Marshall I. Hertz

The registry of the international society for heart and lung transplantation: 29th official adult heart transplant report-2012

This 29th adult transplant report is based on data submitted by 394 transplant centers worldwide. In excess of 104,000 heart transplants have been registered in the database. Summary data are provided for the entire cohort of patients, whereas a number of additional analyses focus on cohorts of patients transplanted more recently. Detailed data analyses can be viewed on the slide set of the registry of the International Society for Heart and Lung Transplantation (ISHLT), which is available online (www.ishlt.org/registries). The report is divided into several sections. Baseline donor, recipient and medical center demographics are reviewed first. The second part focuses on immunosuppressive therapies and acute allograft rejection. Survival after heart transplant is examined next, and data on post-transplant morbidities and quality of life after transplant conclude the report.

Registry of the International Society for Heart and Lung Transplantation: Twelfth Official Pediatric Heart Transplantation Report-2009

he ISHLT Registry data are provided by individual enters or a data-sharing arrangement with a national or egional organ procurement or exchange organization. pproximately 450 pediatric heart transplants are reorted to the Registry each year. Most the data are rovided from North American centers, but significant ontributions come from centers in Europe and the rest f the world (Figure 1). The Registry Committee is ctively seeking participation from all centers performng pediatric heart transplants. The tables and figures in this report and additional lides are all available from the ISHLT Web site. ontributing centers are recognized in the Introduction o the 2009 Annual Reports. Survival rates were calculated using the Kaplan-Meier ethod and compared using the log-rank test. Multivaiable analyses were performed using Cox proportional azard regression analysis. Results of the multivariable nalyses are reported as relative risks (RR) with a orresponding p-value or 95% confidence interval, or oth. A RR significantly 1 indicate that the factor is

The Registry of the International Society for Heart and Lung Transplantation: 29th Adult Lung and Heart-Lung Transplant Report—2012

This section of the 29th official International Society for Heart and Lung Transplantation (ISHLT) Registry report summarizes the current status of adult lung and heart-lung transplantation by reporting data on this international group of patients. The Registry contains data on 3,631 adult heart-lung and 39,835 adult lung transplants performed through June 30, 2011 from centers around the world. More detailed information is presented in the full slide set, which is available on the ISHLT Web site at www.ishlt.org/registries/.

The Registry of the International Society for Heart and Lung Transplantation: Twenty-eighth Adult Heart Transplant Report—2011

This Twenty-eighth Report of the International Society for Heart and Lung Transplantation (ISHLT) Transplant Registry is based on data submitted by participating transplant centers worldwide. A total of 388 heart transplant centers have contributed information to the Registry. This year we have also achieved another important milestone: the 100,000 heart transplant recipient was registered in the database. This report reviews important statistics for the entire cohort of patients registered in the database. However, similar to prior reports, many of the more detailed analyses will focus on recent transplant recipients, exploring information relevant to contemporary heart transplantation practice. The first part of the report reviews important donor, recipient, and medical center demographics. The second part provides an overview of immunosuppressive therapies used after transplantation. The third part examines survival, mortality risk factors, and causes of death after adult heart transplantation. The last section focuses on quality of life after transplant.

Mechanical circulatory support device database of the international society for heart and lung transplantation: first annual report—2003

Over the last 2 decades, mechanical circulatory support devices have been developed with the goal of supporting patients with advanced heart failure as a bridge to cardiac transplantation, a bridge to recovery, and an alternative to transplantation (also called chronic or destination therapy). The current generation of devices provides a differentiated spectrum of circulatory support. The major limitations of mechanical circulatory support devices are infection, coagulopathies and device dysfunction. The Scientific Council on Mechanical Circulatory Support of the International Society for Heart and Lung Transplantation has established an international database to generate critical data to advance knowledge about the effectiveness of mechanical circulatory support device therapy for one of the most difficult and costly contemporary medical problems, the malignant syndrome of advanced heart failure.

The Registry of the International Society for Heart and Lung Transplantation: Twenty-eighth Adult Lung and Heart-Lung Transplant Report--2011

The Registry of the International Society for Heart and Lung Transplantation (ISHLT) has documented trends in clinical lung and heart-lung transplantation since the inception of these procedures. Detailed heart-lung transplantation data have been included in the Registry annual reports since 1984 and lung transplantation data since 1989. Through June 30, 2010, the Registry contains data on 4,248 heart-lung and 38,119 lung transplants from centers around the world. This 28th Lung and Heart-Lung Registry Report summarizes the current status of lung and heart-lung transplantation by reporting data on this international group of patients, focusing on adults. More detailed information is presented in the full set of more than 200 slides that can be found on the ISHLT Web site at www.ishlt.org/registries/.

Registry of the International Society for Heart and Lung Transplantation: Twenty-fifth Official Adult Heart Transplant Report—2008

e a t d t n this twenty-fifth official report of the International ociety for Heart and Lung Transplant (ISHLT) Registry, e present information regarding 80,000 heart translants performed worldwide. As in prior years’ reorts, we focus our principal analysis on recently ransplanted patients—rather than the entire cohort of eart recipients—to provide a contemporary represenation of the state of heart transplantation.

Risk factors for the development of bronchiolitis obliterans syndrome after lung transplantation

OBJECTIVE This study identifies specific clinical and immunologic factors in lung transplant recipients that influence the subsequent development of chronic allograft dysfunction. METHODS The study group consisted of 132 consecutive patients who received lung allografts (76 single, 25 bilateral single, and 31 heart-lung) and survived at least 90 days. One hundred twenty-one patients were used in the analysis that modeled time to development of histologic obliterative bronchiolitis or bronchiolitis obliterans syndrome. RESULTS Variables noted to have an effect on the time to development of bronchiolitis obliterans syndrome included cytomegalovirus pneumonitis (RR = 3.2, p = 0.001), late acute rejection (RR = 1.3, p = 0.02), human leukocyte antigen mismatches at the A loci (RR = 1.8, p = 0.02), total human leukocyte antigen mismatches (RR = 1.4, p = 0.04), and absence of donor antigen-specific hyporeactivity (52% vs 100% survival free from bronchiolitis obliterans syndrome at 2 years; p = 0.005). Cytomegalovirus pneumonitis had a significant effect on time to obliterative bronchiolitis (RR = 3.6, p = 0.0005), as did donor antigen-specific hyporeactivity (52% vs 100% survival free from obliterative bronchiolitis at 2 years; p = 0.01). In multivariate analysis, cytomegalovirus pneumonitis (RR = 3.2, p = 0.02), human leukocyte antigen mismatches at the A loci (RR = 2.4, p = 0.006), and late acute rejection (RR = 1.3, p = 0.02) were identified as predictors of bronchiolitis obliterans syndrome. Cytomegalovirus pneumonitis was associated with time to development of histologic obliterative bronchiolitis (RR = 2.3, p = 0.02). CONCLUSIONS Several risk factors were associated with the development of chronic allograft dysfunction, which, in turn, had a significant impact on long-term survival. Early identification of lung allograft recipients with risk factors for the development of bronchiolitis obliterans syndrome may allow modification in immunosuppression and antiviral therapy to potentially decrease the prevalence of this disorder.

Respiratory syncytial virus-Induced acute lung injury in adult patients with bone marrow transplants: A clinical approach and review of the literature

Acute lung injury induced by respiratory syncytial virus (RSV) is a major cause of morbidity and mortality in patients who have undergone bone marrow transplantation. Twenty-nine of the 74 patients who received bone marrow transplants at the University of Minnesota during a 1-year period developed evidence of acute lung injury, and RSV was identified as the cause in 8. We discuss the clinical course of these 8 patients and offer a clinical approach to RSV infection occurring after bone marrow transplantation. We also review the immune response to infection with RSV and relate this information to the nature and degree of immunosuppression present in patients undergoing this type of transplantation. We found bronchoalveolar lavage with rapid antigen detection to be particularly useful for the prompt diagnosis of this serious infection. The virus was obtained from the lower respiratory tract of each patient and was identified in lavage effluent by culture and by antigen detection (ELISA). The mean time to a positive culture was 6 days, while detection of antigens of respiratory syncytial virus by ELISA was completed within 18 hours in all cases. The clinical progression of the illness in immunocompromised patients appears to be the same as in non-immunocompromised persons: upper respiratory tract infection and illness precede lower respiratory tract infection and acute lung injury. Seven of our 8 patients had upper respiratory tract symptoms or abnormal sinus radiographs, and upper respiratory specimens (cultures and ELISA from nasopharynx, throat, and sputum) were positive in 5 of 8 patients. Six patients developed RSV-induced lung injury before marrow engraftment; 4 of them had respiratory failure requiring mechanical ventilation and died, including 3 in whom RSV was eliminated from the lower respiratory tract following treatment with ribavirin aerosol. Two additional pre-engraftment patients had only relatively mild lung injury 4 days after beginning treatment with ribavirin for RSV infection in the upper respiratory tract. Their recovery suggests that early treatment may ameliorate RSV-induced lung injury. The remaining 2 patients developed lung injury after marrow engraftment. Both of these patients had clear chest radiographs, responded clinically to ribavirin, and survived. RSV is a potentially treatable cause of life-threatening lung injury, if the physician is aggressive in identifying the virus in the upper respiratory tract before evidence of lung injury appears. Rapid detection methods are essential when bone marrow transplant patients have fever along with signs, symptoms, or radiographic indications of nasal or sinus disorders.(ABSTRACT TRUNCATED AT 400 WORDS)

The registry of the international society for heart and lung transplantation: twentieth official adult heart transplant report—2003

Although only a small number of lung and heart– lung transplantation procedures were performed between 1963 and 1973, the current eras of heart–lung and lung transplantation, which began in 1981 and 1983, respectively, are now entering their third decades. The optimism of the considerable success of these modalities has been tempered by limitations, such as the shortage of donor organs, and by problems, such as chronic allograft dysfunction. This portion of the Twentieth Official Report summarizes the current status of adult heart–lung and lung transplantation from data submitted to the Registry from centers around the world. The Registry now contains information on more than 2000 adult heart–lung recipients and almost 14,000 adult lung recipients, and provides a robust database for analysis.