2001 the registry of the international society for heart and lung transplantation: eighteenth annual...

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2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

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Page 1: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

THE REGISTRY OF THE INTERNATIONAL SOCIETY

FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL

REPORT

Page 2: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ACKNOWLEDGMENTS:We wish to extend our sincere thanksto the many thoracic transplant surgeons, physicians and data coordinators in transplant programsthroughout the world whose timely and accurate submission of data hasmade these analyses possible.

Page 3: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

REGISTRY DATABASENUMBER OF CENTERS

PERFORMING TRANSPLANTS:ORGAN

1993 1999 TOTAL

Heart 227 211 321

Heart-Lung 60 44 126

Single Lung 91 91 161

Bilateral/Double Lung 67 91 148

Page 4: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

REGISTRY DATABASENUMBER OF TRANSPLANTS

PERFORMEDORGAN

Through 1993 In 2000

Heart 30882 3175

Heart-Lung 1751 104

Single Lung 2181 673

Bilateral/ Double Lung 1158 739

Page 5: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

HEART TRANSPLANTATION

* Numbers may be low due to incomplete reporting.

475910

11931433 1637

1879 1999 1976 2002 2002 1890 1688 17411390 1190 978354

721

1305

1496

16761706

21062126 2171 2297 2340

23592343 2294

23452179

2197

78 143 316111 174

0

1000

2000

3000

4000

5000

Non-US US

Nu

mb

er o

f T

ran

spla

nts

*

*

12%

9%

6%

3%

% donors 50-55% donors 50+ P

ercent o

f Do

no

rs by A

ge

Page 6: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

AGE DISTRIBUTIONOF HEART RECIPIENTS (1982-2000)

% o

f T

r%

of

Tra

ns

pla

nts

ns

pla

nts

0

10

20

30

40

50

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

Recipient Age

Page 7: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

Congenital1.6%

ReTX2.1%

CAD46.1%

Valvular3.6%

Misc.1.3%

Myopathy45.3%

ADULT HEART TRANSPLANTATIONINDICATIONS

20

3040

5060

70

1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

% o

f C

as

es

Myopathy CAD

Page 8: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS

0

100

200

300

400

11-17 Years1-10 Years

<1 Year

Nu

mb

er o

f T

ran

spla

nts

11 942

75

111 128

194

255

326365 363

386362 374

346375 352

332347

Page 9: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

PEDIATRIC HEART TRANSPLANTATIONINDICATIONS BY AGE (1982-1999)

52.4%37.3%

5.0%5.3%

Myopathy Congenital Other ReTX

25.0%

6.3%3.4%

65.4%

2.6%76.5%

1.2%

19.7%

< 1 Year 1-10 Years 11-17 Years

Page 10: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

HEART TRANSPLANTATIONACTUARIAL SURVIVAL (1982-2000)

0

20

40

60

80

100

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

Years Post-Transplantation

Su

rviv

al (

%)

N=52,195

Half-life =9.1 yearsConditional Half-life = 11.6 years

Page 11: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT HEART TRANSPLANTATION ACTUARIAL SURVIVAL

50

60

70

80

90

100

0 6 12 18 24 30 36 42 48 54 60

Months Post Transplantation

1980-1987 (N=5,674) 1988-1992 (N=15,278)1993-1996 (N=13,622) 1997-2000 (N=11,639)

All comparisons with 1980-1987are significant at p < 0.0001

Su

rviv

al (

%)

Page 12: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

0

20

40

60

80

100

0-1month

>1-2months

>2-6months

>6-12months

>12-24months

>24-36months

>36-48months

>48-60months

>60-84months

>84months

Inter-transplant interval

ADULT HEART RE-TRANSPLANTATION(1982-1999)

1 Y

ea

r P

atie

nt

Su

rviv

al (

%)

Page 13: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT HEART TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY

N=38,943

VARIABLEOddsRatio P-value

95%Confidence

Interval

Ventilator 2.45 <.0001 2.05 -2.93

Repeat Transplant 2.39 <.0001 2.05 -2.80

Diagnosis: Congenital 1.67 <.0001 1.38 -2.02

VAD 1.29 0.0005 1.12 -1.49

Balloon Pump 1.26 0.002 1.09 -1.47

TX Year: 1988-1989 1.26 <.0001 1.16 -1.37

Page 14: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT HEART TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY

N=38,943

VARIABLE Odds Ratio

P-value 95%

Confidence Interval

Diagnosis: Not CAD, Myopathy or Congenital 1.24 <.0001 1.13 -1.37

Female Donor/ Male Recipient 1.18 <.0001 1.11 -1.26

Pre-transplant Transfusions 1.18 0.01 1.04 -1.33

Donor CMV+/ Recipient CMV- 1.17 0.003 1.06 -1.29

Diagnosis: CAD 1.10 0.002 1.04 -1.17

TX Year: 1996-1999 0.93 0.02 0.87 -0.99

*

* Latest period in cohort

Page 15: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT HEART TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY

N=38,943

VARIABLE ODDS RATIO P-VALUERecipient Age - linear <0.0001Recipient Age - quadratic <0.0001

20 years 0.91

35 years 0.86

50 years 0.99

65 years 1.37

Donor Age - linear <0.000120 years 0.83

35 years 1.07

50 years 1.40

65 years 1.81

Page 16: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT HEART TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY

N=38,943

VARIABLE ODDS RATIO P-VALUEPeak PRA - linear <0.0001

0% 0.96

25% 1.15

50% 1.37

75% 1.64

100% 1.97

Recipient BMI - quadratic 0.0009Recipient Height - linear <0.0001

150 cm 1.34

175 cm 0.98

BMI: 25

200 cm 0.72

150 cm 1.77

175 cm 1.29

BMI: 33

200 cm 0.95

Page 17: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT HEART TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY

N=38,943

VARIABLE ODDS RATIO P-VALUECenter Volume - linear <0.0001Center Volume - quadratic <0.0001

5 transplants/year 1.33

10 transplants/year 1.24

50 transplants/year 0.96

100 transplants/year 1.46

Ischemia Time - linear <0.00011 hour 0.84

3 hours 1.02

5 hours 1.24

7 hours 1.50

Page 18: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT HEART TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY

N=26,250

VARIABLE Odds Ratio P-value

95% Confidence Interval

Repeat Transplant 2.645 <.0001 2.19 -3.17

Ventilator 1.65 <.0001 1.36 -2.00

Diagnosis: Congenital 1.28 0.02 1.04 -1.58 Diagnosis: Not CAD, Myopathy or Congenital 1.22 0.0001 1.10 -1.35

Female Donor/ Male Recipient 1.12 0.002 1.04 -1.20

Diagnosis: CAD 1.10 0.002 1.03 -1.17

Page 19: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT HEART TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY

N=26,250

VARIABLE ODDS RATIO P-VALUERecipient Age - linear <0.0001Recipient Age - quadratic <0.0001

20 years 1.12

35 years 0.93

50 years 0.99

65 years 1.37

Donor Age - linear <0.000120 years 0.83

35 years 1.07

50 years 1.38

65 years 1.77

Page 20: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT HEART TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY

N=26,250

VARIABLE ODDS RATIO P-VALUEPeak PRA - linear 0.0002

0% 0.97

25% 1.09

50% 1.22

75% 1.37

100% 1.53

Recipient BMI - quadratic 0.03Recipient Height - linear <0.0001

150 cm 1.30

175 cm 0.98

BMI: 25

200 cm 0.74

150 cm 1.57

175 cm 1.19

BMI: 33

200 cm 0.90

Page 21: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT HEART TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY

N=26,250

VARIABLE ODDS RATIO P-VALUECenter Volume - linear <0.0001Center Volume - quadratic <0.0001

5 transplants/year 1.26

10 transplants/year 1.19

50 transplants/year 0.97

100 transplants/year 1.40

Ischemia Time - linear 0.00021 hour 0.90

3 hours 1.01

5 hours 1.14

7 hours 1.29

Page 22: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

PEDIATRIC HEART TRANSPLANTATIONACTUARIAL SURVIVAL (1982-2000)

50

60

70

80

90

100

0 6 12 18 24 30 36 42 48 54 60

Months Post Transplantation

Su

rviv

al

(%)

<1 Year (N=1,099) 1-10 Years (N=1,642)11-17 Years (N=1,678) Overall (N=4,419)

All comparisons with <1 year significant at p < 0.0001

Page 23: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

PEDIATRIC HEART TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY

N=3,760

VARIABLEOddsRatio P-value

95%Confidence

Interval

Balloon or VAD 2.23 0.0001 1.47 -3.37

Repeat Transplant 2.17 0.0005 1.40 -3.35

Ventilator 1.60 <.0001 1.27 -2.01

Diagnosis: Congenital 1.59 <.0001 1.32 -1.91

TX Year: 1988-1995 1.54 <.0001 1.28 -1.86

* Earliest period in cohort

*

Page 24: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

PEDIATRIC HEART TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY

N=3,760

VARIABLE ODDS RATIO P-VALUERecipient Age - linear <.0001Recipient Age - quadratic 0.004

0 years 1.90

6 years 1.05

12 years 0.86

18 years 1.03

Donor Age - quadratic 0.002

0 years 1.06

10 years 1.00

20 years 1.06

30 years 1.24

Page 25: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

PEDIATRIC HEART TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY

N=2,465

VARIABLEOddsRatio P-value

95%Confidence

Interval

Repeat Transplant 2.04 0.006 1.23 -3.41

Ventilator 1.49 0.002 1.16 -1.91

Female Recipient 1.28 0.008 1.07 -1.53

Diagnosis: Cardiomyopathy 0.79 0.02 0.65 -0.96

TX Year: 1995 0.70 0.01 0.53 -0.92

* Latest year in cohort

*

Page 26: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

PEDIATRIC HEART TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY

N=2,465

VARIABLE ODDS RATIO P-VALUERecipient Age - linear <.0001Recipient Age - quadratic 0.0003

0 years 1.88

6 years 1.04

12 years 0.94

18 years 1.41

Donor Age - linear 0.005

0 years 1.06

10 years 1.00

20 years 1.06

30 years 1.24

Page 27: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

PEDIATRIC HEART TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY

N=2,465

VARIABLE ODDSRATIO

P-VALUE

Donor BMI/Recipient BMI - linear 0.02

0.75 (donor size < recipient size) 1.29

1.00 (donor size = recipient size) 1.02

1.50 (donor size > recipient size) 0.65

Page 28: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

FUNCTIONAL STATUS

0%

20%

40%

60%

80%

100%

1 Year 3 Years 5 Years

No Activity Limitations Performs with Assistance Total Assistance

Heart (April 1994-Dec. 2000)

Page 29: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

EMPLOYMENT STATUS

0%

20%

40%

60%

80%

100%

1 Year 3 Years 5 Years

Working Full Time Working Part Time Not Working Retired

Heart (US Data: April 1994-Dec. 2000)

Page 30: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

REHOSPITALIZATION POST HEARTTRANSPLANTATION (April 1994 - Dec. 2000)

0%

20%

40%

60%

80%

100%

1 Year 3 Years 5 Years

No Hospitalization Hospitalized, Not Rejection/Not Infection

Hospitalized, Rejection Hospitalized, Infection Only

Hospitalized, Rejection + Infection

Page 31: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

0

20

40

60

80

100

Cyclosporine Tacrolimus MMF/Cellcept Azathioprine Prednisone

Year 1 Year 5

HEART TRANSPLANT MAINTENANCEIMMUNOSUPPRESSION

% o

f P

atie

nts

Page 32: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

HEART TRANSPLANTATIONDonor age versus Ejection Fraction yr 1 to yr 2

-10%

-5%

0%

5%

10%

<20n=1326

20-29n=1291

30-39n=992

40-49n=764

50-59n=359

60-69n=41

Donor Age (Years)

% C

ha

ng

e i

n E

F

Page 33: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

POST-HEART TRANSPLANT MORBIDITY (April 1994-December 2000)

Outcome 1-year Follow-up 5-year Follow-up

Hypertension 68.1% 68.0%

Renal Function None 78.1% 75.1% Renal Dysfunction 12.8% 14.0% Creatinine>5 mg/dl 7.8% 8.6% Chronic Dialysis 1.2% 1.9% Renal Transplant 0.1% 0.4%

Hyperlipidemia 40.6% 43.8%

Diabetes 20.8% 16.2%

CAV 7.8% 20.8%

Page 34: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT HEART TRANSPLANTATION RISK FACTORS FOR CAV WITHIN 3 YEARS

N=7,691

VARIABLE Odds Ratio P-value95% Confidence

Interval

Diagnosis: CAD 1.15 0.02 1.03 - 1.30

TX Year: 1997 0.83 0.008 0.72 - 0.95

Female Donor 0.82 0.002 0.72 - 0.93

Page 35: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT HEART TRANSPLANTATION RISK FACTORS FOR CAV WITHIN 3 YEARS

N=7,691

VARIABLE ODDS RATIO P-VALUERecipient Age - linear 0.005Recipient Age - quadratic 0.008

20 years 0.81

35 years 1.02

50 years 1.01

65 years 0.80

Donor Age - linear <.0001

Donor Age - quadratic 0.03

20 years 0.73

35 years 1.19

50 years 2.31

65 years 5.40

Page 36: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

MALIGNANCY POST-HEART TRANSPLANTATION (April 1994-December 2000)

Yes3.5%

No96.5%

Not Reported13.5%

Skin37.3%

Other20.2%

Lymph29.0%

1-Year Followup

Yes8.8%

No91.2%

Not Reported13.1%

Skin52.1%

Other22.3%

Lymph12.5%

5-Year Followup

Page 37: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

HEART TRANSPLANTS: CAUSE OF DEATH (1982-2000)

0

20

40

60

80

100

0-30 Days 31 Days - 1 Year >1 - 3 Years >3 - 5 Years

CAV Lymphoma Malignancy, OtherCMV Acute Rejection Infection, Non-CMV1°/NS Graft Failure

Timing of Death

Cau

se o

f D

eath

(%

)

Page 38: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

1319

35

83

119

159

213

240 232221 217

194

221 218

145161

130131

104

0

50

100

150

200

250

No

. o

f T

ran

spla

nts

19

82

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

HEART-LUNG TRANSPLANTATION

Page 39: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ReTX2.6%

Congenital32.4%

A1A3.1%

IPF2.8%

Misc.12.8%

PPH25.4%

COPD4.4% CF

16.3%

ADULT HEART-LUNG TRANSPLANTATIONINDICATIONS (1982-2000)

Page 40: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

HEART-LUNG TRANSPLANTATIONACTUARIAL SURVIVAL (1982-2000)

0

20

40

60

80

100

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

Years Post Transplantation

N=2,550

Half-life = 2.8 yearsConditional Half-life = 8.2 years

Su

rviv

al (

%)

Page 41: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

LUNG TRANSPLANTATION

0

200

400

600

800

1000

1200

1400

1600

1800

Nu

mb

er

of

Tra

ns

pla

nts

Bilateral/Double LungSingle Lung

18

20

22

24

26

28

30

32

34

36

38

Mean

Do

no

r Ag

e

4 7 38 74184

404

675

887

10621176

13311284

138613851325

1412

Page 42: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

AGE DISTRIBUTION OF LUNG TRANSPLANTATION

0

10

20

30

40

50

% o

f tr

an

sp

lan

ts

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

Recipient Age

Page 43: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

PPH4%

COPD47%

CF3%A1A

11%ReTX

3%

IPF21%

Misc.11%

ADULT LUNG TRANSPLANTATIONINDICATIONS (1983-2000)

Single Lung Bilateral/Double Lung

IPF7.8%

PPH9.0%

Misc.17.7%

COPD20.1%

CF33.3%ReTX

2.2%

A1A9.8%

Page 44: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

PEDIATRIC LUNG TRANSPLANTATION

AGE DISTRIBUTION (1986-2000)

0

20

40

60

80

100

11-17 Years1-10 Years

<1 Year

Nu

mb

er o

f T

ran

spla

nts

1 3 4 6

19

4750

4541

80

68

85 86

64 65

Page 45: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

CF51%

PPH12%

ReTX8%

Congenital

7%

Misc.18%

IPF4%

PEDIATRIC LUNG TRANSPLANTATIONINDICATIONS (1986-2000)

0

25

50

75

100

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

% o

f C

as

es PPH CF

Page 46: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

LUNG TRANSPLANTATIONACTUARIAL SURVIVAL (1983-2000)

0

25

50

75

100

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

Years Post Transplantation

Su

rviv

al (

%)

Bilateral/Double Lung (N=4,908)

Single Lung (N=6,375)

All Lungs (N=11,283)

Double lung: 1/2-life = 4.5 Years; Conditional 1/2-life = 7.9 YearsSingle lung: 1/2-life = 3.6 Years; Conditional 1/2-life = 5.7 YearsAll lungs: 1/2-life = 3.8 Years; Conditional 1/2-life = 6.3 Years

Page 47: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT LUNG TRANSPLANTATIONACTUARIAL SURVIVAL (1988-2000)

0

25

50

75

100

0 1 2 3 4 5

Years Post-Transplantation

Su

rviv

al (

%)

1988-1992 (N=1,955)1993-1996 (N=4,115)1997-2000 (N=4,500)

Comparison of 1988-1992 vs. 1997-2000 was significant at p = 0.002

Page 48: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

PEDIATRIC LUNG/HRT-LUNG TRANSPLANTATION

ACTUARIAL SURVIVAL (1984-2000)

0

25

50

75

100

0 1 2 3 4 5 6 7

Years Post Transplantation

Su

rviv

al (

%)

Single Lung (N=115)

Bilateral/Double Lung (N=484)

Heart-Lung (N=417)

Page 49: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY

N=9,653

VARIABLEOddsRatio P-value

95%Confidence

Interval

Ventilator 3.48 <.0001 2.51 - 4.81

Diagnosis: Congenital 2.04 <.0001 1.50 - 2.78

Diagnosis: PPH 1.50 <.0001 1.23 - 1.83

Donor CMV+/ Recipient CMV- 1.44 <.0001 1.25 - 1.67

TX Year: 1988-1991 1.37 <.0001 1.19 - 1.58

* Earliest period in cohort

*

Page 50: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY

N=9,653

VARIABLE Odds Ratio P-value

95% Confidence

Interval

Repeat Transplant 1.35 0.002 1.11 - 1.64

Female Recipient 0.85 0.002 0.77 - 0.94

Diagnosis: Alpha-1 Antitrypsin 0.83 0.04 0.70 - 0.99

Diagnosis: Emphysema/COPD 0.56 <.0001 0.49 - 0.63

Page 51: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY

N=9,653

VARIABLE ODDS RATIO P-VALUERecipient Age - linear <.0001Recipient Age - quadratic 0.0002

20 years 0.82

35 years 0.83

50 years 1.09

65 years 1.86

Recipient BMI - linear <0.000117 0.83

22 0.97

27 1.13

32 1.32

Page 52: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY

N=9,653

VARIABLE ODDS RATIO P-VALUEDonor Height - linear 0.0052

140 cm 1.41

160 cm 1.15

180 cm 0.94

200 cm 0.76

Page 53: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 1 YEAR MORTALITY

N=9,653

VARIABLE ODDSRATIO

P-VALUE

Donor Age - quadratic 0.002Center Volume - linear <.0001

Interaction of Donor Age and Volume 0.02

5 transplant/year 1.17

30 transplant/year 0.88

30 year

55 transplant/year 0.66

5 transplant/year 1.52

30 transplant/year 1.42

60 years

55 transplant/year 1.32

Page 54: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY

N=5,050

VARIABLEOddsRatio P-value

95%Confidence

Interval

Ventilator 3.01 <.0001 1.79 - 5.06

Donor CMV +/Recipient CMV - 1.42 0.0007 1.16 - 1.74

TX Year: 1988-1991 1.21 0.01 1.04 - 1.41

Female Recipient 0.87 0.02 0.77 - 0.98

Double Lung Transplant 0.84 0.02 0.73 - 0.97

Diagnosis: Emphysema/COPD 0.76 0.0005 0.65 - 0.89

Diagnosis: Alpha-1 Antitrypsin 0.70 0.0005 0.57 - 0.86

* Earliest period in cohort

*

Page 55: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY

N=5,050

VARIABLE ODDS RATIO P-VALUERecipient Age - linear <.0001Recipient Age - quadratic <.0001

20 years 1.22

35 years 0.91

50 years 1.08

65 years 2.10

Recipient BMI - linear 0.002

17 0.83

22 0.97

27 1.13

32 1.31

Page 56: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY

N=5,050

VARIABLE ODDSRATIO

P-VALUE

Donor Age - quadratic 0.01Center Volume - linear 0.003Interaction of Donor Age and Volume 0.01

5 Transplants/Year 1.12

30 Transplants/Year 0.91

30 Years

55 Transplants/Year 0.74

5 Transplants/Year 2.37

30 Transplants/Year 1.16

60 Years

55 Transplants/Year 0.57

Page 57: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT LUNG TRANSPLANTATION RISK FACTORS FOR 5 YEAR MORTALITY

N=5,050

VARIABLE ODDSRATIO

P-VALUE

Interaction of Donor Age and Ischemia Time 0.03

1 Hour 1.01

4 Hours 1.00

30 Years

7 Hours 0.99

1 Hours 1.12

4 Hours 1.55

60 Years

7 Hours 2.14

Page 58: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

FUNCTIONAL STATUS

0%

20%

40%

60%

80%

100%

1 Year 3 Years 5 Years

No Activity Limitations Performs with Assistance Total Assistance

Lung (April 1994-December 2000)

Page 59: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

EMPLOYMENT STATUS

0%

20%

40%

60%

80%

100%

1 Year 3 Years 5 Years

Working Full Time Working Part Time Not Working Retired

Lung (US: April 1994-December 2000)

Page 60: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

REHOSPITALIZATION POST LUNGTRANSPLANTATION (April 1994 - December 2000)

0%

20%

40%

60%

80%

100%

1 Year 3 Years 5 Years

No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Only Hospitalized, Infection OnlyHospitalized, Rejection and Infection

Page 61: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

POST-LUNG TRANSPLANT MORBIDITY (April 1994-December 2000)

Outcome 1-year Follow-up 5-year Follow-up

Hypertension 48.0% 62.5%

Renal Function None 77.8% 64.0% Renal Dysfunction 12.6% 17.6% Creatinine>5 mg/dl 8.0% 14.4% Chronic Dialysis 1.6% 3.2% Renal Transplant 0.0% 0.7%

Hyperlipidemia 12.5% 20.5%

Diabetes 16.5% 16.1%

Bronchiolitis Obliterans 10.7% 29.5%

Page 62: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT LUNG TRANSPLANTATION RISK FACTORS FOR BRONCHIOLITIS WITHIN 3 YEARS

N=2,756

VARIABLEOddsRatio P-value

95% ConfidenceInterval

Repeat Transplant 2.68 0.001 1.47 - 4.87

TX Year: 1993 1.41 0.003 1.13 - 1.77

Female Donor 0.79 0.01 0.66 - 0.95

TX Year: 1997 0.66 0.0001 0.53 - 0.81

** Latest year in cohort

* Earliest year in cohort

*

**

Page 63: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT LUNG TRANSPLANTATION RISK FACTORS FOR BRONCHIOLITIS WITHIN 3 YEARS

N=2,756

VARIABLE ODDS RATIO P-VALUERecipient Age - quadratic 0.01

20 years 1.52

35 years 1.09

50 years 1.00

65 years 1.20

Recipient BMI - linear 0.05

17 0.86

22 0.97

27 1.10

32 1.25

Page 64: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

ADULT LUNG TRANSPLANTATION RISK FACTORS FOR BRONCHIOLITIS WITHIN 3 YEARS

N=2,756

VARIABLE ODDS RATIO P-VALUEIschemia Time - linear 0.002

1 Hour 0.773 Hours 0.905 Hours 1.047 Hours 1.21

Page 65: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

MALIGNANCY POST-LUNG TRANSPLANTATION (April 1994-December 2000)

Yes4.4%

No95.6%

Not Reported12.4%

Skin15.3%

Other19.2% Lymph

53.1%

1-Year Followup

Yes5.8%

No94.2%

Not Reported9.7%

Skin55.6%

Other18.1%

Lymph16.7%

5-Year Followup

Page 66: 2001 THE REGISTRY OF THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION: EIGHTEENTH ANNUAL REPORT

2001

LUNG TRANSPLANTS: CAUSE OF DEATH (1982-2000)

0

20

40

60

80

100

0-30 Days 31 Days - 1 Year >1 - 3 Years >3 - 5 Years

CAD Cardiac Malignancy, OtherLymphoma CMV Acute RejectionInfection, Non-CMV Bronchiolitis 1°/NS Graft FailureTechnical

Timing of Death

Cau

se o

f D

eath

(%

)