The Registry of the International Society for Heart and Lung Transplantation: Thirty-second Official Adult Heart Transplantation Report—2015; Focus Theme: Early Graft Failure

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Data collection and statistical methods

Data are submitted to the ISHLT Registry by national and multinational organ/data exchange organizations and individual centers. Since the Registry’s inception, 418 heart transplant centers, 242 lung transplant centers and 174 heart–lung transplant centers have reported data. The Registry website (www.ishlt.org/registries) provides spreadsheets that show data elements collected in the Registry. The online slide set (http://www.ishlt.org/registries/slides.asp?slides=heartLungRegistry) provides

Transplant volumes

A total of 4,477 heart transplants (including 3,817 adult transplants) from 252 centers were performed in 2013 and reported to the ISHLT. After a gradual decline between 1993 and 2004, the number of reported heart transplants remained stable for several years, then slowly increased and appears to have increased distinctly in 2013 (Figure 1). Not all worldwide transplants are captured in the Registry and, therefore, it is not possible to ascertain whether these trends are reflective of the

Survival

For all 112,521 pediatric and adult heart transplants (excluding heart-lung) between 1982 and June 2013, 1-year survival was 82% and 5-year survival was 69%, with median survival of 11 years for all and 13 years for those surviving the first year (Heart Overall eSlide 15). Survival was better in the pediatric population, particularly in the long term (Heart Overall eSlide 16).

Survival of adult heart transplant recipients has improved compared with transplants done in the 1980s and 1990s. This

Induction immunosuppression

Immunosuppressive induction use was just above 50% (Figure 12) and more frequent in North America (51%) than in Europe (34%) (eSlide 30). Interleukin-2 receptor (IL-2R) antagonists were the most frequently used induction agents, in 30% of all transplants, whereas polyclonal anti-lymphocytic antibodies were used in 21% and alemtuzumab in 2%. OKT3 is no longer available for clinical use in most countries. Induction strategy did not appear to be associated with differences in survival in

Morbidity

Hypertension, hyperlipidemia, renal dysfunction, diabetes and CAV were the most common post-transplant morbidities (eSlides 88 and 89). Of these, renal dysfunction and CAV, in addition to graft failure, infection, acute rejection and malignancy just described, were the important direct contributors to mortality (eSlides 78 and 82). Details of post-transplant morbidity are shown in the eSlides and the independent roles of post-transplant morbidities are examined in the multivariable analyses in

Multivariable analyses

Unadjusted mortality and morbidity rates have been described in the previous sections. To determine the independent factors associated with mortality and morbidity, we performed multivariable proportional hazards regression analyses for transplants that took place in more recent eras. Categorical variables associated with post-transplant mortality risk at 1 year (Figure 15) included major markers of pre-transplant severity of illness, such as right ventricular assist device (RVAD) use,

Focus theme: Early graft failure

PGD is common early after transplant5 and anecdotal reports suggest it is increasing. Transplant centers use different definitions of and parameters to characterize PGD. A recent consensus document reviewed epidemiology, pathogenesis, risk factors, biomarkers and management, and arrived at definitions of PGD.5 Nonetheless, the incidence of and risk factors for PGD remain poorly understood. In this report we explored EGF, defined as a composite end-point of death or retransplant associated with

Conclusions

Thanks to the data-reporting efforts of participating heart transplant centers worldwide, this report brings to the public comprehensive and current information regarding developments and challenges in adult heart transplantation.

Trends that are notable in this report include a distinct increase in heart transplant volumes to 4,477 reported globally in 2013. Age, comorbidity, short-term MCS use and other baseline characteristics reflect a willingness to accept recipients of higher risk and

Disclosure statement

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

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