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2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
HEART-LUNG TRANSPLANTATION
Overall
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
0
50
100
150
200
25019
82
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
*
Num
ber
of T
rans
plan
tsNUMBER OF HEART-LUNG
TRANSPLANTS REPORTED BY YEAR
* Numbers may be low due to delayed reporting
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
HEART-LUNG TRANSPLANTATIONACTUARIAL SURVIVAL (1982-2001)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Years Post Transplantation
N=2,928
Half-life = 2.8 yearsConditional Half-life = 8.2 years
Su
rviv
al (
%)
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
HEART-LUNG RECIPIENTSFunctional Status (April 1994 – December 2001)
0%
20%
40%
60%
80%
100%
1 Year (N=240) 3 Years (N=180) 5 Years (N=164)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
HEART-LUNG RECIPIENTSEmployment Status (U.S.: April 1994 – December 2001)
0%
20%
40%
60%
80%
100%
1 Year (N = 196) 3 Years (N = 140) 5 Years (N = 134)
Working Full Time Working Part Time Not Working Retired
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant (April 1994 - December 2001)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N = 281)
Between 2 and 3 Years (N = 197)
Between 4 and 5 Years (N = 168)
No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Only Hospitalized, Infection OnlyHospitalized, Rejection and Infection
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
HEART-LUNG TRANSPLANTATION
Adult Recipients
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
Other 8%
Alpha-13%
Acquired heart disease
4%
CF17%
IPF3%
PPH26%
COPD4%
Congenital heart disease
35%
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (1982-2001)
“Other” includes cancer, LAM, OB, bronchiectasis, retransplant, sarcoidosis
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (1982-2001)
Diagnosis N %
Congenital Heart Disease 693 36.4
PPH 520 27.3
CF 340 17.8
Acquired Heart Disease 90 4.7
COPD/Emphysema 87 4.6
IPF 59 3.1
Alpha-1 58 3.0
Re-TX: Non-OB 31 1.6
Sarcoidosis 27 1.4
Re-TX: OB 22 1.2
Bronchiectasis 13 0.7
OB (not Re-TX) 9 0.5
Other 52 2.7
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
3%
4%
16%3% 4%
35%
25%
6%
2%
2%
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA
1982-1990
38%
22%
1%
4%
1%4%
5%4%17%
4%
COPD Congenital Heart Disease Acquired Heart DiseaseAlpha-1 CF IPFOther PPH Re-TX: Non-OBRe-TX: OB
3%41%
7%
1%
19%2%
6%
20%
1%
0%
1991-1995 1996-2001
“Other” includes OB (non-ReTX), Bronchiectasis, Sarcoidosis
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
0
10
20
30
40
50
Any Induction (N = 48)
Polyclonal ATG/ALG (N = 34)
OKT3 (N = 5) IL2-R Antagonist (N=12)
% o
f p
ati
en
tsADULT HEART-LUNG RECIPIENTS
Induction ImmunosuppressionFor follow-ups between October 1999 and December 2001
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
atie
nts
Year 1 (N = 47)
Year 5 (N = 53)
ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression at Any Time During Follow-up
For follow-ups between October 1999 and December 2001
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
atie
nts
Year 1 (N = 41) Year 5 (N = 41)
ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up
For follow-ups between October 1999 and December 2001
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
0%
20%
40%
60%
80%
100%
Year 1 (N = 41) Year 5 (N = 41)
% o
f P
atie
nts
Other
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine + MMF
Cyclosporine + AZA
ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up
For follow-ups between October 1999 and December 2001
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
ADULT POST-HEART-LUNG TRANSPLANT MORBIDITYCumulative Incidence of Survivors (April 1994-December 2001)
Outcome By 1 Year By 5 Years
Hypertension 53.0% (N=234) 84.2% (N=57)
Renal Function (N=227) (N=59) Normal 84.6% 81.4% Renal Dysfunction 7.9% 11.9% Creatinine>2.5 mg/dl 3.1% 6.8% Chronic Dialysis 4.4% 0.0% Renal Transplant 0.0% 0.0%
Hyperlipidemia 17.0% (N=241) 56.9% (N=58)
Diabetes 11.7% (N=231) 18.2% (N=55)
Bronchiolitis Obliterans 10.0% (N=221) 25.6% (N=43)
CAV 1.0% (N=194) 10.0% (N=30)
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
Freedom from CAV For Adult Heart-Lung Recipients (April 1994-December 2000)
50
60
70
80
90
100
0 12 24 36 48 60
Months
% F
ree
from
CA
V
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
Freedom from Bronchiolitis Obliterans For Adult Heart-Lung Recipients (April 1994-December 2000)
50
60
70
80
90
100
0 12 24 36 48 60
Months
% F
ree
fro
m B
ron
chio
litis
O
blit
eran
s
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
Freedom from Renal DysfunctionFor Adult Heart-Lung Recipients (April 1994-December 2000)
50
60
70
80
90
100
0 12 24 36 48 60
Months
% F
reed
om fr
om R
enal
D
ysfu
nctio
n
* Renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTSCumulative Incidence for Survivors (April 1994-December 2001)
Malignancy/Type 1-Year Survivors 5-Year Survivors
No Malignancy 211 (90.9%) 53 90.8%)
Malignancy (all types combined) 21 (9.1%) 6 (9.2%)
Malignancy Type
Skin 1
Lymph 14 2
Other 2 2
Type Not Reported 4 2
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
Freedom from MalignancyFor Adult Heart-Lung Recipients (April 1994-December 2000)
50
60
70
80
90
100
0 12 24 36 48 60
Months
% F
ree
from
Mal
igna
ncy
All malignancy
Lymph
Skin
Other
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (1987-2001)
0%
20%
40%
60%
80%
100%
0-30 Days (N = 235)
31 Days - 1 Year (N = 184)
>1 Year - 3 Years(N = 112)
>3 Years - 5Years (N = 58)
>5 Years (N = 52)
Timing of Death
Per
cen
tag
e o
f D
eath
s
Other
Malignancy, Other
Lymphoma
CMV
CAV
Graft Failure - Other
Primary Graft Failure
Infection, Non-CMV
Acute Rejection
Bronchiolitis
Technical
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
HEART-LUNG TRANSPLANTATION
Pediatric Recipients
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS (1982-2001)
0
10
20
30
40
50
60
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Recipient Age (Years)
Nu
mb
er o
f T
ran
spla
nts
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART-LUNG RECIPIENTS (1982-2001)
0
10
20
30
40
50
60
70
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18+
Donor Age (Years)
Nu
mb
er o
f T
ran
spla
nts
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS
By Year of Transplant
0
5
10
15
20
25
30
35
40
4511-17 Years1-10 Years
<1 Year
Nu
mb
er o
f T
ran
spla
nts
* Numbers may be low due to delayed reporting.
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS
0
5
10
15
20
2519
84
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
*
Transplant Year
Num
ber
of P
edia
tric
Tra
nspl
ant C
ente
rs
* Numbers may be low due to delayed reporting.
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
39%2%
27%
3%
2% 21%
6%
Congenital
Acquired heart disease
Cystic Fibrosis
ReTX: OB
ReTX: Non-OB
PPH
Other
DIAGNOSIS IN PEDIATRIC HEART –LUNG TRANSPLANT RECIPIENTS (Age: 11-17 Years)
0
25
50
75
100
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
% o
f Cas
es
PPH Cystic Fibrosis Congenital
“Other” includes Alpha-1, Bronchiectasis, IPF and OB (non-ReTX)
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
PEDIATRIC HEART-LUNG TRANSPLANTATION Actuarial Survival (1982-2001)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years Post-Transplantation
Sur
viva
l (%
)
1-10 (N = 112)
11-17 (N = 189)
Overall (N = 311)
Comparison between 1-10 years and 11-17 years not significant
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
PEDIATRIC HEART-LUNG TRANSPLANTATION Actuarial Survival by Era (1982-2001)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years Post-Transplantation
1982-1987 (N=70)
1988-1992 (N=191)
1993-1997 (N=133)
1998-2001 (N=72)
Su
rviv
al (
%)
No comparisons are statistically significant
2002ISHLT
J Heart Lung Transplant 2002; 21: 950-970.
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (1987-2001)
0%
20%
40%
60%
80%
100%
0-30 Days (N = 30)
31 Days - 1 Year (N = 37)
>1 Year - 3 Years(N = 27)
>3 Year - 5 Years(N = 13)
>5 Years (N = 11)
Timing of Death
Pe
rce
nta
ge
of
De
ath
s Other
Graft Failure - Other
Primary Graft Failure
Infection, Non-CMV
Acute Rejection
Bronchiolitis
Technical