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 United States grew modestly as indicated by a 12% increase from 1990 (n = 2,108) to 1995 (n = 2,360). From 1990 (n = 203) to 1995 (n = 871), lung transplant procedures increased by 329%. This trend has continued with 723 procedures performed in 1994 and 871 (21% increase from 1994) reported for 1995. As in the US, the number of non-US heart transplants has leveled during recent years. 2. The number of heart transplant programs in the United States has remained relatively constant over the last 3 years with a decrease of 5 heart programs from 1995 to 1996. The number of centers performing lung transplantation has also leveled during the last 3 years with an increase of only 4 programs from 1994 to 1996. Non-US lung programs increased 90% from 1994 to 1995. 3. The most frequently reported indication for heart transplantation in the US has changed from coronary artery disease (40.9%) in previous registry reports to all cardiomyopathies (44.7%). For other thoracic transplants, the most frequently reported indications included cystic fibrosis (36.7%) for double-lung, emphysema/COPD (46.8%) for single-lung and congenital lung disease (41.2%) for heart-lung transplants. The most frequently reported diagnoses for thoracic transplantation outside the US included cardiomyopathy (48.5%) for heart, cystic fibrosis (36.0%) for double-lung, idiopathic pulmonary fibrosis (26.5%) for single-lung and primary pulmonary hypertension (25.0%) for heart-lung transplants. 4. US heart transplant recipients were predominantly male (77.8%), 50-64 years old (51.1%) and white (82.7%). In contrast, US lung transplant recipients were predominantly female (52.9%), 35-64 years old (73.1%) and white (89.9%). No significant variance from the US recipient demographic profile was noted for non-US recipients in these analyses. 5. The one-year survival rate for US heart transplant recipients during recent years was fairly consistent, with only a 0.4% increase from 1990-1995. Improvement in the one-year US lung transplant survival rate was demonstrated by a rise from 35.3% in 1987 to 74.0% in 1995. The one-year survival rates at non-US centers were 76.0% for heart recipients and 64.5% for lung recipients in 1995. 6. The long-term thoracic patient survival rates in the United States were: 33.3% at 12 years for heart, 43.7% at 5 years for lung and 27.6% at 10 years for heart-lung recipients. Long-term survival rates for non-US cases were: 30.3% at 12 years for heart, 44.8% at 6 years for lung and 19.8% at 10 years for heart-lung. 7. The most important risk factor for US heart recipients at 1 month, 1 year, 3 years and 5 years after transplantation was receipt of a previous heart transplant. Other substantial long-term risk factors included recipient age less than 1 year, donor aged 45-54, and non-white recipient. 8. The most important mortality risk factor in US lung recipients was the order of the transplant (primary or repeat). Diagnosis and ventilator use remained highly influential risk factors for mortality.