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

The number of heart transplant operations performed in the United States has grown modestly as indicated by an 11% increase from 1990 (n=2,108) to 1994 (n=2,340). From 1987 (n=18) to 1993 (n=666), lung transplant procedures have increased by 3600%. This trend continued with 722 procedures performed in 1994 and 760 (22% increase from 1993) currently reported for 1995. Non-US heart transplants have also leveled during recent years. The number of new heart transplant programs in the United States has not increased during the last 2 years with no change from 1993-1994 and a decrease of 2 heart programs from 1994-1995. From 1990 (n=37) to 1995 (n=71), the number of centers performing lung transplantation increased by 92%. No significant changes were noted in the number non-US heart or lung programs from 1993-1994. The most frequently reported US indications for thoracic transplantation were coronary artery disease (43.5%) for heart, cystic fibrosis (37.9%) for double lung, emphysema/COPD (44.1 %) for single lung and congenital lung disease (40%) for heart-lung. The most frequently reported non-US diagnoses for thoracic transplantation included cardiomyopathy (48.8%) for heart, cystic fibrosis (39.4%) for double lung, idiopathic pulmonary fibrosis (31.4%) for single lung and primary pulmonary hypertension (24.3%) for heart-lung. US heart transplant recipients were predominantly male (77.9%), over 50 years of age (54.3%) and white (83.3%); while US lung transplant recipients were predominantly female (53.2%), between 35- 64 years of age (73.2%) and white (90.7%). No significant variance from the US recipient demographic profile was noted for non-US recipients in this analysis. Differences were noted in the percent distribution of non-US and US donor causes of death. The top US causes of donor death were motor vehicle accidents (31.7%), cerebrovascular/strokes (24.0%), gunshot/stab wounds (23.2%) and non-motor vehicle head traumas (11.8%). The leading causes of donor death for non-US cases included cerebrovascular/strokes (55.7%), non-motor vehicle head traumas (28.7%), motor vehicle accidents (7.7%) and central nervous system tumors (3.0%). Gunshot/stab wounds accounted for only 0.9% of donor deaths. A leveling of US heart transplant one-year survival during recent years was indicated by a 1.5% increase from 1988-1994. Improvement in one-year US lung transplant survival was indicated by a rise from 35.3% in 1987 to 74.1 % in 1994. Non-US one-year survival rates were 77.5% for heart and 67.5% for lung in 1994. The long-term thoracic patient survival rates in the United States were: 36.9% at 11 years for heart, 41 % at 5 years for lung and 24.7% at 10 years for heart-lung recipients. Long-term survival rates for non-US cases were 37.1 % at 11 years for heart, 39.7% at 5 years for lung and 16.8% at 10 years for heart-lung. The most important risk factor for US heart recipients at one month, one year, 2 years and 3 years posttransplant was receipt of a previous heart transplant. Other substantial risk factors included congenital diagnosis, donor age greater than 50 years and recipient on a ventilator at the time of transplant. The most important risk factor for mortality in US lung recipients was the transplant number (primary or repeat). Diagnosis and ventilator use were also highly influential risk factors for mortality.