Worldwide thoracic organ transplantation: a report from the UNOS/ISHLT International Registry for Thoracic Organ Transplantation.
1. The number of heart transplant operations performed in the US decreased by 52 procedures between 1996 (2,344) and 1997 (2,292). The number of lung transplants increased by 118 in 1997 (928). 2. The most frequently reported indication for heart transplantation in the US was coronary artery disease (44.9%). For other thoracic transplants, the most frequently reported indications included cystic fibrosis (36.8%) for double-lung, emphysema/COPD (53.8%) for single-lung and congenital disease (33.9%) for heart-lung transplants. The most frequently reported diagnoses for thoracic transplantation outside the US included cardiomyopathy (50.4%) for heart, cystic fibrosis (31.3%) for double-lung, idiopathic pulmonary fibrosis (32.4%) for single-lung and primary pulmonary hypertension (23.3%) for heart-lung transplants. 3. US heart transplant recipients were predominately male (77.4%), over age 50 (55.9%) and white (82.1%). In contrast, US lung transplant recipients were predominantly female (51.9%), between ages 35-64 (73.4%) and white (89.5%). No meaningful variance from the US recipient demographic profile was noted for the non-US recipients during the same time period. 4. Mean ischemic time showed minimal change for hearts (2 minutes), a sharp increase for heart-lungs (29.5 minutes) and a decrease for lungs (11 minutes) from 1997-1998. 5. The one-year survival rates for thoracic transplants performed in the US were 83.2% for heart, 75.7% for lung and 34.1% for heart-lung in 1997. Five-year survival rates for US thoracic transplants were 66% for heart and 46.4% for lung for transplants performed in 1993. 6. Long-term patient survival rates were: 29.5% at 14 years for heart, 19.4% at 9 years for lung and 26.2% at 11 years for heart-lung recipients. 7. The most important risk factor for mortality of US heart recipients at one month, one year and conditionally at 5 years after transplantation was receipt of a previous heart transplant. Significant short-term risk factors included recipient age and ischemic time. Substantial long-term risk factors included older donor age and donor race. 8. The factors having the most significant impact on lung mortality at all time points were related to either the patient's medical condition (e.g.x, in the ICU prior to transplant, requiring mechanical ventilation) or diagnosis. 9. Mechanical ventilation and previous transplant had the largest impact on heart-lung mortality. 10. For heart and lung recipients, the major cause of rehospitalization during the first year after transplantation was infection alone.
Keck
B M
BM
United Network for Organ Sharing, Richmond, Virginia, USA.
Bennett
L E
LE
Fiol
B S
BS
Daily
O P
OP
Novick
R J
RJ
Hosenpud
J D
JD
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D016027:Heart Transplantation / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*; D016041:Heart-Lung Transplantation / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007390:International Agencies; D016040:Lung Transplantation / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012737:Sex Factors; D015996:Survival Rate; D014019:Tissue Donors / Q000145:classification / Q000706:statistics & numerical data; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D014481:United States