2004 ISHLT J Heart Lung Transplant 2004; 23: 804-15 HEART-LUNG TRANSPLANTATION Overall
Jan 11, 2016
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
HEART-LUNG TRANSPLANTATION
Overall
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2002
Num
ber
of T
rans
plan
tsNUMBER OF HEART-LUNG
TRANSPLANTS REPORTED BY YEAR
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
AVERAGE CENTER VOLUMEHeart-Lung Transplants: January 1, 1998 - June 30, 2003
75
2 20
25
50
75
1-4 5-9 10-19
Average number of heart-lung transplants per year
Nu
mb
er o
f ce
nte
rs
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME
Heart-Lung Transplants: January 1, 1998 - June 30, 2003
0
25
50
75
1-4 5-9 10-19
Average number of lung transplants per year
Per
cen
tag
e o
f tr
ansp
lan
ts
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
HEART-LUNG TRANSPLANTATIONKaplan-Meier SURVIVAL (Transplants: January 1982 - June 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
Years
N=2,973
Half-life = 2.8 yearsConditional Half-life = 8.3 years
Su
rviv
al (
%)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
HEART-LUNG TRANSPLANTATION
Adult Recipients
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
Congenital heart disease
32%
COPD6%
PPH24%
IPF3%
CF15%
Other 12%
Acquired heart disease
4%
Alpha-12%
Retransplant2%
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (1/1982-6/2003)
“Other” includes cancer, LAM, OB, sarcoidosis, bronchiectasis
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2003)
Diagnosis N (%)
Congenital Heart Disease 726 (32.1%)
PPH 550 (24.3%)
CF 355 (15.7%)
Acquired Heart Disease 98 ( 4.3%)
COPD/Emphysema 89 ( 3.9%)
IPF 63 ( 2.8%)
Alpha-1 57 ( 2.5%)
Re-TX: Non-OB 30 ( 1.3%)
Sarcoidosis 26 ( 1.1%)
Re-TX: OB 24 ( 1.1%)
Bronchiectasis 14 ( 0.6%)
OB (not Re-TX) 8 ( 0.4%)
Other 225 ( 9.9%)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA
36%
1%
3%
17%
2%
19%6%
13%
3%
COPD/Alpha-1 Congenital Heart Disease Acquired Heart Disease
Alpha-1 CF IPF
PPH Re-TX Other
8%29%
4%
3% 26%
3%
12%
15%
1982-1995 1/1996-6/2003“Other” includes OB (non-ReTX), Bronchiectasis, Sarcoidosis
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for Adult Recipients
(Transplants: January 1982 - June 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
Years
N=2,389
Half-life = 3.1 yearsConditional Half-life = 8.8 years
Su
rviv
al (
%)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2002)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al (
%)
Other Congenital (N = 169)Eisenmenger's Syndrome (N = 405)PPH (N=334)
Congenital vs. Eisenmenger's: p < 0.0001Congenital vs. PPH: p = 0.003Eisenmenger's vs. PPH: p = 0.07
HALF-LIFE Congenital: 1.0 Years; Eisenmenger's: 5.1 Years; PPH: 3.2 Years
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT HEART-LUNG RECIPIENTSFunctional Status (Follow-ups: April 1994 – June 2003)
0%
20%
40%
60%
80%
100%
1 Year (N = 238) 3 Years (N = 178) 5 Years (N = 160) 7 Years (N = 128)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT HEART-LUNG RECIPIENTSEmployment Status (Follow-ups: April 1994 – June 2003)
0%
20%
40%
60%
80%
100%
1 Year (N = 227) 3 Years (N = 168) 5 Years (N = 156) 7 Years (N = 114)
Working Full Time Working Part Time Not Working Retired
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant (Follow-ups: April 1994 - June 2003)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N =271)
Between 2 and 3Years (N = 191)
Between 4 and 5Years (N = 163)
Between 6 and 7Years (N = 139)
No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Only Hospitalized, Infection OnlyHospitalized, Rejection and Infection
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
0
10
20
30
40
50
Any Induction (N = 51) Polyclonal ALG/ATG (N= 23)
OKT3 (N = 4) IL2R-antagonist (N =26)
% o
f p
ati
en
tsADULT HEART-LUNG RECIPIENTS
Induction ImmunosuppressionFor follow-ups between January 2001 through June 2003
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
0
10
20
30
40
50
60
Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist
% o
f p
atie
nts
2000 2001 2002
ADULT HEART-LUNG RECIPIENTSInduction Immunosuppression (Follow-ups: January 2000 - June 2003)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
atie
nts
Year 1 (N = 47) Year 5 (N = 38)
ADULT HEART-LUNG RECIPIENTSMaintenance 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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
0%
20%
40%
60%
80%
100%
Year 1 (N = 47) Year 5 (N = 38)
% 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
For follow-ups between January 2001 through June 2003
NOTE: Different patients are analyzed in Year 1 and Year 5
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
POST-HEART-LUNG 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 55.6% (N = 270)
Renal Dysfunction 12.5% (N = 278)
Abnormal Creatinine < 2.5 mg/dl 9.5% Creatinine > 2.5 mg/dl 3.0%
Hyperlipidemia 18.3% (N = 278)
Diabetes 13.1% (N = 268)
CAV 2.2% (N = 227)
Bronchiolitis Obliterans 9.8% (N = 255)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant
(Follow-ups: April 1994 - June 2003)
Outcome Within 5
Years Total number with known response
Hypertension 85.5% (N = 76)
Renal Dysfunction 28.8% (N = 80)
Abnormal Creatinine < 2.5 mg/dl 18.8% Creatinine > 2.5 mg/dl 10.0%
Hyperlipidemia 60.0% (N = 80)
Diabetes 19.5% (N = 77)
CAV 9.5% (N = 42)
Bronchiolitis Obliterans 27.6% (N = 58)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
Freedom from CAV For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2003)
50
60
70
80
90
100
0 1 2 3 4 5
Years
% F
ree
fro
m C
AV
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
Freedom from Bronchiolitis Obliterans For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2003)
50
60
70
80
90
100
0 1 2 3 4 5
Years
% F
ree
fro
m B
ron
chio
liti
s O
bli
tera
ns
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
Freedom from Severe Renal Dysfunction*For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2003)
50
60
70
80
90
100
0 1 2 3 4 5
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994-June 2003)
Malignancy/Type 1-Year Survivors 5-Year Survivors
No Malignancy 245 (91.4%) 68 (86.1%)
Malignancy (all types combined) 23 (8.6%) 11 (13.9%)
Malignancy Type
Skin 2 3
Lymph 16 5
Other 1 1
Type Not Reported 4 2
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
Freedom from MalignancyFor Adult Heart-Lung Recipients (Follow-ups: April 1994- June 2003)
50
60
70
80
90
100
0 1 2 3 4 5
Years
% F
ree
from
Mal
igna
ncy
All malignancy
Lymph
Skin
Other
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2003)
CAUSE OF DEATH 0-30 Days
(N = 181)
31 Days - 1 Year (N = 117)
>1 Year - 3 Years (N = 96)
>3 Years - 5 Years (N = 56)
>5 Years
(N = 82)
BRONCHIOLITIS . (.%) 4 (3.4%) 25 (26.0%) 21 (37.5%) 17 (20.7%)
ACUTE REJECTION 3 (1.7%) 3 (2.6%) 1 (1.0%) 1 (1.8%) 1 (1.2%)
LYMPHOMA . (.%) 3 (2.6%) 4 (4.2%) 3 (5.4%) 1 (1.2%)
MALIGNANCY, OTHER . (.%) 1 (0.9%) 6 (6.3%) 2 (3.6%) 5 (6.1%)
CMV . (.%) 1 (0.9%) . (.%) 1 (1.8%) . (.%)
INFECTION, NON-CMV 37 (20.4%) 52 (44.4%) 31 (32.3%) 3 (5.4%) 11 (13.4%)
GRAFT FAILURE 57 (31.5%) 23 (19.7%) 17 (17.7%) 8 (14.3%) 20 (24.4%)
CARDIOVASCULAR 17 (9.4%) 7 (6.0%) 5 (5.2%) 8 (14.3%) 7 (8.5%)
TECHNICAL 35 (19.3%) 2 (1.7%) 1 (1.0%) . (.%) . (.%)
OTHER 32 (17.7%) 21 (17.9%) 6 (6.3%) 9 (16.1%) 20 (24.4%)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
HEART-LUNG TRANSPLANTATION
Pediatric Recipients
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNGRECIPIENTS (Transplants: January 1982 - June 2003)
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January 1982 - June 2003)
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS
0
5
10
15
20
25
301
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
20
02
Transplant Year
Nu
mb
er
of
Pe
dia
tric
Tra
ns
pla
nt
Ce
nte
rs
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
37%2%
24%
5%
19%
13%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
% o
f Cas
es
Cystic Fibrosis Congenital PPH
“Other” includes Alpha-1, Bronchiectasis, IPF and OB (non-ReTX)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
PEDIATRIC HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2002)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al
(%)
Other Congenital (N = 169)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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier 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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2002)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11Years
1982-1987 (N=70)
1989-1993 (N=177)
1994-1998 (N=129)
1999-6/2002 (N=52)
HALF-LIFE Unconditional 1982-1988: 1.7 Years; 1989-1993: 3.0 Years; 1994-1998: 3.0 Years; 1999-6/2002: 3.0 YearsConditional 1982-1988: 8.0 Years; 1989-1993: 7.2 Years; 1994-1998: 5.9 Years; 1999-6/2002: n.c.
No comparisons are statistically significant
Su
rviv
al (
%)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2003)
CAUSE OF DEATH 0-30 Days (N = 25)
31 Days - 1 Year (N = 27)
>1 Year - 3 Years (N = 25)
>3 Years - 5 Years (N = 16)
>5 Years
(N = 17)
BRONCHIOLITIS 1 (3.7%) 13 (52.0%) 8 (50.0%) 5 (29.4%)
ACUTE REJECTION 2 (7.4%)
INFECTION, NON-CMV 5 (20.0%) 9 (33.3%) 5 (20.0%) 1 (6.3%) 5 (29.4%)
GRAFT FAILURE 12 (48.0%) 2 (7.4%) 5 (20.0%) 4 (25.0%) 3 (17.6%)
CARDIOVASCULAR 1 (4.0%) 3 (11.1%) 1 (6.3%) 2 (11.8%)
TECHNICAL 3 (12.0%) 1 (3.7%)
OTHER 4 (16.0%) 9 (33.3%) 2 (8.0%) 2 (12.5%) 2 (11.8%)