heart transplantation

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

HEART TRANSPLANTATION

Overall


NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR

189 318669

1185

21652720

3156 3380

4024 4186 4219 4382 4438 4356 4206 40873769

3436 3314 3219 3107

0

500

1000

1500

2000

2500

3000

3500

4000

450019

82

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

Num

ber

of T

rans

plan

ts


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

63

37

83

42

18

43 50

79

2314 5 5 2455

0

10

20

30

40

50

60

70

80

90

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

Num

ber o

f cen

ters

1997-19992000-6/2003


DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME

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

0

5

10

15

20

25

30

35

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

Perc

enta

ge o

f tra

nspl

ants 1997-1999

2000-6/2003


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%19

82

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

% o

f Tra

nspl

ants

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

0

5

10

15

20

25

30

35

Mea

n do

nor a

ge (y

ears

)

Mean Age

HEART TRANSPLANTS: Donor Age by Year of Transplant


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

% o

f Tr

% o

f Tra

nspl

ants

nspl

ants

0

10

20

30

40

50

60

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

Recipient Age


AGE DISTRIBUTION OF HEART TRANSPLANT RECIPIENTS BY ERA

0

10

20

30

40

50

60

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

Recipient age

% o

f tra

nspl

ants

1997-19992000-6/2003

p < 0.0001


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

0

20

40

60

80

100

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

Years

Surv

ival

(%)

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

% o

f Cas

es

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

20

40

60

80

100

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

Years

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

Surv

ival

(%)


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

0

20

40

60

80

100

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

Years

Surv

ival

(%)

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

20

40

60

80

100

0 1 2 3 4 5 6 7

Years

Surv

ival

(%)

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

20

40

60

80

100

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

Years

Surv

ival

(%)

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

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Years

Surv

ival

(%)

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

20

40

60

80

100

0 1 2 3 4 5 6

Years

Surv

ival

(%)

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)

50

60

70

80

90

100

0 1 2 3 4 5 6

Years

Surv

ival

(%)

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

20

40

60

80

100

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

>12-36months

>36-60months

>60 months

Time between previous and current transplant

1 Ye

ar P

atie

nt S

urvi

val (

%)

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

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

610

6

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

0

0.5

1

1.5

2

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

Odd

s of

1 Y

ear M

orta

lity

1995-19981999-6/2002

p = 0.01p < 0.0001



Donor Age

0

0.5

1

1.5

2

15 25 35 45 55Donor Age

Odd

s of

1 Y

ear M

orta

lity

1995-19981999-6/2002

p < 0.0001p < 0.0001



Recipient Height

0

0.5

1

1.5

2

150 160 170 180 190Recipient Height (cm)

Odd

s of

1 Y

ear M

orta

lity

1995-19981999-6/2002

p < 0.0001p = 0.14



Center volume

0

0.5

1

1.5

2

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

Odd

s of

1 Y

ear M

orta

lity

1995-19981999-6/2002

p = 0.003p < 0.0001



Ischemia time

0

0.25

0.5

0.75

1

1.25

1.5

1 2 3 4 5Ischemia time (hours)

Odd

s of

1 Y

ear M

orta

lity

1995-19981999-6/2002

p < 0.0001p = 0.004



Recipient Bilirubin

0

0.5

1

1.5

2

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

Odd

s of

1 Y

ear M

orta

lity

1995-19981999-6/2002

p = 0.03p < 0.0001



Recipient creatinine

0

0.5

1

1.5

2

0.5 1 1.5 2

Recipient creatinine (mg/dl)

Odd

s of

1 Y

ear M

orta

lity

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

0

0.5

1

1.5

2

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

Odd

s of

5 Y

ear M

orta

lity

p = 0.0001



Donor Age

0

0.5

1

1.5

2

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

Odd

s of

5 Y

ear M

orta

lity

p < 0.0001



Donor BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30 32

Donor BMI (kg/m2)

Odd

s of

5 Y

ear M

orta

lity

p = 0.05



Recipient Height

0

0.5

1

1.5

2

150 160 170 180 190Recipient Height (cm)

Odd

s of

5 Y

ear M

orta

lity

p < 0.0001



Center volume

0

0.5

1

1.5

2


Odd

s of

5 Y

ear M

orta

lity

p = 0.02



Ischemia time

0

0.25

0.5

0.75

1

1.25

1.5

1 2 3 4 5Ischemia time (hours)

Odd

s of

5 Y

ear M

orta

lity

p = 0.003




0

0.5

1

1.5

2

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

Odd

s of

5 Y

ear M

orta

lity

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

0

0.5

1

1.5

2

2.5

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

Odd

s of

5 Y

ear M

orta

lity

p < 0.0001



Donor Age

0

0.5

1

1.5

2

15 25 35 45 55Donor Age

Odd

s of

5 Y

ear M

orta

lity

p < 0.0001



Donor BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30 32

Donor BMI (kg/m2)

Odd

s of

5 Y

ear M

orta

lity

p = 0.003




0

0.5

1

1.5

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

Odd

s of

5 Y

ear M

orta

lity

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

0

0.5

1

1.5

2

2.5

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

Odd

s of

10

Year

Mor

talit

y

p < 0.0001



Donor Age

0

0.5

1

1.5

2

15 25 35 45 55Donor Age

Odd

s of

10

Year

Mor

talit

y

p < 0.0001



Donor BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30

Donor BMI (kg/m2)

Odd

s of

10

Year

Mor

talit

y

p = 0.0006



Center volume

0

0.5

1

1.5

2

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

Odd

s of

10

Year

Mor

talit

y

p = 0.007


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

0%

20%

40%

60%

80%

100%

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)

0%

20%

40%

60%

80%

100%

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)

0%

20%

40%

60%

80%

100%

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


0

10

20

30

40

50

Any Induction (N =2,391)

Polyclonal ALG/ATG (N= 1,181)

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

% o

f pat

ient

s

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


0

10

20

30

40

50

Any Induction PolyclonalALG/ATG

OKT3 IL2R-antagonist

% o

f pat

ient

s

2001 2002 1/2003-6/2003

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


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f Pat

ient

s

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


0%

20%

40%

60%

80%

100%

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

% o

f Pat

ient

s

Other

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)

0

10

20

30

40

50

60

70

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

% tr

eate

d fo

r rej

ectio

n w

ithin

1 y

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)

0

0.5

1

1.5

2

2.5

3

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

Ave

rage

num

ber o

f rej

ectio

n ep

isod

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)

0

10

20

30

40

50

60

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

% tr

eate

d fo

r rej

ectio

n w

ithin

1 y

ear

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)

0

0.5

1

1.5

2

2.5

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

Ave

rage

num

ber o

f rej

ectio

n ep

isod

es

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

10

20

30

40

50

60

70

80

90

100

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

% F

ree

from

CA

V or

Fre

edom

from

Sev

ere

Ren

al D

ysfu

nctio

n

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

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7Years

% F

ree

from

CA

V

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

100

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

% F

ree

from

Mal

igna

ncy

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

0

0.5

1

1.5

2

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

Odd

s of

CA

V by

3 Y

ears

p < 0.0001



Donor Age

0

0.5

1

1.5

2

2.5

15 20 25 30 35 40 45 50 55Donor Age

Odd

s of

CA

V by

3 Y

ears

p < 0.0001



Recipient BMI

0

0.5

1

1.5

2

18 20 22 24 26 28 30 32Recipient BMI

Odd

s of

CA

V by

3 Y

ears

p = 0.005



Center Volume

0

0.5

1

1.5

2


Odd

s of

CA

V by

3 Y

ears

p < 0.0001



Recipient Diastolic PA Pressure

0

0.5

1

1.5

2

10 15 20 25 30 35 40Recipient Diastolic PA Pressure

Odd

s of

CA

V by

3 Y

ears

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

0

0.5

1

1.5

2

2.5

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

Odd

s of

CA

V by

7 Y

ears

p = 0.007



on no CAV within 1 Year Donor Age

0

0.5

1

1.5

2

15 20 25 30 35 40 45 50 55Donor Age

Odd

s of

CA

V by

7 Y

ears

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%)

heart transplantation

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