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THE AUSTRALIA AND NEW ZEALAND CARDIOTHORACIC ORGAN TRANSPLANT REGISTRY
TWENTY 2ND ANNUAL REPORT 1984 – 2017 ANZCOTR 2017
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NUMBER OF ALL TRANSPLANT TYPES BY YEAR 1984 - 2017
ANZCOTR 2017
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NUMBER OF ALL TRANSPLANTS* 1984 - 2017
*Includes domino, heterotopic and retransplants ANZCOTR 2017
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ALL HEART TRANSPLANTS BY HOSPITAL 1984 - 2017
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HEART LUNG TRANSPLANTS BY HOSPITAL 1986 - 2017
Prince Charles 2005 figure includes one retransplant ANZCOTR 2017
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SINGLE LUNG TRANSPLANTS BY HOSPITAL 1990 - 2017
ANZCOTR 2017
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BILATERAL LUNG TRANSPLANTS BY HOSPITAL 1992 - 2017
ANZCOTR 2017 Includes retransplants
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ANZ COMBINED WAITING LIST ACTIVITY 2017
HEARTS TOTAL LUNGS TOTAL Active as at 1 January 2017 53 85 New Additions during 2017 109 268 From on hold to Active from 2016 10 7 Removals from Waiting List (Permanent) W1 - Transplant Performed 117 230 W2 - Patients condition Improved 3 2 W3 - Too ill, new dev of contraindications etc 9 W4 - Patient declined 1 W5 - Transferred to another interstate list W6 - Died waiting 8 W7-Removed - unspecified TOTAL at Year end - (Active) 31 December 2016 55 95 Total at month end inactive - (On HOLD) 13 *Contains complete calendar year activity from all Registry Participant Centres. NB lungs column includes heart/lung procedures ANZCOTR 2017
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MEAN WAIT TIME IN DAYS TO TRANSPLANT BY TRANSPLANT TYPE BY RECIPIENT ABO TYPE 2017 v All
ANZCOTR 2017
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PRE TRANSPLANT DIAGNOSIS ALL HEARTS 1984 – 2017 n=2833
ANZCOTR 2017
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PRE TRANSPLANT DIAGNOSIS ALL HEARTS 1984 - 2017 n = 2833
ANZCOTR 2017
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PRE-TRANSPLANT STATUS HEARTS 1996 -2017
ANZCOTR 2017
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PRE-TRANSPLANT STATUS HEARTS 1993 - 2017
ANZCOTR 2017
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DONOR / RECIPIENT STATE OF ORIGIN HEARTS 1984 - 2017
Number ANZCOTR 2017
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DONOR / RECIPIENT STATE OF ORIGIN HEARTS 1984 - 2017
ANZCOTR 2017
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MEAN WAITING TIME TO TRANSPLANT HEARTS 1984 - 2017
DAYS YEAR ANZCOTR 2017
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WAITING DAYS TO HEART TRANSPLANT 1984-2017
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 2016 124 156 0-1268 2017 164 221 1-1043 ANZCOTR 2017
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MEAN RECIPIENT AGE AT TRANSPLANT HEARTS 1984 -2017
Age(yrs) Year ANZCOTR 2017
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RECIPIENT AGE AT HEART TRANSPLANT YEARS 1984 - 2017
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 2016 124 1-73 2017 117 ANZCOTR 2017
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HEARTS MEAN DONOR AGE Age in years Year ANZCOTR 2017
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DONOR AGE HEARTS - YEARS 1984-2017
ANZCOTR 2017
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HEARTS – MEAN COLD ISCHEMIC TIME 1984 - 2017
Minutes Year ANZCOTR 2017
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MEAN COLD HEART ISCHEMIC TIME - MINUTES 1984 - 2017
year105 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 2001 265 102 253 2002 237 224 2003 88 258 268 2004 87 239 88-427 2005 91 59-491 2006 246 84 238 2007 66 248 73-510 2008 86 252 2009 68 231 227 90-254 2010 229 226 94-390 2011 2012 67 59-448 2013 225 209 70-470 2014 234 230 59-482 2015 99 64-412 2016 111 214 92 206 63-488 2017 219 222 80-420 ANZCOTR 2017
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ACTUARIAL SURVIVAL - HEART TRANSPLANT 1984 - 2017
n* = Number alive at start of year ANZCOTR 2017
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ACTUARIAL SURVIVAL - HEART TRANSPLANT 1984 - 2017
Percent Survival YEAR Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2017
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ACTUARIAL SURVIVAL – ORTHOTOPIC v HETEROTOPIC v DOMINO v RETRANSPLANTS 1984 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL ORTHOTOPIC v HETEROTOPIC v DOMINO v RETRANSPLANT HEARTS 1984 - 2017
Percent Survival Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2017
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ACTUARIAL SURVIVAL ALL HEARTS PERIOD COMPARISON 1984 – 2017
v p<0.05 v p<0.05 Percent Survival Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2017
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ACTUARIAL SURVIVAL HEARTS PERIOD COMPARISON 1984 - 2017
*N = NUMBER ALIVE AT START OF YEAR ANZCOTR 2017
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ACTUARIAL SURVIVAL PRE TRANSPLANT DIAGNOSIS 1984 - 2017
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 2017
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ACTUARIAL SURVIVAL PRE TRANSPLANT DIAGNOSIS HEARTS 1984 – 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL PRE-TRANSPLANT STATUS HEARTS 1984 - 2017
p=ns Percent Survival Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2017
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ACTUARIAL SURVIVAL PRE-TRANSPLANT STATUS HEARTS 1984 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL RECIPIENT AGE BY GENDER HEARTS 1984 - 2017
*N= NUMBER SURVIVING AT START OF YEAR ANZCOTR 2017
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ACTUARIAL SURVIVAL BY RECIPIENT AGE AND GENDER HEARTS 1984 - 2017
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 2017
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ACTUARIAL SURVIVAL RECIPIENT AGE HEARTS 1984 - 2017
60+ v all groups p=<0.001 50 to 59 v 0 to p=<0.05 50 to 59 v 17 to 39 p=<0.001 50 to 59 v 40 to 49 p=<0.05 17 to 39 v 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 2017
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ACTUARIAL SURVIVAL RECIPIENT AGE HEARTS 1984 - 2017
* ANZCOTR 2017 * 2 OF THE 16 CASES IN THE GREATER THAN 59 YEARS CATEGORY ARE HETEROTOPIC HEART TRANSPLANTS
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ACTUARIAL SURVIVAL DONOR AGE HEARTS 1984 - 2017
* * 2 OF THE 16 CASES IN THE GREATER THAN 59 YEARS CATEGORY ARE HETEROTOPIC HEART TRANSPLANTS ANZCOTR 2017
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ACTUARIAL SURVIVAL DONOR AGE HEARTS 1984 - 2017
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 2017
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ACTUARIAL SURVIVAL DONOR GENDER HEARTS 1984 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL DONOR GENDER HEARTS 1984 - 2017
p=ns Percent Survival Year Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2017
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ACTUARIAL SURVIVAL DONOR AGE AND DONOR GENDER HEARTS 1984 - 2017
Percent Survival Year Females 0-55 n=868 Females 56+ n=52, Males 0-50=1738, Males 51+ n=170 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2017
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ACTUARIAL SURVIVAL RECIPIENT GENDER HEARTS 1984 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL RECIPIENT GENDER HEARTS 1984 - 2017
Percent Survival p=ns Year Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2017
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ACTUARIAL SURVIVAL COLD ISCHEMIC TIME HEARTS 1984 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL COLD ISCHEMIC TIME HEARTS 1984 - 2017
p=ns Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2017
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ACTUARIAL SURVIVAL CROSSMATCH HEARTS 1984 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL CROSSMATCH HEARTS 1984 - 2017
p < 0.01 Percent Survival Year Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2017
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ACTUARIAL SURVIVAL PEAK PANEL REACTIVE ANTIBODIES ALL HEARTS 1984 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL PEAK PRA ALL HEARTS 1984 - 2017
p=ns Percent Survival Year ANZCOTR 2017 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel
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ACTUARIAL SURVIVAL CMV IgG SEROLOGICAL STATUS HEARTS 1984 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL CMV IgG SEROLOGICAL STATUS HEARTS 1984 - 2017
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 2017
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ACTUARIAL SURVIVAL HLA MISMATCH HEARTS 1984 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL HLA MISMATCH HEARTS 1984 - 2017
p<0.05 Percent Survival Year Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2017
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ACTUARIAL SURVIVAL HLA DR LOCUS MISMATCH HEARTS 1984 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL HLA DR LOCUS MISMATCH HEARTS 1984 - 2017
p= ns Percent Survival Year ANZCOTR 2017 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel
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ACTUARIAL SURVIVAL MALIGNANCIES HEART 1984 - 2017
*Survival of the group who were defined by having developed a malignancy ANZCOTR 2017
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ACTUARIAL SURVIVAL MALIGNANCIES HEARTS 1984 - 2017
Percent Survival ptld v other mal p=<0.005 Year Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2017
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MALIGNANCIES* - HEART n = 721 1984 - 2017
PTLD 15 % Other 85 % *Only then the first diagnosis is counted ANZCOTR 2017
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MALIGNANCIES* - HEART N=721 1984 - 2017
ANZCOTR 2017 * Only the first malignancy diagnosis is counted
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RECIPIENT CAUSE OF DEATH - HEARTS 1984 - 2017 n = 1396
28% No of Deaths 18% 15% 14% 10% 6% 4% 4% 1% TxCAD Misc Infection Acute Rejection Other Malignancies NSGF PTLD CVA Hemorrhage ANZCOTR 2017
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CAUSE OF DEATH HEARTS ANZCOTR 2017
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CAUSE OF DEATH ALL HEARTS <5 YEARS AFTER TX 1984-2017
No % Infection 125 22 Misc (incl 6 no data ) 92 17 Rejection 102 18 Non Specific Graft Failure 71 13 Graft Atherosclerosis (TxCAD) 64 12 Non Lymphoid Malignancy 32 6 Lymphoproliferative Disease (PTLD) 2 CVA 4 Haemorrhage Graft Atherosclerosis & Rejection 10 1.5 Pulmonary Failure 5 1 Pulmonary Hypertension .5 Totals 556 100.0 ANZCOTR 2017
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CAUSE OF DEATH ALL HEARTS ≥5 YEARS AFTER TX 1984-2017
No % Misc (incl 45 data pending) 256 30 Graft Atherosclerosis (TxCAD) 181 22 Non Lymphoid Malignancy 183 Infection 76 9 Lymphoproliferative Disease (PTLD) 40 5 Rejection 35 4 CVA 27 3 Non Specific Graft Failure Pulmonary Failure 6 1 Haemorrhage 0.05 Graft Atherosclerosis & Rejection Pulmonary Hypertension Totals 840 100.0 ANZCOTR 2017
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Reason for Transplant Heart Lung 1986 – 2017 n=201
Misc 7% Bronchiectasis 2% IPF 3% PPH 25% Cystic Fibrosis 14% Congenital Heart Disease 16% Eisenmenger’s 20% Emphysema 3% AAT deficiency 7% Other PH 3% ANZCOTR 2017
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REASON FOR TRANSPLANT HEART LUNG n = 201 1986 - 2017
Primary Pulmonary Hypertension Eisenmenger's Syndrome Congenital Heart Disease Cystic Fibrosis COPD (AAT=13, Emphysema=6 ) Other Pulmonary Hypertension 6 Idiopathic Pulmonary Fibrosis Bronchiectasis Miscellaneous Total ANZCOTR 2017
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REASON FOR TRANSPLANT HEART LUNG PERIOD COMPARISON 1986-1996 v 1997-2017
ANZCOTR 2017
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Reason for Transplant Single Lung 1990 – 2017 n=524
Misc 7% Other PH / Eisenmengers / CF 1% Bronchiectasis 1% AAT 14% IPF 28% Emphysema 49% ANZCOTR 2017
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REASON FOR TRANSPLANT SINGLE LUNG 1990 - 2017 n = 524
ANZCOTR 2017
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Reason for Transplant Bilateral Lung 1992 – 2017 n=2533
PPH 4% Eisenmengers 1% Other PH 1% IPF 11% AAT 6% Misc 13% Emphysema 29% Bronchiectasis 6% Cystic Fibrosis 29% ANZCOTR 2017
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REASON FOR TRANSPLANT BILATERAL LUNG 1992 - 2017 n = 2533
ANZCOTR 2017
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Donor / Recipient State of Origin All Lungs* 1986 - 2017
Number ANZCOTR 2017 *Unknown state of origins are not included
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DONOR / RECIPIENT STATE OF ORIGIN ALL LUNGS 1986 - 2017
Unknown state of origins are not included ANZCOTR 2017
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Mean Wait to Transplant All Lungs 1990 - 2017
Days Year ANZCOTR 2017
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MEAN WAITING TIME TO LUNG TRANSPLANT – DAYS 1990 - 2017
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 2017
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Mean Recipient Age at Transplant LUNGS 1989 - 2017
Age in Years ANZCOTR 2017
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MEAN RECIPIENT AGE AT LUNG TRANSPLANT 1989 - 2017
ANZCOTR 2017
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Mean Donor Age at Transplant ALL LUNGS 1989 - 2017
Years of Age ANZCOTR 2017
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MEAN DONOR AGE AT TRANSPLANT LUNGS 1989 - 2017
ANZCOTR 2017
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LUNGS MEAN COLD ISCHEMIC TIME 1989 - 2017
Minutes ANZCOTR 2017
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LUNGS - MEAN COLD ISCHEMIC TIME 1989 - 2017 MINUTES
ANZCOTR 2017
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Recipient Gender % Lung Transplants 1986 - 2017
ANZCOTR 2017
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Recipient Gender Lung Transplants 1986 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL ALL LUNGS 1986 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL ALL LUNG TRANSPLANTS 1986 - 2017
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 2017
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ACTUARIAL SURVIVAL DCD DONORS V DBD DONORS 2006 - 2017
Percent Survival p=ns Year ANZCOTR 2017 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel
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ACTUARIAL SURVIVAL DCD DONORS v DBD DONORS 2006 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL BILATERAL LUNG PERIOD COMPARISON 1990 – 2017
Percent Survival Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2017
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ACTUARIAL SURVIVAL RECIPIENT AGE ALL LUNGS* 1986 - 2017
ANZCOTR 2017 * Single, Bilateral and Heart Lung procedures all combined
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ACTUARIAL SURVIVAL RECIPIENT AGE ALL LUNGS 1984 - 2017
17-39 v p = <0.00 17-39 v > p = <0.005 17-39 v p = <0.05 40-49 v p = <0.05 60+ v p = <0.05 Percent Survival YEAR Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2017
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ACTUARIAL SURVIVAL DONOR AGE ALL LUNGS 1986 - 2017
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 2017
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ACTUARIAL SURVIVAL DONOR AGE ALL LUNGS 1986 – 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL ISCHEMIC TIME ALL LUNGS 1986 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL ISCHEMIC TIME ALL LUNGS 1986 - 2017
p=ns Percent Survival Year Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel ANZCOTR 2017
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ACTUARIAL SURVIVAL CROSSMATCH ALL LUNGS 1986 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL CROSSMATCH* LUNGS 1986 - 2017
Percent Survival p=ns Year ANZCOTR 2017 *B and T cell combined Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel
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ACTUARIAL SURVIVAL ALL LUNGS POST OP SURVIVAL GT 365 days v All 1986 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL GT 365 DAY POSTOP * SURVIVAL v ALL LUNGS 1986 - 2017
Percent Survival Year ANZCOTR 2017 *Comparison of recipients who have survived the first 365 days post op v all lung tx recipients Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel
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ACTUARIAL SURVIVAL CMV STATUS ALL LUNGS 1986 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL CMV STATUS ALL LUNGS 1986 - 2017
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 2017
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ACTUARIAL SURVIVAL HLA MISMATCH ALL LUNGS 1986 - 2017
ANZCOTR 2017
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ACTUARIAL SURVIVAL HLA MISMATCH ALL LUNGS 1986 – 2017
MM0-1 v MM p<0.05 MM0-1 v MM p<0.05 Percent Survival Years ANZCOTR 2017 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel
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ACTUARIAL SURVIVAL HLA DR LOCUS MISMATCH ALL LUNGS 1986 -2017
p=ns Percent Survival Years ANZCOTR 2017 Survival by Cutler-Ederer life tables, comparisons by log rank Cox-Mantel
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ACTUARIAL SURVIVAL HLA DR LOCUS MISMATCH ALL LUNGS 1986 – 2017
ANZCOTR 2017
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CAUSE OF DEATH - ALL LUNGS 1986 - 2017
ANZCOTR 2017
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CAUSE OF DEATH - LUNGS 1986 - 2017 n = 1646
ANZCOTR 2017
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CAUSE OF DEATH ALL LUNGS < 5 YEARS POST TX
ANZCOTR 2017
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CAUSE OF DEATH ALL LUNGS < 6 Months POST TX
ANZCOTR 2017
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