J Heart Lung Transplant 2009;28: 989-1049 HEART TRANSPLANTATION Overall ISHLT 2009.

J Heart Lung Transplant 2009;28: 989-1049

HEART TRANSPLANTATION

Overall

ISHLT 2009


NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR

189 320667

1190

2172

2728

31513381

40204199 4229

4395 4460 4427 4283 42063898

3642 3508 3469 3372 3346 3271 3341 3362 3355

0

500

1000

1500

2000

2500

3000

3500

4000

4500

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

Nu

mb

er

of

Tra

ns

pla

nts

ISHLTNOTE: 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

2009


NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR

0

500

1000

1500

2000

2500

3000

3500

4000

4500

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

Nu

mb

er

of

Tra

ns

pla

nts

Other

EuropeNorth America

ISHLTNOTE: 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

2009


AVERAGE CENTER VOLUMEHeart Transplants: January 1, 2003 – June 30, 2008

44

90

2414

51

63 20

10

20

30

40

50

60

70

80

90

100

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

Number of centers Percentage of transplants

Pe

rce

nta

ge

of

tra

ns

pla

nts

ISHLT

2009


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

% 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+ Mean Age

Mea

n d

on

or

age

(yea

rs)

HEART TRANSPLANTS: Donor Age by Year of Transplant

ISHLT

2009


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 = 21,126)

1992-2001 (N = 40,356)

2002-6/2008 (N = 21,609)

P < 0.0001

ISHLT

2009


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

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Years

Su

rviv

al

(%)

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

N=78,050

ISHLT

N at risk at 22 years: 145

HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2007)

2009


HEART TRANSPLANTATION

Adult Recipients

ISHLT

2009


Congenital2%

ReTX2%

Myopathy46%

Misc.3%

Valvular3%

CAD44%

1/1982-6/2008

DIAGNOSIS IN ADULT HEART TRANSPLANTS

203040506070

% o

f Cas

es Myopathy CAD

CAD38%

Valvular2%

Misc.4%

Myopathy51%

ReTX3%

Congenital2%

1/2005-6/2008

ISHLT

2009


1992-2001(N=36,458)

2002-6/2008 (N=18,798)

p-value

Recipient age (years) 51.4 ± 11.0 (18.0 - 79.0) 51.1 ± 12.4 (18.0 - 78.0) 0.0776

Donor age (years) 32.3 ± 12.8 (8.0 - 67.0) 33.6 ± 13.0 (8.0 - 67.0) <0.0001

Recipient/donor gender (% male) 80.0%/ 67.8% 77.3%/ 69.5% <0.0001/ <0.0001

Recipient weight (kg) 76.0 ± 14.4 (35.0 - 120.0) 78.3 ± 15.5 (35.0 - 120.0) <0.0001

Recipient height (cm) 172.7 ± 8.7 (140.0 - 190.0) 172.9 ± 8.9 (140.0 - 190.0) 0.0020

Recipient BMI 25.3 ± 4.1 (11.5 - 50.9) 26.0 ± 4.3 (12.9 - 49.2) <0.0001

Recipient/donor diabetes mellitus 13.1%/ 1.6% 22.0%/ 2.2% <0.0001/ <0.0001

Recipient amiodarone use (US only)

22.6% 29.0% <0.0001

Recipient/donor cigarette history 18.5%/ 37.5% 44.9%/ 25.2% <0.0001/ <0.0001

Ischemic time (hours) 2.5 ± 1.4 (0.0 - 8.0) 2.8 ± 1.5 (0.0 - 8.0) <0.0001

Most recent PRA > 10%*

Overall 7.8% 9.0% 0.0050

Class I 12.3%

Class II 8.5%

ISHLT

Continuous factors are expressed as mean ± standard deviation (range)

ADULT HEART TRANSPLANTATIONCharacteristics of Donors, Recipients and Transplants

* Until mid-2004 PRA was collected as a single percentage. After this date, PRA was collected separately for Class I and Class II.

2009


1992-2001(N=36,458)

2002-6/2008 (N=18,798)

p-value

Creatinine at time of transplant 1.3 ± 0.5 (0.1 - 4.0) 1.3 ± 0.5 (0.1 - 4.0) 0.8009

Pulmonary vascular resistance (Wood units)

2.8 ± 1.5 (1.0 - 11.7) 2.6 ± 1.4 (1.0 - 12.0) <0.0001

HLA Mismatches

0.0065 0-2 4.8% 4.3%

3-4 41.5% 40.5%

5-6 53.7% 55.2%

Diagnosis

<0.0001

Coronary artery disease 45.2% 39.5%

Cardiomyopathy 45.9% 49.5%

Valvular 3.2% 2.4%

Retransplant 1.9% 2.3%

Congenital 1.8% 2.4%

Other causes 1.9% 3.8%

ISHLT

Data are expressed as mean ± standard deviation (range)

ADULT HEART TRANSPLANTATION Characteristics of Donors, Recipients and Transplants

(Cont’d)

2009


1992-2001(N=36,458)

2002-6/2008 (N=18,798)

p-value

Donor cause of death

<0.0001 Head trauma 45.2% 52.1%

Stroke 28.4% 29.6%

Other 26.5% 18.3%

Pre-operative support (multiple items may be reported)

Hospitalized at time of transplant 58.6% 46.4% <0.0001

On IV inotropes 48.9% 44.8% <0.0001

LVAD 4.1% 19.0% <0.0001

IABP 6.8% 6.9% 0.6740

RVAD 0.1% 2.9% <0.0001

Ventilator 3.1% 2.9% 0.1738

TAH 0.4% 0.4% 0.6900

ECMO 0.3% 0.7% <0.0001

ISHLT

ADULT HEART TRANSPLANTATION Characteristics of Donors, Recipients and Transplants

(Cont’d)

2009


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 2008

ISHLT

2009Mean/median recipient age: Europe = 50.8/53.0 North America = 51.7/54.0 Other = 48.4/51.0


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 TRANSPLANTS:DONOR AGE DISTRIBUTION BY LOCATION

Transplants between January 2000 and June 2008

ISHLT

2009Mean/median donor age: Europe = 38.0/39.0 North America = 31.6/29.0 Other = 33.0/32.0


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982 – 6/2007)

0

20

40

60

80

100

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

Years

1982-1991 (N=18,846)

1992-2001 (N=35,238)

2002-6/2007 (N=15,620)

All comparisons significant at p < 0.0001

HALF-LIFE 1982-1991: 8.8 years; 1992-2001: 10.5 years; 2002-6/2007: NA

Su

rviv

al (

%)

ISHLT

2009


ADULT HEART TRANSPLANTATION Conditional Kaplan-Meier Survival by Era

(Transplants: 1/1982 – 6/2007)

0

20

40

60

80

100

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

Years

1982-1991 (N=14,374)

1992-2001 (N=27,772)

2002-6/2007 (N=11,732)

1982-1991 vs. 1992-2001: p < 0.0001;1982-1991 vs. 2002-6/2007: p < 0.0001;1992-2001 vs. 2002-6/2007: p = 0.1961.


Su

rviv

al (

%)

ISHLT

2009


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1982-6/2007)

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 (

%)

18-29 (N=4,790) 30-39 (N=6,793)

40-49 (N=15,541) 50-59 (N=27,521)

60-69 (N=14,646) 70+ (N=413)

HALF-LIFE 18-29: 11.9 years; 30-39: 11.8 years; 40-49: 10.9 years; 50-59: 9.9 years; 60-69: 8.9 years; 70+: 7.0 years

All pair-wise comparisons are statistically significant at p < 0.01 except for 18-29 vs 30-39 p=0.2482; 18-29 vs 40-49 p=0.0517

ISHLT

2009


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/2002-6/2007)

0

20

40

60

80

100

0 1 2 3 4 5 6

Years

Su

rviv

al (

%)

18-29 (N= 1,248) 30-39 (N=1,551)40-49 (N=2,890) 50-59 (N=5,598)60-69 (N= 4,159) 70+ (N=174)

All pair-wise comparisons are statistically significant at p < 0.05 except 18-29 vs. 60-69; 30-39 vs. 40-49; and 30-39 vs. 50-59

ISHLT

2009


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1982-6/2007)

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 = 31,350) Coronary artery disease (N =30,259)Congenital diagnosis (N = 1,264) Retransplant (N = 1,418)Valvular (N = 2,181) Other (N = 1,754)

HALF-LIFE Cardiomyopathy: 11.3 years; CAD: 9.4 years; Congenital: 13.1 years; Retransplant: 5.5 years; Valvular: 10.9 years; Other: 10.0 years

All pair-wise comparisons are significant at p < 0.05 except Cardiomyopathy vs. Congenital, CAD vs. Other, Valvular vs. Congenital and Valvular vs. Other

ISHLT

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=7,893)

1992-2001 (N=15,852)

2002-6/2007 (N=7,605)

All comparisons are significant at p < 0.0001


Su

rviv

al (

%)

ISHLT

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=8,326)

1992-2001 (N=15,686)

2002-6/2007 (N=6,247)



Su

rviv

al (

%)

ISHLT

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=242)

1992-2001 (N=624)

2002-6/2007 (N=398)

1982-1991 vs. 1992-2001: p = 0.46131982-1991 vs. 2002-6/2007: p = 0.24081992-2001 vs. 2002-6/2007: p = 0.0381


Su

rviv

al (

%)

ISHLT

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=391)

1992-2001 (N=669)

2002-6/2007 (N=358)



Su

rviv

al (

%)

ISHLT

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=696)

1992-2001 (N=1,091)

2002-6/2007 (N=394)

No comparisons are significant at 0.05


Su

rviv

al (

%)

ISHLT

2009


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis

Conditional on Survival to 1 Year (Transplants: 1/1982-6/2007)

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=24,717)Coronary artery disease (N=23,570)Congenital diagnosis (N=915)Retransplant (N=915)Valvular (N=1,629)Other (N=1,176)

All pair-wise comparisons are significant at p <.05 except cardiomyopathy vs. valvular, cardiomyopathy vs. other, and valvular vs. other.

HALF-LIFE Cardiomyopathy: 13.5 years; CAD: 11.5 years; Congenital: 18.0 years; Retransplant: 9.8 years; Valvular: 13.9 years; Other: 13.4 years

ISHLT

2009


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/2002-6/2007)

50

60

70

80

90

100

0 1 2 3 4 5 6

Years

Su

rviv

al (

%)

Cardiomyopathy (N=7,605) Coronary artery disease (N=6,247)

Congenital Diagnosis (N=398) Retransplant (N=358)

Valvular (N=394) Other (N=528)

All pair-wise comparisons with Cardiomyopathy and CAD are significant at p < 0.05 except CAD vs. Congenital and CAD vs. valvular. All other pair-wise comparisons were not statistically significant.

ISHLT

2009


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

(Transplants: 1/2002-6/2007)

50

60

70

80

90

100

0 1 2 3 4 5 6

Years

Su

rviv

al (

%)

Cardiomyopathy (N=5,746) Coronary artery disease (N=4,780)Congenital Diagnosis (N=290) Retransplant (N=267)Valvular (N=2881) Other (N=315)

No comparisons are significant at p = 0.05

ISHLT

2009


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by PVR (Transplants: 1/2002-6/2007)

50

60

70

80

90

100

0 1 2 3 4 5

Years

Su

rviv

al (

%)

1-<3 Wood units (N = 5,373) 3-<5 Wood units (N = 1,585)

5+ Wood units (N = 548)

1-<3 vs. 3-<5: p = 0.0018; 1-<3 vs. 5+: p = 0.0180; 3-<5 vs. 5+: p = 0.7697

ISHLT

2009



PVR: 1- < 3 Wood units

50

60

70

80

90

100

0 1 2 3 4 5

Years

Su

rviv

al (

%)

<0.8 Weight ratio (N=794) 0.8-<0.9 Weight ratio (N=1,068)

0.9-<1.1 Weight ratio (N=2,034) 1.1-<1.2 Weight ratio (N=582)

1.2+ Weight ratio (N=884)

No pair-wise comparisons are statistically significant at p < 0.05 except <0.8 vs. 1.1 - <1.2 p = 0.0071 and <0.8 vs. 1.2+ p = 0.0160

ISHLT

2009



PVR: 3- < 5 Wood units

50

60

70

80

90

100

0 1 2 3 4 5

Years

Su

rviv

al (

%)

<0.8 Weight ratio (N=155) 0.8-<0.9 Weight ratio (N=272)

0.9-<1.1 Weight ratio (N=591) 1.1-<1.2 Weight ratio (N=207)


No pair-wise comparisons are statistically significant at p < 0.05

ISHLT

2009



PVR: 5+ Wood units

50

60

70

80

90

100

0 1 2 3 4

Years

Su

rviv

al (

%)

<0.8 Weight ratio (N=62) 0.8-<0.9 Weight ratio (N=72)

0.9-<1.1 Weight ratio (N=185) 1.1-<1.2 Weight ratio (N=78)


No pair-wise comparisons are statistically significant at p < 0.05 except <0.8 vs. 1.1 - <1.2 p = 0.0215

ISHLT

2009


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage (Transplants: 4/1994-6/2007)

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

VAD (N=4,154) No LVAD / No Inotropes (N=10,944)

No LVAD / Inotropes (N=12,640)

VAD vs. no LVAD/no inotropes: p < 0.0001VAD vs. no LVAD/inotropes: p < 0.0001No LVAD/no inotropes vs No LVAD/inotropes: p = 0.0023

ISHLT

2009



50

60

70

80

90

100

0 1 2 3 4 5 6

Years

Su

rviv

al (

%)

Pulsatile flow (N=1,898) Continuous flow (N=331)

No LVAD / No Inotropes (N=4,337) No LVAD / Inotropes (N=4,152)

Pulsatile vs. No LVAD/Inotropes: p < 0.0001;Pulsatile vs. No LVAD/No inotropes: p < 0.0001; No LVAD/No Inotropes vs. Continuous: p = 0.0259

ISHLT

2009



Conditional on Survival to 6 Months

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

Su

rviv

al (

%)

Pulsatile flow (N=2,359) Continuous flow (N=300)

No LVAD / No Inotropes (N=5,805) No LVAD / Inotropes (N=6,071)

No LVAD/Inotropes vs. No LVAD/No inotropes : p = 0.0517

ISHLT

2009


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage and Era (Transplants: 1/1999-6/2007)

50

60

70

80

90

100

0 1 2 3 4 5 6

Years

Su

rviv

al (

%)

Pulsatile, 1999-2002 (N=1,327) No LVAD/Inotrope, 1999-2002 (N=3,583)

Pulsatile, 2003-6/2007 (N=1,506) No LVAD/Inotrope, 2003-6/2007 (N=3,284)

Pulsatile vs. no LVAD/Inotropes (1999-2002): p = 0.0015Pulsatile vs. no LVAD/Inotropes (2003-6/2007): p = 0.0002Pulsatile 1999-2002 vs. 2003-6/2007: p = 0.2946No LVAD/Inotropes 1999-2002 vs. 2003-6/2007: p = 0.0428

ISHLT

2009


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

(%

) 1/1982-12/19911/1992-12/20011/2002-6/2007

Comparison of survival for interval < 12 months vs. > 12 months: p < 0.0001Comparison of survival for interval < 12 months vs. > 12 months for 1/2002-6/2007: p < 0.0001

25

2

20

6

63 8

4 88

30

49 94

28 34

35

4

27

4

18

,35

3

34

,39

0

15

,16

9

ADULT HEART RE-TRANSPLANTS1-Year Survival

ISHLT

2009


ADULT HEART RECIPIENTS Functional Status of Surviving Recipients

(Follow-ups: 1995 - June 2008)

0%

20%

40%

60%

80%

100%

1 Year (N = 16,084) 3 Years (N = 14,221) 5 Years (N = 12,160) 7 Years (N = 9,651)

No Activity Limitations Performs with Some Assistance Requires Total Assistance

ISHLT

2009


ADULT HEART RECIPIENTS Functional Status of Surviving Recipients

For the Same Patients(Follow-ups: 1995 - June 2008)

0%

20%

40%

60%

80%

100%

1 Year (N = 6,554) 3 Years (N = 6,554) 5 Years (N = 6,554)

No Activity Limitations Performs with Some Assistance Requires Total Assistance

ISHLT

2009


ADULT HEART RECIPIENTSEmployment Status of Surviving Recipients


0%

20%

40%

60%

80%

100%

1 Year (N =18,666)

3 Year (N =16,135)

5 Year (N =13,978)

7 Year (N =11,075)

Retired

Not Working

Working Part Time

Working Full Time

Working (FT/PTstatus unknown)

ISHLT

2009


ADULT HEART RECIPIENTSEmployment Status of Surviving Recipients

Age at Follow-up: 25-55 Years (Follow-ups: 1995 - June 2008)

0%

20%

40%

60%

80%

100%

1 Year (N =8,164)

3 Year (N =6,190)

5 Year (N =4,656)

7 Year (N =3,312)

Retired

Not Working

Working Part Time

Working Full Time

Working (FT/PTstatus unknown)

ISHLT

2009


ADULT HEART RECIPIENTSRehospitalization Post-transplant of Surviving Recipients


0%

20%

40%

60%

80%

100%

Up to 1 Year (N = 23,170)

Between 2 and 3 Years (N = 19,629)



No Hospitalization Hospitalized: Not Rejection/Not Infection

Hospitalized: Rejection Only Hospitalized: Infection Only

Hospitalized: Rejection + Infection

ISHLT

2009


0

10

20

30

40

50

Any Induction (N =6,472)

IL2R-antagonist (N =3,331)

Polyclonal ALG/ATG(N =2,857)

OKT3 (N = 405)

% o

f p

ati

en

tsADULT HEART RECIPIENTS

Induction Immunosuppression (Transplants: January 2002 – June 2008)

ISHLT

Analysis is limited to patients who were alive at the time of the follow-up2009


0

10

20

30

40

50

60

Any Induction IL2R-antagonist PolyclonalALG/ATG

OKT3

% o

f p

ati

en

ts

1997 2002 1/2008-6/2008

ADULT HEART RECIPIENTSInduction Immunosuppression

(Transplants: 1997, 2002 and 1/2008-6/2008)

ISHLT



ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Type

(Transplants: 1/2000-6/2007, conditional on survival to 14 days)

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

Su

rviv

al (

%)

No induction (N = 7,091) Polyclonal induction (N = 3,232)

IL2-R antagonist (N = 3,383) OKT3 (N = 642)

No induction vs. IL2-R: p = 0.0137;Polyclonal vs. IL2-R: p = 0.0302.

ISHLT

2009


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

ati

en

ts

Year 1 (N = 5,680) Year 5 (N = 4,117)

ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up

(Follow-ups: January 2005 - June 2008)

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

ISHLT



0

20

40

60

80

100


% o

f P

ati

en

ts

Year 1 (N = 5,068) Year 5 (N = 5,068)

ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up

For the Same Patients(Follow-ups: January 2000 - June 2008)

ISHLT



0

20

40

60

80

100


% o

f P

atie

nts

2000 (N = 1,503) 2003 (N = 1,610) July 2007 - June 2008 (N = 1,705)

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

NOTE: Different patients are analyzed in each time frame.

ISHLT

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

2009


0%

20%

40%

60%

80%

100%

Year 1 (N = 5,680) Year 5 (N = 4,117)

None

Other

Tacrolimus

Cyclosporine

Rapa + cellcycle

Rapa + calcineurin

Tacrolimus + MMF

Tacrolimus + AZA

Cyclosporine + MMF

Cyclosporine + AZA

% o

f P

ati

en

tsADULT HEART RECIPIENTS

Maintenance Immunosuppression Drug Combinations at Time of Follow-up(Follow-ups: January 2005 - June 2008)

NOTES: Different patients are analyzed in Year 1 and Year 5. In the Year 1 cohort 72.55% of patients were on prednisone; in the Year 5 cohort 52.13% of patients were on prednisone.ISHLT


2009


0%

20%

40%

60%

80%

100%

Year 1 (N = 5,068) Year 5 (N = 5,068)

% o

f P

ati

en

ts

None

Other

Tacrolimus

Cyclosporine

Rapa + cellcycle

Rapa + calcineurin

Tacrolimus + MMF

Tacrolimus + AZA

Cyclosporine + MMF

Cyclosporine + AZA

ADULT HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up

For the Same Patients(Follow-ups: January 2000 - June 2008)

ISHLT



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, 2008)

0

10

20

30

40

50

60

% e

xp

eri

en

cin

g r

eje

cti

on

wit

hin

1 y

ea

r.

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

ISHLT

Overall 18-44 45-62 63+ Female Male

No induction: N=3,133Polyclonal: 1,304IL2R-antagonist: N=1,866OKT3: N=161

Overall: no induct vs. poly (p<0.0001); no induct vs. IL2 (p<0.0001), no induct vs. OKT3 (p=0.048), poly vs. IL2 (p=0.038)18-44: no induct vs. poly (p=0.009); no induct vs. IL2 (p=0.001)45-62: no induct vs. poly (p=0.024); no induct vs. IL2 (p<0.0001) 63+: no induct vs. poly (p=0.015); no induct vs. IL2 (p<0.0001); no induct vs. OKT3 (p=0.002)F: no induct vs. poly (p=0.001); no induct vs. IL2 (p<0.0001)M: no induct vs. poly (p=0.011); no induct vs. IL2 (p<0.0001); poly vs. IL2 (p=0.021)


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.

2009


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, 2008)

0

10

20

30

40

50

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

% e

xp

eri

en

cin

g r

eje

cti

on

wit

hin

1 y

ea

r

Overall: p < 0.000118-44: p < 0.000145-62: p < 0.0001Female: p = 0.007Male: p < 0.0001

ISHLT

NOTE: There were 149 patients with cyclosporine+AZA and 41 with tacrolimus+AZA. These groups were excluded due to small numbers.

Cyclosporine + MMF: N = 2,360Tacrolimus + MMF: N = 3,065

18-44 45-62 63+ MaleFemaleOverall




2009


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Treatment for Rejection

Within 1st YearConditional on survival to 1 year (follow-ups: 7/2004-6/2007)

50

60

70

80

90

100

0 1 2 3

Years

Su

rviv

al (

%)

No rejection (N=2,205) Treated Rejection (N=979)

p <0.0001

ISHLT



2009


POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 1, 5 and 10 Years Post-

Transplant (Follow-ups: April 1994 - June 2008)

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

Hypertension 73.3% (N = 22,977) 93.3% (N = 9,853) 97.4% (N = 2,229)

Renal Dysfunction 27.2% (N = 23,581) 31.9% (N = 11,110) 38.3% (N = 3,077)

Abnormal Creatinine < 2.5 mg/dl 18.5% 21.6% 24.8% Creatinine > 2.5 mg/dl 7.0% 7.5% 7.4% Chronic Dialysis 1.4% 2.4% 4.7% Renal Transplant 0.3% 0.4% 1.5%

Hyperlipidemia 57.6% (N = 24,319) 87.7% (N = 11,093) 93.3% (N = 2,650)

Diabetes 27.8% (N = 23,623) 36.1% (N = 10,235) 38.6% (N = 2,392)

Cardiac Allograft Vasculopathy 7.8% (N = 21,357) 30.8% (N = 7,495) 51.9% (N = 1,542)

ISHLT

2009


POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 1, 5 and 10 Years Post-

Transplant (Transplants: 1994 - June 1998)For the Same Patients

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

Hypertension 67.7% (N = 1,010) 92.5% (N = 1,010) 95.7% (N = 1,010)

Renal Dysfunction 14.0% (N = 1,010) 25.2% (N = 1,010) 37.3% (N = 1,010)

Abnormal Creatinine < 2.5 mg/dl 8.7% 19.0% 25.7% Creatinine > 2.5 mg/dl 5.2% 5.2% 6.5% Chronic Dialysis 0.0% 0.6% 3.6% Renal Transplant 0.0% 0.4% 1.5%

Hyperlipidemia 47.5% (N = 1,010) 91.7% (N = 1,010) 96.0% (N = 1,010)

Diabetes 17.6% (N = 1,010) 29.7% (N = 1,010) 37.9% (N = 1,010)

Cardiac Allograft Vasculopathy 6.5% (N = 1,010) 29.0% (N = 1,010) 50.8% (N = 1,010)

ISHLT

2009


POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 and 5 Years

Post-Transplant (Transplants: 2000 - June 2003)For the Same Patients

Outcome Within 1

Year

Total number

with known response

Within 5 Years

Total number

with known response

Hypertension 76.3% (N = 2,324) 89.8% (N = 2,324)

Renal Dysfunction 26.9% (N = 2,324) 30.9% (N = 2,324)

Abnormal Creatinine < 2.5 mg/dl 20.4% 24.2%

Creatinine > 2.5 mg/dl 5.6% 4.6%

Chronic Dialysis 0.6% 1.7%

Renal Transplant 0.2% 0.3%

Hyperlipidemia 74.1% (N = 2,324) 91.3% (N = 2,324)

Diabetes 26.6% (N = 2,324) 38.7% (N = 2,324)

Cardiac Allograft Vasculopathy 5.2% (N = 2,324) 27.5% (N = 2,324)

ISHLT

2009


FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY For Adult Heart Recipients (Transplants: April 1994-June 2007)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

Freedom from CAV 4/1994-2000 (N = 10,050)

Freedom from CAV 2001-6/2007 (N = 9,696)

% F

ree

do

m f

rom

CA

V

p < 0.0001

ISHLT

2009


FREEDOM FROM SEVERE RENAL DYSFUNCTION BY ERA* For Adult Heart Recipients (Transplants: April 1994-June 2007)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

Freedom from Severe Renal Dysfunction 4/1994-2000 (N = 11,181)

Freedom from Severe Renal Dysfunction 2001-6/2007 (N = 10,751)

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

% F

reed

om

fro

m S

ever

e R

enal

Dys

fucn

tio

n

p < 0.0001

ISHLT

2009


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

(Transplants: April 1994-June 2007)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Time after Report of CAV* (Years)

Su

rviv

al (

%)

No CAV (N = 14,419)

CAV (N = 3,375)

p < 0.0001

ISHLT

* Patients without CAV conditioned on survival to median time of CAV development (501 days)

2009


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

(Transplants: April 1994-June 2007)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Time after Report of CAV* (Years)

Su

rviv

al (

%)

No CAV 4/1994-2000 (N = 7,562)

CAV 4/1994-2000 (N = 1,918)

No CAV 2001-6/2007 (N = 6,857)

CAV 2001-6/2007 (N = 1,457)

No CAV 4/1994-2000 vs. 2001-6/2007: p = 0.0695CAV 4/1994-2000 vs. 2001-6/2007: p = 0.0244

ISHLT

* Patients without CAV conditioned on survival to median time of CAV development (501 days)

2009


MALIGNANCY POST-HEART TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2008)

Malignancy/Type 1-Year Survivors

5-Year Survivors

10-Year Survivors

No Malignancy 23,626 (97.2%) 9,619 (85.6%) 2,074 (69.4%)

Malignancy (all types combined) 676 (2.8%) 1,618 (14.4%) 913 (30.6%)

Malignancy Type

Skin 318 1085 653

Lymph 147 137 73

Other 153 454 279

Type Not Reported 58 27 10

”Other” includes: prostate (11, 32, 17), adenocarcinoma (6, 3, 1), lung (6, 5, 1), bladder (4, 5, 4), Kaposi's sarcoma (1, 3, 1), breast (2, 7, 2), cervical (2, 4, 2), colon (2, 3, 1), and renal (2, 7, 2). Numbers in parentheses are those reported within 1 year, 5 years and 10 years, respectively.

ISHLT

NOTE: Multiple types may be reported; sum of types may be greater than total number with malignancy.

2009


FREEDOM FROM MALIGNANCYFor Adult Heart Recipients (Follow-ups: April 1994 - June 2008)

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

All malignancy Lymph Skin Other

% F

ree

fro

m M

alig

na

nc

y

ISHLT

2009


FREEDOM FROM MALIGNANCYFor Adult Heart Recipients (Transplants : April 1994 - June 2007)

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 2001-6/2007

% F

ree

fro

m M

alig

na

nc

y

p < 0.0001

ISHLT

2009


FREEDOM FROM LYMPHOMAFor Adult Heart Recipients (Transplants : April 1994 - June 2007)

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 2001-6/2007

% F

ree

fro

m L

ym

ph

om

a

p < 0.0001

ISHLT

2009


FREEDOM FROM SKIN MALIGNANCYFor Adult Heart Recipients (Transplants : April 1994 - June 2007)

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 2001-6/2007

% F

ree

fro

m S

kin

ma

lign

an

cy

p < 0.0001

ISHLT

2009


FREEDOM FROM OTHER MALIGNANCYFor Adult Heart Recipients (Transplants : April 1994 - June 2007)

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 2001-6/2007

% F

ree

fro

m O

the

r c

an

ce

r

p < 0.0001

ISHLT

2009


ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2008)

CAUSE OF DEATH0-30 Days

(N = 3,531)

31 Days –

1 Year

(N = 3,513)

>1 Year –

3 Years

(N = 2,716)

>3 Years –

5 Years

(N = 2,356)

>5 Years –

10 Years

(N = 5,335 )

>10 Years

(N = 3,677)

CARDIAC ALLOGRAFT VASCULOPATHY

62 (1.8%) 163 (4.6%) 383 (14.1%) 369 (15.7%) 767 (14.4%) 520 (14.1%)

ACUTE REJECTION 227 (6.4%) 427 (12.2%) 274 (10.1%) 104 (4.4%) 88 (1.6%) 33 (0.9%)

LYMPHOMA 1 (0.0%) 66 (1.9%) 93 (3.4%) 103 (4.4%) 246 (4.6%) 145 (3.9%)

MALIGNANCY, OTHER 4 (0.1%) 78 (2.2%) 301 (11.1%) 440 (18.7%) 999 (18.7%) 690 (18.8%)

CMV 4 (0.1%) 43 (1.2%) 17 (0.6%) 4 (0.2%) 6 (0.1%) 1 (0.0%)

INFECTION, NON-CMV 458 (13.0%) 1,066 (30.3%) 343 (12.6%) 229 (9.7%) 570 (10.7%) 361 (9.8%)

GRAFT FAILURE 1,452 (41.1%) 626 (17.8%) 636 (23.4%) 473 (20.1%) 965 (18.1%) 609 (16.6%)

TECHNICAL 253 (7.2%) 38 (1.1%) 19 (0.7%) 17 (0.7%) 41 (0.8%) 33 (0.9%)

OTHER 209 (5.9%) 303 (8.6%) 272 (10.0%) 220 (9.3%) 531 (10.0%) 364 (9.9%)

MULTIPLE ORGAN FAILURE

451 (12.8%) 386 (11.0%) 135 (5.0%) 122 (5.2%) 369 (6.9%) 293 (8.0%)

RENAL FAILURE 23 (0.7%) 34 (1.0%) 43 (1.6%) 86 (3.7%) 309 (5.8%) 308 (8.4%)

PULMONARY 150 (4.2%) 137 (3.9%) 105 (3.9%) 112 (4.8%) 218 (4.1%) 165 (4.5%)

CEREBROVASCULAR 237 (6.7%) 146 (4.2%) 95 (3.5%) 77 (3.3%) 226 (4.2%) 155 (4.2%)

ISHLT 2009


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

(Deaths: January 1992 - June 2008)

CAUSE OF DEATH

DATE OF DEATH

0-30 Days

(N = 3,531)

31 Days –

1 Year

(N = 3,513)

>1 Year –

3 Years

(N = 2,716)

>3 Years –

5 Years

(N = 2,356)

>5 Years – 10 Years

(N = 5,335)>10 Years

(N = 3,677)

ACUTE REJECTION

1992-1997 135 (7.4%) 267 (14.6%) 123 (8.9%) 42 (4.0%) 21 (1.3%) 3 (1.5%)

1998-6/2008 92 (5.4%) 160 (9.5%) 151 (11.3%) 62 (4.7%) 67 (1.8%) 30 (0.9%)

CARDIAC ALLOGRAFT VASCULOPATHY

1992-1997 39 (2.1%) 100 (5.5%) 224 (16.3%) 222 (21.3%) 314 (19.2%) 47 (24.2%)

1998-6/2008 23 (1.3%) 63 (3.7%) 159 (11.9%) 147 (11.2%) 453 (12.2%) 473 (13.6%)

GRAFT FAILURE1992-1997 798 (44.0%) 383 (21.0%) 326 (23.7%) 186 (17.8%) 299 (18.3%) 33 (17.0%)

1998-6/2008 654 (38.1%) 243 (14.4%) 310 (23.2%) 287 (21.9%) 666 (18.0%) 576 (16.5%)

MALIGNANCY, OTHER

1992-1997 4 (0.2%) 49 (2.7%) 158 (11.5%) 202 (19.3%) 303 (18.5%) 26 (13.4%)

1998-6/2008 0 (0.0%) 29 (1.7%) 143 (10.7%) 238 (18.1%) 696 (18.8%) 664 (19.1%)

ISHLT

2009


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

(Deaths: January 1992 - June 2008)

0

10

20

30

40

50

0-30 Days (N= 3,531)

31 Days – 1Year (N =

3,513)

>1 Year – 3Years (N =

2,716)

>3 Years – 5Years (N =

2,356)

>5 Years – 10Years (N =

5,335 )

>10 Years (N= 3,677)

CAV Acute Rejection

Malignancy (non-Lymph/PTLD) Infection (non-CMV)

Graft Failure

Pe

rce

nta

ge

of

De

ath

s

ISHLT

2009


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

(Transplants: January 1992 - June 2007)

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

0 1 2 3 4 5 6 7 8 9 10

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

2009


ADULT HEART TRANSPLANTS (1/2002-6/2007) Risk Factors for 1 Year Mortality

2009ISHLT (N=10,705)

VARIABLE N

Relative Risk

P-value 95% Confidence

Interval

Temporary circulatory support* 164 3.05 <0.0001 2.27 -4.09

Diagnosis: Congenital vs. cardiomyopathy 267 2.30 <0.0001 1.72 -3.10

VAD (type not collected) 49 2.25 0.0057 1.27 -4.01

Recipient on ventilator at time of transplant 293 1.59 0.0005 1.23 -2.07

Recipient history of dialysis 324 1.58 0.0001 1.26 -1.99

Female recipient 2460 1.31 0.0002 1.14 -1.50

Chronic pulsatile device 1701 1.25 0.0087 1.06 -1.49

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

1116 1.25 0.0075 1.06 -1.47

Not ABO identical 1570 1.21 0.0088 1.05 -1.40

Prior transfusion 2093 1.20 0.0177 1.03 -1.40

Diagnosis: coronary artery disease vs. cardiomyopathy

4701 1.17 0.0221 1.02 -1.33

* Temporary circulatory support includes ECMO and Abiomed.

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



Continuous Factors (see figures)

Recipient age

Recipient BMI

Donor age

Donor BMI

Transplant center volume

Ischemia time

PCW (borderline)

Bilirubin

Serum creatinine

PVR

2009ISHLT


ADULT HEART TRANSPLANTS (1/2002-6/2007) Relative Risk of 1 Year Mortality with 95% Confidence Limits

Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

2009ISHLT (N=10,705)



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

2009ISHLT (N=10,705)



Recipient BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30 32 34

Recipient BMI (kg/m2)

p = 0.0044

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

2009ISHLT (N=10,705)



Donor BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30 32 34

Donor BMI (kg/m2)

p = 0.0026

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

2009ISHLT (N=10,705)



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 = 0.0004Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

2009ISHLT (N=10,705)



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 = 0.0277

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

2009ISHLT (N=10,705)



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 = 0.0013

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

2009ISHLT (N=10,705)



Pre-Transplant Creatinine

0

0.5

1

1.5

2

2.5

3

3.5

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=10,705)2009ISHLT



Recipient PCW

0

0.5

1

1.5

2

5 10 15 20 25 30 35

PA PCW (mm Hg)

p = 0.059Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=10,705)2009ISHLT



Recipient PVR

0

0.5

1

1.5

2

0 2 4 6 8

PVR

p = 0.0007Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=10,705)2009ISHLT


ADULT HEART TRANSPLANTS (1/2002-6/2007)

Factors Not Significant for 1 Year Mortality

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

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

Transplant Factors: HLA mismatch, CMV mismatch, prior transplant

2009ISHLT


ADULT HEART TRANSPLANTS (1/2002-6/2007) Recipients: Age=18-30 Years

Risk Factors for 1 Year Mortality

(N=932)

VARIABLE N Relative

Risk P-value

95% Confidence Interval

Diagnosis: Congenital vs. cardiomyopathy 131 2.46 0.0001 1.58 -3.83



2009ISHLT





Recipient age (borderline)

Donor age

Recipient height

PA diastolic pressure

Serum creatinine

2009ISHLT



Relative Risk of 1 Year Mortality with 95% Confidence LimitsRecipient Age

0

0.5

1

1.5

2

18 21 24 27 30

Recipient Age

p = 0.06

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=932)2009ISHLT



Relative Risk of 1 Year Mortality with 95% Confidence LimitsDonor Age

0

0.5

1

1.5

2

2.5

3

15 20 25 30 35 40 45 50

Donor Age

p = 0.0063Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=932)2009ISHLT



Relative Risk of 1 Year Mortality with 95% Confidence LimitsRecipient Height

0

0.5

1

1.5

2

2.5

155 160 165 170 175 180 185 190

Recipient height (cm)

p = 0.0021

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=932)2009ISHLT



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


p = 0.00017

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=932)2009ISHLT



Relative Risk of 1 Year Mortality with 95% Confidence Limits Recipient PA Diastolic Pressure

0

0.5

1

1.5

2

2.5

5 10 15 20 25 30 35

PA Diastolic (mm Hg)

p = 0.016

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=932)2009ISHLT




(N=7,113)

VARIABLE N

Relative Risk


Interval


VAD (type not collected) 38 2.62 0.0029 1.39 -4.96



Recipient history of insulin-dependent diabetes 125 1.75 0.0129 1.13 -2.71


PRA ≥ 10% 475 1.41 0.0075 1.10 -1.80


Prior transfusion 1543 1.23 0.0327 1.02 -1.49


Diagnosis: Coronary artery disease vs. cardiomyopathy

2975 1.18 0.0474 1.00 -1.38



2009ISHLT


ADULT HEART TRANSPLANTS (1/2002-6/2007 ) Recipients: Age=31-60 Years

Borderline Significant Risk Factors for 1 Year Mortality

(N=7,113)

VARIABLE N Relative

Risk P-value


Chronic continuous device 217 1.45 0.0601 0.98 -2.13

On balloon pump at time of transplant 445 0.78 0.0848 0.58 -1.04

2009ISHLT




Continuous Factors (see figures) Recipient age

Donor age

Recipient height

BSA ratio

PVR

PCW

Serum creatinine

Ischemia time

Bilirubin

2009ISHLT




0

0.5

1

1.5

2

30 35 40 45 50 55 60

Recipient Age

p = 0.028

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=7,113)2009ISHLT




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=7,113)2009ISHLT



Relative Risk of 1 Year Mortality with 95% Confidence LimitsRecipient Height

0

0.5

1

1.5

2

155 160 165 170 175 180 185 190


p = 0.0036

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=7,113)2009ISHLT



Relative Risk of 1 Year Mortality with 95% Confidence LimitsBSA Ratio

0

0.5

1

1.5

2

0.8 0.9 1 1.1 1.2

Donor Body Surface Area/Recipient Body Surface Area

p = 0.0018

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=7,113)2009ISHLT




0

0.5

1

1.5

2

2.5

0.5 1 1.5 2 2.5


p < 0.0001

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=7,113)2009ISHLT



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 = 0.0008

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=7,113)2009ISHLT



Relative Risk of 1 Year Mortality with 95% Confidence Limits Recipient PCW Pressure

0

0.5

1

1.5

2

5 10 15 20 25 30 35

PCW (mm Hg)

p = 0.023

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=7,113)2009ISHLT



Relative Risk of 1 Year Mortality with 95% Confidence Limits Recipient PVR

0

0.5

1

1.5

2

0 1 2 3 4 5 6 7 8

PVR

p = 0.0078

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=7,113)2009ISHLT



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 = 0.0039

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=7,113)2009ISHLT




(N=2,646)

VARIABLE N

Relative Risk


Interval


Repeat transplant 54 2.78 0.0002 1.62 -4.78


Female recipient/male donor vs. male recipient/male donor

174 1.75 0.0095 1.15 -2.66


216 1.66 0.0009 1.23 -2.25



Defibrillator 1650 1.33 0.0149 1.06 -1.67



2009ISHLT


ADULT HEART TRANSPLANTS (1/2002-6/2007 ) Recipients: Age=61-75 Years

Borderline Significant Risk Factors for 1 Year Mortality

(N=2,646)

VARIABLE N Relative

Risk P-value


Diagnosis: other* vs. cardiomyopathy 36 2.03 0.0591 0.97 -4.22

Diagnosis: valvular disease vs. cardiomyopathy

69 1.67 0.0869 0.93 -3.02

Cerebrovascular event prior to transplant

130 1.43 0.0697 0.97 -2.12

Prior transfusions 424 1.31 0.053 1.00 -1.72

* Other diagnosis = diagnoses other than cardiomyopathy, coronary artery disease, valvular heart disease and retransplant.

2009ISHLT





Donor age

Recipient BSA

Donor BSA (borderline)

BMI ratio

Serum creatinine

Ischemia time

Bilirubin

Center volume

2009ISHLT




0

0.5

1

1.5

2

2.5

60 63 66 69 72 75

Recipient Age

p = 0.023

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=2,646)2009ISHLT




0

0.5

1

1.5

2

2.5

20 25 30 35 40 45 50 55 60

Donor Age

p = 0.0031

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=2,646)2009ISHLT



Relative Risk of 1 Year Mortality with 95% Confidence LimitsRecipient BSA

0

0.5

1

1.5

2

1.6 1.7 1.8 1.9 2 2.1 2.2 2.3

Recipient BSA (m2)

p = 0.032

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=2,646)2009ISHLT



Relative Risk of 1 Year Mortality with 95% Confidence LimitsDonor BSA

0

0.5

1

1.5

2

1.6 1.7 1.8 1.9 2 2.1 2.2 2.3

Donor BSA (m2)

p = 0.071

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=2,646)2009ISHLT



Relative Risk of 1 Year Mortality with 95% Confidence LimitsBMI Ratio

0

0.5

1

1.5

2

0.7 0.9 1.1 1.3 1.5

Donor BMI/Recipient BMI

p = 0.0042

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=2,646)2009ISHLT




0

0.5

1

1.5

2

2.5

0.5 1 1.5 2 2.5


p < 0.0001

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=2,646)2009ISHLT



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 = 0.024

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=2,646)2009ISHLT



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


p = 0.0009Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=2,646)2009ISHLT



Relative Risk of 1 Year Mortality with 95% Confidence Limits Center Volume

0

0.5

1

1.5

2

2.5

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

Center volume (cases per year)

p = 0.0064

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=2,646)2009ISHLT



by Recipient Age Group Ischemia Time

0

0.5

1

1.5

2

2.5

30 60 90 120 150 180 210 240 270 300 330 360Ischemia time (minutes)

18-30 Years 31-60 Years 61-75 Years

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

Recipient Age:

2009ISHLT



2009ISHLT (N=7,171)

VARIABLE N

Relative Risk


Interval


Ventilator 203 1.78 <0.0001 1.41 -2.24


Recipient on dialysis at transplant 221 1.62 <0.0001 1.31 -2.01

Previous pregnancy 1022 1.27 0.0193 1.04 -1.55

Recipient history of diabetes 1379 1.25 0.0001 1.11 -1.40


Previously cerebrovascular event 416 1.21 0.0414 1.01 -1.45


3405 1.19 0.0025 1.06 -1.33

Hospitalized (including ICU) 3640 1.16 0.005 1.04 -1.28

Male recipient/female donor vs. male recipient/male donor

1286 1.15 0.0345 1.01 -1.31

Transplant year: 2000 vs. 2002/2003 2031 1.14 0.0266 1.01 -1.27

Total number of HLA mismatches 0-3 MM (N= 872)

4-6 MM (N= 6299) 1.06 0.0176 1.01 -1.11

o

* Temporary circulatory support includes ECMO and Abiomed





Recipient age

Donor age

Recipient height

Bilirubin

Ischemia time

Serum creatinine


PA mean pressure

2009ISHLT (N=7,171)



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

2009ISHLT (N=7,171)



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

2009ISHLT (N=7,171)



Ischemia Time

0

0.5

1

1.5

2

2.5

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


p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

2009ISHLT (N=7,171)



Center Volume

0

0.5

1

1.5

2

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


p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

2009ISHLT (N=7,171)


ADULT HEART TRANSPLANTS (1/2000-6/2003) Relative Risk of 5 Year Mortality with 95% Confidence

LimitsRecipient Pre-Transplant Height

0

0.5

1

1.5

2

160 165 170 175 180 185 190 195


p = 0.0022

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

2009ISHLT (N=7,171)


ADULT HEART TRANSPLANTS (1/2000-6/2003)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 = 0.0021

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

2009ISHLT (N=7,171)



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

2009ISHLT (N=7,171)



Recipient Pre-Transplant PA Mean Pressure

0

0.5

1

1.5

2

15 20 25 30 35 40 45 50

PA Mean (mm Hg)

p = 0.022

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

2009ISHLT (N=7,171)


ADULT HEART TRANSPLANTS (1/2000-6/2003) Factors Not Significant for 5 Year Mortality

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

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

Transplant Factors: CMV mismatch, ABO match

2009ISHLT



Risk Factors for 5 Year MortalityConditional on Survival to 1 Year

2009ISHLT (N=5,857)

VARIABLE N

Relative Risk

P-value 95%

Confidence Interval

CAV within 1st year 320 1.69 <0.001 1.33 -2.16

Retransplant 126 1.65 0.0171 1.09 -2.50

Ventilator at time of transplant 120 1.6 0.0168 1.09 -2.34

Rejection between discharge and 1st year 1946 1.42 <0.0001 1.23 -1.64


Drug-treated rejection prior to discharge 1033 1.26 0.0078 1.06 -1.49


2789 1.2 0.0277 1.02 -1.41


ADULT HEART TRANSPLANTS (1/2000-6/2003) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year


Recipient age

Donor age

Recipient weight


2009ISHLT (N=5,857)



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

2009ISHLT (N=5,857)



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 = 0.0003

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

2009ISHLT (N=5,857)



Conditional on Survival to 1 Year Recipient Weight

0

0.5

1

1.5

2

55 65 75 85 95 105 115

Recipient Weight (kg)

p = 0.021

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

2009ISHLT (N=5,857)



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


p = 0.019

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

2009ISHLT (N=5,857)



2009ISHLT

(N=8,818)

VARIABLE N Relative

Risk P-value

95% Conf. Interval

Repeat transplant 206 1.67 <0.0001 1.38 -2.02

Recipient on dialysis 131 1.57 0.0001 1.25 -1.96

Diagnosis: congenital vs. cardiomyopathy 146 1.5 0.0012 1.17 -1.91

Ventilator at time of transplant 230 1.36 0.0007 1.14 -1.62

Female recipient/male donor 936 1.27 0.0001 1.13 -1.43


4468 1.26 <0.0001 1.17 -1.36

Female recipient/female donor 936 1.24 0.0001 1.11 -1.39

Recipient history of diabetes 1230 1.22 <0.0001 1.12 -1.33


659 1.22 0.0009 1.08 -1.37

Recipient history of malignancy 262 1.21 0.0279 1.02 -1.44

On VAD at time of transplant 837 1.2 0.0008 1.08 -1.34

PRA > 10% 567 1.17 0.0128 1.03 -1.32

Year of transplant: 1994/1995 vs. 1997/1998 3310 1.11 0.0067 1.03 -1.19

Male recipient/female donor 1817 1.1 0.029 1.01 -1.21

Number of total HLA mismatches 1.05 0.0026 1.02 -1.08

Year of transplant: 1996 vs. 1997/1998 131 1.08 0.0544 1.00 -1.18




Recipient age

Recipient BMI (borderline)

Donor age

Donor BMI

Creatinine

Bilirubin

Ischemia time

Volume

(N=8,818)2009ISHLT



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=8,818)2009ISHLT



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=8,818)2009ISHLT



Pre-Transplant Recipient BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30 32 34

Recipient BMI (kg/m2)

p = 0.057

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

(N=8,818)2009ISHLT



Donor BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30 32 34

Donor BMI (kg/m2)

p = 0.0086

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

(N=8,818)2009ISHLT



Ischemia Time

0

0.5

1

1.5

2

60 90 120 150 180 210 240 270 300


p = 0.0031

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

(N=8,818)2009ISHLT



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=8,818)2009ISHLT



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 = 0.0081

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

(N=8,818)2009ISHLT



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

p = 0.0042

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

(N=8,818)2009ISHLT


ADULT HEART TRANSPLANTS (7/1994-6/1998) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years

2009ISHLT

(N=6,175)

VARIABLE N

Relative Risk


Interval

Recipient history of malignancy 186 1.30 0.0339 1.02 -1.65

CAV within 1st year 376 1.28 0.0062 1.07 -1.52


Drug-treated infection prior to discharge 1101 1.22 0.0008 1.09 -1.37

Diagnosis: coronary artery disease vs. cardiomyopathy 3086 1.21 0.0004 1.09 -1.34


434 1.20 0.0357 1.01 -1.42

Rejection between discharge and 1st year 1713 1.19 0.0006 1.08 -1.31

Transplant year: 1994/1995 vs. 1997/1998 2313 1.13 0.0247 1.02 -1.25

Donor CMV+/ Recipient CMV- 1018 0.87 0.0316 0.76 -0.99


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


Recipient age

Donor BMI

Creatinine

PA mean pressure

2009ISHLT

(N=6,175)



Conditional on Survival to 3 YearsRecipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

2009ISHLT

(N=6,175)



Conditional on Survival to 3 YearsRecipient Pre-Transplant Creatinine

0

0.5

1

1.5

2

0.5 1 1.5 2 2.5

Recipient creatinine (mg/dL)

p < 0.0001

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

2009ISHLT

(N=6,175)



Conditional on Survival to 3 YearsDonor BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30 32 34

Donor BMI (kg/m2)

p = 0.0003

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

2009ISHLT

(N=6,175)



Conditional on Survival to 3 YearsRecipient Pre-Transplant PA Mean Pressure

0

0.5

1

1.5

2

15 20 25 30 35 40 45 50

PA Mean pressure (mm Hg)

p = 0.023

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty

2009ISHLT

(N=6,175)


ADULT HEART TRANSPLANTS (1989-6/1993) Risk Factors for 15 Year Mortality

(N=7,478)

VARIABLE

N

Relative Risk

P-value 95%

Confidence Interval

Retransplant 204 2.20 <.0001 1.87 -2.59

On ventilator 194 1.40 0.0001 1.18 -1.66


3715 1.16 <.0001 1.09 -1.24

Female recipient/male donor vs. male recipient/male donor

770 1.13 0.0216 1.02 -1.25

Number of DR mismatches 0 DR MM (N=449) 1 DR MM (N=4024) 2 DR MM (N=3005)

1.12 <.0001 1.07 -1.18

Male recipient/female donor vs. male recipient/male donor

1434 1.10 0.0215 1.02 -1.18

2009ISHLT


ADULT HEART TRANSPLANTS (1989-6/1993) Borderline Significant Risk Factors for 15 Year Mortality

(N=7,478)

VARIABLE N

Relative Risk

P-value 95%

Confidence Interval

Number of mismatches at A locus

0 A MM (N=554) 1 A MM (N=3691) 2 A MM (N=3233)

1.05 0.0537 1.00 -1.10

Number of mismatches at B locus

0 B MM (N=182) 1 B MM (N=1997) 2 B MM (N=5299)

0.95 0.0898 0.90 -1.01

2009ISHLT


ADULT HEART TRANSPLANTSRisk Factors for 15 Year Mortality


Recipient age

Donor age

Ischemia time

PRA

Center volume

(N=7,478)2009ISHLT


ADULT HEART TRANSPLANTS (1989-6/1993) 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=7,478)2009ISHLT



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=7,478)2009ISHLT



Ischemia Time

0

0.5

1

1.5

2

60 90 120 150 180 210 240 270 300


p = 0.0006

Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty

(N=7,478)2009ISHLT



Recipient Pre-Transplant PRA

0

0.5

1

1.5

2

0 10 20 30

PRA

p = 0.0100

Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty

(N=7,478)2009ISHLT



Center Volume

0

0.5

1

1.5

2

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


p = 0.027

Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty

(N=7,478)2009ISHLT


ADULT HEART TRANSPLANTS (1989-6/1993) Risk Factors for 15 Year MortalityConditional on Survival to 5 Years

2009ISHLT

(N=4,816)

VARIABLE N Relative

Risk P-value 95% Confidence

Interval

Retransplant 82 1.90 <0.0001 1.42 -2.53


2401 1.28 <0.0001 1.16 -1.40

Number of HLA mismatches at the DR locus

0 DR MM (N=315) 1 DR MM (N = 2632) 2 DR MM (N=1869

1.08 0.0385 1.00 -1.15

Diagnosis: congenital vs cardiomyopathy

69 0.64 0.0887 0.38 -1.07


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


Recipient age

Donor age

PRA prior to transplant

2009ISHLT

(N=4,816)



Conditional on Survival to 5 Years Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty

2009ISHLT

(N=4,816)



Conditional on Survival to 5 Years Donor Age

0

0.5

1

1.5

2

15 20 25 30 35 40 45 50

Donor Age

p = 0.0003Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty

2009ISHLT

(N=4,816)



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

0

0.5

1

1.5

2

0 10 20 30 40

Most recent PRA prior to transplant (%)

p = 0.048Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty

2009ISHLT

(N=4,816)


ADULT HEART TRANSPLANTS (1982-6/1987) Risk Factors for 20 Year Mortality

(N=4,487)

VARIABLE N Relative

Risk P-value


Transplant year: 1982 vs. 1986/1987 132 1.99 <0.0001 1.64 -2.42





1789 1.16 0.0002 1.07 -1.26

2009ISHLT


ADULT HEART TRANSPLANTSRisk Factors for 20 Year Mortality


Recipient age

(N=4,487)2009ISHLT



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=4,487)2009ISHLT


ADULT HEART TRANSPLANTS (1/2001-6/2007)Risk Factors for Developing Renal Dysfunction within 1 Year

Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant

VARIABLE N Relative

Risk P-value

95% Confidence

Interval




Donor cause of death: CNS tumor 112 1.86 0.0219 1.09 -3.18

Continuous chronic device 253 1.73 0.0295 1.06 -2.84

Infection requiring IV antibiotics within 2 weeks prior to transplant

966 1.66 <0.0001 1.31 -2.10


Rapamycin at discharge 521 1.44 0.0144 1.08 -1.93

Azathioprine at discharge 529 1.40 0.0344 1.03 -1.92

IL2R antagonist used for induction 2575 1.24 0.0182 1.04 -1.48

Recipient diabetes pre-transplant 2102 1.23 0.0293 1.02 -1.49

In hospital at transplant (incl. ICU) 4510 1.23 0.0148 1.04 -1.46

Diagnosis: coronary artery disease vs. cardiomyopathy 4379 0.79 0.0113 0.66 -0.95

Tacrolimus at discharge 4227 0.68 <0.0001 0.57 -0.81

(N=9,750)ISHLT 2009

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


ADULT HEART TRANSPLANTS (1/2001-6/2007) Risk Factors for Developing Renal Dysfunction within 1 Year

Limited to Recipients without Severe Renal Dysfunction Pre-Transplant


Recipient age

Recipient creatinine

Height difference

ISHLT 2009

(N=9,750)




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

0

0.5

1

1.5

20 25 30 35 40 45 50 55 60 65

Recipient Age

p = 0.0011

Re

lati

ve

Ris

k o

f R

en

al

Dy

sfu

nc

tio

n w

ith

in 1

Ye

ar

ISHLT 2009

(N=9,750)




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

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

0.5 1 1.5 2 2.5

Creatinine (mg/dl)

p < 0.0001

Re

lati

ve

Ris

k o

f R

en

al

Dy

sfu

nc

tio

n w

ith

in 1

Ye

ar

ISHLT 2009

(N=9,750)




Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Height Difference

0

0.5

1

1.5

2

-15 -10 -5 0 5 10 15 20 25

Donor Height - Recipient Height (cm)

p = 0.01

Re

lati

ve

Ris

k o

f R

en

al

Dy

sfu

nc

tio

n w

ith

in 1

Ye

ar

ISHLT 2009

(N=9,750)



ADULT HEART TRANSPLANTS (7/1996-6/2000) 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 history of hypertension 594 1.39 <0.0001 1.20 -1.60

Induction with IL2R antagonist 324 1.38 0.0025 1.12 -1.70

Induction with OKT3 645 1.19 0.0144 1.04 -1.38


2890 1.17 0.005 1.05 -1.31

Donor clinical infection 1048 1.13 0.044 1.00 -1.28

Number of mismatches at DR locus 0 DR MM (N=293)

1.09 0.0315 1.01 -1.19

Number of Class I mismatches 0-1 Class I MM (N=192)) 0.92 0.0115 0.87 -0.98

(N=5,672)ISHLT 2009



Height difference

Recipient PCW

Donor age

Donor age*donor gender interaction


ISHLT 2009

(N=5,672)

ADULT HEART TRANSPLANTS (7/1996-6/2000) Risk Factors for Developing Cardiac Allograft Vasculopathy

within 8 YearsConditional on Survival to Transplant Discharge


ADULT HEART TRANSPLANTS (7/1996-6/2000)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 < 0.0001Re

lati

ve

Ris

k o

f C

AV

wit

hin

8 Y

ea

rs

ISHLT 2009

(N=5,672)



Conditional on Survival to Transplant Discharge Height Difference

0

0.5

1

1.5

2

-15 -10 -5 0 5 10 15 20 25

Donor Height - Recipient Height (cm)

p = 0.004Re

lati

ve

Ris

k o

f C

AV

wit

hin

8 Y

ea

rs

ISHLT 2009

(N=5,672)



Conditional on Survival to Transplant Discharge Donor Age, Donor Gender and Recipient Gender

0

0.5

1

1.5

2

2.5

3

3.5

15 20 25 30 35 40 45 50 55

Donor Age

Male Recip/Male Donor

Male Recip/Female Donor

Female Recip/Male Donor

Female Recip/Female Donor

p < 0.0001Re

lati

ve

Ris

k o

f C

AV

wit

hin

8 Y

ea

rs

ISHLT 2009

(N=5,672)

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



Conditional on Survival to Transplant Discharge Recipient Pre-Transplant PCW

0

0.5

1

1.5

2

5 10 15 20 25 30 35

Recipient PCW (mm Hg)

p = 0.0035Re

lati

ve

Ris

k o

f C

AV

wit

hin

8 Y

ea

rs

ISHLT 2009

(N=5,672)



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


p < 0.0001Re

lati

ve

Ris

k o

f C

AV

wit

hin

8 Y

ea

rs

ISHLT 2009

(N=5,672)


ADULT HEART TRANSPLANTS (7/1996-6/2000) Risk Factors for Developing Non-Skin Malignancy within 8 Years Limited to Recipients without History of Malignancy Pre-Transplant and

Conditional on Survival to Transplant Discharge

VARIABLE N Relative

risk P-value 95% Conf.

Interval

Rejection prior to transplant discharge 963 1.36 0.0076 1.09 -1.71

Hospitalized at transplant (incl. ICU) 3199 1.23 0.0426 1.01 -1.51

(N=4,904)ISHLT 2009


Continuous Factors (see figures) Recipient age Recipient height Donor BSA

Recipient bilirubin Transplant center volume

ISHLT 2009

(N=4,904)

ADULT HEART TRANSPLANTS (7/1996-6/2000) Risk Factors for Developing Non-Skin Malignancy within 8 Years Limited to Recipients without History of Malignancy Pre-Transplant and

Conditional on Survival to Transplant Discharge


ADULT HEART TRANSPLANTS (7/1996-6/2000)Relative Risk for Developing Non-Skin Malignancy within 8 Years

Limited to Recipients without History of Malignancy Pre-Transplant and 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 < 0.0001Re

lati

ve

Ris

k o

f N

on

-Sk

in M

ali

gn

an

cy

w

ith

in 8

Ye

ars

ISHLT 2009

(N=4,904)




Recipient Height

0

0.5

1

1.5

2

155 160 165 170 175 180 185 190

Recipient Height (cm)

p = 0.049Re

lati

ve

Ris

k o

f N

on

-Sk

in M

ali

gn

an

cy

w

ith

in 8

Ye

ars

ISHLT 2009

(N=4,904)




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 2.4 2.5

Donor Body Surface Area (m2)

p = 0.042Re

lati

ve

Ris

k o

f N

on

-Sk

in M

ali

gn

an

cy

w

ith

in 8

Ye

ars

ISHLT 2009

(N=4,904)



Relative Risk for Developing Non-Skin Malignancy within 8 YearsLimited to Recipients without History of Malignancy Pre-Transplant

and Conditional on Survival to Transplant Discharge Recipient Bilirubin

0

0.5

1

1.5

2

0.5 1 1.5 2 2.5 3 3.5

p = 0.013Re

lati

ve

Ris

k o

f N

on

-Sk

in M

ali

gn

an

cy

w

ith

in 8

Ye

ars

Bilirubin (mg/dL)ISHLT 2009

(N=4,904)



Relative Risk for Developing Non-Skin Malignancy within 8 YearsLimited to Recipients without History of Malignancy Pre-Transplant

and 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


p = 0.0035Re

lati

ve

Ris

k o

f N

on

-Sk

in M

ali

gn

an

cy

w

ith

in 8

Ye

ars

ISHLT 2009

(N=4,904)

J Heart Lung Transplant 2009;28: 989-1049 HEART TRANSPLANTATION Overall ISHLT 2009.

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Transcript of J Heart Lung Transplant 2009;28: 989-1049 HEART TRANSPLANTATION Overall ISHLT 2009.