HEART TRANSPLANTATION
Overall
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
NUMBER OF HEART TRANSPLANTS
BY YEAR
5000
4000
3500
3000
2500
2000
1500
1000
500
0
187
322
670
1,255
2,352
2,991
3,508
3,801
4,464
4,679
4,646
4,851
4,761
4,755
4,630
4,538
4,281
3,995
3,858
3,836
3,726
3,650
3,610
3,709
3,772
3,777
3,745
3,774
3,892
Number of transplants
4500
ISHLT
2012
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 .
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
NUMBER OF HEART TRANSPLANTS
BY YEAR AND LOCATION
5000
Number of transplants
4500
4000
Other
Europe
North America
3500
3000
2500
2000
1500
1000
500
0
ISHLT
2012
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 .
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AVERAGE CENTER VOLUME
110
55
100
50
90
45
80
40
70
35
60
30
104
50
25
40
20
30
20
15
58
43
10
37
10
10
4
8
2
30-39
40-49
50-74
75+
0
1-4
5-9
10-19
20-29
Average number of heart transplants per year
Number of centers
ISHLT
Percentage of transplants
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
5
0
% of transplants
Number of centers
Heart Transplants: January 2006 – June 2011
HEART TRANSPLANTS
Donor Age by Year of Transplant
35
90%
30
% of transplants
80%
70%
25
60%
20
50%
40%
15
30%
10
20%
5
10%
0%
0
0-10
ISHLT
11-17
18-34
35-49
50-59
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
60+
Median Age
Median donor age (years)
100%
HEART TRANSPLANTS
Median Donor Age by Location
45
Median donor age (years)
40
35
30
25
20
15
10
5
Europe
North America
Other
0
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AGE DISTRIBUTION OF HEART TRANSPLANT
RECIPIENTS BY ERA
40
% of transplants
35
30
1982-1995 (N = 42,890)
1996-2005 (N = 39,797)
2006-6/2011 (N = 20,645)
25
20
p < 0.0001
15
10
5
0
0-9
10-19
20-29
30-39
40-49
Recipient age
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
50-59
60-69
70+
HEART TRANSPLANTS
Kaplan-Meier Survival
(Transplants: January 1982 - June 2010)
100
Half-life = 10 years
Conditional half-life = 13 years
Survival (%)
75
50
N = 96,273
N at risk at 25 years = 112
25
0
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
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Survival is based on adult and
pediatric transplant recipients
HEART TRANSPLANTATION
Adult Recipients
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
DIAGNOSIS IN ADULT HEART TRANSPLANTS
CAD
44%
CAD
37%
Misc.
0%
Valvular
4%
ReTX
2%
Misc.
1%
Valvular
3%
ReTX
3%
Congenital
3%
Congenital
2%
Myopathy
48%
Myopathy
54%
1/1982 – 6/2011
ISHLT
1/2006 – 6/2011
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
% of cases
% of cases
% of cases
ADULT HEART TRANSPLANTS
Diagnosis: Cardiomyopathy vs. CAD by Location
70
All Locations
60
50
40
30
20
1982 1984 1986 1988
70
Europe
60
50
40
30
20
1982 1984 1986 1988
70
60
50
40
30
20
1982
Myopathy
1990
1992
1994
CAD
1996
Myopathy
1990
1992
1994
1986
ISHLT
1988
2000
2002
2004
2006
2008
2010
2000
2002
2004
2006
2008
2010
2004
2006
2008
2010
CAD
1996
North America
1984
1998
1998
Myopathy
1990
1992
1994
1996
1998
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
CAD
2000
2002
ADULT HEART TRANSPLANTS
Diagnosis by Location
(Transplants: January 2006 – June 2011)
CAD
33%
ReTX
1%
CAD
40%
Misc.
0%
Valvular
3%
Congenital
4%
Misc.
1%
Valvular
2%
ReTX
3%
Congenital
3%
CAD
32%
Myopathy
58%
Europe
Misc.
6%
ReTX
1%
Valvular
2%
Congenital
2%
Myopathy
57%
ISHLT
Other
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Myopathy
51%
North America
ADULT HEART TRANSPLANTS
Donor and Recipient Characteristics
1992-2000
(N = 36,507)
2001-2005
(N = 16,352)
2006-6/2011
(N = 17,868)
p-value
Recipient age (years)
54.0 (28.0-65.0)
54.0 (26.0-66.0)
54.0 (24.0-67.0)
0.0064
Donor age (years)
31.0 (15.0-54.0)
33.0 (16.0-55.0)
34.0 (17.0-56.0)
<0.0001
Donor and Recipient
Age Difference (years)
-19.0 (-44.0-7.0)
-17.0 (-43.0-10.0)
-16.0 (-43.0-12.0)
<0.0001
Recipient weight (kg)
75.0 (51.0-101.6)
77.6 (53.0-106.6)
79.4 (53.1-110.2)
<0.0001
Recipient height (cm)
173.0 (157.0-188.0)
174.0 (157.5-188.0)
175.0 (157.5-188.0)
<0.0001
25.0 (18.9-32.7)
25.6 (19.2-33.8)
26.0 (19.2-34.9)
<0.0001
Donor weight (kg)
74.8 (52.0-103.0)1
76.7 (55.0-108.6)
79.4 (56.7-113.0)
<0.0001
Donor height (cm)
175.0 (155.0-188.0)1
175.0 (157.0-189.0)
175.0 (158.0-190.0)
<0.0001
24.2 (18.8-32.9)1
24.8 (19.5-34.3)
25.5 (19.9-36.2)
<0.0001
Recipient BMI
Donor BMI
Continuous factors are expressed as median (5th-95th percentiles)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
1
Based on 4/1994-2000 transplants.
ADULT HEART TRANSPLANTS
Donor and Recipient Characteristics
1992-2000
(N = 36,507)
2001-2005
(N = 16,352)
2006-6/2011
(N = 17,868)
p-value
80.7%/ 68.4%
77.7%/ 69.0%
76.3%/ 69.4%
<0.0001/ 0.0545
Male recipient/ female donor
21.2%
18.4%
16.6%
<0.0001
Female recipient/ male donor
9.1%
9.7%
9.7%
0.0327
17.8%1/ 1.6%1
20.2%/ 2.0%
25.4%/ 2.8%
<0.0001/ <0.0001
21.7%1
29.0%
30.2%
<0.0001
-/ 38.0%1
46.6%2/ 29.1%
46.5%/ 19.2%
0.9848/ <0.0001
34.2%1/ 10.8%1
38.1%/ 11.4%
44.1%/ 13.4%
<0.0001/ <0.0001
-
38.9%2
45.4%
<0.0001
Recipient Peripheral Vascular Disease
3.8%1
3.2%
2.9%
0.0002
Recipient previous malignancy
3.2%1
4.5%
6.4%
<0.0001
Recipient COPD
3.2%1
3.2%
4.2%
0.0001
2.6 (0.0-4.5)
2.9 (0.0-4.9)
3.1 (0.0-5.0)
<0.0001
Recipient/donor gender (% male)
Recipient/donor diabetes mellitus
Recipient amiodarone use (US only)
Recipient/donor cigarette history
Recipient/donor hypertension
Recipient prior cardiac surgery
Ischemic time (hours)
Continuous factors are expressed as median (5th-95th percentiles)
ISHLT
(Cont’d)
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
1
2
Based on 4/1994-2000 transplants.
Based on 7/2004-2005 transplants.
ADULT HEART TRANSPLANTS
Donor and Recipient Characteristics
1992-2000
(N = 36,507)
2001-2005
(N = 16,352)
2006-6/2011
(N = 17,868)
Overall
7.7%
8.8%
12.7%
Class I
-
-
14.2%
Class II
-
-
9.1%
-
Creatinine at time of transplant
1.2 (0.7-2.5)
1.2 (0.7-2.4)
1.2 (0.7-2.3)
<0.0001
Pulmonary vascular resistance (Wood units)
2.2 (0.4-6.1)5
2.0 (0.3-5.6)
2.1 (0.3-5.4)
<0.0001
0-2
4.3%
4.4%
3.8%
3-4
40.2%
40.0%
38.9%
5-6
55.5%
55.5%
57.4%
p-value
Most recent PRA > 10%1
2
3
4
4
<0.0001
-
HLA Mismatches
0.0051
Continuous factors are expressed as median (5th-95th percentiles)
1
PRA was collected as a single percentage outside of US. 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.
2 Based on US 2001-6/2004 transplants and
non US 2001 - 2005 transplants.
3 Based on non US transplants.
(Cont’d)
4 Based on US transplants.
5
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 Based on 4/1994-2000 transplants.
ISHLT
2012
ADULT HEART TRANSPLANTS
Donor and Recipient Characteristics
1992-2000
(N = 36,507)
2001-2005
(N = 16,352)
2006-6/2011
(N = 17,868)
Cardiomyopathy
46.4%
48.5%
53.8%
Coronary artery disease
45.8%
42.6%
37.1%
Valvular
3.8%
3.3%
2.6%
p-value
Diagnosis
<0.0001
Retransplant
1.9%
2.2%
2.6%
Congenital
1.8%
2.7%
3.0%
Other causes
0.4%
0.6%
0.9%
Head trauma
44.6%
54.5%
46.6%
Stroke
28.2%
33.0%
24.8%
Other
27.2%
12.5%
28.6%
Donor cause of death
ISHLT
(Cont’d)
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
<0.0001
ADULT HEART TRANSPLANTS
Donor and Recipient Characteristics
1992-2000
(N = 36,507)
2001-2005
(N = 16,352)
2006-6/2011
(N = 17,868)
p-value
Hospitalized at time of transplant
60.2%
47.8%
44.6%
<0.0001
On IV inotropes
55.8%1
47.3%
42.6%
<0.0001
LVAD
12.12
17.0%
27.3%
<0.0001
IABP
6.8%
6.9%
6.2%
0.0731
RVAD
-
5.0%3
3.8%
0.0125
Ventilator
3.5%
3.3%
2.9%
0.0141
TAH
0.1%2
0.1%
0.9%
<0.0001
ECMO
0.3%4
0.5%
1.0%
<0.0001
Pre-operative support (multiple items may be
reported)
1
2
ISHLT
(Cont’d)
3
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
4
Based on 4/1994-2000 transplants.
Based on 11/1999-2000 transplants.
Based on 2005 transplants.
Based on 5/1995-2000 transplants.
ADULT HEART TRANSPLANTS
Donor and Recipient Age
(Transplants: January 2006 – June 2011)
Donor Age:
0-10
11-17
18-34
35-49
50-59
60+
100%
% of Transplants
80%
60%
40%
20%
0%
18-19
20-29
30-39
40-49
Recipient Age
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
50-59
60-69
70+
ADULT HEART TRANSPLANTS
Donor and Recipient Age
(Transplants: January 2006 – June 2011)
Recipient Age:
18-19
20-29
30-39
40-49
50-59
60-69
70+
100%
% of Transplants
80%
60%
40%
20%
0%
0-10
11-17
18-34
35-49
Donor Age
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
50-59
60+
ADULT HEART TRANSPLANTS
PRA Distribution
(Transplants: January 2006 – June 2011)
80
% of transplants
70
60
50
40
30
20
10
0
0
1-9
10-39
40-79
80+
PRA
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
If Class I and Class II values were reported
separately, the higher of the two values was
used.
ADULT HEART TRANSPLANTS
% of Patients Bridged with Mechanical Circulatory Support*
(Transplants: January 2000 – December 2010)
50
% of patients
40
30
20
10
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Year
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
* LVAD, RVAD, TAH
ADULT HEART TRANSPLANTS
% of Patients Bridged with Mechanical Circulatory Support*
by Year and Device Type
50
TAH
LVAD+RVAD
40
% of patients
RVAD
LVAD
30
20
10
0
2005
2006
2007
2008
2009
2010
Year
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
* LVAD, RVAD, TAH
ADULT HEART TRANSPLANTS
Number of Combined Organ Transplants Reported
By Year and Type of Transplant
90
Number of transplants
80
70
60
Other Combined Organ Transplants
Heart-Kidney-Pancreas
Heart-Kidney-Liver
Heart-Liver
Heart-Kidney
50
40
30
20
10
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS
% of Combined Organ Transplants Reported By Year
% of transplants
4
3
2
1
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS
Donor Age Distribution By Location
(Transplants: January 2006 – June 2011)
0-10 years
11-17 years
18-34 years
35-49 years
50-59 years
60+ years
100%
% of Donors
80%
60%
40%
20%
0%
Europe
ISHLT
North America
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Other
Mean/median donor age:
Europe = 40.2/42.0
North America = 31.6/29.0
Other = 32.2/30.0
ADULT HEART TRANSPLANTS
Recipient Age Distribution By Location
(Transplants: January 2006 – June 2011)
18-19 years
50-59 years
20-29 years
60-69 years
30-39 years
70+ years
40-49 years
100%
% of Donors
80%
60%
40%
20%
0%
Europe
ISHLT
North America
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Other
Mean/median recipient age:
Europe = 49.6/52.0
North America = 52.0/55.0
Other = 48.5/51.0
ADULT HEART TRANSPLANTS
Recipient BMI Distribution By Location
(Transplants: January 2006 – June 2011)
<18.5
18.5-<25
25-<30
30-<40
40+
100%
% of Transplants
80%
60%
40%
20%
0%
Europe
ISHLT
North America
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Other
ADULT HEART TRANSPLANTS
Recipient BMI Distribution By Diagnosis
(Transplants: January 2006 – June 2011)
<18.5
18.5-<25
25-<30
30-<40
40+
100%
% of Transplants
80%
60%
40%
20%
0%
Cardiomyopathy
ISHLT
Coronary Artery Disease
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS
Recipient Diabetes Mellitus Distribution By Location
(Transplants: January 2006 – June 2011)
Diabetes
No diabetes
100%
% of Transplants
80%
60%
40%
20%
0%
Europe
ISHLT
North America
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Other
ADULT HEART TRANSPLANTS
Recipient Diabetes Mellitus Distribution By Diagnosis
(Transplants: January 2006 – June 2011)
Diabetes
No diabetes
100%
% of Transplants
80%
60%
40%
20%
0%
Cardiomyopathy
ISHLT
Coronary Artery Disease
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS
Recipient Cigarette History By Location
(Transplants: January 2006 – June 2011)
Cigarette history
No cigarette history
100%
% of Transplants
80%
60%
40%
20%
0%
Europe
ISHLT
North America
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Other
ADULT HEART TRANSPLANTS
Recipient Cigarette History By Diagnosis
(Transplants: January 2006 – June 2011)
Cigarette history
No cigarette history
100%
% of Transplants
80%
60%
40%
20%
0%
Cardiomyopathy
ISHLT
Coronary Artery Disease
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by Era
(Transplants: January 1982 - June 2010)
100
1982-1992 vs. 1993-2002: p < 0.0001
1982-1992 vs. 2003-6/2010: p <0.0001
1993-2002 vs. 2003-6/2010: p <0.0001
Survival (%)
80
60
1982-1992 (N = 25,138)
1993-2002 (N = 37,193)
40
2003-6/2010 (N = 24,021)
20
HALF-LIFE 1982-1992: 8.5 years; 1993-2002: 10.9 years; 2003-6/2010: NA
0
0
1
2
3
4
5
6
7
8
9
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
10
11
12
13
14
15
ADULT HEART TRANSPLANTS
Conditional Kaplan-Meier Survival by Era
(Transplants: January 1982 - June 2010)
100
1982-1992 vs. 1993-2002: p < 0.0001
1982-1992 vs. 2003-6/2010: p <0.0001
1993-2002 vs. 2003-6/2010: p = 0.3073
Survival (%)
80
60
1982-1992 (N = 18,877)
1993-2002 (N = 29,293)
40
2003-6/2010 (N = 18,021)
20
HALF-LIFE 1982-1992: 11.8 years; 1993-2002: 13.4 years; 2003-6/2010: NA
0
0
1
2
3
4
5
6
7
8
9
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
10
11
12
13
14
15
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by Age Group
(Transplants: January 1982 - June 2010)
100
HALF-LIFE 18-29: 12.2 years; 30-39: 12.0 years; 40-49: 11.1 years; 50-59:
10.0 years; 60-69: 8.9 years; 70+: 7.4 years
Survival (%)
80
All pair-wise comparisons are
statistically significant at p < 0.01
except 18-29 vs. 30-39 (p=0.8452)
60
40
20
18-29 (N=6,134)
30-39 (N=8,623)
40-49 (N=19,179)
50-59 (N=33,178)
60-69 (N=18,655)
70+ (N=573)
0
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by Age Group
(Transplants: January 2003 - June 2010)
100
Survival (%)
80
60
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 and 60-69 vs. 70+
40
20
18-29 (N=2,068)
30-39 (N=2,413)
40-49 (N=4,602)
50-59 (N=8,283)
60-69 (N=6,362)
70+ (N=293)
0
0
1
2
3
4
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
5
6
7
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by Diagnosis
(Transplants: January 1982 - June 2010)
Cardiomyopathy (N=39,096)
Congenital diagnosis (N=1,690)
Valvular (N=3,010)
100
Coronary artery disease (N=36,430)
Retransplant (N=1,740)
Survival (%)
80
HALF-LIFE Cardiomyopathy: 11.4 years; CAD:
9.4 years; Congenital: 13.7 years; Retransplant:
6.0 years; Valvular: 10.9 years
60
40
All pair-wise comparisons are statistically
significant at < 0.001 except cardiomyopathy vs.
congenital (p=0.6340).
20
0
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by Diagnosis Conditional on Survival
to 1 Year (Transplants: January 1982 - June 2010)
100
HALF-LIFE Cardiomyopathy: 14.0 years; CAD: 11.7
years; Congenital: 20.4 years; Retransplant: 10.7
years; Valvular: 14.3 years
Survival (%)
80
60
40
All pair-wise comparisons are significant at p < 0.05
except cardiomyopathy vs. valvular
20
Cardiomyopathy (N=30,529)
Congenital diagnosis (N=1,195)
Valvular (N=2,206)
Coronary artery disease (N=28,163)
Retransplant (N=1,153)
0
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2010)
Diagnosis: Cardiomyopathy
100
All comparisons are significant at p < 0.0001
Survival (%)
80
60
1982-1992 (N = 10,582)
1993-2002 (N = 16,370)
40
2003-6/2010 (N = 12,144)
20
HALF-LIFE 1982-1992: 9.6 years; 1993-2002: 12.0 years; 2003-6/2010: NA
0
0
1
2
3
4
5
6
7
8
9
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
10
11
12
13
14
15
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2010)
Diagnosis: Coronary Artery Disease
100
All comparisons are significant at p < 0.0001
Survival (%)
80
60
1982-1992 (N = 10,820)
1993-2002 (N = 16,572)
40
2003-6/2010 (N = 9,038)
20
HALF-LIFE 1982-1992: 8.1 years; 1993-2002: 10.0 years; 2003-6/2010: NA
0
0
1
2
3
4
5
6
7
8
9
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
10
11
12
13
14
15
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2010)
Diagnosis: Congenital
100
No comparisons are significant at < 0.05
except 1993-2002 vs. 2003-6/2010: p = 0.0489
Survival (%)
80
60
1982-1992 (N = 320)
1993-2002 (N = 710)
40
2003-6/2010 (N = 660)
20
HALF-LIFE 1982-1992: 13.5 years; 1993-2002: 13.1 years; 2003-6/2010: NA
0
0
1
2
3
4
5
6
7
8
9
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
10
11
12
13
14
15
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2010)
Diagnosis: Retransplant
100
1982-1992 (N = 470)
1993-2002 (N = 697)
80
2003-6/2010 (N = 573)
Survival (%)
All comparisons are significant at p < 0.0001
60
40
20
HALF-LIFE 1982-1992: 1.9 years; 1993-2002: 6.6 years; 2003-6/2010: NA
0
0
1
2
3
4
5
6
7
8
9
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
10
11
12
13
14
15
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2010)
Diagnosis: Valvular
100
All comparisons are significant at < 0.05
except 1993-2002 vs. 2003-6/2010
Survival (%)
80
60
1982-1992 (N = 1,038)
1993-2002 (N = 1,298)
40
2003-6/2010 (N = 674)
20
HALF-LIFE 1982-1992: 9.2 years; 1993-2002: 12.0 years; 2003-6/2010: NA
0
0
1
2
3
4
5
6
7
8
9
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
10
11
12
13
14
15
ADULT HEART TRANSPLANTS
Kaplan-Meier 1 Year Survival by Diagnosis
(Transplants: January 2003 – June 2010)
100
Survival (%)
90
80
All pair-wise comparisons are significant at p < 0.05 except CAD vs. retransplant,
valvular vs. congenital, valvular vs. retransplant and congenital vs. retransplant
70
Cardiomyopathy (N=12,144)
Congenital diagnosis (N=660)
Valvular (N=674)
60
Coronary artery disease (N=9,038)
Retransplant (N=573)
50
0
1
2
3
4
5
6
7
Months
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
8
9
10
11
12
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by Diagnosis
(Transplants: January 2003 – June 2010)
100
Cardiomyopathy (N=12,144)
Congenital diagnosis (N=660)
Valvular (N=674)
Survival (%)
90
Coronary artery disease (N=9,038)
Retransplant (N=573)
80
70
60
All pair-wise comparisons are significant at p < 0.05 except CAD vs. congenital,
valvular vs. congenital, valvular vs. retransplant and congenital vs. retransplant
50
0
1
2
3
4
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
5
6
7
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by Diagnosis Conditional on Survival
to 1 Year (Transplants: January 2003 – June 2010)
100
Survival (%)
90
80
No pair-wise comparisons are significant at < 0.05 except
cardiomyopathy vs. CAD, cardiomyopathy vs. retransplant, CAD
vs. congenital and congenital vs. retransplant
70
60
Cardiomyopathy (N=9,208)
Coronary artery disease (N=6,861)
Congenital diagnosis (N=452)
Retransplant (N=434)
Valvular (N=481)
50
0
1
2
3
4
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
5
6
7
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by PVR
(Transplants: January 2003 – June 2010)
100
1-<3 vs. 3-<5: p < 0.0001
1-<3 vs. 5+: p = 0.3483
3-<5 vs. 5+: p = 0.1762
Survival (%)
90
80
70
60
1-<3 Wood units (N = 7,270)
3-<5 Wood units (N = 2,350)
5+ Wood units (N = 768)
50
0
1
2
3
4
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
5
6
7
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by Donor/Recipient Weight Ratio
(Transplants: January 2003 – June 2010)
For recipients with PVR: 1–<3 wood units
100
No pair-wise comparisons are statistically significant at p < 0.05
Survival (%)
90
80
70
60
<0.8 Weight ratio (N=1,039)
0.9-<1.1 Weight ratio (N=2,735)
1.2+ Weight ratio (N=1,268)
0.8-<0.9 Weight ratio (N= 1,430)
1.1-<1.2 Weight ratio (N=798)
50
0
1
ISHLT
2
3
4
Years
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
5
6
7
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by Donor/Recipient Weight Ratio
(Transplants: January 2003 – June 2010)
For recipients with PVR: 3–<5 wood units
100
No pair-wise comparisons are statistically significant at p < 0.05
Survival (%)
90
80
70
60
<0.8 Weight ratio (N=220)
0.9-<1.1 Weight ratio (N=886)
1.2+ Weight ratio (N=542)
0.8-<0.9 Weight ratio (N=390)
1.1-<1.2 Weight ratio (N=312)
50
0
1
ISHLT
2
3
4
Years
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
5
6
7
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by Donor/Recipient Weight Ratio
(Transplants: January 2003 – June 2010)
For recipients with PVR: 5+ wood units
100
No pair-wise comparisons are statistically significant at p < 0.05
Survival (%)
90
80
70
60
<0.8 Weight ratio (N=84)
0.9-<1.1 Weight ratio (N=258)
1.2+ Weight ratio (N=206)
0.8-<0.9 Weight ratio (N=113)
1.1-<1.2 Weight ratio (N=107)
50
0
1
ISHLT
2
3
Years
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
4
5
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by BMI Group
(Transplants: January 2003 – June 2010)
100
p = 0.0007
Survival (%)
90
80
70
60
<18.5 (N=581)
18.5-<25 (N=12,217)
30-<40 (N=3,761)
40+ (N=74)
25-<30 (N=7,388)
50
0
1
ISHLT
2
3
Years
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
4
5
6
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by Recipient Diabetes Mellitus
(Transplants: January 2003 – June 2010)
100
p = 0.0007
Survival (%)
90
80
70
60
Diabetes (N=3,599)
No diabetes (N=11,945)
1
3
50
0
ISHLT
2
4
Years
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
5
6
7
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by Recipient Cigarette History
(Transplants: July 2004 – June 2010)
100
p = 0.1663
Survival (%)
90
80
70
60
Cigarette history (N = 5,431)
No cigarette history (N = 6,169)
50
0
1
ISHLT
2
3
Years
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
4
5
6
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by VAD usage
(Transplants: April 1994 – June 2010)
100
90
80
Survival (%)
70
60
Pulsatile vs. Continuous: p=0.0207
Pulsatile vs. No LVAD/No Inotropes: p = 0.0005
Pulsatile vs. No LVAD/Inotropes: p = 0.0187
No other pair-wise comparisons are statistically
significant at p < 0.05
50
40
30
20
Pulsatile flow (N=3,681)
Continuous flow (N=1,434)
10
No LVAD / No Inotropes (N=13,053)
No LVAD / Inotropes (N=14,829)
0
0
1
2
ISHLT
3
4
5
6
7
8
Years
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
9
10
11
12
13
14
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by VAD usage
(Transplants: January 2003 – June 2010)
100
Pulsatile flow (N=2,142)
Continuous flow (N=1,408)
No LVAD / No Inotropes (N=5,781)
No LVAD / Inotropes (N=5,542)
Survival (%)
90
80
70
Pulsatile vs. No LVAD/No Inotropes: p = 0.0012
Pulsatile vs. No LVAD/Inotropes: p = 0.0008
Continuous vs. No LVAD/No Inotropes: p = 0.0027
Continuous vs. No LVAD/Inotropes: p = 0.0006
No other pair-wise comparisons are statistically
significant at p < 0.05
60
50
0
1
ISHLT
2
3
4
Years
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
5
6
7
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by VAD usage Conditional on Survival to 6 Months
(Transplants: January 1999 – June 2010)
100
Survival (%)
90
80
Continuous vs. No LVAD/No Inotropes: p = 0.0038
No other pair-wise comparisons are statistically
significant at p < 0.05
70
60
Pulsatile flow (N=2,903)
Continuous flow (N=1,270)
No LVAD / No Inotropes (N=7,639)
No LVAD / Inotropes (N=8,174)
50
0
1
ISHLT
2
3
4
5
6
Years
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
7
8
9
10
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival by VAD usage
(Transplants: January 2005 – June 2010)
LVAD Pulsatile (N=1,045)
LVAD+RVAD Pulsatile (N=367)
No LVAD, Inotropes (N=3,959)
100
LVAD Continuous (N=1,291)
No LVAD, No Inotropes (N=4,428)
Survival (%)
90
80
70
All pair-wise comparisons with LVAD+RVAD Pulsatile
are statistically significant at p < 0.001.
LVAD Continuous vs. No LVAD/ Inotropes: p= 0.0239
No other pair-wise comparisons are statistically
significant at p < 0.05.
60
50
0
1
ISHLT
2
3
Years
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
4
5
ADULT HEART RE-TRANSPLANTS
1 Year Survival
Comparison of survival for interval ≤ 12 months vs. > 12 months: p < 0.0001
Comparison of survival for interval ≤ 12 months vs. > 12 months for 1/2003-6/2010: p < 0.0001
1/1982-12/1992
90
1/1993-12/2002
80
1/2003-6/2010
70
60
23,315
36,332
24,401
408
55
57
86
61
46
76
20
188
30
80
95
40
389
50
305
1 Year Patient Survival (%)
100
10
0
0-12 months
>12-36 months
>36-60 months
>60 months
Time between previous and current transplant
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Primary
transplant
ADULT HEART RECIPIENTS
Cross-Sectional Analysis
Functional Status of Surviving Recipients
(Follow-ups: January 2000 – June 2011)
100%
80%
60%
40%
20%
No Activity Limitations
Performs with Assistance
Total Assistance
0%
1 Year (N = 8,060)
ISHLT
3 Years (N = 7,324)
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
5 Years (N = 6,534)
ADULT HEART RECIPIENTS
Functional Status of Surviving Recipients
US Recipients Only
(Follow-ups: January 2006 – June 2011)
100%
10%
20%
80%
30%
40%
60%
50%
60%
40%
70%
80%
20%
90%
100%
0%
1 Year (N = 8,740)
ISHLT
2 Years (N = 7,848)
3 Years (N = 7,265)
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTS
Employment Status of Surviving Recipients
(Follow-ups: January 2000 – June 2011)
100%
Retired
80%
Not Working
60%
Working Part Time
Working Full Time
40%
Working (FT/PT status
unknown)
20%
0%
1 Year
(N = 14,729)
ISHLT
3 Years
(N = 12,973)
5 Years
(N = 11,413)
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTS
Employment Status of Surviving Recipients
100%
Age at Follow-up: 25-55 Years
(Follow-ups: January 2000 – June 2011)
Retired
80%
Not Working
60%
Working Part Time
Working Full Time
40%
Working (FT/PT status
unknown)
20%
0%
1 Year
(N = 6,213)
ISHLT
3 Years
(N = 4,740)
5 Years
(N = 3,563)
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTS
Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: January 2000 – June 2011)
100%
80%
60%
40%
20%
No Hospitalization
Hospitalized, Rejection
Hospitalized, Rejection + Infection
Hospitalized, Not Rejection/Not Infection
Hospitalized, Infection Only
0%
Up to 1 Year
(N = 19,800)
ISHLT
Between 2 and 3
Years (N = 16,940)
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Between 4 and 5
Years (N = 14,930)
ADULT HEART RECIPIENTS
Induction Immunosuppression
(Transplants: January 2005 – June 2011)
60
% of patients
50
40
30
20
10
0
Any Induction IL-2R Antagonist
Polyclonal
OKT3 (N=175)
(N=6,382)
(N=3,540) ALG/ATG (N=2,546)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Alemtuzumab
(N=311)
Analysis is limited to patients who were
alive at the time of the discharge
ADULT HEART RECIPIENTS
Induction Immunosuppression by Location
(Transplants: January 2005 – June 2011)
70
Europe
% of patients
60
North America
50
40
30
20
10
0
Any Induction
ISHLT
IL-2R Antagonist
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Polyclonal ALG/ATG
Analysis is limited to patients who were
alive at the time of the discharge
ADULT HEART RECIPIENTS
Induction Immunosuppression
(Transplants: 2002, 2007 and 1/2011–6/2011)
60
2002
2007
1/2011-6/2011
% of patients
50
40
30
20
10
0
Any Induction
ISHLT
IL-2R
Antagonist
Polyclonal
ALG/ATG
2012
OKT3
Alemtuzumab
Analysis is limited to patients who were alive at
the time of the follow-up
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTS
Kaplan-Meier Survival by Induction Type
Conditional on Survival to 14 Days
(Transplants: January 2001 – June 2010)
100
No induction vs. IL-2R: p = 0.0002
Polyclonal vs. IL-2R: p = 0.0131
IL-2R vs. OKT3: p = 0.0368
Survival (%)
90
80
70
60
No induction (N = 8,556)
Polyclonal induction (N = 3,989)
IL-2R antagonist (N = 4,582)
OKT3 (N = 509)
50
0
1
ISHLT
2
3
4
5
Years
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
6
7
8
9
ADULT HEART RECIPIENTS
Maintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2008 – June 2011)
100
Year 1 (N = 5,840)
Year 5 (N = 3,559)
% of patients
80
60
40
20
0
Cyclosporine Tacrolimus
Sirolimus/
Everolimus
MMF/MPA
Azathioprine
Prednisone
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT
2012
Analysis is limited to patients who were alive at
the time of the follow-up
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTS
Maintenance Immunosuppression at Time of 1 Year
Follow-up
100
2000 (N = 1,538)
2005 (N = 2,768)
1/2011-6/2011 (N = 1,459)
% of patients
80
60
40
20
0
Cyclosporine Tacrolimus
Sirolimus/
Everolimus
MMF/MPA
Azathioprine Prednisone
NOTE: Different patients are analyzed in each time frame
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Analysis is limited to patients who were alive
at the time of the follow-up
ADULT HEART RECIPIENTS
Maintenance Immunosuppression Drug Combinations at Time of Follow-up
For the Same Patients
(Follow-ups: January 2001 – June 2011)
100%
None
Other
80%
% of Patients
Sirolimus/Everolimus +calcineurin+cellcycle
Tacrolimus
60%
Cyclosporine
Sirolimus/Everolimus + cellcycle
Sirolimus/Everolimus + calcineurin
40%
Tacrolimus + MMF/MPA
Tacrolimus + AZA
20%
Cyclosporine + MMF/MPA
Cyclosporine + AZA
0%
Year 1 (N = 7,060)
ISHLT
Year 5 (N = 7,060)
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Analysis is limited to patients who were
alive at the time of the follow-up
ADULT HEART RECIPIENTS
Maintenance Immunosuppression Drug Combinations at Time of Follow-up
(Follow-ups: January 2006 – June 2011)
100%
None
Other
80%
% of Patients
Sirolimus/Everolimus +calcineurin+cellcycle
Tacrolimus
60%
Cyclosporine
Sirolimus/Everolimus + cellcycle
Sirolimus/Everolimus + calcineurin
40%
Tacrolimus + MMF/MPA
Tacrolimus + AZA
20%
Cyclosporine + MMF/MPA
Cyclosporine + AZA
0%
Year 1 (N = 9,120)
Year 5 (N = 5,975)
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Analysis is limited to patients who were
alive at the time of the follow-up
ADULT HEART RECIPIENTS
Maintenance Immunosuppression Drug Combinations at Time of Follow-up
by Location
(Follow-ups: January 2006 – June 2011)
100%
None
% of Patients
Other
80%
Sirolimus/Everolimus
+calcineurin+cellcycle
Tacrolimus
60%
Cyclosporine
Sirolimus/Everolimus + cellcycle
Sirolimus/Everolimus + calcineurin
40%
Tacrolimus + MMF/MPA
Tacrolimus + AZA
20%
Cyclosporine + MMF/MPA
Cyclosporine + AZA
0%
Europe
North
America
Europe
Year 1
ISHLT
North
America
Year 5
NOTE: Different patients are analyzed in Year 1 and Year 5
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Analysis is limited to patients who were
alive at the time of the follow-up
PERCENTAGE OF ADULT HEART RECIPIENTS
Rejection between Transplant Discharge and 1-Year Follow-Up by Year
Transplant
Year
Rejection, Treated
Rejection,
Untreated
No Rejection
Total
N
%
N
%
N
%
N
%
2004
399
25.5
106
6.8
1,058
67.7
1,563
100.0
2005
386
23.1
96
5.7
1,192
71.2
1,674
100.0
2006
375
21.6
157
9.1
1,202
69.3
1,734
100.0
2007
311
17.9
199
11.4
1,230
70.7
1,740
100.0
2008
258
15.6
196
11.8
1,202
72.6
1,656
100.0
2009
276
16.0
242
14.0
1,208
70.0
1,726
100.0
Analysis is limited to patients who were alive at the time of the follow-up
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
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 RECIPIENTS
% experiencing rejection within 1 year
Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
Stratified by Type of Induction (Follow-ups: January 2005 – June 30, 2011)
60
50
No induction, Treatment
Polyclonal, Treatment
IL-2R antagonist, Treatment
OKT3, Treatment
No induction, No Treatment
Polyclonal, No Treatment
IL-2R antagonist, No Treatment
OKT3, No Treatment
40
30
20
10
0
Overall
18-44
45-62
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.
poly
Overall: no induct vs. OKT3 (p=0.0130); poly vs. IL-2R (p=0.0005)
45-62: poly vs. IL-2R (p=0.0030)
63+: no induct vs. OKT3 (p=0.0440)
F: no induct vs. OKT3 (p=0.0338)
M: poly vs. IL-2R (p=0.0004)
63+
Male
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.
Analysis is limited to patients who were alive at the time of the follow-up
ISHLT
Female
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
No induction: N=5,192
Polyclonal: N=2,161
IL-2R antagonist: N=3,094
OKT3: N=168
PERCENTAGE OF ADULT HEART RECIPIENTS
Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
% experiencing rejection within 1 year
Stratified by Maintenance Immunosuppression (Follow-ups: 2005 – June 30, 2011)
60
Cyclosporine + MMF/MPA, Treatment
Cyclosporine + MMF/MPA, No Treatment
Tacrolimus + MMF/MPA, Treatment
Tacrolimus + MMF/MPA, No Treatment
50
40
30
20
10
0
Overall
Overall: p < 0.0001
18-44: p < 0.0001
45-62: p < 0.0001
63+: p = 0.0026
Female: p < 0.0001
Male: p < 0.0001
18-44
45-62
63+
Male
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.
Analysis is limited to patients who were alive at the time of the follow-up
ISHLT
Female
2012
Cyclosporine + MMF/MPA: N = 2,966
Tacrolimus + MMF/MPA: N = 6,493
NOTE: There were 138 patients with cyclosporine +
AZA and 62 with tacrolimus+AZA. These groups were
excluded due to small numbers.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival Stratified by Treatment for Rejection Within 1st Year
Conditional on survival to 1 year (1 Year follow-ups: 2005 – 6/2010)
100
Survival (%)
90
80
p < 0.0001
70
60
No Rejection (N=6,401)
Treated Rejection (N=5,455)
50
0
1
2
3
Years
ISHLT
2012
4
5
6
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.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM HOSPITALIZATION FOR REJECTION BY ERA
% Freedom from hospitalization for rejection
For Adult Heart Recipients (Transplants: April 1994 – June 2010)
100
90
80
70
60
50
40
All pair-wise comparisons are statistically
significant at p < 0.0001
30
20
4/1994-1999 (N = 4,107)
10
2000-2004 (N = 3,660)
2005-6/2010 (N = 4,089)
0
0
1
ISHLT
2
Years
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
3
4
POST-HEART TRANSPLANT MORBIDITY FOR ADULTS
Cumulative Morbidity Rates in Survivors within 1, 5 and 10 Years PostTransplant (Follow-ups: January 1995 – June 2011)
Within
1 Year
Total N with
known
response
Within
5 Years
Total N with
known
response
Hypertension*
72.8%
(N = 25,542)
92.6%
(N = 11,853)
–
Renal Dysfunction
26.7%
(N = 27,478)
53.0%
(N = 13,481)
68.2%
Outcome
Total N
Within
with known
10 Years
response
18.3%
33.2%
37.5%
Creatinine > 2.5 mg/dl
6.6%
15.8%
21.1%
Chronic Dialysis
1.5%
2.9%
6.1%
Renal Transplant
0.3%
1.2%
3.6%
Abnormal Creatinine < 2.5 mg/dl
Hyperlipidemia*
60.2%
(N = 26,810)
88.0%
(N = 13,191)
–
Diabetes*
26.5%
(N = 27,474)
38.0%
(N = 13,306)
–
Cardiac Allograft Vasculopathy
7.9%
(N = 24,790)
30.4%
(N = 9,819)
49.7%
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 4,339)
(N = 2,482)
* Data are not available 10 years post
transplant
POST-HEART TRANSPLANT MORBIDITY FOR ADULTS
Cumulative Morbidity Rates in Survivors within 1, 5 and 10 Years PostTransplant (Follow-ups: January 1995 – June 2001)
For the Same Patients
Outcome
Renal Dysfunction
Within
1 Year
Total N with
known
response
Within
5 Years
Total N with
known
response
21.3%
(N = 1,902)
48.6%
(N = 1,902)
Total N
Within
with known
10 Years
response
65.4%
14.7%
33.1%
39.2%
Creatinine > 2.5 mg/dl
6.3%
13.7%
18.7%
Chronic Dialysis
0.1%
0.9%
4.0%
Renal Transplant
0.3%
0.9%
3.5%
Abnormal Creatinine < 2.5 mg/dl
Cardiac Allograft Vasculopathy
ISHLT
6.8%
(N = 1,902)
29.6%
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 1,902)
48.9%
(N = 1,902)
(N = 1,902)
POST-HEART TRANSPLANT MORBIDITY FOR ADULTS
Cumulative Morbidity Rates in Survivors within 1 and 5 Years
Post-Transplant (Follow-ups: January 2001 - June 2006)
For the Same Patients
Within
1 Year
Total N with
known
response
Within
5 Years
Total N with
known
response
Hypertension
73.0%
(N = 3,000)
88.3%
(N = 3,000)
Renal Dysfunction
26.4%
(N = 3,000)
50.6%
(N = 3,000)
Outcome
22.2%
38.1%
Creatinine > 2.5 mg/dl
3.5%
9.7%
Chronic Dialysis
0.5%
1.8%
Renal Transplant
0.2%
0.9%
Abnormal Creatinine < 2.5 mg/dl
Hyperlipidemia
72.4%
(N = 3,000)
89.9%
(N = 3,000)
Diabetes
29.3%
(N = 3,000)
40.6%
(N = 3,000)
Cardiac Allograft Vasculopathy
5.4%
(N = 3,000)
26.7%
(N = 3,000)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS
Kaplan-Meier Survival Stratified by Renal Dysfunction Within 1st Year
Conditional on survival to 1 year (1 Year follow-ups: April 1994-June 2010)
100
p < 0.0001
Survival (%)
80
60
* Severe renal dysfunction = Creatinine > 2.5
mg/dl (221 μmol/L), dialysis or renal transplant
40
20
No Renal Dysfunction (N=18,277)
Severe Renal Dysfunction* (N=1,904)
0
0
1
2
3
4
5
6
7
8
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
9
10
11
12
13
14
FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY
For Adult Heart Recipients (Transplants: April 1994 – June 2010)
% Freedom from CAV
100
80
60
p < 0.0001
40
20
Freedom from CAV 4/1994-2002 (N = 12,981)
Freedom from CAV 2003-6/2010 (N = 11,456)
0
0
1
2
3
4
5
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
6
7
8
9
10
FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY
Stratified by Ischemia Time
For Adult Heart Recipients (Transplants: April 1994 – June 2010)
% Freedom from CAV
100
80
60
p = 0.5705
40
<2 hours (N = 3,244)
20
2-<4 hours (N = 15,789)
4+ hours (N = 4,125)
0
0
1
2
3
4
5
6
7
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
8
9
10
11
12
FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY
Stratified by Recipient Age Group
For Adult Heart Recipients (Transplants: April 1994 – June 2010)
% Freedom from CAV
100
80
60
p = 0.5938
40
20
18-29 (N = 1,710)
30-39 (N = 2,117)
40-49 (N = 4,563)
50-59 (N = 9,101)
60-69 (N = 6,637)
70+ (N = 309)
0
0
1
2
3
4
5
6
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
7
8
9
10
11
FREEDOM FROM SEVERE RENAL DYSFUNCTION BY ERA*
For Adult Heart Recipients (Transplants: April 1994 – June 2010)
% Freedom from Severe Renal
Dysfunction
100
80
p < 0.0001
60
* Severe renal dysfunction = Creatinine > 2.5
mg/dl (221 μmol/L), dialysis or renal transplant
40
20
Freedom from Severe Renal Dysfunction 4/1994-2002 (N = 14,469)
Freedom from Severe Renal Dysfunction 2003-6/2010 (N = 12,612)
0
0
1
2
3
4
5
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
6
7
8
9
10
FREEDOM FROM SEVERE RENAL DYSFUNCTION*
Stratified by Ischemia Time
For Adult Heart Recipients (Transplants: April 1994 – June 2010)
% Freedom from Severe Renal
Dysfunction
100
80
p = 0.5729
60
* Severe renal dysfunction = Creatinine > 2.5
mg/dl (221 μmol/L), dialysis or renal transplant
40
<2 hours (N = 3,638)
20
2-<4 hours (N = 17,436)
4+ hours (N = 4,514)
0
0
1
2
3
4
5
6
7
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
8
9
10
11
12
FREEDOM FROM SEVERE RENAL DYSFUNCTION*
Stratified by Age Group
For Adult Heart Recipients (Transplants: April 1994 – June 2010)
% Freedom from Severe Renal
Dysfunction
100
80
60
p < 0.0001
40
20
18-29 (N = 1,884)
30-39 (N = 2,322)
40-49 (N = 5,031)
50-59 (N = 10,040)
60-69 (N = 7,460)
70+ (N = 344)
0
0
1
2
3
4
5
6
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
7
8
9
10
11
Patient Survival After Report of CAV Within 3 Years of
Transplant and Patient Survival In Patients Without CAV*
(Transplants: April 1994 – June 2010)
100
Survival (%)
80
60
p < 0.0001
40
20
No CAV (N = 17,865)
CAV (N = 4,235)
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Time after Report of CAV* (Years)
ISHLT
2012
* Survival for patients without CAV within 3 years after
transplant was conditioned on survival to median time
of CAV development (501 days). Median time to CAV
development is based on patients who developed
CAV within 3 years of transplant.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Patient Survival After Report of CAV Within 3 Years of
Transplant and Patient Survival In Patients Without CAV* by Era
(Transplants: April 1994 – June 2010)
100
Survival (%)
80
60
4/1994-2002: No CAV vs. CAV p < 0.0001
2003-6/2010: No CAV vs. CAV p < 0.0001
No CAV: 4/1994-2002 vs. 2003-6/2010 p = 0.5210
CAV: 4/1994-2002 vs. 2003-6/2010 p = 0.0154
40
20
No CAV 4/1994-2002 (N = 9,862)
CAV 4/1994-2002 (N = 2,434)
No CAV 2003-6/2010 (N = 8,003)
CAV 2003-6/2010 (N = 1,801)
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Time after Report of CAV* (Years)
ISHLT
2012
* Survival for patients without CAV within 3 years after
transplant was conditioned on survival to median time
of CAV development (501 days). Median time to CAV
development is based on patients who developed
CAV within 3 years of transplant.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
MALIGNANCY POST-HEART TRANSPLANT FOR ADULTS
Cumulative Morbidity Rates in Survivors
(Follow-ups: April 1994 – June 2011)
Malignancy/Type
No Malignancy
Malignancy (all types combined)
1-Year
Survivors
5-Year
Survivors
10-Year
Survivors
29,101 (97.3%)
12,750 (85.8%)
3,565 (71.2%)
795 (2.7%)
2,102 (14.2%)
1,439 (28.8%)
Skin
390
1,402
1,020
Lymphoma
165
162
97
Other
185
608
455
Type Not Reported
55
42
16
Malignancy
Type*
“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.
* Recipients may have experienced more than one type of malignancy so sum of
individual malignancy types may be greater than total number with malignancy.
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM MALIGNANCY
For Adult Heart Recipients (Follow-ups: April 1994 – June 2011)
% Free from Malignancy
100
80
60
40
20
All malignancy
Lymphoma
Skin
Other
0
0
1
2
3
4
5
6
7
8
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
9
10
11
12
13
14
15
FREEDOM FROM MALIGNANCY
by Maintenance Immunosuppression Combinations at Discharge
For Adult Heart Recipients (Transplants: January 2001 - June 2010)
Conditional on Survival to 14 days
% Free from Malignancy
100
90
80
p = 0.0015
70
60
TAC+MMF/MPA
CyA+MMF/MPA
CyA+AZA
50
0
1
2
3
4
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
5
6
7
8
FREEDOM FROM MALIGNANCY
For Adult Heart Recipients (Transplants: April 1994 – June 2010)
% Free from Malignancy
100
90
80
p < 0.0001
70
60
Freedom from malignancy 4/1994-2002
Freedom from malignancy 2003-6/2010
50
0
1
2
3
4
5
6
7
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
8
9
10
11
12
FREEDOM FROM SKIN MALIGNANCY
For Adult Heart Recipients (Transplants: April 1994 – June 2010)
% Free from Skin Malignancy
100
90
80
p < 0.0001
70
60
Freedom from skin malignancy 4/1994-2002
Freedom from skin malignancy 2003-6/2010
50
0
1
2
3
4
5
6
7
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
8
9
10
11
12
FREEDOM FROM LYMPHOMA
For Adult Heart Recipients (Transplants: April 1994 – June 2010)
% Free from Lymphoma
100
90
80
p < 0.0001
70
60
Freedom from lymphoma 4/1994-2002
Freedom from lymphoma 2003-6/2010
50
0
1
2
3
4
5
6
7
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
8
9
10
11
12
FREEDOM FROM LYMPHOMA
By Recipient Age Group
For Adult Heart Recipients (Follow-ups: April 1994 – June 2011)
% Free from Lymphoma
100
95
90
p = 0.0074
85
18-29
30-39
40-49
50-59
60-69
70+
80
75
0
1
2
3
4
5
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
6
7
8
9
10
FREEDOM OTHER MALIGNANCY
For Adult Heart Recipients (Transplants: April 1994 – June 2010)
% Free from Other Malignancy
100
90
80
p < 0.0001
70
60
Freedom from other malignancy 4/1994-2002
Freedom from other malignancy 2003-6/2010
50
0
1
2
3
4
5
6
7
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
8
9
10
11
12
FREEDOM FROM NON SKIN MALIGNANCY
By Recipient Age Group
% Free from Non Skin Malignancy
For Adult Heart Recipients (Follow-ups: April 1994 – June 2011)
100
90
80
p < 0.0001
70
18-29
30-39
40-49
50-59
60-69
70+
60
50
0
1
2
3
4
5
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
6
7
8
9
10
ADULT HEART TRANSPLANT RECIPIENTS:
Cause of Death (Deaths: January 1994 – June 2011)
0-30 Days
(N = 4,092)
31 Days –
1 Year
(N = 3,801)
>1 Year –
3 Years
(N = 2,846)
>3 Years –
5 Years
(N = 2,547)
>5 Years –
10 Years
(N = 6,617)
>10 Years
– 15 Years
(N =4,221)
>15 Years
(N =1,937)
Cardiac Allograft
Vasculopathy
71 (1.7%)
161 (4.2%)
373 (13.1%)
369 (14.5%)
951 (14.4%)
619 (14.7%)
248 (12.8%)
Acute Rejection
222 (5.4%)
394 (10.4%)
296 (10.4%)
127 (5.0%)
127 (1.9%)
42 (1.0%)
13 (0.7%)
Lymphoma
3 (0.1%)
59 (1.6%)
81 (2.8%)
105 (4.1%)
283 (4.3%)
163 (3.9%)
66 (3.4%)
Malignancy, Other
1 (0.0%)
91 (2.4%)
326 (11.5%)
472 (18.5%)
1,344 (20.3%)
847 (20.1%)
345 (17.8%)
CMV
3 (0.1%)
42 (1.1%)
14 (0.5%)
6 (0.2%)
6 (0.1%)
2 (0.0%)
0
548 (13.4%)
1,155 (30.4%)
354 (12.4%)
241 (9.5%)
703 (10.6%)
432 (10.2%)
226 (11.7%)
1,522 (37.2%)
631 (16.6%)
688 (24.2%)
543 (21.3%)
1,150 (17.4%)
670 (15.9%)
305 (15.7%)
Technical
307 (7.5%)
53 (1.4%)
21 (0.7%)
24 (0.9%)
78 (1.2%)
59 (1.4%)
27 (1.4%)
Other
199 (4.9%)
305 (8.0%)
253 (8.9%)
201 (7.9%)
547 (8.3%)
311 (7.4%)
167 (8.6%)
Multiple Organ Failure
716 (17.5%)
533 (14.0%)
164 (5.8%)
155 (6.1%)
455 (6.9%)
345 (8.2%)
175 (9.0%)
Renal Failure
31 (0.8%)
39 (1.0%)
45 (1.6%)
85 (3.3%)
392 (5.9%)
359 (8.5%)
175 (9.0%)
Pulmonary
142 (3.5%)
158 (4.2%)
123 (4.3%)
126 (4.9%)
282 (4.3%)
173 (4.1%)
88 (4.5%)
Cerebrovascular
327 (8.0%)
180 (4.7%)
108 (3.8%)
93 (3.7%)
299 (4.5%)
199 (4.7%)
102 (5.3%)
CAUSE OF DEATH
Infection, Non-CMV
Graft Failure
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Percentages represent % of deaths in
the respective time period
ADULT HEART RECIPIENTS
Cause of Death from Leading Causes by Time since
Transplant and Era (Deaths: January 1994 - June 2011)
100
90
Acute Rejection
CAV
Graft Failure
Renal Failure
Infection (Non-CMV)
Malignancy
% of Deaths
80
70
60
50
4
0
14
1
1
40
0
5
2
6
2
8
3
22
11
26
9
6
24
3
9
0
13
8
0
17
12
9
18
5
18
1
21
1
4
1
0-30 Days 31 Days - >1 Year - >3 Years >5 Years >10 Years
(N=2,275) 1 Year 3 Years - 5 Years - 10 Years (N=1,123)
(N=2,051) (N=1,601) (N=1,435) (N=3,296)
3
9
23
12
11
6
9
18
16
11
13
2
1
11
4
25
10
10
12
5
0-30 Days 31 Days - >1 Year - >3 Years >5 Years >10 Years
(N=1,817) 1 Year 3 Years - 5 Years - 10 Years (N=5,035)
(N=1,750) (N=1,245) (N=1,112) (N=3,321)
Deaths 1994 – 2001
ISHLT
2
29
17
23
14
1
14
34
16
20
27
19
17
20
10
25
11
32
40
30
17
Deaths 2002 – 6/2011
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANT RECIPIENTS
Relative Incidence of Leading Causes of Death
(Deaths: January 1994 - June 2011)
50
CAV
Malignancy (non-Lymph/PTLD)
Graft Failure
Renal Failure
% of Deaths
40
Acute Rejection
Infection (non-CMV)
Multiple Organ Failure
30
20
10
0
0-30 Days
(N=4,092)
31 Days – 1
Year
(N=3,801)
ISHLT
>1 Year – 3
Years
(N=2,846)
>3 Years – 5 >5 Years – 10
Years
Years
(N=2,547)
(N=6,617)
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
>10 – 15
Years
(N=4,221)
>15 Years
(N=1,937)
ADULT HEART TRANSPLANT RECIPIENTS
Cumulative Incidence of Leading Causes of Death
Incidence of Cause-Specific Deaths
(Transplants: January 1994 - June 2010)
14%
12%
CAV
Acute Rejection
Malignancy (non-Lymph/PTLD)
Graft Failure
Infection
10%
8%
6%
4%
2%
0%
0
1
2
3
4
5
6
7
8
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
9
10
11
12
13
14
15
ADULT HEART TRANSPLANT RECIPIENTS
Relative Incidence of Leading Causes of Death
(Deaths: January 2004 - June 2011)
50
CAV
Malignancy (non-Lymph/PTLD)
Graft Failure
Renal Failure
% of Deaths
40
Acute Rejection
Infection (non-CMV)
Multiple Organ Failure
30
20
10
0
0-30 Days
(N=1,444)
31 Days – 1
Year
(N=1,410)
ISHLT
>1 Year – 3
Years
(N=999)
>3 Years – 5 >5 Years – 10
Years
Years
(N=857)
(N=2,494)
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
>10 – 15
Years
(N=2,510)
>15 Years
(N=1,707)
ADULT HEART TRANSPLANT RECIPIENTS
Cumulative Incidence of Leading Causes of Death
Incidence of Cause-Specific Deaths
(Transplants: January 2003 - June 2010)
10%
8%
CAV
Acute Rejection
Malignancy (non-Lymph/PTLD)
Graft Failure
Infection
6%
4%
2%
0%
0
1
2
3
Years
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
4
5
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality
N
Relative P-value
Risk
VARIABLE
95% Confidence
Interval
Temporary circulatory support*
175
3.05
<.0001
2.26-4.10
Diagnosis: Congenital vs. cardiomyopathy
274
2.11
<.0001
1.56-2.86
Total artificial heart
77
1.90
0.0137
1.14-3.16
Temporary continuous flow device
49
1.84
0.0261
1.08-3.15
Recipient history of dialysis
231
1.72
<.0001
1.33-2.23
Recipient on ventilator at time of
transplant
300
1.63
0.0002
1.26-2.09
Chronic continuous flow device
1241
1.53
<.0001
1.25-1.88
Previous transplant
297
1.53
0.004
1.14-2.04
Chronic pulsatile flow device
1237
1.38
0.0012
1.14-1.68
N = 10,288
ISHLT
2012
* Temporary circulatory support includes ECMO and
temporary pulsatile flow devices.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality (continued)
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
Prior transfusion
2202
1.35
<.0001
1.17-1.57
Recipient with infection requiring IV drug
therapy within 2 weeks prior to transplant
1044
1.25
0.0093
1.06-1.49
Ventricular remodeling
1556
0.76
0.0033
0.64-0.91
Transplant year: 2006 vs. 2009/2010
1927
1.36
0.0007
1.14-1.63
Transplant year: 2007 vs. 2009/2010
1869
1.23
0.0285
1.02-1.47
Transplant year: 2005 vs. 2009/2010
1884
1.22
0.0372
1.01-1.46
N = 10,288
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Borderline Significant Risk Factors For 1 Year Mortality
N
Relative P-value
Risk
VARIABLE
95% Confidence
Interval
Transplant year: 2008 vs. 2009/2010
1778
1.18
0.0696
0.99-1.42
Diagnosis: coronary artery disease vs.
cardiomyopathy
4196
1.14
0.0561
1.00-1.30
Not hospitalized just prior to transplant
5593
0.89
0.0717
0.78-1.01
N = 10,288
Reference group = Cardiomyopathy, year=2009/2010
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality
Continuous Factors (see figures)
Recipient age
Ischemia time
Recipient height
Recipient pre-transplant bilirubin
Recipient weight
Recipient pre-transplant creatinine
Donor age
PRA Class II
Donor BMI
Recipient mean pulmonary artery
pressure
Transplant center volume
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits
Recipient Age
Relative Risk of 1 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
20
30
40
50
60
Recipient Age (years)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 10,288)
70
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits
Donor Age
Relative Risk of 1 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
15
20
25
30
35
40
45
50
55
Donor Age (years)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 10,288)
60
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits
Recipient Height
Relative Risk of 1 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
155
160
165
170
175
180
185
190
Recipient Height (cm)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
* The risk associated with recipient height should be
considered in conjunction with the risk associated
with recipient weight and donor BMI.
(N = 10,288)
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits
Recipient Weight
Relative Risk of 1 Year Mortality
2.5
p = 0.0051
2.0
1.5
1.0
0.5
0.0
50
60
70
80
90
100
110
120
130
Recipient Weight (kg)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
* The risk associated with recipient weight should
be considered in conjunction with the risk
associated with recipient height and donor BMI.
(N = 10,288)
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits
Donor BMI
Relative Risk of 1 Year Mortality
2.0
p = 0.0182
1.5
1.0
0.5
0.0
20
25
30
35
40
Donor BMI (kg/m2)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
* The risk associated with donor BMI should be
considered in conjunction with the risk associated
with recipient weight and recipient height.
(N = 10,288)
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits
Ischemia Time
Relative Risk of 1 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
30
60
90
120
150
180
210
240
270
300
330
Ischemia time (minutes)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 10,288)
360
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits
Center Volume
Relative Risk of 1 Year Mortality
2.0
p = 0.0256
1.5
1.0
0.5
0.0
5
10
15
20
25
30
35
40
45
50
55
60
65
Center Volume (cases per year)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 10,288)
70
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant Bilirubin
Relative Risk of 1 Year Mortality
2.5
p = 0.0026
2.0
1.5
1.0
0.5
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Recipient Bilirubin (mg/dL)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 10,288)
3.5
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant Creatinine
Relative Risk of 1 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
0.5
1.0
1.5
2.0
Recipient Creatinine (mg/dL)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 10,288)
2.5
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits
PRA Class II (%)
Relative Risk of 1 Year Mortality
3.0
p = 0.0028
2.5
2.0
1.5
1.0
0.5
0.0
0
10
20
30
40
50
60
70
80
90
Recipient PRA Class II (%)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 10,288)
100
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits
Mean Pulmonary Artery Pressure
Relative Risk of 1 Year Mortality
2.0
p = 0.0073
1.5
1.0
0.5
0.0
10
15
20
25
30
35
40
45
50
Mean PA Pressure
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 10,288)
55
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality
N
Relative P-value
Risk
VARIABLE
95% Confidence
Interval
Temporary circulatory support*
175
2.49
<.0001
1.96-3.16
Total artificial heart
45
1.70
0.0420
1.02-2.82
Recipient history of dialysis
328
1.67
<.0001
1.40-2.00
Diagnosis: Congenital vs.
cardiomyopathy
292
1.47
0.0008
1.17-1.84
Recipient on ventilator at time of
transplant
314
1.41
0.0008
1.15-1.72
0 A MM (N=665)
1 A MM (N=5089)
2 A MM (N=4753)
1.29
0.0003
1.13-1.49
Number of HLA mismatches at A locus
(per locus)
ISHLT
2012
* Temporary circulatory support includes ECMO and
temporary pulsatile flow devices.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
N = 10,507
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality (continued)
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
Female recipient with prior pregnancy/
male donor vs. male recipient/male donor
780
1.22
0.0286
1.02-1.45
PRA > 10%
766
1.21
0.0066
1.06-1.40
Recipient with infection requiring IV drug
therapy within 2 weeks prior to transplant
1161
1.18
0.0082
1.04-1.33
Recipient history of diabetes
2177
1.14
0.0062
1.04-1.26
Diagnosis: coronary artery disease vs.
cardiomyopathy
4792
1.14
0.0063
1.04-1.25
Not hospitalized just prior to transplant
5516
0.92
0.0475
0.84-1.00
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
N = 10,507
ADULT HEART TRANSPLANTS (2001-6/2006)
Borderline Significant Risk Factors For 5 Year Mortality
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
Recipient Hep B core (+)
397
1.20
0.06
0.99-1.44
Male recipient/female donor vs. male
recipient/male donor
1763
1.11
0.0762
0.99-1.24
Not ABO identical
1487
1.10
0.0968
0.98-1.22
N = 10,507
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality
Continuous Factors (see figures)
Recipient age
Transplant center volume
Recipient height
Ischemia time
Recipient BMI
Recipient pre-transplant bilirubin
Donor age
Recipient pre-transplant creatinine
Donor weight
Recipient PVR
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits
Recipient Age
Relative Risk of 5 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
20
30
40
50
60
Recipient Age (years)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 10,507)
70
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits
Donor Age
Relative Risk of 5 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
15
20
25
30
35
40
45
50
55
Donor Age (years)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 10,507)
60
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits
Recipient Height
Relative Risk of 5 Year Mortality
2.5
p = 0.0018
2.0
1.5
1.0
0.5
0.0
155
160
165
170
175
180
185
190
Recipient Height (cm)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
* The risk associated with recipient height should be
considered in conjunction with the risk associated
with recipient BMI and donor weight.
(N = 10,507)
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits
Recipient BMI
Relative Risk of 5 Year Mortality
2.0
p < 0.0001
1.5
1.0
0.5
0.0
20
25
30
35
Recipient BMI (kg/m2)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
* The risk associated with recipient BMI should be
considered in conjunction with the risk associated
with recipient height and donor weight.
(N = 10,507)
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits
Donor Weight
Relative Risk of 5 Year Mortality
2.0
p = 0.0083
1.5
1.0
0.5
0.0
50
60
70
80
90
100
110
120
130
Donor Weight (kg)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
* The risk associated with donor weight should be
considered in conjunction with the risk associated
with recipient weight and recipient BMI.
(N = 10,507)
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits
Ischemia Time
Relative Risk of 5 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
30
60
90
120
150
180
210
240
270
300
330
Ischemia time (minutes)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 10,507)
360
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits
Center Volume
Relative Risk of 5 Year Mortality
2.0
p < 0.0001
1.5
1.0
0.5
0.0
5
10
15
20
25
30
35
40
45
50
55
60
65
Center Volume (cases per year)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 10,507)
70
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant Bilirubin
Relative Risk of 5 Year Mortality
2.0
p < 0.0001
1.5
1.0
0.5
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Recipient Bilirubin (mg/dL)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 10,507)
3.5
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant Creatinine
Relative Risk of 5 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
0.5
1.0
1.5
2.0
Recipient Creatinine (mg/dL)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 10,507)
2.5
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits
Pulmonary Vascular Resistance
Relative Risk of 5 Year Mortality
3.0
p = 0.0003
2.5
2.0
1.5
1.0
0.5
0.0
0
2
4
6
8
PVR
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 10,507)
10
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality
Conditional on Survival to 1 Year
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
Rejection between discharge and 1st year
2427
1.63
<.0001
1.45-1.83
No AZA, MMF/MPA or Sirolimus at 1 year
726
1.59
<.0001
1.31-1.95
No Cyclo, TAC or Sirolimus at 1 year
316
1.48
0.0052
1.13-1.96
Dialysis prior to discharge
531
1.43
0.0011
1.15-1.76
Recipient history of dialysis prior to
transplant
216
1.39
0.0334
1.03-1.87
Female recipient with prior pregnancy/
male donor vs. male recipient/male donor
657
1.31
0.0117
1.06-1.61
0 A MM: N = 585
1 A MM: N = 4444
2 A MM: N = 3953
1.28
0.0097
1.06-1.55
Number of HLA mismatches at A locus
(per mismatch)
ISHLT
N = 8,982
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality
Conditional on Survival to 1 Year (continued)
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
Treated for infection prior to discharge
1879
1.23
0.003
1.07-1.40
Recipient history of diabetes
1839
1.21
0.0079
1.05-1.38
Diagnosis: Coronary artery disease vs.
cardiomyopathy
4068
1.17
0.0187
1.03-1.34
IL-2R antagonist used for induction
2334
1.15
0.0272
1.02-1.30
Not hospitalized at transplant
4807
0.88
0.0259
0.78-0.98
Chronic pulsatile flow device
1526
0.81
0.0084
0.69-0.95
N = 8,982
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Borderline Significant Risk Factors For 5 Year Mortality
Conditional on Survival to 1 Year
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
Recipient Hep B core (+)
333
1.28
0.0666
0.98-1.66
Recipient history of malignancy
404
1.25
0.0741
0.98-1.60
Transplant year: 2004 vs. 2005/2006
1532
1.18
0.0602
0.99-1.40
Male recipient/female donor vs. male
recipient/male donor
1470
1.14
0.0964
0.98-1.34
Diagnosis: Congenital vs. cardiomyopathy
223
0.72
0.0976
0.50 -1.06
N = 8,982
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality
Conditional on Survival to 1 Year
Continuous Factors (see figures)
Recipient age
Recipient pre-transplant creatinine
Recipient BMI
Recipient TPG
Donor age
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS
(2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year
Recipient Age
Relative Risk of 5 Year Mortality
3.0
2.5
2.0
1.5
1.0
0.5
p < 0.0001
0.0
20
30
40
50
60
Recipient Age (years)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 8,982)
70
ADULT HEART TRANSPLANTS
(2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year
Donor Age
Relative Risk of 5 Year Mortality
2.5
p = 0.0005
2.0
1.5
1.0
0.5
0.0
15
20
25
30
35
40
45
50
55
Donor Age (years)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 8,982)
60
ADULT HEART TRANSPLANTS
(2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year
Recipient BMI
Relative Risk of 5 Year Mortality
2.0
p = 0.0026
1.5
1.0
0.5
0.0
20
25
30
35
Recipient BMI (kg/m2)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 8,982)
ADULT HEART TRANSPLANTS
(2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year
Recipient Pre-Transplant Creatinine
Relative Risk of 5 Year Mortality
2.5
P = 0.0187
2.0
1.5
1.0
0.5
0.0
0.5
1.0
1.5
2.0
Recipient Creatinine (mg/dL)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 8,982)
2.5
ADULT HEART TRANSPLANTS
(2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year
Transpulmonary Pressure Gradient
Relative Risk of 5 Year Mortality
2.0
p = 0.0033
1.5
1.0
0.5
0.0
3
6
9
12
TPG
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 8,982)
15
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
ECMO
29
1.82
0.0107
1.15-2.87
Ventilator at time of transplant
346
1.65
<.0001
1.43-1.92
Recipient on dialysis
233
1.50
<.0001
1.26-1.78
Repeat transplant
283
1.43
<.0001
1.21-1.70
Recipient history of diabetes
1967
1.28
<.0001
1.19-1.37
PRA > 20%
599
1.27
<.0001
1.13-1.43
Transplant year: 1996 vs. 2000/2001
2054
1.23
<.0001
1.12-1.34
Diagnosis: coronary artery disease vs.
cardiomyopathy
5762
1.18
<.0001
1.11-1.26
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
N = 11,531
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality (continued)
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
Recipient with infection requiring IV drug
therapy within 2 weeks prior to transplant
1003
1.16
0.0041
1.05-1.28
Prior cerebrovascular event
603
1.15
0.0225
1.02-1.29
On VAD at time of transplant
1605
1.13
0.006
1.03-1.23
Year of transplant: 1997 vs. 2000/2001
2084
1.11
0.016
1.02-1.21
Donor history of hypertension
1293
1.11
0.0251
1.01-1.21
Year of transplant: 1998 vs. 2000/2001
2162
1.10
0.0263
1.01-1.20
Total HLA mismatches (per mismatch)
0/1 MM (N=67)
2 MM (N=304)
3 MM (N=1102)
4 MM (N=2520)
5 MM (N=5600)
6 MM (N=1938)
1.04
0.0048
1.01-1.07
4337
0.93
0.0321
0.88-0.99
Not hospitalized at transplant
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
N = 11,531
ADULT HEART TRANSPLANTS (1996-6/2001)
Borderline Significant Risk Factors For 10 Year Mortality
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
Recipient Hep B core (+)
327
1.15
0.0792
0.98-1.35
Recipient prior pregnancy
1617
1.09
0.0654
0.99-1.20
N = 11,531
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality
Continuous Factors (see figures)
Recipient age
Transplant center volume
Recipient height
Ischemia time
Recipient weight
Recipient pre-transplant bilirubin
Donor age
Recipient pre-transplant creatinine
Donor weight
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits
Recipient Age
Relative Risk of 10 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
20
30
40
50
60
Recipient Age (years)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 11,531)
70
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits
Donor Age
Relative Risk of 10 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
15
20
25
30
35
40
45
50
55
Donor Age (years)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 11,531)
60
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits
Recipient Height
Relative Risk of 10 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
155
160
165
170
175
180
185
190
Recipient Height (cm)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
* The risk associated with recipient height should be
considered in conjunction with the risk associated
with recipient weight and donor weight.
(N = 11,531)
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits
Recipient Weight
Relative Risk of 10 Year Mortality
2.0
p = 0.0023
1.5
1.0
0.5
0.0
50
60
70
80
90
100
110
120
130
Recipient Weight (kg)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
* The risk associated with recipient BMI should be
considered in conjunction with the risk associated
with recipient height and donor weight.
(N = 11,531)
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits
Donor Weight
Relative Risk of 10 Year Mortality
2.0
p = 0.0299
1.5
1.0
0.5
0.0
50
60
70
80
90
100
110
120
130
Donor Weight (kg)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
* The risk associated with donor weight should be
considered in conjunction with the risk associated
with recipient weight and recipient height.
(N = 11,531)
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits
Ischemia Time
Relative Risk of 10 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
30
60
90
120
150
180
210
240
270
300
330
Ischemia time (minutes)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 11,531)
360
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits
Center Volume
Relative Risk of 10 Year Mortality
2.0
p < 0.0001
1.5
1.0
0.5
0.0
5
10
15
20
25
30
35
40
45
50
55
60
65
Center Volume (cases per year)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 11,531)
70
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant Bilirubin
Relative Risk of 10 Year Mortality
2.0
p = 0.0006
1.5
1.0
0.5
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Recipient Bilirubin (mg/dL)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 11,531)
3.5
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant Creatinine
Relative Risk of 10 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
0.5
1.0
1.5
2.0
Recipient Creatinine (mg/dL)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 11,531)
2.5
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
Retransplant
273
1.82
<.0001
1.56-2.11
Diagnosis: not cardiomyopathy, coronary
artery disease, congenital heart disease,
valvular heart disease or retransplant vs.
cardiomopathy
113
1.35
0.0191
1.05-1.74
On ventilator
338
1.34
0.0002
1.15-1.56
Recipient Hep B Core (+)
244
1.33
0.0004
1.14-1.56
PR A> 20%
487
1.19
0.0021
1.07-1.33
Male recipient/female donor vs. male
recipient/male donor
2253
1.19
<.0001
1.09-1.30
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
N = 10,888
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality (continued)
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
On VAD at transplant
578
1.15
0.0124
1.03-1.29
Diagnosis: Coronary artery disease vs.
cardiomyopathy
5295
1.14
<.0001
1.08-1.20
Transplant year: 1991 vs. 1995/1996
1842
1.12
0.0038
1.04-1.21
Transplant year: 1992 vs. 1995/1996
1881
1.11
0.0082
1.03-1.20
Transplant year: 1993 vs. 1995/1996
2017
1.09
0.0308
1.01-1.18
0-3 vs. 4-6 total HLA mismatches
1497
0.91
0.0103
0.85-0.98
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
N = 10,888
ADULT HEART TRANSPLANTS (1991-6/1996)
Borderline Significant Risk Factors For 15 Year Mortality
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
Female recipient/female donor vs. male
recipient/male donor
1006
1.13
0.0758
0.99-1.29
Hospitalized (inc. ICU) at transplant
6431
1.05
0.0899
0.99-1.10
N = 10,888
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality
Continuous Factors (see figures)
Recipient age
Transplant center volume
Recipient height
Ischemia time
Recipient weight
Recipient pre-transplant creatinine
Donor age
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality with 95% Confidence Limits
Recipient Age
Relative Risk of 15 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
20
30
40
50
60
Recipient Age (years)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 11,531)
70
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality with 95% Confidence Limits
Donor Age
Relative Risk of 15 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
15
20
25
30
35
40
45
50
55
Donor Age (years)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 11,531)
60
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality with 95% Confidence Limits
Recipient Height
Relative Risk of 15 Year Mortality
2.5
p = 0.0003
2.0
1.5
1.0
0.5
0.0
155
160
165
170
175
180
185
190
Recipient Height (cm)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
* The risk associated with recipient height should be
considered in conjunction with the risk associated
with recipient weight.
(N = 11,531)
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality with 95% Confidence Limits
Recipient Weight
Relative Risk of 15 Year Mortality
2.0
p = 0.0009
1.5
1.0
0.5
0.0
50
60
70
80
90
100
110
120
130
Recipient Weight (kg)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
* The risk associated with recipient BMI should be
considered in conjunction with the risk associated
with recipient height.
(N = 11,531)
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality with 95% Confidence Limits
Ischemia Time
Relative Risk of 15 Year Mortality
2.0
p < 0.0001
1.5
1.0
0.5
0.0
30
60
90
120
150
180
210
240
270
300
330
Ischemia time (minutes)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 11,531)
360
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality with 95% Confidence Limits
Center Volume
Relative Risk of 15 Year Mortality
2.0
p = 0.0015
1.5
1.0
0.5
0.0
5
10
15
20
25
30
35
40
45
50
55
60
65
Center Volume (cases per year)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 11,531)
70
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant Creatinine
Relative Risk of 15 Year Mortality
2.0
p < 0.0001
1.5
1.0
0.5
0.0
0.5
1.0
1.5
2.0
Recipient Creatinine (mg/dL)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 11,531)
2.5
ADULT HEART TRANSPLANTS (1986-6/1991)
Risk Factors For 20 Year Mortality
N
Relative
Risk
P-value
Retransplant
294
2.19
<.0001
1.92-2.49
Diagnosis: not cardiomyopathy, coronary artery
disease, congenital heart disease, valvular heart
disease or retransplant vs. cardiomopathy
1170
1.39
<.0001
1.29-1.50
Transplant year: 1986 vs. 1990/1991
2067
1.16
<.0001
1.09-1.24
Transplant year: 1987 vs. 1990/1991
2634
1.15
<.0001
1.08-1.21
Diagnosis: Coronary artery disease vs.
cardiomyopathy
7444
1.11
<.0001
1.06-1.16
Transplant year: 1988 vs. 1990/1991
3083
1.11
0.0002
1.05-1.17
Transplant year: 1989 vs. 1990/1991
3289
1.06
0.021
1.01-1.12
Female recipient vs. male recipient
2687
0.94
0.0225
0.89-0.99
Diagnosis: congenital vs. cardiomyopathy
194
0.78
0.0159
0.64-0.96
VARIABLE
ISHLT
95% Confidence
Interval
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
N = 10,888
ADULT HEART TRANSPLANTS (1986-6/1991)
Risk Factors For 20 Year Mortality
Continuous Factors (see figures)
Recipient age
Transplant center volume
Donor age
Ischemia time
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1986-6/1991)
Risk Factors For 20 Year Mortality with 95% Confidence Limits
Recipient Age
Relative Risk of 20 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
20
30
40
50
60
Recipient Age (years)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 11,531)
70
ADULT HEART TRANSPLANTS (1986-6/1991)
Risk Factors For 20 Year Mortality with 95% Confidence Limits
Donor Age
Relative Risk of 20 Year Mortality
2.5
p < 0.0001
2.0
1.5
1.0
0.5
0.0
15
20
25
30
35
40
45
50
55
Donor Age (years)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 11,531)
60
ADULT HEART TRANSPLANTS (1986-6/1991)
Risk Factors For 20 Year Mortality with 95% Confidence Limits
Ischemia Time
Relative Risk of 20 Year Mortality
2.0
p = 0.0068
1.5
1.0
0.5
0.0
30
60
90
120
150
180
210
240
270
300
330
Ischemia time (minutes)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 11,531)
360
ADULT HEART TRANSPLANTS (1986-6/1991)
Risk Factors For 20 Year Mortality with 95% Confidence Limits
Center Volume
Relative Risk of 20 Year Mortality
2.0
p < 0.0001
1.5
1.0
0.5
0.0
5
10
15
20
25
30
35
40
45
50
55
60
65
Center Volume (cases per year)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 11,531)
70
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors for Developing Severe Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant
Conditional on Survival to Transplant Discharge
N
Relative
Risk
P-value
Dialysis prior to discharge
480
3.80
<.0001
2.99-4.82
Continuous chronic device
1090
1.61
0.0004
1.24-2.08
Infection requiring IV antibiotics within 2 weeks
prior to transplant
834
1.60
0.0005
1.23-2.08
Rejection prior to discharge
824
1.59
0.0013
1.20-2.12
Recipient history of malignancy
531
1.48
0.02
1.06-2.05
Female donor
2352
1.43
0.0016
1.14-1.78
Cyclosporine vs. Tacrolimus at discharge
2487
1.31
0.0115
1.06-1.61
1.10
0.0421
1.00-1.21
0.81
0.0486
0.66-1.00
VARIABLE
Total number of HLA mismatches (per mismatch)
Diagnosis: Coronary artery disease vs.
cardiomyopathy
3574
N = 8,794
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
95% Confidence
Interval
*Severe renal dysfunction =
creatinine > 2.5 mg/dl or dialysis
ADULT HEART TRANSPLANTS (2005-6/2010)
Borderline Significant Risk Factors for Developing Severe Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant
Conditional on Survival to Transplant Discharge
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
AZA vs. MMF/MPA at discharge
135
1.72
0.0798
0.94-3.15
Stroke prior to discharge
135
1.62
0.0833
0.94-2.79
Transplant year: 2006 vs. 2009/2010
1604
0.78
0.0957
0.57-1.05
N = 8,794
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
*Severe renal dysfunction =
creatinine > 2.5 mg/dl or dialysis
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors for Developing Severe Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant
Conditional on Survival to Transplant Discharge
Continuous Factors (see figures)
Recipient age
Recipient pre-transplant creatinine
Recipient weight
Recipient systolicpulmonary artery
pressure (borderline)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
*Severe renal dysfunction =
creatinine > 2.5 mg/dl or dialysis
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors for Developing Severe Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant
Conditional on Survival to Transplant Discharge
Recipient Age
Relative Risk of Renal Dysfunction
within 1 Year
2.0
p = 0.0013
1.5
1.0
0.5
0.0
20
30
40
50
60
70
Recipient Age (years)
ISHLT
*Severe renal dysfunction =
creatinine > 2.5 mg/dl or dialysis
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 8,794)
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors for Developing Severe Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant
Conditional on Survival to Transplant Discharge
Recipient Weight
Relative Risk of Renal Dysfunction
within 1 Year
3.5
p = 0.0043
3.0
2.5
2.0
1.5
1.0
0.5
0.0
50
60
70
80
90
100
110
120
130
Recipient Weight (kg)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
*Severe renal dysfunction =
creatinine > 2.5 mg/dl or dialysis
(N = 8,794)
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors for Developing Severe Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant
Conditional on Survival to Transplant Discharge
Recipient Pre-Transplant Creatinine
Relative Risk of Renal Dysfunction
within 1 Year
5.0
4.5
p < 0.0001
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
0.5
1.0
1.5
2.0
2.5
Recipient Creatinine (mg/dL)
ISHLT
*Severe renal dysfunction =
creatinine > 2.5 mg/dl or dialysis
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 8,794)
ADULT HEART TRANSPLANTS
(2005-6/2010)
Risk Factors for Developing Severe Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant
Conditional on Survival to Transplant Discharge
Systolic Pulmonary Artery Pressure
Relative Risk of Renal Dysfunction
within 1 Year
2.0
p = 0.0952
1.5
1.0
0.5
0.0
5
10
15
20
25
30
35
40
Systolic PA Pressure
ISHLT
*Severe renal dysfunction =
creatinine > 2.5 mg/dl or dialysis
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 8,794)
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant
Conditional on Survival to Transplant Discharge
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
Dialysis prior to discharge
407
3.17
<.0001
2.49-4.03
Donor cause of death: CNS tumor vs. head
trauma
97
2.13
0.0046
1.26-3.59
Transplant year: 2001 vs. 2005/2006
1519
1.69
<.0001
1.30-2.20
Transplant year: 2003 vs. 2005/2006
1469
1.58
0.0006
1.22-2.05
Transplant year: 2002 vs. 2005/2006
1412
1.56
0.0009
1.20-2.03
Pacemaker prior to discharge
278
1.52
0.0266
1.05-2.21
No AZA, MMF/MPA or Sirolimus at
discharge
392
1.50
0.029
1.04-2.16
N = 8,168
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
*Severe renal dysfunction =
creatinine > 2.5 mg/dl or dialysis
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant
Conditional on Survival to Transplant Discharge (continued)
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
Cyclosporine vs. Tacrolimus at discharge
4385
1.41
0.0004
1.17-1.71
Pulsatile chronic device
1384
1.32
0.0113
1.06-1.63
Recipient history of diabetes
1698
1.25
0.0216
1.03-1.51
Diagnosis: Coronary artery disease vs.
cardiomyopathy
3752
0.81
0.0213
0.67-0.97
Polyclonal agent used for induction
1570
0.79
0.0486
0.62-1.00
Diagnosis: Congenital vs. cardiomyopathy
205
0.36
0.0477
0.13-0.99
N = 8,168
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
*Severe renal dysfunction =
creatinine > 2.5 mg/dl or dialysis
ADULT HEART TRANSPLANTS (2001-6/2006)
Borderline Significant Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant
Conditional on Survival to Transplant Discharge
N
VARIABLE
Hospitalized (inc. ICU) at transplant
Relative P-value
Risk
3792
1.16
0.0931
95% Confidence
Interval
0.98-1.37
N = 8,168
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
*Severe renal dysfunction =
creatinine > 2.5 mg/dl or dialysis
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant
Conditional on Survival to Transplant Discharge
Continuous Factors (see figures)
Recipient age
Recipient pre-transplant creatinine
Donor/recipient height ratio
Transplant center volume (borderline)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
*Severe renal dysfunction =
creatinine > 2.5 mg/dl or dialysis
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant
Conditional on Survival to Transplant Discharge
Recipient Age
Relative Risk of Renal Dysfunction
within 5 Years
2.0
p = 0.0017
1.5
1.0
0.5
0.0
20
30
40
50
60
70
Recipient Age (years)
ISHLT
*Severe renal dysfunction =
creatinine > 2.5 mg/dl or dialysis
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 8,168)
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant
Conditional on Survival to Transplant Discharge
Donor Height/Recipient Height Ratio
Relative Risk of Renal Dysfunction
within 5 Years
3.5
p = 0.0313
3.0
2.5
2.0
1.5
1.0
0.5
0.0
0.85
0.95
1.05
1.15
Donor height/recipient height
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
*Severe renal dysfunction =
creatinine > 2.5 mg/dl or dialysis
(N = 8,168)
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant
Conditional on Survival to Transplant Discharge
Recipient Pre-Transplant Creatinine
Relative Risk of Renal Dysfunction
within 5 Years
5.0
4.5
p < 0.0001
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
0.5
1.0
1.5
2.0
2.5
Recipient Creatinine (mg/dL)
ISHLT
*Severe renal dysfunction =
creatinine > 2.5 mg/dl or dialysis
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 8,168)
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant
Conditional on Survival to Transplant Discharge
Center Volume
Relative Risk of Renal Dysfunction
within 5 Years
2.0
p = 0.0985
1.5
1.0
0.5
0.0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
Center Volume (cases per year)
ISHLT
*Severe renal dysfunction =
creatinine > 2.5 mg/dl or dialysis
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 8,168)
ADULT HEART TRANSPLANTS (1999-6/2003)
Risk Factors for Developing Non-Skin Malignancy within 8 Years
Limited to Recipients without Malignancy Pre-Transplant
Conditional on Survival to Transplant Discharge
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
Diagnosis: Congenital vs. cardiomyopathy
94
3.35
0.007
1.39-8.07
Retransplant
82
2.97
0.0006
1.60-5.52
Donor history of cancer
89
2.83
<.0001
1.72-4.65
Female recipient/female donor vs. male
recipient/male donor
585
1.71
0.009
1.14-2.56
Transplant year: 1999 vs. 2002/2003
1018
1.47
0.005
1.12-1.92
Transplant year: 2000 vs. 2002/2003
1046
1.39
0.0158
1.06-1.81
Implantable defibrillator prior to transplant
1761
1.28
0.0145
1.05-1.56
N = 4,846
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1999-6/2003)
Borderline Significant Risk Factors for
Developing Non-Skin Malignancy within 8 Years
Limited to Recipients without Malignancy Pre-Transplant
Conditional on Survival to Transplant Discharge
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
Pacemaker prior to discharge
189
1.48
0.0737
0.96-2.29
Male recipient/female donor vs. male
recipient/male donor
856
1.28
0.0725
0.98-1.68
Transplant year: 2001 vs. 2002/2003
1094
1.27
0.0865
0.97-1.67
Prior sternotomy
2232
0.83
0.0865
0.67-1.03
N = 4,846
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1999-6/2003)
Risk Factors for Developing Non-Skin Malignancy within 8 Years
Limited to Recipients without Malignancy Pre-Transplant
Conditional on Survival to Transplant Discharge
Continuous Factors (see figures)
Recipient age
Transplant center volume
Ischemia time (borderline)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1999-6/2003)
Risk Factors for Developing Non-Skin Malignancy within 8 Years
Limited to Recipients without Malignancy Pre-Transplant
Conditional on Survival to Transplant Discharge
Recipient Age
Relative Risk of Non-Skin
Malignancy within 8 Years
3.0
p < 0.0001
2.5
2.0
1.5
1.0
0.5
0.0
20
30
40
50
60
Recipient Age (years)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 4,846)
70
ADULT HEART TRANSPLANTS (1999-6/2003)
Risk Factors for Developing Non-Skin Malignancy within 8 Years
Limited to Recipients without Malignancy Pre-Transplant
Conditional on Survival to Transplant Discharge
Center Volume
Relative Risk of Non-Skin
Malignancy within 8 Years
2.0
p = 0.0006
1.5
1.0
0.5
0.0
5
10
15
20
25
30
35
40
45
50
55
60
65
Center Volume (cases per year)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 4,846)
70
ADULT HEART TRANSPLANTS (1999-6/2003)
Risk Factors for Developing Non-Skin Malignancy within 8 Years
Limited to Recipients without Malignancy Pre-Transplant
Conditional on Survival to Transplant Discharge
Ischemia Time
Relative Risk of Non-Skin
Malignancy within 8 Years
2.5
2.0
1.5
1.0
0.5
p = 0.052
0.0
30
60
90
120
150
180
210
240
270
300
330
Ischemia time (minutes)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 4,846)
360
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors for Developing CAV within 5 Years
Conditional on Survival to Transplant Discharge
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
OTK3 used for induction
333
1.74
<.0001
1.43-2.11
AZA vs. MMF/MPA at discharge
497
1.56
<.0001
1.31-1.85
Pulmonary embolism prior to transplant
121
1.43
0.0362
1.02-1.99
Pacemaker prior to discharge
263
1.37
0.0074
1.09-1.73
Rejection prior to discharge
1094
1.30
<.0001
1.14-1.49
Cyclosporine vs. Tacrolimus at discharge
4256
1.30
<.0001
1.17-1.45
Donor history of hypertension
869
1.16
0.0381
1.01-1.33
Recipient CMV(-)/Donor CMV(+)
1485
1.14
0.0238
1.02-1.28
N = 7,788
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors for Developing CAV within 5 Years
Conditional on Survival to Transplant Discharge
(continued)
N
Relative
Risk
P-value
Transplant year: 2001 vs. 2005/2006
1427
0.84
0.0228
0.72-0.98
Male recipient/female donor vs. male
recipient/male donor
1266
0.83
0.0109
0.72-0.96
Chronic pulsatile flow device
1372
0.82
0.003
0.72-0.93
Female recipient with prior pregnancy/female
donor vs. male recipient/male donor
591
0.78
0.0099
0.65-0.94
Recipient history of malignancy
353
0.72
0.0105
0.56-0.93
Diagnosis: Congenital vs. cardiomyopathy
205
0.59
0.006
0.41-0.86
Female recipient without prior pregnancy/
female donor vs. male recipient/male donor
325
0.54
<.0001
0.40-0.73
VARIABLE
N = 7,788
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
95% Confidence
Interval
ADULT HEART TRANSPLANTS (2001-6/2006)
Borderline Significant Risk Factors for Developing CAV within 5 Years
Conditional on Survival to Transplant Discharge
N
VARIABLE
Relative P-value
Risk
95% Confidence
Interval
No Cyclosporine, Tacrolimus or Sirolimus
at discharge
195
1.35
0.0816
0.96-1.90
Donor history of cancer
136
1.33
0.054
1.00-1.78
N = 7,788
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors for Developing CAV within 5 Years
Conditional on Survival to Transplant Discharge
Continuous Factors (see figures)
Recipient BMI
Donor age
Donor/recipient height difference
Ischemia time (borderline)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors for Developing CAV within 5 Years
Conditional on Survival to Transplant Discharge
Recipient BMI
Relative Risk of CAV within 5
Years
2.0
p = 0.0103
1.5
1.0
0.5
0.0
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
Recipient BMI (kg/m2)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 7,788)
35
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors for Developing CAV within 5 Years
Conditional on Survival to Transplant Discharge
Difference Between Donor Height and Recipient Height
Relative Risk of CAV within 5 Years
2.0
p = 0.0293
1.5
1.0
0.5
0.0
-30
-20
-10
0
10
20
Donor Height – Recipient Height (cm)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 7,788)
30
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors for Developing CAV within 5 Years
Conditional on Survival to Transplant Discharge
Donor Age
Relative Risk of CAV within 5 Years
3.0
p < 0.0001
2.5
2.0
1.5
1.0
0.5
0.0
15
20
25
30
35
40
45
50
55
Donor Age (years)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 7,788)
60
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors for Developing CAV within 5 Years
Conditional on Survival to Transplant Discharge
Ischemia Time
Relative Risk of CAV within 5
Years
2.0
p = 0.0552
1.5
1.0
0.5
0.0
30
60
90
120
150
180
210
240
270
300
330
Ischemia time (minutes)
ISHLT
2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
(N = 7,788)
360