heart transplantation

2004ISHLTJ Heart Lung Transplant 2004; 23: 796-803

HEART TRANSPLANTATION

Overall

NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR

189 318669

21652720

3156 3380

4024 4186 4219 4382 4438 4356 4206 40873769

3436 3314 3219 3107

450019

AVERAGE CENTER VOLUMEHeart Transplants: January 1, 1997 - June 30, 2003

2314 5 5 2455

1-4 5-9 10-19 20-29 30-39 40-49 50-74 75+Average number of heart transplants per year

1997-19992000-6/2003

DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME

Heart Transplants: January 1, 1997 - June 30, 2003

1-4 5-9 10-19 20-29 30-39 40-49 50-74 75+Average number of heart transplants per year

ants 1997-1999

2000-6/2003

100%19

0-10 11-17 18-35 36-49 50-59 60+

Mean Age

HEART TRANSPLANTS: Donor Age by Year of Transplant

AGE DISTRIBUTIONOF HEART RECIPIENTS (1/1982-6/2003)

<1 1-5 6-10 11-17 18-34 35-49 50-64 65+

Recipient Age

AGE DISTRIBUTION OF HEART TRANSPLANT RECIPIENTS BY ERA

<1 1-5 6-10 11-17 18-34 35-49 50-64 65+

Recipient age

1997-19992000-6/2003

p < 0.0001

HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2002)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Half-life = 9.4 yearsConditional Half-life = 12.0 years

N=62,952

HEART TRANSPLANTATION

Adult Recipients

Congenital2%

ReTX2%

Myopathy45%

Misc.1%

Valvular4%

CAD46%

1982-1999

DIAGNOSIS IN ADULT HEART TRANSPLANTS

203040506070

Myopathy CAD

Congenital2%

ReTX2%

Myopathy46%

Misc.2%

Valvular3%

CAD45%

1/2000-6/2003

ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2002)

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

1982-1988 (N=9,143)1989-1993 (N=17,869)1994-1998 (N=18,557)1999-6/2002 (N=10,234)

All comparisons significant at p < 0.01

HALF-LIFE 1982-1988: 8.1 years; 1989-1993: 9.5 years; 1994-1998: 9.1 years

ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1982-6/2002)

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

18-34 (N= 5,858) 35-49 (N=16,337)50-64 (N=30,600) 65-69 (N= 2,511)70+ (N= 250)

HALF-LIFE 18-34: 11.5 years; 35-49: 10.1 years; 50-64: 8.9 years; 65-69: 8.1 years; 70+: 5.9 years

All pair-wise comparisons are statistically significant at p < 0.001 except 18-34 vs. 35-49 and 65-69 vs. 70+

ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1996-6/2002)

0 1 2 3 4 5 6 7

18-34 (N= 1,916) 35-49 (N= 5,066)50-64 (N=12,182) 65-69 (N= 1,543)70+ (N= 183)

All pair-wise comparisons are statistically significant at p < 0.05 except 18-34 vs. 50-64, 18-34 vs. 70+ and 65-69 vs. 70+

ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: 1/1982-6/2002)

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

Male (N=45,017) Female (N=10,427)

HALF-LIFE Male: 9.3 years; Female: 9.7 years

p < 0.0001

ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1982-6/2002)

0 1 2 3 4 5 6 7 8 9 10

Cardiomyopathy (N = 24,147) Coronary artery disease (N = 24,663)Congenital diagnosis (N = 899) Retransplant (1,070)Valvular (N= 1,929) Other (N= 610)

All pair-wise comparisons with Cardiomyopathy are significant at p < 0.05 except for Congenital and Other; Coronary Artery Disease vs. ReTX: p < 0.0001; Valvular vs. ReTX: p < 0.0001; Congenital vs. ReTX: p < 0.0001; Other vs. ReTX: p < 0.0001

HALF-LIFE Cardiomyopathy: 10.5 years; CAD: 8.7 years; Congenital: 11.5 years; Retransplant: 4.2 years; Valvular: 10.0 years; Other: 10.9 years

ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1996-6/2002)

0 1 2 3 4 5 6

Cardiomyopathy (N=9,310) Coronary artery disease (N=9,427)Congenital Diagnosis (N=379) Retransplant (N=408)Valvular (N=619) Other (N=273)

All pair-wise comparisons with Cardiomyopathy are significant at p < 0.05 except for Valvular; Coronary Artery Disease vs. ReTX: p = 0.0001

ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by PVR (Transplants: 1/1996-6/2002)

0 1 2 3 4 5 6

1-<3 (N= 6,571) 3-<5 (N= 2,200) 5+ (N= 869)

1-3 vs. 3-5: p = 0.091-3 vs. 5+: p = 0.023-5 vs. 5+: p = 0.3

0-2 months >2-6 months >6-12months

>12-36months

>36-60months

>60 months

Time between previous and current transplant

1/1982-12/19901/1991-12/19951/1996-6/2002

Comparison of survival for interval < 12 months vs. > 12 months: p < 0.000112

32 19 2231 66 483736 25 109

74 18 7 62 56 269

ADULT HEART RE-TRANSPLANTS1-Year Survival

ADULT HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality

1995-1998 (N=13,523)

1999-6/2002 (N=7,067)

Factor Odds Ratio p-value Odds

Ratio p-value

Dialysis 2.11 0.0001 2.52 <.0001

Diagnosis: Congenital heart disease 1.97 0.0002 2.66 <.0001

Ventilator 1.85 0.0002 2.47 <.0001

Repeat transplant 1.76 <.0001 1.08 0.7

Intra-aortic balloon pump 1.46 0.002 1.23 0.2

1995-1998 (N=13,523)

1999-6/2002 (N=7,067)

Factor Odds Ratio p-value Odds

Ratio p-value

Diagnosis: Other (excluding Cardiomyopathy) 1.35 0.0011 1.42 0.0105

Donor history of cancer 1.33 0.21 1.78 0.0124

Diagnosis: Coronary artery disease 1.31 <.0001 1.05 0.5

In hospital (including ICU) 1.26 0.0009 1.42 <.0001

Infection requiring IV drug therapy within 2 weeks of transplant 1.25 0.05 1.02 0.8576

1995-1998 (N=13,523)

1999-6/2002 (N=7,067)

Factor Odds Ratio

p-value

Odds Ratio

p-value

HLA B mismatches (per mismatch) 1.22 0.0002 1.13 0.1102

Prior transfusions 1.21 0.046 1.25 0.06

Donor CMV+/Recipient CMV - 1.20 0.0011 1.34 0.0003

PRA > 10% 1.19 0.13 1.43 0.02

HLA DR mismatches (per mismatch) 1.15 0.0013 1.1 0.1336

1995-1998 (N=13,523)

1999-6/2002 (N=7,067)

Factor Odds Ratio

p-value

Odds Ratio

p-value

Insulin dependent diabetes 1.13 0.3 1.41 0.02

Female donor 1.11 0.0433 1.07 0.3736

Sternotomy 0.86 0.03 1.01 0.8948

IV inotropes 0.83 0.005 0.83 0.04

Continuous Factors (see figures)

Recipient age

Recipient height

Donor age

Ischemia time

Transplant center volume

Bilirubin

Serum creatinine

Recipient Age

20 25 30 35 40 45 50 55 60 65Recipient Age

1995-19981999-6/2002

p = 0.01p < 0.0001

Donor Age

15 25 35 45 55Donor Age

1995-19981999-6/2002

p < 0.0001p < 0.0001

Recipient Height

150 160 170 180 190Recipient Height (cm)

1995-19981999-6/2002

p < 0.0001p = 0.14

Center volume

0 10 20 30 40 50 60 70Center Volume (cases per year)

1995-19981999-6/2002

p = 0.003p < 0.0001

Ischemia time

1 2 3 4 5Ischemia time (hours)

1995-19981999-6/2002

p < 0.0001p = 0.004

Recipient Bilirubin

0.5 1.5 2.5 3.5 4.5Recipient bilirubin (mg/dl)

1995-19981999-6/2002

p = 0.03p < 0.0001

Recipient creatinine

0.5 1 1.5 2

Recipient creatinine (mg/dl)

1995-19981999-6/2002

p < 0.0001p < 0.0001

ADULT HEART TRANSPLANTS (1/1995-6/2002) Factors Not Significant for 1 Year Mortality

Recipient Factors:VAD, ABO identical/compatible, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, cardiac output, weight

Donor Factors:Clinical infection, history of cancer, history of hypertension, history of diabetes, height, weight, cause of death

Transplant Factors:Donor/recipient BMI ratio, donor/recipient weight ratio

ADULT HEART TRANSPLANTS (1995-6/1998) Risk Factors for 5 Year Mortality

VARIABLE Odds Ratio P-value

95% Confidence

Interval

Repeat Transplant 1.93 <.0001 1.46 2.55

Dialysis 1.80 0.004 1.21 2.68

Intra-aortic balloon pump 1.66 0.02 1.07 2.55

Ventilator 1.62 0.008 1.14 2.32

(N=11,963)

95% Confidence

Interval

Diagnosis: Congenital heart disease 1.51 0.02 1.07 2.13

Infection requiring IV drug therapy within 2 weeks of transplant 1.37 0.002 1.12 1.68

Diagnosis: Coronary artery disease 1.29 <.0001 1.16 1.42

Diagnosis: Other (excluding Cardiomyopathy) 1.19 0.04 1.01 1.41

Diabetes 1.19 0.02 1.03 1.37

(N=11,963)

95% Confidence

Interval

HLA DR Mismatches (per mismatch) 1.12 0.006 1.03 1.21

HLA B Mismatches (per mismatch) 1.11 0.03 1.01 1.22

IV inotropes 0.87 0.02 0.77 0.98

Sternotomy 0.85 0.005 0.75 0.95

(N=11,963)

Continuous Factors (see figures) Recipient age Recipient height Donor age Donor BMI

Ischemia time Transplant center volume Serum creatinine Wedge pressure

Recipient Age

20 25 30 35 40 45 50 55 60 65Recipient Age

p = 0.0001

Donor Age

10 15 20 25 30 35 40 45 50 55 60Donor Age

p < 0.0001

Donor BMI

18 20 22 24 26 28 30 32

Donor BMI (kg/m2)

p = 0.05

Recipient Height

150 160 170 180 190Recipient Height (cm)

p < 0.0001

Center volume

p = 0.02

Ischemia time

1 2 3 4 5Ischemia time (hours)

p = 0.003

0.5 1 1.5 2 2.5Recipient creatinine (mg/dl)

p < 0.0001

Recipient Factors:VAD, in hospital, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, PA diastolic, PVR, history of malignancy, weight, gender, history of malignancy, bilirubin, PCW

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

Transplant Factors:Donor/recipient BMI ratio, donor/recipient height ratio, CMV mismatch, ABO identical/compatible

ADULT HEART TRANSPLANTS (1995-6/1998) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

95% Confidence Interval

Previous transplant 2.19 0.0002 1.45 -3.28

CAV during 1st year 1.62 0.0001 1.25 -2.08

Cerebrovascular disease at transplant 1.59 0.002 1.19 -2.14

Treated for rejection during 1st year 1.44 <0.0001 1.22 -1.71

Treated for infection prior to transplant discharge 1.37 0.004 1.15 -1.64

Diagnosis: Coronary Artery Disease 1.25 0.003 1.08 -1.44

CMV mismatch (Donor+/Recipient-) 0.83 0.009 0.72 -0.95

(N=9,182)

ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year

Recipient age Donor age

Donor BMI Serum creatinine

ADULT HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

Recipient Age

20 25 30 35 40 45 50 55 60 65Recipient Age

p < 0.0001

Donor Age

15 25 35 45 55Donor Age

p < 0.0001

Donor BMI

18 20 22 24 26 28 30 32

Donor BMI (kg/m2)

p = 0.003

0.6 0.8 1 1.2 1.4 1.6 1.8 2 2.2 2.4Creatinine (mg/dl)

p = 0.005

Conditional on Survival to 1 Year

Recipient Factors:VAD, ventilator, in hospital, IV inotropes, balloon, ABO identical/compatible, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, PA diastolic, PCW, PVR, history of malignancy, height, weight, gender, diabetes, PRA, bilirubin

ADULT HEART TRANSPLANTS (1/1995-6/1998) Factors Not Significant for 5 Year Mortality Conditional on

Survival to 1 YearDonor Factors:Gender, cause of death, clinical infection, history of cancer, history of hypertension, history of diabetes

Transplant Factors:Donor/recipient BMI ratio, donor/recipient height ratio, CMV mismatch, HLA mismatch, center volume, ischemia time

Post-transplant Factors:Dialysis, prolonged graft dysfunction, permanent pacemaker

ADULT HEART TRANSPLANTS (1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years

95% Confidence Interval

Previous transplant 1.76 0.012 1.13 -2.74

Previous pregnancy 1.39 0.03 1.03 -1.86

Diagnosis: Coronary artery disease 1.34 <0.0001 1.18 -1.52

Female recipient 0.73 0.015 0.56 -0.94

Diagnosis: Congenital heart disease 0.39 0.01 0.19 -0.81

(N=5,952)

ADULT HEART TRANSPLANTS (1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years

Recipient age Donor age

Donor BMI Center volume

ADULT HEART TRANSPLANTS (1/1990-6/1992) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years

Recipient Age

20 25 30 35 40 45 50 55 60 65Recipient Age

p < 0.0001

Donor Age

15 25 35 45 55Donor Age

p < 0.0001

Donor BMI

18 20 22 24 26 28 30

Donor BMI (kg/m2)

p = 0.0006

Center volume

0 20 40 60 80 100Center Volume (cases per year)

p = 0.007

ADULT HEART RECIPIENTS Functional Status (Follow-ups: January 1996 - June 2003)

1 Year (N = 14,353) 3 Years (N =12,6286)

5 Years (N =10,668)

7 Years (N = 8,054)

No Activity Limitations Performs with Some Assistance Requires Total Assistance

ADULT HEART RECIPIENTSEmployment Status (Follow-ups: January 1996-June 2003)

1 Year (N = 13,542) 3 Year (N = 11,741) 5 Year (N = 9,831) 7 Year (N = 7,490)

Retired

Not Working

Working Part Time

Working Full Time

ADULT HEART RECIPIENTSRehospitalization Post-transplant (Follow-ups: January 1996 - June 2003)

Up to 1 Year (N =15,704)

Between 2 and 3 Years (N = 13,392)

No Hospitalization Hospitalized: Not Rejection/Not InfectionHospitalized: Rejection Only Hospitalized: Infection OnlyHospitalized: Rejection + Infection

Any Induction (N =2,391)

Polyclonal ALG/ATG (N= 1,181)

OKT3 (N = 318) IL2R-antagonist (N =974)

ADULT HEART RECIPIENTSInduction Immunosuppression (Follow-ups: January 2001 – June 2003)

Any Induction PolyclonalALG/ATG

OKT3 IL2R-antagonist

2001 2002 1/2003-6/2003

ADULT HEART RECIPIENTSInduction Immunosuppression (Follow-ups: January 2001 - June 2003)

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

Year 1 (N = 3,888) Year 5 (N = 3,271)

ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up

For follow-ups between January 2001 through June 2003

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

Year 1 (N = 3,967) Year 5 (N = 3,351)

Tacrolimus + MMF

Tacrolimus + AZA

Cyclosporine + MMF

Cyclosporine + AZA

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

For follow-ups between January 2001 through June 2003

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

PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEARStratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2002)

Overall 18-34 35-49 50-64 65+ F M

ear No induction Polyclonal

IL2R-antagonist OKT3

For female: no induction vs. OKT3 (p = 0.006); polyclonal vs. OKT3 (p = 0.005); IL2R vs. OKT3 (p = 0.016)For male: no induction vs. OKT3 (p = 0.002); polyclonal vs. OKT3 (p = 0.002); IL2R vs. OKT3 (p = 0.003)

For the 50-64 age group: all comparisons with OKT3 were significant at p < 0.0001. No other comparisons within age groups were statistically significant.

NUMBER OF REJECTION EPISODES FOR ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR

Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2002)

Overall 18-34 35-49 50-64 65+ F M

es No induction Polyclonal IL2R-antagonist OKT3

35-49: IL2R vs. OKT3 (p = 0.03); 50-64: No induction vs. OKT3 (p = 0.04); polyclonal vs. OKT3 (p = 0.02)Male: Polyclonal vs. OKT3 (p = 0.02); IL2R vs. OKT3 (p = 0.004)

PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR

Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2002)

Overall 18-34 35-49 50-64 65+ F M

Cyclosporin + MMF Cyclosporin + AZATacrolimus + MMF Tacrolimus + AZA

35-49: CyA + MMF vs. TAC + MMF (p = 0.0001); CyA + AZA vs. TAC + MMF (p = 0.03)50-64: CyA + MMF vs. TAC + MMF and CyA + AZA vs. TAC + MMF p < 0.0001Male: CyA + MMF vs. TAC + MMF and CyA + AZA vs. TAC + MMF p < 0.0001

NUMBER OF REJECTION EPISODES FOR ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2002)

Overall 18-34 35-49 50-64 65+ F M

Cyclosporin + MMF Cyclosporin + AZATacrolimus + MMF Tacrolimus + AZA

No within-age group comparisons were statistically significant.Male: CyA + AZA vs. TAC + MMF (p = 0.009)

POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant

(Follow-ups: April 1994 - June 2003)

Outcome Within 1 Year

Total number with known response

Hypertension 73.2% (N = 15,305)

Renal Dysfunction 26.2% (N = 15,249) Abnormal Creatinine < 2.5 mg/dl 16.2% Creatinine > 2.5 mg/dl 8.6% Chronic Dialysis 1.3% Renal Transplant 0.2%

Hyperlipidemia 52.0% (N = 16,178)

Diabetes 25.0% (N = 15,300)

CAV 7.9% (N = 13,812)

POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant

Outcome Within 5 Years

Diabetes 32.8% (N = 5,128)

CAV 32.9% (N = 3,644)

POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 7 Years Post-Transplant

Outcome Within 7 Years

Diabetes 35.0% (N = 2,362)

CAV 43.0% (N = 1,510)

FREEDOM FROM CAV AND FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Adult Heart Recipients (Follow-ups: January 1996-June 2003)

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5Years

Freedom from CAVFreedom from Severe Renal Dysfunction

* Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant

FREEDOM FROM CAV Stratified by Diagnosis

For Adult Heart Recipients (Follow-ups: January 1996-June 2003)

0 1 2 3 4 5 6 7Years

Coronary Artery Disease (N = 8,195)Cardiomyopathy (N = 7,924)

p = 0.005

MALIGNANCY POST-HEART TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994-June 2003)

Malignancy/Type 1-Year Survivors

5-Year Survivors

7-Year Survivors

No Malignancy 15396 (96.8%) 4697 (83.1%) 1994 (75.9%)Malignancy (all types combined) 502 (3.2%) 957 (16.9%) 633 (24.1%)

Malignancy Type

Skin 228 639 462Lymph 119 105 57

Other 109 228 157Type Not Reported 46 39 15

”Other” includes: prostate (11, 33, 25), adenocarcinoma (7, 4, 2), lung (5, 3, 2), bladder (4, 5, 5), sarcoma (3, 3, 1), breast (2, 8, 6), cervical (2, 4, 1), colon (2, 2, 3), and renal (2, 7, 3). Numbers in parentheses are those reported within 1 year, 5 years and 7 years, respectively.

FREEDOM FROM MALIGNANCYFor Adult Heart Recipients (Follow-ups: April 1994 - June 2003)

0102030405060708090

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5Years

All malignancy Lymph Skin Other

ADULT HEART TRANSPLANTS (1996-6/2000) Risk Factors for Developing CAV within 3 Years

95% Confidence

Interval

Donor history of hypertension 1.47 0.0002 1.20 -1.80

Diagnosis: Coronary artery disease 1.17 0.03 1.01 -1.36

Female recipient 0.81 0.048 0.66 -1.00

Female donor 0.72 0.0002 0.60 -0.86

(N=5,787)

Continuous Factors (see figures) Recipient age Donor age Recipient BMI

Transplant center volume Diastolic PA pressure

Recipient Age

20 25 30 35 40 45 50 55 60 65Recipient Age

p < 0.0001

Donor Age

15 20 25 30 35 40 45 50 55Donor Age

p < 0.0001

Recipient BMI

18 20 22 24 26 28 30 32Recipient BMI

p = 0.005

Center Volume

p < 0.0001

Recipient Diastolic PA Pressure

10 15 20 25 30 35 40Recipient Diastolic PA Pressure

p = 0.04

ADULT HEART TRANSPLANTS (1995-6/1996) Risk Factors for Developing CAV within 7 Years Conditional

on no CAV within 1 Year

95% Confidence

Interval

Donor history of hypertension 1.72 0.02 1.08 -2.73

Recipient rejection during 1st year 1.45 0.02 1.05 -2.00

Diagnosis: coronary artery disease 1.39 0.03 1.04 -1.87

DR mismatches (per mismatch) 1.34 0.03 1.02 -1.75

(N=1,414)

on no CAV within 1 Year

Continuous Factors (see figures) Recipient age Donor age

on no CAV within 1 Year Recipient Age

20 25 30 35 40 45 50 55 60 65Recipient Age

p = 0.007

on no CAV within 1 Year Donor Age

15 20 25 30 35 40 45 50 55Donor Age

p = 0.0009

ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2003)

CAUSE OF DEATH 0-30 Days (N = 2,759 )

31 Days - 1 Year (N = 2,310 )

>1 Year - 3 Years (N = 1,737 )

>3 Years - 5 Years (N = 1,492 )

>5 Years (N = 4,009 )

CAV 43 (1.6%) 111 (4.8%) 257 (14.8%) 268 (18.0%) 651 (16.2%)

ACUTE REJECTION 188 (6.8%) 288 (12.5%) 165 (9.5%) 63 (4.2%) 43 (1.1%)

LYMPHOMA 2 (0.1%) 46 (2.0%) 77 (4.4%) 80 (5.4%) 201 (5.0%)

MALIGNANCY, OTHER 2 (0.1%) 49 (2.1%) 181 (10.4%) 281 (18.8%) 763 (19.0%)

CMV 4 (0.1%) 29 (1.3%) 15 (0.9%) 3 (0.2%) 4 (0.1%)

INFECTION, NON-CMV 370 (13.4%) 784 (33.9%) 234 (13.5%) 145 (9.7%) 393 (9.8%)

PRIMARY FAILURE 747 (27.1%) 186 (8.1%) 119 (6.9%) 68 (4.6%) 200 (5.0%)

GRAFT FAILURE 400 (14.5%) 245 (10.6%) 298 (17.2%) 218 (14.6%) 567 (14.1%)

TECHNICAL 208 (7.5%) 28 (1.2%) 15 (0.9%) 17 (1.1%) 43 (1.1%)

OTHER 101 (3.7%) 122 (5.3%) 123 (7.1%) 104 (7.0%) 240 (6.0%)

MULTIPLE ORGAN FAILURE 382 (13.8%) 228 (9.9%) 86 (5.0%) 83 (5.6%) 335 (8.4%)

RENAL FAILURE 17 (0.6%) 19 (0.8%) 31 (1.8%) 51 (3.4%) 238 (5.9%)

PULMONARY 116 (4.2%) 77 (3.3%) 77 (4.4%) 60 (4.0%) 163 (4.1%)

CEREBROVASCULAR 179 (6.5%) 98 (4.2%) 59 (3.4%) 51 (3.4%) 168 (4.2%)

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