2015 REPORT. Australia and New Zealand Cardiothoracic Organ Transplant Registry. Edited By

Transcription

1 Australia and New Zealand Cardiothoracic Organ Transplant Registry 215 REPORT (Transplant Data collected from February 1984 to December 215) Edited By Professor Anne Keogh AM, MBBS (Hons), MD, FRACP, FCSANZ Professor Trevor Williams MBBS, MD, FRACP Ross Pettersson BA (Hons)

2 TABLE OF CONTENTS Forward 4 Number of All Transplants by Year Heart Transplants by Year by Hospital Heart Lung Transplants by Year by Hospital Single Lung Transplants by Year by Hospital Bilateral Lung Transplants by Year by Hospital Waiting List Activity 215 Average Wait to Transplant by blood group 11 HEART TRANSPLANTATION Reason for Transplant Pre Transplant Status Donor/Recipient State of Origin Demographics Waiting time Recipient age Donor Age Ischemic time CUTLER-EDERER Survival All Hearts 2 Orthotopic v Heterotopic v Domino 21 All Hearts Time Group Comparison 22 Pre-Transplant Diagnosis 23 Pre-Transplant Status 24 Recipient Age by Gender 25 Recipient Age 26 Donor Age 27 Donor Gender 28 Recipient Gender 29 Ischemic Time 3 Crossmatch 31 Panel Reactive Antibodies 32 CMV Status 33 HLA A or B Locus Mismatch 34 HLA DR Locus Mismatch 35 Malignancies 36 Malignancies All Recipient Cause of Death Cause of Death All Heart Transplants 38 Cause of Death < 5 Years Post Transplant 39 Cause of Death 5 Years Post Transplant 39 LUNG TRANSPLANTATION Reason for Transplant Heart-Lung Single Lung Bilateral Sequential Lung Donor/Recipient State of Origin Demographics Waiting Time Recipient Age Donor Age

3 Ischemic Time Recipient Gender CUTLER-EDERER Survival All Transplants 5 DCD Recipient Age 52 Donor Age 53 Ischemic Time 54 Crossmatch 55 CMV Status 56 HLA All Locus Mismatch 57 HLA DR Locus Mismatch 58 Recipient Cause of Death Cause of Death All Lung Transplants 59 Cause of Death < 5 Years Post Transplant 6 Cause of Death 5 Years Post Transplant 6 3

4 The Australia and New Zealand Cardiothoracic Organ Transplant Registry TWENTIETH ANNUAL REPORT This is the twentieth annual report of the Australia and New Zealand Cardiothoracic Transplant Registry (ANZCOTR) and includes data from all transplants performed between February 1984 and December 215. Participating units The Prince Charles Hospital, Brisbane The Alfred Hospital, Melbourne The Royal Children's Hospital, Melbourne Auckland City Hospital, New Zealand St Vincent s Hospital, Sydney Fiona Stanley Hospital, Perth Co-ordinating Centre ANZCOTR C/-Heart Transplant Unit Level 4 Xavier Building St Vincent's Hospital Victoria Street, Darlinghurst NSW 21 Phone : (61-2) Ross Pettersson Fax : (61-2) ross.pettersson@svha.org.au anne.keogh@svha.org.au Funding ANZCOTR : Unfunded : Funded by SVH Heart Transplant Unit : Funding since 23 by The Commonwealth of Australia, Organ and Tissue Authority, Canberra Management Committee Members for 215 Registry Director : Prof Anne Keogh : St Vincent s Hospital, Sydney Registry Database Manager : Ross Pettersson Denise Reddy : Transplant Co-ordinator : Auckland City Hospital, New Zealand Prof Keith McNeil : external member for Prince Charles Hospital - Brisbane Prof Trevor Williams : The Alfred Hospital - Melbourne Dr Lawrence Dembo : Fiona Stanley Hospital Perth 4

5 Anne Shipp: Transplant Co-ordinator - Royal Children's Hospital Melbourne Acknowledgements The Editors would like to thank the Transplant Coordinators and Team Administrators, whose accurate and timely reporting of their transplantation data has made the 215 Report possible. St Vincent s, Sydney Michelle Harkess Lisa Singleton Auckland City Hospital, Auckland Denise Reddy Josephine Power Fiona Stanley Hospital, Perth Clare Wood Helen Hayes Sharon Lawrence The Prince Charles Hospital, Brisbane Jo Maddicks-Law Trish Leisfield The Alfred Hospital, Melbourne Jamie Hobson Jim Duncan The Royal Children's Hospital, Melbourne Anne Shipp The Editors would also like to thank the members of the Management Committee who have given up their valuable time to prove the Registry with their extensive knowledge and experience, and the Organ and Tissue Authority, for their continued assistance and support. Thanks also to Kylie Hurst, Registry Manager at ANZOD Registry and her team. Data Requests Additional data or research project material may be made available after consideration of the request by the Management Committee. Statistical Methods Cutler Ederer survival curves were produced using SPSS for Windows Release 19., SPSS Inc. Significance calculated using Log Rank testing. All data and tables herein ANZCOTR 215 5

6 NUMBER OF ALL TRANSPLANTS BY YEAR HEARTS HEART-LUNG SINGLE LUNG B-L LUNG YEAR HEART HEART-LUNG SINGLE LUNG BILATERAL LUNG Grand Total All Transplants Totals

7 ALL HEART TRANSPLANTS* BY YEAR BY HOSPITAL St Vincents The Alfred Perth Auckland Prince Charles Royal Childrens Year Totals Totals * Includes Heart - Kidney Transplants (34) St Vincent s 16, Prince Charles 7, Auckland City 6, The Alfred 5 Domino Transplants (36) St Vincent s 12, The Alfred 17, Royal Children s 4, Prince Charles 3 Retransplants (28) St Vincent s 1, Prince Charles 4, Auckland City 1, The Alfred 6, Royal Children s 5, Perth 2 Heterotopic Transplants (31) The Alfred 26, St Vincent s 5 DCD Donors (6) St Vincents 6 7

8 HEART LUNG TRANSPLANTS BY YEAR BY HOSPITAL St Vincents The Alfred Royal Perth Auckland Prince Charles Royal Childrens Year Totals Totals

9 SINGLE LUNG TRANSPLANTS BY YEAR BY HOSPITAL St Vincents The Alfred Royal Perth Auckland Prince Charles Royal Childrens Year Totals Totals

10 BILATERAL LUNG TRANSPLANTS BY YEAR BY HOSPITAL St Vincents The Alfred Royal Perth Auckland Prince Charles Royal Childrens Year Totals Total

11 WAITING LIST ACTIVITY 215 Waiting List HEARTS LUNGS HEARTS TOTAL LUNGS TOTAL Active as at 1 January New Additions during from on hold to active from Removals from Waiting List (Permanent) W1 - Transplant Performed W2 - Patients condition Improved 1 4 W3 - Too ill, New develop of contraindications etc 8 14 W4 - Patient declined 2 2 W5 - Transferred to an interstate list W6 - Died waiting 5 9 W7 - Removed - unspecified 2 3 TOTAL at Year end - (Active) 31 December AVERAGE WAIT TIME IN DAYS TO TRANSPLANT BY BLOOD GROUP FOR 215 Transplant Type A B AB O Orthotopic Heart Bilateral Lung Single Lung 36 no cases no cases 22 Heart Lung 223 no cases no cases

12 HEART TRANSPLANTATION

13 PRE TRANSPLANT DIAGNOSIS ALL HEARTS n = 2585 Familial Cardiomyopathy 3% Peripartum Cardiomyopathy 1% Other 13% Re Transplant 1% Viral Cardiomyopathy / Myocarditis 3% Congenital Heart Disease 6% Ischemic Heart Disease 32% Idiopathic Dilated Cardiomyopathy (IDCM) 41% Idiopathic Dilated Cardiomyopathy (IDCM) % Ischemic Heart Disease (IHD) % Other (eg. Valve disease, adriamycin toxicity) % Congenital Heart Disease 146 6% Viral Cardiomyopathy/Myocarditis 66 3% Familial Cardiomyopathy 67 3% Peripartum Cardiomyopathy 26 1% Retransplantation 28 1% Total % 13

14 PRE-TRANSPLANT STATUS ALL HEARTS STATUS Year n= NYHA III % NYHA IV % Inotropic support % Intra-aortic Balloon Pump % Ventricular Assist Device % Total Artificial Heart %

15 DONOR / RECIPIENT STATE OF ORIGIN ALL HEARTS ACT NT NSW QLD VIC SA WA TAS NZ Recipients Donors Location Recipients % Donors % Recipients 215 % Donors 215 % ACT NT NSW QLD VIC SA WA TAS NZ TOTALS

16 MEAN WAITING TIME TO TRANSPLANT ALL HEARTS Days Mean Waiting Time in days Year n= mean std dev + - median min-max * * * * * * * * * * * Due to limitations within the software, values over 1 until 212 are represented as

17 MEAN RECIPIENT AGE AT TRANSPLANT ALL HEARTS Years Year n= mean std dev + - median min-max

18 MEAN DONOR AGE ALL HEARTS Years Year n= mean std dev + - median min-max

19 ALL HEARTS - MEAN COLD ISCHEMIC TIME Minutes Year n mean std dev +- median min-max

20 Percent Survival CUTLER-EDERER SURVIVAL ALL* HEART TRANSPLANTS YEAR n= % *All Hearts includes Orthotopic(253), Heterotopic(31), Domino(36), Retransplant(28) 2

21 CUTLER-EDERER SURVIVAL ORTHOTOPIC v HETEROTOPIC v DOMINO v RETRANSPLANT HEART TRANSPLANTS Percent Survival Orthotopic Heterotopic Domino Retransplant Orthotopic Heterotopic Domino Retransplant YEAR n % n % n % n %

22 CUTLER-EDERER SURVIVAL ALL HEARTS PERIOD COMPARISON Percent Survival Year n= % n= % n= % n= %

23 CUTLER-EDERER SURVIVAL ALL HEARTS PRE- TRANSPLANT DIAGNOSIS Percent Survival 4 2 IHD v IDCM IHD v Others p<.5 p< IHD IDCM Others IHD IDCM Others Year n= % n= % n= %

24 CUTLER-EDERER SURVIVAL PRE-TRANSPLANT STATUS ALL HEARTS Percent Survival 4 p=ns NYHA III NYHA IV INOTROPES IABP All VAD NYHA III NYHA IV INOTROPES IABP All VAD Year n= % n= % n= % n= % n= %

25 CUTLER-EDERER SURVIVAL BY RECIPIENT AGE AND GENDER HEARTS Percent Survival MALES -39 years v MALES >39 years MALES >39 years v FEMALES>39 years p<.5 p< MALES -39 FEMALES -39 MALES >39 FEMALES > 39 MALES -39 FEMALES - 39 MALES >39 FEMALES > 39 Year n= % n= % n= % n= %

26 CUTLER-EDERER SURVIVAL RECIPIENT AGE ALL HEARTS Percent Survival v 5-59 years p = < v > 6+ years p = < v 4-49 years p = < v 5-59 years p = <.5 6+ v 4-49 years p = < > >59 Year n= % n= % n= % n= % n= %

27 CUTLER-EDERER SURVIVAL DONOR AGE ALL HEARTS Percent Survival 6-16yrs v 4-49yrs p<.1-16yrs v 5-59yrs p< yrs v 4-49yrs p< yrs v 5-59yrs p< > >59 Year n= % n= % n= % n= % n= % * 2 of the 1 cases in the >59 years category are Heterotopic Heart Transplants 27

28 CUTLER-EDERER SURVIVAL DONOR GENDER ALL HEARTS Percent Survival 4 p=ns Female Male Female Male Year n= % n= %

29 CUTLER-EDERER SURVIVAL RECIPIENT GENDER ALL HEARTS Percent Survival 6 p=ns Female Male Female Male Year n= % n= %

30 CUTLER-EDERER SURVIVAL ISCHEMIC TIME ALL HEARTS Percent Survival <2hrs 2-4 hrs 4-6 hrs >6 hrs <2hrs 2-4 hrs 4-6 hrs >6 hrs Year n= % n= % n= % n= %

31 1 CUTLER-EDERER SURVIVAL CROSSMATCH* ALL HEARTS p<.1 Percent Survival Positive Negative * B or T cell positive are combined Positive Negative Year n= % n= %

32 CUTLER-EDERER SURVIVAL PEAK PANEL REACTIVE ANTIBODIES PRE HEART TRANSPLANT p=ns 6 Percent survival PRA<15% PRA>=15% PRA<15% PRA>=15 Year n= % n= %

33 1 8 CUTLER-EDERER SURVIVAL CMV STATUS HEARTS Percent Survival 4 p = ns R-ve/D-ve R-ve/D+ve R+ve Donor Neg Rec Neg Donor Pos Rec Neg Recipient Pos Year n= % n= % n= %

34 CUTLER-EDERER SURVIVAL HLA MISMATCH HEARTS p<.5 Percent Survival MM MM1 MM2 MM3 MM4 MM5 MM6 MM MM1 MM2 MM3 MM4 MM5 MM6 Year n= % n= % n= % n= % n= % n= % n= %

35 CUTLER-EDERER SURVIVAL HLA DR LOCUS MISMATCH HEARTS Percent Survival 6 4 p=ns MM MM1 MM2 MM MM1 MM2 Year n= % n= % n= %

36 CUTLER-EDERER SURVIVAL MALIGNANCIES HEARTS Percent Survival PTLD v other malignancy p< PTLD OTHER MALIGNANCIES OTHER MALIGNANCIES (skin PTLD SCC/other) Year n= % n= % * Survival of patients who were diagnosed post transplant with any form of cancer, invasive or otherwise i.e. all types of skin cancers included with only first occurrence counted. Only SCC, melamona and Kaposis Sarcoma counted as skin cancer for the purpose of survival curves 36

37 ALL MALIGNANCIES* - HEART n = PTLD 15% (of all cancers diagnosed) OTHER 85% (of all cancers diagnosed) PTLD 13 13/2559=4% Skin SCC /2559=16% BCC 78 Melanoma 37 Spindle Cell 3 Merkle Cell 5 Dermatofibrosarcoma 2 43 Other 17/2559=8% Lung 4 Bowel 21 Prostate 17 Liver 12 Bladder 11 Renal 8 Pancreas 7 Tonsil/throat/tongue 5 Parotid 4 Oesophagus 4 Mesothelioma 4 Bone/myeloma 4 Cervix 3 Thyroid/Parathyroid 3 Breast 3 Caecum 3 Larynx 2 Testicle 2 Brain 2 Carcinoid Tumour 1 Ear/Face/Neck 1 Uterus 1 Endometrium 1 Leiomyosarcoma 1 Leukaemia 1 Liposarcoma 1 Mediastinum 1 Neuroblastoma 1 Pituitary 1 Seminoma 1 Unspecified 9 37

38 RECIPIENT CAUSE OF DEATH ALL HEARTS n = % % 14% 15% 15 9% 1 5 7% 4% 4% 1% TxCAD Misc Infection Rejection Non PTLD Mal NSGF PTLD CVA Hemorrhage Transplant Coronary Artery Disease (TxCAD) 211 Other Malignancy (non PTLD) 189 Infection 183 Acute Rejection 112 Non-specific Graft Failure (NSGF) 88 PTLD 45 CVA 43 Hemorrage 16 OTHER TOTAL(incl unspecified) 362 Renal Failure 69 Multi-organ Failure 36 Cardiac Arrest/MI 34 Sudden Death 32 Heart Failure 25 TxCAD + Rejection 17 Pulmonary/Resp Failure 12 Non-compliance 9 Suicide 8 Pancreatitis 7 Motor Vehicle Accident 6 Total all Deaths = 1249 Bowel Ischaemia 6 Liver Failure 5 Post Surgical Complication 5 Right Ventricular Failure 5 Pulmonary Hypertension 3 Pulmonary Embolism 3 Drug Overdose 2 Aortic Dissection (Marfan's) 2 congenital bronchomalacia (1), pericarditis(1), peripheral vascular disease(4), anoxic brain/head inj(2) acute abdomen (2), myelodysplasia (1), esophogeal perforation (1)drug induced lung damage (1) esophageal diverticulum (1) COPD (3) Hepatic Encephalopathy (2) general deterioration (4) amyloidosis (1), Parkinson's(1),mesenteric ischemia(1), died on table(2) aortic aneurysm(2) Brain stem bleed (2), dissenting myopathy (1), stroke (2), Motor Neuron Disease (1) OB (1) Unspecified (data pending) 24 38

39 CAUSE OF DEATH ALL HEARTS <5 YEARS POST Tx No % Infection Misc Rejection Non Specific Graft Failure 7 13 TxCAD Non PTLD Malignancy 31 6 Lymphoproliferative Disease (PTLD) 13 2 CVA 2 4 Hemorrhage 13 2 TxCAD and Rejection Pulmonary Failure 6 1 Pulmonary Hypertension 2.5 No Data 6 1 TOTALS CAUSE OF DEATH ALL HEARTS 5 YEARS POST Tx No % Misc TxCAD Non PTLD Malignancy Infection 56 8 Lymphoproliferative Disease (PTLD) 32 4 Rejection 21 3 CVA 23 3 Non Specific Graft Failure 18 2 Hemorrhage 3.5 Pulmonary Failure 6 1 TxCAD and Rejection 8 1 Pulmonary Hypertension 1.5 No Data 18 3 TOTALS

40 LUNG TRANSPLANTATION

41 PRE TRANSPLANT DIAGNOSIS HEART LUNG N = 189 Other PHT 3% Emphysema 3% CFA 3% Bronchiectasis 3% Misc 7% PAH 26% AAT 7% Congenital heart disease 15% Cystic Fibrosis 14% Eisenmengers 21% Primary Pulmonary Hypertension 48 Eisenmenger's Syndrome 38 Cystic Fibrosis 26 Congenital Heart Disease 3 Alpha-1-Antitrypsin Deficiency 13 Emphysema 6 Cryogenic Fibrosing Alveolitis 5 Other Pulmonary Hypertension 6 Bronchiectasis 4 Miscellaneous 13 Total = 189 Sarcoidosis(1), Asbestosis(1), Histiocytosis(1), Silicosis(1), Restrictive CM(1), Prednisone induced CM(1), Asthma(1), Agammaglobulinemia(1), OB(1), Hypoplastic LH(1), asthma and DCM(1), congenital cyanotic heart(1), eosinophilic granulomatosis(1), restrictive valvular heart disease(1) 41

42 PRE TRANSPLANT DIAGNOSIS SINGLE LUNG N = 498 Eisenmengers.5% Other PHT.5% Cystic Fibrosis.5% Misc 6% Bronchiectasis.5% AAT 16% Emphysema 49% IPF 27% Emphysema 246 Idiopathic Pulmonary Fibrosis 133 Alpha-1-Antitrypsin Deficiency 74 Bronchiectasis 5 Other Pulmonary Hypertension 3 Cystic Fibrosis 1 Eisenmengers Syndrome 1 Miscellaneous 35 Lymphangioleiomyomatosis(5), OB(6), PLAM(4), sarcoidosis(3), pulmonary eosinophillic granulomatosis(2), allergic alveolitis(3), tuberous sclerosis(2), severe air flow obstruction(1), Histiocytosis X(2), alveolar cell sarcoma(1), asthma(1), Agammaglobulinaemia(1), hypersensitive pneumonitis(1),uip(1),graft v Host(1) Total =

43 PRE TRANSPLANT DIAGNOSIS BILATERAL LUNG N = 2125 Misc 13% PHT 4% Cystic Fibrosis 31% Emphysema 27% Other PHT 1% Eisenmengers 1% Bronchiectasis 7% AAT 7% IPF 1% Cystic Fibrosis 658 Emphysema 572 Idiopathic Pulmonary Fibrosis 223 Bronchiectasis 149 Alpha-1-Antitrypsin Deficiency 134 Primary Pulmonary Hypertension 94 Other Pulmonary Hypertension 19 Eisenmengers Syndrome 1 Miscellaneous 266 ILD(67), Retx (61), OB(25), sarcoidosis(25), PLAM (22), histiocytosis X(9), asthma (7) TOTAL = 2125 alveolitis(8), eosinophilic granulomatosis(3), ARDS(3), silicosis(1), diffuse alveolar damage(2), cystic lung disease (2), x -linked hypogammaglobulinemia(2), graft v host(1), viral pneumonia(1), Wegeners granulomatosis(1), surfacant c protein deficiency(1), alveolar proteinosis(1), microlithiasis(1), pulmonary venoocclusive disease(1), pulmonary capillary hemangiomatosis (1), hypersensitivity pneumonitis(6), connective tissue disease(1) 43

44 DONOR/RECIPIENT STATE OF ORIGIN ALL LUNGS ACT NT NSW QLD VIC SA WA TAS NZ Norfolk Isl Recipients Donors Location Recipients % Donors % Recipients 215 % Donors 215 % ACT NT NSW QLD VIC SA WA TAS NZ Norfolk Isl 1... Total

45 MEAN WAIT TO TRANSPLANT ALL LUNGS mean wait in days Year n= mean std dev median min-max * * * * * * * * * * * * * * * * * * * *Due to limitations in the software, values over 1 are represented as

46 MEAN RECIPIENT AGE AT TRANSPLANT ALL LUNGS Age in Years HLTx SLTx BSLTx HLTx SLTx BSLTx year n= mean std dev min-max year n= mean std dev min-max year n= mean std dev min-max na na na na na na na

47 MEAN DONOR AGE AT TRANSPLANT ALL LUNGS Age in Years HLTx SLTx BSLTx HLTx SLTx BSLTx year n= mean std dev min-max year n= mean std dev min-max year n= mean std dev min-max na na na na na na na

48 All LUNGS MEAN COLD ISCHEMIC TIME Minutes SLTx BSLTx HLTx HLTx SLTx BSLTx Year mean std dev min-max mean std dev min-max mean std dev min-max na na na na na na na

49 RECIPIENT GENDER ALL LUNG TRANSPLANTS Percent % 49% 56% 44% 46% 54% Bilat Lung Single Lung Heart Lung Male Female Transplant Type Male n= % Female n= % Bilateral Lung Single Lung Heart Lung

50 CUTLER-EDERER SURVIVAL ALL LUNG TRANSPLANTS Percent Survival 4 SL v HL p <.5 SL v BL p < HLTx SLTx BSLTx HLTx SLTx BSLTx Year n= % n= % n= %

51 CUTLER-EDERER SURVIVAL DCD BSLTX DONORS v NON DCD BSLTX DONORS p =ns Years DCD Donors NON DCD Donors DCD ONLY NON DCD Year n= % n= %

52 CUTLER-EDERER SURVIVAL RECIPIENT AGE ALL LUNGS v 5-59 p = < v > 6+ p = < v 4-49 p = < v 5-59 p = <.5 6+ v 4-49 p = < Years > >59 Year n= % n= % n= % n= % n= %

53 CUTLER-EDERER SURVIVAL DONOR AGE ALL LUNGS Percent Survival yrs v 4-49yrs 17-39yrs v 4-49yrs p<.5 p< Years > Year n= % n= % n= % n= %

54 1 8 CUTLER-EDERER SURVIVAL ISCHEMIC TIME ALL LUNGS Percent Survival 4 p=ns Years <2hrs 2-4 hrs 4-6 hrs >6 hrs <2hrs 2-4 hrs 4-6 hrs >6 hrs Year n= % n= % n= % n= %