Cardiac allograft vasculopathy epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]; Raviteja Guddeti, M.B.B.S. [3]
Overview
As per data from the Registry of the International Society of Heart and Lung transplantation[1], the number of reported heart transplants has increased slowly in the recent years, especially in North America.
Epidemiology and Demographics
Donor demographics and characteristics
- In the recent cohort from the ISHLT (International Registry of Heart and Lung Transplant)[1], 69% of the donors are male and the incidence of female donor to male recipient transplantation is seen less frequently than previously.
- Average donor age is 34 years whereas average donor recipient age difference is 16 years.
- The leading cause of donor death was head trauma (46%) whereas the second most common cause was stroke (24%). Donor diabetes and hypertension is rare but increasing steadily. Average ischemia time was 3.3 hours (range 1.6 to 5.1 hours).
Recipient demographics and characteristics
- Cardiomyopathy and coronary artery disease are the most frequent diagnoses leading to a heart transplant. The proportion of recipients with history of cardiomyopathy is increasing over time.
- Increasing proportions of high risk patients like re-transplants, congenital heart diseases, co-morbidities like diabetes mellitus, hypertension, prior history of dialysis, previous malignancy and previous cardiac surgery reflect changes in patient characteristics over time. Also the use of left ventricular assist devices (LVAD's) in the interim period as a bridge to transplant has increased over time (28%).
- The average recipient age has stayed stable at 54 years in the last decade whereas the proportion of male recipients has decreased over years from 81% in 1992- 2000 to 76% in 2006- 2012.
Survival
- Overall data from 1982 up to June 2011 shows 1 year survival of 81% and 5 year survival of 69%, with median survival of 10 years for all and 13 years for those surviving until the end of first year. The most recent cohort of patients show unadjusted 1 year survival of 84%.
- The survival curve demonstrates a steep fall in survival in the first 6 months post-transplant. Thereafter, it steadily decreases by 3.5% per year and continues to do so well beyond 15 years. However, the risk adjusted Kaplan-Meier curves suggests a significant improvement in long term survival in recent years.
- Re-transplantation: Patients who underwent re-transplantation between 2002 to 2006, who were more than 12 months from their index transplantation had a 1 year survival of approximately 85%, which is the same as index transplants performed during that period.
Causes of death
The following table outlines the common causes of death in post cardiac transplant patients:
| First 30 days post-transplant | From 1 month to 12 months post-transplant | After 5 years post-transplant |
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Cardiac allograft vasculopathy
- The Kaplan-Meier curves from data collected by The 25th official report by Heart and Lung Transplant Registry, demonstrates a steady increase in the incidence of CAV post-transplant, such that only 46% of patients are free from angiographic evidence of CAV at the end of 10 years. Moreover, the survival after development of CAV appears to have minimal improvement in recent years in comparison to immediately preceding years.
- Early CAV (diagnosed within 1 year post-transplant) was a powerful predictor of 5 year mortality.
- According to ISHLT Registry, higher donor age, younger recipient age, history of hypertension, pre-transplant diagnosis of ischemic heart disease, HLA-DR mismatches were important predictors for development of CAV.
References=
- ↑ 1.0 1.1 Taylor DO, Edwards LB, Boucek MM, Trulock EP, Aurora P, Christie J; et al. (2007). "Registry of the International Society for Heart and Lung Transplantation: twenty-fourth official adult heart transplant report--2007". J Heart Lung Transplant. 26 (8): 769–81. doi:10.1016/j.healun.2007.06.004. PMID 17692781.