HEART-LUNG TRANSPLANTATION Overall ISHLT 2005 J Heart Lung Transplant 2005;24: 945-982

HEART-LUNG TRANSPLANTATION

Overall

ISHLT 2005J Heart Lung Transplant 2005;24: 945-982

0

50

100

150

200

250

Num

ber

of T

rans

plan

ts

.NUMBER OF HEART-LUNG

TRANSPLANTS REPORTED BY YEAR

ISHLT 2005

NOTE: This figure includes only the heart-lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of heart-lung transplants worldwide has declined in recent years.

J Heart Lung Transplant 2005;24: 945-982

AVERAGE CENTER VOLUMEHeart-Lung Transplants: January 1, 1998 - June 30, 2004

76

3 20

25

50

75

1-4 5-9 10-19

Average number of heart-lung transplants per year

Nu

mb

er

of

cen

ters

.


DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY CENTER VOLUME

Heart-Lung Transplants: January 1, 1998 - June 30, 2004

0

25

50

75

1-4 5-9 10-19

Average number of heart-lung transplants per year

Perc

en

tag

e o

f h

eart

-lu

ng

tra

nsp

lan

tss


DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME

Lung Transplants: January 1, 1998 - June 30, 2004

0

10

20

30

40

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

Average number of lung transplants per year

Perc

en

tag

e o

f h

eart

-lu

ng

tra

nsp

lan

ts .


HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1982 - June 2003)

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

Years

N=3,080

Half-life = 2.9 yearsConditional Half-life = 8.6 years

Su

rviv

al (

%)

ISHLT 2005

N followed at longest time point: 1,899



Adult Recipients


Congenital heart disease

30%

COPD6%

PPH23%

IPF3%CF

15%

Other 11%

Acquired heart disease

4%

Alpha-16%

Re-transplant2%

DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (1/1982-6/2004)

“Other” includes cancer, LAM, OB, sarcoidosis, bronchiectasis


DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2004)

Diagnosis N (%)

Congenital Heart Disease 746 (32.4%)

Primary Pulmonary Hypertension 574 (24.9%)

Cystic Fibrosis 357 (15.5%)

Acquired Heart Disease 98 (4.3%)

COPD/Emphysema 92 (4.0%)

Idiopathic Pulmonary Fibrosis 64 (2.8%)

Alpha-1 57 (2.5%)

Re-Transplant: Not Obliterative Bronchiolitis 30 (1.3%)

Sarcoidosis 27 (1.2%)

Re-Transplant: Obliterative Bronchiolitis 24 (1.0%)

Bronchiectasis 15 (0.7%)

Obliterative Bronchiolitis

(not Re-Transplant)

8 (0.3%)

Other 212 (9.2%)


DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA

37%

1%

3%

16%

2%

20%6%

12%

3%

COPD/Alpha-1 Congenital Heart Disease Acquired Heart Disease

Alpha-1 CF IPF

PPH Re-TX Other

8%30%

3%

3% 27%

3%

11%

15%

1982-1995 1/1996-6/2004“Other” includes OB (non-ReTX), Bronchiectasis, Sarcoidosis


ADULT HEART-LUNG TRANSPLANTATIONIndications By Year (%)

0

20

40

60

80

100

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Transplant Year

% o

f T

ran

spla

nts

Congenital Heart Disease Primary Pulmonary HypertensionCystic Fibrosis COPD/Alpha-1Acquired Heart Disease


ADULT HEART-LUNG TRANSPLANTATIONIndications By Year (Number)

0

50

100

150

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Transplant Year

Nu

mb

er o

f T

ran

spla

nts

Congenital Heart Disease Primary Pulmonary HypertensionCystic Fibrosis COPD/Alpha-1Acquired Heart Disease


HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for Adult Recipients

(Transplants: January 1982 - June 2003)

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

Years

N=2,488

Half-life = 3.2 yearsConditional Half-life = 9.0 years

Su

rviv

al (

%)


ADULT HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2003)

0

25

50

75

100

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

Su

rviv

al (

%)

Other Congenital (N = 174)Eisenmenger's Syndrome (N = 420)PPH (N=356)

Congenital vs. Eisenmenger's: p = 0.0004Congenital vs. PPH: p = 0.02Eisenmenger's vs. PPH: p = 0.16

HALF-LIFE Congenital: 1.2 Years; Eisenmenger's: 5.1 Years; PPH: 3.2 Years


ADULT HEART-LUNG RECIPIENTSFunctional Status of Surviving Recipients

(Follow-ups: April 1994 – June 2004)

0%

20%

40%

60%

80%

100%

1 Year (N = 252) 3 Years (N = 201) 5 Years (N = 167) 7 Years (N = 142)

No Activity Limitations Performs with Some Assistance Requires Total Assistance


ADULT HEART-LUNG RECIPIENTSEmployment Status of Surviving Recipients

(Follow-ups: April 1994 – June 2004)

0%

20%

40%

60%

80%

100%

1 Year (N = 241) 3 Years (N = 183) 5 Years (N = 163) 7 Years (N = 122)

Working Full Time Working Part Time Not Working Retired


ADULT HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients

(Follow-ups: April 1994 - June 2004)

0%

20%

40%

60%

80%

100%

Up to 1 Year (N = 290)

Between 2 and 3Years (N = 216)



No Hospitalization Hospitalized, Not Rejection/Not Infection

Hospitalized, Rejection Only Hospitalized, Infection Only

Hospitalized, Rejection and Infection


0

10

20

30

40

50

Any Induction (N = 66) Polyclonal ALG/ATG (N = 32)

OKT3 (N = 4) IL2R-antagonist (N = 32)

% o

f p

ati

en

tsADULT HEART-LUNG RECIPIENTS

Induction ImmunosuppressionFor follow-ups between January 2001 through June 2004


0

10

20

30

40

50

60

Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist

% o

f p

atien

ts

2000 20012002 2003

ADULT HEART-LUNG RECIPIENTSInduction Immunosuppression (Follow-ups: January 2000 - December 2003)


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

atie

nts

.

Year 1 (N = 62) Year 5 (N = 48)

ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up

For follow-ups between January 2001 through June 2004

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


0%

20%

40%

60%

80%

100%

Year 1 (N = 62) Year 5 (N = 48)

% o

f P

ati

en

ts .

Other

Tacrolimus + MMF

Tacrolimus + AZA

Cyclosporine + MMF

Cyclosporine + AZA

ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression Drug Combinations at Time of Follow-up

For follow-ups between January 2001 through June 2004

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


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


Outcome Within 1

Year Total number with known response

Hypertension 55.6% (N = 288)

Renal Dysfunction 17.8% (N = 281)

Abnormal Creatinine < 2.5 mg/dl 10.7% Creatinine > 2.5 mg/dl 3.2% Chronic Dialysis 3.6% Renal transplant 0.4%

Hyperlipidemia 19.2% (N = 297)

Diabetes 13.0% (N = 285)

Coronary Artery Vasculopathy 2.1% (N = 242)

Bronchiolitis Obliterans 8.7% (N = 263)


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


Outcome Within 5

Years Total number with known response

Hypertension 86.9% (N = 84)

Renal Dysfunction 28.4% (N = 88)

Abnormal Creatinine < 2.5 mg/dl 17.0% Creatinine > 2.5 mg/dl 10.2% Chronic Dialysis 1.1%

Hyperlipidemia 62.9% (N = 89)

Diabetes 19.0% (N = 84)

Coronary Artery Vasculopathy 10.6% (N = 47)

Bronchiolitis Obliterans 29.2% (N = 65)


Freedom from Coronary Artery Vasculopathy

For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2004)

50

60

70

80

90

100

0 1 2 3 4 5 6

Years

% F

ree

fro

m C

AV

.


Freedom from Bronchiolitis Obliterans For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2004)

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

% F

ree f

rom

Bro

nch

ioliti

s O

blite

ran

s .


Freedom from Severe Renal Dysfunction*For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2004)

50

60

70

80

90

100

0 1 2 3 4 5

Years

% F

ree f

rom

Severe

Ren

al D

ysfu

ncti

on

.

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


MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994-June 2004)

Malignancy/Type 1-Year Survivors 5-Year Survivors

No Malignancy 264 (92.0%) 77 (87.5%)

Malignancy (all types combined) 23 (8.0%) 11 (12.5%)

Malignancy Type

Skin 2 3

Lymph 16 5

Other 1 1

Type Not Reported 4 2


Freedom from MalignancyFor Adult Heart-Lung Recipients (Follow-ups: April 1994- June 2004)

50

60

70

80

90

100

0 1 2 3 4 5 6

Years

% F

ree

from

Mal

igna

ncy

.

All malignancy

Lymph

Skin

Other


ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2004)

CAUSE OF DEATH 0-30 Days

(N = 195)

31 Days - 1 Year (N = 124)

>1 Year - 3 Years (N = 101)

>3 Years - 5 Years (N = 58)

>5 Years

(N = 94)

BRONCHIOLITIS 0 4 (3.2%) 26 (25.7%) 22 (37.9%) 21 (21.4%)

ACUTE REJECTION 3 (1.5%) 3 (2.4%) 1 (1.0%) 1 (1.7%) 1 (1.0%)

LYMPHOMA 0 3 (2.4%) 4 (4.0%) 3 (5.2%) 1 (1.0%)

MALIGNANCY, OTHER 0 1 (0.8%) 6 (5.9%) 2 (3.4%) 5 (5.1%)

CMV 0 2 (1.6%) 0 1 (1.7%) 0

INFECTION, NON-CMV 39 (20.0%) 53 (43.7%) 32 (31.7%) 3 (5.2%) 14 (14.3%)

GRAFT FAILURE 62 (31.8%) 23 (18.5%) 17 (16.8%) 9 (15.5%) 23 (23.5%)

CARDIOVASCULAR 17 (8.7%) 7 (5.6%) 5 (5.0%) 8 (13.8%) 7 (7.1%)

TECHNICAL 41 (21.0%) 2 (1.6%) 1 (1.0%) 0 0

OTHER 33 (16.9%) 26 (21.0%) 9 (8.9%) 9 (15.5%) 26 (26.5%)



Pediatric Recipients


AGE DISTRIBUTION OF PEDIATRIC HEART-LUNGRECIPIENTS (Transplants: January 1982 - June 2004)

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

Recipient Age (Years)

Nu

mb

er o

f T

ran

spla

nts

.


AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January 1982 - June 2004)

0

5

10

15

20

25

30

35

40

45

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18-25

26-30

31+

Donor Age (Years)

Nu

mb

er o

f T

ran

spla

nts


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

ISHLT 2005

NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of pediatric heart-lung transplants worldwide has declined in recent years.


NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS

0

5

10

15

20

25

30

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Transplant Year

Nu

mb

er o

f P

edia

tric

Tra

nsp

lan

t C

ente

rs


39%2%

24%

5%

20%

10%Congenital

Acquired heart disease

Cystic Fibrosis

ReTX

PPH

Other

DIAGNOSIS IN PEDIATRIC HEART –LUNG TRANSPLANT RECIPIENTS (Age: 11-17 Years)

0

25

50

75

100

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

% o

f C

ases

Cystic Fibrosis Congenital PPH

“Other” includes Alpha-1, Bronchiectasis, IPF and OB (non-ReTX)


PEDIATRIC HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2003)

0

25

50

75

100

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

Su

rviv

al (%

)

Congenital (N = 75)Eisenmenger's Syndrome (N = 46)PPH (N=64)

Congenital vs. Eisenmenger's: p= 0.5Congenital vs. PPH: p = 0.8Eisenmenger's vs. PPH: p = 0.7


PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1982 - June 2003)

0

20

40

60

80

100

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

Years

Sur

viva

l (%

)

.

1-10 (N = 173)

11-17 (N = 292)

Overall (N = 479)

HALF-LIFE 1-10: 2.1 Years; 11-17: 3.3 Years


PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2003)

0

20

40

60

80

100

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

1982-1988 (N=111) 1989-1993 (N=177)

1994-1998 (N=129) 1999-6/2003 (N=62)

HALF-LIFE Unconditional 1982-1988: 1.7 Years; 1989-1993: 3.0 Years; 1994-1998: 2.8 Years; 1999-6/2003: 3.0 YearsConditional 1982-1988: 8.0 Years; 1989-1993: 7.2 Years; 1994-1998: 6.1 Years; 1999-6/200: 3.0

No comparisons are statistically significant

Su

rviv

al (

%)


PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2004)

CAUSE OF DEATH 0-30 Days (N = 27)

31 Days - 1 Year (N = 28)

>1 Year - 3 Years (N = 25)

>3 Years - 5 Years (N = 17)

>5 Years

(N = 18)

BRONCHIOLITIS 1 (3.6%) 13 (52.0%) 8 (47.1%) 6 (33.3%)

ACUTE REJECTION 2 (7.1%)

INFECTION, NON-CMV 5 (18.5%) 9 (32.1%) 5 (20.0%) 1 (5.9%) 5 (27.8%)

GRAFT FAILURE 12 (44.4%) 2 (7.1%) 5 (20.0%) 4 (23.5%) 3 (16.7%)

CARDIOVASCULAR 2 (7.4%) 3 (10.7%) 1 (5.9%) 2 (11.1%)

TECHNICAL 3 (11.1%) 1 (3.6%)

OTHER 5 (18.5%) 10 (35.7%) 2 (8.0%) 2 (11.8%) 2 (11.1%)


Documents

HEART-LUNG TRANSPLANTATION Overall ISHLT 2005 J Heart Lung Transplant 2005;24: 945-982