2002 ISHLT J Heart Lung Transplant 2002; 21: 950-970. HEART-LUNG TRANSPLANTATION Overall.
HEART-LUNG TRANSPLANTATION
description
Transcript of HEART-LUNG TRANSPLANTATION
HEART-LUNG TRANSPLANTATION
Overall
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0
50
100
150
200
250
Num
ber
of T
rans
plan
ts
.NUMBER OF HEART-LUNG
TRANSPLANTS REPORTED BY YEAR
ISHLT 2005
NOTE: This figure includes only the heart-lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of heart-lung transplants worldwide has declined in recent years.
J Heart Lung Transplant 2005;24: 945-982
AVERAGE CENTER VOLUMEHeart-Lung Transplants: January 1, 1998 - June 30, 2004
76
3 20
25
50
75
1-4 5-9 10-19
Average number of heart-lung transplants per year
Nu
mb
er
of
cen
ters
.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY CENTER VOLUME
Heart-Lung Transplants: January 1, 1998 - June 30, 2004
0
25
50
75
1-4 5-9 10-19
Average number of heart-lung transplants per year
Perc
en
tag
e o
f h
eart
-lu
ng
tra
nsp
lan
tss
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME
Lung Transplants: January 1, 1998 - June 30, 2004
0
10
20
30
40
1-4 5-9 10-19 20-29 30-39 40-49 50+
Average number of lung transplants per year
Perc
en
tag
e o
f h
eart
-lu
ng
tra
nsp
lan
ts .
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1982 - June 2003)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Years
N=3,080
Half-life = 2.9 yearsConditional Half-life = 8.6 years
Su
rviv
al (
%)
ISHLT 2005
N followed at longest time point: 1,899
J Heart Lung Transplant 2005;24: 945-982
HEART-LUNG TRANSPLANTATION
Adult Recipients
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
Congenital heart disease
30%
COPD6%
PPH23%
IPF3%CF
15%
Other 11%
Acquired heart disease
4%
Alpha-16%
Re-transplant2%
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (1/1982-6/2004)
“Other” includes cancer, LAM, OB, sarcoidosis, bronchiectasis
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2004)
Diagnosis N (%)
Congenital Heart Disease 746 (32.4%)
Primary Pulmonary Hypertension 574 (24.9%)
Cystic Fibrosis 357 (15.5%)
Acquired Heart Disease 98 (4.3%)
COPD/Emphysema 92 (4.0%)
Idiopathic Pulmonary Fibrosis 64 (2.8%)
Alpha-1 57 (2.5%)
Re-Transplant: Not Obliterative Bronchiolitis 30 (1.3%)
Sarcoidosis 27 (1.2%)
Re-Transplant: Obliterative Bronchiolitis 24 (1.0%)
Bronchiectasis 15 (0.7%)
Obliterative Bronchiolitis
(not Re-Transplant)
8 (0.3%)
Other 212 (9.2%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA
37%
1%
3%
16%
2%
20%6%
12%
3%
COPD/Alpha-1 Congenital Heart Disease Acquired Heart Disease
Alpha-1 CF IPF
PPH Re-TX Other
8%30%
3%
3% 27%
3%
11%
15%
1982-1995 1/1996-6/2004“Other” includes OB (non-ReTX), Bronchiectasis, Sarcoidosis
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART-LUNG TRANSPLANTATIONIndications By Year (%)
0
20
40
60
80
100
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Transplant Year
% o
f T
ran
spla
nts
Congenital Heart Disease Primary Pulmonary HypertensionCystic Fibrosis COPD/Alpha-1Acquired Heart Disease
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART-LUNG TRANSPLANTATIONIndications By Year (Number)
0
50
100
150
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Transplant Year
Nu
mb
er o
f T
ran
spla
nts
Congenital Heart Disease Primary Pulmonary HypertensionCystic Fibrosis COPD/Alpha-1Acquired Heart Disease
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for Adult Recipients
(Transplants: January 1982 - June 2003)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Years
N=2,488
Half-life = 3.2 yearsConditional Half-life = 9.0 years
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2003)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al (
%)
Other Congenital (N = 174)Eisenmenger's Syndrome (N = 420)PPH (N=356)
Congenital vs. Eisenmenger's: p = 0.0004Congenital vs. PPH: p = 0.02Eisenmenger's vs. PPH: p = 0.16
HALF-LIFE Congenital: 1.2 Years; Eisenmenger's: 5.1 Years; PPH: 3.2 Years
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART-LUNG RECIPIENTSFunctional Status of Surviving Recipients
(Follow-ups: April 1994 – June 2004)
0%
20%
40%
60%
80%
100%
1 Year (N = 252) 3 Years (N = 201) 5 Years (N = 167) 7 Years (N = 142)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART-LUNG RECIPIENTSEmployment Status of Surviving Recipients
(Follow-ups: April 1994 – June 2004)
0%
20%
40%
60%
80%
100%
1 Year (N = 241) 3 Years (N = 183) 5 Years (N = 163) 7 Years (N = 122)
Working Full Time Working Part Time Not Working Retired
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2004)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N = 290)
Between 2 and 3Years (N = 216)
Between 4 and 5Years (N = 171)
Between 6 and 7Years (N = 154)
No Hospitalization Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection Only Hospitalized, Infection Only
Hospitalized, Rejection and Infection
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0
10
20
30
40
50
Any Induction (N = 66) Polyclonal ALG/ATG (N = 32)
OKT3 (N = 4) IL2R-antagonist (N = 32)
% o
f p
ati
en
tsADULT HEART-LUNG RECIPIENTS
Induction ImmunosuppressionFor follow-ups between January 2001 through June 2004
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0
10
20
30
40
50
60
Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist
% o
f p
atien
ts
2000 20012002 2003
ADULT HEART-LUNG RECIPIENTSInduction Immunosuppression (Follow-ups: January 2000 - December 2003)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
atie
nts
.
Year 1 (N = 62) Year 5 (N = 48)
ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2001 through June 2004
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0%
20%
40%
60%
80%
100%
Year 1 (N = 62) Year 5 (N = 48)
% o
f P
ati
en
ts .
Other
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine + MMF
Cyclosporine + AZA
ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression Drug Combinations at Time of Follow-up
For follow-ups between January 2001 through June 2004
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994 - June 2004)
Outcome Within 1
Year Total number with known response
Hypertension 55.6% (N = 288)
Renal Dysfunction 17.8% (N = 281)
Abnormal Creatinine < 2.5 mg/dl 10.7% Creatinine > 2.5 mg/dl 3.2% Chronic Dialysis 3.6% Renal transplant 0.4%
Hyperlipidemia 19.2% (N = 297)
Diabetes 13.0% (N = 285)
Coronary Artery Vasculopathy 2.1% (N = 242)
Bronchiolitis Obliterans 8.7% (N = 263)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant
(Follow-ups: April 1994 - June 2004)
Outcome Within 5
Years Total number with known response
Hypertension 86.9% (N = 84)
Renal Dysfunction 28.4% (N = 88)
Abnormal Creatinine < 2.5 mg/dl 17.0% Creatinine > 2.5 mg/dl 10.2% Chronic Dialysis 1.1%
Hyperlipidemia 62.9% (N = 89)
Diabetes 19.0% (N = 84)
Coronary Artery Vasculopathy 10.6% (N = 47)
Bronchiolitis Obliterans 29.2% (N = 65)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
Freedom from Coronary Artery Vasculopathy
For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2004)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
% F
ree
fro
m C
AV
.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
Freedom from Bronchiolitis Obliterans For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2004)
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
% F
ree f
rom
Bro
nch
ioliti
s O
blite
ran
s .
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
Freedom from Severe Renal Dysfunction*For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2004)
50
60
70
80
90
100
0 1 2 3 4 5
Years
% F
ree f
rom
Severe
Ren
al D
ysfu
ncti
on
.
*Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994-June 2004)
Malignancy/Type 1-Year Survivors 5-Year Survivors
No Malignancy 264 (92.0%) 77 (87.5%)
Malignancy (all types combined) 23 (8.0%) 11 (12.5%)
Malignancy Type
Skin 2 3
Lymph 16 5
Other 1 1
Type Not Reported 4 2
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
Freedom from MalignancyFor Adult Heart-Lung Recipients (Follow-ups: April 1994- June 2004)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
% F
ree
from
Mal
igna
ncy
.
All malignancy
Lymph
Skin
Other
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2004)
CAUSE OF DEATH 0-30 Days
(N = 195)
31 Days - 1 Year (N = 124)
>1 Year - 3 Years (N = 101)
>3 Years - 5 Years (N = 58)
>5 Years
(N = 94)
BRONCHIOLITIS 0 4 (3.2%) 26 (25.7%) 22 (37.9%) 21 (21.4%)
ACUTE REJECTION 3 (1.5%) 3 (2.4%) 1 (1.0%) 1 (1.7%) 1 (1.0%)
LYMPHOMA 0 3 (2.4%) 4 (4.0%) 3 (5.2%) 1 (1.0%)
MALIGNANCY, OTHER 0 1 (0.8%) 6 (5.9%) 2 (3.4%) 5 (5.1%)
CMV 0 2 (1.6%) 0 1 (1.7%) 0
INFECTION, NON-CMV 39 (20.0%) 53 (43.7%) 32 (31.7%) 3 (5.2%) 14 (14.3%)
GRAFT FAILURE 62 (31.8%) 23 (18.5%) 17 (16.8%) 9 (15.5%) 23 (23.5%)
CARDIOVASCULAR 17 (8.7%) 7 (5.6%) 5 (5.0%) 8 (13.8%) 7 (7.1%)
TECHNICAL 41 (21.0%) 2 (1.6%) 1 (1.0%) 0 0
OTHER 33 (16.9%) 26 (21.0%) 9 (8.9%) 9 (15.5%) 26 (26.5%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
HEART-LUNG TRANSPLANTATION
Pediatric Recipients
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNGRECIPIENTS (Transplants: January 1982 - June 2004)
0
10
20
30
40
50
60
70
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Recipient Age (Years)
Nu
mb
er o
f T
ran
spla
nts
.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January 1982 - June 2004)
0
5
10
15
20
25
30
35
40
45
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18-25
26-30
31+
Donor Age (Years)
Nu
mb
er o
f T
ran
spla
nts
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS
By Year of Transplant
0
5
10
15
20
25
30
35
40
4511-17 Years1-10 Years
<1 Year
Nu
mb
er o
f T
ran
spla
nts
ISHLT 2005
NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of pediatric heart-lung transplants worldwide has declined in recent years.
J Heart Lung Transplant 2005;24: 945-982
NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS
0
5
10
15
20
25
30
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Transplant Year
Nu
mb
er o
f P
edia
tric
Tra
nsp
lan
t C
ente
rs
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
39%2%
24%
5%
20%
10%Congenital
Acquired heart disease
Cystic Fibrosis
ReTX
PPH
Other
DIAGNOSIS IN PEDIATRIC HEART –LUNG TRANSPLANT RECIPIENTS (Age: 11-17 Years)
0
25
50
75
100
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
% o
f C
ases
Cystic Fibrosis Congenital PPH
“Other” includes Alpha-1, Bronchiectasis, IPF and OB (non-ReTX)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2003)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al (%
)
Congenital (N = 75)Eisenmenger's Syndrome (N = 46)PPH (N=64)
Congenital vs. Eisenmenger's: p= 0.5Congenital vs. PPH: p = 0.8Eisenmenger's vs. PPH: p = 0.7
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1982 - June 2003)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Years
Sur
viva
l (%
)
.
1-10 (N = 173)
11-17 (N = 292)
Overall (N = 479)
HALF-LIFE 1-10: 2.1 Years; 11-17: 3.3 Years
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2003)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years
1982-1988 (N=111) 1989-1993 (N=177)
1994-1998 (N=129) 1999-6/2003 (N=62)
HALF-LIFE Unconditional 1982-1988: 1.7 Years; 1989-1993: 3.0 Years; 1994-1998: 2.8 Years; 1999-6/2003: 3.0 YearsConditional 1982-1988: 8.0 Years; 1989-1993: 7.2 Years; 1994-1998: 6.1 Years; 1999-6/200: 3.0
No comparisons are statistically significant
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2004)
CAUSE OF DEATH 0-30 Days (N = 27)
31 Days - 1 Year (N = 28)
>1 Year - 3 Years (N = 25)
>3 Years - 5 Years (N = 17)
>5 Years
(N = 18)
BRONCHIOLITIS 1 (3.6%) 13 (52.0%) 8 (47.1%) 6 (33.3%)
ACUTE REJECTION 2 (7.1%)
INFECTION, NON-CMV 5 (18.5%) 9 (32.1%) 5 (20.0%) 1 (5.9%) 5 (27.8%)
GRAFT FAILURE 12 (44.4%) 2 (7.1%) 5 (20.0%) 4 (23.5%) 3 (16.7%)
CARDIOVASCULAR 2 (7.4%) 3 (10.7%) 1 (5.9%) 2 (11.1%)
TECHNICAL 3 (11.1%) 1 (3.6%)
OTHER 5 (18.5%) 10 (35.7%) 2 (8.0%) 2 (11.8%) 2 (11.1%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982