HEART TRANSPLANTATION Overall ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

HEART TRANSPLANTATION

Overall

ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR

32

2 67

0 1,2

54

2,3

49 2,9

89

3,5

04

3,7

96 4,4

56

4,6

69

4,6

39

4,8

41

4,7

47

4,7

41

4,6

14

4,5

16

4,2

58

3,9

92

3,8

55

3,8

30

3,7

25

3,6

50

3,6

08

3,7

08

3,7

64

3,7

65

3,7

20

3,7

42

18

7

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Nu

mb

er

of

Tra

ns

pla

nts

NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, the presented data may not mirror the changes in the number of heart transplants performed worldwide


NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Nu

mb

er

of

Tra

ns

pla

nts

Other

EuropeNorth America

NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, the presented data may not mirror the changes in the number of heart transplants performed worldwide


AVERAGE CENTER VOLUMEHeart Transplants: January 1, 2003 – June 30, 2010

45

103

3013 24

6

62

0

10

20

30

40

50

60

70

80

90

100

110

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

of

ce

nte

rs

0

5

10

15

20

25

30

35

40

45

50

55

Number of centers Percentage of transplants

Pe

rce

nta

ge

of

tra

ns

pla

nts


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

% o

f T

ran

spla

nts

0

5

10

15

20

25

30

35

0-10 11-17 18-34 35-49 50-59 60+ Median Age

Med

ian

do

no

r ag

e (y

ears

)

HEART TRANSPLANTS: Donor Age by Year of Transplant


AGE DISTRIBUTION OF HEART TRANSPLANT RECIPIENTS BY ERA

0

5

10

15

20

25

30

35

40

0-9 10-19 20-29 30-39 40-49 50-59 60-69 70+

Recipient Age

% o

f tr

an

sp

lan

ts

1982-1991 (N = 23,929)

1992-2001 (N =43,912)

2002-6/2010 (N = 31,398)

p < 0.0001


HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2005)

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 21 22 23 24 25

Years

Su

rviv

al (

%)

Half-life = 11.0 yearsConditional Half-life = 14.0 years

N=89,006

N at risk at 25 years = 98

HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2009)


HEART TRANSPLANTATION

Adult Recipients


Congenital2%

ReTX2%

Myopathy48%

Misc.0%

Valvular4%

CAD44%

1/1982-6/2010

DIAGNOSIS IN ADULT HEART TRANSPLANTS

CAD38%

Valvular3%

Misc.1%

Myopathy53%

ReTX3%

Congenital3%

1/2005-6/2010


DIAGNOSIS IN ADULT HEART TRANSPLANTSCardiomyopathy vs. CAD by Location

20

30

40

50

60

70

1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

% o

f C

ases Myopathy CADNorth America

20

30

40

50

60

70

1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

% o

f C

ases

Myopathy CADEurope

20

30

40

50

60

70

1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

% o

f C

ases Myopathy CADAll Locations


Congenital3%

ReTX1%

Myopathy58%

Misc.0%

Valvular4%

CAD33%

Europe

ADULT HEART TRANSPLANTS:DIAGNOSIS BY LOCATION

Transplants between January 2005 and June 2010

Congenital2%

ReTX1%

Myopathy58%

Misc.7%

Valvular1%

CAD30%

Other

Congenital3%

ReTX3%

Myopathy50%

Misc.1%

Valvular2%

CAD41%

North America


1992-2001(N=39,812 )

2002-6/2010 (N=27,387)

p-value

Recipient age (years) 54.0 ± 11.0 (28.0 - 65.0) 54.0 ± 12.4 (25.0 - 67.0) 0.5756

Donor age (years) 31.0 ± 12.8 (15.0 - 54.0) 34.0 ± 13.1 (16.0 - 56.0) <0.0001

Recipient/donor gender (% male) 80.5%/ 68.4% 77.2%/ 69.5% <0.0001/ 0.0030

Recipient weight (kg) 75.0 ± 16.7 (51.7 - 102.1) 78.0 ± 17.2 (53.0 - 108.8) <0.0001

Recipient height (cm) 173.0 ± 11.3 (157.0 - 188.0) 175.0 ± 10.7 (157.5 - 188.0) <0.0001

Recipient BMI 25.0 ± 4.3 (18.9 - 32.8) 25.8 ± 4.7 (19.2 - 34.4) <0.0001

Donor weight (kg) 75.0 ± 17.6 (52.0 - 103.9)* 78.0 ± 17.1 (55.6 - 110.0) <0.0001

Donor height (cm) 175.0 ± 18.9 (155.0 - 188.0)* 175.0 ± 10.3 (159.0 - 190.0) <0.0001

Donor BMI 24.2 ± 4.5 (18.8 - 33.0)* 25.2 ± 4.9 (19.7 - 35.4) <0.0001

Recipient/donor diabetes mellitus 14.5%*/ 1.6%* 22.7%/ 2.5% <0.0001/ <0.0001

Recipient amiodarone use (US only)

22.6%* 29.4% <0.0001

Recipient/donor cigarette history -/ 37.5%* 46.9%**/ 23.6% -/ <0.0001

Recipient/donor hypertension 34.6%*/ 10.8%* 40.9%/ 12.4% <0.0001/ <0.0001

Recipient prior cardiac surgery - 43.0%** -

Continuous factors are expressed as median ± standard deviation (5th-95th percentiles)

* Based on 4/1994-2001 transplants.

** Based on 7/2004-6/2010 transplants.

ADULT HEART TRANSPLANTATION Donor and Recipient Characteristics


1992-2001(N=39,812 )

2002-6/2010 (N=27,387)

p-value

Recipient Peripheral Vascular Disease

3.9%* 3.0% <0.0001

Recipient previous malignancy 3.5%* 5.3% <0.0001

Recipient COPD 3.2%* 3.6% 0.0601

Ischemic time (hours) 2.6 ± 1.5 (0.0 - 4.6) 3.0 ± 1.5 (0.0 - 5.0) <0.0001

Most recent PRA > 10%

Overall 7.8% 9.2%** 0.0016

Class I 13.3%***

Class II 9.0%***

Creatinine at time of transplant 1.2 ± 9.7 (0.7 - 2.5) 1.2 ± 0.9 (0.7 - 2.3) 0.0001

Pulmonary vascular resistance (Wood units)

2.1 ± 2.2 (0.4 - 6.0)* 2.1 ± 2.0 (0.3 - 5.6) <0.0001

Continuous factors are expressed as median ± standard deviation (5th-95th percentiles)


** Based on US 2002-6/2004 transplants and non US 2002 - 6/2010 transplants

*** Based on US 7/2004-6/2010 transplants. Until mid-2004 PRA was collected in US as a single percentage. After this date, PRA was collected separately for Class I and Class II.

(Cont’d)

ADULT HEART TRANSPLANTATIONDonor and Recipient Characteristics


1992-2001(N=39,812 )

2002-6/2010 (N=27,387)

p-value

HLA Mismatches

0.0003 0-2 4.8% 4.2%

3-4 41.6% 40.4%

5-6 53.6% 55.4%

Diagnosis

<0.0001

Coronary artery disease 45.7% 39.5%

Cardiomyopathy 46.4% 51.6%

Valvular 3.7% 3.0%

Retransplant 1.9% 2.4%

Congenital 1.9% 2.8%

Other causes 0.4% 0.7%


(Cont’d)ISHLT 2011ISHLT

J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

1992-2001(N=39,812 )

2002-6/2010 (N=27,387)

p-value

Donor cause of death

<0.0001 Head trauma 45.7% 50.2%

Stroke 28.5% 28.8%

Other 25.8% 21.1%

Pre-operative support (multiple items may be reported)

Hospitalized at time of transplant 58.7% 46.0% <0.0001

On IV inotropes 55.3%* 44.8% <0.0001

LVAD 1.7%*** 19.0% <0.0001

IABP 6.7% 6.7% 0.7815

RVAD - 4.1%**** -

Ventilator 3.5% 3.0% 0.0065

TAH 0.1%*** 0.5% <0.0001

ECMO 0.3%** 0.8% <0.0001

(Cont’d)



** Based on 5/1995-2001 transplants.

*** Based on 11/1999-2001 transplants.

**** Based on 2005-6/2010 transplants.


ADULT HEART TRANSPLANTATION PRA DISTRIBUTION

Transplants between July 2004 and June 2010

0

10

20

30

40

50

60

70

80

0 1-9 10-39 40-79 80+

PRA

% o

f tr

an

sp

lan

ts

If Class I and Class II values were reported separately Class I PRA value was used


ADULT HEART TRANSPLANTATION % OF PATIENTS BRIDGED WITH MECHANICAL

CIRCULATORY SUPPORT* (Transplants: 1/2000 – 12/2009)

0

10

20

30

40

50

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Year

% o

f p

ati

en

ts

* LVAD, RVAD, TAHISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

ADULT HEART TRANSPLANTATION % OF PATIENTS BRIDGED WITH RVAD*

(Transplants: 1/2005 – 12/2009)

0

1

2

3

4

5

6

7

8

9

10

2005 2006 2007 2008 2009

Year

% o

f p

ati

en

ts

* RVAD, RVAD+LVADISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

ADULT HEART TRANSPLANTATIONNumber of Combined Organ Transplants Reported

By Year and Type of Transplant

ISHLT 2011

0

10

20

30

40

50

60

70

80

90

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Nu

mb

er

of

Tra

ns

pla

nts

Other Combined Organ TransplantsHeart-Kidney-PancreasHeart-Kidney-LiverHeart-LiverHeart-Kidney

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

0%

20%

40%

60%

80%

100%

Europe North America Other

% o

f D

on

ors

0-10 years 11-17 years 18-34 years35-49 years 50-59 years 60+ years

ADULT HEART TRANSPLANTSDONOR AGE DISTRIBUTION BY LOCATION

Transplants between January 2000 and June 2010

Mean/median donor age: Europe = 38.3/40.0 North America = 31.7/29.0 Other = 32.9/31.0


0%

20%

40%

60%

80%

100%


18-19 years 20-29 years 30-39 years 40-49 years50-59 years 60-69 years 70+ years

% o

f T

ran

sp

lan

tsADULT HEART TRANSPLANTS

RECIPIENT AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010

Mean/median recipient age: Europe = 50.1/53.0 North America = 51.8/55.0 Other = 48.3/51.0


0%

20%

40%

60%

80%

100%


<18.5 18.5-<25 25-<30 30-<40 40+

% o

f T

ran

sp

lan


RECIPIENT BMI DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010


0%

20%

40%

60%

80%

100%


Diabetes No diabetes

% o

f T

ran

sp

lan


RECIPIENT DIABETES MELLITUS BY LOCATION Transplants between January 2000 and June 2010


0%

20%

40%

60%

80%

100%


Cigarette history No cigarette history

% o

f T

ran

sp

lan


RECIPIENT CIGARETTE HISTORY BY LOCATION Transplants between July 2004 and June 2010


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era

(Transplants: 1/1982 – 6/2009)

0

20

40

60

80

100

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

Years

1982-1991 (N=20,504)

1992-2001 (N=36,879)

2002-6/2009 (N=22,477)

1982-1991 vs. 1992-2001: p = 0.84601982-1991 vs. 2002-6/2009: p < 0.00011992-2001 vs. 2002-6/2009: p < 0.0001

HALF-LIFE 1982-1991: 10.2 years; 1992-2001: 10.7 years; 2002-6/2009: NA

Su

rviv

al (

%)


ADULT HEART TRANSPLANTATION Conditional Kaplan-Meier Survival by Era

(Transplants: 1/1982 – 6/2009)

0

20

40

60

80

100

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

Years

1982-1991 (N=16,059)

1992-2001 (N=29,287)

2002-6/2009 (N=16,686)

1982-1991 vs. 1992-2001: p = 0.00021982-1991 vs. 2002-6/2009: p = 0.00131992-2001 vs. 2002-6/2009: p = 0.2327


Su

rviv

al (

%)


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group

(Transplants: 1/1982-6/2009)

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

Su

rviv

al (

%)

18-29 (N=5,580) 30-39 (N=7,898)40-49 (N=17,714) 50-59 (N=30,967)60-69 (N=17,187) 70+ (N=514)

HALF-LIFE 18-29: 12.3 years; 30-39: 13.2 years; 40-49: 11.7 years; 50-59: 10.5 years; 60-69: 9.5 years; 70+: 7.5 years

All pair-wise comparisons are statistically significant at p < 0.02 except 18-29 vs. 40-49 (p=0.2807)


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group

(Transplants: 1/2002-6/2009)

0

20

40

60

80

100

0 1 2 3 4 5 6 7

Years

Su

rviv

al (

%)

18-29 (N=1,860) 30-39 (N=2,223)40-49 (N=4,214) 50-59 (N=7,902)60-69 (N=6,010) 70+ (N=268)

All pair-wise comparisons are statistically significant at p < 0.05 except 18-29 vs. 60-69; 18-29 vs. 70+, 30-39 vs. 40-49; 30-39 vs. 50-59 and 60-69 vs. 70+


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1982-6/2009)

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

Su

rviv

al (

%)

Cardiomyopathy (N = 35,912) Coronary artery disease (N = 34,220)Congenital diagnosis (N = 1,511) Retransplant (N = 1,628)Valvular (N = 2,788) Other (N = 351)

HALF-LIFE Cardiomyopathy: 11.9 years; CAD: 9.8 years; Congenital: 13.1 years; Retransplant: 5.8 years;Valvular: 12.1 years; Other: 11.8 years

All pair-wise comparisons with coronary artery disease and retransplant are significant at p = 0.001 except CAD vs. other (p=0.1541). All other pair-wise comparisons were not statistically significant.


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis

Conditional on Survival to 1 Year (Transplants: 1/1982-6/2009)

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

Su

rviv

al (

%)

Cardiomyopathy (N=28,336) Coronary artery disease (N=26,762)

Congenital diagnosis (N=1,085) Retransplant (N=1,071)

Valvular (N=2,122)

All pair-wise comparisons are significant at p < 0.05

HALF-LIFE Cardiomyopathy: 14.7 years; CAD: 12.2 years; Congenital: 18.7 years; Retransplant: 10.1 years; Valvular: 16.3 years


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982 – 6/2009)

Diagnosis: Cardiomyopathy

0

20

40

60

80

100

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

Years

1982-1991 (N=8,564)

1992-2001 (N=16,147)

2002-6/2009 (N=11,201)

1982-1991 vs. 1992-2001: p = 0.15181982-1991 vs. 2002-6/2009: p < 0.00011992-2001 vs. 2002-6/2009: p < 0.0001


Su

rviv

al (

%)



Diagnosis: Coronary Artery Disease

0

20

40

60

80

100

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

Years

1982-1991 (N=8,937)

1992-2001 (N=16,486)

2002-6/2009 (N=8,797)

1982-1991 vs. 1992-2001: p = 0.39161982-1991 vs. 2002-6/2009: p < 0.00011992-2001 vs. 2002-6/2009: p < 0.0001


Su

rviv

al (

%)



Diagnosis: Congenital

0

20

40

60

80

100

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

Years

1982-1991 (N=249)

1992-2001 (N=675)

2002-6/2009 (N=587)

No comparisons are significant at 0.05


Su

rviv

al (

%)



Diagnosis: Retransplant

0

20

40

60

80

100

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

Years

1982-1991 (N=389)

1992-2001 (N=696)

2002-6/2009 (N=543)

All comparisons are significant at p < 0.001


Su

rviv

al (

%)



Diagnosis: Valvular

0

20

40

60

80

100

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

Years

1982-1991 (N=845)

1992-2001 (N=1,296)

2002-6/2009 (N=647)

No comparisons are significant at p < 0.05 except 1982-1991 vs. 1992-2001 (p = 0.0041)


Su

rviv

al (

%)


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/2002-6/2009)

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

Su

rviv

al (

%)


Congenital Diagnosis (N=587) Retransplant (N=543)

Valvular (N=647)

All pair-wise comparisons are significant at p < 0.05 except valvular vs. congenital, valvular vs. retransplant and congenital vs. retransplant


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis Conditional on Survival to 1 Year

(Transplants: 1/2002-6/2009)

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

Su

rviv

al (

%)


Congenital Diagnosis (N=402) Retransplant (N=394)Valvular (N=457) Other (N=141)

No comparisons are significant at p < 0.05 exceptCongenital vs. Retransplant p=0.0209


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by PVR (Transplants: 1/2002-6/2009)

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

Su

rviv

al (

%)

1-<3 Wood units (N = 7,269) 3-<5 Wood units (N = 2,277)

5+ Wood units (N = 776)

1-<3 vs. 3-<5: p = 0.00061-<3 vs. 5+: p = 0.08933-<5 vs. 5+: p = 0.6820


ADULT HEART TRANSPLANTATIONKaplan-Meier Survival by Donor/Recipient Weight Ratio

(Transplants: 1/2002-6/2009)

For Recipients with PVR: 1- < 3 Wood units

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

Su

rviv

al (

%)

<0.8 Weight ratio (N=1,044) 0.8-<0.9 Weight ratio (N= 1,444)0.9-<1.1 Weight ratio (N=2,734) 1.1-<1.2 Weight ratio (N=805)1.2+ Weight ratio (N=1,242)

No pair-wise comparisons are statistically significant at p < 0.05 except <0.8 vs. 1.1 - <1.2: p = 0.0230


ADULT HEART TRANSPLANTATION

Kaplan-Meier Survival by Donor/Recipient Weight Ratio (Transplants: 1/2002-6/2009)

For Recipients with PVR: 3- < 5 Wood units

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

Su

rviv

al (

%)

<0.8 Weight ratio (N=218) 0.8-<0.9 Weight ratio (N=397)0.9-<1.1 Weight ratio (N=834) 1.1-<1.2 Weight ratio (N=301)1.2+ Weight ratio (N=527)

No pair-wise comparisons are statistically significant at p < 0.05


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Donor/Recipient Weight Ratio

(Transplants: 1/2002-6/2009)

For Recipients with PVR: 5+ Wood units

50

60

70

80

90

100

0 1 2 3 4 5

Years

Su

rviv

al (

%)

<0.8 Weight ratio (N=81) 0.8-<0.9 Weight ratio (N=106)

0.9-<1.1 Weight ratio (N=268) 1.1-<1.2 Weight ratio (N=113)

1.2+ Weight ratio (N=208)



ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage (Transplants: 4/1994-6/2009)

0

10

20

30

40

50

60

70

80

90

100

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

Years

Su

rviv

al (

%)

Pulsatile flow (N=3,540) Continuous flow (N=891)

No LVAD / No Inotropes (N=12,411) No LVAD / Inotropes (N=14,072)

Pulsatile vs. Continuous: p=0.0298Pulsatile vs. No LVAD/No Inotropes: p < 0.0001Pulsatile vs. No LVAD/Inotropes: p = 0.0032No other pair-wise comparisons are statistically significant at p < 0.05


ADULT HEART TRANSPLANTATION

Kaplan-Meier Survival by VAD usage (Transplants: 1/2002-6/2009)

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

Su

rviv

al (

%)



Pulsatile vs. No LVAD/Inotropes: p < 0.0001Pulsatile vs. No LVAD/No inotropes: p < 0.0001Continuous vs. No LVAD/Inotropes: p = 0.0264Continuous vs. No LVAD/No inotropes: p = 0.0107

No other pair-wise comparisons are statistically significant at p < 0.05


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage (Transplants: 1/1999-6/2009)

Conditional on Survival to 6 Months

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9

Years

Su

rviv

al (

%)





ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage

(Transplants: 7/2004-6/2009)

50

60

70

80

90

100

0 1 2 3 4 5

Years

Su

rviv

al (

%)

LVAD Pulsatile (N=1,113) LVAD Continuous (N=783)

LVAD+RVAD Pulsatile (N=356) No LVAD, No Inotropes (N=4,185)

No LVAD, Inotropes (N=3,541)

All pair-wise comparisons with LVAD+RVAD Pulsatile are statistically significant at p < 0.001. No other pair-wise comparisons are statistically significant at p < 0.05.


0

20

40

60

80

100

0-12 months >12-36 months >36-60 months >60 months Primarytransplant

Time between previous and current transplant

1 Y

ear

Pat

ien

t S

urv

ival

(%

) 1/1982-12/19911/1992-12/20011/2002-6/2009

Comparison of survival for interval ≤ 12 months vs. > 12 months: p < 0.0001Comparison of survival for interval ≤ 12 months vs. > 12 months for 1/2002-6/2009: p < 0.0001

26

2

20

9 88

80 87

47

48 91

52 34

35

4

40

2

20

,01

6

36

,12

7

21

,82

1

ADULT HEART RE-TRANSPLANTS1-Year Survival


ADULT HEART RECIPIENTSCross-Sectional Analysis

Functional Status of Surviving Recipients (Follow-ups: 1995 - June 2010)

0%

20%

40%

60%

80%

100%

1 Year (N = 16,087) 3 Years (N = 14,235) 5 Years (N = 12,181)

No Activity Limitations Performs with Some Assistance Requires Total Assistance


ADULT HEART RECIPIENTS Functional Status of Surviving Recipients

US Recipients Only(Follow-ups: March 2005 - June 2010)

0%

20%

40%

60%

80%

100%

1 Year (N = 8,210) 2 Years (N = 7,403) 3 Years (N =6,976)

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


ADULT HEART RECIPIENTSEmployment Status of Surviving Recipients

(Follow-ups: 1995 - June 2010)

0%

20%

40%

60%

80%

100%

1 Year (N = 20,930) 3 Year (N = 18,213) 5 Year (N = 15,627)

Retired

Not Working

Working Part Time

Working Full Time

Working (FT/PTstatus unknown)


ADULT HEART RECIPIENTSEmployment Status of Surviving Recipients

Age at Follow-up: 25-55 Years (Follow-ups: 1995 - June 2010)

0%

20%

40%

60%

80%

100%

1 Year (N = 9,115) 3 Year (N = 6,967) 5 Year (N = 5,163)

Retired

Not Working

Working Part Time

Working Full Time

Working (FT/PTstatus unknown)


ADULT HEART RECIPIENTSRehospitalization Post-transplant of Surviving Recipients

(Follow-ups: 1995 - June 2010)

0%

20%

40%

60%

80%

100%

Up to 1 Year Between 2 and 3 Years Between 4 and 5 Years

No Hospitalization Hospitalized: Not Rejection/Not Infection

Hospitalized: Rejection Only Hospitalized: Infection Only

Hospitalized: Rejection + Infection

(N = 22,651) (N = 26,546) (N = 19,481)


0

10

20

30

40

50

Any Induction (N = 8,441)

IL-2R Antagonist(N = 4,419)

PolyclonalALG/ATG (N =

3,637)

OKT3 (N = 424) Alemtuzumab (N = 298)

% o

f p

ati

en

tsADULT HEART RECIPIENTS

Induction Immunosuppression (Transplants: January 2002 – June 2010)

Analysis is limited to patients who were alive at the time of the dischargeISHLT 2011ISHLT


0

10

20

30

40

50

60

70

80

Any Induction IL-2R Antagonist Polyclonal ALG/ATG

% o

f p

ati

en

ts

Europe North America

ADULT HEART RECIPIENTSInduction Immunosuppression by Location

Transplants: January 2002 – June 2010

Analysis is limited to patients who were alive at the time of the dischargeISHLT 2011ISHLT


0

10

20

30

40

50

60

Any Induction IL-2R Antagonist PolyclonalALG/ATG

OKT3

% o

f p

ati

en

ts

1997 2002 1/2010-6/2010

ADULT HEART RECIPIENTSInduction Immunosuppression

(Transplants: 1997, 2002 and 1/2010-6/2010)

Analysis is limited to patients who were alive at the time of the discharge

Note: 3.3% of transplant recipients in 1/2010-6/2010 received Alemtuzumab


ADULT HEART TRANSPLANTATIONKaplan-Meier Survival by Induction Type

(Transplants: 1/2000-6/2009, conditional on survival to 14 days)

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9

Years

Su

rviv

al (

%)

No induction (N = 8,724) Polyclonal induction (N = 3,980)

IL-2R antagonist (N = 4,361) OKT3 (N = 671)

No induction vs. IL-2R: p = 0.0019Polyclonal vs. IL-2R: p = 0.0169


0

20

40

60

80

100

Cyclosporine Tacrolimus Sirolimus/Everolimus

MMF/MPA Azathioprine Prednisone

% o

f P

ati

en

ts

Year 1 (N = 5,775) Year 5 (N = 3,591)

ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up

(Follow-ups: January 2007 - June 2010)

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

Analysis is limited to patients who were alive at the time of the follow-up


0

20

40

60

80

100

Cyclosporine Tacrolimus Sirolimus MMF/MPA Azathioprine Prednisone

% o

f P

ati

en

ts

Year 1 (N = 7,148) Year 5 (N =7,148)

ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up

For the Same Patients(Follow-ups: January 2000 - June 2010)



0

20

40

60

80

100

Cyclosporine Tacrolimus Sirolimus/Everolimus

MMF/MPA Azathioprine Prednisone

% o

f P

ati

en

ts

2000 (N = 1,538) 2003 (N = 1,668) July 2009 - June 2010 (N = 1,616)

ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of 1 Year Follow-up

NOTE: Different patients are analyzed in each time frame.



0%

20%

40%

60%

80%

100%

Year 1 (N = 7,148) Year 5 (N = 7,148)

% o

f P

ati

en

ts

None

Other

Sirolimus+calcineurin+cellcycle

Tacrolimus

Cyclosporine

Sirolimus + cellcycle

Sirolimus + calcineurin

Tacrolimus + MMF/MPA

Tacrolimus + AZA

Cyclosporine + MMF/MPA

Cyclosporine + AZA

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

For the Same Patients(Follow-ups: January 2000 - June 2010)

Analysis is limited to patients who were alive at the time of the follow-upISHLT 2011ISHLT


0%

20%

40%

60%

80%

100%

Year 1 (N = 8,907) Year 5 (N = 6,106)

None

Other


Tacrolimus

Cyclosporine




Tacrolimus + AZA


Cyclosporine + AZA

% o

f P

ati

en


Maintenance Immunosuppression Drug Combinations at Time of Follow-up(Follow-ups: January 2005 - June 2010)

NOTES: Different patients are analyzed in Year 1 and Year 5. In the Year 1 cohort 88.8% of patients were on prednisone; in the Year 5 cohort 54.0% of patients were on prednisone.



0%

20%

40%

60%

80%

100%

Europe NorthAmerica

Europe NorthAmerica

None

Other


Tacrolimus

Cyclosporine




Tacrolimus + AZA


Cyclosporine + AZA

% o

f P

ati

en


Maintenance Immunosuppression Drug Combinations at Time of Follow-upby Location

(Follow-ups: January 2005 - June 2010)

NOTES: Different patients are analyzed in Year 1 and Year 5.


Year 1 Year 5


PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up

Stratified by Type of Induction (Follow-ups: July 1, 2004 - June 30, 2010)

0

10

20

30

40

50

60 No induction, Treatment No induction, No TreatmentPolyclonal, Treatment Polyclonal, No TreatmentIL-2R antagonist, Treatment IL-2R antagonist, No Treatment OKT3, Treatment OKT3, No Treatment

% e

xper

ien

cin

g r

ejec

tio

n w

ith

in 1

yea

r

Overall 18-44 45-62 63+ Female Male

No induction: N=4,744Polyclonal: N=1,956IL-2R antagonist: N=2,779OKT3: N=187

All groups: all no induct vs. poly and no induct vs. IL-2R comparisons are significant at p < 0.05 except 45-62: no induct vs. poly and M: no induct vs. polyOverall: no induct vs. OKT3 (p=0.0120); poly vs. IL-2R (p=0.0019)45-62: poly vs. IL-2R (p=0.0280)63+: no induct vs. OKT3 (p=0.0093)M: poly vs. IL-2R (p=0.0014)


Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.

No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.


PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up

Stratified by Maintenance Immunosuppression (Follow-ups: July 1, 2004 - June 30, 2010)

0

10

20

30

40

50

60 Cyclosporine + MMF/MPA, Treatment Cyclosporine + MMF/MPA, No TreatmentTacrolimus + MMF/MPA, Treatment Tacrolimus + MMF/MPA, No Treatment

% e

xper

ien

cin

g r

ejec

tio

n w

ith

in 1

yea

r

Overall: p < 0.000118-44: p < 0.000145-62: p < 0.000163+: p = 0.0450Female: p < 0.0001Male: p < 0.0001

NOTE: There were 163 patients with cyclosporine + AZA and 57 with tacrolimus+AZA. These groups were excluded due to small numbers.

Cyclosporine + MMF/MPA: N = 3,113Tacrolimus + MMF/MPA: N = 5,365

18-44 45-62 63+ MaleFemaleOverall





ADULT HEART TRANSPLANTATIONKaplan-Meier Survival Stratified by Treatment for Rejection

Within 1st YearConditional on survival to 1 year (1 Year follow-ups: 7/2004-6/2009)

50

60

70

80

90

100

0 1 2 3 4 5

Year

Su

rviv

al (

%)

No rejection (N=4,315) Treated Rejection (N=1,736)

p <0.0001




FREEDOM FROM HOSPITALIZATION FOR REJECTION BY ERA

For Adult Heart Recipients (Transplants: April 1994-June 2009)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5

Years

Freedom from hospitalization for rejection 4/1994-2000 (N = 4,890)

Freedom from hospitalization for rejection 2001-6/2009 (N = 6,331)

% F

ree

do

m f

rom

ho

spit

aliz

atio

n f

or

reje

cti

on

p < 0.0001


POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 1, 5 and 10 Years Post-

Transplant (Follow-ups: April 1994 - June 2010)

OutcomeWithin 1

YearTotal N with

known response

Within 5 Years

Total N with known

response

Within 10 Years

Total N with known response

Hypertension* 72.9% (N = 25,435) 92.9% (N = 11,156) -

Renal Dysfunction 26.6% (N = 26,918) 30.3% (N = 13,239) 36.0% (N = 4,274)

Abnormal Creatinine < 2.5 mg/dl 18.1% 20.5% 24.4%

Creatinine > 2.5 mg/dl 6.7% 7.0% 5.3%

Chronic Dialysis 1.5% 2.3% 4.8%

Renal Transplant 0.3% 0.4% 1.5%

Hyperlipidemia* 58.2% (N = 26,773) 87.9% (N = 12,483) -

Diabetes* 26.9% (N = 26,913) 37.4% (N = 12,195) -

Cardiac Allograft Vasculopathy 7.8% (N = 24,361) 30.6% (N = 8,988) 51.1% (N = 2,137)

* Data are not available 10 years post transplantISHLT 2011ISHLT


Outcome

Within 1 Year

Total N with known

response

Within 5 Years

Total N with known

response

Within 10 Years

Total N with known response

Renal Dysfunction 18.7% (N = 1,852) 26.9% (N = 1,852) 34.0% (N = 1,852)

Abnormal Creatinine < 2.5 mg/dl 12.6% 21.2% 25.0%

Creatinine > 2.5 mg/dl 5.9% 4.6% 4.0%

Chronic Dialysis 0.1% 0.7% 3.5%

Renal Transplant 0.2% 0.4% 1.5%

Cardiac Allograft Vasculopathy 7.2% (N = 1,852) 30.2% (N = 1,852) 50.9% (N = 1,852)

POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 1, 5 and 10 Years Post-

Transplant (Transplants: 1994 - June 2000)For the Same Patients


OutcomeWithin 1

YearTotal N with

known response

Within 5 Years

Total N with known

response

Hypertension 75.1% (N = 3,273) 89.5% (N = 3,273)

Renal Dysfunction 26.3% (N = 3,273) 28.9% (N = 3,273)

Abnormal Creatinine < 2.5 mg/dl 20.7% 22.1%

Creatinine > 2.5 mg/dl 4.8% 5.0%

Chronic Dialysis 0.5% 1.5%

Renal Transplant 0.3% 0.3%

Hyperlipidemia 73.4% (N = 3,273) 90.7% (N = 3,273)

Diabetes 28.0% (N = 3,273) 40.0% (N = 3,273)

Cardiac Allograft Vasculopathy 5.4% (N = 3,273) 27.1% (N = 3,273)

POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 and 5 Years

Post-Transplant (Transplants: 2000 - June 2005)For the Same Patients


FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY For Adult Heart Recipients (Transplants: April 1994-June 2009)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

Freedom from CAV 4/1994-2000 (N =10,044)

Freedom from CAV 2001-6/2009 (N = 12,724)

% F

ree

do

m f

rom

CA

V

p < 0.0001


FREEDOM FROM SEVERE RENAL DYSFUNCTION BY ERA* For Adult Heart Recipients (Transplants: April 1994-June 2009)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

Freedom from Severe Renal Dysfunction 4/1994-2000 (N = 11,173)

Freedom from Severe Renal Dysfunction 2001-6/2009 (N = 14,109)

* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant

% F

reed

om

fro

m S

ever

e R

enal

Dys

fucn

tio

n

p < 0.0001


PATIENT SURVIVAL AFTER REPORT OF CAV WITHIN 3 YEARS OF TRANSPLANT AND PATIENT SURVIVAL IN

PATIENTS WITHOUT CAV*(Transplants: April 1994-June 2009)

0

10

20

30

40

50

60

70

80

90

100

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

Time after Report of CAV* (Years)

Su

rviv

al

(%)

No CAV (N = 16,812)

CAV (N = 3,962)

p < 0.0001

* Survival for patients without CAV within 3 years after transplant was conditioned on survival to median time of CAV development (509 days). Median time to CAV development is based on patients who developed CAV within 3 years of transplant.


PATIENT SURVIVAL AFTER REPORT OF CAV WITHIN 3 YEARS OF TRANSPLANT AND PATIENT SURVIVAL IN

PATIENTS WITHOUT CAV* BY ERA(Transplants: April 1994-June 2009)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Time after Report of CAV* (Years)

Su

rviv

al (

%)

No CAV 4/1994-2000 (N = 7,551)

CAV 4/1994-2000 (N = 1,946)

No CAV 2001-6/2009 (N = 9,261)

CAV 2001-6/2009 (N = 2,016)

4/1994-2000: No CAV vs. CAV p < 0.00012001-6/2009: No CAV vs. CAV p < 0.0001No CAV: 4/1994-2000 vs. 2001-6/2009 p = 0.7363CAV: 4/1994-2000 vs. 2001-6/2009 p = 0.0016

ISHLT 2011

* Survival for patients without CAV within 3 years after transplant was conditioned on survival to median time of CAV development (509 days). Median time to CAV development is based on patients who developed CAV within 3 years of transplant.


MALIGNANCY POST-HEART TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2010)

Malignancy/Type 1-Year Survivors

5-Year Survivors

10-Year Survivors

No Malignancy 27,316 (97.3%) 11,751 (85.9%) 3,122 (71.3%)

Malignancy (all types combined) 764 (2.7%) 1,933 (14.1%) 1,256 (28.7%)

Malignancy Type

Skin 373 1,293 896

Lymph 161 154 87

Other 177 548 393

Type Not Reported 53 37 12

”Other” includes: prostate (11, 35, 21), adenocarcinoma (7, 7, 4), lung (6, 4, 1), bladder (4, 5, 4), Kaposi's sarcoma (0, 3, 1), breast (2, 7, 2), cervical (2, 5, 2), colon (2, 4, 2), and renal (2, 7, 2). Numbers in parentheses are those reported within 1 year, 5 years and 10 years, respectively.

NOTE: Multiple types may be reported; sum of types may be greater than total number with malignancy.


FREEDOM FROM MALIGNANCYFor Adult Heart Recipients (Follow-ups: April 1994 - June 2010)

30

40

50

60

70

80

90

100

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

Years

All malignancy Lymph Skin Other

% F

ree

fro

m M

alig

na

nc

y


FREEDOM FROM MALIGNANCYby Maintenance Immunosuppression Combinations at DischargeFor Adult Heart Recipients (Transplants: January 2000 - June 2009)

Conditional on Survival to 14 days

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

TAC+MMF/MPA CyA+MMF/MPA CyA+AZA

% F

ree

fro

m M

ali

gn

an

cy

p <0.0001


FREEDOM FROM MALIGNANCYFor Adult Heart Recipients (Transplants : April 1994 - June 2009)

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

Freedom from malignancy 4/1994-2000

Freedom from malignancy 2001-6/2009

% F

ree

fro

m M

alig

na

nc

y

p < 0.0001


FREEDOM FROM SKIN MALIGNANCYFor Adult Heart Recipients (Transplants : April 1994 - June 2009)

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

Freedom from skin malignancy 4/1994-2000

Freedom from skin malignancy 2001-6/2009

% F

ree

fro

m S

kin

ma

lign

an

cy

p < 0.0001


FREEDOM FROM SKIN MALIGNANCY by LocationFor Adult Heart Recipients (Follow-ups: April 1994 - June 2010)

50

60

70

80

90

100

0 1 2 3 4 5 6

Years

North America Europe Other

% F

ree

fro

m S

kin

ma

lign

an

cy

p = 0.0012


FREEDOM FROM LYMPHOMAFor Adult Heart Recipients (Transplants : April 1994 - June 2009)

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

Freedom from lymphoma 4/1994-2000

Freedom from lymphoma 2001-6/2009

% F

ree

fro

m L

ym

ph

om

a

p < 0.0001


FREEDOM FROM LYMPHOMA by Age GroupFor Adult Heart Recipients (Follow-ups: April 1994 - June 2010)

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

18-29 30-39 40-49

50-59 60-69 70+

% F

ree

fro

m L

ym

ph

om

a

p = 0.0204


FREEDOM FROM OTHER MALIGNANCYFor Adult Heart Recipients (Transplants : April 1994 - June 2009)

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

Freedom from other malignancy 4/1994-2000

Freedom from other malignancy 2001-6/2009

% F

ree

fro

m O

the

r c

an

ce

r

p < 0.0001


ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2010)

CAUSE OF DEATH0-30 Days

(N = 4,094)

31 Days –

1 Year

(N = 4,028)

>1 Year –

3 Years

(N = 3,166)

>3 Years –

5 Years

(N = 2,674)

>5 Years –

10 Years

(N = 6,273)

>10 Years

– 15 Years

(N =3,616)

>15 Years

(N =1,753)

Cardiac Allograft Vasculopathy

78 (1.9%) 195 (4.8%) 458 (14.5%) 428 (16.0%) 944 (15.0%) 521 (14.4%) 232 (13.2%)

Acute Rejection 256 (6.3%) 474 (11.8%) 323 (10.2%) 122 (4.6%) 116 (1.8%) 36 (1.0%) 31 (1.8%)

Lymphoma 3 (0.1%) 76 (1.9%) 110 (3.5%) 110 (4.1%) 271 (4.3%) 146 (4.0%) 61 (3.5%)

Malignancy, Other 3 (0.1%) 106 (2.6%) 360 (11.4%) 489 (18.3%) 1,202 (19.2%) 723 (20.0%) 293 (16.7%)

CMV 4 (0.1%) 45 (1.1%) 18 (0.6%) 5 (0.2%) 6 (0.1%) 1 (0.0%) 4 (0.2%)

Infection, Non-CMV 539 (13.2%) 1,203 (29.9%) 392 (12.4%) 268 (10.0%) 684 (10.9%) 373 (10.3%) 260 (14.8%)

Graft Failure 1,643 (40.1%) 723 (17.9%) 732 (23.1%) 544 (20.3%) 1,112 (17.7%) 582 (16.1%) 246 (14.0%)

Technical 300 (7.3%) 54 (1.3%) 36 (1.1%) 27 (1.0%) 59 (0.9%) 39 (1.1%) 38 (2.2%)

Other 201 (4.9%) 312 (7.7%) 289 (9.1%) 208 (7.8%) 535 (8.5%) 296 (8.2%) 157 (9.0%)

Multiple Organ Failure

591 (14.4%) 460 (11.4%) 152 (4.8%) 150 (5.6%) 441 (7.0%) 289 (8.0%) 144 (8.2%)

Renal Failure 24 (0.6%) 41 (1.0%) 55 (1.7%) 95 (3.6%) 371 (5.9%) 298 (8.2%) 133 (7.6%)

Pulmonary 164 (4.0%) 160 (4.0%) 123 (3.9%) 126 (4.7%) 257 (4.1%) 150 (4.1%) 77 (4.4%)

Cerebrovascular 288 (7.0%) 179 (4.4%) 118 (3.7%) 102 (3.8%) 275 (4.4%) 162 (4.5%) 77 (4.4%)

Percentages represent % of deaths in the respective time period


815

10 5 2 2 5 9 115 2 1

2

6 1722

21 25

24

1212 13 14

44 21

2318

1817

3715

2322

18 15

23

6 4

1

24

6 8

1430 12

10 911

1229

1310

12 12

06

16 24 24 21

03

1422 23 23

0

1

1

0

10

20

30

40

50

60

70

80

90

100

0-30 Days(N=1,800)

31 Days -1 Year

(N=1,844)

>1 Year -3 Years

(N=1,407)

>3 Years- 5 Years(N=1,041)


>10 Years(N=198)

0-30 Days(N=2,294)

31 Days -1 Year

(N=2,184)

>1 Year -3 Years

(N=1,759)



>10 Years(N=5,171)

Acute Rejection CAV Graft Failure

Renal Failure Infection (Non-CMV) Malignancy

% o

f D

ea

ths

ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death from Leading Causes

by Time since Transplant and Era (Deaths: January 1992 - June 2010)

Deaths 1998 – June 2010Deaths 1992-1997


ADULT HEART TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death

(Deaths: January 1992 - June 2010)

0

10

20

30

40

50

0-30 Days (N=4,094)

31 Days – 1 Year

(N=4,028)

>1 Year – 3Years

(N=3,166)

>3 Years –5 Years

(N=2,674)

>5 Years –10 Years(N=6,273)

>10 – 15Years

(N=3,616)

>15 Years(N=1,753)

CAV Acute RejectionMalignancy (non-Lymph/PTLD) Infection (non-CMV)Graft Failure Multiple Organ FailureRenal Failure

Pe

rce

nta

ge

of

De

ath

s


ADULT HEART TRANSPLANT RECIPIENTS: Cumulative Incidence of Leading Causes of Death

(Transplants: January 1992 - June 2009)

0%

2%

4%

6%

8%

10%

12%

14%

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

Time (years)

CAV Acute Rejection

Malignancy (non-Lymph/PTLD) Graft Failure

CMV Infection (non-CMV)

Inc

ide

nc

e o

f C

au

se

-Sp

ec

ific

De

ath

s


ADULT HEART TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death

(Deaths: January 2000 - June 2010)

0

10

20

30

40

50

0-30 Days (N=1,852)

31 Days – 1 Year

(N=1,814)

>1 Year – 3Years

(N=1,402)

>3 Years –5 Years

(N=1,285)

>5 Years –10 Years(N=3,802)

>10 – 15Years

(N=3,138)

>15 Years(N=1,752)

CAV Acute RejectionMalignancy (non-Lymph/PTLD) Infection (non-CMV)Graft Failure Multiple Organ FailureRenal Failure

Pe

rce

nta

ge

of

De

ath

s


ADULT HEART TRANSPLANT RECIPIENTS: Cumulative Incidence of Leading Causes of Death

(Transplants: January 2000 - June 2009)

0%

2%

4%

6%

8%

10%

0 1 2 3 4 5

Time (years)

CAV Acute Rejection

Malignancy (non-Lymph/PTLD) Graft Failure

CMV Infection (non-CMV)

Inc

ide

nc

e o

f C

au

se

-Sp

ec

ific

De

ath

s


ADULT HEART TRANSPLANTS (1/2004-6/2009) Risk Factors for 1 Year Mortality

(N=10,271)

VARIABLE N

Relative Risk

P-value 95% Confidence

Interval

Temporary circulatory support* 180 3.32 <.0001 2.46 -4.48

Diagnosis: Congenital vs. cardiomyopathy 271 2.23 <.0001 1.67 -2.97

Temporary continuous flow device 31 2.10 0.0204 1.12 -3.92

Total artificial heart 58 1.82 0.0365 1.04 -3.20

Recipient history of dialysis 256 1.72 <.0001 1.35 -2.19

Recipient on ventilator at time of transplant 285 1.59 0.0006 1.22 -2.07

Previous transplant 298 1.51 0.0046 1.14 -2.01

Chronic continuous flow device 731 1.48 0.0008 1.18 -1.87

Chronic pulsatile flow device 1401 1.34 0.0022 1.11 -1.62

Prior transfusion 2056 1.26 0.0032 1.08 -1.46

Recipient with infection requiring IV drug therapy within 2 weeks prior to transplant

1021 1.23 0.019 1.03 -1.46

Donor cause of death: anoxia vs. head trauma 1146 1.22 0.0275 1.02 -1.45

Diagnosis: coronary artery disease vs. cardiomyopathy

4257 1.19 0.0126 1.04 -1.36

Ventricular remodeling 1348 0.80 0.0177 0.66 -0.96

Balloon pump 578 0.71 0.0062 0.55 -0.91

* Temporary circulatory support includes ECMO and temporary pulsatile flow devices.ISHLT 2011ISHLT


ADULT HEART TRANSPLANTS (1/2004-6/2009) Borderline Significant Risk Factors for 1 Year Mortality

(N=10,271)

VARIABLE N

Relative Risk


Interval

Donor cause of death: CNS tumor vs. head trauma

105 1.56 0.0651 0.97 -2.52

Transplant year: 1996 vs. 2008/2009 1926 1.18 0.0609 0.99 -1.40



Continuous Factors (see figures)

Recipient age

Recipient height

Recipient weight

Donor age

Donor weight

Transplant center volume

Ischemia time

Bilirubin

Serum creatinine

PRA

Pulmonary capillary wedge pressure

Recipient PVR


ADULT HEART TRANSPLANTS (1/2004-6/2009) Relative Risk of 1 Year Mortality with 95% Confidence Limits

Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65 70

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=10,271)ISHLT 2011ISHLT



Donor Age

0

0.5

1

1.5

2

2.5

15 20 25 30 35 40 45 50 55

Donor Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Recipient Height

0

0.5

1

1.5

2

155 160 165 170 175 180 185 190

Recipient height (cm)

p < 0.0001

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=10,271)ISHLT 2011

* The risk associated with recipient height should be considered in conjunction with the risk associated with recipient weight and donor weight.ISHLT



Recipient Weight

0

0.5

1

1.5

2

2.5

50 60 70 80 90 100 110 120 130

Recipient Weight (kg)

p = 0.0064

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=10,271)ISHLT 2011

* The risk associated with recipient weight should be considered in conjunction with the risk associated with recipient height and donor weight.ISHLT



Donor Weight

0

0.5

1

1.5

2

50 60 70 80 90 100 110 120 130

Donor Weight (kg)

p = 0.0147

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=10,271)ISHLT 2011

* The risk associated with donor weight should be considered in conjunction with the risk associated with recipient height and recipient weight.ISHLT



Ischemia Time

0

0.5

1

1.5

2

30 60 90 120 150 180 210 240 270 300 330 360

Ischemia Time (minutes)

p < 0.0001Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Center Volume

0

0.5

1

1.5

2

5 10 15 20 25 30 35 40 45 50 55 60 65 70

Center Volume (cases per year)

p = 0.0378

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Pre-Transplant Bilirubin

0

0.5

1

1.5

2

0.5 1 1.5 2 2.5 3 3.5

Recipient Bilirubin (mg/dl)

p < 0.0001

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Pre-Transplant Creatinine

0

0.5

1

1.5

2

2.5

3

0.5 1 1.5 2 2.5

Recipient Creatinine (mg/dl)

p < 0.0001

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




PRA Class II (%)

0

0.5

1

1.5

2

2.5

3

0 10 20 30 40 50 60 70 80 90 100

Recipient PRA Class II (%)

p = 0.0203

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Pulmonary Capillary Wedge Pressure

0

0.5

1

1.5

2

5 10 15 20 25 30

Wedge Pressure (mm Hg)

p = 0.0075

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Recipient PVR

0

0.5

1

1.5

2

0 2 4 6 8

PVR

p = 0.0067

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity



ADULT HEART TRANSPLANTS (1/2004-6/2009)

Factors Not Significant for 1 Year Mortality

Recipient Factors: Prior malignancy, hospitalized, prior pregnancy, balloon pump, diabetes, gender

Donor Factors: Clinical infection, history of diabetes, gender, history of hypertension, cause of death, history of malignancy

Transplant Factors: HLA mismatch, CMV mismatch, prior transplant


ADULT HEART TRANSPLANTS (1/2004-6/2009) Recipients: Age=18-30 Years

Risk Factors for 1 Year Mortality

(N=958)

VARIABLE N Relative

Risk P-value

95% Confidence Interval

Diagnosis: Congenital vs. cardiomyopathy

124 2.67 <.0001 1.67 -4.27

Recipient on balloon pump at transplant 50 1.97 0.0413 1.03 -3.78

Female recipient 378 1.67 0.0325 1.04 -2.68

Not ABO identical 166 0.56 0.029 0.33 -0.94



Borderline Significant Risk Factors for 1 Year Mortality

(N=958)

VARIABLE N Relative

Risk P-value

95% Confidence Interval

Temporary circulatory support” 34 2.2 0.0584 0.97 -4.98

Recipient on ventilator at time of transplant

36 1.94 0.0791 0.93 -4.06


117 1.6 0.0548 0.99 -2.59

Donor clinical infection 336 1.36 0.0978 0.94 -1.97

ISHLT 2011

* Temporary circulatory support includes ECMO and temporary pulsatile flow devices. There were too few temporary continuous flow devices to analyze.



Recipients: Age=18-30 Years Risk Factors for 1 Year Mortality


Recipient age

Donor age

Serum creatinine

PRA

PA systolic pressure (borderline)



Relative Risk of 1 Year Mortality with 95% Confidence LimitsRecipient Age

0

0.5

1

1.5

2

2.5

3

18 21 24 27 30

Recipient Age

p = 0.018Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=958)ISHLT 2011ISHLT



Relative Risk of 1 Year Mortality with 95% Confidence LimitsDonor Age

0

0.5

1

1.5

2

2.5

3

3.5

15 20 25 30 35 40 45 50

Donor Age

p = 0.0004Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Relative Risk of 1 Year Mortality with 95% Confidence Limits Pre-Transplant Creatinine

0

0.5

1

1.5

2

2.5

3

0.5 1 1.5 2


p = 0.0004

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Relative Risk of 1 Year Mortality with 95% Confidence Limits PRA Class I (%)

0

1

2

3

4

5

0 10 20 30 40 50 60 70 80 90 100

Recipient PRA Class I (%)

p = 0.007

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Relative Risk of 1 Year Mortality with 95% Confidence Limits Recipient PA Systolic Pressure

0

0.5

1

1.5

2

2.5

10 15 20 25 30 35 40 45 50 55

PA Systolic (mm Hg)

p = 0.069

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity





(N=6,583)

VARIABLE N

Relative Risk


Interval


Temporary continuous flow device 22 2.34 0.025 1.11 -4.93

Diagnosis: Congenital vs. cardiomyopathy 135 2.00 0.0013 1.31 -3.04

Recipient on ventilator at time of transplant 176 1.80 0.0008 1.28 -2.54

Recipient history of dialysis 174 1.80 0.0001 1.33 -2.44



Diagnosis: Coronary artery disease vs. cardiomyopathy

2543 1.28 0.0048 1.08 -1.52

Prior transfusion 1386 1.22 0.048 1.00 -1.48

Ventricular remodeling 940 0.79 0.0488 0.63 -1.00

Balloon pump 397 0.60 0.002 0.43 -0.83

ISHLT 2011

* Temporary circulatory support includes ECMO and temporary pulsatile flow devices. ISHLT



Borderline Significant Risk Factors for 1 Year Mortality

(N=6,583)

VARIABLE N

Relative Risk


Interval

Repeat transplant 175 1.43 0.0616 0.98 -2.07

Hospitalized (incl. ICU) at transplant 3007 1.15 0.0874 0.98 -1.36



Recipients: Age=31-60 Years Risk Factors for 1 Year Mortality

Continuous Factors (see figures) Recipient age

Donor age

Recipient height

Recipient weight

Donor BMI

BMI ratio (borderline)

Serum creatinine

Bilirubin

Ischemia time

PRA

PA diastolic pressure



Relative Risk of 1 Year Mortality with 95% Confidence LimitsRecipient Age

0

0.5

1

1.5

2

30 35 40 45 50 55 60

Recipient Age

p = 0.0073

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity





0

0.5

1

1.5

2

2.5

15 20 25 30 35 40 45 50 55 60

Donor Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Relative Risk of 1 Year Mortality with 95% Confidence LimitsRecipient Height

0

0.5

1

1.5

2

2.5

3

150 160 170 180 190 200

Recipient Height (cm)

p = 0.0003

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=6,583)ISHLT 2011

* The risk associated with recipient height should be considered in conjunction with the risk associated with recipient weight and BMI ratio.ISHLT



Relative Risk of 1 Year Mortality with 95% Confidence LimitsRecipient Weight

0

0.5

1

1.5

2

2.5

50 60 70 80 90 100 110 120 130


p = 0.0058

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=6,583)ISHLT 2011

* The risk associated with recipient weight should be considered in conjunction with the risk associated with recipient height and BMI ratio.ISHLT



Relative Risk of 1 Year Mortality with 95% Confidence Limits Donor BMI

0

0.5

1

1.5

2

15 20 25 30 35 40

Donor BMI (kg/m2)

p = 0.029

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

(N=6,583)ISHLT 2011

* The risk associated with donor BMI should be considered in conjunction with the risk associated with BMI ratio.ISHLT




0

0.5

1

1.5

2

2.5

0.5 1 1.5 2 2.5


p < 0.0001

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Relative Risk of 1 Year Mortality with 95% Confidence Limits Pre-Transplant Bilirubin

0

0.5

1

1.5

2

2.5

0.5 1 1.5 2 2.5 3 3.5


p = 0.007

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Relative Risk of 1 Year Mortality with 95% Confidence Limits Ischemia Time

0

0.5

1

1.5

2

30 60 90 120 150 180 210 240 270 300 330 360

Ischemia time (minutes)

p < 0.0001Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Relative Risk of 1 Year Mortality with 95% Confidence Limits PRA Class I (%)

0

0.5

1

1.5

2

2.5

3

0 10 20 30 40 50 60 70 80 90 100

Recipient PRA Class I (%)

p = 0.0071

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Relative Risk of 1 Year Mortality with 95% Confidence Limits Recipient PA Diastolic Pressure

0

0.5

1

1.5

2

5 10 15 20 25 30 35 40

PA Diastolic Pressure (mm Hg)

p = 0.005

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity





(N=2,721)

VARIABLE N

Relative Risk


Interval

Repeat transplant 55 3.33 <.0001 1.97 -5.62

Ventilator 72 1.86 0.0058 1.20 -2.89

Recipient history of dialysis 56 1.76 0.0192 1.10 -2.81

Prior transfusions 447 1.72 <.0001 1.32 -2.24


215 1.36 0.0587 0.99 -1.88


ISHLT 2011





Continuous Factors (see figures) Donor age

Recipient height

Ischemia time

Serum creatinine

Bilirubin

TPG




0

0.5

1

1.5

2

2.5

20 25 30 35 40 45 50 55 60

Donor Age

p = 0.0013

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Relative Risk of 1 Year Mortality with 95% Confidence LimitsRecipient Height

0

0.5

1

1.5

2

2.5

150 160 170 180 190


p = 0.0007

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Relative Risk of 1 Year Mortality with 95% Confidence Limits Ischemia Time

0

0.5

1

1.5

2

2.5

3

30 60 90 120 150 180 210 240 270 300 330 360


p = 0.0017Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity





0

0.5

1

1.5

2

2.5

0.5 1 1.5 2 2.5


p = 0.0041

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Relative Risk of 1 Year Mortality with 95% Confidence Limits Pre-Transplant Bilirubin

0

0.5

1

1.5

2

2.5

0.5 1 1.5 2 2.5 3


p = 0.0016

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




Relative Risk of 1 Year Mortality with 95% Confidence LimitsTPG

0

0.5

1

1.5

2

3 5 7 9 11 13 15

Transpulmonary Gradient

p = 0.013

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity




(N=10,785)

VARIABLE N Relative

Risk P-value

95% Conf. Int.


Diagnosis: Congenital vs. cardiomyopathy 270 1.66 <.0001 1.32 -2.08

Recipient on dialysis at transplant 328 1.62 <.0001 1.36 -1.93

Ventilator 318 1.59 <.0001 1.31 -1.92


Previous pregnancy 1552 1.26 0.0055 1.07 -1.48

Recipient Hep B Core (+) 395 1.25 0.0195 1.04 -1.50

Number of mismatches at A locus 0 A MM (N=640)

1 A MM (N=5350) 2 A MM (N=4975)

1.24 0.0032 1.08 -1.44

Recipient history of diabetes 2121 1.17 0.0012 1.06 -1.28


5022 1.16 0.0011 1.06 -1.28


1158 1.15 0.024 1.02 -1.29

Hospitalized (incl. ICU) at transplant 5269 1.13 0.0047 1.04 -1.23

Female donor vs. male donor 3229 1.13 0.0273 1.01 -1.25

ISHLT 2011




(N=10,785)

VARIABLE N Relative

Risk P-

value 95% Conf.

Int.

VAD (flow type unknown) 82 1.40 0.0731 0.97 -2.04

PRA > 10% 791 1.12 0.0984 0.98 -1.29

o




Recipient age

Donor age

Recipient height

BMI difference

Bilirubin

Ischemia time

Serum creatinine


TPG




Relative Risk of 5 Year Mortality with 95% Confidence Limits

Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity




Relative Risk of 5 Year Mortality with 95% Confidence Limits

Recipient Height

0

0.5

1

1.5

2

150 160 170 180 190 200


p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity




Donor Age

0

0.5

1

1.5

2

15 20 25 30 35 40 45 50 55

Donor Age

p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity




Donor and Recipient BMI Difference

0

0.5

1

1.5

2

-10 -5 0 5 10

Donor BMI - Recipient BMI (kg/m2)

p = 0.034

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity



ADULT HEART TRANSPLANTS (1/2000-6/2005)Relative Risk of 5 Year Mortality with 95% Confidence Limits

Recipient Pre-Transplant Bilirubin

0

0.5

1

1.5

2

0.5 1 1.5 2 2.5 3 3.5

Bilirubin (mg/dl)

p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity



ADULT HEART TRANSPLANTS (1/2000-6/2005)Relative Risk of 5 Year Mortality with 95% Confidence Limits

TPG

0

0.5

1

1.5

2

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

TPG

p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity




Ischemia Time

0

0.5

1

1.5

2

2.5

30 60 90 120 150 180 210 240 270 300 330 360


p = 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity




Recipient Pre-Transplant Creatinine

0

0.5

1

1.5

2

0.5 1 1.5 2 2.5

Creatinine (mg/dl)

p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity




Center Volume

0

0.5

1

1.5

2

5 10 15 20 25 30 35 40 45 50 55 60 65 70

Center volume (cases per year)

p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity



ADULT HEART TRANSPLANTS (1/2000-6/2005) Factors Not Significant for 5 Year Mortality

Recipient Factors: Sternotomy, pulmonary embolism, IV inotropes, prior malignancy, balloon pump

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

Transplant Factors: CMV mismatch, ABO match, previous transplant



Risk Factors for 5 Year MortalityConditional on Survival to 1 Year

(N=9,189)

VARIABLE N

Relative Risk

P-value 95%

Confidence Interval

No AZA, MMF or Rapamycin at 1 year 768 1.60 <.0001 1.32 -1.94

Rejection between discharge and 1st year

2675 1.53 <.0001 1.36 -1.72

Number of HLA mismatches at A locus (per mismatch)

0 A MM: N = 559 1 A MM: N = 4664 2 A MM: N = 3966

1.41 0.0003 1.17 -1.71

Recipient history of dialysis prior to transplant

214 1.41 0.0242 1.05 -1.89

Dialysis post-transplant 511 1.35 0.0052 1.09 -1.67

Recipient Hep B core (+) 333 1.34 0.0221 1.04 -1.73

Prior pregnancy 1304 1.27 0.0445 1.01 -1.60



Risk Factors for 5 Year MortalityConditional on Survival to 1 Year

(cont’d)

(N=9,189)

VARIABLE N

Relative Risk

P-value 95%

Confidence Interval

Recipient history of diabetes 1786 1.26 0.0007 1.10 -1.44

Treated for infection post-transplant 1916 1.25 0.001 1.09 -1.42


4257 1.22 0.0025 1.07 -1.40

Rejection prior to discharge 1433 1.16 0.0416 1.01 -1.34

Hospitalized (inc. ICU) at transplant 4390 1.13 0.0327 1.01 -1.27




Borderline Significant Risk Factors for 5 Year MortalityConditional on Survival to 1 Year

(N=9,189)

VARIABLE N Relative

Risk P-value

95% Confidence

Interval

MMF and AZA at 1 year 53 1.72 0.0551 0.99 -2.99

No Cyclo, TAC or Rapamycin at 1 year 350 1.27 0.0794 0.97 -1.67

Donor CMV +/ Recipient CMV - 1654 1.14 0.0641 0.99 -1.31

No defibrillator 5265 1.11 0.0749 0.99 -1.25


ADULT HEART TRANSPLANTS (1/2000-6/2005) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year


Recipient age

Donor age

Recipient BMI

Serum creatinine

PVR

Transplant center volume (borderline)




Conditional on Survival to 1 Year Recipient Age

0

0.5

1

1.5

2

2.5

3

20 25 30 35 40 45 50 55 60 65

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity




Conditional on Survival to 1 Year Recipient BMI

0

0.5

1

1.5

2

2.5

3

15 20 25 30 35 40

Recipient BMI

p = 0.0368

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity




Conditional on Survival to 1 Year Donor Age

0

0.5

1

1.5

2

15 20 25 30 35 40 45 50 55

Donor Age

p < 0.0001

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity




Conditional on Survival to 1 Year PVR

0

0.5

1

1.5

2

1 2 3 4 5 6

Recipient PVR

p = 0.0124

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity




Conditional on Survival to 1 YearCenter Volume

0

0.5

1

1.5

2

5 10 15 20 25 30 35 40 45 50 55 60 65 70


p = 0.051

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity




Conditional on Survival to 1 YearPre-Transplant Recipient Serum Creatinine

0

0.5

1

1.5

2

0.5 1 1.5 2 2.5

Serum Creatinine (mg/dL)

p = 0.0039

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity



ADULT HEART TRANSPLANTS (1995-6/2000) Risk Factors for 10 Year Mortality

(N=11,861)

VARIABLE N Relative

Risk P-value

95% Conf. Interval

Repeat transplant 288 1.56 <.0001 1.32 -1.84

Recipient on dialysis 213 1.49 <.0001 1.24 -1.78

Ventilator at time of transplant 365 1.36 <.0001 1.17 -1.59

PRA > 20% 601 1.28 <.0001 1.14 -1.44

Diagnosis: coronary artery disease vs. cardiomyopathy

5997 1.24 <.0001 1.16 -1.32

Recipient history of diabetes 1863 1.23 <.0001 1.15 -1.33


949 1.23 <.0001 1.12 -1.36

Year of transplant: 1995 vs. 1999/2000 2125 1.21 <.0001 1.11 -1.31

Female recip/male donor vs. male recip/male donor 1265 1.19 0.0021 1.06 -1.33

On VAD at time of transplant 1355 1.19 0.0001 1.09 -1.30

Year of transplant: 1996 vs. 1999/2000 2143 1.15 0.0008 1.06 -1.26

Mismatches at B locus (per mismatch) 0 B MM (N=241)

1 B MM (N=2760) 2 B MM (N=8860) 1.13 0.0356 1.01 -1.27

Donor history of hypertension 1275 1.12 0.015 1.02 -1.22

Inotropes at time of transplant 6210 1.07 0.0288 1.01 -1.13


ADULT HEART TRANSPLANTS (1995-6/2000) Borderline Significant Risk Factors for 10 Year Mortality

(N=11,861)

VARIABLE N Relative

Risk P-value

95% Conf. Interval

Donor history of cancer 193 1.22 0.0879 0.97 -1.52

Balloon pump at transplant 618 1.12 0.0795 0.99 -1.26

Male recip/female donor vs. male recip/male donor 2400 1.07 0.0529 1.00 -1.16


Female recip/female donor vs. male recip/male donor

1357 1.12 0.0527 1.00 -1.26

Donor cause of death: CNS tumor vs. head trauma 134 0.78 0.0922 0.58 -1.04


ADULT HEART TRANSPLANTS (1995-6/2000) Risk Factors for 10 Year Mortality


Recipient age

Recipient weight

Recipient height

Donor age

Creatinine

Bilirubin

Ischemia time

Volume

(N=11,861)ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

ADULT HEART TRANSPLANTS (1995-6/2000) Relative Risk of 10 Year Mortality with 95% Confidence Limits

Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65 70

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty



Donor Age

0

0.5

1

1.5

2

15 25 35 45 55

Donor Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty



Pre-Transplant Recipient Weight

0

0.5

1

1.5

2

50 55 60 65 70 75 80 85 90 95 100 105

Recipient weight (kg)

p < 0.0001

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty



Pre-Transplant Recipient Height

0

0.5

1

1.5

2

150 160 170 180 190 200

Recipient height (cm)

p = 0.0011

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty



Ischemia Time

0

0.5

1

1.5

2

60 90 120 150 180 210 240 270 300


p < 0.0001

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty




0

0.5

1

1.5

2

0.5 1 1.5 2 2.5

Creatinine (mg/dL)

p < 0.0001

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty



Recipient Pre-Transplant Bilirubin

0

0.5

1

1.5

2

0.5 1 1.5 2 2.5 3 3.5

Bilirubin (mg/dL)

p = 0.0012

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty



Center Volume

0

0.5

1

1.5

2

5 10 15 20 25 30 35 40 45 50 55 60 65 70


p < 0.0001

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

ali

ty



(N=10,342)

VARIABLE N Relative

Risk P-value 95% Confidence

Interval

Retransplant 266 2.13 <.0001 1.82 -2.48

On ventilator 306 1.38 <.0001 1.18 -1.62

Number of HLA mismatches at the DR locus

0 DR MM (N=573) 1 DR MM (N=5327) 2 DR MM (N=4442)

1.35 <.0001 1.23 -1.49

Recipient Hep B Core (+) 197 1.35 0.002 1.12 -1.63

Male recipient/female donor vs. male recipient/male donor

2075 1.17 0.0018 1.06 -1.29




5087 1.11 0.0023 1.04 -1.19



(N=10,342)

VARIABLE N Relative

Risk P-value

95% Confidence

Interval

Donor cause of death: cerebrovascular/stroke vs. head trauma

2726 1.09 0.0566 1.00 -1.18

Year of transplant 1990 vs. 1993/1994

1532 1.09 0.085 0.99 -1.19

Hospitalized (inc. ICU) at transplant

5839 1.05 0.0863 0.99 -1.12

Donor cause of death: CNS tumor vs. head trauma

44 0.65 0.0885 0.40 -1.07


ADULT HEART TRANSPLANTSRisk Factors for 15 Year Mortality


Recipient age

Donor age

Recipient weight

Recipient height

Serum creatinine

Ischemia time

PRA



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty



Donor Age

0

0.5

1

1.5

2

15 25 35 45 55

Donor Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty



Recipient Height

0

0.5

1

1.5

2

150 160 170 180 190 200


p < 0.0001

Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty



Recipient Weight

0

0.5

1

1.5

2

50 55 60 65 70 75 80 85 90 95 100 105


p = 0.0077

Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty




0

0.5

1

1.5

2

0.5 1 1.5 2 2.5

Creatinine (mg/dl)

p < 0.0001

Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty



Ischemia Time

0

0.5

1

1.5

2

30 60 90 120 150 180 210 240 270 300 330 360


p = 0.0001

Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty



Recipient Pre-Transplant PRA

0

0.5

1

1.5

2

0 10 20 30 40 50 60 70

PRA

p = 0.0087

Re

lati

ve

Ris

k o

f 1

5 Y

ea

r M

ort

ali

ty



(N=13,578)

VARIABLE N Relative

Risk P-value

95% Confidence

Interval

Retransplant 253 3.18 <.0001 2.75 -3.68

Transplant year: 1985 vs. 1989/1990 1057 1.61 <.0001 1.47 -1.76


2910 1.38 <.0001 1.25 -1.52

Transplant year: 1986 vs. 1988/1990 2003 1.18 <.0001 1.11 -1.25



Diagnosis: Valvular heart disease vs. cardiomyopathy

563 1.11 0.0024 1.04 -1.19

ISHLT 2011ISHLT


ADULT HEART TRANSPLANTSRisk Factors for 20 Year Mortality


Recipient age

Donor age

Center volume

Ischemia time



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f 2

0 Y

ea

r M

ort

ali

ty



Donor Age

0

0.5

1

1.5

2

15 20 25 30 35 40 45 50 55

Donor Age

p < 0.0001

Re

lati

ve

Ris

k o

f 2

0 Y

ea

r M

ort

ali

ty



Ischemia Time

0

0.5

1

1.5

2

30 60 90 120 150 180 210 240 270 300 330 360


p = 0.0134

Re

lati

ve

Ris

k o

f 2

0 Y

ea

r M

ort

ali

ty



Center Volume

0

0.5

1

1.5

2

5 10 15 20 25 30 35 40 45 50


p < 0.0001

Re

lati

ve

Ris

k o

f 2

0 Y

ea

r M

ort

ali

ty


ADULT HEART TRANSPLANTS (1/2003-6/2009)Risk Factors for Developing Renal Dysfunction within 1 Year

Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge

VARIABLE N Relative

Risk P-value

95% Confidence

Interval

Dialysis prior to discharge 531 3.75 <.0001 3.01 -4.67

Continuous chronic device 639 1.63 0.0032 1.18 -2.25


Infection requiring IV antibiotics within 2 weeks prior to transplant

929 1.46 0.0034 1.13 -1.89


Rejection prior to discharge 1059 1.35 0.0188 1.05 -1.74

IL2R antagonist used for induction 2876 1.25 0.0148 1.04 -1.49

Donor CMV (+)/Recipient CMV (-) 2097 1.24 0.0367 1.01 -1.51

Tacrolimus at discharge 5529 0.75 0.0023 0.63 -0.90

(N=9,916)

*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis


ADULT HEART TRANSPLANTS (1/2003-6/2009)Borderline Significant Risk Factors for Developing Renal Dysfunction within 1 YearLimited to Recipients without Severe Renal Dysfunction* Pre-Transplant

Conditional on Survival to Transplant Discharge

VARIABLE N Relative

Risk P-value

95% Confidence

Interval Diagnosis: not cardiomyopathy, coronary artery disease, congenital heart disease, valvular heart disease or retransplant vs. cardiomopathy

43 2.46 0.0772 0.91 -6.67

Donor history of diabetes 239 1.5 0.0948 0.93 -2.41

In hospital at transplant (incl. ICU) 4452 1.17 0.0981 0.97 -1.40

Total number of HLA mismatches (per mismatch) 1.08 0.0883 0.99 -1.17

Diagnosis: valvular heart disease vs. cardiomyopathy

247 0.47 0.0516 0.22 -1.01

(N=9,916)



ADULT HEART TRANSPLANTS (1/2003-6/2009) Risk Factors for Developing Renal Dysfunction within 1 Year

Limited to Recipients without Severe Renal Dysfunction Pre-Transplant Conditional on Survival to Transplant Discharge


Recipient age

Recipient weight

Recipient creatinine

PA systolic pressure

(N=9,916)




Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge

Recipient Age

0

0.5

1

1.5

20 25 30 35 40 45 50 55 60 65

Recipient Age

p = 0.0014

Re

lati

ve

Ris

k o

f R

en

al

Dy

sfu

nc

tio

n w

ith

in 1

Ye

ar

(N=9,916)




Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Conditional on Survival to Transplant Discharge Recipient Pre-Transplant Creatinine

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

0.5 1 1.5 2 2.5

Creatinine (mg/dl)

p < 0.0001

Re

lati

ve

Ris

k o

f R

en

al

Dy

sfu

nc

tio

n w

ith

in 1

Ye

ar

(N=9,916)





Recipient Pre-Transplant Weight

0

0.5

1

1.5

2

50 55 60 65 70 75 80 85 90 95 100 105

Weight (kg)

p = 0.0215

Re

lati

ve

Ris

k o

f R

en

al

Dy

sfu

nc

tio

n w

ith

in 1

Ye

ar

(N=9,916)





Recipient PA Systolic Pressure

0

0.5

1

1.5

2

10 15 20 25 30 35 40 45 50 55

PA Systolic pressure (mm Hg)

p = 0.0165

Re

lati

ve

Ris

k o

f R

en

al

Dy

sfu

nc

tio

n w

ith

in 1

Ye

ar

(N=9,916)



ADULT HEART TRANSPLANTS (1/1998-6/2002) Risk Factors for Developing Cardiac Allograft Vasculopathy within 8 Years

Conditional on Survival to Transplant Discharge

VARIABLE N Relative

risk P-value

95% Conf. Interval

Donor cause of death: head trauma vs. anoxia 2402 1.31 0.0113 1.06 -1.61

Use of AZA at discharge vs. MMF/MPA 1542 1.29 <.0001 1.14 -1.45

Induction with OKT3 630 1.21 0.0116 1.04 -1.39

Male donor 4771 1.19 0.0049 1.06 -1.35

Recipient with infection requiring IV antibiotics within 2 weeks prior to transplant

525 1.19 0.0307 1.02 -1.40

Donor history of hypertension 666 1.18 0.0234 1.02 -1.36


3086 1.16 0.0052 1.05 -1.29

Donor clinical infection 1202 1.16 0.0113 1.03 -1.30

Use of CyA at discharge vs. TAC 5047 1.16 0.0482 1.00 -1.34

Number of mismatches at A locus 0 A MM (N=399) 1 A MM (N=3147) 2 A MM (N =2718)

0.86 0.047 0.74 -1.00

Induction with polyclonal agent 1163 0.85 0.0176 0.74 -0.97

Recipient on VAD at transplant 1031 0.82 0.006 0.72 -0.95

(N=6,264)


ADULT HEART TRANSPLANTS (1/1998-6/2002) Borderline Significant Risk Factors for Developing Cardiac Allograft

Vasculopathy within 8 Years Conditional on Survival to Transplant Discharge

VARIABLE N P-value Relative

risk 95% Conf.

Interval

Donor cause of death: CNS tumor vs. anoxia 1.49 0.0656 0.97 2.27 -1.49

Donor history of diabetes 1.34 0.0729 0.97 1.84 -1.34

Donor cause of death: Cerebrovascular/stroke vs. anoxia 1.24 0.0593 0.99 1.54 -1.24

(N=6,264)


Continuous Factors (see figures) Recipient age

Donor BSA

Donor age


(N=6,264)

ADULT HEART TRANSPLANTS (1/1998-6/2002) Risk Factors for Developing Cardiac Allograft Vasculopathy

within 8 YearsConditional on Survival to Transplant Discharge


ADULT HEART TRANSPLANTS (1/1998-6/2002)Relative Risk of Developing Cardiac Allograft Vasculopathy within 8 Years

Conditional on Survival to Transplant Discharge Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

p = 0.0005Re

lati

ve

Ris

k o

f C

AV

wit

hin

8 Y

ea

rs




Conditional on Survival to Transplant Discharge Donor BSA

0

0.5

1

1.5

2

1.5 1.6 1.7 1.8 1.9 2 2.1 2.2 2.3

Donor BSA (m2)

p = 0.0428Re

lati

ve

Ris

k o

f C

AV

wit

hin

8 Y

ea

rs




Conditional on Survival to Transplant Discharge Donor Age

0

0.5

1

1.5

2

2.5

3

15 20 25 30 35 40 45 50 55

Donor Age

p < 0.0001Re

lati

ve

Ris

k o

f C

AV

wit

hin

8 Y

ea

rs




Conditional on Survival to Transplant Discharge Center Volume

0

0.5

1

1.5

2

5 10 15 20 25 30 35 40 45 50 55 60 65 70


p = 0.0078Re

lati

ve

Ris

k o

f C

AV

wit

hin

8 Y

ea

rs



Documents

HEART TRANSPLANTATION Overall ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132