=12,411) No LVAD / Inotropes (N=14,072)
Pulsatile vs. Continuous: p=0.0298Pulsatile vs. No LVAD/No Inotropes: p < 0.0001Pulsatile vs. No LVAD/Inotropes: p = 0.0032No other pair-wise comparisons are statistically significant at p < 0.05
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION
Kaplan-Meier Survival by VAD usage (Transplants: 1/2002-6/2009)
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
Su
rviv
al (
%)
Pulsatile flow (N=2,406) Continuous flow (N=876)
No LVAD / No Inotropes (N=5,817) No LVAD / Inotropes (N=5,653)
Pulsatile vs. No LVAD/Inotropes: p < 0.0001Pulsatile vs. No LVAD/No inotropes: p < 0.0001Continuous vs. No LVAD/Inotropes: p = 0.0264Continuous vs. No LVAD/No inotropes: p = 0.0107
No other pair-wise comparisons are statistically significant at p < 0.05
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage (Transplants: 1/1999-6/2009)
Conditional on Survival to 6 Months
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
Su
rviv
al (
%)
Pulsatile flow (N=2,793) Continuous flow (N=776)
No LVAD / No Inotropes (N=7,089) No LVAD / Inotropes (N=7,469)
No pair-wise comparisons are statistically significant at p < 0.05
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage
(Transplants: 7/2004-6/2009)
50
60
70
80
90
100
0 1 2 3 4 5
Years
Su
rviv
al (
%)
LVAD Pulsatile (N=1,113) LVAD Continuous (N=783)
LVAD+RVAD Pulsatile (N=356) No LVAD, No Inotropes (N=4,185)
No LVAD, Inotropes (N=3,541)
All pair-wise comparisons with LVAD+RVAD Pulsatile are statistically significant at p < 0.001. No other pair-wise comparisons are statistically significant at p < 0.05.
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0
20
40
60
80
100
0-12 months >12-36 months >36-60 months >60 months Primarytransplant
Time between previous and current transplant
1 Y
ear
Pat
ien
t S
urv
ival
(%
) 1/1982-12/19911/1992-12/20011/2002-6/2009
Comparison of survival for interval ≤ 12 months vs. > 12 months: p < 0.0001Comparison of survival for interval ≤ 12 months vs. > 12 months for 1/2002-6/2009: p < 0.0001
26
2
20
9 88
80 87
47
48 91
52 34
35
4
40
2
20
,01
6
36
,12
7
21
,82
1
ADULT HEART RE-TRANSPLANTS1-Year Survival
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART RECIPIENTSCross-Sectional Analysis
Functional Status of Surviving Recipients (Follow-ups: 1995 - June 2010)
0%
20%
40%
60%
80%
100%
1 Year (N = 16,087) 3 Years (N = 14,235) 5 Years (N = 12,181)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART RECIPIENTS Functional Status of Surviving Recipients
US Recipients Only(Follow-ups: March 2005 - June 2010)
0%
20%
40%
60%
80%
100%
1 Year (N = 8,210) 2 Years (N = 7,403) 3 Years (N =6,976)
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART RECIPIENTSEmployment Status of Surviving Recipients
(Follow-ups: 1995 - June 2010)
0%
20%
40%
60%
80%
100%
1 Year (N = 20,930) 3 Year (N = 18,213) 5 Year (N = 15,627)
Retired
Not Working
Working Part Time
Working Full Time
Working (FT/PTstatus unknown)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART RECIPIENTSEmployment Status of Surviving Recipients
Age at Follow-up: 25-55 Years (Follow-ups: 1995 - June 2010)
0%
20%
40%
60%
80%
100%
1 Year (N = 9,115) 3 Year (N = 6,967) 5 Year (N = 5,163)
Retired
Not Working
Working Part Time
Working Full Time
Working (FT/PTstatus unknown)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART RECIPIENTSRehospitalization Post-transplant of Surviving Recipients
(Follow-ups: 1995 - June 2010)
0%
20%
40%
60%
80%
100%
Up to 1 Year Between 2 and 3 Years Between 4 and 5 Years
No Hospitalization Hospitalized: Not Rejection/Not Infection
Hospitalized: Rejection Only Hospitalized: Infection Only
Hospitalized: Rejection + Infection
(N = 22,651) (N = 26,546) (N = 19,481)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0
10
20
30
40
50
Any Induction (N = 8,441)
IL-2R Antagonist(N = 4,419)
PolyclonalALG/ATG (N =
3,637)
OKT3 (N = 424) Alemtuzumab (N = 298)
% o
f p
ati
en
tsADULT HEART RECIPIENTS
Induction Immunosuppression (Transplants: January 2002 – June 2010)
Analysis is limited to patients who were alive at the time of the dischargeISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0
10
20
30
40
50
60
70
80
Any Induction IL-2R Antagonist Polyclonal ALG/ATG
% o
f p
ati
en
ts
Europe North America
ADULT HEART RECIPIENTSInduction Immunosuppression by Location
Transplants: January 2002 – June 2010
Analysis is limited to patients who were alive at the time of the dischargeISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0
10
20
30
40
50
60
Any Induction IL-2R Antagonist PolyclonalALG/ATG
OKT3
% o
f p
ati
en
ts
1997 2002 1/2010-6/2010
ADULT HEART RECIPIENTSInduction Immunosuppression
(Transplants: 1997, 2002 and 1/2010-6/2010)
Analysis is limited to patients who were alive at the time of the discharge
Note: 3.3% of transplant recipients in 1/2010-6/2010 received Alemtuzumab
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATIONKaplan-Meier Survival by Induction Type
(Transplants: 1/2000-6/2009, conditional on survival to 14 days)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
Su
rviv
al (
%)
No induction (N = 8,724) Polyclonal induction (N = 3,980)
IL-2R antagonist (N = 4,361) OKT3 (N = 671)
No induction vs. IL-2R: p = 0.0019Polyclonal vs. IL-2R: p = 0.0169
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0
20
40
60
80
100
Cyclosporine Tacrolimus Sirolimus/Everolimus
MMF/MPA Azathioprine Prednisone
% o
f P
ati
en
ts
Year 1 (N = 5,775) Year 5 (N = 3,591)
ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2007 - June 2010)
NOTE: Different patients are analyzed in Year 1 and Year 5
Analysis is limited to patients who were alive at the time of the follow-up
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0
20
40
60
80
100
Cyclosporine Tacrolimus Sirolimus MMF/MPA Azathioprine Prednisone
% o
f P
ati
en
ts
Year 1 (N = 7,148) Year 5 (N =7,148)
ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
For the Same Patients(Follow-ups: January 2000 - June 2010)
Analysis is limited to patients who were alive at the time of the follow-up
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0
20
40
60
80
100
Cyclosporine Tacrolimus Sirolimus/Everolimus
MMF/MPA Azathioprine Prednisone
% o
f P
ati
en
ts
2000 (N = 1,538) 2003 (N = 1,668) July 2009 - June 2010 (N = 1,616)
ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of 1 Year Follow-up
NOTE: Different patients are analyzed in each time frame.
Analysis is limited to patients who were alive at the time of the follow-up
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0%
20%
40%
60%
80%
100%
Year 1 (N = 7,148) Year 5 (N = 7,148)
% o
f P
ati
en
ts
None
Other
Sirolimus+calcineurin+cellcycle
Tacrolimus
Cyclosporine
Sirolimus + cellcycle
Sirolimus + calcineurin
Tacrolimus + MMF/MPA
Tacrolimus + AZA
Cyclosporine + MMF/MPA
Cyclosporine + AZA
ADULT HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
For the Same Patients(Follow-ups: January 2000 - June 2010)
Analysis is limited to patients who were alive at the time of the follow-upISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0%
20%
40%
60%
80%
100%
Year 1 (N = 8,907) Year 5 (N = 6,106)
None
Other
Sirolimus+calcineurin+cellcycle
Tacrolimus
Cyclosporine
Sirolimus + cellcycle
Sirolimus + calcineurin
Tacrolimus + MMF/MPA
Tacrolimus + AZA
Cyclosporine + MMF/MPA
Cyclosporine + AZA
% o
f P
ati
en
tsADULT HEART RECIPIENTS
Maintenance Immunosuppression Drug Combinations at Time of Follow-up(Follow-ups: January 2005 - June 2010)
NOTES: Different patients are analyzed in Year 1 and Year 5. In the Year 1 cohort 88.8% of patients were on prednisone; in the Year 5 cohort 54.0% of patients were on prednisone.
Analysis is limited to patients who were alive at the time of the follow-up
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0%
20%
40%
60%
80%
100%
Europe NorthAmerica
Europe NorthAmerica
None
Other
Sirolimus+calcineurin+cellcycle
Tacrolimus
Cyclosporine
Sirolimus + cellcycle
Sirolimus + calcineurin
Tacrolimus + MMF/MPA
Tacrolimus + AZA
Cyclosporine + MMF/MPA
Cyclosporine + AZA
% o
f P
ati
en
tsADULT HEART RECIPIENTS
Maintenance Immunosuppression Drug Combinations at Time of Follow-upby Location
(Follow-ups: January 2005 - June 2010)
NOTES: Different patients are analyzed in Year 1 and Year 5.
Analysis is limited to patients who were alive at the time of the follow-up
Year 1 Year 5
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
Stratified by Type of Induction (Follow-ups: July 1, 2004 - June 30, 2010)
0
10
20
30
40
50
60 No induction, Treatment No induction, No TreatmentPolyclonal, Treatment Polyclonal, No TreatmentIL-2R antagonist, Treatment IL-2R antagonist, No Treatment OKT3, Treatment OKT3, No Treatment
% e
xper
ien
cin
g r
ejec
tio
n w
ith
in 1
yea
r
Overall 18-44 45-62 63+ Female Male
No induction: N=4,744Polyclonal: N=1,956IL-2R antagonist: N=2,779OKT3: N=187
All groups: all no induct vs. poly and no induct vs. IL-2R comparisons are significant at p < 0.05 except 45-62: no induct vs. poly and M: no induct vs. polyOverall: no induct vs. OKT3 (p=0.0120); poly vs. IL-2R (p=0.0019)45-62: poly vs. IL-2R (p=0.0280)63+: no induct vs. OKT3 (p=0.0093)M: poly vs. IL-2R (p=0.0014)
Analysis is limited to patients who were alive at the time of the follow-up
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.
No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
Stratified by Maintenance Immunosuppression (Follow-ups: July 1, 2004 - June 30, 2010)
0
10
20
30
40
50
60 Cyclosporine + MMF/MPA, Treatment Cyclosporine + MMF/MPA, No TreatmentTacrolimus + MMF/MPA, Treatment Tacrolimus + MMF/MPA, No Treatment
% e
xper
ien
cin
g r
ejec
tio
n w
ith
in 1
yea
r
Overall: p < 0.000118-44: p < 0.000145-62: p < 0.000163+: p = 0.0450Female: p < 0.0001Male: p < 0.0001
NOTE: There were 163 patients with cyclosporine + AZA and 57 with tacrolimus+AZA. These groups were excluded due to small numbers.
Cyclosporine + MMF/MPA: N = 3,113Tacrolimus + MMF/MPA: N = 5,365
18-44 45-62 63+ MaleFemaleOverall
Analysis is limited to patients who were alive at the time of the follow-up
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.
No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTATIONKaplan-Meier Survival Stratified by Treatment for Rejection
Within 1st YearConditional on survival to 1 year (1 Year follow-ups: 7/2004-6/2009)
50
60
70
80
90
100
0 1 2 3 4 5
Year
Su
rviv
al (
%)
No rejection (N=4,315) Treated Rejection (N=1,736)
p <0.0001
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.
No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
FREEDOM FROM HOSPITALIZATION FOR REJECTION BY ERA
For Adult Heart Recipients (Transplants: April 1994-June 2009)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5
Years
Freedom from hospitalization for rejection 4/1994-2000 (N = 4,890)
Freedom from hospitalization for rejection 2001-6/2009 (N = 6,331)
% F
ree
do
m f
rom
ho
spit
aliz
atio
n f
or
reje
cti
on
p < 0.0001
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 1, 5 and 10 Years Post-
Transplant (Follow-ups: April 1994 - June 2010)
OutcomeWithin 1
YearTotal N with
known response
Within 5 Years
Total N with known
response
Within 10 Years
Total N with known response
Hypertension* 72.9% (N = 25,435) 92.9% (N = 11,156) -
Renal Dysfunction 26.6% (N = 26,918) 30.3% (N = 13,239) 36.0% (N = 4,274)
Abnormal Creatinine < 2.5 mg/dl 18.1% 20.5% 24.4%
Creatinine > 2.5 mg/dl 6.7% 7.0% 5.3%
Chronic Dialysis 1.5% 2.3% 4.8%
Renal Transplant 0.3% 0.4% 1.5%
Hyperlipidemia* 58.2% (N = 26,773) 87.9% (N = 12,483) -
Diabetes* 26.9% (N = 26,913) 37.4% (N = 12,195) -
Cardiac Allograft Vasculopathy 7.8% (N = 24,361) 30.6% (N = 8,988) 51.1% (N = 2,137)
* Data are not available 10 years post transplantISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Outcome
Within 1 Year
Total N with known
response
Within 5 Years
Total N with known
response
Within 10 Years
Total N with known response
Renal Dysfunction 18.7% (N = 1,852) 26.9% (N = 1,852) 34.0% (N = 1,852)
Abnormal Creatinine < 2.5 mg/dl 12.6% 21.2% 25.0%
Creatinine > 2.5 mg/dl 5.9% 4.6% 4.0%
Chronic Dialysis 0.1% 0.7% 3.5%
Renal Transplant 0.2% 0.4% 1.5%
Cardiac Allograft Vasculopathy 7.2% (N = 1,852) 30.2% (N = 1,852) 50.9% (N = 1,852)
POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 1, 5 and 10 Years Post-
Transplant (Transplants: 1994 - June 2000)For the Same Patients
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
OutcomeWithin 1
YearTotal N with
known response
Within 5 Years
Total N with known
response
Hypertension 75.1% (N = 3,273) 89.5% (N = 3,273)
Renal Dysfunction 26.3% (N = 3,273) 28.9% (N = 3,273)
Abnormal Creatinine < 2.5 mg/dl 20.7% 22.1%
Creatinine > 2.5 mg/dl 4.8% 5.0%
Chronic Dialysis 0.5% 1.5%
Renal Transplant 0.3% 0.3%
Hyperlipidemia 73.4% (N = 3,273) 90.7% (N = 3,273)
Diabetes 28.0% (N = 3,273) 40.0% (N = 3,273)
Cardiac Allograft Vasculopathy 5.4% (N = 3,273) 27.1% (N = 3,273)
POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 and 5 Years
Post-Transplant (Transplants: 2000 - June 2005)For the Same Patients
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY For Adult Heart Recipients (Transplants: April 1994-June 2009)
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 4/1994-2000 (N =10,044)
Freedom from CAV 2001-6/2009 (N = 12,724)
% F
ree
do
m f
rom
CA
V
p < 0.0001
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
FREEDOM FROM SEVERE RENAL DYSFUNCTION BY ERA* For Adult Heart Recipients (Transplants: April 1994-June 2009)
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 Severe Renal Dysfunction 4/1994-2000 (N = 11,173)
Freedom from Severe Renal Dysfunction 2001-6/2009 (N = 14,109)
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
% F
reed
om
fro
m S
ever
e R
enal
Dys
fucn
tio
n
p < 0.0001
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PATIENT SURVIVAL AFTER REPORT OF CAV WITHIN 3 YEARS OF TRANSPLANT AND PATIENT SURVIVAL IN
PATIENTS WITHOUT CAV*(Transplants: April 1994-June 2009)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Time after Report of CAV* (Years)
Su
rviv
al
(%)
No CAV (N = 16,812)
CAV (N = 3,962)
p < 0.0001
* Survival for patients without CAV within 3 years after transplant was conditioned on survival to median time of CAV development (509 days). Median time to CAV development is based on patients who developed CAV within 3 years of transplant.
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PATIENT SURVIVAL AFTER REPORT OF CAV WITHIN 3 YEARS OF TRANSPLANT AND PATIENT SURVIVAL IN
PATIENTS WITHOUT CAV* BY ERA(Transplants: April 1994-June 2009)
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 4/1994-2000 (N = 7,551)
CAV 4/1994-2000 (N = 1,946)
No CAV 2001-6/2009 (N = 9,261)
CAV 2001-6/2009 (N = 2,016)
4/1994-2000: No CAV vs. CAV p < 0.00012001-6/2009: No CAV vs. CAV p < 0.0001No CAV: 4/1994-2000 vs. 2001-6/2009 p = 0.7363CAV: 4/1994-2000 vs. 2001-6/2009 p = 0.0016
ISHLT 2011
* Survival for patients without CAV within 3 years after transplant was conditioned on survival to median time of CAV development (509 days). Median time to CAV development is based on patients who developed CAV within 3 years of transplant.
ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
MALIGNANCY POST-HEART TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2010)
Malignancy/Type 1-Year Survivors
5-Year Survivors
10-Year Survivors
No Malignancy 27,316 (97.3%) 11,751 (85.9%) 3,122 (71.3%)
Malignancy (all types combined) 764 (2.7%) 1,933 (14.1%) 1,256 (28.7%)
Malignancy Type
Skin 373 1,293 896
Lymph 161 154 87
Other 177 548 393
Type Not Reported 53 37 12
”Other” includes: prostate (11, 35, 21), adenocarcinoma (7, 7, 4), lung (6, 4, 1), bladder (4, 5, 4), Kaposi's sarcoma (0, 3, 1), breast (2, 7, 2), cervical (2, 5, 2), colon (2, 4, 2), and renal (2, 7, 2). Numbers in parentheses are those reported within 1 year, 5 years and 10 years, respectively.
NOTE: Multiple types may be reported; sum of types may be greater than total number with malignancy.
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
FREEDOM FROM MALIGNANCYFor Adult Heart Recipients (Follow-ups: April 1994 - June 2010)
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Years
All malignancy Lymph Skin Other
% F
ree
fro
m M
alig
na
nc
y
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
FREEDOM FROM MALIGNANCYby Maintenance Immunosuppression Combinations at DischargeFor Adult Heart Recipients (Transplants: January 2000 - June 2009)
Conditional on Survival to 14 days
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
TAC+MMF/MPA CyA+MMF/MPA CyA+AZA
% F
ree
fro
m M
ali
gn
an
cy
p <0.0001
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
FREEDOM FROM MALIGNANCYFor Adult Heart Recipients (Transplants : April 1994 - June 2009)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
Freedom from malignancy 4/1994-2000
Freedom from malignancy 2001-6/2009
% F
ree
fro
m M
alig
na
nc
y
p < 0.0001
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
FREEDOM FROM SKIN MALIGNANCYFor Adult Heart Recipients (Transplants : April 1994 - June 2009)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
Freedom from skin malignancy 4/1994-2000
Freedom from skin malignancy 2001-6/2009
% F
ree
fro
m S
kin
ma
lign
an
cy
p < 0.0001
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
FREEDOM FROM SKIN MALIGNANCY by LocationFor Adult Heart Recipients (Follow-ups: April 1994 - June 2010)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
North America Europe Other
% F
ree
fro
m S
kin
ma
lign
an
cy
p = 0.0012
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
FREEDOM FROM LYMPHOMAFor Adult Heart Recipients (Transplants : April 1994 - June 2009)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
Freedom from lymphoma 4/1994-2000
Freedom from lymphoma 2001-6/2009
% F
ree
fro
m L
ym
ph
om
a
p < 0.0001
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
FREEDOM FROM LYMPHOMA by Age GroupFor Adult Heart Recipients (Follow-ups: April 1994 - June 2010)
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
18-29 30-39 40-49
50-59 60-69 70+
% F
ree
fro
m L
ym
ph
om
a
p = 0.0204
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
FREEDOM FROM OTHER MALIGNANCYFor Adult Heart Recipients (Transplants : April 1994 - June 2009)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
Freedom from other malignancy 4/1994-2000
Freedom from other malignancy 2001-6/2009
% F
ree
fro
m O
the
r c
an
ce
r
p < 0.0001
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2010)
CAUSE OF DEATH0-30 Days
(N = 4,094)
31 Days –
1 Year
(N = 4,028)
>1 Year –
3 Years
(N = 3,166)
>3 Years –
5 Years
(N = 2,674)
>5 Years –
10 Years
(N = 6,273)
>10 Years
– 15 Years
(N =3,616)
>15 Years
(N =1,753)
Cardiac Allograft Vasculopathy
78 (1.9%) 195 (4.8%) 458 (14.5%) 428 (16.0%) 944 (15.0%) 521 (14.4%) 232 (13.2%)
Acute Rejection 256 (6.3%) 474 (11.8%) 323 (10.2%) 122 (4.6%) 116 (1.8%) 36 (1.0%) 31 (1.8%)
Lymphoma 3 (0.1%) 76 (1.9%) 110 (3.5%) 110 (4.1%) 271 (4.3%) 146 (4.0%) 61 (3.5%)
Malignancy, Other 3 (0.1%) 106 (2.6%) 360 (11.4%) 489 (18.3%) 1,202 (19.2%) 723 (20.0%) 293 (16.7%)
CMV 4 (0.1%) 45 (1.1%) 18 (0.6%) 5 (0.2%) 6 (0.1%) 1 (0.0%) 4 (0.2%)
Infection, Non-CMV 539 (13.2%) 1,203 (29.9%) 392 (12.4%) 268 (10.0%) 684 (10.9%) 373 (10.3%) 260 (14.8%)
Graft Failure 1,643 (40.1%) 723 (17.9%) 732 (23.1%) 544 (20.3%) 1,112 (17.7%) 582 (16.1%) 246 (14.0%)
Technical 300 (7.3%) 54 (1.3%) 36 (1.1%) 27 (1.0%) 59 (0.9%) 39 (1.1%) 38 (2.2%)
Other 201 (4.9%) 312 (7.7%) 289 (9.1%) 208 (7.8%) 535 (8.5%) 296 (8.2%) 157 (9.0%)
Multiple Organ Failure
591 (14.4%) 460 (11.4%) 152 (4.8%) 150 (5.6%) 441 (7.0%) 289 (8.0%) 144 (8.2%)
Renal Failure 24 (0.6%) 41 (1.0%) 55 (1.7%) 95 (3.6%) 371 (5.9%) 298 (8.2%) 133 (7.6%)
Pulmonary 164 (4.0%) 160 (4.0%) 123 (3.9%) 126 (4.7%) 257 (4.1%) 150 (4.1%) 77 (4.4%)
Cerebrovascular 288 (7.0%) 179 (4.4%) 118 (3.7%) 102 (3.8%) 275 (4.4%) 162 (4.5%) 77 (4.4%)
Percentages represent % of deaths in the respective time period
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
815
10 5 2 2 5 9 115 2 1
2
6 1722
21 25
24
1212 13 14
44 21
2318
1817
3715
2322
18 15
23
6 4
1
24
6 8
1430 12
10 911
1229
1310
12 12
06
16 24 24 21
03
1422 23 23
0
1
1
0
10
20
30
40
50
60
70
80
90
100
0-30 Days(N=1,800)
31 Days -1 Year
(N=1,844)
>1 Year -3 Years
(N=1,407)
>3 Years- 5 Years(N=1,041)
>5 Years- 10 Years(N=1,663)
>10 Years(N=198)
0-30 Days(N=2,294)
31 Days -1 Year
(N=2,184)
>1 Year -3 Years
(N=1,759)
>3 Years- 5 Years(N=1,633)
>5 Years- 10 Years(N=4,610)
>10 Years(N=5,171)
Acute Rejection CAV Graft Failure
Renal Failure Infection (Non-CMV) Malignancy
% o
f D
ea
ths
ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death from Leading Causes
by Time since Transplant and Era (Deaths: January 1992 - June 2010)
Deaths 1998 – June 2010Deaths 1992-1997
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death
(Deaths: January 1992 - June 2010)
0
10
20
30
40
50
0-30 Days (N=4,094)
31 Days – 1 Year
(N=4,028)
>1 Year – 3Years
(N=3,166)
>3 Years –5 Years
(N=2,674)
>5 Years –10 Years(N=6,273)
>10 – 15Years
(N=3,616)
>15 Years(N=1,753)
CAV Acute RejectionMalignancy (non-Lymph/PTLD) Infection (non-CMV)Graft Failure Multiple Organ FailureRenal Failure
Pe
rce
nta
ge
of
De
ath
s
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANT RECIPIENTS: Cumulative Incidence of Leading Causes of Death
(Transplants: January 1992 - June 2009)
0%
2%
4%
6%
8%
10%
12%
14%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Time (years)
CAV Acute Rejection
Malignancy (non-Lymph/PTLD) Graft Failure
CMV Infection (non-CMV)
Inc
ide
nc
e o
f C
au
se
-Sp
ec
ific
De
ath
s
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death
(Deaths: January 2000 - June 2010)
0
10
20
30
40
50
0-30 Days (N=1,852)
31 Days – 1 Year
(N=1,814)
>1 Year – 3Years
(N=1,402)
>3 Years –5 Years
(N=1,285)
>5 Years –10 Years(N=3,802)
>10 – 15Years
(N=3,138)
>15 Years(N=1,752)
CAV Acute RejectionMalignancy (non-Lymph/PTLD) Infection (non-CMV)Graft Failure Multiple Organ FailureRenal Failure
Pe
rce
nta
ge
of
De
ath
s
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANT RECIPIENTS: Cumulative Incidence of Leading Causes of Death
(Transplants: January 2000 - June 2009)
0%
2%
4%
6%
8%
10%
0 1 2 3 4 5
Time (years)
CAV Acute Rejection
Malignancy (non-Lymph/PTLD) Graft Failure
CMV Infection (non-CMV)
Inc
ide
nc
e o
f C
au
se
-Sp
ec
ific
De
ath
s
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Risk Factors for 1 Year Mortality
(N=10,271)
VARIABLE N
Relative Risk
P-value 95% Confidence
Interval
Temporary circulatory support* 180 3.32 <.0001 2.46 -4.48
Diagnosis: Congenital vs. cardiomyopathy 271 2.23 <.0001 1.67 -2.97
Temporary continuous flow device 31 2.10 0.0204 1.12 -3.92
Total artificial heart 58 1.82 0.0365 1.04 -3.20
Recipient history of dialysis 256 1.72 <.0001 1.35 -2.19
Recipient on ventilator at time of transplant 285 1.59 0.0006 1.22 -2.07
Previous transplant 298 1.51 0.0046 1.14 -2.01
Chronic continuous flow device 731 1.48 0.0008 1.18 -1.87
Chronic pulsatile flow device 1401 1.34 0.0022 1.11 -1.62
Prior transfusion 2056 1.26 0.0032 1.08 -1.46
Recipient with infection requiring IV drug therapy within 2 weeks prior to transplant
1021 1.23 0.019 1.03 -1.46
Donor cause of death: anoxia vs. head trauma 1146 1.22 0.0275 1.02 -1.45
Diagnosis: coronary artery disease vs. cardiomyopathy
4257 1.19 0.0126 1.04 -1.36
Ventricular remodeling 1348 0.80 0.0177 0.66 -0.96
Balloon pump 578 0.71 0.0062 0.55 -0.91
* Temporary circulatory support includes ECMO and temporary pulsatile flow devices.ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Borderline Significant Risk Factors for 1 Year Mortality
(N=10,271)
VARIABLE N
Relative Risk
P-value 95% Confidence
Interval
Donor cause of death: CNS tumor vs. head trauma
105 1.56 0.0651 0.97 -2.52
Transplant year: 1996 vs. 2008/2009 1926 1.18 0.0609 0.99 -1.40
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Recipient age
Recipient height
Recipient weight
Donor age
Donor weight
Transplant center volume
Ischemia time
Bilirubin
Serum creatinine
PRA
Pulmonary capillary wedge pressure
Recipient PVR
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) 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 70
Recipient Age
p < 0.0001
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=10,271)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Relative Risk of 1 Year Mortality with 95% Confidence Limits
Donor Age
0
0.5
1
1.5
2
2.5
15 20 25 30 35 40 45 50 55
Donor Age
p < 0.0001
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=10,271)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Relative Risk of 1 Year Mortality with 95% Confidence Limits
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
(N=10,271)ISHLT 2011
* The risk associated with recipient height should be considered in conjunction with the risk associated with recipient weight and donor weight.ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Relative Risk of 1 Year Mortality with 95% Confidence Limits
Recipient Weight
0
0.5
1
1.5
2
2.5
50 60 70 80 90 100 110 120 130
Recipient Weight (kg)
p = 0.0064
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=10,271)ISHLT 2011
* The risk associated with recipient weight should be considered in conjunction with the risk associated with recipient height and donor weight.ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Relative Risk of 1 Year Mortality with 95% Confidence Limits
Donor Weight
0
0.5
1
1.5
2
50 60 70 80 90 100 110 120 130
Donor Weight (kg)
p = 0.0147
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=10,271)ISHLT 2011
* The risk associated with donor weight should be considered in conjunction with the risk associated with recipient height and recipient weight.ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Relative Risk of 1 Year Mortality with 95% Confidence Limits
Ischemia Time
0
0.5
1
1.5
2
30 60 90 120 150 180 210 240 270 300 330 360
Ischemia Time (minutes)
p < 0.0001Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=10,271)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Relative Risk of 1 Year Mortality 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 = 0.0378
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=10,271)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Relative Risk of 1 Year Mortality with 95% Confidence Limits
Pre-Transplant Bilirubin
0
0.5
1
1.5
2
0.5 1 1.5 2 2.5 3 3.5
Recipient Bilirubin (mg/dl)
p < 0.0001
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=10,271)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Relative Risk of 1 Year Mortality with 95% Confidence Limits
Pre-Transplant Creatinine
0
0.5
1
1.5
2
2.5
3
0.5 1 1.5 2 2.5
Recipient Creatinine (mg/dl)
p < 0.0001
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=10,271)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Relative Risk of 1 Year Mortality with 95% Confidence Limits
PRA Class II (%)
0
0.5
1
1.5
2
2.5
3
0 10 20 30 40 50 60 70 80 90 100
Recipient PRA Class II (%)
p = 0.0203
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=10,271)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Relative Risk of 1 Year Mortality with 95% Confidence Limits
Pulmonary Capillary Wedge Pressure
0
0.5
1
1.5
2
5 10 15 20 25 30
Wedge Pressure (mm Hg)
p = 0.0075
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=10,271)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Relative Risk of 1 Year Mortality with 95% Confidence Limits
Recipient PVR
0
0.5
1
1.5
2
0 2 4 6 8
PVR
p = 0.0067
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=10,271)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009)
Factors Not Significant for 1 Year Mortality
Recipient Factors: Prior malignancy, hospitalized, prior pregnancy, balloon pump, diabetes, gender
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
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=18-30 Years
Risk Factors for 1 Year Mortality
(N=958)
VARIABLE N Relative
Risk P-value
95% Confidence Interval
Diagnosis: Congenital vs. cardiomyopathy
124 2.67 <.0001 1.67 -4.27
Recipient on balloon pump at transplant 50 1.97 0.0413 1.03 -3.78
Female recipient 378 1.67 0.0325 1.04 -2.68
Not ABO identical 166 0.56 0.029 0.33 -0.94
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=18-30 Years
Borderline Significant Risk Factors for 1 Year Mortality
(N=958)
VARIABLE N Relative
Risk P-value
95% Confidence Interval
Temporary circulatory support” 34 2.2 0.0584 0.97 -4.98
Recipient on ventilator at time of transplant
36 1.94 0.0791 0.93 -4.06
Recipient with infection requiring IV drug therapy within 2 weeks prior to transplant
117 1.6 0.0548 0.99 -2.59
Donor clinical infection 336 1.36 0.0978 0.94 -1.97
ISHLT 2011
* Temporary circulatory support includes ECMO and temporary pulsatile flow devices. There were too few temporary continuous flow devices to analyze.
ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009)
Recipients: Age=18-30 Years Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Recipient age
Donor age
Serum creatinine
PRA
PA systolic pressure (borderline)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=18-30 Years
Relative Risk of 1 Year Mortality with 95% Confidence LimitsRecipient Age
0
0.5
1
1.5
2
2.5
3
18 21 24 27 30
Recipient Age
p = 0.018Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=958)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=18-30 Years
Relative Risk of 1 Year Mortality with 95% Confidence LimitsDonor Age
0
0.5
1
1.5
2
2.5
3
3.5
15 20 25 30 35 40 45 50
Donor Age
p = 0.0004Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=958)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=18-30 Years
Relative Risk of 1 Year Mortality with 95% Confidence Limits Pre-Transplant Creatinine
0
0.5
1
1.5
2
2.5
3
0.5 1 1.5 2
Recipient Creatinine (mg/dl)
p = 0.0004
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=958)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=18-30 Years
Relative Risk of 1 Year Mortality with 95% Confidence Limits PRA Class I (%)
0
1
2
3
4
5
0 10 20 30 40 50 60 70 80 90 100
Recipient PRA Class I (%)
p = 0.007
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=958)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=18-30 Years
Relative Risk of 1 Year Mortality with 95% Confidence Limits Recipient PA Systolic Pressure
0
0.5
1
1.5
2
2.5
10 15 20 25 30 35 40 45 50 55
PA Systolic (mm Hg)
p = 0.069
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=958)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=31-60 Years
Risk Factors for 1 Year Mortality
(N=6,583)
VARIABLE N
Relative Risk
P-value 95% Confidence
Interval
Temporary circulatory support* 127 3.44 <.0001 2.34 -5.06
Temporary continuous flow device 22 2.34 0.025 1.11 -4.93
Diagnosis: Congenital vs. cardiomyopathy 135 2.00 0.0013 1.31 -3.04
Recipient on ventilator at time of transplant 176 1.80 0.0008 1.28 -2.54
Recipient history of dialysis 174 1.80 0.0001 1.33 -2.44
Chronic continuous flow device 485 1.64 0.0008 1.23 -2.20
Chronic pulsatile flow device 986 1.38 0.009 1.08 -1.75
Diagnosis: Coronary artery disease vs. cardiomyopathy
2543 1.28 0.0048 1.08 -1.52
Prior transfusion 1386 1.22 0.048 1.00 -1.48
Ventricular remodeling 940 0.79 0.0488 0.63 -1.00
Balloon pump 397 0.60 0.002 0.43 -0.83
ISHLT 2011
* Temporary circulatory support includes ECMO and temporary pulsatile flow devices. ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=31-60 Years
Borderline Significant Risk Factors for 1 Year Mortality
(N=6,583)
VARIABLE N
Relative Risk
P-value 95% Confidence
Interval
Repeat transplant 175 1.43 0.0616 0.98 -2.07
Hospitalized (incl. ICU) at transplant 3007 1.15 0.0874 0.98 -1.36
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009)
Recipients: Age=31-60 Years Risk Factors for 1 Year Mortality
Continuous Factors (see figures) Recipient age
Donor age
Recipient height
Recipient weight
Donor BMI
BMI ratio (borderline)
Serum creatinine
Bilirubin
Ischemia time
PRA
PA diastolic pressure
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=31-60 Years
Relative Risk of 1 Year Mortality with 95% Confidence LimitsRecipient Age
0
0.5
1
1.5
2
30 35 40 45 50 55 60
Recipient Age
p = 0.0073
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=6,583)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=31-60 Years
Relative Risk of 1 Year Mortality with 95% Confidence LimitsDonor 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
(N=6,583)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=31-60 Years
Relative Risk of 1 Year Mortality with 95% Confidence LimitsRecipient Height
0
0.5
1
1.5
2
2.5
3
150 160 170 180 190 200
Recipient Height (cm)
p = 0.0003
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=6,583)ISHLT 2011
* The risk associated with recipient height should be considered in conjunction with the risk associated with recipient weight and BMI ratio.ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=31-60 Years
Relative Risk of 1 Year Mortality with 95% Confidence LimitsRecipient Weight
0
0.5
1
1.5
2
2.5
50 60 70 80 90 100 110 120 130
Recipient Weight (kg)
p = 0.0058
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=6,583)ISHLT 2011
* The risk associated with recipient weight should be considered in conjunction with the risk associated with recipient height and BMI ratio.ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=31-60 Years
Relative Risk of 1 Year Mortality with 95% Confidence Limits Donor BMI
0
0.5
1
1.5
2
15 20 25 30 35 40
Donor BMI (kg/m2)
p = 0.029
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=6,583)ISHLT 2011
* The risk associated with donor BMI should be considered in conjunction with the risk associated with BMI ratio.ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=31-60 Years
Relative Risk of 1 Year Mortality with 95% Confidence Limits Pre-Transplant Creatinine
0
0.5
1
1.5
2
2.5
0.5 1 1.5 2 2.5
Recipient Creatinine (mg/dl)
p < 0.0001
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=6,583)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=31-60 Years
Relative Risk of 1 Year Mortality with 95% Confidence Limits Pre-Transplant Bilirubin
0
0.5
1
1.5
2
2.5
0.5 1 1.5 2 2.5 3 3.5
Recipient Bilirubin (mg/dl)
p = 0.007
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=6,583)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=31-60 Years
Relative Risk of 1 Year Mortality with 95% Confidence Limits Ischemia Time
0
0.5
1
1.5
2
30 60 90 120 150 180 210 240 270 300 330 360
Ischemia time (minutes)
p < 0.0001Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=6,583)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=31-60 Years
Relative Risk of 1 Year Mortality with 95% Confidence Limits PRA Class I (%)
0
0.5
1
1.5
2
2.5
3
0 10 20 30 40 50 60 70 80 90 100
Recipient PRA Class I (%)
p = 0.0071
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=6,583)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=31-60 Years
Relative Risk of 1 Year Mortality with 95% Confidence Limits Recipient PA Diastolic Pressure
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40
PA Diastolic Pressure (mm Hg)
p = 0.005
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=6,583)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=61-75 Years
Risk Factors for 1 Year Mortality
(N=2,721)
VARIABLE N
Relative Risk
P-value 95% Confidence
Interval
Repeat transplant 55 3.33 <.0001 1.97 -5.62
Ventilator 72 1.86 0.0058 1.20 -2.89
Recipient history of dialysis 56 1.76 0.0192 1.10 -2.81
Prior transfusions 447 1.72 <.0001 1.32 -2.24
Recipient with infection requiring IV drug therapy within 2 weeks prior to transplant
215 1.36 0.0587 0.99 -1.88
Not ABO identical 418 1.26 0.0858 0.97 -1.65
ISHLT 2011
* Temporary circulatory support includes ECMO and temporary pulsatile flow devices. There were too few temporary continuous flow devices to analyze.
ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=61-75 Years
Risk Factors for 1 Year Mortality
Continuous Factors (see figures) Donor age
Recipient height
Ischemia time
Serum creatinine
Bilirubin
TPG
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=61-75 Years
Relative Risk of 1 Year Mortality with 95% Confidence LimitsDonor Age
0
0.5
1
1.5
2
2.5
20 25 30 35 40 45 50 55 60
Donor Age
p = 0.0013
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=2,721)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=61-75 Years
Relative Risk of 1 Year Mortality with 95% Confidence LimitsRecipient Height
0
0.5
1
1.5
2
2.5
150 160 170 180 190
Recipient Height (cm)
p = 0.0007
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=2,721)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=61-75 Years
Relative Risk of 1 Year Mortality with 95% Confidence Limits 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 = 0.0017Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=2,721)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=61-75 Years
Relative Risk of 1 Year Mortality with 95% Confidence Limits Pre-Transplant Creatinine
0
0.5
1
1.5
2
2.5
0.5 1 1.5 2 2.5
Recipient Creatinine (mg/dl)
p = 0.0041
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=2,721)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=61-75 Years
Relative Risk of 1 Year Mortality with 95% Confidence Limits Pre-Transplant Bilirubin
0
0.5
1
1.5
2
2.5
0.5 1 1.5 2 2.5 3
Recipient Bilirubin (mg/dl)
p = 0.0016
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=2,721)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=61-75 Years
Relative Risk of 1 Year Mortality with 95% Confidence LimitsTPG
0
0.5
1
1.5
2
3 5 7 9 11 13 15
Transpulmonary Gradient
p = 0.013
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
(N=2,721)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005) Risk Factors for 5 Year Mortality
(N=10,785)
VARIABLE N Relative
Risk P-value
95% Conf. Int.
Temporary circulatory support* 171 2.14 <.0001 1.69 -2.71
Diagnosis: Congenital vs. cardiomyopathy 270 1.66 <.0001 1.32 -2.08
Recipient on dialysis at transplant 328 1.62 <.0001 1.36 -1.93
Ventilator 318 1.59 <.0001 1.31 -1.92
Chronic continuous flow device 115 1.42 0.0369 1.02 -1.98
Previous pregnancy 1552 1.26 0.0055 1.07 -1.48
Recipient Hep B Core (+) 395 1.25 0.0195 1.04 -1.50
Number of mismatches at A locus 0 A MM (N=640)
1 A MM (N=5350) 2 A MM (N=4975)
1.24 0.0032 1.08 -1.44
Recipient history of diabetes 2121 1.17 0.0012 1.06 -1.28
Diagnosis: Coronary artery disease vs. cardiomyopathy
5022 1.16 0.0011 1.06 -1.28
Recipient with infection requiring IV drug therapy within 2 weeks prior to transplant
1158 1.15 0.024 1.02 -1.29
Hospitalized (incl. ICU) at transplant 5269 1.13 0.0047 1.04 -1.23
Female donor vs. male donor 3229 1.13 0.0273 1.01 -1.25
ISHLT 2011
* Temporary circulatory support includes ECMO and temporary pulsatile flow devices. There were too few temporary continuous flow devices to analyze.
ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005) Borderline Significant Risk Factors for 5 Year Mortality
(N=10,785)
VARIABLE N Relative
Risk P-
value 95% Conf.
Int.
VAD (flow type unknown) 82 1.40 0.0731 0.97 -2.04
PRA > 10% 791 1.12 0.0984 0.98 -1.29
o
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005) Risk Factors for 5 Year Mortality
Continuous Factors (see figures)
Recipient age
Donor age
Recipient height
BMI difference
Bilirubin
Ischemia time
Serum creatinine
Transplant center volume
TPG
(N=10,785)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005)
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
(N=10,785)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005)
Relative Risk of 5 Year Mortality with 95% Confidence Limits
Recipient Height
0
0.5
1
1.5
2
150 160 170 180 190 200
Recipient Height (cm)
p < 0.0001
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
(N=10,785)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Donor Age
0
0.5
1
1.5
2
15 20 25 30 35 40 45 50 55
Donor Age
p < 0.0001
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
(N=10,785)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Donor and Recipient BMI Difference
0
0.5
1
1.5
2
-10 -5 0 5 10
Donor BMI - Recipient BMI (kg/m2)
p = 0.034
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
(N=10,785)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005)Relative Risk of 5 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant Bilirubin
0
0.5
1
1.5
2
0.5 1 1.5 2 2.5 3 3.5
Bilirubin (mg/dl)
p < 0.0001
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
(N=10,785)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005)Relative Risk of 5 Year Mortality with 95% Confidence Limits
TPG
0
0.5
1
1.5
2
3 4 5 6 7 8 9 10 11 12 13 14 15
TPG
p < 0.0001
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
(N=10,785)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005) Relative Risk of 5 Year Mortality with 95% Confidence Limits
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
(N=10,785)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant Creatinine
0
0.5
1
1.5
2
0.5 1 1.5 2 2.5
Creatinine (mg/dl)
p < 0.0001
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
(N=10,785)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005) Relative Risk of 5 Year Mortality 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 < 0.0001
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
(N=10,785)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005) Factors Not Significant for 5 Year Mortality
Recipient Factors: Sternotomy, pulmonary embolism, IV inotropes, prior malignancy, balloon pump
Donor Factors: History of cancer, clinical infection, cause of death, history of hypertension
Transplant Factors: CMV mismatch, ABO match, previous transplant
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005)
Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
(N=9,189)
VARIABLE N
Relative Risk
P-value 95%
Confidence Interval
No AZA, MMF or Rapamycin at 1 year 768 1.60 <.0001 1.32 -1.94
Rejection between discharge and 1st year
2675 1.53 <.0001 1.36 -1.72
Number of HLA mismatches at A locus (per mismatch)
0 A MM: N = 559 1 A MM: N = 4664 2 A MM: N = 3966
1.41 0.0003 1.17 -1.71
Recipient history of dialysis prior to transplant
214 1.41 0.0242 1.05 -1.89
Dialysis post-transplant 511 1.35 0.0052 1.09 -1.67
Recipient Hep B core (+) 333 1.34 0.0221 1.04 -1.73
Prior pregnancy 1304 1.27 0.0445 1.01 -1.60
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005)
Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
(cont’d)
(N=9,189)
VARIABLE N
Relative Risk
P-value 95%
Confidence Interval
Recipient history of diabetes 1786 1.26 0.0007 1.10 -1.44
Treated for infection post-transplant 1916 1.25 0.001 1.09 -1.42
Diagnosis: Coronary artery disease vs. cardiomyopathy
4257 1.22 0.0025 1.07 -1.40
Rejection prior to discharge 1433 1.16 0.0416 1.01 -1.34
Hospitalized (inc. ICU) at transplant 4390 1.13 0.0327 1.01 -1.27
Chronic pulsatile flow device 1487 0.85 0.0391 0.72 -0.99
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005)
Borderline Significant Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
(N=9,189)
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
MMF and AZA at 1 year 53 1.72 0.0551 0.99 -2.99
No Cyclo, TAC or Rapamycin at 1 year 350 1.27 0.0794 0.97 -1.67
Donor CMV +/ Recipient CMV - 1654 1.14 0.0641 0.99 -1.31
No defibrillator 5265 1.11 0.0749 0.99 -1.25
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
Continuous Factors (see figures)
Recipient age
Donor age
Recipient BMI
Serum creatinine
PVR
Transplant center volume (borderline)
(N=9,189)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year Recipient Age
0
0.5
1
1.5
2
2.5
3
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
(N=9,189)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year Recipient BMI
0
0.5
1
1.5
2
2.5
3
15 20 25 30 35 40
Recipient BMI
p = 0.0368
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
(N=9,189)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year Donor Age
0
0.5
1
1.5
2
15 20 25 30 35 40 45 50 55
Donor Age
p < 0.0001
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
(N=9,189)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year PVR
0
0.5
1
1.5
2
1 2 3 4 5 6
Recipient PVR
p = 0.0124
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
(N=9,189)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 YearCenter 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 = 0.051
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
(N=9,189)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2000-6/2005) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 YearPre-Transplant Recipient Serum Creatinine
0
0.5
1
1.5
2
0.5 1 1.5 2 2.5
Serum Creatinine (mg/dL)
p = 0.0039
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
(N=9,189)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1995-6/2000) Risk Factors for 10 Year Mortality
(N=11,861)
VARIABLE N Relative
Risk P-value
95% Conf. Interval
Repeat transplant 288 1.56 <.0001 1.32 -1.84
Recipient on dialysis 213 1.49 <.0001 1.24 -1.78
Ventilator at time of transplant 365 1.36 <.0001 1.17 -1.59
PRA > 20% 601 1.28 <.0001 1.14 -1.44
Diagnosis: coronary artery disease vs. cardiomyopathy
5997 1.24 <.0001 1.16 -1.32
Recipient history of diabetes 1863 1.23 <.0001 1.15 -1.33
Recipient with infection requiring IV drug therapy within 2 weeks prior to transplant
949 1.23 <.0001 1.12 -1.36
Year of transplant: 1995 vs. 1999/2000 2125 1.21 <.0001 1.11 -1.31
Female recip/male donor vs. male recip/male donor 1265 1.19 0.0021 1.06 -1.33
On VAD at time of transplant 1355 1.19 0.0001 1.09 -1.30
Year of transplant: 1996 vs. 1999/2000 2143 1.15 0.0008 1.06 -1.26
Mismatches at B locus (per mismatch) 0 B MM (N=241)
1 B MM (N=2760) 2 B MM (N=8860) 1.13 0.0356 1.01 -1.27
Donor history of hypertension 1275 1.12 0.015 1.02 -1.22
Inotropes at time of transplant 6210 1.07 0.0288 1.01 -1.13
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1995-6/2000) Borderline Significant Risk Factors for 10 Year Mortality
(N=11,861)
VARIABLE N Relative
Risk P-value
95% Conf. Interval
Donor history of cancer 193 1.22 0.0879 0.97 -1.52
Balloon pump at transplant 618 1.12 0.0795 0.99 -1.26
Male recip/female donor vs. male recip/male donor 2400 1.07 0.0529 1.00 -1.16
Not ABO identical 1679 0.93 0.0939 0.86 -1.01
Female recip/female donor vs. male recip/male donor
1357 1.12 0.0527 1.00 -1.26
Donor cause of death: CNS tumor vs. head trauma 134 0.78 0.0922 0.58 -1.04
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1995-6/2000) Risk Factors for 10 Year Mortality
Continuous Factors (see figures)
Recipient age
Recipient weight
Recipient height
Donor age
Creatinine
Bilirubin
Ischemia time
Volume
(N=11,861)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1995-6/2000) 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 70
Recipient Age
p < 0.0001
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
(N=11,861)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1995-6/2000) Relative Risk of 10 Year Mortality with 95% Confidence Limits
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
(N=11,861)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1995-6/2000) Relative Risk of 10 Year Mortality with 95% Confidence Limits
Pre-Transplant Recipient Weight
0
0.5
1
1.5
2
50 55 60 65 70 75 80 85 90 95 100 105
Recipient weight (kg)
p < 0.0001
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
(N=11,861)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1995-6/2000) Relative Risk of 10 Year Mortality with 95% Confidence Limits
Pre-Transplant Recipient Height
0
0.5
1
1.5
2
150 160 170 180 190 200
Recipient height (cm)
p = 0.0011
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
(N=11,861)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1995-6/2000) Relative Risk of 10 Year Mortality with 95% Confidence Limits
Ischemia Time
0
0.5
1
1.5
2
60 90 120 150 180 210 240 270 300
Ischemia time (minutes)
p < 0.0001
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
(N=11,861)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1995-6/2000) Relative Risk of 10 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant Creatinine
0
0.5
1
1.5
2
0.5 1 1.5 2 2.5
Creatinine (mg/dL)
p < 0.0001
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
(N=11,861)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1995-6/2000) Relative Risk of 10 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant Bilirubin
0
0.5
1
1.5
2
0.5 1 1.5 2 2.5 3 3.5
Bilirubin (mg/dL)
p = 0.0012
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
(N=11,861)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1995-6/2000) Relative Risk of 10 Year Mortality 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 < 0.0001
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
(N=11,861)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1990-6/1995) Risk Factors for 15 Year Mortality
(N=10,342)
VARIABLE N Relative
Risk P-value 95% Confidence
Interval
Retransplant 266 2.13 <.0001 1.82 -2.48
On ventilator 306 1.38 <.0001 1.18 -1.62
Number of HLA mismatches at the DR locus
0 DR MM (N=573) 1 DR MM (N=5327) 2 DR MM (N=4442)
1.35 <.0001 1.23 -1.49
Recipient Hep B Core (+) 197 1.35 0.002 1.12 -1.63
Male recipient/female donor vs. male recipient/male donor
2075 1.17 0.0018 1.06 -1.29
Transplant year: 1991 vs. 1994/1995 1842 1.12 0.0155 1.02 -1.22
Transplant year: 1992 vs. 1994/1995 1881 1.12 0.0192 1.02 -1.22
Diagnosis: Coronary artery disease vs. cardiomyopathy
5087 1.11 0.0023 1.04 -1.19
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1990-6/1995) Borderline Significant Risk Factors for 15 Year Mortality
(N=10,342)
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Donor cause of death: cerebrovascular/stroke vs. head trauma
2726 1.09 0.0566 1.00 -1.18
Year of transplant 1990 vs. 1993/1994
1532 1.09 0.085 0.99 -1.19
Hospitalized (inc. ICU) at transplant
5839 1.05 0.0863 0.99 -1.12
Donor cause of death: CNS tumor vs. head trauma
44 0.65 0.0885 0.40 -1.07
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTSRisk Factors for 15 Year Mortality
Continuous Factors (see figures)
Recipient age
Donor age
Recipient weight
Recipient height
Serum creatinine
Ischemia time
PRA
(N=10,342)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1990-6/1995) Relative Risk of 15 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
5 Y
ea
r M
ort
ali
ty
(N=10,342)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1990-6/1995) Relative Risk of 15 Year Mortality with 95% Confidence Limits
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
(N=10,342)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1990-6/1995) Relative Risk of 15 Year Mortality with 95% Confidence Limits
Recipient Height
0
0.5
1
1.5
2
150 160 170 180 190 200
Recipient Height (cm)
p < 0.0001
Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
ali
ty
(N=10,342)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1990-6/1995) Relative Risk of 15 Year Mortality with 95% Confidence Limits
Recipient Weight
0
0.5
1
1.5
2
50 55 60 65 70 75 80 85 90 95 100 105
Recipient Weight (kg)
p = 0.0077
Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
ali
ty
(N=10,342)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1990-6/1995) Relative Risk of 15 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant Creatinine
0
0.5
1
1.5
2
0.5 1 1.5 2 2.5
Creatinine (mg/dl)
p < 0.0001
Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
ali
ty
(N=10,342)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1990-6/1995) Relative Risk of 15 Year Mortality with 95% Confidence Limits
Ischemia Time
0
0.5
1
1.5
2
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 1
5 Y
ea
r M
ort
ali
ty
(N=10,342)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1990-6/1995) Relative Risk of 15 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant PRA
0
0.5
1
1.5
2
0 10 20 30 40 50 60 70
PRA
p = 0.0087
Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
ali
ty
(N=10,342)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1985-6/1990) Risk Factors for 20 Year Mortality
(N=13,578)
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Retransplant 253 3.18 <.0001 2.75 -3.68
Transplant year: 1985 vs. 1989/1990 1057 1.61 <.0001 1.47 -1.76
Diagnosis: Coronary artery disease vs. cardiomyopathy
2910 1.38 <.0001 1.25 -1.52
Transplant year: 1986 vs. 1988/1990 2003 1.18 <.0001 1.11 -1.25
Transplant year: 1987 vs. 1988/1990 2565 1.17 0.0001 1.08 -1.26
Female recipient 2170 1.11 0.0032 1.04 -1.20
Diagnosis: Valvular heart disease vs. cardiomyopathy
563 1.11 0.0024 1.04 -1.19
ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTSRisk Factors for 20 Year Mortality
Continuous Factors (see figures)
Recipient age
Donor age
Center volume
Ischemia time
(N=13,578)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1985-6/1990) Relative Risk of 20 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 2
0 Y
ea
r M
ort
ali
ty
(N=13,578)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1985-6/1990) Relative Risk of 20 Year Mortality with 95% Confidence Limits
Donor Age
0
0.5
1
1.5
2
15 20 25 30 35 40 45 50 55
Donor Age
p < 0.0001
Re
lati
ve
Ris
k o
f 2
0 Y
ea
r M
ort
ali
ty
(N=13,578)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1985-6/1990) Relative Risk of 20 Year Mortality with 95% Confidence Limits
Ischemia Time
0
0.5
1
1.5
2
30 60 90 120 150 180 210 240 270 300 330 360
Ischemia time (minutes)
p = 0.0134
Re
lati
ve
Ris
k o
f 2
0 Y
ea
r M
ort
ali
ty
(N=10,342)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1985-6/1990) Relative Risk of 20 Year Mortality with 95% Confidence Limits
Center Volume
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40 45 50
Center Volume (cases per year)
p < 0.0001
Re
lati
ve
Ris
k o
f 2
0 Y
ea
r M
ort
ali
ty
(N=10,342)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2003-6/2009)Risk Factors for Developing Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Dialysis prior to discharge 531 3.75 <.0001 3.01 -4.67
Continuous chronic device 639 1.63 0.0032 1.18 -2.25
Transplant year: 2003 vs. 2008/2009 1412 1.51 0.0036 1.14 -1.99
Infection requiring IV antibiotics within 2 weeks prior to transplant
929 1.46 0.0034 1.13 -1.89
Female recipient 2335 1.43 0.0069 1.10 -1.86
Rejection prior to discharge 1059 1.35 0.0188 1.05 -1.74
IL2R antagonist used for induction 2876 1.25 0.0148 1.04 -1.49
Donor CMV (+)/Recipient CMV (-) 2097 1.24 0.0367 1.01 -1.51
Tacrolimus at discharge 5529 0.75 0.0023 0.63 -0.90
(N=9,916)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2003-6/2009)Borderline Significant Risk Factors for Developing Renal Dysfunction within 1 YearLimited to Recipients without Severe Renal Dysfunction* Pre-Transplant
Conditional on Survival to Transplant Discharge
VARIABLE N Relative
Risk P-value
95% Confidence
Interval Diagnosis: not cardiomyopathy, coronary artery disease, congenital heart disease, valvular heart disease or retransplant vs. cardiomopathy
43 2.46 0.0772 0.91 -6.67
Donor history of diabetes 239 1.5 0.0948 0.93 -2.41
In hospital at transplant (incl. ICU) 4452 1.17 0.0981 0.97 -1.40
Total number of HLA mismatches (per mismatch) 1.08 0.0883 0.99 -1.17
Diagnosis: valvular heart disease vs. cardiomyopathy
247 0.47 0.0516 0.22 -1.01
(N=9,916)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2003-6/2009) Risk Factors for Developing Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction Pre-Transplant Conditional on Survival to Transplant Discharge
Continuous Factors (see figures)
Recipient age
Recipient weight
Recipient creatinine
PA systolic pressure
(N=9,916)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2003-6/2009)Risk Factors for Developing Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge
Recipient Age
0
0.5
1
1.5
20 25 30 35 40 45 50 55 60 65
Recipient Age
p = 0.0014
Re
lati
ve
Ris
k o
f R
en
al
Dy
sfu
nc
tio
n w
ith
in 1
Ye
ar
(N=9,916)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2003-6/2009) Risk Factors for Developing Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge Recipient Pre-Transplant Creatinine
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
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 w
ith
in 1
Ye
ar
(N=9,916)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2003-6/2009) Risk Factors for Developing Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge
Recipient Pre-Transplant Weight
0
0.5
1
1.5
2
50 55 60 65 70 75 80 85 90 95 100 105
Weight (kg)
p = 0.0215
Re
lati
ve
Ris
k o
f R
en
al
Dy
sfu
nc
tio
n w
ith
in 1
Ye
ar
(N=9,916)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/2003-6/2009)Risk Factors for Developing Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge
Recipient PA Systolic Pressure
0
0.5
1
1.5
2
10 15 20 25 30 35 40 45 50 55
PA Systolic pressure (mm Hg)
p = 0.0165
Re
lati
ve
Ris
k o
f R
en
al
Dy
sfu
nc
tio
n w
ith
in 1
Ye
ar
(N=9,916)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1998-6/2002) Risk Factors for Developing Cardiac Allograft Vasculopathy within 8 Years
Conditional on Survival to Transplant Discharge
VARIABLE N Relative
risk P-value
95% Conf. Interval
Donor cause of death: head trauma vs. anoxia 2402 1.31 0.0113 1.06 -1.61
Use of AZA at discharge vs. MMF/MPA 1542 1.29 <.0001 1.14 -1.45
Induction with OKT3 630 1.21 0.0116 1.04 -1.39
Male donor 4771 1.19 0.0049 1.06 -1.35
Recipient with infection requiring IV antibiotics within 2 weeks prior to transplant
525 1.19 0.0307 1.02 -1.40
Donor history of hypertension 666 1.18 0.0234 1.02 -1.36
Diagnosis: Coronary artery disease vs. cardiomyopathy
3086 1.16 0.0052 1.05 -1.29
Donor clinical infection 1202 1.16 0.0113 1.03 -1.30
Use of CyA at discharge vs. TAC 5047 1.16 0.0482 1.00 -1.34
Number of mismatches at A locus 0 A MM (N=399) 1 A MM (N=3147) 2 A MM (N =2718)
0.86 0.047 0.74 -1.00
Induction with polyclonal agent 1163 0.85 0.0176 0.74 -0.97
Recipient on VAD at transplant 1031 0.82 0.006 0.72 -0.95
(N=6,264)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1998-6/2002) Borderline Significant Risk Factors for Developing Cardiac Allograft
Vasculopathy within 8 Years Conditional on Survival to Transplant Discharge
VARIABLE N P-value Relative
risk 95% Conf.
Interval
Donor cause of death: CNS tumor vs. anoxia 1.49 0.0656 0.97 2.27 -1.49
Donor history of diabetes 1.34 0.0729 0.97 1.84 -1.34
Donor cause of death: Cerebrovascular/stroke vs. anoxia 1.24 0.0593 0.99 1.54 -1.24
(N=6,264)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Continuous Factors (see figures) Recipient age
Donor BSA
Donor age
Transplant center volume
(N=6,264)
ADULT HEART TRANSPLANTS (1/1998-6/2002) Risk Factors for Developing Cardiac Allograft Vasculopathy
within 8 YearsConditional on Survival to Transplant Discharge
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1998-6/2002)Relative Risk of Developing Cardiac Allograft Vasculopathy within 8 Years
Conditional on Survival to Transplant Discharge Recipient Age
0
0.5
1
1.5
2
20 25 30 35 40 45 50 55 60 65
Recipient Age
p = 0.0005Re
lati
ve
Ris
k o
f C
AV
wit
hin
8 Y
ea
rs
(N=6,264)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1998-6/2002)Relative Risk of Developing Cardiac Allograft Vasculopathy within 8 Years
Conditional on Survival to Transplant Discharge Donor BSA
0
0.5
1
1.5
2
1.5 1.6 1.7 1.8 1.9 2 2.1 2.2 2.3
Donor BSA (m2)
p = 0.0428Re
lati
ve
Ris
k o
f C
AV
wit
hin
8 Y
ea
rs
(N=6,264)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1998-6/2002)Relative Risk of Developing Cardiac Allograft Vasculopathy within 8 Years
Conditional on Survival to Transplant Discharge Donor Age
0
0.5
1
1.5
2
2.5
3
15 20 25 30 35 40 45 50 55
Donor Age
p < 0.0001Re
lati
ve
Ris
k o
f C
AV
wit
hin
8 Y
ea
rs
(N=6,264)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART TRANSPLANTS (1/1998-6/2002)Relative Risk of Developing Cardiac Allograft Vasculopathy within 8 Years
Conditional on Survival to Transplant Discharge 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 = 0.0078Re
lati
ve
Ris
k o
f C
AV
wit
hin
8 Y
ea
rs
(N=6,264)ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132