heart transplantation overall ishlt 2008 j heart lung transplant 2008;27: 937-983
TRANSCRIPT
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HEART TRANSPLANTATION
Overall
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
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NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR
189 318665
1182
2159
2713
31363363
40034171 4203
4364 4429 4396 4263 41993864
3581 3433 3390 3283 3226 3065 3185 3205
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Nu
mb
er
of
Tra
ns
pla
nts
ISHLT 2008
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 hearts transplanted worldwide has declined in recent years.
J Heart Lung Transplant 2008;27: 937-983
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AVERAGE CENTER VOLUMEHeart Transplants: January 1, 1992 - June 30, 1996
and January 1, 2002 – June 30, 2006
58 59
81
49
15
4055
80
2515 3 4 3455
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
Nu
mb
er
of
cen
ters
.
1992-6/1996
2002-6/2006
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
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DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUMEHeart Transplants: January 1, 1992 - June 30, 1996
and January 1, 2002 – June 30, 2006
28
24 26
129
6
14
2
11
33
18 16
47 9
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
Per
cen
tag
e o
f tr
ansp
lan
ts
1992-6/1996
2002-6/2006
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% o
f T
ran
sp
lan
ts
0-10 11-17 18-34 35-49 50-59 60+
0
5
10
15
20
25
30
35
Me
an
do
no
r a
ge
(y
ea
rs)
Mean Age
HEART TRANSPLANTS: Donor Age by Year of Transplant
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
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AGE DISTRIBUTIONOF HEART RECIPIENTS (1/1982-6/2006)
% o
f T
r%
of
Tra
ns
pla
nts
ns
pla
nts
0
5
10
15
20
25
30
35
40
0-9 10-19 20-29 30-39 40-49 50-59 60+
Recipient Age
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
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AGE DISTRIBUTION OF HEART TRANSPLANT RECIPIENTS BY ERA
0
5
10
15
20
25
30
35
40
0-9 10-19 20-29 30-39 40-49 50-59 60+
Recipient Age
% o
f tr
an
sp
lan
ts
1982-1991 (N = 20,991)
1992-2001 (N = 39,801)
2002 - 6/2006 (N = 14,041)
P < 0.0001
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
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HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2005)
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 21 22
Years
Su
rviv
al
(%)
Half-life = 10.0 yearsConditional Half-life = 13.0 years
N=74,267
ISHLT 2008
N at risk at 22 years: 70
HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2006)
J Heart Lung Transplant 2008;27: 937-983
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HEART TRANSPLANTATION
Adult Recipients
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
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Congenital2%
ReTX2%
Myopathy45%
Misc.4%
Valvular3%
CAD44%
1/1982-6/2007
DIAGNOSIS IN ADULT HEART TRANSPLANTS
203040506070
% o
f Cas
es
Myopathy CAD
CAD35% Valvular
2%
Misc.14%
Myopathy44%
ReTX2%
Congenital3%
1/2004-6/2007
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
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0%
20%
40%
60%
80%
100%
Europe North America Other
10-19 years 20-29 years 30-39 years 40-49 years50-59 years 60+ years
% o
f T
ran
sp
lan
tsADULT HEART TRANSPLANTS:
RECIPIENT AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
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0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f Don
ors
0-10 years 11-17 years 18-34 years35-49 years 50-59 years 60+ years
ADULT HEART TRANSPLANTS:DONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2006
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982 – 6/2006)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Years
1982-1991 (N=18,854)
1992-2001 (N=35,146)
2002-6/2006 (N=12,369)
All comparisons significant at p < 0.0001
HALF-LIFE 1982-1991: 8.8 years; 1992-2001: 10.5 years; 2002-6/2006: NA
Su
rviv
al (
%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART TRANSPLANTATION Conditional Kaplan-Meier Survival by Era
(Transplants: 1/1982 – 6/2006)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Years
1982-1991 (N=14,381)
1992-2001 (N=27,686)
2002-6/2006 (N=9,326)
1982-1991 vs. 1992-2001: p < 0.0001;1982-1991 vs. 2002-6/2006: p = 0.0004;1992-2001 vs. 2002-6/2006: p = 0.1444.
HALF-LIFE 1982-1991: 11.8 years; 1992-2001: 12.8 years; 2002-6/2005: NA
Su
rviv
al (
%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1982-6/2005)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Years
Su
rviv
al
(%)
18-34 (N= 6,688) 35-49 (N=17,969)50-59 (N=25,166) 60-64 (N=9,648)65-69 (N= 3,241) 70+ (N= 346)
HALF-LIFE 18-34: 11.9 years; 35-49: 10.8 years; 50-59: 9.7 years; 60-64: 8.8 years; 65-69: 8.1 years; 70+: 6.9 years
All pair-wise comparisons are statistically significant at p < 0.01
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1998-6/2005)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8
Years
Su
rviv
al
(%)
18-34 (N= 2,248) 35-49 (N= 5,244)50-59 (N=8,292) 60-64 (N=4,001)65-69 (N= 1,814) 70+ (N= 235)
All pair-wise comparisons are statistically significant at p < 0.05
except 18-34 vs. 50-64; 18-34 vs. 60-64; and 65-69 vs. 70+
ISHLT 2008
HALF-LIFE 18-34: NA; 35-49: NA; 50-59: NA;
60-64: 8.3 years; 65-69: 8.1 years; 70+: 7.3 years
Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1982-6/2005)
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
Su
rviv
al (
%)
Cardiomyopathy (N = 27,393) Coronary artery disease (N = 27,846)Congenital diagnosis (N = 1,081) Retransplant (1,255)Valvular (N= 2,027) Other (N= 1,578)
HALF-LIFE Cardiomyopathy: 11.0 years; CAD: 9.1 years; Congenital: 13.4 years; Retransplant: 4.6 years; Valvular: 10.6 years; Other: 11.8 years
All pair-wise comparisons with Cardiomyopathy are significant at p < 0.005 except for Congenital; CAD vs. ReTx: p < 0.0001; CAD vs. Valvular: p = 0.005; Valvular vs. ReTx: p < 0.0001; Congenital vs. ReTx: p < 0.0001; ReTx vs. Other: p < 0.0001
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis
Conditional on Survival to 1 Year (Transplants: 1/1982-6/2005)
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
Su
rviv
al (
%)
Cardiomyopathy (N = 21,707)Coronary artery disease (N = 21,661)Congenital diagnosis (N = 773)Retransplant (766)Valvular (N= 1,506)Other (N= 929)
All pair-wise comparisons are significant at p <.05 except Cardiomyopathy vs. valvular (p = 34), valvular vs. other (p= .14), andCongenital vs. other (p = .12).
HALF-LIFE Cardiomyopathy: 13.3 years; CAD: 11.3 years; Congenital: 17.1 years; Retransplant: 9.3 years; Valvular: 13.4 years; Other: 14.4 years
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/2000-6/2005)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
Su
rviv
al (
%)
Cardiomyopathy (N=6,722) Coronary artery disease (N=6,520)
Congenital Diagnosis (N=358) Retransplant (N=318)
Valvular (N=405) Other (N=903)
All pair-wise comparisons with Cardiomyopathy are significant at p < 0.001; All pair-wise comparisons with CAD are significant at p < 0.5 except CAD vs. valvular. All other pair-wise comparisons were not statistically significant.
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis Conditional on Survival to 1 Year
(Transplants: 1/2000-6/2005)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
Su
rviv
al (%
)
Cardiomyopathy (N=5,344) Coronary artery disease (N=5.096)
Congenital Diagnosis (N=251) Retransplant (N=230)
Valvular (N=305) Other (N=449)
ISHLT 2008
Cardiomyopathy vs. Re-TX: p = .006; Cardiomyopathy vs. Other: p = .02; CAD vs. Re-TX: p = .03; Congenital vs. Re-TX: p = .01; Valvular vs. Other: = .01; Re-TX vs. Other: p = .0003
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ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by PVR (Transplants: 1/2002-6/2006)
50
60
70
80
90
100
0 1 2 3 4 5
Years
Su
rviv
al (
%)
1-<3 Wood units (N = 4,383) 3-<5 Wood units (N = 1,287)
5+ Wood units (N= 457)
1-<3 vs. 3-<5: p = 0.0005; 1-<3 vs. 5+: p = 0.0133; 3-<5 vs. 5+: p = 0.8661
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage (Transplants: 4/1994-6/2006)
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
VAD (N=3,757) No VAD / No Inotropes (N=9,435)
No VAD / Inotropes (N=11,576)
VAD vs. no VAD/no inotropes: p < 0.0001VAD vs. no VAD/inotropes: p < 0.0001No VAD/no inotropes vs No VAD/inotropes: p = 0.0008
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage (Transplants: 1/1999-6/2006)
50
60
70
80
90
100
0 1 2 3 4 5
Years
Su
rviv
al (
%)
Pulsatile flow (N=2,563) No LVAD / No Inotropes (N=5,638)
No LVAD / Inotropes (N=6,173)
Pulsatile vs. No LVAD/Inotropes: p < 0.0001;Pulsatile vs. No LVAD/No inotropes: p < 0.0001; No LVAD/No inotropes vs. No LVAD/Inotropes: p = 0.0510
NOTE: There were 206 transplants with continuous flow VADs
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage (Transplants: 1/1999-6/2006)
50
60
70
80
90
100
0 1 2 3 4 5
Years
Su
rviv
al (
%)
Pulsatile flow (N=2,563) Continuous flow (N=206)
No LVAD / No Inotropes (N=5,638) No LVAD / Inotropes (N=6,173)
Pulsatile vs. No LVAD/Inotropes: p < 0.0001;Pulsatile vs. No LVAD/No inotropes: p < 0.0001; No LVAD/Inotropes vs. No LVAD/No inotropes : p = 0.0510No LVAD/Inotropes vs. Continuous: p = 0.0852No LVAD/No Inotropes vs. Continuous: p = 0.0149
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ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage and Era (Transplants: 1/1999-6/2006)
50
60
70
80
90
100
0 1 2 3 4 5
Years
Su
rviv
al (
%)
Pulsatile, 1999-2002 (N=1,328) No LVAD/Inotrope, 1999-2002 (N=3,583)
Pulsatile, 2003-6/2006 (N=1,235) No LVAD/Inotrope, 2003-6/2006 (N=2,590)
Pulsatile vs. no LVAD/Inotropes (1999-2002): p = 0.0028Pulsatile vs. no LVAD/Inotropes (2003-6/2006): p < 0.0001
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART TRANSPLANTS1-Year Predicted Survival Model (Transplants: 1/2002-6/2006)
Impact of Pre-Transplant VAD
ISHLT 2008
75%
80%
85%
90%
95%
100%
0 30 60 90 120 150 180 210 240 270 300 330 360
Time (days)
Pre
dic
ted
Su
rviv
al
No Pre-op VAD
Pre-op pulsatile VAD
Recipient: 54 y.o., Dx=cardiomyopathy, height=175 cm, volume=22/year, bilirubin=0.8, PA systolic=40, creatinine=1.2 mg/dl, ischemia=180 min, transplant year = 2005/2006
Donor: 30 y.o., BMI = 25 kg/m2
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0
20
40
60
80
100
0-2months
>2-6months
>6-12months
>12-36months
>36-60months
>60months
Primarytransplant
Time between previous and current transplant
1 Y
ear
Pat
ien
t S
urv
ival
(%
) 1/1982-12/19911/1992-12/20011/2002-6/2006
Comparison of survival for interval < 12 months vs. > 12 months: p < 0.0001Comparison of survival for interval < 12 months vs. > 12 months for 1/02-6/2006: p < 0.0001
85
16
91
72
43 2
2 22 83
20
18
,91
53
5,2
17
43
84
49
35
1
12
,16
4
N=17 N=5 N=7
40 94
21
4
ADULT HEART RE-TRANSPLANTS1-Year Survival
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: 1995 - June 2006)
0%
20%
40%
60%
80%
100%
1 Year (N = 15,388) 3 Years (N = 13,600) 5 Years (N = 11,698) 7 Years (N = 9,306)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART RECIPIENTSEmployment Status of Surviving Recipients
(Follow-ups: 1995 - June 2006)
0%
20%
40%
60%
80%
100%
1 Year (N = 16,161) 3 Year (N = 14,165) 5 Year (N = 12,175) 7 Year (N = 9,910)
Retired
Not Working
Working Part Time
Working Full Time
Working (FT/PTstatus unknown)
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART RECIPIENTSRehospitalization Post-transplant of Surviving Recipients
(Follow-ups: 1995 - June 2006)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N = 19,425)
Between 2 and 3 Years (N = 16,781)
Between 4 and 5 Years (N = 14,451)
Between 6 and 7 Years (N = 11,746)
No Hospitalization Hospitalized: Not Rejection/Not InfectionHospitalized: Rejection Only Hospitalized: Infection OnlyHospitalized: Rejection + Infection
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0
10
20
30
40
50
Any Induction (N = 5,529) Polyclonal ALG/ATG (N =2,458)
OKT3 (N = 374) IL2R-antagonist (N =2,851)
% o
f p
ati
en
tsADULT HEART RECIPIENTS
Induction Immunosuppression (Transplants: January 2002 – June 2007)
ISHLT 2008
Analysis is limited to patients who were alive at the time of the follow-up
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0
10
20
30
40
50
60
Any Induction PolyclonalALG/ATG
OKT3 IL2R-antagonist
% o
f p
ati
en
ts
1997 2002 1/2007-6/2007
ADULT HEART RECIPIENTSInduction Immunosuppression
(Transplants: 1997, 2002 and 1/2007-6/2007)
ISHLT 2008
Analysis is limited to patients who were alive at the time of the follow-up
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ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Type
(Transplants: 1/2000-6/2006, conditional on survival to 14 days)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
Su
rviv
al (
%)
No induction (N = 6,274) Polyclonal induction (N = 2,859)
IL2-R antagonist (N = 2,875) OKT3 (N = 594)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
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0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
ati
en
ts
Year 1 (N = 3,973) Year 5 (N = 3,084)
ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2005 - June 2007)
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2008
Analysis is limited to patients who were alive at the time of the follow-up
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0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
atie
nts
2000 (N = 2,796) 2003 (N = 2,940) July 2006 - June 2007 (N = 2,829)
ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of 1 Year Follow-up
NOTE: Different patients are analyzed in each time frame.
ISHLT 2008
Analysis is limited to patients who were alive at the time of the follow-up
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0%
20%
40%
60%
80%
100%
Year 1 (N = 3,973) Year 5 (N = 3,084)
None
Other
Tacrolimus
Cyclosporine
Rapa + cellcycle
Rapa + calcineurin
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine + MMF
Cyclosporine + AZA
% o
f P
ati
en
tsADULT HEART RECIPIENTS
Maintenance Immunosuppression Drug Combinations at Time of Follow-up(Follow-ups: January 2005 - June 2007)
NOTES: Different patients are analyzed in Year 1 and Year 5. In the Year 1 cohort 73.40% of patients were on prednisone; in the Year 5 cohort 54.12% of patients were on prednisone.ISHLT 2008
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0%
20%
40%
60%
80%
100%
Year 1 (N = 4,089) Year 5 (N = 4,089)
% o
f P
atie
nts
None
Other
Tacrolimus
Cyclosporine
Rapa + cellcycle
Rapa + calcineurin
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine + MMF
Cyclosporine + AZA
ADULT HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
For the Same Patients(Follow-ups: January 2000 - June 2007)
ISHLT 2008
Analysis is limited to patients who were alive at the time of the follow-up
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PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS EXPERIENCING REJECTION IN 1ST YEAR
Stratified by Type of Induction (Follow-ups: July 1, 2004 - June 30, 2007)
0
10
20
30
40
50
60
% e
xp
eri
en
cin
g r
eje
cti
on
wit
hin
1 y
ea
r.
No induction, Treatment No induction, No TreatmentPolyclonal, Treatment Polyclonal, No TreatmentIL2R-antagonist, Treatment IL2R-antagonist, No Treatment OKT3, Treatment OKT3, No Treatment
ISHLT 2008
Overall 18-44 45-62 63+ Female Male
No induction: N=2,580Polyclonal: 1,137IL2R-antagonist: N=1,461OKT3: N=126
Overall: no induct vs. poly (p<0.0001); no induct vs. IL2 (p<0.0001), no induct vs. OKT3 (p=0.019) 18-44: no induct vs. poly (p=0.018); no induct vs. IL2 (p=0.002)45-62: no induct vs. poly (p=0.008); no induct vs. IL2 (p<0.0001) 63+: no induct vs. poly (p=0.004); no induct vs. IL2 (p<0.0001); no induct vs. OKT3 (p=0.044)F: no induct vs. poly (p=0.001); no induct vs. IL2 (p=0.0004)M: all comparisons were statistically significant at 0.05 except poly vs. OKT3 and IL2 vs. OKT3
Analysis is limited to patients who were alive at the time of the follow-up
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PERCENTAGE OF ADULT HEART TRANSPLANT RECIPIENTS EXPERIENCING REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression (Follow-ups: July 1, 2004 - June 30, 2007)
0
10
20
30
40
50
60 Cyclosporine + MMF, Treatment Cyclosporine + MMF, No TreatmentTacrolimus + MMF, Treatment Tacrolimus + MMF, No Treatment
% e
xp
eri
en
cin
g r
eje
cti
on
wit
hin
1 y
ea
r
Overall: p<0.000118-44: p<0.000145-62: p<0.0001Female: p<0.001Male: p<0.0001
ISHLT 2008
NOTE: There were 257 patients with cyclosporine+AZA and 42 with tacrolimus+AZA. These groups were excluded due to small numbers.
Cyclosporine + MMF: N = 1,981Tacrolimus + MMF: N = 2,249
18-44 45-62 63+ MaleFemaleOverall
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ADULT HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Rejection Within 1st Year
Conditional on survival to 1 year (follow-ups: 7/2004-6/2006)
50
60
70
80
90
100
0 1 2
Years
Su
rviv
al (
%)
No rejection (N=1,164) Rejection (N=713)
p <0.0001
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POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 1 Year Post-Transplant
(Follow-ups: April 1994 – December 1997 and January 2002 - June 2006)
Follow-ups: April 1994-
December 1997 Follow-ups: January 2002 –
June 2006
Outcome Within 1
Year Total N with
known response Within 1
Year Total N with
known response
Hypertension 68.9% (N = 6,425) 74.4% (N = 7,099)
Renal Dysfunction 20.4% (N = 6,378) 30.4% (N = 7.247)
Abnormal Creatinine < 2.5 mg/dl 11.3% 22.4% Creatinine > 2.5 mg/dl 8.1% 5.9% Chronic Dialysis 1.0% 1.6% Renal Transplant 0.1% 0.4%
Hyperlipidemia 33.3% (N = 6,816) 67.8% (N = 7,640)
Diabetes 20.9% (N = 6,433) 31.5% (N = 7,199)
Cardiac Allograft Vasculopathy 7.9% (N = 5,847) 7.1% (N = 6,556)
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POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 5 and 10 Years Post-Transplant
(Follow-ups: April 1994 - June 2006)
Outcome Within 5
Years Total N with
known response Within 10
Years Total N with
known response
Hypertension 93.8% (N = 8,266) 98.5% (N = 1,586)
Renal Dysfunction 32.6% (N = 8,859) 38.7% (N = 1,829)
Abnormal Creatinine < 2.5 mg/dl 21.2% 24.4% Creatinine > 2.5 mg/dl 8.4% 8.2% Chronic Dialysis 2.5% 4.9% Renal Transplant 0.5% 1.2%
Hyperlipidemia 87.1% (N = 9,237) 93.3% (N = 1,890)
Diabetes 34.8% (N = 8,219) 36.7% (N = 1,601)
Cardiac Allograft Vasculopathy 31.5% (N = 5,944) 52.7% (N = 896)
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FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY AND FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Adult Heart Recipients (Follow-ups: April 1994-June 2007)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
Freedom from CAV (N = 19,897)
Freedom from Severe Renal Dysfunction (N = 21,867)
* Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant
% F
ree
do
m f
rom
CA
V o
r F
ree
do
m
fro
m S
ev
ere
Re
na
l D
ys
fuc
nti
on
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FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY AND FREEDOM FROM SEVERE RENAL DYSFUNCTION BY ERA*
For Adult Heart Recipients (Transplants: April 1994-June 2006)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
Freedom from CAV 4/1994-1999 (N = 8,610)Freedom from Severe Renal Dysfunction 4/1994-1999 (N = 9,559)Freedom from CAV 2000-6/2006 (N = 9,583)Freedom from Severe Renal Dysfunction 2000-6/2006 (N = 10,599)
* Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant
% F
ree
do
m f
rom
CA
V o
r F
ree
do
m
fro
m S
ev
ere
Re
na
l D
ys
fuc
nti
on
Freedom from CAV 4/1994-1999 vs 2000-6/2006: p < 0.0001;Freedom from Severe Renal Dysfunction 4/1994-1999 vs. 2000-6/2006: p < 0.0001
ISHLT 2008
This slide is based on the date of transplant. As a result sample sizes are different from ones on the previous slide
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PATIENT SURVIVAL AFTER REPORT OF CAV AND PATIENT SURVIVAL IN PATIENTS WITHOUT CAV*
(Transplants: April 1994-June 2006)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Time after Report of CAV* (Years)
Su
rviv
al
(%)
No CAV (N = 13,244)
CAV (N = 3,104)
p < 0.0001
ISHLT 2008
* Patients without CAV conditioned on survival to median time of CAV development (504 days)
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PATIENT SURVIVAL AFTER REPORT OF CAV AND PATIENT SURVIVAL IN PATIENTS WITHOUT CAV* BY ERA
(Transplants: April 1994-June 2006)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Time after Report of CAV* (Years)
Su
rviv
al
(%)
No CAV 4/1994-1999 (N = 6,490)CAV 4/1994-1999 (N = 1,668)No CAV 2000-6/2006 (N = 6,754)CAV 2000-6/2006 (N = 1,436)
No CAV 4/1994-1999 vs. 2000-6/2006: p = 0.0903CAV 4/1994-1999 vs. 2000-6/2006: p = 0.1889
ISHLT 2008
* Patients without CAV conditioned on survival to median time of CAV development (504 days)
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MALIGNANCY POST-HEART TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2006)
Malignancy/Type 1-Year Survivors
5-Year Survivors
10-Year Survivors
No Malignancy 20441 (97.1%) 7780 (84.9%) 1264 (68.1%)
Malignancy (all types combined) 612 (2.9%) 1389 (15.1%) 592 (31.9%)
Malignancy Type
Skin 282 937 360
Lymph 142 127 38
Other 132 359 108
Type Not Reported 56 39 126
”Other” includes: prostate (11, 34, 17), adenocarcinoma (7, 4, 2), lung (5, 4, 1), bladder (4, 5, 4), sarcoma (3, 3, 1), breast (2, 8, 3), cervical (2, 4, 0), colon (2, 3, 1), and renal (2, 7, 2). Numbers in parentheses are those reported within 1 year, 5 years and 10 years, respectively.
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FREEDOM FROM MALIGNANCYFor Adult Heart Recipients (Follow-ups: April 1994 - June 2006)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
All malignancy Lymph Skin Other
% F
ree f
rom
Malig
nan
cy
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ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2006)
CAUSE OF DEATH 0-30 Days
(N = 3,006)
31 Days –
1 Year
(N = 2,722)
>1 Year –
3 Years
(N = 2,135)
>3 Years –
5 Years
(N = 1,857)
>5 Years –
10 Years
(N = 4,054)
>10 Years
(N = 2,107)
CARDIAC ALLOGRAFT VASCULOPATHY
52 (1.7%) 127 (4.7%) 298 (14.0%) 299 (16.1%) 581 (14.3%) 309 (14.7%)
ACUTE REJECTION 193 (6.4%) 338 (12.4%) 220 (10.3%) 82 (4.4%) 69 (1.7%) 26 (1.2%)
LYMPHOMA 2 (0.1%) 54 (2.0%) 85 (4.0%) 96 (5.2%) 195 (4.8%) 73 (3.5%)
MALIGNANCY, OTHER 1 (0.0%) 57 (2.1%) 218 (10.2%) 340 (18.3%) 749 (18.5%) 392 (18.6%)
CMV 4 (0.1%) 34 (1.2%) 16 (0.7%) 3 (0.2%) 5 (0.1%) 1 (0.0%)
INFECTION, NON-CMV 393 (13.1%) 896 (32.9%) 276 (12.9%) 180 (9.7%) 442 (10.9%) 213 (10.1%)
GRAFT FAILURE 1,257 (41.8%) 500 (18.4%) 499 (23.4%) 379 (20.4%) 765 (18.9%) 353 (16.8%)
TECHNICAL 233 (7.8%) 28 (1.0%) 17 (0.8%) 17 (0.9%) 36 (0.9%) 20 (0.9%)
OTHER 162 (5.4%) 175 (6.4%) 187 (8.8%) 147 (7.9%) 339 (8.4%) 175 (8.3%)
MULTIPLE ORGAN FAILURE
356 (11.8%) 268 (9.8%) 117 (5.5%) 102 (5.5%) 309 (7.6%) 190 (9.0%)
RENAL FAILURE 20 (0.7%) 25 (0.9%) 36 (1.7%) 65 (3.5%) 225 (5.6%) 173 (8.2%)
PULMONARY 133 (4.4%) 108 (4.0%) 96 (4.5%) 85 (4.6%) 172 (4.2%) 99 (4.7%)
CEREBROVASCULAR 200 (6.7%) 112 (4.1%) 70 (3.3%) 62 (3.3%) 167 (4.1%) 83 (3.9%)
ISHLTLast updated based on data as of December 2006
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ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death from Leading Causes by Era
(Deaths: January 1992 - June 2006)
CAUSE OF DEATH
DATE OF DEATH
0-30 Days
(N = 3,005)
31 Days –
1 Year
(N = 2,722)
>1 Year –
3 Years
(N = 2,135)
>3 Years –
5 Years
(N = 1,857)
>5 Years – 10 Years
(N = 4,054)>10 Years
(N = 2,107)
ACUTE REJECTION
1992-1997 122 (7.1%) 231 (14.3%) 113 (9.3%) 41 (4.4%) 16 (1.1%) 3 (1.7%)
1998-6/2006 71 (5.5%) 107 (9.7%) 107 (11.7%) 41 (4.5%) 53 (2.0%) 23 (1.2%)
CARDIAC ALLOGRAFT VASCULOPATHY
1992-1997 32 (1.9%) 83 (5.1%) 184 (15.1%) 189 (20.1%) 262 (18.3%) 40 (22.6%)
1998-6/2006 20 (1.6%) 44 (4.0%) 114 (12.4%) 110 (12.0%) 319 (12.2%) 269 (13.9%)
GRAFT FAILURE1992-1997 766 (44.5%) 347 (21.4%) 305 (25.0%) 168 (17.9%) 273 (19.0%) 30 (16.9%)
1998-6/2006 491 (38.3%) 153 (13.9%) 194 (21.2%) 211 (23.0%) 492 (18.8%) 323 (16.7%)
MALIGNANCY, OTHER
1992-1997 1 (0.1%) 40 (2.5%) 118 (9.7%) 177 (18.8%) 257 (17.9%) 25 (14.1%)
1998-6/2006 0 (0.0%) 17 (1.5%) 100 (10.9%) 163 (17.8%) 492 (18.8%) 367 (19.0%)
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ADULT HEART TRANSPLANT RECIPIENTS: Cumulative Incidence of Leading Causes of Death
(Transplants: January 1992 - June 2005)
0%
1%
2%
3%
4%
5%
6%
0 1 2 3 4 5 6 7 8 9 10
Time (years)
CAV Acute Rejection
Malignancy (non-Lymph/PTLD) Primary Failure
Graft Failure CMV
Infection (non-CMV)
Incid
en
ce o
f C
au
se-S
pecif
ic D
eath
s
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ADULT HEART TRANSPLANTS (1/2002-6/2006) Risk Factors for 1 Year Mortality
2008ISHLT (N=8,823)
VARIABLE N
Relative Risk
P-value 95% Confidence
Interval
Temporary circulatory support* 137 3.19 <0.0001 2.32 -4.37
Diagnosis: Congenital vs. cardiomyopathy 228 1.89 0.0002 1.35 -2.64
Recipient on ventilator at time of transplant 248 1.50 0.0044 1.13 -1.98
Recipient history of dialysis 273 1.48 0.0021 1.15 -1.91
Recipient with infection requiring IV drug therapy within 2 weeks prior to transplant
923 1.30 0.0047 1.08 -1.56
Chronic pulsatile device 1456 1.26 0.0205 1.04 -1.53
Not ABO identical 1288 1.25 0.0067 1.06 -1.46
Prior transfusion 1749 1.19 0.0432 1.01 -1.41
Diagnosis: coronary artery disease vs. cardiomyopathy
3939 1.16 0.0431 1.00 -1.35
Recipient on inotropes at time of transplant 3673 0.85 0.0282 0.73 -0.98
* Temporary circulatory support includes ECMO and Abiomed.
NOTE: There were too few continuous flow devices to analyze.
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ADULT HEART TRANSPLANTS (1/2002-6/2006) Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Recipient age
Recipient height
Donor age
Donor BMI
Transplant center volume
Ischemia time
PA systolic pressure
Bilirubin
Serum creatinine
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ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits
Recipient Age
0
0.5
1
1.5
2
20 25 30 35 40 45 50 55 60 65
Recipient Age
p < 0.0001
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ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits
Donor Age
0
0.5
1
1.5
2
2.5
15 20 25 30 35 40 45 50 55 60
Donor Age
p < 0.0001
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ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits
Recipient Height
0
0.5
1
1.5
2
155 160 165 170 175 180 185 190
Recipient height (cm)
p < 0.0001
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ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits
Donor BMI
0
0.5
1
1.5
2
18 20 22 24 26 28 30 32 34
Donor BMI (kg/m2)
p = 0.0288
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ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits
Ischemia Time
0
0.5
1
1.5
2
2.5
3
30 60 90 120 150 180 210 240 270 300 330 360
Ischemia Time (minutes)
p = 0.0060Re
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ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits
Center Volume
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40 45 50 55 60 65 70
Center Volume (cases per year)
p = 0.0032
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ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits
Pre-Transplant Bilirubin
0
0.5
1
1.5
2
0.2 1.2 2.2 3.2
Bilirubin (mg/dl)
p = 0.0006
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ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits
Pre-Transplant Creatinine
0
0.5
1
1.5
2
2.5
3
3.5
0.5 1 1.5 2 2.5 3
Recipient Creatinine (mg/dl)
p < 0.0001
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ADULT HEART TRANSPLANTS (1/2002-6/2006) Relative Risk of 1 Year Mortality with 95% Confidence Limits
Recipient PA Systolic Pressure
0
0.5
1
1.5
2
20 25 30 35 40 45 50 55 60 65 70 75
PA Systolic (mm Hg)
p = 0.0004Re
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ADULT HEART TRANSPLANTS (1/2002-6/2006)
Factors Not Significant for 1 Year Mortality
Recipient Factors: Prior malignancy, gender, hospitalized, prior pregnancy, balloon pump, diabetes, PRA
Donor Factors: Clinical infection, history of diabetes, gender, history of hypertension, cause of death, history of malignancy
Transplant Factors: HLA mismatch, CMV mismatch, prior transplant
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ADULT HEART TRANSPLANTS (1/2002-6/2006) 1-Year Predicted Survival Model
75%
80%
85%
90%
95%
100%
0 30 60 90 120 150 180 210 240 270 300 330 360
Time (days)
Cohort average
Recipient: Creatinine=1.7 mg/dl; inotropes; bilirubin=1.1 mg/dl. Donor: 60 y.o.
Recipient: Creatinine=1.3 mg/dl; pulsatile chronic VAD; bilirubin=0.8 mg/dl. Donor: 30 y.o.
Pre
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Su
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ISHLT 2008
Recipient: 55 y.o., Dx=CAD, height=175 cm, volume=22/year, PA systolic=40, ischemia=180 min
Donor: BMI = 25 kg/m2
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ADULT HEART TRANSPLANTS (1/2000-6/2002) Risk Factors for 5 Year Mortality
2008ISHLT (N=5,131)
VARIABLE N
Relative Risk
P-value 95% Confidence
Interval
Temporary circulatory support* 91 2.26 0.0004 1.44 -3.55
Diagnosis: Congenital vs. cardiomyopathy 117 2.00 <0.0001 1.43 -2.78
Ventilator 149 1.97 <0.0001 1.50 -2.57
Recipient on dialysis 136 1.74 <0.0001 1.33 -2.26
Diagnosis: Other** vs cardiomyopathy 162 1.52 0.0035 1.15 -2.02
Chronic pulsatile device 836 1.51 0.0188 1.07 -2.12
Previous pregnancy 723 1.46 <0.0001 1.22 -1.74
Diagnosis: Valvular heart disease vs. cardiomyopathy
153 1.41 0.025 1.04 -1.91
Recipient history of diabetes 968 1.26 0.0007 1.10 -1.45
Diagnosis: Coronary artery disease vs. cardiomyopathy
2438 1.23 0.0018 1.08 -1.40
Hospitalized (including ICU) 2648 1.19 0.0056 1.05 -1.34
Total number of HLA mismatches 0-3 MM (N= 621) 4-6 MM (N= 4510)
1.08 0.0127 1.02 -1.14
o ** Other = not cardiomyopathy, coronary artery disease, valvular
heart disease, or congenital heart disease
* Temporary circulatory support includes ECMO and Abiomed
NOTE: There were too few continuous flow devices to analyze.
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ADULT HEART TRANSPLANTS (1/2000-6/2002) Risk Factors for 5 Year Mortality
Continuous Factors (see figures)
Recipient age
Donor age
Bilirubin (+ interaction with VAD)
Transplant center volume
Ischemia time
Serum creatinine
PVR
Recipient BMI
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ADULT HEART TRANSPLANTS (1/2000-6/2002)
Relative Risk of 5 Year Mortality with 95% Confidence Limits
Recipient Age
0
0.5
1
1.5
2
20 25 30 35 40 45 50 55 60 65
Recipient Age
p < 0.0001
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ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Donor Age
0
0.5
1
1.5
2
15 20 25 30 35 40 45 50 55 60
Donor Age
p < 0.0001
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ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Ischemia Time
0
0.5
1
1.5
2
2.5
30 60 90 120 150 180 210 240 270 300 330 360
Ischemia time (minutes)
p < 0.0001
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ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Center Volume
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40 45 50 55 60 65 70
Center volume (cases per year)
p < 0.0001
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ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence
LimitsRecipient Pre-Transplant BMI
0
0.5
1
1.5
2
15 20 25 30 35
Recipient BMI (kg/m2)
p = 0.025
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ADULT HEART TRANSPLANTS (1/2000-6/2002)Relative Risk of 5 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant Bilirubin
0
0.5
1
1.5
2
0.2 1.2 2.2 3.2
Bilirubin (mg/dl)
No VAD VAD
p = 0.0002
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ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant Creatinine
0
0.5
1
1.5
2
0.5 1 1.5 2 2.5 3
Creatinine (mg/dl)
p < 0.0001
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ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant PVR
0
0.5
1
1.5
2
0 1 2 3 4 5 6 7
PVR (Wood units)
p = 0.0127
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ADULT HEART TRANSPLANTS (1/2000-6/2002) Factors Not Significant for 5 Year Mortality
Recipient Factors: Sternotomy, gender, pulmonary embolism, IV inotropes, transfusions, prior malignancy, PRA, balloon pump, infection requiring IV antibiotics prior to transplant
Donor Factors: History of cancer, clinical infection, cause of death, history of hypertension, height, weight
Transplant Factors: CMV mismatch, ABO match, prior transplant
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ADULT HEART TRANSPLANTS (1/2000-6/2002) 5-Year Predicted Survival Model
50%
60%
70%
80%
90%
100%
0 1 2 3 4 5
Time (years)
Cohort average
Recipient: Creatinine = 1.7 mg/dl; bilirubin = 1.1 mg/dl; balloon pump; in hospitalDonor: 60 y.o.
Recipient: Creatinine = 1.3 mg/dl; bilirubin = 0.8 mg/dl; pulsatile chronic VAD; not hospitalizedDonor: 30 y.o.
Pre
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Su
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ISHLT 2008
Recipient: 55 y.o.; Dx=CAD; BMI = 26 kg/m2; PVR=2.2; volume=24/year; ischemia=180 min; HLA mismatch = 5, transplant year = 2001/2002
Donor: BSA = 1.9 m2
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ADULT HEART TRANSPLANTS (1/2000-6/2002) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
2008ISHLT (N=4,144)
VARIABLE N
Relative Risk
P-value 95% Confidence
Interval
Ventilator at time of transplant 86 2.00 0.0023 1.28 -3.13
CAV within 1st year 210 1.94 <0.0001 1.45 -2.58
Diagnosis: other* vs. cardiomyopathy 112 1.79 0.008 1.16 -2.75
Rejection between discharge and 1st year 1415 1.39 0.0002 1.17 -1.65
Recipient history of diabetes 779 1.38 0.0016 1.13 -1.69
Drug-treated rejection prior to discharge 732 1.35 0.0038 1.10 -1.65
Other surgical procedures (excl. cardiac re-operation) prior to discharge
457 1.30 0.0394 1.01 -1.66
Diagnosis: coronary artery disease vs. cardiomyopathy
1986 1.28 0.0122 1.06 -1.55
Drug-treated infection prior to discharge 884 1.21 0.0624 0.99 -1.47
* Other = not cardiomyopathy, coronary artery disease, valvular heart disease, or congenital heart disease
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ADULT HEART TRANSPLANTS (1/2000-6/2002) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
Continuous Factors (see figures)
Recipient age
Donor age
PVR
Donor BMI
Donor/recipient weight ratio
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ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year Recipient Age
0
0.5
1
1.5
2
2.5
3
3.5
4
20 25 30 35 40 45 50 55 60 65
Recipient Age
p < 0.0001
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ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year Donor Age
0
0.5
1
1.5
2
15 20 25 30 35 40 45 50 55 60
Donor Age
p = 0.0006
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ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year Donor BMI
0
0.5
1
1.5
2
18 20 22 24 26 28 30 32 34
Donor BMI (kg/m2)
p = 0.0062
Re
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2008ISHLT (N=4,144)
NOTE: These results should be considered in the context of donor/recipient weight ratio (next slide)
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ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year Donor/Recipient Weight Ratio
0
0.5
1
1.5
2
0.5 0.7 0.9 1.1 1.3 1.5
Donor Weight/Recipient Weight
p = 0.0106
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NOTE: These results should be considered in the context of donor BMI (previous slide)
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ADULT HEART TRANSPLANTS (1/2000-6/2002) Relative Risk of 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year Recipient Pre-Transplant PVR
0
0.5
1
1.5
2
0 1 2 3 4 5 6 7
PVR (Wood units)
p = 0.0057
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ADULT HEART TRANSPLANTS (1993-6/1996) Risk Factors for 10 Year Mortality
2008ISHLT
(N=8,298)
VARIABLE N
Relative Risk
P-value 95% Conf. Interval
Repeat transplant 175 1.67 0.0013 1.22 -2.29
Ventilator at time of transplant 230 1.51 <0.0001 1.27 -1.80
Diagnosis: congenital vs. cardiomyopathy 153 1.29 0.046 1.00 -1.66
Female recipient/female donor 695 1.24 0.0122 1.05 -1.46
Female recipient/male donor 831 1.21 0.0107 1.05 -1.41
On VAD at time of transplant 473 1.19 0.0168 1.03 -1.36
Male recipient/female donor 1795 1.17 0.0008 1.07 -1.28
Diagnosis: coronary artery disease vs. cardiomyopathy 4146 1.14 0.0004 1.06 -1.23
On inotropes at time of transplant 3569 1.10 0.0371 1.01 -1.21
Year of transplant: 1993 vs. 1995/1996 2381 1.09 0.0403 1.00 -1.18
Number of HLA mismatches at the B locus 0 B MM (N=183)
1 B MM (N=1968) 2 B MM (N=6147)
1.08 0.0264 1.01 -1.15
Number of HLA mismatches at the DR locus 0 DR MM (N=390)
1 DR MM (N=4239) 2 DR MM (N=3669)
1.06 0.0393 1.00 -1.12
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ADULT HEART TRANSPLANTS (1993-6/1996) Risk Factors for 10 Year Mortality
Continuous Factors (see figures)
Recipient age
Recipient BMI
Donor age
PRA
Ischemia time
2008ISHLT
(N=8,298)
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ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits
Recipient Age
0
0.5
1
1.5
2
20 25 30 35 40 45 50 55 60 65
Recipient Age
p < 0.0001
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
2008ISHLT
(N=8,298)
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ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits
Donor Age
0
0.5
1
1.5
2
15 25 35 45 55
Donor Age
p < 0.0001
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
2008ISHLT
(N=8,298)
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ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits
Pre-Transplant Recipient BMI
0
0.5
1
1.5
2
18 20 22 24 26 28 30 32 34
Recipient BMI (kg/m2)
p = 0.0003
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
2008ISHLT
(N=8,298)
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ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits
Ischemia Time
0
0.5
1
1.5
2
30 60 90 120 150 180 210 240 270 300 330 360
Ischemia time (minutes)
p = 0.0028
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
2008ISHLT
(N=8,298)
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ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits
Pre-transplant PRA
0
0.5
1
1.5
2
2.5
0 20 40 60 80 100
Most recent PRA prior to transplant (%)
p = 0.0176
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
2008ISHLT
(N=8,298)J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART TRANSPLANTS (1993-6/1996) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years
2008ISHLT
(N=5,869)
VARIABLE N
Relative Risk
P-value 95%
Confidence Interval
Diagnosis: coronary artery disease vs. cardiomyopathy
2893 1.15 .0121 1.03 -1.27
Female recipient 1098 1.12 .0836 0.99 -1.27
Number of HLA mismatches at the DR locus
0 DR MM (N=289) 1 DR MM (N=3164) 2 DR MM (N=2416)
1.08 .0529 1.00 -1.17
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ADULT HEART TRANSPLANTSRisk Factors for 10 Year MortalityConditional on Survival to 3 Years
Continuous Factors (see figures)
Recipient age
Recipient BMI
Donor age
Donor BMI
2008ISHLT
(N=5,869)
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ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits
Conditional on Survival to 3 YearsRecipient Age
0
0.5
1
1.5
2
20 25 30 35 40 45 50 55 60 65
Recipient Age
p < 0.0001
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
2008ISHLT
(N=5,869)
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ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits
Conditional on Survival to 3 YearsDonor Age
0
0.5
1
1.5
2
15 25 35 45 55
Donor Age
p = 0.016
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
2008ISHLT
(N=5,869)
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ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits
Conditional on Survival to 3 YearsPre-Transplant Recipient BMI
0
0.5
1
1.5
2
18 20 22 24 26 28 30 32 34
Recipient BMI (kg/m2)
p = 0.0321
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
2008ISHLT
(N=5,869)
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ADULT HEART TRANSPLANTS (1993-6/1996) Relative Risk of 10 Year Mortality with 95% Confidence Limits
Conditional on Survival to 3 YearsDonor Weight
0
0.5
1
1.5
2
18 20 22 24 26 28 30 32 34
Donor BMI (kg/m2)
p = 0.0029
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
2008ISHLT
(N=5,869)
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ADULT HEART TRANSPLANTS (1989-6/1992) Risk Factors for 15 Year Mortality
2008ISHLT
(N=5,605)
VARIABLE N
Relative Risk
P-value 95% Confidence
Interval
Repeat transplant 156 1.96 0.0001 1.39 -2.76
Ventilator at time of transplant 142 1.23 0.0468 1.00 -1.51
Diagnosis: coronary artery disease vs. cardiomyopathy
2821 1.14 0.0005 1.06 -1.23
Number of HLA mismatches at the DR locus
0 DR MM (N=338) 1 DR MM (N=2983) 2 DR MM (N=2284)
1.13 <0.0001 1.07 -1.20
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ADULT HEART TRANSPLANTSRisk Factors for 15 Year Mortality
Continuous Factors (see figures)
Recipient age
Donor age
Ischemia time
PRA
Center volume (borderline)
2008ISHLT
(N=5,605)
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ADULT HEART TRANSPLANTS (1989-6/1992) Relative Risk of 15 Year Mortality with 95% Confidence Limits
Recipient Age
0
0.5
1
1.5
2
20 25 30 35 40 45 50 55 60 65
Recipient Age
p < 0.0001
Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
ali
ty
2008ISHLT
(N=5,605)
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ADULT HEART TRANSPLANTS (1989-6/1992) Relative Risk of 15 Year Mortality with 95% Confidence Limits
Donor Age
0
0.5
1
1.5
2
15 25 35 45 55
Donor Age
p < 0.0001
Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
ali
ty
2008ISHLT
(N=5,605)
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ADULT HEART TRANSPLANTS (1989-6/1992) Relative Risk of 15 Year Mortality with 95% Confidence Limits
Ischemia Time
0
0.5
1
1.5
2
30 60 90 120 150 180 210 240 270 300 330 360
Ischemia time (minutes)
p = 0.005
Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
ali
ty
2008ISHLT
(N=5,605)
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ADULT HEART TRANSPLANTS (1989-6/1992) Relative Risk of 15 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant PRA
0
0.5
1
1.5
2
0 10 20 30 40
PRA
p = 0.0223
Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
ali
ty
2008ISHLT
(N=5,605)
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ADULT HEART TRANSPLANTS (1989-6/1992) Relative Risk of 15 Year Mortality with 95% Confidence Limits
Center Volume
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40 45 50 55 60 65 70
Center volume (cases per year)
p = 0.0642
Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
ali
ty
2008ISHLT
(N=5,605)
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ADULT HEART TRANSPLANTS (1989-6/1992) Risk Factors for 15 Year MortalityConditional on Survival to 5 Years
2008ISHLT
(N=3,647)
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Diagnosis: coronary artery disease vs. cardiomyopathy
1849 1.29 <0.0001 1.16 -1.43
Number of HLA mismatches at the A locus
0 A MM (N=261) 1 A MM (N = 1792) 2 A MM (N=1594)
1.08 0.0495 1.00 -1.17
Number of HLA mismatches at the B locus
0 B MM (N=99) 1 B MM (N=964)
2 B MM (N=2584) 0.91 0.0389 0.84 -1.00
Previous transplant 60 1.61 0.0802 0.94 -2.75
Number of HLA mismatches at the DR locus
0 DR MM (N=242) 1 DR MM (N=1986) 2DR MM (N=1419)
1.08 0.0637 1.00 -1.17
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ADULT HEART TRANSPLANTSRisk Factors for 15 Year Mortality Conditional on Survival to 5 Years
Continuous Factors (see figures)
Recipient age
Donor age
PRA prior to transplant
2008ISHLT
(N=3,647)
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ADULT HEART TRANSPLANTS (1989-6/1992) Relative Risk of 15 Year Mortality with 95% Confidence Limits
Conditional on Survival to 5 Years Recipient Age
0
0.5
1
1.5
2
20 25 30 35 40 45 50 55 60 65
Recipient Age
p < 0.0001
Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
ali
ty
2008ISHLT
(N=3,647)
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ADULT HEART TRANSPLANTS (1989-6/1992) Relative Risk of 15 Year Mortality with 95% Confidence Limits
Conditional on Survival to 5 Years Donor Age
0
0.5
1
1.5
2
15 20 25 30 35 40 45 50
Donor Age
p = 0.0011Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
ali
ty
2008ISHLT
(N=3,647)
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ADULT HEART TRANSPLANTS (1989-6/1992) Relative Risk of 15 Year Mortality with 95% Confidence Limits
Conditional on Survival to 5 Years Recipient Pre-Transplant PRA (%)
0
0.5
1
1.5
2
0 10 20 30 40
Most recent PRA prior to transplant (%)
p = 0.029Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
ali
ty
2008ISHLT
(N=3,647)
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ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Cardiac Allograft Vasculopathy
after 5 Years (with no CAV prior to 5 years)
VARIABLE N Relative
risk P-value
95% Confidence
Interval
Diagnosis: Congenital vs. cardiomyopathy 52 1.77 0.0434 1.02 -3.10
Diagnosis: Coronary artery disease vs. cardiomyopathy
1703 1.23 0.0289 1.02 -1.48
Other surgical procedures (excl. cardiac re-operation) prior to transplant discharge
282 0.66 0.0270 0.46 -0.95
Transplant year = 2000 vs. 2001/2002 472 0.50 0.0084 0.30 -0.84
Recipient history of diabetes prior to transplant 505 1.24 0.0691 0.98 -1.57
Recipient on dialysis prior to transplant 502 0.39 0.0625 0.14 -1.05
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Continuous Factors (see figures)
Recipient age
Donor age
Donor age*donor gender interaction
Transplant center volume (borderline)
ISHLT 2008
(N=3,610)
ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Cardiac Allograft Vasculopathy
after 5 Years (with no CAV prior to 5 years)
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ADULT HEART TRANSPLANTS (4/1994-6/2002)Relative Risk of Developing Cardiac Allograft Vasculopathy after 5 Years
Donor Age, Donor Gender and Recipient Gender
0
0.5
1
1.5
2
2.5
3
3.5
15 20 25 30 35 40 45 50 55
Donor Age
Male Recip/Male Donor Male Recip/Female Donor
Female Recip/Male Donor Female Recip/Female Donor
p < 0.0001Re
lati
ve
Ris
k o
f C
AV
aft
er
5 Y
ea
rs
ISHLT 2008
(N=3,610)
Relative risk includes impact of donor gender, recipient gender and donor age.
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ADULT HEART TRANSPLANTS (4/1994-6/2002) Relative Risk of Developing Cardiac Allograft Vasculopathy after 5 Years
with 95% Confidence Limits Recipient Age
0
0.5
1
1.5
2
2.5
20 25 30 35 40 45 50 55 60 65
Recipient Age
p = 0.0052
Re
lati
ve
Ris
k o
f C
AV
aft
er
5 Y
ea
rs
ISHLT 2008
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ADULT HEART TRANSPLANTS (4/1994-6/2002) Relative Risk of Developing Cardiac Allograft Vasculopathy after 5 Years
with 95% Confidence Limits Center Volume
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40 45 50 55 60 65 70
Center Volume (cases per year)
p = 0.067
Re
lati
ve
Ris
k o
f C
AV
aft
er
5 Y
ea
rs
ISHLT 2008
(N=3,610)J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction within 7 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Recipient diabetes pre-transplant 1381 1.48 <0.0001 1.34 -1.64
Donor history of malignancy 139 1.36 0.0412 1.01 -1.82
Donor history of hypertension 907 1.20 0.0089 1.05 -1.37
Infection requiring IV antibiotics within 2 weeks prior to transplant
692 1.17 0.0325 1.01 -1.36
Inotropes at transplant 4960 1.15 0.001 1.06 -1.24
Recipient treated for hypertension pre-transplant
2954 1.15 0.0017 1.05 -1.25
Diagnosis: congenital vs. cardiomyopathy
119 0.52 0.0305 0.28 -0.94
(N=9,161)ISHLT 2008
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
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ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction within 7 Years
Limited to Recipients without Severe Renal Dysfunction Pre-Transplant
Continuous Factors (see figures)
Recipient age
Recipient creatinine
Recipient weight
Recipient PRA
Ischemia time (borderline)
PVR
Bilirubin
ISHLT 2008
(N=9,161)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
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ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction within 7 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Pre-Transplant Creatinine
0
0.5
1
1.5
2
2.5
3
0.5 1 1.5 2 2.5
Creatinine (mg/dl)
p < 0.0001
Re
lati
ve
Ris
k o
f R
en
al
Dy
sfu
nc
tio
n w
ith
in 7
Ye
ars
ISHLT 2008
(N=9,161)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
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ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction within 7 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Age
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
25 30 35 40 45 50 55 60 65
Recipient Age
p < 0.0001
Re
lati
ve
Ris
k o
f R
en
al
Dy
sfu
nc
tio
n w
ith
in 7
Ye
ars
ISHLT 2008
(N=9,161)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
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ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction within 7 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Weight
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
50 60 70 80 90 100 110
Recipient Weight (kg)
p < 0.0001
Re
lati
ve
Ris
k o
f R
en
al
Dy
sfu
nc
tio
n w
ith
in 7
Ye
ars
ISHLT 2008
(N=9,161)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
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ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction within 7 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Pre-Transplant Bilirubin
0
0.5
1
1.5
2
0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2 2.2 2.4 2.6 2.8
Bilirubin (mg/dl)
p = 0.0032
Re
lati
ve
Ris
k o
f R
en
al
Dy
sfu
nc
tio
n w
ith
in 7
Ye
ars
ISHLT 2008
(N=9,161)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
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ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction within 7 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient Pre-Transplant PVR
0
0.5
1
1.5
2
0 1 2 3 4 5 6 7 8
PVR (Wood units)
p = 0.046
Re
lati
ve
Ris
k o
f R
en
al
Dy
sfu
nc
tio
n w
ith
in 7
Ye
ars
ISHLT 2008
(N=9,161)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
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ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction within 7 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant Recipient PRA
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
0 5 10 15 20 25 30 35 40
Recipient PRA (%)
p = 0.043
Re
lati
ve
Ris
k o
f R
en
al
Dy
sfu
nc
tio
n w
ith
in 7
Ye
ars
ISHLT 2008
(N=9,161)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
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ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction after 7 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant or Renal Dysfunction within 7 Years
VARIABLE N Relative
Risk P-value 95% Confidence
Interval
Recipient diabetes pre-transplant 296 1.81 0.0005 1.29 -2.53
Pre-transplant transfusions 374 1.42 0.04 1.02 -1.99
Donor clinical infection 474 1.39 0.0284 1.04 -1.85
Recipient treated for rejection prior to transplant hospitalization discharge
524 1.33 0.0572 0.99 -1.78
(N=2,775)ISHLT 2008
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
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ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction after 7 Years
Limited to Recipients without Severe Renal Dysfunction Pre-Transplant or Renal Dysfunction within 7 Years
Continuous Factors (see figures) Recipient creatinine
Donor age
Bilirubin
Recipient PRA (borderline)
Donor/recipient BMI ratio (borderline)
ISHLT 2008
(N=2,775)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
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ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction after 7 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant or Renal Dysfunction within 7 Years
Recipient Pre-Transplant Creatinine
0
1
2
3
4
5
0.5 1 1.5 2 2.5
Creatinine (mg/dl)
p < 0.0001
Re
lati
ve
Ris
k o
f R
en
al
Dy
sfu
nc
tio
n b
ey
on
d 7
Ye
ars
ISHLT 2008
(N=2,775)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
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ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction after 7 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant or Renal Dysfunction within 7 Years
Donor Age
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2
15 25 35 45 55
Donor Age (years)
p = 0.0017Re
lati
ve
Ris
k o
f R
en
al
Dy
sfu
nc
tio
n b
ey
on
d 7
Ye
ars
ISHLT 2008
(N=2,775)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
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ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction after 7 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant or Renal Dysfunction within 7 Years
Donor/Recipient BMI Ratio
0
0.25
0.5
0.75
1
1.25
1.5
0.8 0.9 1 1.1 1.2 1.3
Donor BMI/Recipient BMI
p = 0.0636
Re
lati
ve
Ris
k o
f R
en
al
Dy
sfu
nc
tio
n b
ey
on
d 7
Ye
ars
ISHLT 2008
(N=2,775)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
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ADULT HEART TRANSPLANTS (4/1994-6/2000) Risk Factors for Developing Renal Dysfunction after 7 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant or Renal Dysfunction within 7 Years
Recipient Pre-Transplant Bilirubin
0
0.5
1
1.5
2
0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2 2.2 2.4 2.6 2.8
Bilirubin (mg/dl)
p = 0.0032
Re
lati
ve
Ris
k o
f R
en
al
Dy
sfu
nc
tio
n b
ey
on
d 7
Ye
ars
ISHLT 2008
(N=2,775)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
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ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy within 5 Years
Limited to Recipients without History of Malignancy Pre-Transplant
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Year of transplant: 1994/1995 vs. 2000-2002 2077 2.00 <0.0001 1.72 -2.32
Year of transplant: 1996/1997 vs. 2000-2002 2208 1.56 <0.0001 1.34 -1.82
Donor cause of death: anoxia 643 1.23 0.0417 1.01 -1.51
Year of transplant: 1998/1999 vs. 2000-2002 2469 1.21 0.0157 1.04 -1.41
Donor and recipient not ABO identical 1411 0.84 0.0436 0.72 -1.00
Recipient PRA > 10% 658 0.74 0.0199 0.57 -0.95
Recipient female 2288 0.63 <0.0001 0.52 -0.75
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ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy within 5 Years
Limited to Recipients without History of Malignancy Pre-Transplant
Continuous Factors (see figures) Recipient age
Donor weight Center volume
ISHLT 2008
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ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy within 5 Years
Limited to Recipients without History of Malignancy Pre-Transplant Recipient Age
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2
25 35 45 55 65
Age (years)
p < 0.0001
Re
lati
ve
Ris
k o
f M
ali
gn
an
cy
w
ith
in 5
Ye
ars
ISHLT 2008
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ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy within 5 Years
Limited to Recipients without History of Malignancy Pre-Transplant Donor Weight
0
0.25
0.5
0.75
1
1.25
1.5
50 60 70 80 90 100 110
Donor Weight (kg)
p = 0.0145
Re
lati
ve
Ris
k o
f M
ali
gn
an
cy
w
ith
in 5
Ye
ars
ISHLT 2008
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ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy within 5 Years
Limited to Recipients without History of Malignancy Pre-Transplant Center Volume
0
0.25
0.5
0.75
1
1.25
1.5
5 10 15 20 25 30 35 40 45 50 55 60 65 70
Center volume (cases per year)
p < 0.0001
Re
lati
ve
Ris
k o
f M
ali
gn
an
cy
w
ith
in 5
Ye
ars
ISHLT 2008
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ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy after 5 Years
Limited to Recipients without Malignancy within 5 Years
VARIABLE N Relative
Risk P-value 95% Confidence
Interval
Donor history of diabetes 89 1.65 0.043 1.02 -2.69
Drug-treated hypertension prior to transplant 1690 0.84 0.0463 0.70 -1.00
Female recipient 1226 0.64 0.0363 0.42 -0.97
(N=5,041)ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART TRANSPLANTS (4/1994-6/2002)Risk Factors for Developing Malignancy after 5 Years
Limited to Recipients without Malignancy within 5 Years
Continuous Factors (see figures) Recipient age
Center volume
Bilirubin
Donor BSA
Recipient BSA (borderline)
ISHLT 2008
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ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy after 5 Years
Limited to Recipients without Malignancy within 5 Years Recipient Age
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2
25 35 45 55 65
Recipient Age (years)
p < 0.0001
Re
lati
ve
Ris
k o
f M
ali
gn
an
cy
b
ey
on
d 5
Ye
ars
ISHLT 2008
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ADULT HEART TRANSPLANTS (4/1994-6/2002)Risk Factors for Developing Malignancy after 5 Years
Limited to Recipients without Malignancy within 5 Years Donor Body Surface Area (BSA)
0
0.25
0.5
0.75
1
1.25
1.5
1.6 1.8 2 2.2
Donor BSA
p = 0.0086
Re
lati
ve
Ris
k o
f M
ali
gn
an
cy
b
ey
on
d 5
Ye
ars
ISHLT 2008
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ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy after 5 Years
Limited to Recipients without Malignancy within 5 Years Recipient Pre-Transplant Bilirubin
0
0.25
0.5
0.75
1
1.25
1.5
0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2 2.2 2.4 2.6 2.8
Bilirubin (mg/dl)
p = 0.0367
Re
lati
ve
Ris
k o
f M
ali
gn
an
cy
b
ey
on
d 5
Ye
ars
ISHLT 2008
(N=5,041)J Heart Lung Transplant 2008;27: 937-983
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ADULT HEART TRANSPLANTS (4/1994-6/2002) Risk Factors for Developing Malignancy after 5 Years
Limited to Recipients without Malignancy within 5 Years Center Volume
0
0.25
0.5
0.75
1
1.25
1.5
5 10 15 20 25 30 35 40 45 50 55 60 65 70
Center volume (cases per year)
p = 0.0147
Re
lati
ve
Ris
k o
f M
ali
gn
an
cy
b
ey
on
d 5
Ye
ars
ISHLT 2008
(N=5,041)J Heart Lung Transplant 2008;27: 937-983
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ERA ANALYSIS:ADULT HEART TRANSPLANTS (1/1988-6/2002)
Risk Factors for 5 Year Mortality
2008ISHLT (N=27,596)
VARIABLE N
Relative Risk
P-value 95% Confidence
Interval
On ventilator at transplant 818 1.88 <0.0001 1.68 -2.10
Year of transplant 1989 (vs. 2002) 1314 1.57 <0.0001 1.34 -1.84
Year of transplant 1988 (vs. 2002) 1349 1.56 <0.0001 1.33 -1.83
Year of transplant 1992 (vs. 2002) 1874 1.52 <0.0001 1.31 -1.77
Previous transplant 701 1.50 0.0003 1.21 -1.87
Year of transplant 1991 (vs. 2002) 1820 1.49 <0.0001 1.28 -1.74
Year of transplant 1993 (vs. 2002) 2015 1.46 <0.0001 1.26 -1.69
Other diagnosis* vs. cardiomyopathy 900 1.38 0.0018 1.13 -1.68
Year of transplant 1990 (vs. 2002) 1530 1.38 0.0001 1.18 -1.61
Congenital diagnosis vs. cardiomyopathy 456 1.30 0.0027 1.10 -1.55
Year of transplant 1996 (vs. 2002) 2084 1.29 0.0008 1.11 -1.50
Year of transplant 1995 (vs. 2002) 2079 1.28 0.0011 1.10 -1.49
o * Other = not cardiomyopathy, coronary artery disease, valvular
heart disease, or congenital heart disease
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ERA ANALYSIS:ADULT HEART TRANSPLANTS (1/1988-6/2002)
Risk Factors for 5 Year Mortality
2008ISHLT (N=27,596)
VARIABLE N
Relative Risk
P-value 95% Confidence
Interval
Year of transplant 1994 (vs. 2002) 2098 1.26 0.0022 1.09 1.47
Female recipient/male donor 3028 1.20 <0.0001 1.11 1.29
On VAD at time of transplant 2486 1.19 <0.0001 1.10 1.29
Year of transplant 1998 (vs. 2002) 2211 1.19 0.0246 1.02 1.38
Year of transplant 1999 (vs. 2002) 1987 1.16 0.0477 1.00 1.35
Number of HLA mismatches at DR locus 1.11 <0.0001 1.07 1.15
Female recipient/female donor 2890 1.10 0.0135 1.02 1.19
Coronary artery disease vs. cardiomyopathy 13749 1.10 0.0005 1.04 1.15
Male recipient/female donor 5380 1.10 0.002 1.03 1.16
Number of HLA mismatches at B locus 1.09 0.0003 1.04 1.14
In hospital prior to transplant (incl. ICU) 15883 1.08 0.0024 1.03 1.13
o
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ERA ANALYSIS:ADULT HEART TRANSPLANTS (1/1988-6/2002)
Risk Factors for 5 Year Mortality
Continuous Factors
Recipient age
Donor age
Transplant center volume
Ischemia time
PRA
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ERA ANALYSIS:ADULT HEART TRANSPLANTS (1/1988-6/2002) 5-Year Predicted Survival Model by Year of Transplant
50%
60%
70%
80%
90%
100%
0 1 2 3 4 5
Time (years)
2002 1998 1993 1988
Pre
dic
ted
Su
rviv
al
ISHLT 2008
Recipient: 54 y.o., Dx=cardiomyopathy, primary transplant, male, PRA = 0, volume=23/year, ischemia=180 min; HLA A mismatches = 1; HLA B mismatches = 2; HLA DR mismatches = 1; in hospital; not on VAD or ventilator or balloon pump
Donor: 28 y.o. male
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ERA ANALYSIS:ADULT HEART TRANSPLANTS (1/1988-6/2002)
Mortality within 5 YearsRecipient Age
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2
25 35 45 55 65
Recipient Age (years)
p < 0.0001
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
P < 0.0001
ISHLT 2008
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ERA ANALYSIS:ADULT HEART TRANSPLANTS (1/1988-6/2002)
Mortality within 5 YearsDonor Age
0
0.5
1
1.5
2
2.5
15 25 35 45 55
Donor Age (years)
p < 0.0001
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
2008ISHLT
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ERA ANALYSIS:ADULT HEART TRANSPLANTS (1/1988-6/2002)
Mortality within 5 YearsIschemia Time
0
0.25
0.5
0.75
1
1.25
1.5
1.75
30 60 90 120 150 180 210 240 270 300 330 360
Ischemia time (minutes)
p = 0.0147
Rel
ativ
e R
isk
of
5 Y
ear
Mo
rtal
ity
P < 0.0001
ISHLT 2008
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ERA ANALYSIS:ADULT HEART TRANSPLANTS (1/1988-6/2002)
Mortality within 5 YearsCenter Volume
0
0.25
0.5
0.75
1
1.25
1.5
5 10 15 20 25 30 35 40 45 50 55 60 65 70
Center volume (cases per year)
p = 0.0147
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity P < 0.0001
ISHLT 2008
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ERA ANALYSIS:ADULT HEART TRANSPLANTS (1/1988-6/2002)
Mortality within 5 YearsPre-transplant PRA
0
0.5
1
1.5
2
2.5
0 20 40 60 80 100
Most recent PRA prior to transplant (%)
p < 0.0001
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
2008ISHLT
(N=27,596)J Heart Lung Transplant 2008;27: 937-983
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ERA ANALYSIS:ADULT HEART TRANSPLANTS (1/1988-6/2002)
Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
2008ISHLT (N=22,901)
VARIABLE N
Relative Risk
P-value 95% Confidence
Interval
Year of transplant 1989 (vs. 2002) 1079 1.41 0.0037 1.12 -1.78
Year of transplant 1992 (vs. 2002) 1531 1.4 0.0025 1.13 -1.75
Year of transplant 1988 (vs. 2002) 1102 1.39 0.0053 1.10 -1.76
Year of transplant 1993 (vs. 2002) 1643 1.37 0.0045 1.10 -1.70
Year of transplant 1991 (vs. 2002) 1487 1.36 0.0069 1.09 -1.69
Year of transplant 1990 (vs. 2002) 1293 1.31 0.0222 1.04 -1.64
Year of transplant 1995 (vs. 2002) 1733 1.25 0.0474 1.00 -1.55
Number of mismatches at the DR locus 1.12 0.0001 1.06 -1.18
Female recipient/male donor 2485 1.12 0.0443 1.00 -1.25
Congenital diagnosis vs. cardiomyopathy 343 0.71 0.0296 0.53 -0.97
o
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ERA ANALYSIS:ADULT HEART TRANSPLANTS (1/1988-6/2002)
Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
2008ISHLT (N=22,901)
VARIABLE N Relative
Risk P-value
95% Confidence Interval
Repeat transplant 473 1.40 .0578 0.99 -1.98
Year of transplant 1996 (vs. 2002) 1728 1.24 .0501 1.00 -1.54
Year of transplant 1994 (vs. 2002) 1777 1.23 .0577 0.99 -1.53
Coronary artery disease vs. cardiomyopathy
11354 1.08 .0537 1.00 -1.16
In hospital prior to transplant (incl. ICU) 13006 1.06 .0985 0.99 -1.14
o
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ERA ANALYSIS:ADULT HEART TRANSPLANTS (1/1988-6/2002) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
Continuous Factors
Recipient age
Donor age
Transplant center volume
Ischemia time
2008ISHLT (N=22,901)J Heart Lung Transplant 2008;27: 937-983
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ERA ANALYSIS:ADULT HEART TRANSPLANTS (1/1988-6/2002) 5-Year Predicted Survival Model by Year of Transplant
Conditional on Survival to 1 Year
50%
60%
70%
80%
90%
100%
0 1 2 3 4 5
Time (years)
2002 1998 1993 1988
Pre
dic
ted
Su
rviv
al
ISHLT 2008
Recipient: 54 y.o., Dx=cardiomyopathy, primary transplant, male, PRA = 0, volume=23/year, ischemia=180 min; HLA A mismatches = 1; HLA B mismatches = 2; HLA DR mismatches = 1; in hospital; not on VAD or ventilator or balloon pump
Donor: 28 y.o. male
J Heart Lung Transplant 2008;27: 937-983