heart transplantation overall ishlt 2005 j heart lung transplant 2005;24: 945-982

HEART TRANSPLANTATION

Overall

ISHLT 2005J Heart Lung Transplant 2005;24: 945-982

NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR

189 317669

1185

2160

2718

31573383

40314196 4219 4389 4435 4358 4251 4157

38183547 3402 3340 3252 3135

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Nu

mb

er

of

Tra

nsp

lan

ts .

ISHLT 2005

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 2005;24: 945-982

AVERAGE CENTER VOLUMEHeart Transplants: January 1, 1997 - June 30, 2004

62

39

82

45

18

4552

79

22 203 5 2455

0

10

20

30

40

50

60

70

80

90

1-4 5-9 10-19 20-29 30-39 40-49 50-74 75+

Average number of heart transplants per year

Nu

mb

er

of

cen

ters

.

1997-1999

2000-6/2004


DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME

Heart Transplants: January 1, 1997 - June 30, 2004

3 6

28 27

15

58 9

310

33

1620

49

60

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 1997-1999

2000-6/2004


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

Mean

do

no

r ag

e (years

)

Mean Age

HEART TRANSPLANTS: Donor Age by Year of Transplant


AGE DISTRIBUTIONOF HEART RECIPIENTS (1/1982-6/2004)

% 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


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

1982-1988 (N = 9,718)1989-1993 (N = 19,602)1994-1998 (N = 20,587)1999-2003 (N = 16,657)

P < 0.0001


HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2003)

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

Years

Su

rviv

al (%

) .

Half-life = 9.6 yearsConditional Half-life = 12 years

N=66,751

ISHLT 2005

N followed at longest time point: 25,908


HEART TRANSPLANTATION

Adult Recipients


Congenital2%

ReTX2%

Myopathy45%

Misc.1%

Valvular4%

CAD46%

1982-1999

DIAGNOSIS IN ADULT HEART TRANSPLANTS

203040506070

% o

f Cas

es

Myopathy CAD

CAD45%

Valvular3%

Misc.1%

Myopathy47%

ReTX2%

Congenital2%

1/2000-6/2004


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982 – 6/2003)

0

20

40

60

80

100

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

Years

1982-1988 (N=9,148)

1989-1993 (N=17,898)

1994-1998 (N=18,714)

1999-6/2003 (N=13,480)

All comparisons significant at p < 0.01

HALF-LIFE 1982-1988: 8.1 years; 1989-1993: 9.5 years; 1994-1998: 9.8 years

Su

rviv

al (

%)


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1982-6/2003)

0

20

40

60

80

100

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

Years

Su

rviv

al (%

) .

18-34 (N= 6,211) 35-49 (N=17,276)50-59 (N=23,589) 60-64 (N=8,808)65-69 (N= 2,812) 70+ (N= 284)

HALF-LIFE 18-34: 11.7 years; 35-49: 10.4 years; 50-59: 9.3 years; 60-64: 8.5 years; 65-69: 8.1 years; 70+: 7.1 years

All pair-wise comparisons are statistically significant at p < 0.05 except 65-69 vs. 70+


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: 1/1996-6/2003)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8

Years

Su

rviv

al (%

) .

18-34 (N= 2,267) 35-49 (N= 5,988)50-59 (N=9,520) 60-64 (N=4,446)65-69 (N= 1,845) 70+ (N= 217)

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


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival for Simultaneous Heart and Kidney

Transplants Compared to Heart-Alone Transplants (Transplants: 1/1982-6/2003)

0

20

40

60

80

100

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

Years

Su

rviv

al (

%)

.

Heart alone (N=58,343) Simultaneous Heart+Kidney (N=336)

HALF-LIFE:Heart alone = 9.5 YearsSimultaneous Heart + Kidney = n.c.


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival for Kidney after Heart Transplants Compared to

Heart-Alone Transplants* (Transplants: 1/1982-6/2003)

0

20

40

60

80

100

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

Years from Kidney Transplant Report for Kidney after Heart Transplants and Years from Transplant + Median for Heart-Alone Transplants**

Su

rviv

al (

%)

.

Heart alone (N=12,867) Kidney after Heart (N=499)

HALF-LIFE FOLLOWING KIDNEY TRANSPLANT (KI AFTER HR) OR FROM MEDIAN TIME TO KIDNEY TRANSPLANT REPORT (HEART ALONE):Heart alone* = 7.4 YearsKidney after Heart = 4.9 Years

ISHLT 2005

* For comparison purposes, the heart-alone transplant cohort was limited to those transplants that had survived to the median time to kidney transplant for the kidney after heart transplant (8.0 years).

** Survival time since “kidney transplant” (transplant date not reported, only time point at which kidney transplant has already occurred)


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival for Kidney after Heart Transplants Compared to

Kidney after Simultaneous Heart and Kidney Transplants (Transplants: 1/1982-6/2003)

0

20

40

60

80

100

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

Years from Kidney Transplant Report*

Su

rviv

al (

%)

.

Kidney after Heart+Kidney (N=62) Kidney after Heart (N=499)

HALF-LIFE FOLLOWING KIDNEY TRANSPLANT:Kidney after Heart+Kidney = 5.1 YearsKidney after Heart = 4.9 Years

ISHLT 2005* Survival time since “kidney transplant” (transplant date not reported, only time point at which kidney transplant has already occurred)


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1982-6/2003)

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 = 25,623) Coronary artery disease (N = 26,065)Congenital diagnosis (N = 971) Retransplant (1,125)Valvular (N= 2,021) Other (N= 804)

HALF-LIFE Cardiomyopathy: 10.6 years; CAD: 8.9 years; Congenital: 11.7 years; Retransplant: 4.4 years; Valvular: 10.2 years; Other: 11.3 years

All pair-wise comparisons with Cardiomyopathy are significant at p < 0.05 except for Congenital; Coronary Artery Disease vs. ReTx: p < 0.0001; Coronary Artery Disease vs. Valvular: p = 0.02; Valvular vs. ReTx: p < 0.0001; Congenital vs. ReTx: p < 0.0001; ReTx vs. Other: p < 0.0001


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis

Conditional on Survival to 1 Year (Transplants: 1/1982-6/2003)

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 = 19,185)Coronary artery disease (N = 19,293)Congenital diagnosis (N = 658)Retransplant (659)Valvular (N= 1,369)Other (N= 505)

All pair-wise comparisons are significant except Cardiomyopathy vs. valvular, valvular vs. other, and congenital vs. other

HALF-LIFE Cardiomyopathy: 12.8 years; CAD: 11.0 years; Congenital: 11.5 years; Retransplant: 8.5 years; Valvular: 12.9 years; Other: 14.4 years


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis (Transplants: 1/1996-6/2003)

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8

Years

Su

rviv

al (

%)

.

Cardiomyopathy (N=10,770) Coronary artery disease (N=10,810)Congenital Diagnosis (N=454) Retransplant (N=465)Valvular (N=712) Other (N=456)

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


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by Diagnosis Conditional on Survival to 1 Year (Transplants: 1/1996-6/2003)

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8

Years

Su

rviv

al (

%)

Cardiomyopathy (N=8,080) Coronary artery disease (N=7,949)

Congenital Diagnosis (N=290) Retransplant (N=307)

Valvular (N=475) Other (N=289)

Cardiomyopathy vs. CAD: p = 0.0009; Cardiomyopathy vs. ReTx: p = 0.02; CAD vs. Congenital: p = 0.03; CAD vs. Valvular: p = 0.01; Valvular vs. ReTx: p = 0.006; Congenital vs. ReTx: p = 0.01


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by PVR (Transplants: 1/2000-6/2003)

50

60

70

80

90

100

0 1 2 3 4

Years

Su

rviv

al (

%)

1-<3 Wood units (N= 3,644) 3-<5 Wood units (N= 1,019)

5+ Wood units (N= 342)

1-<3 vs. 3-<5: p = 0.02

1-<3 vs. 5+: p = 0.009


ADULT HEART TRANSPLANTATION Kaplan-Meier Survival by VAD usage (Transplants: 1/1999-6/2003)

50

60

70

80

90

100

0 1 2 3 4 5

Years

Su

rviv

al (

%)

Heartmate/Novacor (N=1,055) No LVAD (N=7,000)

p = 0.022

ISHLT 2005

Note: Only 32 transplants involving continuous flow devices and 33 with ECMO; too few to analyze.


0

20

40

60

80

100

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

>12-36months

>36-60months

>60 months

Time between previous and current transplant

1 Y

ear

Pat

ien

t S

urv

ival

(%

)

1/1982-12/1990

1/1991-12/1998

1/1999-6/2003

Comparison of survival for interval < 12 months vs. > 12 months: p < 0.0001Comparison of survival for interval < 12 months vs. > 12 months for 1/99-6/2003: p < 0.0001

124

143

32 19 2731 66 863722 25 231

50 2 2 81 21 190

ADULT HEART RE-TRANSPLANTS1-Year Survival


ADULT HEART RECIPIENTS Functional Status of Surviving Recipients

(Follow-ups: April 1994 - June 2004)

0%

20%

40%

60%

80%

100%

1 Year (N = 15,901) 3 Years (N = 13,954) 5 Years (N = 11,872) 7 Years (N = 9,144)

No Activity Limitations Performs with Some Assistance Requires Total Assistance


ADULT HEART RECIPIENTSEmployment Status of Surviving Recipients


0%

20%

40%

60%

80%

100%

1 Year (N = 14,888) 3 Year (N = 12,842) 5 Year (N = 10,848) 7 Year (N = 8,371)

Retired

Not Working

Working Part Time

Working Full Time


ADULT HEART RECIPIENTSRehospitalization Post-transplant of Surviving Recipients


0%

20%

40%

60%

80%

100%

Up to 1 Year (N = 17,511)

Between 2 and 3 Years (N = 14,928)



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


0

10

20

30

40

50

Any Induction (N = 3,607) Polyclonal ALG/ATG (N = 1,699)

OKT3 (N = 427) IL2R-antagonist (N = 1,618)

% o

f p

atien

tsADULT HEART RECIPIENTS

Induction Immunosuppression (Follow-ups: January 2001 – June 2004)


0

10

20

30

40

50

60

Any Induction PolyclonalALG/ATG

OKT3 IL2R-antagonist

% o

f p

ati

en

ts

2001 2002 2003 1/2004-6/2004

ADULT HEART RECIPIENTSInduction Immunosuppression (Follow-ups: January 2001 - June 2004)


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

ati

en

ts .

Year 1 (N = 4,015) Year 5 (N = 3,389)

ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up

(Follow-ups: January 2002 - June 2004)

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


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

atie

nts

.

1998 (N = 216) 2002 (N = 1,648) Jan 2004 - Jun 2004 (N = 809)

ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of 1 Year Follow-up

NOTE: Different patients are analyzed in each time frame.


0%

20%

40%

60%

80%

100%

Year 1 (N = 3,939) Year 5 (N = 3,353)

% o

f P

atie

nts

.

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

(Follow-ups: January 2002 - June 2004)

NOTES: Different patients are analyzed in Year 1 and Year 5. In the Year 1 cohort 77.5% of patients were on prednisone; in the Year 5 cohort 62% of patients were on prednisone.


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

Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2003)

0

10

20

30

40

50

60

70

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

% t

reate

d f

or

reje

cti

on

wit

hin

1 y

ear

.

No induction (N = 4,236) Polyclonal (N = 1,715)IL2R-antagonist (N = 1,376) OKT3 (N = 491)

For females: no induction vs. OKT3 (p = 0.0001); polyclonal vs. OKT3 (p = 0.001); IL2R vs. OKT3 (p = 0.002)For males: no induction vs. OKT3 (p = 0.0002); polyclonal vs. OKT3 (p = 0.0002); IL2R vs. OKT3 (p = 0.002)

Overall: All comparisons with OKT3 were significant at p < 0.0001. 50-64: All comparisons with OKT3 were significant at p < 0.0001. No other comparisons within age groups were statistically significant.


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

Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2003)

0

0.5

1

1.5

2

2.5

3

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

Avera

ge n

um

ber

of

reje

cti

on

ep

iso

des .

No induction (N = 4,236) Polyclonal (N = 1,715)IL2R-antagonist (N = 1,376) OKT3 (N = 491)

Overall: No induction vs. OKT3 (p = 0.0026); polyclonal vs. OKT3 (p=0.0065); IL2 vs. OKT3 (p=0.0004).

50-64: No induction vs. OKT3 (p = 0.006); polyclonal vs. OKT3 (p = 0.045); IL2 vs. OKT3 (p = 0.002)

For females: no induction vs. OKT3 (p = 0.008)

For males: polyclonal vs. OKT3 (p =0.04); IL2 vs. OKT3 (p = 0.003)


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

Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2003)

0

10

20

30

40

50

60

70

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

% t

reate

d f

or

reje

cti

on

wit

hin

1 y

ear

.

Cyclosporin + MMF (N = 1,850) Cyclosporin + AZA (N = 375)Tacrolimus + MMF (N = 400) Tacrolimus + AZA (N = 47)

Overall: CyA + MMF vs. TAC + MMF (p<0.0001); CyA + MMF vs. TAC + AZA (p=0.02); CyA + AZA vs. TAC + MMF (p<0.0001); CyA + AZA vs. TAC + AZA (p=0.0056). 18-34: All comparisons significant except CyA + MMF vs. CyA + AZA. 35-49: CyA + MMF vs. TAC + MMF (p=0.0001); CyA + AZA vs. TAC + MMF (p=0.004). 50-64: CyA + MMF vs. TAC + MMF (p<0.0001); CyA + AZA vs. TAC + MMF (p<0.0001). 65+: CyA + AZA vs. TAC + MMF (p=0.04). For females all comparisons are significant except TAC + MMF vs. TAC + AZA. For males: CyA + MMF vs. TAC + MMF (p<0.0001); CyA + AZA vs. TAC + MMF (p<0.0001)


NUMBER OF REJECTION EPISODES FOR ADULT HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2003)

0

0.5

1

1.5

2

2.5

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

Avera

ge n

um

ber

of

reje

cti

on

ep

iso

des .

Cyclosporin + MMF (N = 1,850) Cyclosporin + AZA (N = 375)Tacrolimus + MMF (N = 400) Tacrolimus + AZA (N = 47)

Overall: CyA + MMF vs. TAC + MMF (p = 0.04); CyA + AZA vs. TAC + MMF (p = 0.014)35-49: CyA + MMF vs. TAC + MMF (p = 0.04)Male: CyA + AZA vs. TAC + MMF (p = 0.008)


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


Follow-ups: April 1994-

December 1999 Follow-ups: January 2000 –

June 2003

Outcome Within 1

Years Total N with

known response Within 1

Year Total N with

known response

Hypertension 72.6% (N = 9,659) 76.8% (N = 5,668)

Renal Dysfunction 25.7% (N = 9,534) 31.7% (N = 5,727)

Abnormal Creatinine < 2.5 mg/dl 15.2% 22.1% Creatinine > 2.5 mg/dl 9.1% 7.8% Chronic Dialysis 1.2% 1.5% Renal Transplant 0.2% 0.3%

Hyperlipidemia 49.8% (N = 10,225) 68.7% (N = 6,035)

Diabetes 23.7% (N = 9,634) 30.2% (N = 5,674)

Coronary Artery Vasculopathy 8.7% (N = 8,577) 7.0% (N = 5,125)


POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 5 and 8 Years Post-Transplant


Outcome Within 5

Years Total N with

known response Within 8

Years Total N with

known response

Hypertension 94.0% (N = 6,221) 97.7% (N = 2,103)

Renal Dysfunction 32.4% (N = 6,650) 35.6% (N = 2,348)

Abnormal Creatinine < 2.5 mg/dl 20.5% 19.7% Creatinine > 2.5 mg/dl 9.1% 10.6% Chronic Dialysis 2.5% 4.4% Renal Transplant 0.4% 0.9%

Hyperlipidemia 85.1% (N = 6,927) 91.2% (N = 2,425)

Diabetes 33.2% (N = 6,167) 36.5% (N = 2,108)

Coronary Artery Vasculopathy 32.3% (N = 4,418) 45.7% (N = 1,305)


FREEDOM FROM CORONARY ARTERY VASCULOPATHY AND FREEDOM FROM SEVERE RENAL DYSFUNCTION*

For Adult Heart Recipients (Follow-ups: April 1994-June 2004)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

% F

ree f

rom

CA

V o

r F

reed

om

fro

m .

Severe

Ren

al D

ysfu

ncti

on

Freedom from CAV

Freedom from Severe Renal Dysfunction

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


FREEDOM FROM CORONARY ARTERY VASCULOPATHY Stratified by Diagnosis

For Adult Heart Recipients (Follow-ups: April 1994 - June 2004)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

% F

ree f

rom

CA

V .

Coronary Artery Disease (N = 9,428)

Cardiomyopathy (N = 8,870)

p = 0.0003


MALIGNANCY POST-HEART TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2004)

Malignancy/Type 1-Year Survivors

5-Year Survivors

8-Year Survivors

No Malignancy 17250 (96.9%) 5753 (83.9%) 1757 (73.8%)

Malignancy (all types combined) 544 (3.1%) 1108 (16.1%) 625 (26.2%)

Malignancy Type

Skin 249 748 423

Lymph 129 115 40

Other 115 267 123

Type Not Reported 47 39 15

”Other” includes: prostate (11, 34, 21), adenocarcinoma (7, 4, 2), lung (5, 4, 1), bladder (4, 5, 5), sarcoma (3, 3, 1), breast (2, 8, 3), cervical (2, 4, 0), colon (2, 3, 3), and renal (2, 7, 2). Numbers in parentheses are those reported within 1 year, 5 years and 8 years, respectively.


FREEDOM FROM MALIGNANCYFor Adult Heart Recipients (Follow-ups: April 1994 - June 2004)

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

% F

ree f

rom

Malig

nan

cy .

All malignancy Lymph Skin Other


ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2004)

CAUSE OF DEATH 0-30 Days

(N = 2,984)31 Days - 1 Year

(N = 2,523)>1 Year - 3 Years

(N = 1,892)>3 Years - 5 Years

(N = 1,631)>5 Years

(N = 4,823)

Coronary Artery Vasculopathy

47 (1.6%) 117 (4.6%) 271 (14.3%) 275 (16.9%) 719 (14.9%)

ACUTE REJECTION 199 (67%) 306 (12.1%) 182 (9.6%) 67 (4.1%) 65 (1.3%)

LYMPHOMA 2 (0.1%) 48 (1.9%) 81 (4.3%) 86 (5.3%) 221 (4.6%)

MALIGNANCY, OTHER 2 (0.1%) 52 (2.1%) 196 (10.3%) 299 (18.3%) 883 (18.3%)

CMV 4 (0.1%) 31 (1.2%) 15 (0.8%) 3 (0.2%) 5 (0.1%)

INFECTION, NON-CMV 386 (12.9%) 826 (32.7%) 252 (13.3%) 153 (9.4%) 481 (10.0%)

PRIMARY FAILURE 786 (26.3%) 190 (7.5%) 125 (6.6%) 68 (4.2%) 208 (4.3%)

GRAFT FAILURE 416 (13.9%) 263 (10.4%) 314 (16.6%) 236 (14.5%) 668 (13.9%)

TECHNICAL 220 (7.4%) 28 (1.1%) 15 (0.8%) 17 (1.0%) 44 (0.9%)

OTHER 175 (5.9%) 200 (7.9%) 172 (9.1%) 158 (9.7%) 453 (9.4%)

MULTIPLE ORGAN FAILURE

417 (14.0%) 254 (10.1%) 97 (5.1%) 94 (5.8%) 396 (8.2%)

RENAL FAILURE 18 (0.6%) 19 (0.8%) 31 (1.6%) 59 (3.6%) 291 (6.0%)

PULMONARY 122 (4.1%) 85 (3.4%) 85 (4.5%) 62 (3.8%) 189 (3.9%)

CEREBROVASCULAR 190 (6.4%) 104 (4.1%) 61 (3.2%) 54 (3.3%) 200 (4.1%)


ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death from Leading Causes by Era

(Deaths: January 1992 - June 2004)

CAUSE OF DEATH

DATE OF DEATH

0-30 Days

(N = 2,984)31 Days - 1 Year

(N = 2,523)>1 Year - 3 Years

(N = 1,892)>3 Years - 5 Years

(N = 1,631)>5 Years

(N = 4,823)

ACUTE REJECTION

1992-1997 118 (6.9%) 221 (13.8%) 111 (9.2%) 37 (4.0%) 19 (1.2%)

1998-6/2004 81 (6.3%) 85 (9.2%) 71 (10.2%) 30 (4.3%) 49 (1.4%)

CORONARY ARTERY VASCULOPATHY

1992-1997 29 (1.7%) 82 (5.1%) 180 (15.0%) 186 (20.1%) 296 (18.6%)

1998-6/2004 18 (1.4%) 35 (3.8%) 91 (13.1%) 89 (12.6%) 423 (13.1%)

GRAFT FAILURE1992-1997

251 (28.0%)

175 (11.0%) 194 (16.1%) 116 (12.5%) 187 (11.7%)

1998-6/2004165

(12.9%)88 (9.5%) 120 (17.3%) 120 (17.0%) 481 (14.9%)

MALIGNANCY, OTHER

1992-1997 2 (0.1%) 38 (2.4%) 116 (9.7%) 177 (19.1%) 281 (17.6%)

1998-6/2004 14 (1.5%) 80 (11.5%) 122 (17.3%) 602 (18.6%)

PRIMARY FAILURE

1992-1997 497

(29.1%)169 (10.6%) 105 (8.7%) 48 (5.2%) 108 (6.8%)

1998-6/2004 289

(22.6%)21 (2.3%) 20 (2.9%) 20 (2.8%) 100 (3.1%)


ADULT HEART TRANSPLANT RECIPIENTS: Cumulative Incidence of Leading Causes of Death

(Transplants: January 1992 - June 2003)

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

0 1 2 3 4 5 6 7 8

Time (years)

% c

au

se-s

pecif

ic d

eath

s

CAV Acute Rejection Malignancy (non-Lymph/PTLD)Primary Failure Graft Failure CMV

Infection (non-CMV)


ADULT HEART TRANSPLANTS (1/1996-6/2003) Risk Factors for 1 Year Mortality

1996-1999 (N=13,365)

2000-6/2003 (N=9,743)

Risk Factor N Relative

Risk p-value N

Relative Risk

p-value

Diagnosis: Congenital heart disease 203 1.77 .0001 221 2.51 <0.0001

Temporary circulatory support* 46 2.40 .0001 129 2.07 <0.0001

Ventilator 263 1.59 .0002 244 1.73 .0001

Dialysis 160 1.56 .0018 222 1.69 .0001

Hospitalized at transplant (including ICU) 9494 1.30 <0.0001 6084 1.58 <0.0001

Donor history of cancer 150 1.22 .2719 137 1.58 .0117

Female recipient/male donor 1244 1.11 .2220 971 1.46 .0001

Donor cause of death: cerebrovascular/stroke

3419 0.98 .6972 2658 1.27 .0002

Female recipient/female donor 1549 1.07 .4298 1273 1.25 .0292

Pulsatile chronic VAD 304** 0.99 .9340 1234 1.22 .0394

2005ISHLTNote: All factors were significant at p < 0.05 in at least one of the eras.

* Temporary circulatory support includes ECMO and Abiomed.**VAD type collected for only part of era. Only those with known type were included in this group.



1996-1999 (N=13,365)

2000-6/2003 (N=9,743)


Risk p-

value N

Relative Risk

p-value

Repeat transplant 306 1.91 <0.0001 225 1.18 .3747

Transplant year = 2000 vs. 2002/2003 . . 2892 1.18 .0101

Diagnosis: Coronary artery disease 6030 1.13 .0120 4324 1.17 .0128

PRA > 10% 606 1.40 .0002 492 1.13 .3018

HLA DR mismatches (per mismatch) 591 0 MM

1.16 .0003 433 0 MM

1.10 .0596

Intra-aortic balloon pump 479 1.41 .0006 427 1.02 .8722

HLA B mismatches (per mismatch) 237 0 MM

1.17 .0015 155 0 MM

1.02 .7367

Infection requiring IV drug therapy within 2 weeks of transplant

691 1.21 .0366 798 0.99 .9348

Prior transfusions 1367 1.20 .0129 1454 0.90 .2329

IV inotropes 4811 0.79 <0.0001 3401 0.75 <0.0001

2005ISHLTNote: All factors were significant at p < 0.05 in at least one of the eras.


ADULT HEART TRANSPLANTS (1/1996-6/2003) Borderline Significant Risk Factors for 1 Year Mortality

1996-1999 (N=13,365)

2000-6/2003 (N=9,743)


Risk p-value N

Relative Risk

p-value

Diagnosis: Valvular heart disease 392 1.22 .0975 283 1.24 .1485

Insulin-dependent diabetes 645 1.10 .3040 574 1.21 .0824

Male recipient/female donor 2873 1.10 .0770 1900 1.10 .1779

2005ISHLTNote: All factors were significant at 0.5 < p < 0.1 in at least one of the eras.



Continuous Factors (see figures)

Recipient age

Recipient weight

Donor age

Donor/recipient weight ratio

Transplant center volume

PA diastolic pressure

Ischemia time

Bilirubin

Serum creatinine

2005ISHLTJ Heart Lung Transplant 2005;24: 945-982


Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Rela

tive R

isk o

f 1 Y

ear

Mo

rtalit

y

1996-1999

2000-6/2003

p < 0.0001p < 0.0001



Donor Age

0

0.5

1

1.5

2

15 25 35 45 55

Donor Age

Rela

tive R

isk o

f 1 Y

ear

Mo

rtalit

y

1996-1999

2000-6/2003

p < 0.0001p < 0.0001


ADULT HEART TRANSPLANTS (1/1996-6/2003) Risk Factors for 1 Year MortalityPre-Transplant Recipient Weight

0

0.5

1

1.5

2

50 60 70 80 90 100 110

Recipient Weight (kg)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtalit

y

1996-1999

2000-6/2003

p = 0.0006p = 0.53



Pre-Transplant Recipient BMI

0

0.5

1

1.5

2

17 21 25 29 33 37

Recipient BMI (kg/m2)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtalit

y

1996-1999

2000-6/2003

p = 0.04p = 0.43


ADULT HEART TRANSPLANTS (1/1996-6/2003) Risk Factors for 1 Year MortalityDonor Weight/Recipient Weight

0

0.5

1

1.5

2

0.6 0.7 0.8 0.9 1 1.1 1.2 1.3 1.4 1.5 1.6 1.7

Donor Weight/Recipient Weight

Rela

tive R

isk o

f 1 Y

ear

Mo

rtalit

y

1996-1999

2000-6/2003

p = 0.0002p = 0.11



Center Volume

0

0.5

1

1.5

2

0 10 20 30 40 50 60 70

Center Volume (cases per year)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtalit

y

1996-1999

2000-6/2003

p = 0.0001p < 0.0001



Ischemia Time

0

0.25

0.5

0.75

1

1.25

1.5

1 2 3 4 5

Ischemia time (hours)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtalit

y 1996-1999

2000-6/2003

p < 0.0001p < 0.0001



Pre-Transplant Bilirubin

0

0.5

1

1.5

2

0.5 1.5 2.5 3.5 4.5

Recipient bilirubin (mg/dl)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtalit

y

1996-1999

2000-6/2003

p = 0.0004p = 0.0004



Pre-Transplant Creatinine

0

0.5

1

1.5

2

0.6 1.1 1.6 2.1 2.6

Recipient creatinine (mg/dl)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtalit

y

1996-1999

2000-6/2003

p < 0.0001p < 0.0001


ADULT HEART TRANSPLANTS (1/1996-6/2003) Risk Factors for 1 Year MortalityRecipient PA Diastolic Pressure

0

0.5

1

1.5

2

5 10 15 20 25 30 35 40

PA Diastolic Pressure (mm Hg)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtalit

y 1996-1999

2000-6/2003

p = 0.0087p = 0.0073


ADULT HEART TRANSPLANTS (1/196-6/2003)

Factors Not Significant for 1 Year Mortality

Recipient Factors: Pneumothorax, sternotomy, thoracotomy, ventricular remodeling, pregnancy, pulmonary embolism, prior malignancy, pulmonary vascular resistance, PCW, PA systolic

Donor Factors: Clinical infection, history of diabetes, height, history of hypertension

Transplant Factors: ABO identical/compatible


ADULT HEART TRANSPLANTS (1/1995-6/2003) 1-Year Predicted Survival – Hypothetical Patient 1

50%

60%

70%

80%

90%

100%

0 0.2 0.4 0.6 0.8 1

Time (years)

Pre

dic

ted

Su

rviv

al

.

Recipient: 30 year old female, PRA = 50%, creatinine=1.4, hospitalized on inotropes, weight=80 kg, height=65 in., center volume=22/year, multiple pregnancies, year of transplant=2000

Donor: female, 30 years old

Cohort average



50%

60%

70%

80%

90%

100%

0 0.2 0.4 0.6 0.8 1

Time (years)

Pre

dic

ted

Su

rviv

al

.

Recipient: 63 year old male with coronary artery disease, PRA < 10%, creatinine=1.8, pulsatile long-term VAD, weight=95 kg, height=70 in., 3 hours ischemia time

Cohort average



50%

60%

70%

80%

90%

100%

0 0.2 0.4 0.6 0.8 1

Time (years)

Pre

dic

ted

Su

rviv

al .

30 year old donor 55 year old donor

Recipient: 71 year old male with idiopathic DCM, hospitalized on inotropes, creatinine=1.0, PRA < 10%, weight=70 kg, height=70 in., 3 hours ischemia time



50%

60%

70%

80%

90%

100%

0 0.2 0.4 0.6 0.8 1

Time (years)

Pre

dic

ted

Su

rviv

al

.

Recipient: 24 year old male retransplant recipient, PRA < 10%, creatinine=1.2, weight=85 kg, height=72 in., 2.5 hours ischemia time

Donor: male, 32 years old

Cohort average


ADULT HEART TRANSPLANTS (1996-6/1999) Risk Factors for 5 Year Mortality

VARIABLE N Relative

Risk P-value

95% Confidence

Interval

Repeat Transplant 271 1.96 <0.0001 1.57 -2.43

Ventilator 210 1.51 .0003 1.21 -1.89

Dialysis 137 1.49 .0027 1.15 -1.92

Diabetes 1268 1.20 .0013 1.07 -1.33

In hospital at time of transplant 8465 1.19 .0003 1.08 -1.30


576 1.17 .0416 1.01 -1.37

(N=11,794)


ADULT HEART TRANSPLANTS (1996-6/1999) Risk Factors for 5 Year Mortality

VARIABLE N Relative

Risk P-

value

95% Confidence

Interval

HLA DR mismatches (per mismatch) 533 0 MM 1.15 .0000 1.08 -1.23

Diagnosis: Coronary artery disease 5314 1.15 .0007 1.06 -1.25

Transplant year 1996 vs. 1998/1999 3565 1.14 .0020 1.05 -1.24

Previous transfusions 1179 1.14 .0323 1.01 -1.28

Female recipient 2443 1.13 .0211 1.02 -1.26

IV inotropes 4312 0.87 .0012 0.79 -0.94

(N=11,794)


ADULT HEART TRANSPLANTS (1996-6/1999) Borderline Significant Risk Factors for 5 Year Mortality

VARIABLE N Relative

Risk P-value

95% Confidence

Interval

Diagnosis: Congenital heart disease 176 1.29 .0804 0.97 -1.71

PRA > 10% 529 1.16 .0573 1.00 -1.36

Intra-aortic balloon pump 407 1.15 .1225 0.96 -1.39

HLA B mismatches (per mismatch) 212 0 MM 1.07 .0716 0.99 -1.16

(N=11,794)




Recipient age

Recipient weight

Donor age

Weight ratio

Ischemia time


Serum creatinine

Bilirubin

Wedge pressure



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Rela

tive R

isk o

f 5 Y

ear

Mo

rtalit

y

p < 0.0001



Donor Age

0

0.5

1

1.5

2

15 20 25 30 35 40 45 50 55 60

Donor Age

Rela

tive R

isk o

f 5 Y

ear

Mo

rtalit

y

p < 0.0001


ADULT HEART TRANSPLANTS (1/1996-6/1999) Risk Factors for 5 Year MortalityPre-Transplant Recipient Weight

0

0.5

1

1.5

2

50 60 70 80 90 100 110

Recipient Weight (kg)

Rela

tive R

isk o

f 5 Y

ear

Mo

rtalit

y

p < 0.0001




0

0.5

1

1.5

2

17 19 21 23 25 27 29 31 33 35 37


Rela

tive R

isk o

f 5 Y

ear

Mo

rtalit

y

p = 0.031



Donor Weight/Recipient Weight Ratio

0

0.5

1

1.5

2

0.6 0.7 0.8 0.9 1 1.1 1.2 1.3 1.4 1.5 1.6 1.7

Donor Weight/Recipient Weight Ratio

Rela

tive R

isk o

f 5 Y

ear

Mo

rtalit

y

p = 0.0015



Center Volume

0

0.5

1

1.5

2

0 10 20 30 40 50 60 70


Rela

tive R

isk o

f 5 Y

ear

Mo

rtalit

y

p = 0.0001



Ischemia Time

0

0.5

1

1.5

2

1 2 3 4 5

Ischemia time (hours)

Rela

tive R

isk o

f 5 Y

ear

Mo

rtalit

y

p < 0.0001



Pre-Transplant Creatinine

0

0.5

1

1.5

2

0.5 1 1.5 2 2.5

Recipient creatinine (mg/dl)

Rela

tive R

isk o

f 5 Y

ear

Mo

rtalit

y

p < 0.0001



Pre-Transplant Bilirubin

0

0.5

1

1.5

2

0.5 1.5 2.5 3.5 4.5 5.5

Recipient bilirubin (mg/dl)

Rela

tive R

isk o

f 5 Y

ear

Mo

rtalit

y

p < 0.0001


ADULT HEART TRANSPLANTS (1/1996-6/1999) Factors Not Significant for 5 Year Mortality

Recipient Factors: VAD, gender, pulmonary vascular resistance, PA systolic, PA diastolic, thoracotomy, sternotomy, pregnancy, history of malignancy, pneumothorax, pulmonary embolism symptomatic cerebrovascular disease/ cerebrovascular event

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

Transplant Factors: Donor/recipient BMI ratio, ABO identical/compatible



50%

60%

70%

80%

90%

100%

0 1 2 3 4 5

Time (years)

Pre

dic

ted

Su

rviv

all



Cohort average



50%

60%

70%

80%

90%

100%

0 1 2 3 4 5

Time (years)

Pre

dic

ted

Su

rviv

all


Cohort average



50%

60%

70%

80%

90%

100%

0 1 2 3 4 5

Time (years)

Pre

dic

ted

Su

rviv

all





50%

60%

70%

80%

90%

100%

0 1 2 3 4 5

Time (years)

Pre

dic

ted

Su

rviv

all



Cohort average


ADULT HEART TRANSPLANTS (1996-6/1999) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

VARIABLE N Relative

Risk P-value 95% Confidence

Interval

Repeat transplant 181 1.70 .0072 1.16 -2.52

Stroke prior to transplant discharge 100 1.66 .0138 1.11 -2.48

Cerebrovascular event prior to transplant 299 1.40 .0094 1.09 -1.81

Coronary Artery Vasculopathy during 1st year 432 1.40 .0025 1.13 -1.74

Diabetes 999 1.35 .0003 1.15 -1.58

Treated for rejection during 1st year 2574 1.30 <0.0001 1.15 -1.47

Treated for infection prior to transplant discharge

1166 1.26 .0023 1.09 -1.47

Transplant year = 1996 vs. 1998/1999 2825 1.24 .0012 1.09 -1.42

HLA DR mismatches (per mismatch) 425 0 MM 1.16 .0047 1.05 -1.28

(N=9,120)


ADULT HEART TRANSPLANTS (1/1996-6/1999) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year


Recipient age

Donor age

Recipient weight


ADULT HEART TRANSPLANTS (1/1996-6/1999) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

Recipient Age

0

0.5

1

1.5

2

2.5

20 25 30 35 40 45 50 55 60 65

Recipient Age

Rela

tive R

isk o

f 5 Y

ear

Mo

rtality

.

p = 0.002



Donor Age

0

0.5

1

1.5

2

15 25 35 45 55

Donor Age

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.0003


ADULT HEART TRANSPLANTS (1/1996-6/1999) Risk Factors for 5 Year Mortality Conditional on Survival to 1 YearPre-Transplant Recipient Weight

0

0.5

1

1.5

2

50 60 70 80 90 100 110

Recipient weight (kg)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity p = 0.0014




0

0.5

1

1.5

2

17 19 21 23 25 27 29 31 33 35 37


Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity p = 0.18



Conditional on Survival to 1 Year

Recipient Factors:Diagnosis, gender, ventilator, VAD, in hospital, IV inotropes, dialysis, infection prior to transplant, transfusions, PRA, balloon, pulmonary embolism, PA pressures, PCW, pulmonary vascular resistance, cardiac output, history of malignancy, height, sternotomy, bilirubin, pregnancy



Conditional on Survival to 1 Year

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

Transplant Factors:Donor/recipient BMI ratio, donor/recipient weight ratio, CMV mismatch, center volume, ischemia time, ABO compatible/identical

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


ADULT HEART TRANSPLANTS (1990-6/1993) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years

VARIABLE N Relative

Risk P-value 95% Confidence

Interval

Repeat transplant 164 1.37 .0371 1.02 -1.83

Diagnosis: other than cardiomyopathy, coronary artery disease, congenital heart disease, or valvular heart disease

538 1.24 .0378 1.01 -1.52

Diagnosis: Coronary artery disease 4946 1.19 <0.0001 1.10 -1.29

Transplant year: 1990 vs. 1992/1993 2364 1.11 .0299 1.01 -1.21

HLA DR mismatches (per mismatch) 534 0 MM

1.09 .0108 1.02 -1.16

Female/no previous pregnancy 1212 0.83 .0060 0.73 -0.95

(N=10,982)


ADULT HEART TRANSPLANTS (1990-6/1993) Borderline Significant Risk Factors for 10 Year Mortality

Conditional on Survival to 3 Years

VARIABLE N Relative

Risk P-value

95% Confidence

Interval

HLA A mismatches (per mismatch) 679 0 MM 1.06 .0821 0.99 -1.13

HLA B mismatches (per mismatch) 229 0 MM 0.94 .0916 0.87 -1.01

(N=10,982)


ADULT HEART TRANSPLANTS (1990-6/1993) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years


Recipient age

Donor age

Recipient BMI

Donor weight


ADULT HEART TRANSPLANTS (1/1990-6/1993) Risk Factors for 10 Year Mortality Conditional on Survival to 3 Years

Recipient Age

0

0.5

1

1.5

2

2.5

20 25 30 35 40 45 50 55 60 65

Recipient Age

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

alit

y p < 0.0001



Donor Age

0

0.5

1

1.5

2

15 25 35 45 55

Donor Age

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

alit

y

p < 0.0001




0

0.5

1

1.5

2

18 20 22 24 26 28 30 32 34


Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

alit

y p < 0.0001



Donor Weight

0

0.5

1

1.5

2

40 50 60 70 80 90 100 110

Donor Weight (kg)

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

alit

y p = 0.0004


ADULT HEART TRANSPLANTS (1/1990-6/1993) Conditional 10-Year Predicted Survival – Hypothetical Patient 1

50%

60%

70%

80%

90%

100%

3 4 5 6 7 8 9 10

Time (years)

Pre

dic

ted

Su

rviv

all



Cohort average



50%

60%

70%

80%

90%

100%

3 4 5 6 7 8 9 10

Time (years)

Pre

dic

ted

Su

rviv

all


Cohort average



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

3 4 5 6 7 8 9 10

Time (years)

Pre

dic

ted

Su

rviv

all





50%

60%

70%

80%

90%

100%

3 4 5 6 7 8 9 10

Time (years)

Pre

dic

ted

Su

rviv

all



Cohort average


ADULT HEART TRANSPLANTS (1996-6/2001) Risk Factors for Developing Coronary Artery

Vasculopathy within 3 Years

VARIABLE Relative

RIsk P-value

95% Confidence

Interval

Transplant year = 1996 vs. 2000/2001 1.36 .0004 1.14 -1.61



1.25 .0240 1.03 -1.52

Donor history of hypertension 1.24 .0089 1.06 -1.45


Prior transfusions 0.84 .0411 0.71 -0.99

Female recipient 0.82 .0116 0.71 -0.96

Female donor 0.82 .0026 0.72 -0.93

(N=6,730)


ADULT HEART TRANSPLANTS (1996-6/2001) Risk Factors for Developing Coronary Artery

Vasculopathy within 3 Years


Recipient age

Donor age

Recipient BMI



ADULT HEART TRANSPLANTS (1996-6/2001) Risk Factors for Developing Coronary Artery Vasculopathy within 3 Years

Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Ris

k o

f C

AV

wit

hin

3 Y

ears

.

p = 0.0057



Donor Age

0

0.5

1

1.5

2

2.5

15 20 25 30 35 40 45 50 55

Donor Age

Ris

k o

f C

AV

wit

hin

3 Y

ears

.

p < 0.0001




0

0.5

1

1.5

2

18 20 22 24 26 28 30 32

Recipient BMI

Ris

k o

f C

AV

wit

hin

3 Y

ears

.

p = 0.0031



Center Volume

0

0.5

1

1.5

2

0 10 20 30 40 50 60 70


Ris

k o

f C

AV

wit

hin

3 Y

ears

.

p < 0.0001


ADULT HEART TRANSPLANTS (1996-6/1997) Risk Factors for Developing CAV within 7 Years Conditional

on no CAV within 1 Year

VARIABLE Relative

Risk P-value

95% Confidence

Interval

Donor history of diabetes 1.87 0.0287 1.07 -3.28

Donor cause of death: cerebrovascular/stroke

1.37 0.0208 1.05 -1.79

HLA B mismatches (per mismatch) 0.72 0.0004 0.6 -0.86

Female donor 0.66 0.0014 0.51 -0.85

(N=1,461)


ADULT HEART TRANSPLANTS (1996-6/1997) Borderline Significant Risk Factors for Developing CAV

within 7 Years Conditional on no CAV within 1 Year

VARIABLE Relative

Risk P-value

95% Confidence

Interval

Diagnosis: Coronary artery disease 1.23 0.0825 0.97 -1.56

(N=1,461)



on no CAV within 1 Year


Recipient age

Donor age

Recipient BMI




on no CAV within 1 Year Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Ris

k o

f C

AV

wit

hin

7 y

ea

rs

p = 0.014



on no CAV within 1 Year Donor Age

0

0.5

1

1.5

2

15 20 25 30 35 40 45 50 55

Donor Age

Ris

k o

f C

AV

wit

hin

7 y

ea

rs

p < 0.0001



on no CAV within 1 Year Pre-Transplant Recipient BMI

0

0.5

1

1.5

2

17 21 25 29 33 37


Ris

k o

f C

AV

wit

hin

7 y

ea

rs

p = 0.029



on no CAV within 1 Year Center Volume

0

0.5

1

1.5

2

0 10 20 30 40 50 60 70


Ris

k o

f C

AV

wit

hin

7 y

ea

rs

p = 0.042


heart transplantation overall ishlt 2005 j heart lung transplant 2005;24: 945-982

Documents

j heart lung transplant

adult heart transplants

simultaneous heart

number of heart transplants

adult heart retransplants

year of transplant ishlt

ishlt transplant registry

kidney transplants transplants