Download - HEART TRANSPLANTATION Overall ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
HEART TRANSPLANTATION
Overall
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
NUMBER OF HEART TRANSPLANTSBY YEAR
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
0
500
1000
1500
2000
2500
3000
3500
4000
4500
50001
87
32
2 67
0 1,2
55 2
,35
2
2,9
91
3,5
08
3,8
01
4,4
64
4,6
79
4,6
46
4,8
51
4,7
61
4,7
55
4,6
30
4,5
38
4,2
81
3,9
95
3,8
58
3,8
36
3,7
26
3,6
50
3,6
10
3,7
09
3,7
72
3,7
77
3,7
45
3,7
74
3,8
92
Nu
mb
er
of
tra
ns
pla
nts
NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, the presented data may not mirror the changes in the number of heart transplants performed worldwide .ISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
NUMBER OF HEART TRANSPLANTSBY YEAR AND LOCATION
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000Other
Europe
North America
Nu
mb
er
of
tra
ns
pla
nts
NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, the presented data may not mirror the changes in the number of heart transplants performed worldwide .ISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AVERAGE CENTER VOLUMEHeart Transplants: January 2006 – June 2011
1-4 5-9 10-19 20-29 30-39 40-49 50-74 75+0
10
20
30
40
50
60
70
80
90
100
110
0
5
10
15
20
25
30
35
40
45
50
55
4358
104
37
10 4 8 2
Number of centers Percentage of transplants
Average number of heart transplants per year
Nu
mb
er
of
ce
nte
rs
% o
f tr
an
sp
lan
ts
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
HEART TRANSPLANTSDonor Age by Year of Transplant
19821984
19861988
19901992
19941996
19982000
20022004
20062008
20100%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
5
10
15
20
25
30
35
0-10 11-17 18-34 35-49 50-59 60+ Median Age
% o
f tr
an
sp
lan
ts
Me
dia
n d
on
or
ag
e (
ye
ars
)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
HEART TRANSPLANTSMedian Donor Age by Location
ISHLT 2012
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
0
5
10
15
20
25
30
35
40
45
Europe North America Other
Me
dia
n d
on
or
ag
e (
ye
ars
)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AGE DISTRIBUTION OF HEART TRANSPLANTRECIPIENTS BY ERA
0-9 10-19 20-29 30-39 40-49 50-59 60-69 70+0
5
10
15
20
25
30
35
40
1982-1995 (N = 42,890)
1996-2005 (N = 39,797)
2006-6/2011 (N = 20,645)
Recipient age
% o
f tr
an
sp
lan
ts
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
HEART TRANSPLANTSKaplan-Meier Survival
(Transplants: January 1982 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 250
25
50
75
100
Years
Su
rviv
al (
%)
Half-life = 10 yearsConditional half-life = 13 years
ISHLT 2012 Survival is based on adult and pediatric transplant recipients
N = 96,273
N at risk at 25 years = 112
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
HEART TRANSPLANTATION
Adult Recipients
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
DIAGNOSIS IN ADULT HEART TRANSPLANTS
Myopathy48%
Congenital2%
ReTX2%
CAD44%
Misc.0%
Valvular4%
1/1982 – 6/2011
ISHLT 2012
Myopathy54%
Congenital3%
ReTX3%
CAD37% Misc.
1%
Valvular3%
1/2006 – 6/2011
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS Diagnosis: Cardiomyopathy vs. CAD by Location
ISHLT 2012
20
30
40
50
60
70Myopathy CAD
% o
f cases All Locations
20
30
40
50
60
70Myopathy CAD
% o
f cases Europe
20
30
40
50
60
70
Myopathy CAD
% o
f cases North America
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSDiagnosis by Location
(Transplants: January 2006 – June 2011)
Myopathy58%
Congenital4%
ReTX1%
CAD33% Misc.
0%
Valvular3%
Europe
ISHLT 2012
Myopathy51%
Congenital3%
ReTX3%
CAD40% Misc.
1%Valvular
2%
North America
Myopathy57%
Congenital2%
ReTX1%
CAD32%
Misc.6%
Valvular2%
Other
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSDonor and Recipient Characteristics
ISHLT 2012
1992-2000(N = 36,507)
2001-2005(N = 16,352)
2006-6/2011(N = 17,868) p-value
Recipient age (years) 54.0 (28.0-65.0) 54.0 (26.0-66.0) 54.0 (24.0-67.0) 0.0064
Donor age (years) 31.0 (15.0-54.0) 33.0 (16.0-55.0) 34.0 (17.0-56.0) <0.0001
Donor and Recipient Age Difference (years) -19.0 (-44.0-7.0) -17.0 (-43.0-10.0) -16.0 (-43.0-12.0) <0.0001
Recipient weight (kg) 75.0 (51.0-101.6) 77.6 (53.0-106.6) 79.4 (53.1-110.2) <0.0001
Recipient height (cm) 173.0 (157.0-188.0) 174.0 (157.5-188.0) 175.0 (157.5-188.0) <0.0001
Recipient BMI 25.0 (18.9-32.7) 25.6 (19.2-33.8) 26.0 (19.2-34.9) <0.0001
Donor weight (kg) 74.8 (52.0-103.0)1 76.7 (55.0-108.6) 79.4 (56.7-113.0) <0.0001
Donor height (cm) 175.0 (155.0-188.0)1 175.0 (157.0-189.0) 175.0 (158.0-190.0) <0.0001
Donor BMI 24.2 (18.8-32.9)1 24.8 (19.5-34.3) 25.5 (19.9-36.2) <0.0001
Continuous factors are expressed as median (5th-95th percentiles)
1 Based on 4/1994-2000 transplants.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSDonor and Recipient Characteristics
ISHLT 2012
1992-2000(N = 36,507)
2001-2005(N = 16,352)
2006-6/2011(N = 17,868) p-value
Recipient/donor gender (% male) 80.7%/ 68.4% 77.7%/ 69.0% 76.3%/ 69.4% <0.0001/ 0.0545
Male recipient/ female donor 21.2% 18.4% 16.6% <0.0001
Female recipient/ male donor 9.1% 9.7% 9.7% 0.0327
Recipient/donor diabetes mellitus 17.8%1/ 1.6%1 20.2%/ 2.0% 25.4%/ 2.8% <0.0001/ <0.0001
Recipient amiodarone use (US only) 21.7%1 29.0% 30.2% <0.0001
Recipient/donor cigarette history -/ 38.0%1 46.6%2/ 29.1% 46.5%/ 19.2% 0.9848/ <0.0001
Recipient/donor hypertension 34.2%1/ 10.8%1 38.1%/ 11.4% 44.1%/ 13.4% <0.0001/ <0.0001
Recipient prior cardiac surgery - 38.9%2 45.4% <0.0001
Recipient Peripheral Vascular Disease 3.8%1 3.2% 2.9% 0.0002
Recipient previous malignancy 3.2%1 4.5% 6.4% <0.0001
Recipient COPD 3.2%1 3.2% 4.2% 0.0001
Ischemic time (hours) 2.6 (0.0-4.5) 2.9 (0.0-4.9) 3.1 (0.0-5.0) <0.0001
Continuous factors are expressed as median (5th-95th percentiles)
1 Based on 4/1994-2000 transplants.2 Based on 7/2004-2005 transplants.
(Cont’d)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSDonor and Recipient Characteristics
ISHLT 2012
1992-2000(N = 36,507)
2001-2005(N = 16,352)
2006-6/2011(N = 17,868) p-value
Most recent PRA > 10%1
Overall 7.7% 8.8%2 12.7%3 <0.0001
Class I - - 14.2%4 -
Class II - - 9.1%4 -
Creatinine at time of transplant 1.2 (0.7-2.5) 1.2 (0.7-2.4) 1.2 (0.7-2.3) <0.0001
Pulmonary vascular resistance (Wood units) 2.2 (0.4-6.1)5 2.0 (0.3-5.6) 2.1 (0.3-5.4) <0.0001
HLA Mismatches
0-2 4.3% 4.4% 3.8%
0.0051 3-4 40.2% 40.0% 38.9%
5-6 55.5% 55.5% 57.4%
Continuous factors are expressed as median (5th-95th percentiles)
2 Based on US 2001-6/2004 transplants and non US 2001 - 2005 transplants.3 Based on non US transplants.4 Based on US transplants.5 Based on 4/1994-2000 transplants.
1 PRA was collected as a single percentage outside of US. Until mid-2004 PRA was collected in US as a single percentage. After this date, PRA was collected separately for Class I and Class II.
(Cont’d)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSDonor and Recipient Characteristics
ISHLT 2012
1992-2000(N = 36,507)
2001-2005(N = 16,352)
2006-6/2011(N = 17,868) p-value
Diagnosis
Cardiomyopathy 46.4% 48.5% 53.8%
<0.0001
Coronary artery disease 45.8% 42.6% 37.1%
Valvular 3.8% 3.3% 2.6%
Retransplant 1.9% 2.2% 2.6%
Congenital 1.8% 2.7% 3.0%
Other causes 0.4% 0.6% 0.9%
Donor cause of death
Head trauma 44.6% 54.5% 46.6%
<0.0001 Stroke 28.2% 33.0% 24.8%
Other 27.2% 12.5% 28.6%
(Cont’d)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSDonor and Recipient Characteristics
ISHLT 2012
1992-2000(N = 36,507)
2001-2005(N = 16,352)
2006-6/2011(N = 17,868) p-value
Pre-operative support (multiple items may be reported)
Hospitalized at time of transplant 60.2% 47.8% 44.6% <0.0001
On IV inotropes 55.8%1 47.3% 42.6% <0.0001
LVAD 12.12 17.0% 27.3% <0.0001
IABP 6.8% 6.9% 6.2% 0.0731
RVAD - 5.0%3 3.8% 0.0125
Ventilator 3.5% 3.3% 2.9% 0.0141
TAH 0.1%2 0.1% 0.9% <0.0001
ECMO 0.3%4 0.5% 1.0% <0.0001
1 Based on 4/1994-2000 transplants.2 Based on 11/1999-2000 transplants.3 Based on 2005 transplants.4 Based on 5/1995-2000 transplants.
(Cont’d)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSDonor and Recipient Age
(Transplants: January 2006 – June 2011)
18-19 20-29 30-39 40-49 50-59 60-69 70+0%
20%
40%
60%
80%
100%
0-10 11-17 18-34 35-49 50-59 60+
Recipient Age
% o
f T
ran
sp
lan
ts
Donor Age:
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSDonor and Recipient Age
(Transplants: January 2006 – June 2011)
0-10 11-17 18-34 35-49 50-59 60+0%
20%
40%
60%
80%
100%
18-19 20-29 30-39 40-49 50-59 60-69 70+
Donor Age
% o
f T
ran
sp
lan
ts
Recipient Age:
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS PRA Distribution
(Transplants: January 2006 – June 2011)
0 1-9 10-39 40-79 80+0
10
20
30
40
50
60
70
80
PRA
% o
f tr
an
sp
lan
ts
ISHLT 2012If Class I and Class II values were reported separately, the higher of the two values was used.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS % of Patients Bridged with Mechanical Circulatory Support*
(Transplants: January 2000 – December 2010)
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
Year
% o
f p
ati
en
ts
ISHLT 2012* LVAD, RVAD, TAH
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS % of Patients Bridged with Mechanical Circulatory Support*
by Year and Device Type
2005 2006 2007 2008 2009 20100
10
20
30
40
50
TAH
LVAD+RVAD
RVAD
LVAD
Year
% o
f p
ati
en
ts
ISHLT 2012* LVAD, RVAD, TAH
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS Number of Combined Organ Transplants Reported
By Year and Type of Transplant
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90Other Combined Organ TransplantsHeart-Kidney-PancreasHeart-Kidney-LiverHeart-LiverHeart-Kidney
Nu
mb
er
of
tra
ns
pla
nts
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS % of Combined Organ Transplants Reported By Year
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
% o
f tr
an
sp
lan
ts
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSDonor Age Distribution By Location
(Transplants: January 2006 – June 2011)
Europe North America Other0%
20%
40%
60%
80%
100%
0-10 years 11-17 years 18-34 years 35-49 years 50-59 years 60+ years
% o
f D
on
ors
ISHLT 2012
Mean/median donor age: Europe = 40.2/42.0 North America = 31.6/29.0 Other = 32.2/30.0J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSRecipient Age Distribution By Location
(Transplants: January 2006 – June 2011)
Europe North America Other0%
20%
40%
60%
80%
100%
18-19 years 20-29 years 30-39 years 40-49 years 50-59 years60-69 years 70+ years
% o
f D
on
ors
ISHLT 2012
Mean/median recipient age: Europe = 49.6/52.0 North America = 52.0/55.0 Other = 48.5/51.0J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSRecipient BMI Distribution By Location
(Transplants: January 2006 – June 2011)
Europe North America Other0%
20%
40%
60%
80%
100%
<18.5 18.5-<25 25-<30 30-<40 40+
% o
f T
ran
sp
lan
ts
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSRecipient BMI Distribution By Diagnosis
(Transplants: January 2006 – June 2011)
Cardiomyopathy Coronary Artery Disease0%
20%
40%
60%
80%
100%
<18.5 18.5-<25 25-<30 30-<40 40+
% o
f T
ran
sp
lan
ts
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSRecipient Diabetes Mellitus Distribution By Location
(Transplants: January 2006 – June 2011)
Europe North America Other0%
20%
40%
60%
80%
100%
Diabetes No diabetes
% o
f T
ran
sp
lan
ts
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSRecipient Diabetes Mellitus Distribution By Diagnosis
(Transplants: January 2006 – June 2011)
Cardiomyopathy Coronary Artery Disease0%
20%
40%
60%
80%
100%
Diabetes No diabetes
% o
f T
ran
sp
lan
ts
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSRecipient Cigarette History By Location
(Transplants: January 2006 – June 2011)
Europe North America Other0%
20%
40%
60%
80%
100%
Cigarette history No cigarette history
% o
f T
ran
sp
lan
ts
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSRecipient Cigarette History By Diagnosis
(Transplants: January 2006 – June 2011)
Cardiomyopathy Coronary Artery Disease0%
20%
40%
60%
80%
100%
Cigarette history No cigarette history
% o
f T
ran
sp
lan
ts
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by Era
(Transplants: January 1982 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
100
1982-1992 (N = 25,138)1993-2002 (N = 37,193)2003-6/2010 (N = 24,021)
Years
Su
rviv
al (
%)
HALF-LIFE 1982-1992: 8.5 years; 1993-2002: 10.9 years; 2003-6/2010: NA
1982-1992 vs. 1993-2002: p < 0.00011982-1992 vs. 2003-6/2010: p <0.0001 1993-2002 vs. 2003-6/2010: p <0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSConditional Kaplan-Meier Survival by Era
(Transplants: January 1982 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
100
1982-1992 (N = 18,877)1993-2002 (N = 29,293)2003-6/2010 (N = 18,021)
Years
Su
rviv
al (
%)
HALF-LIFE 1982-1992: 11.8 years; 1993-2002: 13.4 years; 2003-6/2010: NA
1982-1992 vs. 1993-2002: p < 0.00011982-1992 vs. 2003-6/2010: p <0.0001 1993-2002 vs. 2003-6/2010: p = 0.3073
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by Age Group
(Transplants: January 1982 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 200
20
40
60
80
100
18-29 (N=6,134) 30-39 (N=8,623)
40-49 (N=19,179) 50-59 (N=33,178)
60-69 (N=18,655) 70+ (N=573)
Years
Su
rviv
al (
%)
HALF-LIFE 18-29: 12.2 years; 30-39: 12.0 years; 40-49: 11.1 years; 50-59: 10.0 years; 60-69: 8.9 years; 70+: 7.4 years
All pair-wise comparisons are statistically significant at p < 0.01 except 18-29 vs. 30-39 (p=0.8452)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by Age Group
(Transplants: January 2003 - June 2010)
0 1 2 3 4 5 6 70
20
40
60
80
100
18-29 (N=2,068) 30-39 (N=2,413)
40-49 (N=4,602) 50-59 (N=8,283)
60-69 (N=6,362) 70+ (N=293)
Years
Su
rviv
al (
%)
All pair-wise comparisons are statistically significant at p < 0.05 except 18-29 vs. 60-69; 18-29 vs. 70+, 30-39 vs. 40-49 and 60-69 vs. 70+
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by Diagnosis
(Transplants: January 1982 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 200
20
40
60
80
100 Cardiomyopathy (N=39,096) Coronary artery disease (N=36,430)
Congenital diagnosis (N=1,690) Retransplant (N=1,740)
Valvular (N=3,010)
Years
Su
rviv
al (
%)
All pair-wise comparisons are statistically significant at < 0.001 except cardiomyopathy vs. congenital (p=0.6340).
ISHLT 2012
HALF-LIFE Cardiomyopathy: 11.4 years; CAD: 9.4 years; Congenital: 13.7 years; Retransplant: 6.0 years; Valvular: 10.9 years
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by Diagnosis Conditional on Survival
to 1 Year (Transplants: January 1982 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 200
20
40
60
80
100
Cardiomyopathy (N=30,529) Coronary artery disease (N=28,163)
Congenital diagnosis (N=1,195) Retransplant (N=1,153)
Valvular (N=2,206)
Years
Su
rviv
al (
%)
All pair-wise comparisons are significant at p < 0.05 except cardiomyopathy vs. valvular
ISHLT 2012
HALF-LIFE Cardiomyopathy: 14.0 years; CAD: 11.7 years; Congenital: 20.4 years; Retransplant: 10.7 years; Valvular: 14.3 years
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by Era (Transplants: January 1982 - June 2010)
Diagnosis: Cardiomyopathy
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
100
1982-1992 (N = 10,582)1993-2002 (N = 16,370)2003-6/2010 (N = 12,144)
Years
Su
rviv
al (
%)
HALF-LIFE 1982-1992: 9.6 years; 1993-2002: 12.0 years; 2003-6/2010: NA
All comparisons are significant at p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by Era (Transplants: January 1982 - June 2010)
Diagnosis: Coronary Artery Disease
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
100
1982-1992 (N = 10,820)
1993-2002 (N = 16,572)
2003-6/2010 (N = 9,038)
Years
Su
rviv
al (
%)
HALF-LIFE 1982-1992: 8.1 years; 1993-2002: 10.0 years; 2003-6/2010: NA
All comparisons are significant at p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by Era (Transplants: January 1982 - June 2010)
Diagnosis: Congenital
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
100
1982-1992 (N = 320)
1993-2002 (N = 710)
2003-6/2010 (N = 660)
Years
Su
rviv
al (
%)
HALF-LIFE 1982-1992: 13.5 years; 1993-2002: 13.1 years; 2003-6/2010: NA
No comparisons are significant at < 0.05 except 1993-2002 vs. 2003-6/2010: p = 0.0489
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by Era (Transplants: January 1982 - June 2010)
Diagnosis: Retransplant
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
1001982-1992 (N = 470)
1993-2002 (N = 697)
2003-6/2010 (N = 573)
Years
Su
rviv
al (
%)
HALF-LIFE 1982-1992: 1.9 years; 1993-2002: 6.6 years; 2003-6/2010: NA
All comparisons are significant at p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by Era (Transplants: January 1982 - June 2010)
Diagnosis: Valvular
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
100
1982-1992 (N = 1,038)
1993-2002 (N = 1,298)
2003-6/2010 (N = 674)
Years
Su
rviv
al (
%)
HALF-LIFE 1982-1992: 9.2 years; 1993-2002: 12.0 years; 2003-6/2010: NA
All comparisons are significant at < 0.05 except 1993-2002 vs. 2003-6/2010
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier 1 Year Survival by Diagnosis
(Transplants: January 2003 – June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 1250
60
70
80
90
100
Cardiomyopathy (N=12,144) Coronary artery disease (N=9,038)
Congenital diagnosis (N=660) Retransplant (N=573)
Valvular (N=674)
Months
Su
rviv
al (
%)
All pair-wise comparisons are significant at p < 0.05 except CAD vs. retransplant, valvular vs. congenital, valvular vs. retransplant and congenital vs. retransplant
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by Diagnosis
(Transplants: January 2003 – June 2010)
0 1 2 3 4 5 6 750
60
70
80
90
100Cardiomyopathy (N=12,144) Coronary artery disease (N=9,038)
Congenital diagnosis (N=660) Retransplant (N=573)
Valvular (N=674)
Years
Su
rviv
al (
%)
All pair-wise comparisons are significant at p < 0.05 except CAD vs. congenital, valvular vs. congenital, valvular vs. retransplant and congenital vs. retransplant
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by Diagnosis Conditional on Survival
to 1 Year (Transplants: January 2003 – June 2010)
0 1 2 3 4 5 6 750
60
70
80
90
100
Cardiomyopathy (N=9,208) Coronary artery disease (N=6,861)
Congenital diagnosis (N=452) Retransplant (N=434)
Valvular (N=481)
Years
Su
rviv
al (
%)
No pair-wise comparisons are significant at < 0.05 except cardiomyopathy vs. CAD, cardiomyopathy vs. retransplant, CAD vs. congenital and congenital vs. retransplant
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by PVR
(Transplants: January 2003 – June 2010)
0 1 2 3 4 5 6 750
60
70
80
90
100
1-<3 Wood units (N = 7,270) 3-<5 Wood units (N = 2,350)
5+ Wood units (N = 768)
Years
Su
rviv
al (
%)
1-<3 vs. 3-<5: p < 0.00011-<3 vs. 5+: p = 0.34833-<5 vs. 5+: p = 0.1762
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by Donor/Recipient Weight Ratio
(Transplants: January 2003 – June 2010)
For recipients with PVR: 1–<3 wood units
0 1 2 3 4 5 6 750
60
70
80
90
100
<0.8 Weight ratio (N=1,039) 0.8-<0.9 Weight ratio (N= 1,430)0.9-<1.1 Weight ratio (N=2,735) 1.1-<1.2 Weight ratio (N=798)1.2+ Weight ratio (N=1,268)
Years
Su
rviv
al (
%)
No pair-wise comparisons are statistically significant at p < 0.05
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by Donor/Recipient Weight Ratio
(Transplants: January 2003 – June 2010)
For recipients with PVR: 3–<5 wood units
0 1 2 3 4 5 6 750
60
70
80
90
100
<0.8 Weight ratio (N=220) 0.8-<0.9 Weight ratio (N=390)
0.9-<1.1 Weight ratio (N=886) 1.1-<1.2 Weight ratio (N=312)
1.2+ Weight ratio (N=542)
Years
Su
rviv
al (
%)
No pair-wise comparisons are statistically significant at p < 0.05
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by Donor/Recipient Weight Ratio
(Transplants: January 2003 – June 2010)
For recipients with PVR: 5+ wood units
0 1 2 3 4 550
60
70
80
90
100
<0.8 Weight ratio (N=84) 0.8-<0.9 Weight ratio (N=113)0.9-<1.1 Weight ratio (N=258) 1.1-<1.2 Weight ratio (N=107)1.2+ Weight ratio (N=206)
Years
Su
rviv
al (
%)
No pair-wise comparisons are statistically significant at p < 0.05
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by BMI Group
(Transplants: January 2003 – June 2010)
0 1 2 3 4 5 650
60
70
80
90
100
<18.5 (N=581) 18.5-<25 (N=12,217) 25-<30 (N=7,388) 30-<40 (N=3,761)
40+ (N=74)
Years
Su
rviv
al (
%)
p = 0.0007
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by Recipient Diabetes Mellitus
(Transplants: January 2003 – June 2010)
0 1 2 3 4 5 6 750
60
70
80
90
100
Diabetes (N=3,599) No diabetes (N=11,945)
Years
Su
rviv
al (
%)
p = 0.0007
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by Recipient Cigarette History
(Transplants: July 2004 – June 2010)
0 1 2 3 4 5 650
60
70
80
90
100
Cigarette history (N = 5,431) No cigarette history (N = 6,169)
Years
Su
rviv
al (
%)
p = 0.1663
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by VAD usage
(Transplants: April 1994 – June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 140
10
20
30
40
50
60
70
80
90
100
Pulsatile flow (N=3,681) Continuous flow (N=1,434)
No LVAD / No Inotropes (N=13,053) No LVAD / Inotropes (N=14,829)
Years
Su
rviv
al (
%)
Pulsatile vs. Continuous: p=0.0207Pulsatile vs. No LVAD/No Inotropes: p = 0.0005Pulsatile vs. No LVAD/Inotropes: p = 0.0187No other pair-wise comparisons are statistically significant at p < 0.05
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by VAD usage
(Transplants: January 2003 – June 2010)
0 1 2 3 4 5 6 750
60
70
80
90
100Pulsatile flow (N=2,142) Continuous flow (N=1,408)
No LVAD / No Inotropes (N=5,781) No LVAD / Inotropes (N=5,542)
Years
Su
rviv
al (
%)
Pulsatile vs. No LVAD/No Inotropes: p = 0.0012Pulsatile vs. No LVAD/Inotropes: p = 0.0008Continuous vs. No LVAD/No Inotropes: p = 0.0027Continuous vs. No LVAD/Inotropes: p = 0.0006No other pair-wise comparisons are statistically significant at p < 0.05
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by VAD usage Conditional on Survival to 6 Months
(Transplants: January 1999 – June 2010)
0 1 2 3 4 5 6 7 8 9 1050
60
70
80
90
100
Pulsatile flow (N=2,903) Continuous flow (N=1,270)
No LVAD / No Inotropes (N=7,639) No LVAD / Inotropes (N=8,174)
Years
Su
rviv
al (
%)
Continuous vs. No LVAD/No Inotropes: p = 0.0038No other pair-wise comparisons are statistically significant at p < 0.05
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival by VAD usage
(Transplants: January 2005 – June 2010)
0 1 2 3 4 550
60
70
80
90
100 LVAD Pulsatile (N=1,045) LVAD Continuous (N=1,291)LVAD+RVAD Pulsatile (N=367) No LVAD, No Inotropes (N=4,428)No LVAD, Inotropes (N=3,959)
Years
Su
rviv
al (
%)
All pair-wise comparisons with LVAD+RVAD Pulsatile are statistically significant at p < 0.001.LVAD Continuous vs. No LVAD/ Inotropes: p= 0.0239No other pair-wise comparisons are statistically significant at p < 0.05.
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RE-TRANSPLANTS 1 Year Survival
0-12 months >12-36 months >36-60 months >60 months Primary transplant
0
10
20
30
40
50
60
70
80
90
100
1/1982-12/1992
1/1993-12/2002
1/2003-6/2010
1 Y
ea
r P
ati
en
t S
urv
iva
l (%
)
305
188
76
95 80 46
61 86 57 55 389
408
24,4
01
36,3
32
23,3
15
ISHLT 2012
Time between previous and current transplant
Comparison of survival for interval ≤ 12 months vs. > 12 months: p < 0.0001Comparison of survival for interval ≤ 12 months vs. > 12 months for 1/2003-6/2010: p < 0.0001
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTS Cross-Sectional Analysis
Functional Status of Surviving Recipients (Follow-ups: January 2000 – June 2011)
1 Year (N = 8,060) 3 Years (N = 7,324) 5 Years (N = 6,534)0%
20%
40%
60%
80%
100%
No Activity Limitations Performs with Assistance Total Assistance
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTSFunctional Status of Surviving Recipients
US Recipients Only(Follow-ups: January 2006 – June 2011)
0%
20%
40%
60%
80%
100%
1 Year (N = 8,740)
2 Years (N = 7,848)
3 Years (N = 7,265)
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTSEmployment Status of Surviving Recipients
(Follow-ups: January 2000 – June 2011)
0%
20%
40%
60%
80%
100%
1 Year(N = 14,729)
3 Years(N = 12,973)
5 Years(N = 11,413)
Retired
Not Working
Working Part Time
Working Full Time
Working (FT/PT status unknown)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTSEmployment Status of Surviving Recipients
Age at Follow-up: 25-55 Years (Follow-ups: January 2000 – June 2011)
0%
20%
40%
60%
80%
100%
1 Year(N = 6,213)
3 Years(N = 4,740)
5 Years(N = 3,563)
Retired
Not Working
Working Part Time
Working Full Time
Working (FT/PT status unknown)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTSRehospitalization Post-transplant of Surviving Recipients
(Follow-ups: January 2000 – June 2011)
0%
20%
40%
60%
80%
100%
Up to 1 Year(N = 19,800)
Between 2 and 3 Years (N =
16,940)
Between 4 and 5 Years (N =
14,930)
No Hospitalization Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection Hospitalized, Infection Only
Hospitalized, Rejection + Infection
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTSInduction Immunosuppression
(Transplants: January 2005 – June 2011)
0
10
20
30
40
50
60
% o
f p
ati
en
ts
Analysis is limited to patients who were alive at the time of the dischargeISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTSInduction Immunosuppression by Location
(Transplants: January 2005 – June 2011)
Any Induction IL-2R Antagonist Polyclonal ALG/ATG0
10
20
30
40
50
60
70
Europe North America
% o
f p
ati
en
ts
Analysis is limited to patients who were alive at the time of the dischargeISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTSInduction Immunosuppression
(Transplants: 2002, 2007 and 1/2011–6/2011)
Any Induction IL-2R Antag-onist
Polyclonal ALG/ATG
OKT3 Alemtuzumab0
10
20
30
40
50
60
2002 2007 1/2011-6/2011
% o
f p
ati
en
ts
Analysis is limited to patients who were alive at the time of the follow-upISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTSKaplan-Meier Survival by Induction Type
Conditional on Survival to 14 Days(Transplants: January 2001 – June 2010)
0 1 2 3 4 5 6 7 8 950
60
70
80
90
100
No induction (N = 8,556) Polyclonal induction (N = 3,989)
IL-2R antagonist (N = 4,582) OKT3 (N = 509)
Years
Su
rviv
al (
%)
No induction vs. IL-2R: p = 0.0002Polyclonal vs. IL-2R: p = 0.0131IL-2R vs. OKT3: p = 0.0368
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTSMaintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2008 – June 2011)
Cyclosporine Tacrolimus Sirolimus/ Everolimus
MMF/MPA Azathioprine Prednisone0
20
40
60
80
100
Year 1 (N = 5,840) Year 5 (N = 3,559)
% o
f p
ati
en
ts
NOTE: Different patients are analyzed in Year 1 and Year 5
Analysis is limited to patients who were alive at the time of the follow-upISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of 1 Year
Follow-up
Cy-closporine
Tacrolimus Sirolimus/ Everolimus
MMF/MPA Azathioprine Prednisone0
20
40
60
80
1002000 (N = 1,538) 2005 (N = 2,768) 1/2011-6/2011 (N = 1,459)
% o
f p
ati
en
ts
Analysis is limited to patients who were alive at the time of the follow-up
NOTE: Different patients are analyzed in each time frame
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
For the Same Patients(Follow-ups: January 2001 – June 2011)
0%
20%
40%
60%
80%
100%
Year 1 (N = 7,060)
Year 5 (N = 7,060)
None
Other
Sirolimus/Everolimus +calcineurin+cellcycle
Tacrolimus
Cyclosporine
Sirolimus/Everolimus + cellcycle
Sirolimus/Everolimus + calcineurin
Tacrolimus + MMF/MPA
Tacrolimus + AZA
Cyclosporine + MMF/MPA
Cyclosporine + AZA
% o
f P
ati
en
ts
Analysis is limited to patients who were alive at the time of the follow-upISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
(Follow-ups: January 2006 – June 2011)
0%
20%
40%
60%
80%
100%
Year 1 (N = 9,120)
Year 5 (N = 5,975)
None
Other
Sirolimus/Everolimus +calcineurin+cellcycle
Tacrolimus
Cyclosporine
Sirolimus/Everolimus + cellcycle
Sirolimus/Everolimus + calcineurin
Tacrolimus + MMF/MPA
Tacrolimus + AZA
Cyclosporine + MMF/MPA
Cyclosporine + AZA
% o
f P
ati
en
ts
Analysis is limited to patients who were alive at the time of the follow-up
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
by Location(Follow-ups: January 2006 – June 2011)
0%
20%
40%
60%
80%
100%None
Other
Sirolimus/Everolimus +calcineurin+cellcycle
Tacrolimus
Cyclosporine
Sirolimus/Everolimus + cellcycle
Sirolimus/Everolimus + calcineurin
Tacrolimus + MMF/MPA
Tacrolimus + AZA
Cyclosporine + MMF/MPA
Cyclosporine + AZA
% o
f P
ati
en
ts
Europe EuropeNorth America
North America
Analysis is limited to patients who were alive at the time of the follow-up
NOTE: Different patients are analyzed in Year 1 and Year 5ISHLT 2012
Year 1 Year 5
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF ADULT HEART RECIPIENTS Rejection between Transplant Discharge and 1-Year Follow-Up by Year
Analysis is limited to patients who were alive at the time of the follow-upTreated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
ISHLT 2012
Transplant Year
Rejection, Treated Rejection, Untreated
No Rejection Total
N % N % N % N %
2004 399 25.5 106 6.8 1,058 67.7 1,563 100.0
2005 386 23.1 96 5.7 1,192 71.2 1,674 100.0
2006 375 21.6 157 9.1 1,202 69.3 1,734 100.0
2007 311 17.9 199 11.4 1,230 70.7 1,740 100.0
2008 258 15.6 196 11.8 1,202 72.6 1,656 100.0
2009 276 16.0 242 14.0 1,208 70.0 1,726 100.0
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF ADULT HEART RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
Stratified by Type of Induction (Follow-ups: January 2005 – June 30, 2011)
0
10
20
30
40
50
60 No induction, Treatment No induction, No TreatmentPolyclonal, Treatment Polyclonal, No TreatmentIL-2R antagonist, Treatment IL-2R antagonist, No Treatment OKT3, Treatment OKT3, No Treatment
% e
xp
eri
en
cin
g r
eje
cti
on
wit
hin
1 y
ea
r
Overall 18-44 45-62 63+ FemaleAll groups: all no induct vs. poly and no induct vs. IL-2R comparisons are significant at p < 0.05 except 45-62: no induct vs. poly and M: no induct vs. polyOverall: no induct vs. OKT3 (p=0.0130); poly vs. IL-2R (p=0.0005)45-62: poly vs. IL-2R (p=0.0030)63+: no induct vs. OKT3 (p=0.0440)F: no induct vs. OKT3 (p=0.0338)M: poly vs. IL-2R (p=0.0004)
Male
Analysis is limited to patients who were alive at the time of the follow-up
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
ISHLT 2012
No induction: N=5,192Polyclonal: N=2,161IL-2R antagonist: N=3,094OKT3: N=168J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF ADULT HEART RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up Stratified by Maintenance Immunosuppression (Follow-ups: 2005 – June 30, 2011)
0
10
20
30
40
50
60 Cyclosporine + MMF/MPA, Treatment Cyclosporine + MMF/MPA, No Treatment
Tacrolimus + MMF/MPA, Treatment Tacrolimus + MMF/MPA, No Treatment
% e
xp
eri
en
cin
g r
eje
cti
on
wit
hin
1 y
ea
r
Overall 18-44 45-62 63+ Female
Overall: p < 0.000118-44: p < 0.000145-62: p < 0.000163+: p = 0.0026Female: p < 0.0001Male: p < 0.0001
Male
Analysis is limited to patients who were alive at the time of the follow-up
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
ISHLT 2012
Cyclosporine + MMF/MPA: N = 2,966Tacrolimus + MMF/MPA: N = 6,493
NOTE: There were 138 patients with cyclosporine + AZA and 62 with tacrolimus+AZA. These groups were excluded due to small numbers.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival Stratified by Treatment for Rejection Within 1st Year
Conditional on survival to 1 year (1 Year follow-ups: 2005 – 6/2010)
0 1 2 3 4 5 650
60
70
80
90
100
No Rejection (N=6,401) Treated Rejection (N=5,455)
Years
Su
rviv
al (
%)
ISHLT 2012
p < 0.0001
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM HOSPITALIZATION FOR REJECTION BY ERA
For Adult Heart Recipients (Transplants: April 1994 – June 2010)
0 1 2 3 40
10
20
30
40
50
60
70
80
90
100
4/1994-1999 (N = 4,107) 2000-2004 (N = 3,660) 2005-6/2010 (N = 4,089)
Years
% F
reed
om f
rom
hos
pit
aliz
atio
n f
or r
ejec
tion
ISHLT 2012
All pair-wise comparisons are statistically significant at p < 0.0001
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
POST-HEART TRANSPLANT MORBIDITY FOR ADULTSCumulative Morbidity Rates in Survivors within 1, 5 and 10 Years Post-
Transplant (Follow-ups: January 1995 – June 2011)
Outcome Within 1 Year
Total N with known
response
Within 5 Years
Total N with known
response
Within 10 Years
Total N with known response
Hypertension* 72.8% (N = 25,542) 92.6% (N = 11,853) –
Renal Dysfunction 26.7% (N = 27,478) 53.0% (N = 13,481) 68.2% (N = 4,339)
Abnormal Creatinine < 2.5 mg/dl 18.3% 33.2% 37.5%
Creatinine > 2.5 mg/dl 6.6% 15.8% 21.1%
Chronic Dialysis 1.5% 2.9% 6.1%
Renal Transplant 0.3% 1.2% 3.6%
Hyperlipidemia* 60.2% (N = 26,810) 88.0% (N = 13,191) –
Diabetes* 26.5% (N = 27,474) 38.0% (N = 13,306) –
Cardiac Allograft Vasculopathy 7.9% (N = 24,790) 30.4% (N = 9,819) 49.7% (N = 2,482)
ISHLT 2012* Data are not available 10 years post transplant
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
POST-HEART TRANSPLANT MORBIDITY FOR ADULTSCumulative Morbidity Rates in Survivors within 1, 5 and 10 Years Post-
Transplant (Follow-ups: January 1995 – June 2001) For the Same Patients
Outcome Within 1 Year
Total N with known
response
Within 5 Years
Total N with known
response
Within 10 Years
Total N with known response
Renal Dysfunction 21.3% (N = 1,902) 48.6% (N = 1,902) 65.4% (N = 1,902)
Abnormal Creatinine < 2.5 mg/dl 14.7% 33.1% 39.2%
Creatinine > 2.5 mg/dl 6.3% 13.7% 18.7%
Chronic Dialysis 0.1% 0.9% 4.0%
Renal Transplant 0.3% 0.9% 3.5%
Cardiac Allograft Vasculopathy 6.8% (N = 1,902) 29.6% (N = 1,902) 48.9% (N = 1,902)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
POST-HEART TRANSPLANT MORBIDITY FOR ADULTSCumulative Morbidity Rates in Survivors within 1 and 5 Years
Post-Transplant (Follow-ups: January 2001 - June 2006) For the Same Patients
Outcome Within 1 Year
Total N with known
response
Within 5 Years
Total N with known
response
Hypertension 73.0% (N = 3,000) 88.3% (N = 3,000)
Renal Dysfunction 26.4% (N = 3,000) 50.6% (N = 3,000)
Abnormal Creatinine < 2.5 mg/dl 22.2% 38.1%
Creatinine > 2.5 mg/dl 3.5% 9.7%
Chronic Dialysis 0.5% 1.8%
Renal Transplant 0.2% 0.9%
Hyperlipidemia 72.4% (N = 3,000) 89.9% (N = 3,000)
Diabetes 29.3% (N = 3,000) 40.6% (N = 3,000)
Cardiac Allograft Vasculopathy 5.4% (N = 3,000) 26.7% (N = 3,000)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTSKaplan-Meier Survival Stratified by Renal Dysfunction Within 1st Year
Conditional on survival to 1 year (1 Year follow-ups: April 1994-June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 140
20
40
60
80
100
No Renal Dysfunction (N=18,277)
Years
Su
rviv
al (
%)
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
ISHLT 2012
p < 0.0001
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY For Adult Heart Recipients (Transplants: April 1994 – June 2010)
0 1 2 3 4 5 6 7 8 9 100
20
40
60
80
100
Freedom from CAV 4/1994-2002 (N = 12,981)
Years
% F
ree
do
m f
rom
CA
V
ISHLT 2012
p < 0.0001
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHYStratified by Ischemia Time
For Adult Heart Recipients (Transplants: April 1994 – June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 120
20
40
60
80
100
<2 hours (N = 3,244)
2-<4 hours (N = 15,789)
4+ hours (N = 4,125)
Years
% F
ree
do
m f
rom
CA
V
ISHLT 2012
p = 0.5705
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHYStratified by Recipient Age Group
For Adult Heart Recipients (Transplants: April 1994 – June 2010)
0 1 2 3 4 5 6 7 8 9 10 110
20
40
60
80
100
18-29 (N = 1,710) 30-39 (N = 2,117)
40-49 (N = 4,563) 50-59 (N = 9,101)
60-69 (N = 6,637) 70+ (N = 309)
Years
% F
ree
do
m f
rom
CA
V
ISHLT 2012
p = 0.5938
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM SEVERE RENAL DYSFUNCTION BY ERA* For Adult Heart Recipients (Transplants: April 1994 – June 2010)
0 1 2 3 4 5 6 7 8 9 100
20
40
60
80
100
Freedom from Severe Renal Dysfunction 4/1994-2002 (N = 14,469)
Years
% F
ree
do
m f
rom
Se
ve
re R
en
al D
ys
-fu
nc
tio
n
ISHLT 2012
p < 0.0001
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM SEVERE RENAL DYSFUNCTION*Stratified by Ischemia Time
For Adult Heart Recipients (Transplants: April 1994 – June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 120
20
40
60
80
100
<2 hours (N = 3,638)
2-<4 hours (N = 17,436)
4+ hours (N = 4,514)
Years
% F
ree
do
m f
rom
Se
ve
re R
en
al D
ys
-fu
nc
tio
n
ISHLT 2012
p = 0.5729
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM SEVERE RENAL DYSFUNCTION*Stratified by Age Group
For Adult Heart Recipients (Transplants: April 1994 – June 2010)
0 1 2 3 4 5 6 7 8 9 10 110
20
40
60
80
100
18-29 (N = 1,884) 30-39 (N = 2,322)
40-49 (N = 5,031) 50-59 (N = 10,040)
60-69 (N = 7,460) 70+ (N = 344)
Years
% F
ree
do
m f
rom
Se
ve
re R
en
al D
ys
-fu
nc
tio
n
ISHLT 2012
p < 0.0001
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Patient Survival After Report of CAV Within 3 Years of Transplant and Patient Survival In Patients Without CAV*
(Transplants: April 1994 – June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 140
20
40
60
80
100
No CAV (N = 17,865)CAV (N = 4,235)
Time after Report of CAV* (Years)
Su
rviv
al (
%)
ISHLT 2012
p < 0.0001
* Survival for patients without CAV within 3 years after transplant was conditioned on survival to median time of CAV development (501 days). Median time to CAV development is based on patients who developed CAV within 3 years of transplant.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Patient Survival After Report of CAV Within 3 Years of Transplant and Patient Survival In Patients Without CAV* by Era
(Transplants: April 1994 – June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 140
20
40
60
80
100
No CAV 4/1994-2002 (N = 9,862) CAV 4/1994-2002 (N = 2,434)
No CAV 2003-6/2010 (N = 8,003) CAV 2003-6/2010 (N = 1,801)
Time after Report of CAV* (Years)
Su
rviv
al (
%)
ISHLT 2012
4/1994-2002: No CAV vs. CAV p < 0.00012003-6/2010: No CAV vs. CAV p < 0.0001No CAV: 4/1994-2002 vs. 2003-6/2010 p = 0.5210CAV: 4/1994-2002 vs. 2003-6/2010 p = 0.0154
* Survival for patients without CAV within 3 years after transplant was conditioned on survival to median time of CAV development (501 days). Median time to CAV development is based on patients who developed CAV within 3 years of transplant.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
MALIGNANCY POST-HEART TRANSPLANT FOR ADULTSCumulative Morbidity Rates in Survivors
(Follow-ups: April 1994 – June 2011)
Malignancy/Type 1-Year Survivors
5-Year Survivors
10-Year Survivors
No Malignancy 29,101 (97.3%) 12,750 (85.8%) 3,565 (71.2%)
Malignancy (all types combined) 795 (2.7%) 2,102 (14.2%) 1,439 (28.8%)
Malignancy Type*
Skin390 1,402 1,020
Lymphoma165 162 97
Other185 608 455
Type Not Reported55 42 16
* Recipients may have experienced more than one type of malignancy so sum of individual malignancy types may be greater than total number with malignancy.
“Other” includes: prostate (11, 35, 21), adenocarcinoma (7, 7, 4), lung (6, 4, 1), bladder (4, 5, 4), Kaposi's sarcoma (0, 3, 1), breast (2, 7, 2), cervical (2, 5, 2), colon (2, 4, 2), and renal (2, 7, 2). Numbers in parentheses are those reported within 1 year, 5 years and 10 years, respectively.
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM MALIGNANCYFor Adult Heart Recipients (Follow-ups: April 1994 – June 2011)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
100
All malignancy Lymphoma Skin Other
Years
% F
ree
fro
m M
alig
na
nc
y
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM MALIGNANCYby Maintenance Immunosuppression Combinations at Discharge
For Adult Heart Recipients (Transplants: January 2001 - June 2010) Conditional on Survival to 14 days
0 1 2 3 4 5 6 7 850
60
70
80
90
100
TAC+MMF/MPA CyA+MMF/MPA CyA+AZA
Years
% F
ree
fro
m M
alig
na
nc
y
ISHLT 2012
p = 0.0015
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM MALIGNANCYFor Adult Heart Recipients (Transplants: April 1994 – June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 1250
60
70
80
90
100
Freedom from malignancy 4/1994-2002
Freedom from malignancy 2003-6/2010
Years
% F
ree
fro
m M
alig
na
nc
y
ISHLT 2012
p < 0.0001
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM SKIN MALIGNANCYFor Adult Heart Recipients (Transplants: April 1994 – June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 1250
60
70
80
90
100
Freedom from skin malignancy 4/1994-2002
Freedom from skin malignancy 2003-6/2010
Years
% F
ree
fro
m S
kin
Ma
lign
an
cy
ISHLT 2012
p < 0.0001
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM LYMPHOMA For Adult Heart Recipients (Transplants: April 1994 – June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 1250
60
70
80
90
100
Freedom from lymphoma 4/1994-2002
Freedom from lymphoma 2003-6/2010
Years
% F
ree
fro
m L
ym
ph
om
a
ISHLT 2012
p < 0.0001
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM LYMPHOMA By Recipient Age Group
For Adult Heart Recipients (Follow-ups: April 1994 – June 2011)
0 1 2 3 4 5 6 7 8 9 1075
80
85
90
95
100
18-29 30-39 40-49
50-59 60-69 70+
Years
% F
ree
fro
m L
ym
ph
om
a
ISHLT 2012
p = 0.0074
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM OTHER MALIGNANCYFor Adult Heart Recipients (Transplants: April 1994 – June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 1250
60
70
80
90
100
Freedom from other malignancy 4/1994-2002
Years
% F
ree
fro
m O
the
r M
alig
na
nc
y
ISHLT 2012
p < 0.0001
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM NON SKIN MALIGNANCYBy Recipient Age Group
For Adult Heart Recipients (Follow-ups: April 1994 – June 2011)
0 1 2 3 4 5 6 7 8 9 1050
60
70
80
90
100
18-29 30-39 40-49
50-59 60-69 70+
Years
% F
ree
fro
m N
on
Sk
in M
alig
na
nc
y
ISHLT 2012
p < 0.0001
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANT RECIPIENTS:Cause of Death (Deaths: January 1994 – June 2011)
CAUSE OF DEATH 0-30 Days (N = 4,092)
31 Days – 1 Year
(N = 3,801)
>1 Year – 3 Years
(N = 2,846)
>3 Years – 5 Years
(N = 2,547)
>5 Years –10 Years
(N = 6,617)
>10 Years – 15 Years (N =4,221)
>15 Years (N =1,937)
Cardiac Allograft Vasculopathy 71 (1.7%) 161 (4.2%) 373 (13.1%) 369 (14.5%) 951 (14.4%) 619 (14.7%) 248 (12.8%)
Acute Rejection 222 (5.4%) 394 (10.4%) 296 (10.4%) 127 (5.0%) 127 (1.9%) 42 (1.0%) 13 (0.7%)
Lymphoma 3 (0.1%) 59 (1.6%) 81 (2.8%) 105 (4.1%) 283 (4.3%) 163 (3.9%) 66 (3.4%)
Malignancy, Other 1 (0.0%) 91 (2.4%) 326 (11.5%) 472 (18.5%) 1,344 (20.3%) 847 (20.1%) 345 (17.8%)
CMV 3 (0.1%) 42 (1.1%) 14 (0.5%) 6 (0.2%) 6 (0.1%) 2 (0.0%) 0
Infection, Non-CMV 548 (13.4%) 1,155 (30.4%) 354 (12.4%) 241 (9.5%) 703 (10.6%) 432 (10.2%) 226 (11.7%)
Graft Failure 1,522 (37.2%) 631 (16.6%) 688 (24.2%) 543 (21.3%) 1,150 (17.4%) 670 (15.9%) 305 (15.7%)
Technical 307 (7.5%) 53 (1.4%) 21 (0.7%) 24 (0.9%) 78 (1.2%) 59 (1.4%) 27 (1.4%)
Other 199 (4.9%) 305 (8.0%) 253 (8.9%) 201 (7.9%) 547 (8.3%) 311 (7.4%) 167 (8.6%)
Multiple Organ Failure 716 (17.5%) 533 (14.0%) 164 (5.8%) 155 (6.1%) 455 (6.9%) 345 (8.2%) 175 (9.0%)
Renal Failure 31 (0.8%) 39 (1.0%) 45 (1.6%) 85 (3.3%) 392 (5.9%) 359 (8.5%) 175 (9.0%)
Pulmonary 142 (3.5%) 158 (4.2%) 123 (4.3%) 126 (4.9%) 282 (4.3%) 173 (4.1%) 88 (4.5%)
Cerebrovascular 327 (8.0%) 180 (4.7%) 108 (3.8%) 93 (3.7%) 299 (4.5%) 199 (4.7%) 102 (5.3%)
ISHLT 2012 Percentages represent % of deaths in the respective time period
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART RECIPIENTS Cause of Death from Leading Causes by Time since
Transplant and Era (Deaths: January 1994 - June 2011)
0-30 Days (N=2,275)
31 Days - 1 Year
(N=2,051)
>1 Year - 3 Years
(N=1,601)
>3 Years - 5 Years (N=1,435)
>5 Years - 10
Years (N=3,296)
>10 Years
(N=1,123)
0-30 Days (N=1,817)
31 Days - 1 Year
(N=1,750)
>1 Year - 3 Years
(N=1,245)
>3 Years - 5 Years (N=1,112)
>5 Years - 10
Years (N=3,321)
>10 Years
(N=5,035)
0
10
20
30
40
50
60
70
80
90
100
612 9 5 1 1 4 9 12
5 2 1
2
516
1818 21
13
10
1011 13
4017
2219
17 1434
17
27
2518 16
1
1
23
6 8 0
1
2
4
6 9
1432
118 9 9 13
29
14
1112 11
04 17
25 26 24
0
3
1120
23 23
Acute Rejection CAV Graft Failure Renal Failure
Infection (Non-CMV) Malignancy
% o
f D
ea
ths
ISHLT 2012
Deaths 1994 – 2001 Deaths 2002 – 6/2011
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANT RECIPIENTS Relative Incidence of Leading Causes of Death
(Deaths: January 1994 - June 2011)
0-30 Days (N=4,092)
31 Days – 1 Year
(N=3,801)
>1 Year – 3 Years
(N=2,846)
>3 Years – 5 Years
(N=2,547)
>5 Years – 10 Years
(N=6,617)
>10 – 15 Years
(N=4,221)
>15 Years (N=1,937)
0
10
20
30
40
50CAV Acute RejectionMalignancy (non-Lymph/PTLD) Infection (non-CMV)Graft Failure Multiple Organ FailureRenal Failure
% o
f D
ea
ths
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANT RECIPIENTS Cumulative Incidence of Leading Causes of Death
(Transplants: January 1994 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15-2%
0%
2%
4%
6%
8%
10%
12%
14%CAV Acute Rejection
Malignancy (non-Lymph/PTLD) Graft Failure
Infection
Years
Inc
ide
nc
e o
f C
au
se
-Sp
ec
ific
D
ea
ths
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANT RECIPIENTS Relative Incidence of Leading Causes of Death
(Deaths: January 2004 - June 2011)
0-30 Days (N=1,444)
31 Days – 1 Year
(N=1,410)
>1 Year – 3 Years
(N=999)
>3 Years – 5 Years
(N=857)
>5 Years – 10 Years
(N=2,494)
>10 – 15 Years
(N=2,510)
>15 Years (N=1,707)
0
10
20
30
40
50CAV Acute RejectionMalignancy (non-Lymph/PTLD) Infection (non-CMV)Graft Failure Multiple Organ FailureRenal Failure
% o
f D
ea
ths
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANT RECIPIENTS Cumulative Incidence of Leading Causes of Death
(Transplants: January 2003 - June 2010)
0 1 2 3 4 5
-2%
0%
2%
4%
6%
8%
10%CAV Acute Rejection
Malignancy (non-Lymph/PTLD) Graft Failure
Infection
Years
Inc
ide
nc
e o
f C
au
se
-Sp
ec
ific
D
ea
ths
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Temporary circulatory support* 175 3.05 <.0001 2.26-4.10
Diagnosis: Congenital vs. cardiomyopathy 274 2.11 <.0001 1.56-2.86
Total artificial heart 77 1.90 0.0137 1.14-3.16
Temporary continuous flow device 49 1.84 0.0261 1.08-3.15
Recipient history of dialysis 231 1.72 <.0001 1.33-2.23
Recipient on ventilator at time of transplant 300 1.63 0.0002 1.26-2.09
Chronic continuous flow device 1241 1.53 <.0001 1.25-1.88
Previous transplant 297 1.53 0.004 1.14-2.04
Chronic pulsatile flow device 1237 1.38 0.0012 1.14-1.68
N = 10,288
ISHLT 2012* Temporary circulatory support includes ECMO and temporary pulsatile flow devices.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality (continued)
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Prior transfusion 2202 1.35 <.0001 1.17-1.57
Recipient with infection requiring IV drug therapy within 2 weeks prior to transplant 1044 1.25 0.0093 1.06-1.49
Ventricular remodeling 1556 0.76 0.0033 0.64-0.91
Transplant year: 2006 vs. 2009/2010 1927 1.36 0.0007 1.14-1.63
Transplant year: 2007 vs. 2009/2010 1869 1.23 0.0285 1.02-1.47
Transplant year: 2005 vs. 2009/2010 1884 1.22 0.0372 1.01-1.46
N = 10,288
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Borderline Significant Risk Factors For 1 Year Mortality
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Transplant year: 2008 vs. 2009/2010 1778 1.18 0.0696 0.99-1.42
Diagnosis: coronary artery disease vs. cardiomyopathy 4196 1.14 0.0561 1.00-1.30
Not hospitalized just prior to transplant 5593 0.89 0.0717 0.78-1.01
N = 10,288Reference group = Cardiomyopathy, year=2009/2010
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality
Continuous Factors (see figures)
Recipient age Ischemia time
Recipient height Recipient pre-transplant bilirubin
Recipient weight Recipient pre-transplant creatinine
Donor age PRA Class II
Donor BMI Recipient mean pulmonary artery pressure
Transplant center volume
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Age
20 30 40 50 60 700.0
0.5
1.0
1.5
2.0
2.5
Recipient Age (years)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012 (N = 10,288)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Donor Age
15 20 25 30 35 40 45 50 55 600.0
0.5
1.0
1.5
2.0
2.5
Donor Age (years)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012 (N = 10,288)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Height
155 160 165 170 175 180 185 1900.0
0.5
1.0
1.5
2.0
2.5
Recipient Height (cm)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012(N = 10,288)
* The risk associated with recipient height should be considered in conjunction with the risk associated with recipient weight and donor BMI.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Weight
50 60 70 80 90 100 110 120 1300.0
0.5
1.0
1.5
2.0
2.5
Recipient Weight (kg)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0051
ISHLT 2012(N = 10,288)
* The risk associated with recipient weight should be considered in conjunction with the risk associated with recipient height and donor BMI.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Donor BMI
20 25 30 35 400.0
0.5
1.0
1.5
2.0
Donor BMI (kg/m2)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0182
ISHLT 2012(N = 10,288)
* The risk associated with donor BMI should be considered in conjunction with the risk associated with recipient weight and recipient height.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Ischemia Time
30 60 90 120 150 180 210 240 270 300 330 3600.0
0.5
1.0
1.5
2.0
2.5
Ischemia time (minutes)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012 (N = 10,288)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Center Volume
5 10 15 20 25 30 35 40 45 50 55 60 65 700.0
0.5
1.0
1.5
2.0
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0256
ISHLT 2012 (N = 10,288)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Bilirubin
0.5 1.0 1.5 2.0 2.5 3.0 3.50.0
0.5
1.0
1.5
2.0
2.5
Recipient Bilirubin (mg/dL)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0026
ISHLT 2012 (N = 10,288)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Creatinine
0.5 1.0 1.5 2.0 2.50.0
0.5
1.0
1.5
2.0
2.5
Recipient Creatinine (mg/dL)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012 (N = 10,288)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits PRA Class II (%)
0 10 20 30 40 50 60 70 80 90 1000.0
0.5
1.0
1.5
2.0
2.5
3.0
Recipient PRA Class II (%)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0028
ISHLT 2012 (N = 10,288)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Mean Pulmonary Artery Pressure
10 15 20 25 30 35 40 45 50 550.0
0.5
1.0
1.5
2.0
Mean PA Pressure
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0073
ISHLT 2012 (N = 10,288)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Temporary circulatory support* 175 2.49 <.0001 1.96-3.16
Total artificial heart 45 1.70 0.0420 1.02-2.82
Recipient history of dialysis 328 1.67 <.0001 1.40-2.00
Diagnosis: Congenital vs. cardiomyopathy 292 1.47 0.0008 1.17-1.84
Recipient on ventilator at time of transplant 314 1.41 0.0008 1.15-1.72
Number of HLA mismatches at A locus (per locus)
0 A MM (N=665) 1 A MM (N=5089)2 A MM (N=4753)
1.29 0.0003 1.13-1.49
N = 10,507ISHLT 2012
* Temporary circulatory support includes ECMO and temporary pulsatile flow devices.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality (continued)
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Female recipient with prior pregnancy/ male donor vs. male recipient/male donor 780 1.22 0.0286 1.02-1.45
PRA > 10% 766 1.21 0.0066 1.06-1.40
Recipient with infection requiring IV drug therapy within 2 weeks prior to transplant 1161 1.18 0.0082 1.04-1.33
Recipient history of diabetes 2177 1.14 0.0062 1.04-1.26
Diagnosis: coronary artery disease vs. cardiomyopathy 4792 1.14 0.0063 1.04-1.25
Not hospitalized just prior to transplant 5516 0.92 0.0475 0.84-1.00
N = 10,507ISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Borderline Significant Risk Factors For 5 Year Mortality
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Recipient Hep B core (+) 397 1.20 0.06 0.99-1.44
Male recipient/female donor vs. male recipient/male donor 1763 1.11 0.0762 0.99-1.24
Not ABO identical 1487 1.10 0.0968 0.98-1.22
N = 10,507
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality
Continuous Factors (see figures)
Recipient age Transplant center volume
Recipient height Ischemia time
Recipient BMI Recipient pre-transplant bilirubin
Donor age Recipient pre-transplant creatinine
Donor weight Recipient PVR
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient Age
20 30 40 50 60 700.0
0.5
1.0
1.5
2.0
2.5
Recipient Age (years)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012 (N = 10,507)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Donor Age
15 20 25 30 35 40 45 50 55 600.0
0.5
1.0
1.5
2.0
2.5
Donor Age (years)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012 (N = 10,507)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient Height
155 160 165 170 175 180 185 1900.0
0.5
1.0
1.5
2.0
2.5
Recipient Height (cm)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0018
ISHLT 2012(N = 10,507)
* The risk associated with recipient height should be considered in conjunction with the risk associated with recipient BMI and donor weight.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient BMI
20 25 30 350.0
0.5
1.0
1.5
2.0
Recipient BMI (kg/m2)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012(N = 10,507)
* The risk associated with recipient BMI should be considered in conjunction with the risk associated with recipient height and donor weight.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Donor Weight
50 60 70 80 90 100 110 120 1300.0
0.5
1.0
1.5
2.0
Donor Weight (kg)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0083
ISHLT 2012(N = 10,507)
* The risk associated with donor weight should be considered in conjunction with the risk associated with recipient weight and recipient BMI.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Ischemia Time
30 60 90 120 150 180 210 240 270 300 330 3600.0
0.5
1.0
1.5
2.0
2.5
Ischemia time (minutes)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012 (N = 10,507)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Center Volume
5 10 15 20 25 30 35 40 45 50 55 60 65 700.0
0.5
1.0
1.5
2.0
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012 (N = 10,507)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Bilirubin
0.5 1.0 1.5 2.0 2.5 3.0 3.50.0
0.5
1.0
1.5
2.0
Recipient Bilirubin (mg/dL)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012 (N = 10,507)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Creatinine
0.5 1.0 1.5 2.0 2.50.0
0.5
1.0
1.5
2.0
2.5
Recipient Creatinine (mg/dL)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012 (N = 10,507)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Pulmonary Vascular Resistance
0 2 4 6 8 100.0
0.5
1.0
1.5
2.0
2.5
3.0
PVR
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0003
ISHLT 2012 (N = 10,507)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year MortalityConditional on Survival to 1 Year
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Rejection between discharge and 1st year 2427 1.63 <.0001 1.45-1.83
No AZA, MMF/MPA or Sirolimus at 1 year 726 1.59 <.0001 1.31-1.95
No Cyclo, TAC or Sirolimus at 1 year 316 1.48 0.0052 1.13-1.96
Dialysis prior to discharge 531 1.43 0.0011 1.15-1.76
Recipient history of dialysis prior to transplant 216 1.39 0.0334 1.03-1.87
Female recipient with prior pregnancy/ male donor vs. male recipient/male donor 657 1.31 0.0117 1.06-1.61
Number of HLA mismatches at A locus (per mismatch)
0 A MM: N = 5851 A MM: N = 44442 A MM: N = 3953
1.28 0.0097 1.06-1.55
N = 8,982ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year MortalityConditional on Survival to 1 Year (continued)
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Treated for infection prior to discharge 1879 1.23 0.003 1.07-1.40
Recipient history of diabetes 1839 1.21 0.0079 1.05-1.38
Diagnosis: Coronary artery disease vs. cardiomyopathy 4068 1.17 0.0187 1.03-1.34
IL-2R antagonist used for induction 2334 1.15 0.0272 1.02-1.30
Not hospitalized at transplant 4807 0.88 0.0259 0.78-0.98
Chronic pulsatile flow device 1526 0.81 0.0084 0.69-0.95
N = 8,982
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Borderline Significant Risk Factors For 5 Year MortalityConditional on Survival to 1 Year
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Recipient Hep B core (+) 333 1.28 0.0666 0.98-1.66
Recipient history of malignancy 404 1.25 0.0741 0.98-1.60
Transplant year: 2004 vs. 2005/2006 1532 1.18 0.0602 0.99-1.40
Male recipient/female donor vs. male recipient/male donor 1470 1.14 0.0964 0.98-1.34
Diagnosis: Congenital vs. cardiomyopathy 223 0.72 0.0976 0.50 -1.06
N = 8,982
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)
Risk Factors For 5 Year MortalityConditional on Survival to 1 Year
Continuous Factors (see figures)
Recipient age Recipient pre-transplant creatinine
Recipient BMI Recipient TPG
Donor age
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors For 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year Recipient Age
20 30 40 50 60 700.0
0.5
1.0
1.5
2.0
2.5
3.0
Recipient Age (years)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012 (N = 8,982)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors For 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year Donor Age
15 20 25 30 35 40 45 50 55 600.0
0.5
1.0
1.5
2.0
2.5
Donor Age (years)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0005
ISHLT 2012 (N = 8,982)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors For 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year Recipient BMI
20 25 30 350.0
0.5
1.0
1.5
2.0
Recipient BMI (kg/m2)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0026
ISHLT 2012(N = 8,982)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors For 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year Recipient Pre-Transplant Creatinine
0.5 1.0 1.5 2.0 2.50.0
0.5
1.0
1.5
2.0
2.5
Recipient Creatinine (mg/dL)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
P = 0.0187
ISHLT 2012 (N = 8,982)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors For 5 Year Mortality with 95% Confidence Limits
Conditional on Survival to 1 Year Transpulmonary Pressure Gradient
3 6 9 12 150.0
0.5
1.0
1.5
2.0
TPG
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0033
ISHLT 2012 (N = 8,982)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
ECMO 29 1.82 0.0107 1.15-2.87
Ventilator at time of transplant 346 1.65 <.0001 1.43-1.92
Recipient on dialysis 233 1.50 <.0001 1.26-1.78
Repeat transplant 283 1.43 <.0001 1.21-1.70
Recipient history of diabetes 1967 1.28 <.0001 1.19-1.37
PRA > 20% 599 1.27 <.0001 1.13-1.43
Transplant year: 1996 vs. 2000/2001 2054 1.23 <.0001 1.12-1.34
Diagnosis: coronary artery disease vs. cardiomyopathy 5762 1.18 <.0001 1.11-1.26
N = 11,531ISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality (continued)
VARIABLE N Relative Risk
P-value 95% Confidence Interval
Recipient with infection requiring IV drug therapy within 2 weeks prior to transplant 1003 1.16 0.0041 1.05-1.28
Prior cerebrovascular event 603 1.15 0.0225 1.02-1.29
On VAD at time of transplant 1605 1.13 0.006 1.03-1.23
Year of transplant: 1997 vs. 2000/2001 2084 1.11 0.016 1.02-1.21
Donor history of hypertension 1293 1.11 0.0251 1.01-1.21
Year of transplant: 1998 vs. 2000/2001 2162 1.10 0.0263 1.01-1.20
Total HLA mismatches (per mismatch)
0/1 MM (N=67)2 MM (N=304)3 MM (N=1102)4 MM (N=2520)5 MM (N=5600)6 MM (N=1938)
1.04 0.0048 1.01-1.07
Not hospitalized at transplant 4337 0.93 0.0321 0.88-0.99
N = 11,531ISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1996-6/2001)
Borderline Significant Risk Factors For 10 Year Mortality
VARIABLE
N Relative Risk
P-value 95% Confidence Interval
Recipient Hep B core (+) 327 1.15 0.0792 0.98-1.35
Recipient prior pregnancy 1617 1.09 0.0654 0.99-1.20
N = 11,531
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality
Continuous Factors (see figures)
Recipient age Transplant center volume
Recipient height Ischemia time
Recipient weight Recipient pre-transplant bilirubin
Donor age Recipient pre-transplant creatinine
Donor weight
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits Recipient Age
20 30 40 50 60 700.0
0.5
1.0
1.5
2.0
2.5
Recipient Age (years)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y
p < 0.0001
ISHLT 2012 (N = 11,531)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits Donor Age
15 20 25 30 35 40 45 50 55 600.0
0.5
1.0
1.5
2.0
2.5
Donor Age (years)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y
p < 0.0001
ISHLT 2012 (N = 11,531)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits Recipient Height
155 160 165 170 175 180 185 1900.0
0.5
1.0
1.5
2.0
2.5
Recipient Height (cm)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y
p < 0.0001
ISHLT 2012(N = 11,531)
* The risk associated with recipient height should be considered in conjunction with the risk associated with recipient weight and donor weight.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits Recipient Weight
50 60 70 80 90 100 110 120 1300.0
0.5
1.0
1.5
2.0
Recipient Weight (kg)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y
p = 0.0023
ISHLT 2012(N = 11,531)
* The risk associated with recipient BMI should be considered in conjunction with the risk associated with recipient height and donor weight.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits Donor Weight
50 60 70 80 90 100 110 120 1300.0
0.5
1.0
1.5
2.0
Donor Weight (kg)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y
p = 0.0299
ISHLT 2012(N = 11,531)
* The risk associated with donor weight should be considered in conjunction with the risk associated with recipient weight and recipient height.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits Ischemia Time
30 60 90 120 150 180 210 240 270 300 330 3600.0
0.5
1.0
1.5
2.0
2.5
Ischemia time (minutes)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y
p < 0.0001
ISHLT 2012 (N = 11,531)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits Center Volume
5 10 15 20 25 30 35 40 45 50 55 60 65 700.0
0.5
1.0
1.5
2.0
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y
p < 0.0001
ISHLT 2012 (N = 11,531)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Bilirubin
0.5 1.0 1.5 2.0 2.5 3.0 3.50.0
0.5
1.0
1.5
2.0
Recipient Bilirubin (mg/dL)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y
p = 0.0006
ISHLT 2012 (N = 11,531)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1996-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Creatinine
0.5 1.0 1.5 2.0 2.50.0
0.5
1.0
1.5
2.0
2.5
Recipient Creatinine (mg/dL)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y
p < 0.0001
ISHLT 2012 (N = 11,531)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Retransplant 273 1.82 <.0001 1.56-2.11
Diagnosis: not cardiomyopathy, coronary artery disease, congenital heart disease, valvular heart disease or retransplant vs. cardiomopathy
113 1.35 0.0191 1.05-1.74
On ventilator 338 1.34 0.0002 1.15-1.56
Recipient Hep B Core (+) 244 1.33 0.0004 1.14-1.56
PR A> 20% 487 1.19 0.0021 1.07-1.33
Male recipient/female donor vs. male recipient/male donor 2253 1.19 <.0001 1.09-1.30
N = 10,888ISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality (continued)
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
On VAD at transplant 578 1.15 0.0124 1.03-1.29
Diagnosis: Coronary artery disease vs. cardiomyopathy 5295 1.14 <.0001 1.08-1.20
Transplant year: 1991 vs. 1995/1996 1842 1.12 0.0038 1.04-1.21
Transplant year: 1992 vs. 1995/1996 1881 1.11 0.0082 1.03-1.20
Transplant year: 1993 vs. 1995/1996 2017 1.09 0.0308 1.01-1.18
0-3 vs. 4-6 total HLA mismatches 1497 0.91 0.0103 0.85-0.98
N = 10,888ISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1991-6/1996)
Borderline Significant Risk Factors For 15 Year Mortality
VARIABLE N Relative Risk
P-value 95% Confidence Interval
Female recipient/female donor vs. male recipient/male donor 1006 1.13 0.0758 0.99-1.29
Hospitalized (inc. ICU) at transplant 6431 1.05 0.0899 0.99-1.10
N = 10,888
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality
Continuous Factors (see figures)
Recipient age Transplant center volume
Recipient height Ischemia time
Recipient weight Recipient pre-transplant creatinine
Donor age
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality with 95% Confidence Limits Recipient Age
20 30 40 50 60 700.0
0.5
1.0
1.5
2.0
2.5
Recipient Age (years)
Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
alit
y
p < 0.0001
ISHLT 2012 (N = 11,531)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality with 95% Confidence Limits Donor Age
15 20 25 30 35 40 45 50 55 600.0
0.5
1.0
1.5
2.0
2.5
Donor Age (years)
Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
alit
y
p < 0.0001
ISHLT 2012 (N = 11,531)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality with 95% Confidence Limits Recipient Height
155 160 165 170 175 180 185 1900.0
0.5
1.0
1.5
2.0
2.5
Recipient Height (cm)
Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
alit
y
p = 0.0003
ISHLT 2012(N = 11,531)
* The risk associated with recipient height should be considered in conjunction with the risk associated with recipient weight.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality with 95% Confidence Limits Recipient Weight
50 60 70 80 90 100 110 120 1300.0
0.5
1.0
1.5
2.0
Recipient Weight (kg)
Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
alit
y
p = 0.0009
ISHLT 2012(N = 11,531)
* The risk associated with recipient BMI should be considered in conjunction with the risk associated with recipient height.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality with 95% Confidence Limits Ischemia Time
30 60 90 120 150 180 210 240 270 300 330 3600.0
0.5
1.0
1.5
2.0
Ischemia time (minutes)
Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
alit
y
p < 0.0001
ISHLT 2012 (N = 11,531)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality with 95% Confidence Limits Center Volume
5 10 15 20 25 30 35 40 45 50 55 60 65 700.0
0.5
1.0
1.5
2.0
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
alit
y
p = 0.0015
ISHLT 2012 (N = 11,531)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1991-6/1996)
Risk Factors For 15 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Creatinine
0.5 1.0 1.5 2.0 2.50.0
0.5
1.0
1.5
2.0
Recipient Creatinine (mg/dL)
Re
lati
ve
Ris
k o
f 1
5 Y
ea
r M
ort
alit
y
p < 0.0001
ISHLT 2012 (N = 11,531)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1986-6/1991)
Risk Factors For 20 Year Mortality
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Retransplant 294 2.19 <.0001 1.92-2.49
Diagnosis: not cardiomyopathy, coronary artery disease, congenital heart disease, valvular heart disease or retransplant vs. cardiomopathy
1170 1.39 <.0001 1.29-1.50
Transplant year: 1986 vs. 1990/1991 2067 1.16 <.0001 1.09-1.24
Transplant year: 1987 vs. 1990/1991 2634 1.15 <.0001 1.08-1.21
Diagnosis: Coronary artery disease vs. cardiomyopathy
7444 1.11 <.0001 1.06-1.16
Transplant year: 1988 vs. 1990/1991 3083 1.11 0.0002 1.05-1.17
Transplant year: 1989 vs. 1990/1991 3289 1.06 0.021 1.01-1.12
Female recipient vs. male recipient 2687 0.94 0.0225 0.89-0.99
Diagnosis: congenital vs. cardiomyopathy 194 0.78 0.0159 0.64-0.96
N = 10,888ISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1986-6/1991)
Risk Factors For 20 Year Mortality
Continuous Factors (see figures)
Recipient age Transplant center volume
Donor age Ischemia time
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1986-6/1991)
Risk Factors For 20 Year Mortality with 95% Confidence Limits Recipient Age
20 30 40 50 60 700.0
0.5
1.0
1.5
2.0
2.5
Recipient Age (years)
Re
lati
ve
Ris
k o
f 2
0 Y
ea
r M
ort
alit
y
p < 0.0001
ISHLT 2012 (N = 11,531)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1986-6/1991)
Risk Factors For 20 Year Mortality with 95% Confidence Limits Donor Age
15 20 25 30 35 40 45 50 55 600.0
0.5
1.0
1.5
2.0
2.5
Donor Age (years)
Re
lati
ve
Ris
k o
f 2
0 Y
ea
r M
ort
alit
y
p < 0.0001
ISHLT 2012 (N = 11,531)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1986-6/1991)
Risk Factors For 20 Year Mortality with 95% Confidence Limits Ischemia Time
30 60 90 120 150 180 210 240 270 300 330 3600.0
0.5
1.0
1.5
2.0
Ischemia time (minutes)
Re
lati
ve
Ris
k o
f 2
0 Y
ea
r M
ort
alit
y
p = 0.0068
ISHLT 2012 (N = 11,531)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1986-6/1991)
Risk Factors For 20 Year Mortality with 95% Confidence Limits Center Volume
5 10 15 20 25 30 35 40 45 50 55 60 65 700.0
0.5
1.0
1.5
2.0
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 2
0 Y
ea
r M
ort
alit
y
p < 0.0001
ISHLT 2012 (N = 11,531)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)Risk Factors for Developing Severe Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Dialysis prior to discharge 480 3.80 <.0001 2.99-4.82
Continuous chronic device 1090 1.61 0.0004 1.24-2.08
Infection requiring IV antibiotics within 2 weeks prior to transplant
834 1.60 0.0005 1.23-2.08
Rejection prior to discharge 824 1.59 0.0013 1.20-2.12
Recipient history of malignancy 531 1.48 0.02 1.06-2.05
Female donor 2352 1.43 0.0016 1.14-1.78
Cyclosporine vs. Tacrolimus at discharge 2487 1.31 0.0115 1.06-1.61
Total number of HLA mismatches (per mismatch)
1.10 0.0421 1.00-1.21
Diagnosis: Coronary artery disease vs. cardiomyopathy
3574 0.81 0.0486 0.66-1.00
N = 8,794ISHLT 2012
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)Borderline Significant Risk Factors for Developing Severe Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
VARIABLE
N Relative Risk
P-value 95% Confidence Interval
AZA vs. MMF/MPA at discharge 135 1.72 0.0798 0.94-3.15
Stroke prior to discharge 135 1.62 0.0833 0.94-2.79
Transplant year: 2006 vs. 2009/2010 1604 0.78 0.0957 0.57-1.05
N = 8,794
ISHLT 2012*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)Risk Factors for Developing Severe Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
Continuous Factors (see figures)
Recipient age Recipient pre-transplant creatinine
Recipient weight Recipient systolicpulmonary artery pressure (borderline)
ISHLT 2012*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)Risk Factors for Developing Severe Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
Recipient Age
20 30 40 50 60 700.0
0.5
1.0
1.5
2.0
Recipient Age (years)
Re
lati
ve
Ris
k o
f R
en
al D
ys
fun
cti
on
w
ith
in 1
Ye
ar
p = 0.0013
ISHLT 2012(N = 8,794)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)Risk Factors for Developing Severe Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
Recipient Weight
50 60 70 80 90 100 110 120 1300.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
Recipient Weight (kg)
Re
lati
ve
Ris
k o
f R
en
al D
ys
fun
cti
on
w
ith
in 1
Ye
ar
p = 0.0043
ISHLT 2012(N = 8,794)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)Risk Factors for Developing Severe Renal Dysfunction within 1 Year
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
Recipient Pre-Transplant Creatinine
0.5 1.0 1.5 2.0 2.50.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Recipient Creatinine (mg/dL)
Re
lati
ve
Ris
k o
f R
en
al D
ys
fun
c-
tio
n w
ith
in 1
Ye
ar
p < 0.0001
ISHLT 2012 (N = 8,794)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2005-6/2010)
Risk Factors for Developing Severe Renal Dysfunction within 1 YearLimited to Recipients without Severe Renal Dysfunction* Pre-Transplant
Conditional on Survival to Transplant Discharge Systolic Pulmonary Artery Pressure
5 10 15 20 25 30 35 400.0
0.5
1.0
1.5
2.0
Systolic PA Pressure
Re
lati
ve
Ris
k o
f R
en
al D
ys
fun
cti
on
w
ith
in 1
Ye
ar
p = 0.0952
ISHLT 2012 (N = 8,794)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Dialysis prior to discharge 407 3.17 <.0001 2.49-4.03
Donor cause of death: CNS tumor vs. head trauma 97 2.13 0.0046 1.26-3.59
Transplant year: 2001 vs. 2005/2006 1519 1.69 <.0001 1.30-2.20
Transplant year: 2003 vs. 2005/2006 1469 1.58 0.0006 1.22-2.05
Transplant year: 2002 vs. 2005/2006 1412 1.56 0.0009 1.20-2.03
Pacemaker prior to discharge 278 1.52 0.0266 1.05-2.21
No AZA, MMF/MPA or Sirolimus at discharge 392 1.50 0.029 1.04-2.16
N = 8,168ISHLT 2012
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge (continued)
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Cyclosporine vs. Tacrolimus at discharge 4385 1.41 0.0004 1.17-1.71
Pulsatile chronic device 1384 1.32 0.0113 1.06-1.63
Recipient history of diabetes 1698 1.25 0.0216 1.03-1.51
Diagnosis: Coronary artery disease vs. cardiomyopathy 3752 0.81 0.0213 0.67-0.97
Polyclonal agent used for induction 1570 0.79 0.0486 0.62-1.00
Diagnosis: Congenital vs. cardiomyopathy 205 0.36 0.0477 0.13-0.99
N = 8,168ISHLT 2012
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Borderline Significant Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Hospitalized (inc. ICU) at transplant 3792 1.16 0.0931 0.98-1.37
N = 8,168
ISHLT 2012*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
Continuous Factors (see figures)
Recipient age Recipient pre-transplant creatinine
Donor/recipient height ratio Transplant center volume (borderline)
ISHLT 2012*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
Recipient Age
20 30 40 50 60 700.0
0.5
1.0
1.5
2.0
Recipient Age (years)
Re
lati
ve
Ris
k o
f R
en
al D
ys
fun
cti
on
w
ith
in 5
Ye
ars
p = 0.0017
ISHLT 2012(N = 8,168)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
Donor Height/Recipient Height Ratio
0.85 0.95 1.05 1.150.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
Donor height/recipient height
Re
lati
ve
Ris
k o
f R
en
al D
ys
fun
cti
on
w
ith
in 5
Ye
ars
p = 0.0313
ISHLT 2012(N = 8,168)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
Recipient Pre-Transplant Creatinine
0.5 1.0 1.5 2.0 2.50.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Recipient Creatinine (mg/dL)
Re
lati
ve
Ris
k o
f R
en
al D
ys
fun
c-
tio
n w
ith
in 5
Ye
ars
p < 0.0001
ISHLT 2012 (N = 8,168)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
Center Volume
5 10 15 20 25 30 35 40 45 50 55 60 65 700.0
0.5
1.0
1.5
2.0
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f R
en
al D
ys
fun
c-
tio
n w
ith
in 5
Ye
ars
p = 0.0985
ISHLT 2012 (N = 8,168)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1999-6/2003)Risk Factors for Developing Non-Skin Malignancy within 8 Years
Limited to Recipients without Malignancy Pre-TransplantConditional on Survival to Transplant Discharge
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Diagnosis: Congenital vs. cardiomyopathy 94 3.35 0.007 1.39-8.07
Retransplant 82 2.97 0.0006 1.60-5.52
Donor history of cancer 89 2.83 <.0001 1.72-4.65
Female recipient/female donor vs. male recipient/male donor 585 1.71 0.009 1.14-2.56
Transplant year: 1999 vs. 2002/2003 1018 1.47 0.005 1.12-1.92
Transplant year: 2000 vs. 2002/2003 1046 1.39 0.0158 1.06-1.81
Implantable defibrillator prior to transplant 1761 1.28 0.0145 1.05-1.56
N = 4,846ISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1999-6/2003)Borderline Significant Risk Factors for
Developing Non-Skin Malignancy within 8 YearsLimited to Recipients without Malignancy Pre-Transplant
Conditional on Survival to Transplant Discharge
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Pacemaker prior to discharge 189 1.48 0.0737 0.96-2.29
Male recipient/female donor vs. male recipient/male donor 856 1.28 0.0725 0.98-1.68
Transplant year: 2001 vs. 2002/2003 1094 1.27 0.0865 0.97-1.67
Prior sternotomy 2232 0.83 0.0865 0.67-1.03
N = 4,846
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1999-6/2003)Risk Factors for Developing Non-Skin Malignancy within 8 Years
Limited to Recipients without Malignancy Pre-TransplantConditional on Survival to Transplant Discharge
Continuous Factors (see figures)
Recipient age Transplant center volume
Ischemia time (borderline)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1999-6/2003)Risk Factors for Developing Non-Skin Malignancy within 8 Years
Limited to Recipients without Malignancy Pre-TransplantConditional on Survival to Transplant Discharge
Recipient Age
20 30 40 50 60 700.0
0.5
1.0
1.5
2.0
2.5
3.0
Recipient Age (years)
Re
lati
ve
Ris
k o
f N
on
-Sk
in M
a-
lign
an
cy
wit
hin
8 Y
ea
rs
p < 0.0001
ISHLT 2012(N = 4,846)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1999-6/2003)Risk Factors for Developing Non-Skin Malignancy within 8 Years
Limited to Recipients without Malignancy Pre-TransplantConditional on Survival to Transplant Discharge
Center Volume
5 10 15 20 25 30 35 40 45 50 55 60 65 700.0
0.5
1.0
1.5
2.0
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f N
on
-Sk
in M
a-
lign
an
cy
wit
hin
8 Y
ea
rs p = 0.0006
ISHLT 2012 (N = 4,846)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (1999-6/2003)Risk Factors for Developing Non-Skin Malignancy within 8 Years
Limited to Recipients without Malignancy Pre-TransplantConditional on Survival to Transplant Discharge
Ischemia Time
30 60 90 120 150 180 210 240 270 300 330 3600.0
0.5
1.0
1.5
2.0
2.5
Ischemia time (minutes)
Re
lati
ve
Ris
k o
f N
on
-Sk
in M
a-
lign
an
cy
wit
hin
8 Y
ea
rs
p = 0.052
ISHLT 2012 (N = 4,846)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors for Developing CAV within 5 YearsConditional on Survival to Transplant Discharge
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
OTK3 used for induction 333 1.74 <.0001 1.43-2.11
AZA vs. MMF/MPA at discharge 497 1.56 <.0001 1.31-1.85
Pulmonary embolism prior to transplant 121 1.43 0.0362 1.02-1.99
Pacemaker prior to discharge 263 1.37 0.0074 1.09-1.73
Rejection prior to discharge 1094 1.30 <.0001 1.14-1.49
Cyclosporine vs. Tacrolimus at discharge 4256 1.30 <.0001 1.17-1.45
Donor history of hypertension 869 1.16 0.0381 1.01-1.33
Recipient CMV(-)/Donor CMV(+) 1485 1.14 0.0238 1.02-1.28
N = 7,788ISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors for Developing CAV within 5 YearsConditional on Survival to Transplant Discharge
(continued)
VARIABLE N Relative Risk
P-value 95% Confidence Interval
Transplant year: 2001 vs. 2005/2006 1427 0.84 0.0228 0.72-0.98
Male recipient/female donor vs. male recipient/male donor 1266 0.83 0.0109 0.72-0.96
Chronic pulsatile flow device 1372 0.82 0.003 0.72-0.93
Female recipient with prior pregnancy/female donor vs. male recipient/male donor 591 0.78 0.0099 0.65-0.94
Recipient history of malignancy 353 0.72 0.0105 0.56-0.93
Diagnosis: Congenital vs. cardiomyopathy 205 0.59 0.006 0.41-0.86
Female recipient without prior pregnancy/ female donor vs. male recipient/male donor 325 0.54 <.0001 0.40-0.73
N = 7,788ISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Borderline Significant Risk Factors for Developing CAV within 5 Years
Conditional on Survival to Transplant Discharge
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
No Cyclosporine, Tacrolimus or Sirolimus at discharge 195 1.35 0.0816 0.96-1.90
Donor history of cancer 136 1.33 0.054 1.00-1.78
N = 7,788
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors for Developing CAV within 5 YearsConditional on Survival to Transplant Discharge
Continuous Factors (see figures)
Recipient BMI Donor age
Donor/recipient height difference Ischemia time (borderline)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors for Developing CAV within 5 YearsConditional on Survival to Transplant Discharge
Recipient BMI
20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 350.0
0.5
1.0
1.5
2.0
Recipient BMI (kg/m2)
Re
lati
ve
Ris
k o
f C
AV
wit
hin
5
Ye
ars
p = 0.0103
ISHLT 2012 (N = 7,788)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors for Developing CAV within 5 YearsConditional on Survival to Transplant Discharge
Difference Between Donor Height and Recipient Height
-30 -20 -10 0 10 20 300.0
0.5
1.0
1.5
2.0
Donor Height – Recipient Height (cm)
Re
lati
ve
Ris
k o
f C
AV
wit
hin
5 Y
ea
rs
p = 0.0293
ISHLT 2012(N = 7,788)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors for Developing CAV within 5 YearsConditional on Survival to Transplant Discharge
Donor Age
15 20 25 30 35 40 45 50 55 600.0
0.5
1.0
1.5
2.0
2.5
3.0
Donor Age (years)
Re
lati
ve
Ris
k o
f C
AV
wit
hin
5 Y
ea
rs
p < 0.0001
ISHLT 2012(N = 7,788)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT HEART TRANSPLANTS (2001-6/2006)Risk Factors for Developing CAV within 5 Years
Conditional on Survival to Transplant Discharge Ischemia Time
30 60 90 120 150 180 210 240 270 300 330 3600.0
0.5
1.0
1.5
2.0
Ischemia time (minutes)
Re
lati
ve
Ris
k o
f C
AV
wit
hin
5
Ye
ars
p = 0.0552
ISHLT 2012 (N = 7,788)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095