2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. HEART-LUNG TRANSPLANTATION Overall.

2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.

HEART-LUNG TRANSPLANTATION

Overall


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


AVERAGE CENTER VOLUMEHeart-Lung Transplants: January 1, 1998 - June 30, 2002

66

3 20

10

20

30

40

50

60

70

1-4 5-9 10-19

Average number of heart-lung transplants per year

Nu

mb

er o

f ce

nte

rs


HEART-LUNG TRANSPLANTATIONACTUARIAL SURVIVAL (Transplants: January 1982 - June 2001)

0

20

40

60

80

100

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

Years

N=2,889

Half-life = 2.7 yearsConditional Half-life = 8.1 years

Su

rviv

al (

%)



Adult Recipients


Retransplant2%

Alpha-13%

Acquired heart disease

4%

Other 12%

CF16%

IPF3% PPH

24%

COPD4%

Congenital heart disease

32%

DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (1/1982-6/2002)

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


DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2002)

Diagnosis N (%)

Congenital Heart Disease 705 ( 32.2% )

PPH 526 ( 24.0% )

CF 341 ( 15.6% )

Acquired Heart Disease 91 ( 4.2% )

COPD/Emphysema 88 ( 4.0% )

IPF 60 ( 2.7% )

Alpha-1 58 ( 2.6% )

Re-TX: Non-OB 31 ( 1.4% )

Sarcoidosis 26 ( 1.2% )

Re-TX: OB 23 ( 1.1% )

Bronchiectasis 14 ( 0.6% )

OB (not Re-TX) 8 ( 0.4% )

Other 219 ( 10.0% )

TOTAL 2,190 (100.0%)


3%

4%

15%3% 4%

34%

2%

25%

6%

2%

2%

DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA

1982-1990

34%

19%

5%

3%

15% 3%12%

4%

1%

3%

1%

COPD Congenital Heart Disease Acquired Heart DiseaseAlpha-1 CF IPFOther Cardiac Disease PPH Re-TX: Non-OBRe-TX: OB Other

3%38%

6%

17%2% 4%

19%

1%

0%

9%

1%

1991-1995 1/1996-6/2002“Other” includes OB (non-ReTX), Bronchiectasis, Sarcoidosis


ADULT HEART-LUNG TRANSPLANTATIONActuarial Survival By Diagnosis (Transplants: January 1990 – June 2001)

0

25

50

75

100

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

Su

rviv

al (

%)

Other Congenital (N = 155)Eisenmenger's Syndrome (N = 376)PPH (N=302)

Congenital vs. Eisenmenger's: p < 0.0001Congenital vs. PPH: p = 0.0004Eisenmenger's vs. PPH: p = 0.03


ADULT HEART-LUNG TRANSPLANTATIONActuarial Survival By Diagnosis (Transplants: January 1990 – June 2001)

0

25

50

75

100

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

Su

rviv

al (

%)

Congenital/Eisenmengers (N = 531)

PPH (N=302)

Congenital vs. PPH: p = 0.7


ADULT HEART-LUNG RECIPIENTSFunctional Status (Follow-ups: April 1994 – June 2002)

0%

20%

40%

60%

80%

100%

1 Year (N = 220) 3 Years (N = 164) 5 Years (N = 145)

No Activity Limitations Performs with Some Assistance Requires Total Assistance


ADULT HEART-LUNG RECIPIENTSEmployment Status (Follow-ups: April 1994 – June 2002)

0%

20%

40%

60%

80%

100%

1 Year (N = 211) 3 Years (N = 154) 5 Years (N = 140)

Working Full Time Working Part Time Not Working Retired


ADULT HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant (Follow-ups: April 1994 - June 2002)

0%

20%

40%

60%

80%

100%

Up to 1 Year (N = 254) Between 2 and 3 Years (N = 176)

Between 4 and 5 Years (N = 150)

No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Only Hospitalized, Infection OnlyHospitalized, Rejection and Infection


0

10

20

30

40

50

Any Induction (N = 57) Polyclonal ALG/ATG (N = 39)

OKT3 (N = 4) IL2R-antagonist (N = 17)

% o

f p

ati

en

tsADULT HEART-LUNG RECIPIENTS

Induction ImmunosuppressionFor follow-ups between January 2000 through June 2002


0

10

20

30

40

50

60

Any Induction (N = 30)

Polyclonal ALG/ATG (N = 25)

OKT3 (N = 3)

IL2R-antagonist (N = 3)



OKT3 (N = 1)





% o

f p

ati

en

ts

2000 2001 2002(6 months)

ADULT HEART-LUNG RECIPIENTSInduction Immunosuppression (Follow-ups: January 2000 - June 2002)


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

atie

nts

Year 1 (N = 56)

Year 5 (N = 55)

ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression at Any Time During Follow-up

For follow-ups between January 2000 through June 2002

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


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

atie

nts

Year 1 (N = 53) Year 5 (N = 44)

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




0%

20%

40%

60%

80%

100%

Year 1 (N = 53) Year 5 (N = 44)

% o

f P

atie

nts

Other

Tacrolimus + MMF

Tacrolimus + AZA

Cyclosporine + MMF

Cyclosporine + AZA

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




POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS

Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April 1994-June 2002)

Outcome Within 1 Year

Hypertension 54.5% (N = 253)

Renal Dysfunction 15.5% (N = 245) Abnormal Creatinine < 2.5 mg/dl 8.2% Creatinine>2.5 mg/dl 3.3% Chronic Dialysis 4.1% Renal Transplant 0.0%

Hyperlipidemia 17.4% (N = 259)

Diabetes 12.4% (N = 249)

CAV 1.9% (N = 211)

Bronchiolitis Obliterans 9.2% (N = 238)


POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS

Cumulative Prevalence in Survivors within 5 Years Post-Transplant (Follow-ups: April 1994-June 2002)

Outcome Within 5 Years

Hypertension 84.1% (N = 63)

Renal Dysfunction 21.5% (N = 65) Abnormal Creatinine < 2.5 mg/dl 12.3% Creatinine>2.5 mg/dl 9.2% Chronic Dialysis 0.0% Renal Transplant 0.0%

Hyperlipidemia 60.9% (N = 64)

Diabetes 16.4% (N = 61)

CAV 9.4% (N = 32)

Bronchiolitis Obliterans 25.0% (N = 48)


Freedom from CAV For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2002)

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

% F

ree

fro

m C

AV


Freedom from Bronchiolitis Obliterans For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2002)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

% F

ree

fro

m B

ron

chio

liti

s O

bli

tera

ns


Freedom from Severe Renal Dysfunction*For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2002)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

% F

ree

fro

m S

ev

ere

Re

na

l D

ys

fun

cti

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 2002)

Malignancy/Type 1-Year Survivors 5-Year Survivors

No Malignancy 228 (91.2%) 58 (89.2%)

Malignancy (all types combined) 22 (8.8%) 7 (10.8%)

Malignancy Type

Skin 2 2

Lymph 15 2

Other 1 1

Type Not Reported 4 2


Freedom from MalignancyFor Adult Heart-Lung Recipients (Follow-ups: April 1994- June 2002)

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

% F

ree

from

Mal

igna

ncy

All malignancy

Lymph

Skin

Other


ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2002)

CAUSE OF DEATH 0-30 Days

(N = 164)

31 Days - 1 Year (N = 107)

>1 Year - 3 Years (N = 95)

>3 Years - 5 Years (N = 53)

>5 Years

(N = 74)

BRONCHIOLITIS 4 (3.7%) 24 (25.3%) 21 (39.6%) 15 (20.3%)

ACUTE REJECTION 2 (1.2%) 3 (2.8%) 1 (1.1%) 1 (1.9%)

LYMPHOMA 3 (2.8%) 4 (4.2%) 3 (5.7%) 1 (1.4%)

MALIGNANCY, OTHER 1 (0.9%) 6 (6.3%) 2 (3.8%) 5 (6.8%)

CMV 1 (0.9%) 1 (1.9%)

INFECTION, NON-CMV 34 (20.7%) 47 (43.9%) 31 (32.6%) 3 (5.7%) 10 (13.5%)

GRAFT FAILURE 71 (43.3%) 27 (25.2%) 19 (20.0%) 9 (17.0%) 22 (29.7%)

CARDIOVASCULAR 2 (1.2%) 3 (3.2%) 5 (9.4%) 3 (4.1%)

TECHNICAL 29 (17.7%) 1 (0.9%) 1 (1.1%)

OTHER 26 (15.9%) 20 (18.7%) 6 (6.3%) 8 (15.1%) 18 (24.3%)



Pediatric Recipients


AGE DISTRIBUTION OF PEDIATRIC HEART-LUNGRECIPIENTS (Transplants: January 1982 - June 2002)

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


AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January 1982 - June 2002)

0

10

20

30

40

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

18-2

5

25-3

030

+

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


NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS

0

5

10

15

20

251

98

4

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

Transplant Year

Nu

mb

er

of

Pe

dia

tric

Tra

ns

pla

nt

Ce

nte

rs


35%

2%

25%

3%

2%

20%

13%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 2001

% o

f Cas

es

PPH Cystic Fibrosis Congenital

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


PEDIATRIC HEART-LUNG TRANSPLANTATIONActuarial Survival By Diagnosis (Transplants: January 1990 – June 2001)

0

25

50

75

100

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

Su

rviv

al (

%)

Other Congenital (N = 71)Eisenmenger's Syndrome (N = 39)PPH (N=55)

Congenital vs. Eisenmenger's: p= 0.5Congenital vs. PPH: p = 0.8Eisenmenger's vs. PPH: p = 0.6


PEDIATRIC HEART-LUNG TRANSPLANTATIONActuarial Survival By Diagnosis (Transplants: January 1990 – June 2001)

0

25

50

75

100

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

Su

rviv

al (

%)

Congenital/Eisenmengers (N = 110)

PPH (N=55)

Congenital vs. PPH: p= 0.9


PEDIATRIC HEART-LUNG TRANSPLANTATION Actuarial Survival (Transplants: January 1982 - June 2002)

0

20

40

60

80

100

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

Years

Sur

viva

l (%

)

1-10 (N = 110)

11-17 (N = 185)

Overall (N = 305)

HALF-LIFE 1-10: 2.0 Years; 11-17: 3.3 Years

1-10 years vs. 11-17 years p = 0.9


PEDIATRIC HEART-LUNG TRANSPLANTATION Actuarial Survival by Era (Transplants: January 1982 - June 2001)

0

20

40

60

80

100

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

1982-1987 (N=70)

1988-1992 (N=190)

1993-1997 (N=132)

1998-2001 (N=67)

HALF-LIFE Unconditional 1982-1987: 2.1 Years; 1988-1992: 2.7 Years; 1993-1997: 3.3 Years; 1998-2001: 2.0 YearsConditional 1982-1987: 10.1 Years; 1988-1992: 6.7 Years; 1993-1997: 6.1 Years; 1998-2001: 3.3 Years

No comparisons are statistically significant

Su

rviv

al (

%)


PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2002)

CAUSE OF DEATH 0-30 Days (N = 20)

31 Days - 1 Year (N = 24)

>1 Year - 3 Years (N = 25)

>3 Years - 5 Years (N = 16)

>5 Years

(N = 16)

BRONCHIOLITIS 1 (4.2%) 13 (52.0%) 8 (50.0%) 4 (25.0%)

ACUTE REJECTION 1 (4.2%)

INFECTION, OTHER 5 (25.0%) 9 (37.5%) 5 (20.0%) 1 (6.3%) 5 (31.3%)

GRAFT FAILURE 10 (50.0%) 5 (20.8%) 5 (20.0%) 5 (31.3%) 5 (31.3%)

TECHNICAL 3 (15.0%) 1 (4.2%)

OTHER 2 (10.0%) 7 (29.2%) 2 (8.0%) 2 (12.5%) 2 (12.5%)

2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. HEART-LUNG TRANSPLANTATION Overall.

Documents

ishlt j heart lung transplant

number of heart

renal transplant slide

congenital heart disease

year slide

sarcoidosis slide

bronchiectasis slide

reported42 slide