Worldwide thoracic organ transplantation: a report from the UNOS/ISHLT International Registry for Thoracic Organ Transplantation.

1. The number of heart transplant operations performed in the US has increased by 51 procedures between 1997 (2,294) and 1998 (2,345). The number of lung transplants decreased by 67 in 1998 (862). 2. The most frequently reported indication for heart transplantation in the US is coronary artery disease (44.6%). For other thoracic transplants, the most frequently reported indications include other/unknown (43.9%) for double lung, emphysema/COPD (53.5%) for single lung and other/unknown (53.2%) for heart-lung. The most frequently reported diagnoses for thoracic transplantation outside the US include cardiomyopathy (50.5%) for heart, cystic fibrosis (32.0%) for double lung, idiopathic pulmonary fibrosis (32.7%) for single lung and congenital heart disease (24.7%) for heart-lung. 3. US heart transplant recipients were predominately male (77%), between 50-64 years old (51.4%) and White (81.7%). In contrast, US lung transplant recipients are predominantly female (51.3%), between 50-64 years of age (44.7%) and White (89.7%). No meaningful variance from the US recipient demographic profile was noted for the non-US recipients during the same time period. 4. Pediatric recipients (< 18 years of age) received 10.9% of the reported heart transplants and 6.5% of reported lung transplants. 5. One-year survival for thoracic transplants performed in the US was 83.2% for heart, 70.6% for lung and 62.5%. Five-year survival for US thoracic transplants was 70% for heart and 49.1% for lung. 6. Long-term patient survival rates were: 22.3% at 18 years for heart, 20% at 9 years for lung and 25% at 12 years for heart-lung recipients. 7. The most important risk factor for mortality of US heart recipients at one month, one and 5 years after transplantation was receipt of a previous heart transplant. Significant short-term risk factors included donor age, recipient age and ischemic time. Substantial long-term risk factors include older donor age, donor race and recipient race. 8. The factors having the most significant impact on lung mortality at all time points were related to either the patient's medical condition (e.g., in the ICU prior to transplant, requiring mechanical ventilation) or diagnosis. 9. Mechanical ventilation and previous transplant had the largest impact on heart-lung mortality. 10. For heart and lung recipients, the major cause of hospitalization during the first posttransplant year was infection.