The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Lung And Heart-Lung Transplantation Report—2017; Focus Theme: Allograft ischemic time

Abstract

, and reported to the International Society for Heart and Lung Transplantation (ISHLT) Registry. In addition to reporting key data for donor and recipient characteristics, transplant events, and recipient treatments and outcomes, this year's report focuses on an overall theme of allograft ischemic time. We report geographic, center, donor, and recipient factors associated with variations in allograft ischemic time, associations of allograft ischemic time with outcomes, and other data of interest related to this topic. The Registry's online slide sets show results from additional analyses and complementary information not included in this publication (see http://ishlt. org/registries/slides.asp?slides=heartLungRegistry/). Statistical methods Data collection, conventions, and statistical methods National and multinational organ/data exchange organizations and individual centers submitted data to the ISHLT Registry. Since the Registry's inception, 472 heart transplant centers, 256 lung transplant centers, and 180 heartlung transplant centers have reported data to the Registry. 1-3 We estimate that data submission to the Registry represents approximately 75% of the worldwide thoracic transplant activity. This report presents an overview of donor and recipient characteristics and outcomes. Additional and extended analyses presented in 5 separate online slide sets ("Introduction," " Lung Overall," "Adult Lung Transplant," "Heart-Lung Overall," and "Adult Heart-Lung Transplant" http://ishlt.org/registries/slides.asp?slides=heartLungRegistry) supplement the report. The ISHLT Web site also contains slide sets for previous annual reports. This report references specific online e-slides when particular data are discussed but not shown because of space limitations. The e-slide numbers refer to the online adult lung, shortened to L(a), and adult heart-lung, noted as HL(a) transplant slides. The Registry Web site (http://ishlt.org/registries/heart LungRegistry.asp) provides detailed spreadsheets of the data elements collected in the Registry. The Registry requires submission of core donor, recipient, and transplant proce dure variables at baseline (i.e., around the time of transplantation) and at yearly follow-up, and these variables therefore have low rates of missingness. Nevertheless, data quality depends on the accuracy and completeness of reporting. Rates of missingness may significantly increase for Registry variables that depend on voluntary reporting.

Current state of pediatric cardiac transplantation

“…The number of pediatric heart transplants reported to the ISHLT registry has increased over time with 442 in 2004, 586 in 2014 ( Figure 1) and more recently 684 in 2015 (2). The age distribution of the recipients has remained stable since the mid-1990s ( Figure 2).…”

“…In older patients, cardiomyopathy remains the predominant diagnosis ( Figures 5-7). Primary diagnoses also show geographic variation, with congenital heart disease and retransplantation both more common in North America compared with Europe and the rest of the world ( Figure 8) (1,2). Congenital heart disease represents a diverse group of diagnoses with a variety of reasons leading to transplantation not related to the traditional "congestive heart failure" paradigm thus impacting any registry-based analyses and study trial designs due to the inability to control for the heterogeneity of the patient population.…”

“…Multiple options exist now due to the evolution of mechanical support options including temporary versus durable support and bridge to decision, recovery or transplant, that also allow for crossover between these options. The use of VADs as a bridge to transplant in the pediatric population has continued to increase significantly and currently over 50% of pediatric patients beyond the infant age group are transplanted from VAD support (2) (Figure 9). These patients can often be mobile and undergo physical and nutritional rehabilitation while awaiting transplantation, which has likely contributed to the reduced waitlist mortality (12,13) without compromising post-transplant survival ( Figure 10).…”

“…Remarkably, survival to 10 years in the most recent era conditional on survival to 1 year post-transplant is now 83% for all age groups <10 years at transplantation (1,2) ( Figure 12). The diagnosis before transplantation also affects survival; congenital heart disease continues to be associated with a significantly higher early mortality compared to cardiomyopathy (2,7). Interestingly, the overall survival of cardiomyopathy patients by 3 years posttransplant was 88% compared to 79% for patients with congenital heart disease but this difference was negated by 10 years post-transplant with 70% and 68% survival respectively (1) ( Figure 13).…”

“…Risk factors for CAV in children include older donor age, older recipient age, donor cigarette use, recipient black race, transplant era, no induction therapy, re-transplantation, rejection in the first year posttransplant and repeated episodes of cellular rejection (2,48). Freedom from CAV is 40% by 17 years post-transplant ( Figure 21) but does vary by age (Figure 22), and is one of the few things that is impacted upon by induction therapy (Figure 23).…”