CHAPTER 3 HEART AND LUNG TRANSPLANTATION Editors: Mr Mohamed Ezani Md. Taib Dato’ Dr David Chew Soon Ping Dr Ashari Yunus Expert Panel: Mr Mohamed Ezani Md. Taib (Chairperson) Dr Abdul Rais Sanusi Datuk Dr Aizai Azan Abdul Rahim Dr Ashari Yunus Dato’ Dr David Chew Soon Ping

Table 3.1.1a: Stock and Flow of Heart Transplantation, Year New transplant patients Deaths Retransplanted Lost to follow up Alive at 31 st December Figure 3.1.1a: Stock and Flow of Heart Transplantation, Number of patients Year New transplant patients Alive at 31st December

Table 3.2.1a: Distribution of Patients by Gender, Year TOTAL Gender No. Male Female TOTAL Table 3.2.2a: Distribution of Patients by Ethnic Group, Year TOTAL Ethnic group No. Malay Chinese Indian TOTAL Table 3.2.3a: Distribution of Patients by Age, Year TOTAL Age, years No ≥ TOTAL Mean SD Median Minimum Maximum

Table 3.2.4a: Distribution of Patients by Primary Diagnosis, Table 3.3.1a: Distribution of Patients by Heart Procedure, Year TOTAL Primary diagnosis No. Ischaemic Cardiomyopathy Idiopathic Dilated Cardiomyopathy Restrictive Cardiomyopathy End Stage Valvular Heart Disease Hypertrophic Cardiomyopathy Others TOTAL Year TOTAL Heart ProcedureNo. Orthotopic Bicaval Orthotopic Traditional Heterotopic TOTAL

Table 3.3.2a: Distribution of Patients by Immunosuppressive Used, Year Total Type of immunosuppressiveNo. Steroids Prednisolone Methylprednisolone Calcineurin Inhibitors Cyclosporin A Neoral ® Tacrolimus (FK506) Antimetabolites Azathioprine (AZA) Mycophenolate Mofetil (MMF) Anti-lymphocyte Receptor Antibodies Anti-thymocyte globulin (ATG) TOTAL patients at notification Table 3.3.3a: Immunosuppressive Used at Time of Last Follow-up up to 2008 Year of follow up* Type of immunosuppressiveNo. Steroids Prednisolone Methylprednisolone Calcineurin Inhibitors Cyclosporin A Neoral ® Tacrolimus (FK506) 1 Antimetabolites Azathioprine (AZA) Mycophenolate Mofetil (MMF) TOTAL patients at follow-up 66778

Table 3.3.4a: Duration of Waiting Time on Waiting List, Year TOTAL Duration (months)* No. < ≤ ≤ ≤ ≤ ≤ ≤ ≤ TOTAL Mean SD Median Minimum Maximum

Table 3.4.1a: Post Transplant Events at Last Follow-up up to 2008 Year of transplant* TOTAL Type of post transplant events No. Drug Treated Hypertension Bone Disease (Symptomatic) Chronic Liver Disease Cataracts Diabetes Renal Dysfunction Stroke Drug-Treated Hyperlipidaemia TOTAL patients at follow-up

Table 3.4.2a: Post Transplant Malignancies at Follow-up up to 2008 Year of transplant* TOTAL Type of post transplant malignancies No. Recurrence of pre- transplant tumour De Novo solid tumour De Novo lymphoproliferative disorder Skin TOTAL patients at follow-up Table 3.4.3a: Non-compliance at Follow-up up to 2008 Year of transplant* TOTAL Non-compliance during follow- up No.  Yes  No TOTAL patients at follow-up Areas of non-compliance:  Immunosuppression medication  Patient unable to afford immunosuppression medications  Other medication  Other therapeutic regimen TOTAL patients with noncompliance

Table 3.4.4a: Patient Treated for Rejection at Follow-up up to 2008 Year of transplant* TOTAL Patient treated for rejection No.  Yes  No TOTAL patients at follow-up Number of rejection events 1 2 3 TOTAL patients with rejection Table 3.4.5a: Distribution of Patients by Time of Deaths, Year of discharge TOTAL Time of deaths* No. <3 months (at discharge) <6 months months-1 year >1 year TOTAL patients who died

Figure 3.4.6a: Patient Survival, Table 3.4.6a: Patient Survival, Year of Transplant Interval% SurvivalSE 6 months year year year year year year year year year year Cumulative survival Duration in years Kaplan-Meier survival estimate

Table 3.4.7a: Cause of Death at Discharge, Table 3.4.8a: Cause of Death at Follow-up, Year TOTAL Cause of deathNo. Hyperacute rejection Multi organ failure Respiratory failure secondary to septicaemia Respiratory failure, renal function and liver failure, ARDS, septicaemia Septicaemia, multiorgan failure Graft failure TOTAL patients who died at discharge Year TOTAL Cause of deathNo. Severe bleeding Lung cancer, small cell type, septicaemia, bronchopneumonia Rejection due to non- compliance Unknown TOTAL patients who died at follow-up

LUNG TRANSPLANTATION & HEART-LUNG TRANSPLANTATION Table 3.1.1b: Stock and Flow of Lung Transplantation, Year New transplant patients 1120 Deaths 0110 Retransplanted 0000 Lost to follow up 0000 Alive at 31 st December 1122 Figure 3.1.1b: Stock and Flow of Lung Transplantation,

Table 3.2.1b: Distribution of Patients by Gender, Year GenderNo. Male1110 Female0010 TOTAL1120 Table 3.2.2b: Distribution of Patients by Ethnic Group, Table 3.2.3b: Distribution of Patients by Age, Year RaceNo. Malay0010 Chinese0000 Indian1100 Iban0010 TOTAL1120 Year Age(years)No ≥ TOTAL1120

Year DiagnosisNo. Idiopathic pulmonary fibrosis 1110 Idiopathic pulmonary arterial hypertension 0010 Chronic obstructive pulmonary disease 0000 Bronchiectasis0000 TOTAL1120 Table 3.2.4b: Distribution of Patients by Primary Diagnosis, Table 3.3.1b: Distribution of Patients by Lung Procedure, Year ProcedureNo. Single Lung Transplant1000 Double Lung Transplant0110 Heart – Lung Transplant0010 TOTAL1120 Table 3.3.3b: Immunosuppressive Used at Time Follow-up to 2008 Year Immunosuppresive drugsNo. Steroids: Prednisolone Methylprednisolone Antimetabolites: Azathioprine(AZA) Mycophenolate (MMF) Neoral1230 Tacrolimus0002 TOTAL patients at follow -up1232

Table 3.4.5b: Distribution of patients by time of deaths, Year DeathNo. < 3 months < 6 months – 12 months0000 > 12 months0000 TOTAL0110