The Registry of the International Society for Heart and Lung Transplantation: twenty-first official adult heart transplant report—2004
Section snippets
Statistical methods
Survival rates were calculated by the Kaplan-Meier method1 and compared by the log-rank test. Multivariate analyses were performed by logistic regression analysis.2 Weights were used to account for incomplete follow-up. Patients with known status (eg, alive or dead) at the time point of interest were assigned a weight of 1; patients with incomplete follow-up were assigned a weight proportional to the length of the interval for which their status was known. For example, in the analysis of
Heart transplanation demographics
The number of heart transplantation procedures reported to the Registry each year continues to decrease. This appears to be due to decreased reporting from centers outside of the United States, as noted in Figure 1. Analysis of a variety of worldwide transplant registries suggest that over 2000 heart transplantations are performed annually at non-ISHLT reporting centers, putting the annual worldwide number of heart transplantations at over 4000 (P. Mohacsi, personal communication). Figure 2
Postoperative immunosuppression
Figure 4 demonstrates the trends in anti-lymphocyte antibody use for induction immunosuppression during the last 2.5 years (January 2001–June 2003). Note that perioperative anti-lymphocyte antibody use appears to have leveled off at approximately 45% of patients transplanted. The perioperative use of OKT3 as an induction agent continues to decrease, now used in only 5% of heart transplantation procedures. Figure 5 portrays the maintenance immune suppressive medications reported at the 1- and
Survival
Heart transplantation Kaplan-Meier survival curves and graft half-time calculations are shown in Figure 6. Note that the survival curve for the entire cohort continues to demonstrate that after the steep fall in survival during the first 6 months, survival decreases at a very linear rate, even beyond 15 years after transplantation. In addition, there does not appear to be a point beyond which the slope of the survival curve decreases to approach that seen for the general population. As noted in
Posttransplantation morbidities
For evaluation of the most common posttransplantation morbidities, this year’s analysis includes those transplantations performed from April 1994 through June 2003. The cumulative incidences of hypertension, renal dysfunction, diabetes, and CAV have not changed significantly (http://www.ishlt.org/registries/). This year we added 7-year cumulative incidences (Table 5). We examined CAV differently than in prior years by determining risk factors for early CAV (occurring within 3 years after
Conclusions
For a registry or database to be clinically useful and directly affect patient care, it must provide up-to-date and accurate information. At first glance, the discrepancies between successive year’s reports suggest problems with data validity or analysis. However, after careful review, it becomes clear that the changing risk factors and outcomes are more a reflection of changing medical management and patient selection—proof that we actually do learn from our mistakes. It is likely that as
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All of the figures and tables from this report, and a more comprehensive set of Registry slides, are available at http://www.ishlt.org/registries/.