heart-lung transplantation overall ishlt 2006 j heart lung transplant 2006;25: 880-892
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HEART-LUNG TRANSPLANTATION
Overall
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
0
50
100
150
200
250
Num
ber
of T
rans
plan
ts
NUMBER OF HEART-LUNG
TRANSPLANTS REPORTED BY YEAR
ISHLT 2006
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 2006;25: 880-892
AVERAGE CENTER VOLUMEHeart-Lung Transplants: January 1, 1998 - June 30, 2005
40
32
12
3 20
5
10
15
20
25
30
35
40
1 2 3 4-9 10+
Average number of heart-lung transplants per year
Nu
mb
er
of
ce
nte
rs
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY CENTER VOLUME
Heart-Lung Transplants: January 1, 1998 - June 30, 2005
0
5
10
15
20
25
30
35
1 2 3 4-9 10+
Average number of heart-lung transplants per year
Pe
rce
nta
ge
of
he
art
-lu
ng
tra
ns
pla
nts
s
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME
Lung Transplants: January 1, 1998 - June 30, 2005
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
Pe
rce
nta
ge
of
he
art
-lu
ng
tra
ns
pla
nts
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1982 - June 2004)
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=3,086
Half-life = 3.1 yearsConditional Half-life = 8.7 years
Su
rviv
al (
%)
ISHLT 2006
N alive at 18 years = 18
J Heart Lung Transplant 2006;25: 880-892
HEART-LUNG TRANSPLANTATION
Adult Recipients
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
Acquired heart disease
4%Congenital heart disease
33%
COPD/Alpha-16%
CF16%
IPF3%
PPH24%
Re-transplant2%
Other 12%
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (1/1982-6/2005)
“Other” includes cancer, LAM, OB, sarcoidosis, bronchiectasis
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2005)
Diagnosis N (%)
Congenital Heart Disease 702 (32.2%)
Primary Pulmonary Hypertension 531 (24.4%)
Cystic Fibrosis 342 (15.7%)
Acquired Heart Disease 97 ( 4.5%)
COPD/Emphysema 83 ( 3.8%)
Idiopathic Pulmonary Fibrosis 62 ( 2.8%)
Alpha-1 38 ( 1.7%)
Re-Transplant: Not Obliterative Bronchiolitis 29 ( 1.3%)
Sarcoidosis 28 ( 1.3%)
Re-Transplant: Obliterative Bronchiolitis 23 ( 1.1%)
Bronchiectasis 14 ( 0.6%)
Obliterative Bronchiolitis
(not Re-Transplant)
9 ( 0.4%)
Other 221 (10.1%)
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1982-1995 1996-1999 2000-2005
% o
f T
ran
sp
lan
ts
Other
Re-TX
PPH
IPF
CF
Acquired Heart Disease
Congenital Heart Disease
COPD/Alpha-1
“Other” includes OB (non-ReTX), Bronchiectasis, Sarcoidosis
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
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
2004
Transplant Year
% o
f T
ran
spla
nts
Congenital Heart Disease Primary Pulmonary HypertensionCystic Fibrosis COPD/Alpha-1Acquired Heart Disease
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
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
2004
Transplant Year
Nu
mb
er o
f T
ran
spla
nts
Congenital Heart Disease Primary Pulmonary HypertensionCystic Fibrosis COPD/Alpha-1Acquired Heart Disease
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for Adult Recipients
(Transplants: January 1982 - June 2004)
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=2,496
Half-life = 3.5 yearsConditional Half-life = 9.0 years
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for Adult Recipients by Era
(Transplants: January 1982 - June 2004)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
1982-1995 (N=1,633)
1996-1999 (N=491)
2000-6/2004 (N=372)
Half-life: 1982-1995 = 3.1 years; 1996-1999 = 3.6 years; 2000-6/2005 = 5 yearsConditional Half-life: 1982-1995 = 8.9 years
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
ADULT HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2004)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al (
%)
Other Congenital (N = 179)Eisenmenger's Syndrome (N = 377)PPH (N=322)
Congenital vs. Eisenmenger's: p = 0.0035Congenital vs. PPH: p = 0.049Eisenmenger's vs. PPH: p = 0.25
HALF-LIFE Congenital: 1.5 Years; Eisenmenger's: 5.4 Years; PPH: 3.4 Years
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
ADULT HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year
(Transplants: January 1990 – June 2004)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al (
%)
Other Congenital (N = 90)Eisenmenger's Syndrome (N = 240)PPH (N=197)
No comparisons were statistically different.
HALF-LIFE Congenital: 8.4 Years; Eisenmenger's: 10.0 Years; PPH: 9.1 Years
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
ADULT HEART-LUNG RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: April 1994 – June 2005)
0%
20%
40%
60%
80%
100%
1 Year (N = 258) 3 Years (N = 207) 5 Years (N = 177) 7 Years (N = 148)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
ADULT HEART-LUNG RECIPIENTSEmployment Status of Surviving Recipients
(Follow-ups: April 1994 – June 2005)
0%
20%
40%
60%
80%
100%
1 Year (N = 254) 3 Years (N = 191) 5 Years (N = 174) 7 Years (N = 134)
Working Full Time Working Part Time Not Working Retired
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
ADULT HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2005)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N = 302)
Between 2 and 3Years (N = 228)
Between 4 and 5Years (N = 188)
Between 6 and 7Years (N = 164)
No Hospitalization Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection Only Hospitalized, Infection Only
Hospitalized, Rejection and Infection
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
0
5
10
15
20
25
30
35
40
45
50
55
Any Induction (N = 88) Polyclonal ALG/ATG (N= 42)
OKT3 (N = 5) IL2R-antagonist (N =43)
% o
f p
ati
en
tsADULT HEART-LUNG RECIPIENTS
Induction ImmunosuppressionFor transplants between January 2001 through June 2005
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
0
10
20
30
40
50
60
Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist
% o
f p
ati
en
ts
2000 2001 20022003 2004
ADULT HEART-LUNG RECIPIENTSInduction Immunosuppression (Transplants: January 2000 - December 2004)
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
0
10
20
30
40
50
60
20002001
20022003
20042000
20012002
20032004
20002001
20022003
20042000
20012002
20032004
% o
f p
atie
nts
ADULT HEART-LUNG RECIPIENTS
Induction Immunosuppression (Transplants: January 2000 - December 2004)
ISHLT 2006
Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist
J Heart Lung Transplant 2006;25: 880-892
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
atie
nts
Year 1 (N = 80) Year 5 (N = 58)
ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2001 through June 2005
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
0%
20%
40%
60%
80%
100%
Year 1 (N = 75) Year 5 (N = 63)
% 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 2005
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994 - June 2005)
Outcome Within 1
Year Total number with known response
Hypertension 55.3% (N = 300)
Renal Dysfunction 17.9% (N = 296)
Abnormal Creatinine < 2.5 mg/dl 10.5% Creatinine > 2.5 mg/dl 3.4% Chronic Dialysis 3.7% Renal transplant 0.3%
Hyperlipidemia 19.5% (N = 313)
Diabetes 14.0% (N = 300)
Coronary Artery Vasculopathy 2.4% (N = 250)
Bronchiolitis Obliterans 9.4% (N = 278)
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant
(Follow-ups: April 1994 - June 2005)
Outcome Within 5 Years
Total number with known response
Hypertension 87.5% (N = 96)
Renal Dysfunction 27.7% (N = 101)
Abnormal Creatinine < 2.5 mg/dl 18.8% Creatinine > 2.5 mg/dl 7.0% Chronic Dialysis 1.0% Renal Transplant 0.0%
Hyperlipidemia 64.7% (N = 102)
Diabetes 21.6% (N = 97)
Coronary Artery Vasculopathy 8.9% (N = 56)
Bronchiolitis Obliterans 28.2% (N = 78)
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
Freedom from Coronary Artery Vasculopathy
For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2005)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
% F
ree
fro
m C
AV
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
Freedom from Bronchiolitis Obliterans For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2005)
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
% F
ree
fro
m B
ron
ch
ioli
tis
Ob
lite
ran
s
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
Freedom from Severe Renal Dysfunction*For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2005)
50
60
70
80
90
100
0 1 2 3 4 5
Years
% F
ree
fro
m S
ev
ere
Re
na
l D
ys
fun
cti
on
*Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994-June 2005)
Malignancy/Type 1-Year Survivors
5-Year Survivors
10-Year Survivors
No Malignancy 278 (91.7%) 90 (89.1%) 47 (83.9%)
Malignancy (all types combined) 25 (8.3%) 11 (10.9%) 9 (16.1%)
Malignancy Type
Skin 2 3 5
Lymph 18 5 2
Other 1 1 1
Type Not Reported 4 2 1
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
Freedom from MalignancyFor Adult Heart-Lung Recipients (Follow-ups: April 1994- June 2005)
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 2006 J Heart Lung Transplant 2006;25: 880-892
ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2005)
CAUSE OF DEATH 0-30 Days
(N = 205)
31 Days - 1 Year (N = 127)
>1 Year - 3 Years (N = 100)
>3 Years - 5 Years (N = 59)
>5 Years
(N = 106)
BRONCHIOLITIS 0 5 (3.9%) 26 (26.0%) 23 (39.0%) 21 (19.8%)
ACUTE REJECTION 2 (1.0%) 3 (2.4%) 1 (1.0%) 0 1 (0.9%)
LYMPHOMA 0 4 (3.1%) 4 (4.0%) 3 (5.1%) 1 (0.9%)
MALIGNANCY, OTHER 0 1 (0.8%) 6 (6.0%) 2 (3.4%) 5 (4.7%)
CMV 0 1 (0.8%) 0 1 (1.7%) 0
INFECTION, NON-CMV 39 (19.0%) 52 (40.9%) 31 (31.0%) 3 (5.1%) 16 (15.1%)
GRAFT FAILURE 64 (31.2%) 26 (20.5%) 17 (17.0%) 10 (16.9%) 27 (25.5%)
CARDIOVASCULAR 19 (9.3%) 7 (5.5%) 5 (5.0%) 7 (11.9%) 8 (7.5%)
TECHNICAL 39 (19.0%) 2 (1.6%) 1 (1.0%) 1 (1.7%) 0
OTHER 42 (20.5%) 26 (20.5%) 9 (9.0%) 9 (15.3%) 27 (25.5%)
ISHLT 2006 J Heart Lung Transplant 2006;25: 880-892
HEART-LUNG TRANSPLANTATION
Pediatric Recipients
ISHLT 2006 J Heart Lung Transplant 2006;25:904-911
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNGRECIPIENTS (Transplants: January 1982 - June 2005)
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 2006 J Heart Lung Transplant 2006;25:904-911
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January 1982 - June 2005)
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 2006 J Heart Lung Transplant 2006;25:904-911
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS
By Year of Transplant
0
5
10
15
20
25
30
35
40
45
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
11-17 Years1-10 Years
<1 Year
Nu
mb
er o
f T
ran
spla
nts
ISHLT 2006
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 2006;25:904-911
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS
By Era of Transplant
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1982-1995 1996-6/2005
11-17 Years
1-10 Years
<1 Year
Per
cen
tag
e o
f T
ran
spla
nts
ISHLT 2006 J Heart Lung Transplant 2006;25:904-911
NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS
0
5
10
15
20
25
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Transplant Year
Nu
mb
er o
f P
edia
tric
Tra
nsp
lan
t C
ente
rs
ISHLT 2006 J Heart Lung Transplant 2006;25:904-911
9%
25%21%
16%
1%
2% 20%
3%
3%
Acquired Heart Disease
CF
Congenital (other)Eisenmenger's Syndrome
IPF
Other
PPHRetx: Non-OB
Retx: OB
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 2004
% o
f C
ases
Cystic Fibrosis Congenital PPH
“Other” includes Bronchiectasis, Alpha-1, and OB (non-ReTX)
ISHLT 2006 J Heart Lung Transplant 2006;25:904-911
PEDIATRIC HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2004)
0
25
50
75
100
0 1 2 3 4 5 6 7Years
Su
rviv
al
(%)
Congenital (N = 74)Eisenmenger's Syndrome (N = 37)PPH (N=68)
Congenital vs. Eisenmenger's: p= 0.4Congenital vs. PPH: p = 0.4Eisenmenger's vs. PPH: p = 0.9
ISHLT 2006 J Heart Lung Transplant 2006;25:904-911
PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1982 - June 2004)
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 (N = 12)
1-10 (N = 164)
11-17 (N = 267)
Overall (N = 443)
HALF-LIFE 1-10: 2.0 Years; 11-17: 3.3 Years
ISHLT 2006 J Heart Lung Transplant 2006;25:904-911
PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2004)
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=99)) 1989-1993 (N=158)
1994-1998 (N=116) 1999-6/2004 (N=68)
HALF-LIFE Unconditional 1982-1988: 1.7 Years; 1989-1993: 2.9 Years; 1994-1998: 3.2 Years; 1999-6/2004: 3.0 YearsConditional 1982-1988: 8.0 Years; 1989-1993: 7.2 Years; 1994-1998: 6.1 Years; 1999-6/2004: .
No comparisons are statistically significant
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25:904-911
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2005)
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%) 14 (53.8%) 8 (47.1%) 7 (35.0%)
ACUTE REJECTION 2 (7.1%)
INFECTION, NON-CMV 5 (19.2%) 9 (32.1%) 5 (19.2%) 1 (5.9%) 5 (25.0%)
GRAFT FAILURE 13 (50.0%) 2 (7.1%) 5 (19.2%) 5 (29.4%) 3 (15.0%)
CARDIOVASCULAR 2 (7.7%) 3 (10.7%) 1 (5.9%) 2 (10.0%)
TECHNICAL 3 (11.5%) 1 (3.6%)
OTHER 3 (11.5%) 10 (35.7%) 2 (7.7%) 2 (11.8%) 3 (15.0%)
ISHLT 2006 J Heart Lung Transplant 2006;25:904-911
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