Registry series
The Registry of the International Society for Heart and Lung Transplantation: Twenty-seventh official adult heart transplant report—2010

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Statistical methods

Recipient and donor demographics, immunosuppressive treatments, morbidity, hospitalization, causes of death and functional status are summarized using percentages or median with 5th and 95th percentile, as appropriate.

Survival rates were calculated using the Kaplan-Meier method6 and compared using the log rank test. Multivariable analyses were performed using Cox proportional hazard regression analysis.7 Results of the multivariable analyses are reported as relative risk (RR) with corresponding

Transplant volumes

Although the number of heart transplants reported to the Registry peaked in the mid-1990s, at more than 4,000 patents per year, this number has remained relatively stable in the current decade, with more than 3,000 patients being reported to the Registry every year (Figure 1). We have previously estimated that 2,000 heart transplants performed yearly worldwide are not reported to the Registry.5 Therefore, the number of heart transplants being performed worldwide likely exceeds 5,000 per year.

Post-operative immunosuppression

Immunosuppressive induction therapy continues to be used frequently (Figure 7). In the first 6 months of 2009, 54% of patients received immunosuppressive induction compared with 53% in 2002 and 38% in 1997. Most of the patients receive interleukin-2 receptor (IL2R) antagonists (27% of patients) or polyclonal antilymphocytic antibodies (23%), and we newly see the use of the induction agent alemtuzumab (Campath). The use of monoclonal anti-CD3 antibody OKT3 for immunosuppressive induction is now

Survival

The median survival after transplant, or the time at which 50% of those who received an allograft remain alive, is currently 10 years for the entire cohort of adult and pediatric heart recipients who received allografts since the initiation of the Registry in 1982, with a median survival of 13 years for those surviving to 1 year (Figure 9). Median survival has steadily improved—from 8.3 years during the 1980s to 10.4 years during the 1990s—and survival has further improved since 2000 (Figure 10

Risk factors for 5-year mortality

Mortality at 5 years is affected to a great degree by factors similar to those affecting 1-year mortality (detailed data included in the online Registry slide set). Additional risk factors identified in a multivariable analysis include recipient history of pregnancy (RR, 1.28; p = 0.02), female allograft allocation to a male recipient (RR, 1.26; p < 0.01), and recipient history of stroke (RR, 1.23; p = 0.03).

In an attempt to separate factors associated with the fairly high hazard of death in

Acute allograft rejection

Assessment of the effect of immunosuppressive therapies on rejection risk as well as assessment of the effect of rejection on survival is limited by the nature of data collected by the Registry. Unfortunately, we are not able to distinguish between cellular and antibody-mediated rejection. We do know, however, whether the diagnosis of rejection resulted in treatment with an anti-rejection agent or hospitalization, or whether no such interventions were done.

Among patients who received allografts

Hospitalization and functional status

Heart transplantation restores longevity in patients with advanced heart failure, but a goal of similar, if not higher importance, is restoration of an active lifestyle and good quality of life. Rehospitalization is frequent in the first year after transplant, and 45% of patients are readmitted. After the first post-transplant year, approximately 20% to 25% of patients require hospitalization yearly for diagnoses, both related and unrelated to their heart transplant status.

Many patients return

Disclosure statement

All relevant disclosures for the Registry Director, Executive Committee members, and authors are on file with ISHLT and can be made available for review by contacting the Executive Director of ISHLT.

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