THE AUSTRALIA AND NEW ZEALAND CARDIOTHORACIC ORGAN TRANSPLANT REGISTRY TWENTIETH ANNUAL REPORT 1984 – 2015 ANZCOTR 2015

NUMBER OF ALL TRANSPLANT TYPES BY YEAR 1984 - 2015 ANZCOTR 2015

NUMBER OF ALL TRANSPLANTS* 1984 - 2015 *Includes domino, heterotopic and retransplants ANZCOTR 2015

ALL HEART TRANSPLANTS BY HOSPITAL 1984 - 2015

HEART LUNG TRANSPLANTS BY HOSPITAL 1986 - 2015 Prince Charles 2005 figure includes one retransplant ANZCOTR 2015

SINGLE LUNG TRANSPLANTS BY HOSPITAL 1990 - 2015 ANZCOTR 2015

BILATERAL LUNG TRANSPLANTS BY HOSPITAL 1992 - 2015 Includes retransplants ANZCOTR 2015

COMBINED WAITING LIST ACTIVITY 2015 HEARTS TOTAL LUNGS TOTAL Active as at 1 January 2015 68 124 New Additions during 2015 117 230 From on hold to Active from 2014 17 23 Removals from Waiting List (Permanent) W1 - Transplant Performed 106 218 W2 - Patients condition Improved 1 4 W3 - Too ill, new dev of contraindications etc 8 14 W4 - Patient declined 2 W5 - Transferred to another interstate list W6 - Died waiting 5 9 W7-Removed - unspecified 3 TOTAL at Year end - (Active) 31 December 2015 59 90 Total at month end inactive - (On HOLD) 37 *Contains complete calendar year activity from all Registry Participant Centres. NB lungs column includes heart/lung procedures ANZCOTR 2015

MEAN WAIT TIME IN DAYS TO TRANSPLANT BY TRANSPLANT TYPE BY RECIPIENT ABO TYPE 2015* These figures relate to Transplants performed in the calendar year 2015 only ** Too few cases to calculate a standard deviation ANZCOTR 2015

PRE TRANSPLANT DIAGNOSIS HEART 1984 - 2015 ANZCOTR 2015

PRE TRANSPLANT DIAGNOSIS 1984 - 2015 n = 2585 ANZCOTR 2015

PRE-TRANSPLANT STATUS HEARTS 1996 -2015 ANZCOTR 2015

PRE-TRANSPLANT STATUS HEARTS 1993 - 2015 ANZCOTR 2015

DONOR / RECIPIENT STATE OF ORIGIN HEARTS 1984 - 2015 Number ANZCOTR 2015

DONOR / RECIPIENT STATE OF ORIGIN HEARTS 1984 - 2015 ANZCOTR 2015

Mean Waiting Time to Transplant HEARTS 1984 - 2015 DAYS YEAR ANZCOTR 2015

WAITING DAYS TO HEART TRANSPLANT 1984-2015 year n mean std dev + - median min-max 1984 14 44 77 10 4-295 1985 19 46 54 3-209 1986 32 67 76 37 3-295 1987 30 61 80 40 3-424 1988 56 102 33 1-400 1989 93 86 87 1-445 1990 103 99 154 35 1-842 1991 126 57 1-633 1992 115 119 51 1-790 1993 114 116 127 78 1-626 1994 104 192 219 128 1-999* 1995 108 203 236 107 3-999* 1996 171 200 92 2-999* 1997 105 228 265 1998 82 185 117 1999 75 260 133 2000 70 196 227 120 2001 177 212 88 2002 148 64 2003 143 162 91 1-782 2004 134 176 1-908 2005 89 159 169 113 2-792 2006 79 150 155 2-764 2007 63 163 180 125 1-974 2008 174 1-976 2009 68 147 132 5-565 2010 74 232 97 0-999* 2011 165 1-586 2012 84 202 213 139 2-1181 2013 225 298 0-1668 2014 95 197 279 96 0-1638 2015 194 123 0-1027 ANZCOTR 2015 Due to limitations in the software, values over 1000 , until 2012, are represented as 999

Mean Recipient Age at Transplant HEARTS 1984 -2015 Age(yrs) Year ANZCOTR 2015

RECIPIENT AGE AT HEART TRANSPLANT YEARS 1984 - 2015 mean std dev + - median min-max 1984 14 33 15 39 11-51 1985 19 13 38 10-54 1986 32 40 43 11-57 1987 30 41 12 46 13-56 1988 56 45 4-63 1989 93 42 1-65 1990 103 47 6-65 1991 52 1-64 1992 115 51 4-66 1993 114 1994 104 50 1-66 1995 108 16 2-68 1996 48 53 10-64 1997 105 9-66 1998 82 1999 75 2-67 2000 70 49 12-66 2001 80 2-64 2002 18 7-70 2003 88 1-67 2004 76 2005 89 5-65 2006 79 17 3-67 2007 66 5-71 2008 6-67 2009 68 1-69 2010 74 5-70 2011 5-72 2012 84 2013 1-70 2014 95 2015 102 20 1-72 ANZCOTR 2015

Hearts Mean Donor Age 1984 - 2015 Age in years Year ANZCOTR 2015

DONOR AGE HEARTS - YEARS 1984-2015 ANZCOTR 2015

HEARTS – Mean Cold Ischemic Time 1984 - 2015 Minutes Year ANZCOTR 2015

MEAN COLD HEART ISCHEMIC TIME - MINUTES 1984-2015 year n mean std dev +- median min-max 1984 14 74 16 70 54-108 1985 19 114 41 95 53-183 1986 32 136 47 133 80-235 1987 30 151 45 155 60-260 1988 56 152 44 158 78-240 1989 93 150 57 147 39-311 1990 103 165 144 54-441 1991 178 80 163 55-390 1992 115 183 76 164 52-420 1993 207 82 198 41-446 1994 104 193 75 190 75-445 1995 108 208 98 186 42-465 1996 201 79 177 60-405 1997 105 211 90 194 60-454 1998 240 213 74-612 1999 236 101 244 43-447 2000 247 89 242 102-516 2001 265 102 253 186-338 2002 237 224 107-443 2003 88 258 268 176-323 2004 87 239 88-427 2005 91 59-491 2006 246 84 238 109-413 2007 66 248 73-510 2008 86 252 115-540 2009 68 231 227 90-254 2010 229 226 94-390 2011 101-472 2012 67 59-448 2013 225 209 70-470 2014 234 230 59-482 2015 99 64-412 ANZCOTR 2015

ACTUARIAL SURVIVAL - HEART TRANSPLANT 1984 - 2015 n* = Number alive at start of year ANZCOTR 2015

ACTUARIAL SURVIVAL - HEART TRANSPLANT 1984 - 2015 Percent Survival YEAR Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL – ORTHOTOPIC v HETEROTOPIC v DOMINO v RETRANSPLANTS 1984 - 2015 ANZCOTR 2015

Actuarial Survival Orthotopic v Heterotopic v Domino Hearts v Retransplant 1984 - 2015 Percent Survival Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL ALL HEARTS PERIOD COMPARISON 1984 – 2015 2000-09 v 1984-89 p<0.05 2009-09 v 1990-99 p<0.05 Percent Survival Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL HEARTS PERIOD COMPARISON 1984 - 2015 *N = NUMBER ALIVE AT START OF YEAR ANZCOTR 2015

ACTUARIAL SURVIVAL PRE TRANSPLANT DIAGNOSIS 1984 - 2015 IDCM v IHD p<0.005 IHD v Others p<0.005 Percent Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL PRE TRANSPLANT DIAGNOSIS HEARTS 1984 – 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL PRE-TRANSPLANT STATUS HEARTS 1984 - 2015 p=ns Percent Survival Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL PRE-TRANSPLANT STATUS HEARTS 1984 - 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL RECIPIENT AGE BY GENDER HEARTS 1984 - 2015 *N= NUMBER ALIVE AT START OF YEAR ANZCOTR 2015

ACTUARIAL SURVIVAL BY RECIPIENT AGE AND GENDER HEARTS 1984 - 2015 Percent Survival MALES 0-39 yrsv MALES>39yrs p<0.005 MALES>39yrs v FEMALES>39yrs p <0.05 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL RECIPIENT AGE HEARTS 1984 - 2015 60+ v all groups p=<0.001 50 to 59 v 0 to 16 p=<0.05 50 to 59 v 17 to 39 p=<0.001 50 to 59 v 40 to 49 p=<0.05 Percent Survival YEAR 2 OF THE 11 CASES IN THE GREATER THAN 59 YEARS CATEGORY ARE HETEROTOPIC HEART TRANSPLANTS Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL RECIPIENT AGE HEARTS 1984 - 2015 * ANZCOTR 2015 * 2 OF THE 16 CASES IN THE GREATER THAN 59 YEARS CATEGORY ARE HETEROTOPIC HEART TRANSPLANTS

ACTUARIAL SURVIVAL DONOR AGE HEARTS 1984 - 2015 * ANZCOTR 2015 * 2 OF THE 16 CASES IN THE GREATER THAN 59 YEARS CATEGORY ARE HETEROTOPIC HEART TRANSPLANTS

ACTUARIAL SURVIVAL DONOR AGE HEARTS 1984 - 2015 0-16yrs v 40-49yrs p<0.001 0-16yrs v 50-59yrs p<0.005 17-39yrs v 40-49yrs p<0.001 17-39yrs v 50-59yrs p<0.009 Percent Survival YEAR 2 OF THE 11 CASES IN THE GREATER THAN 59 YEARS CATEGORY ARE HETEROTOPIC HEART TRANSPLANTS Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL DONOR GENDER HEARTS 1984 - 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL DONOR GENDER HEARTS 1984 - 2015 p=ns Percent Survival An excellent addition this year would be a graph of age and gender survival - to prove or disprove the point eg that females >55 are dreadful donors are are males >50 (my observation) Year Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL DONOR AGE AND DONOR GENDER HEARTS 1984 - 2015 Percent Survival Year Females 0-55 n=786, Females 56+ n=43, Males 0-50=1580, Males 51+ n=151 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL RECIPIENT GENDER HEARTS 1984 - 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL RECIPIENT GENDER HEARTS 1984 - 2015 Percent Survival p=ns Year Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL ISCHEMIC TIME HEARTS 1984 - 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL ISCHEMIC TIME HEARTS 1984 - 2015 p=ns Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL CROSSMATCH HEARTS 1984 - 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL CROSSMATCH HEARTS 1984 - 2015 p < 0.01 Percent Survival Year Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL PEAK PANEL REACTIVE ANTIBODIES ALL HEARTS 1984 - 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL PEAK PRA ALL HEARTS 1984 - 2015 p=ns Percent Survival Year ANZCOTR 2015 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

ACTUARIAL SURVIVAL CMV IgG SEROLOGICAL STATUS HEARTS 1984 - 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL CMV IgG SEROLOGICAL STATUS HEARTS 1984 - 2015 p=ns Percent Survival Year R+ve = R+veD+ve or R+veD-ve Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL HLA MISMATCH HEARTS 1984 - 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL HLA MISMATCH HEARTS 1984 - 2015 p<0.05 Percent Survival Year Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL HLA DR LOCUS MISMATCH HEARTS 1984 - 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL HLA DR LOCUS MISMATCH HEARTS 1984 - 2015 p= ns Percent Survival Year ANZCOTR 2015 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

ACTUARIAL SURVIVAL MALIGNANCIES HEART 1984 - 2015 *Survival of the group who were defined by having developed a malignancy ANZCOTR 2015

ACTUARIAL SURVIVAL MALIGNANCIES HEARTS 1984 - 2015 Percent Survival ptld v other mal p=<0.005 Year Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

RECIPIENT CAUSE OF DEATH - HEARTS 1984 - 2015 n = 1249 29% No of Deaths 17% 14% 15% 9% 7% 4% 4% 1% TxCAD Misc Infection Acute Rejection Other Malignancies NSGF PTLD CVA Hemorrhage ANZCOTR 2015

CAUSE OF DEATH HEARTS 1984 - 2015 ANZCOTR 2015

CAUSE OF DEATH ALL HEARTS <5 YEARS AFTER TX 1984-2015 No % Infection 127 24 Misc (incl 6 no data ) 98 18 Rejection 91 17 Non Specific Graft Failure 70 13 Graft Atherosclerosis (TxCAD) 58 11 Non Lymphoid Malignancy 31 6 Lymphoproliferative Disease (PTLD) 2 CVA 20 4 Haemorrhage Graft Atherosclerosis & Rejection 9 1.5 Pulmonary Failure 1 Pulmonary Hypertension .5 Totals 538 100.0 ANZCOTR 2015

CAUSE OF DEATH ALL HEARTS ≥5 YEARS AFTER TX 1984-2015  No  % Misc (incl 18 data pending) 232 33 Graft Atherosclerosis (TxCAD) 153 22 Non Lymphoid Malignancy 158 Infection 56 8 Lymphoproliferative Disease (PTLD) 32 4 Rejection 21 3 CVA 23 Non Specific Graft Failure 18 2 Pulmonary Failure 6 1 Haemorrhage 0.5 Graft Atherosclerosis & Rejection Pulmonary Hypertension   Totals 711 100.0 ANZCOTR 2015

MALIGNANCIES* - HEART n = 676 1984 - 2015 PTLD 15 % Other 85 % *Only then the forst diagnosis is counted ANZCOTR 2015

MALIGNANCIES - HEART N=676 1984 - 2015 ANZCOTR 2015

Reason for Transplant Heart Lung 1986 – 2015 n=189 ANZCOTR 2015

REASON FOR TRANSPLANT HEART LUNG n = 189 1986 - 2015 Primary Pulmonary Hypertension 48 Eisenmenger's Syndrome 38 Congenital Heart Disease 30 Cystic Fibrosis 26 Alpha-1-Antitrypsin Deficiency 13 Emphysema 6 Cryptogenic Fibrosing Alveolitis 5 Other Pulmonary Hypertension 6 Bronchiectasis 4 Miscellaneous 13 Total 189 ANZCOTR 2015

Reason for Transplant Single Lung 1990 – 2015 n=498 ANZCOTR 2015

REASON FOR TRANSPLANT SINGLE LUNG 1990 - 2015 n = 498 ANZCOTR 2015

Reason for Transplant Bilateral Lung 1992 – 2015 n=2125 ANZCOTR 2015

REASON FOR TRANSPLANT BILATERAL LUNG 1992 - 2015 n = 2125 ANZCOTR 2015

Donor / Recipient State of Origin All Lungs 1986 - 2015 Number ANZCOTR 2015 *Retransplants and unknown state of origins are not included

DONOR / RECIPIENT STATE OF ORIGIN ALL LUNGS 1986 - 2015 *Retransplants and unknown state of origins are not included ANZCOTR 2015

Mean Wait to Transplant All Lungs 1990 - 2015 Days Year ANZCOTR 2015

MEAN WAITING TIME TO LUNG TRANSPLANT – DAYS 1990 - 2015 A total of 50 patients waited longer than 1000 days and were included in the above analysis as 999 days (due to limitations in the software) ANZCOTR 2015

Mean Recipient Age at Transplant LUNGS 1989 - 2015 Age in Years ANZCOTR 2015

MEAN RECIPIENT AGE AT LUNG TRANSPLANT 1989 - 2015 ANZCOTR 2015

Mean Donor Age at Transplant ALL LUNGS 1989 - 2015 Years of Age ANZCOTR 2015

MEAN DONOR AGE AT TRANSPLANT LUNGS 1989 - 2015 ANZCOTR 2015

LUNGS MEAN COLD ISCHEMIC TIME 1989 - 2015 Minutes ANZCOTR 2015

LUNGS - MEAN COLD ISCHEMIC TIME 1989 - 2015 MINUTES ANZCOTR 2015

Recipient Gender % Lung Transplants 1986 - 2015 ANZCOTR 2015

Recipient Gender Lung Transplants 1986 - 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL ALL LUNGS 1986 - 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL ALL LUNG TRANSPLANTS 1986 - 2015 SL v HL p<0.005 SL v BL p<0.005 Percent Survival Year Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL DCD DONORS V DBD DONORS 2006 - 2015 Percent Survival p=ns Year ANZCOTR 2015 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

ACTUARIAL SURVIVAL DCD DONORS v DBD DONORS 2006 - 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL RECIPIENT AGE ALL LUNGS* 1986 - 2015 ANZCOTR 2015 * Single, Bilateral and Heart Lung procedures all combined

ACTUARIAL SURVIVAL RECIPIENT AGE ALL LUNGS 1984 - 2015 17-39 v 50-59 p = <0.00 17-39 v > 60+ p = <0.005 17-39 v 40-49 p = <0.05 40-49 v 50-59 p = <0.05 60+ v 40-49 p = <0.05 Percent Survival YEAR Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL DONOR AGE ALL LUNGS 1986 - 2015 Percent Survival 0-16 yrs vs 40-49yrs p<0.05 17-39yrs vs 40-49yrs p<0.05 YEAR Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL DONOR AGE ALL LUNGS 1986 – 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL ISCHEMIC TIME ALL LUNGS 1986 - 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL ISCHEMIC TIME ALL LUNGS 1986 - 2015 p=ns Percent Survival Year Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL CROSSMATCH ALL LUNGS 1986 - 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL CROSSMATCH LUNGS 1986 - 2015 Percent Survival p=ns Year ANZCOTR 2015 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

ACTUARIAL SURVIVAL CMV STATUS ALL LUNGS 1986 - 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL CMV STATUS ALL LUNGS 1986 - 2015 R-D+ vs R+ p<0.05 Percent Survival Years R+ve = R+ve/D+ve or R+ve/D-ve Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2015

ACTUARIAL SURVIVAL HLA MISMATCH ALL LUNGS 1986 - 2015 ANZCOTR 2015

ACTUARIAL SURVIVAL HLA MISMATCH ALL LUNGS 1986 – 2015 MM0-1 v MM5 p<0.05 MM0-1 v MM6 p<0.05 Percent Survival Years ANZCOTR 2015 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

ACTUARIAL SURVIVAL HLA DR LOCUS MISMATCH ALL LUNGS 1986 -2015 p=ns Percent Survival Years ANZCOTR 2015 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel

ACTUARIAL SURVIVAL HLA DR LOCUS MISMATCH ALL LUNGS 1986 – 2015 ANZCOTR 2015

CAUSE OF DEATH - ALL LUNGS 1986 - 2015 ANZCOTR 2015

CAUSE OF DEATH - LUNGS 1986 - 2015 n = 1428 ANZCOTR 2015

CAUSE OF DEATH ALL LUNGS < 5 YEARS POST TX ANZCOTR 2015