2004 ISHLT J Heart Lung Transplant 2004; 23: 796-803 HEART TRANSPLANTATION Overall

2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803

HEART TRANSPLANTATION

Overall


NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR

189 318669

1185

2165

27203156

3380

4024 4186 4219 4382 4438 4356 4206 40873769

3436 3314 3219 3107

0

500

1000

1500

2000

2500

3000

3500

4000

45001

98

2

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

Nu

mb

er o

f T

ran

spla

nts


AVERAGE CENTER VOLUMEHeart Transplants: January 1, 1997 - June 30, 2003

63

37

83

42

18

4350

79

2314 5 5 2455

0

10

20

30

40

50

60

70

80

90

1-4 5-9 10-19 20-29 30-39 40-49 50-74 75+

Average number of heart transplants per year

Nu

mb

er o

f ce

nte

rs

1997-1999

2000-6/2003


DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME

Heart Transplants: January 1, 1997 - June 30, 2003

0

5

10

15

20

25

30

35

1-4 5-9 10-19 20-29 30-39 40-49 50-74 75+

Average number of heart transplants per year

Per

cen

tag

e o

f tr

ansp

lan

ts 1997-1999

2000-6/2003


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%1

98

2

19

84

19

86

19

88

19

90

19

92

19

94

19

96

19

98

20

00

20

02

% o

f T

ran

sp

lan

ts

0-10 11-17 18-35 36-49 50-59 60+

0

5

10

15

20

25

30

35

Me

an

do

no

r a

ge

(y

ea

rs)

Mean Age

HEART TRANSPLANTS: Donor Age by Year of Transplant


AGE DISTRIBUTIONOF HEART RECIPIENTS (1/1982-6/2003)

% o

f T

r%

of

Tra

ns

pla

nts

ns

pla

nts

0

10

20

30

40

50

60

<1 1-5 6-10 11-17 18-34 35-49 50-64 65+

Recipient Age


AGE DISTRIBUTION OF HEART TRANSPLANT RECIPIENTS BY ERA

0

10

20

30

40

50

60

<1 1-5 6-10 11-17 18-34 35-49 50-64 65+

Recipient age

% o

f tr

an

sp

lan

ts

1997-19992000-6/2003

p < 0.0001


HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2002)

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

Sur

viva

l (%

)

Half-life = 9.4 yearsConditional Half-life = 12.0 years

N=62,952


HEART TRANSPLANTATION

Adult Recipients


Congenital2%

ReTX2%

Myopathy45%

Misc.1%

Valvular4%

CAD46%

1982-1999

DIAGNOSIS IN ADULT HEART TRANSPLANTS

203040506070

% o

f Cas

es

Myopathy CAD

Congenital2%

ReTX2%

Myopathy46%

Misc.2%

Valvular3%

CAD45%

1/2000-6/2003


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2002)

0

20

40

60

80

100

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

Years

1982-1988 (N=9,143)

1989-1993 (N=17,869)

1994-1998 (N=18,557)

1999-6/2002 (N=10,234)

All comparisons significant at p < 0.01

HALF-LIFE 1982-1988: 8.1 years; 1989-1993: 9.5 years; 1994-1998: 9.1 years

Su

rviv

al (

%)


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1982-6/2002)

0

20

40

60

80

100

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

Years

Su

rviv

al

(%)

18-34 (N= 5,858) 35-49 (N=16,337)50-64 (N=30,600) 65-69 (N= 2,511)70+ (N= 250)

HALF-LIFE 18-34: 11.5 years; 35-49: 10.1 years; 50-64: 8.9 years; 65-69: 8.1 years; 70+: 5.9 years

All pair-wise comparisons are statistically significant at p < 0.001 except 18-34 vs. 35-49 and 65-69 vs. 70+


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1996-6/2002)

0

20

40

60

80

100

0 1 2 3 4 5 6 7

Years

Su

rviv

al

(%)

18-34 (N= 1,916) 35-49 (N= 5,066)50-64 (N=12,182) 65-69 (N= 1,543)70+ (N= 183)

All pair-wise comparisons are statistically significant at p < 0.05 except 18-34 vs. 50-64, 18-34 vs. 70+ and 65-69 vs. 70+


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: 1/1982-6/2002)

0

20

40

60

80

100

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

Years

Su

rviv

al

(%)

Male (N=45,017) Female (N=10,427)

HALF-LIFE Male: 9.3 years; Female: 9.7 years

p < 0.0001


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1982-6/2002)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al

(%)

Cardiomyopathy (N = 24,147) Coronary artery disease (N = 24,663)Congenital diagnosis (N = 899) Retransplant (1,070)Valvular (N= 1,929) Other (N= 610)

All pair-wise comparisons with Cardiomyopathy are significant at p < 0.05 except for Congenital and Other; Coronary Artery Disease vs. ReTX: p < 0.0001; Valvular vs. ReTX: p < 0.0001; Congenital vs. ReTX: p < 0.0001; Other vs. ReTX: p < 0.0001

HALF-LIFE Cardiomyopathy: 10.5 years; CAD: 8.7 years; Congenital: 11.5 years; Retransplant: 4.2 years; Valvular: 10.0 years; Other: 10.9 years


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1996-6/2002)

0

20

40

60

80

100

0 1 2 3 4 5 6

Years

Su

rviv

al

(%)

Cardiomyopathy (N=9,310) Coronary artery disease (N=9,427)Congenital Diagnosis (N=379) Retransplant (N=408)Valvular (N=619) Other (N=273)

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


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by PVR (Transplants: 1/1996-6/2002)

50

60

70

80

90

100

0 1 2 3 4 5 6

Years

Su

rviv

al (

%)

1-<3 (N= 6,571) 3-<5 (N= 2,200) 5+ (N= 869)

1-3 vs. 3-5: p = 0.091-3 vs. 5+: p = 0.023-5 vs. 5+: p = 0.3


0

20

40

60

80

100

0-2 months >2-6 months >6-12months

>12-36months

>36-60months

>60 months

Time between previous and current transplant

1 Y

ear

Pat

ien

t S

urv

ival

(%

)

1/1982-12/1990

1/1991-12/1995

1/1996-6/2002

Comparison of survival for interval < 12 months vs. > 12 months: p < 0.000112

610

6

32 19 2231 66 483736 25 109

74 18

7 62 56 269

ADULT HEART RE-TRANSPLANTS1-Year Survival


ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality

1995-1998 (N=13,523)

1999-6/2002 (N=7,067)

Factor Odds Ratio

p-value Odds Ratio

p-value

Dialysis 2.11 0.0001 2.52 <.0001

Diagnosis: Congenital heart disease 1.97 0.0002 2.66 <.0001

Ventilator 1.85 0.0002 2.47 <.0001

Repeat transplant 1.76 <.0001 1.08 0.7

Intra-aortic balloon pump 1.46 0.002 1.23 0.2



1995-1998 (N=13,523)

1999-6/2002 (N=7,067)

Factor Odds Ratio

p-value Odds Ratio

p-value

Diagnosis: Other (excluding Cardiomyopathy)

1.35 0.0011 1.42 0.0105

Donor history of cancer 1.33 0.21 1.78 0.0124

Diagnosis: Coronary artery disease 1.31 <.0001 1.05 0.5

In hospital (including ICU) 1.26 0.0009 1.42 <.0001

Infection requiring IV drug therapy within 2 weeks of transplant

1.25 0.05 1.02 0.8576



1995-1998 (N=13,523)

1999-6/2002 (N=7,067)

Factor Odds Ratio

p-value

Odds Ratio

p-value

HLA B mismatches (per mismatch) 1.22 0.0002 1.13 0.1102

Prior transfusions 1.21 0.046 1.25 0.06

Donor CMV+/Recipient CMV - 1.20 0.0011 1.34 0.0003

PRA > 10% 1.19 0.13 1.43 0.02

HLA DR mismatches (per mismatch) 1.15 0.0013 1.1 0.1336



1995-1998 (N=13,523)

1999-6/2002 (N=7,067)

Factor Odds Ratio

p-value

Odds Ratio

p-value

Insulin dependent diabetes 1.13 0.3 1.41 0.02

Female donor 1.11 0.0433 1.07 0.3736

Sternotomy 0.86 0.03 1.01 0.8948

IV inotropes 0.83 0.005 0.83 0.04



Continuous Factors (see figures)

Recipient age

Recipient height

Donor age

Ischemia time

Transplant center volume

Bilirubin

Serum creatinine



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

1 Y

ear

Mo

rtal

ity

1995-1998

1999-6/2002

p = 0.01p < 0.0001



Donor Age

0

0.5

1

1.5

2

15 25 35 45 55

Donor Age

Od

ds

of

1 Y

ear

Mo

rtal

ity

1995-1998

1999-6/2002

p < 0.0001p < 0.0001



Recipient Height

0

0.5

1

1.5

2

150 160 170 180 190

Recipient Height (cm)

Od

ds

of

1 Y

ear

Mo

rtal

ity

1995-1998

1999-6/2002

p < 0.0001p = 0.14



Center volume

0

0.5

1

1.5

2

0 10 20 30 40 50 60 70

Center Volume (cases per year)

Od

ds

of

1 Y

ea

r M

ort

alit

y

1995-1998

1999-6/2002

p = 0.003p < 0.0001



Ischemia time

0

0.25

0.5

0.75

1

1.25

1.5

1 2 3 4 5

Ischemia time (hours)

Od

ds

of

1 Y

ear

Mo

rtal

ity

1995-1998

1999-6/2002

p < 0.0001p = 0.004



Recipient Bilirubin

0

0.5

1

1.5

2

0.5 1.5 2.5 3.5 4.5

Recipient bilirubin (mg/dl)

Od

ds

of

1 Y

ear

Mo

rtal

ity

1995-1998

1999-6/2002

p = 0.03p < 0.0001



Recipient creatinine

0

0.5

1

1.5

2

0.5 1 1.5 2

Recipient creatinine (mg/dl)

Od

ds

of

1 Y

ear

Mo

rtal

ity

1995-1998

1999-6/2002

p < 0.0001p < 0.0001


ADULT HEART TRANSPLANTS (1/1995-6/2002) Factors Not Significant for 1 Year Mortality

Recipient Factors:VAD, ABO identical/compatible, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, cardiac output, weight



Donor Factors:Clinical infection, history of cancer, history of hypertension, history of diabetes, height, weight, cause of death

Transplant Factors:Donor/recipient BMI ratio, donor/recipient weight ratio


ADULT HEART TRANSPLANTS (1995-6/1998) Risk Factors for 5 Year Mortality

VARIABLE Odds Ratio P-value

95% Confidence

Interval

Repeat Transplant 1.93 <.0001 1.46 2.55

Dialysis 1.80 0.004 1.21 2.68

Intra-aortic balloon pump 1.66 0.02 1.07 2.55

Ventilator 1.62 0.008 1.14 2.32

(N=11,963)




95% Confidence

Interval

Diagnosis: Congenital heart disease 1.51 0.02 1.07 2.13

Infection requiring IV drug therapy within 2 weeks of transplant

1.37 0.002 1.12 1.68

Diagnosis: Coronary artery disease 1.29 <.0001 1.16 1.42

Diagnosis: Other (excluding Cardiomyopathy)

1.19 0.04 1.01 1.41

Diabetes 1.19 0.02 1.03 1.37

(N=11,963)




95% Confidence

Interval

HLA DR Mismatches (per mismatch) 1.12 0.006 1.03 1.21

HLA B Mismatches (per mismatch) 1.11 0.03 1.01 1.22

IV inotropes 0.87 0.02 0.77 0.98

Sternotomy 0.85 0.005 0.75 0.95

(N=11,963)



Continuous Factors (see figures) Recipient age

Recipient height

Donor age

Donor BMI

Ischemia time


Serum creatinine

Wedge pressure



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.0001



Donor Age

0

0.5

1

1.5

2

10 15 20 25 30 35 40 45 50 55 60

Donor Age

Od

ds

of

5 Y

ear

Mo

rtal

ity

p < 0.0001



Donor BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30 32

Donor BMI (kg/m2)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.05



Recipient Height

0

0.5

1

1.5

2

150 160 170 180 190

Recipient Height (cm)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p < 0.0001



Center volume

0

0.5

1

1.5

2

0 10 20 30 40 50 60 70


Od

ds

of

5 Y

ea

r M

ort

alit

y

p = 0.02



Ischemia time

0

0.25

0.5

0.75

1

1.25

1.5

1 2 3 4 5

Ischemia time (hours)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.003




0

0.5

1

1.5

2

0.5 1 1.5 2 2.5

Recipient creatinine (mg/dl)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p < 0.0001



Recipient Factors:VAD, in hospital, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, PA diastolic, PVR, history of malignancy, weight, gender, history of malignancy, bilirubin, PCW



Donor Factors:Gender, cause of death, clinical infection, history of cancer, history of hypertension, history of diabetes

Transplant Factors:Donor/recipient BMI ratio, donor/recipient height ratio, CMV mismatch, ABO identical/compatible


ADULT HEART TRANSPLANTS (1995-6/1998) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year


95% Confidence Interval

Previous transplant 2.19 0.0002 1.45 -3.28

CAV during 1st year 1.62 0.0001 1.25 -2.08

Cerebrovascular disease at transplant 1.59 0.002 1.19 -2.14

Treated for rejection during 1st year 1.44 <0.0001 1.22 -1.71

Treated for infection prior to transplant discharge

1.37 0.004 1.15 -1.64

Diagnosis: Coronary Artery Disease 1.25 0.003 1.08 -1.44

CMV mismatch (Donor+/Recipient-) 0.83 0.009 0.72 -0.95

(N=9,182)


ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year


Recipient age

Donor age

Donor BMI

Serum creatinine


ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

Recipient Age

0

0.5

1

1.5

2

2.5

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

5 Y

ear

Mo

rtal

ity

p < 0.0001



Donor Age

0

0.5

1

1.5

2

15 25 35 45 55

Donor Age

Od

ds

of

5 Y

ear

Mo

rtal

ity

p < 0.0001



Donor BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30 32

Donor BMI (kg/m2)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.003




0

0.5

1

1.5

0.6 0.8 1 1.2 1.4 1.6 1.8 2 2.2 2.4

Creatinine (mg/dl)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.005



Conditional on Survival to 1 Year

Recipient Factors:VAD, ventilator, in hospital, IV inotropes, balloon, ABO identical/compatible, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, PA diastolic, PCW, PVR, history of malignancy, height, weight, gender, diabetes, PRA, bilirubin


ADULT HEART TRANSPLANTS (1/1995-6/1998) Factors Not Significant for 5 Year Mortality Conditional on

Survival to 1 Year

Donor Factors:Gender, cause of death, clinical infection, history of cancer, history of hypertension, history of diabetes

Transplant Factors:Donor/recipient BMI ratio, donor/recipient height ratio, CMV mismatch, HLA mismatch, center volume, ischemia time

Post-transplant Factors:Dialysis, prolonged graft dysfunction, permanent pacemaker


ADULT HEART TRANSPLANTS (1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years


95% Confidence Interval

Previous transplant 1.76 0.012 1.13 -2.74

Previous pregnancy 1.39 0.03 1.03 -1.86

Diagnosis: Coronary artery disease 1.34 <0.0001 1.18 -1.52

Female recipient 0.73 0.015 0.56 -0.94

Diagnosis: Congenital heart disease 0.39 0.01 0.19 -0.81

(N=5,952)


ADULT HEART TRANSPLANTS (1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years


Recipient age

Donor age

Donor BMI

Center volume


ADULT HEART TRANSPLANTS (1/1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years

Recipient Age

0

0.5

1

1.5

2

2.5

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

10 Y

ear

Mo

rtal

ity

p < 0.0001



Donor Age

0

0.5

1

1.5

2

15 25 35 45 55

Donor Age

Od

ds

of

10 Y

ear

Mo

rtal

ity

p < 0.0001



Donor BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30

Donor BMI (kg/m2)

Od

ds

of

10 Y

ear

Mo

rtal

ity

p = 0.0006



Center volume

0

0.5

1

1.5

2

0 20 40 60 80 100


Od

ds

of

10

Ye

ar

Mo

rta

lity

p = 0.007


ADULT HEART RECIPIENTS Functional Status (Follow-ups: January 1996 - June 2003)

0%

20%

40%

60%

80%

100%

1 Year (N = 14,353) 3 Years (N =12,6286)

5 Years (N =10,668)

7 Years (N = 8,054)

No Activity Limitations Performs with Some Assistance Requires Total Assistance


ADULT HEART RECIPIENTSEmployment Status (Follow-ups: January 1996-June 2003)

0%

20%

40%

60%

80%

100%

1 Year (N = 13,542) 3 Year (N = 11,741) 5 Year (N = 9,831) 7 Year (N = 7,490)

Retired

Not Working

Working Part Time

Working Full Time


ADULT HEART RECIPIENTSRehospitalization Post-transplant (Follow-ups: January 1996 - June 2003)

0%

20%

40%

60%

80%

100%

Up to 1 Year (N =15,704)

Between 2 and 3 Years (N = 13,392)



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


0

10

20

30

40

50

Any Induction (N =2,391)

Polyclonal ALG/ATG (N= 1,181)

OKT3 (N = 318) IL2R-antagonist (N =974)

% o

f p

ati

en

ts

ADULT HEART RECIPIENTSInduction Immunosuppression (Follow-ups: January 2001 – June 2003)


0

10

20

30

40

50

Any Induction PolyclonalALG/ATG

OKT3 IL2R-antagonist

% o

f p

atie

nts

2001 2002 1/2003-6/2003

ADULT HEART RECIPIENTSInduction Immunosuppression (Follow-ups: January 2001 - June 2003)


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

ati

en

ts

Year 1 (N = 3,888) Year 5 (N = 3,271)

ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up

For follow-ups between January 2001 through June 2003

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


0%

20%

40%

60%

80%

100%

Year 1 (N = 3,967) Year 5 (N = 3,351)

% o

f P

ati

en

ts

Other

Tacrolimus + MMF

Tacrolimus + AZA

Cyclosporine + MMF

Cyclosporine + AZA

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

For follow-ups between January 2001 through June 2003

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


PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEARStratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2002)

0

10

20

30

40

50

60

70

Overall 18-34 35-49 50-64 65+ F M

% t

reat

ed f

or

reje

ctio

n w

ith

in 1

yea

r

No induction PolyclonalIL2R-antagonist OKT3

For female: no induction vs. OKT3 (p = 0.006); polyclonal vs. OKT3 (p = 0.005); IL2R vs. OKT3 (p = 0.016)For male: no induction vs. OKT3 (p = 0.002); polyclonal vs. OKT3 (p = 0.002); IL2R vs. OKT3 (p = 0.003)

For the 50-64 age group: all comparisons with OKT3 were significant at p < 0.0001. No other comparisons within age groups were statistically significant.


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

Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2002)

0

0.5

1

1.5

2

2.5

3

Overall 18-34 35-49 50-64 65+ F M

Av

era

ge

nu

mb

er

of

reje

cti

on

ep

iso

de

s

No induction Polyclonal IL2R-antagonist OKT3

35-49: IL2R vs. OKT3 (p = 0.03); 50-64: No induction vs. OKT3 (p = 0.04); polyclonal vs. OKT3 (p = 0.02)Male: Polyclonal vs. OKT3 (p = 0.02); IL2R vs. OKT3 (p = 0.004)


PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS

TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2002)

0

10

20

30

40

50

60

Overall 18-34 35-49 50-64 65+ F M

% t

reat

ed f

or

reje

ctio

n w

ith

in 1

yea

r

Cyclosporin + MMF Cyclosporin + AZATacrolimus + MMF Tacrolimus + AZA

35-49: CyA + MMF vs. TAC + MMF (p = 0.0001); CyA + AZA vs. TAC + MMF (p = 0.03)50-64: CyA + MMF vs. TAC + MMF and CyA + AZA vs. TAC + MMF p < 0.0001Male: CyA + MMF vs. TAC + MMF and CyA + AZA vs. TAC + MMF p < 0.0001


NUMBER OF REJECTION EPISODES FOR ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2002)

0

0.5

1

1.5

2

2.5

Overall 18-34 35-49 50-64 65+ F M

Av

era

ge

nu

mb

er

of

reje

cti

on

ep

iso

de

s Cyclosporin + MMF Cyclosporin + AZATacrolimus + MMF Tacrolimus + AZA

No within-age group comparisons were statistically significant.Male: CyA + AZA vs. TAC + MMF (p = 0.009)


POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant

(Follow-ups: April 1994 - June 2003)

Outcome Within 1

Year Total number with known response

Hypertension 73.2% (N = 15,305)

Renal Dysfunction 26.2% (N = 15,249) Abnormal Creatinine < 2.5 mg/dl 16.2% Creatinine > 2.5 mg/dl 8.6% Chronic Dialysis 1.3% Renal Transplant 0.2%

Hyperlipidemia 52.0% (N = 16,178)

Diabetes 25.0% (N = 15,300)

CAV 7.9% (N = 13,812)


POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant


Outcome Within 5

Years Total number with known response


Renal Dysfunction 31.8% (N = 5,571)

Abnormal Creatinine < 2.5 mg/dl 19.6% Creatinine > 2.5 mg/dl 9.4% Chronic Dialysis 2.4% Renal Transplant 0.4%


Diabetes 32.8% (N = 5,128)

CAV 32.9% (N = 3,644)


POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 7 Years Post-Transplant


Outcome Within 7

Years Total number with known response


Renal Dysfunction 35.5% (N = 2,657)

Abnormal Creatinine < 2.5 mg/dl 20.2% Creatinine > 2.5 mg/dl 10.4% Chronic Dialysis 4.0% Renal Transplant 0.9%


Diabetes 35.0% (N = 2,362)

CAV 43.0% (N = 1,510)


FREEDOM FROM CAV AND FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Adult Heart Recipients (Follow-ups: January 1996-June 2003)

0

10

20

30

40

50

60

70

80

90

100

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5

Years

% F

ree

fro

m C

AV

or

Fre

ed

om

fro

m S

ev

ere

Re

na

l D

ys

fun

cti

on

Freedom from CAV

Freedom from Severe Renal Dysfunction

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


FREEDOM FROM CAV Stratified by Diagnosis

For Adult Heart Recipients (Follow-ups: January 1996-June 2003)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

% F

ree

fro

m C

AV

Coronary Artery Disease (N = 8,195)

Cardiomyopathy (N = 7,924)

p = 0.005


MALIGNANCY POST-HEART TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994-June 2003)

Malignancy/Type 1-Year Survivors

5-Year Survivors

7-Year Survivors

No Malignancy 15396 (96.8%) 4697 (83.1%) 1994 (75.9%)

Malignancy (all types combined) 502 (3.2%) 957 (16.9%) 633 (24.1%)

Malignancy Type

Skin 228 639 462

Lymph 119 105 57

Other 109 228 157

Type Not Reported 46 39 15

”Other” includes: prostate (11, 33, 25), adenocarcinoma (7, 4, 2), lung (5, 3, 2), bladder (4, 5, 5), sarcoma (3, 3, 1), breast (2, 8, 6), cervical (2, 4, 1), colon (2, 2, 3), and renal (2, 7, 3). Numbers in parentheses are those reported within 1 year, 5 years and 7 years, respectively.


FREEDOM FROM MALIGNANCYFor Adult Heart Recipients (Follow-ups: April 1994 - June 2003)

0

10

20

30

40

50

60

70

80

90

100

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5

Years

% F

ree

fro

m M

alig

nan

cy

All malignancy Lymph Skin Other


ADULT HEART TRANSPLANTS (1996-6/2000) Risk Factors for Developing CAV within 3 Years


95% Confidence

Interval

Donor history of hypertension 1.47 0.0002 1.20 -1.80

Diagnosis: Coronary artery disease 1.17 0.03 1.01 -1.36

Female recipient 0.81 0.048 0.66 -1.00

Female donor 0.72 0.0002 0.60 -0.86

(N=5,787)




Recipient age

Donor age

Recipient BMI


Diastolic PA pressure



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

CA

V b

y 3

Yea

rs

p < 0.0001



Donor Age

0

0.5

1

1.5

2

2.5

15 20 25 30 35 40 45 50 55

Donor Age

Od

ds

of

CA

V b

y 3

Yea

rs

p < 0.0001



Recipient BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30 32

Recipient BMI

Od

ds

of

CA

V b

y 3

Yea

rs

p = 0.005



Center Volume

0

0.5

1

1.5

2

0 10 20 30 40 50 60 70


Od

ds

of

CA

V b

y 3

Yea

rs

p < 0.0001



Recipient Diastolic PA Pressure

0

0.5

1

1.5

2

10 15 20 25 30 35 40

Recipient Diastolic PA Pressure

Od

ds

of

CA

V b

y 3

Yea

rs

p = 0.04


ADULT HEART TRANSPLANTS (1995-6/1996) Risk Factors for Developing CAV within 7 Years Conditional

on no CAV within 1 Year


95% Confidence

Interval

Donor history of hypertension 1.72 0.02 1.08 -2.73

Recipient rejection during 1st year 1.45 0.02 1.05 -2.00

Diagnosis: coronary artery disease 1.39 0.03 1.04 -1.87

DR mismatches (per mismatch) 1.34 0.03 1.02 -1.75

(N=1,414)



on no CAV within 1 Year


Recipient age

Donor age



on no CAV within 1 Year Recipient Age

0

0.5

1

1.5

2

2.5

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

CA

V b

y 7

Yea

rs

p = 0.007



on no CAV within 1 Year Donor Age

0

0.5

1

1.5

2

15 20 25 30 35 40 45 50 55

Donor Age

Od

ds

of

CA

V b

y 7

Yea

rs

p = 0.0009


ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2003)

CAUSE OF DEATH 0-30 Days

(N = 2,759 )31 Days - 1 Year

(N = 2,310 )>1 Year - 3 Years

(N = 1,737 )>3 Years - 5 Years

(N = 1,492 )>5 Years

(N = 4,009 )

CAV 43 (1.6%) 111 (4.8%) 257 (14.8%) 268 (18.0%) 651 (16.2%)

ACUTE REJECTION 188 (6.8%) 288 (12.5%) 165 (9.5%) 63 (4.2%) 43 (1.1%)

LYMPHOMA 2 (0.1%) 46 (2.0%) 77 (4.4%) 80 (5.4%) 201 (5.0%)

MALIGNANCY, OTHER 2 (0.1%) 49 (2.1%) 181 (10.4%) 281 (18.8%) 763 (19.0%)

CMV 4 (0.1%) 29 (1.3%) 15 (0.9%) 3 (0.2%) 4 (0.1%)

INFECTION, NON-CMV 370 (13.4%) 784 (33.9%) 234 (13.5%) 145 (9.7%) 393 (9.8%)

PRIMARY FAILURE 747 (27.1%) 186 (8.1%) 119 (6.9%) 68 (4.6%) 200 (5.0%)

GRAFT FAILURE 400 (14.5%) 245 (10.6%) 298 (17.2%) 218 (14.6%) 567 (14.1%)

TECHNICAL 208 (7.5%) 28 (1.2%) 15 (0.9%) 17 (1.1%) 43 (1.1%)

OTHER 101 (3.7%) 122 (5.3%) 123 (7.1%) 104 (7.0%) 240 (6.0%)

MULTIPLE ORGAN FAILURE

382 (13.8%) 228 (9.9%) 86 (5.0%) 83 (5.6%) 335 (8.4%)

RENAL FAILURE 17 (0.6%) 19 (0.8%) 31 (1.8%) 51 (3.4%) 238 (5.9%)

PULMONARY 116 (4.2%) 77 (3.3%) 77 (4.4%) 60 (4.0%) 163 (4.1%)

CEREBROVASCULAR 179 (6.5%) 98 (4.2%) 59 (3.4%) 51 (3.4%) 168 (4.2%)

Documents

2004 ISHLT J Heart Lung Transplant 2004; 23: 796-803 HEART TRANSPLANTATION Overall