Registry reportThe registry of the international society for heart and lung transplantation: twentieth official adult lung and heart–lung transplant report—2003☆
Section snippets
Statistical methods
Survival rates were calculated using the Kaplan–Meier method1 and compared using the log-rank test. Multivariate analyses were performed using logistic regression analysis. Weights were used to account for incomplete follow-up. Patients with known status (e.g., alive or dead) at the timepoint 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
Centers and activity
The number of centers reporting heart–lung and lung transplants has gradually declined since the mid-1990s (Figure 1). From a peak of 122 centers in 1996, the number of centers that reported lung transplants to the Registry decreased to 101 in 2001, and the number that reported heart–lung transplants dropped from a high of 63 in 1994 to 35 in 2001. As discussed in the accompanying Registry’s introduction, it is not clear if this downward trend indicates a real decline in centers performing
Indications and operations
Pre-transplantation diagnoses and their respective transplant procedures are presented in Table I for the period January 1995 to June 2002. The four main indications for lung transplantation were chronic obstructive pulmonary disease (COPD; 39.0%), idiopathic pulmonary fibrosis (IPF; 17.0%), cystic fibrosis (CF; 16.0%) and α1-anti-trypsin deficiency emphysema (9.1%). For COPD and IPF, single-lung transplantation has been the more common operation, but for α1-anti-trypsin deficiency emphysema
Causes of death and risk factors for mortality
The causes of death after lung transplantation are compiled in Table II for transplants performed during the last decade. Graft failure and non-cytomegalovirus (CMV) infections were the principal fatal complications during the first 30 days, and these were among the major contributors to mortality in all subsequent time periods. Acute rejection and CMV infection have been relatively common problems during the first year, but neither has caused many deaths. After the first year, approximately
Complications and morbidities
The most common morbidities after lung transplantation are collated in Table VII from follow-up reports on 1- and 5-year survivors. Problems caused or aggravated by the immunosuppressive drugs have been prevalent, and these conditions continue to complicate the medical management of many recipients. Despite these morbidities, however, >80% of 1-, 3- and 5-year survivors had no activity limitation reported on their follow-ups between April 1994 and June 2002.
Bronchiolitis obliterans syndrome has
Indications
PPH and pulmonary hypertension associated with Eisenmenger’s syndrome/congenital heart disease have been the main indications for heart–lung transplantation in adults (Table IX). Despite the widespread use of bilateral lung transplantation, CF has been the third most common diagnosis among heart–lung recipients, even in the era 1996 to 2001.5 This activity in heart–lung transplantation for CF probably reflects the role of domino procedures, wherein the CF heart–lung recipient’s healthy heart is
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The Registry of the International Society for Heart and Lung Transplantationnineteenth official report—2002
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Cited by (227)
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All figures and tables from this report and a more comprehensive set of Registry slides are available at www.ishlt.org/registries/.