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Heart transplantation 2008
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  1. Heart transplantation 2008 BWGHF Liège

  2. Evolution of life expectancy at birthin Belgium source: NIS

  3. number of procedures and donor shortage • current results • cost • remaining problems • perspectives

  4. NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of hearts transplanted worldwide has declined in recent years. ISHLT 2007 J Heart Lung Transplant 2007;26: 769-781

  5. U.S. Waiting List Registrations 1998-2007 Source: OPTN and UNOS

  6. U.S. Wait List Death Rates 1998-2007 Percent Source: OPTN and UNOS

  7. heart transplantation in Belgium 1 N active centers 3 4 5 6 7

  8. Eurotransplant region 1967 2000 2007

  9. Eurotransplant annual donor rate pmp Donor and Transplant Statistics 2007

  10. ET waiting list for HTx

  11. ET HTx waiting list mortality

  12. Mortality on the heart waiting list source: www.optn.org and Eurotransplant Annual Reports 538 479 432 387 327 0.92→0.47 pmp USA ~1.23pmp ET 194 222 213 263 214 the expert help of Jacqueline Smits is gratefully acknowledged

  13. reporting of potential donors in Belgium Donor and Transplant Statistics 2007 - 20/03/2008

  14. national waiting list 31/12/2007: non-renal +219% -34%

  15. patient and donor age %

  16. ♀♂ patients donors

  17. DIAGNOSIS IN ADULT HEART TRANSPLANTS ISHLT 2007 J Heart Lung Transplant 2007;26: 769-781

  18. reason for transplantation ‘87-’93 ‘94-’00 ’01-’07

  19. HEART TRANSPLANTATIONKaplan-Meier Survival(1/1982-6/2005) HEART TRANSPLANTATIONKaplan-Meier Survival(1/1982-6/2005) N at risk at 22 years: 33 ISHLT 2007 J Heart Lung Transplant 2007;26: 769-781

  20. survival % years the expert help of A. Belmans and of H. Ector, MD, PhD is gratefully acknowledged

  21. Overall graft survival rates by country,corrected for local vs non-local donor, urgency status, CIT and VAD Crude rates Corrected rates -Belgium -The Neth. -Austria - Germany P=0.0007 P=0.004 Post-transplant time (m) Post-transplant time (m) Adults, first heart only transplants in ET, in 1997 (N=665) ET meeting’99_JS.31

  22. Mortality rates after heart transplantation.How to compare centre-specific outcome data ?Crude centre effects, case-mix adjusted (with 95% CI). Centres sorted by transplant volume Ln(RR) Smits JMA et al. Transplantation 2003;75:90-6.

  23. cost/QALY

  24. acute rejection year 1 % pts 17.4%

  25. FREEDOM FROM CARDIAC ALLOGRAFT VASCULOPATHY AND FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Adult Heart Recipients (Follow-ups: April 1994-June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26: 769-781

  26. FREEDOM FROM MALIGNANCYFor Adult Heart Recipients (Follow-ups: April 1994 - June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26: 769-781

  27. perspectives • xenotransplantation • improved mechanical support systems(BTT, destination therapy, bridge to recovery ?) • new drugs • PSI (sirolimus, everolimus) • monitoring through gene expression profiling • rejection (acute and chronic) • tailored immunosuppression