Thoracic organ transplantation in the US.

Based on data reported to the United Network for Organ Sharing through December 2001: 1. The number of heart transplant procedures performed in the United States increased slightly (< 1%) during each of the last 2 complete years from 2,187 transplants during 1999 to 2,197 transplants during 2000, followed by an additional increase in 2001 to 2,202 transplants. A more substantial increase was seen in the number of lung transplants performed: from 890 transplants in 1999 to 956 in 2000 (+7%) and an additional increase to 1,053 transplants in 2001 (+10%). Fewer than 30 heart-lung transplants were performed in 2001. Living-donor lung transplants comprised 2-3% of lung transplants performed between 1995-2001. 2. Pediatric recipients were more frequently on life support in the ICU; more likely to have an ischemia time of at least 4 hours; more often gender mismatched; and more often ABO-compatible rather than ABO-identical with the donor than adult recipients for all thoracic organ types. 3. The most common indication for transplant since 1996 in adult heart recipients was coronary artery disease (50%), followed closely by cardiomyopathy (42%). Among pediatric heart recipients, the 2 most common indications: cardiomyopathy (46%) and congenital heart disease (43%) accounted for approximately 90% of the transplants. The indications for lung transplants were more disparate. In adult lung recipients, the 4 most common diagnoses (COPD - 42%, IPF - 17%, CF - 15% and A1A - 9%) encompassed more than 80% of the transplants. More than half of the pediatric lung transplants were performed in recipients with CF. The 3 most frequently cited indications for adult heart-lung transplant recipients (Eisenmenger's Syndrome, other congenital heart diagnoses and PPH) accounted for greater than 75% of the transplants. 4. Approximately 30-35% of adult heart transplants since 1999 have been performed in patients who were Status 1A. For pediatric transplant recipients, Status 1A comprised 60-70% of the transplants. 5. The one-year survival rate for transplants performed during the first three-quarters of 2001 was 85% for both adult and pediatric heart transplant recipients and 77% for both adult and pediatric recipients of lung transplants. For adult heart-lung transplants performed during 2000, the one-year survival rate was 69%. 6. The long-term patient survival rates were: 39% for adult heart recipients and 50% for pediatric heart recipients at 12 years; 18% at 11 years for adult lung recipients and 31% at 9 years for pediatric lung recipients; and 24% at 11 years for adult heart-lung recipients and 21% at 8 years for pediatric heart-lung recipients. 7. Drug-treated rejection and drug-treated infection were reported to occur before discharge in approximately 20-40% of transplant recipients, with the exception of pediatric lung and heart-lung recipients, with rates varying by organ and age group. Drug-treated infections were reported before discharge in more than 60% of pediatric lung recipients and approximately half of pediatric heart-lung recipients. 8. Approximately 60% of adult heart recipients and 70% of pediatric heart recipients were hospitalized at least once during the first 3 years following their transplant.