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Based on data reported to the UNOS/ISHLT Thoracic and International Registry for Thoracic Organ Transplantation: 1. The number of heart transplant operations performed in the United States decreased between 1998-1999 and 17 (1%) more procedures were performed in 1999 (2,181) than in 2000 (2,198). Sixty-nine more lung transplants (an 8% increase) were reported in 2000 than in 1999. 2. Coronary artery disease and cardiomyopathy were the most frequently cited indications for heart transplantation in the US and have been reported at similar rates during the past 10 years. Combined, these diagnoses account for approximately 85% of all heart transplants. In 2000, half of all lung transplants were performed for emphysema/COPD or alpha-1 antitrypsin deficiency. The most frequently reported diagnoses for thoracic transplantation outside the US were: cardiomyopathy (49%) for heart, cystic fibrosis (30%) for double lung, emphysema/COPD (34%) for single lung and primary pulmonary hypertension (21%) for heart-lung transplants. 3. US heart transplant recipients were predominately male (76%), aged 50-64 (51%) and white (81%). US lung transplant recipients were also predominately between ages 50-64 (47%) and white (90%), but unlike heart recipients were more likely to be female (51%). No meaningful variance from the US recipient demographic profile was noted for the non-US recipients during the same time period. 4. Pediatric recipients (< 18 years of age) received 11% of the reported heart transplants and 6% of the reported lung transplants in the US. 5. Among US thoracic transplant recipients during 1999, the one-year survival rates were 84% for heart, 59% for heart-lung and 77% for lung. The 5-year survival rates for transplants performed during 1995 were: 71% for heart, 56% for heart-lung and 44% for lung transplants. 6. The long-term patient survival rates were: 23% at 19 years for heart, 16% at 11 years for lung and 23% at 14 years for heart-lung recipients. 7. During the first year after transplantation, 66% of heart recipients and 44% of lung recipients did not require rehospitalization. Among those recipients who were rehospitalized, the major cause was infection.

Based on data reported to the UNOS/ISHLT International Registry for Thoracic Organ Transplantation, we showed that: 1. The number of heart transplant operations performed in the United States has decreased by 164 procedures between 1998 (2,346) and 1999 (2,182). The number of lung transplants increased by 13 in 1999 to 877. 2. The most frequently reported indication for heart transplantation in the US is coronary artery disease (44.8%). For other thoracic transplants, the most frequently reported indications include cystic fibrosis (35.5%) for double lung, emphysema/COPD (49.7%) for single lung and congenital heart disease (46.6%) for heart-lung. The most frequently reported diagnoses for thoracic transplantation outside the US include cardiomyopathy (43.8%) for heart, cystic fibrosis (33.4%) for double-lung, emphysema/COPD (26.6%) for single-lung and primary pulmonary hypertension (24.8%) for heart-lung transplants. 3. US heart transplant recipients are predominately male (76.7%), between 50 and 64 years of age (51.3%) and white (81.4%). US lung transplant recipients are also predominately between 50 and 64 years of age (44.7%) and white (89.9%), but unlike heart recipients are more likely to be female (51.2%). No meaningful variance from the US recipient demographic profile is noted for the non-US recipients during the same time period. 4. Pediatric recipients (< 18 years of age) received 10.9% of the reported heart transplants and 6.2% of reported lung transplants. 5. One-year survival for thoracic transplants performed in the US is 82.4% for heart, 74.1% for lung and 62.0% for heart-lung. Five-year survival for US thoracic transplants is 66.8% for heart and 43.2% for lung. 6. Long-term patient survival rates are: 22.5% at 17 years for heart, 20.8% at 10 years for lung and 24.3% at 13 years for heart-lung recipients. 7. The most important risk factor for mortality of US heart recipients at one month, one year and conditionally at 5 years after transplantation was receipt of a previous heart transplant. Significant short-term risk factors include donor age, recipient age and ischemic time. Substantial long-term risk factors include older donor age, recipient age, recipient race and diagnosis. 8. The factors having the most significant impact on lung mortality at all time points are related to either the patient's medical condition (e.g., in the ICU prior to transplant, requiring mechanical ventilation) or diagnosis. 9. Mechanical ventilation, recipient race and recipient age have the largest impact on heart-lung mortality. 10. For heart and lung recipients, the major cause of hospitalization during the first year after transplantation is infection alone.

1. The number of heart transplant operations performed in the US has increased by 51 procedures between 1997 (2,294) and 1998 (2,345). The number of lung transplants decreased by 67 in 1998 (862). 2. The most frequently reported indication for heart transplantation in the US is coronary artery disease (44.6%). For other thoracic transplants, the most frequently reported indications include other/unknown (43.9%) for double lung, emphysema/COPD (53.5%) for single lung and other/unknown (53.2%) for heart-lung. The most frequently reported diagnoses for thoracic transplantation outside the US include cardiomyopathy (50.5%) for heart, cystic fibrosis (32.0%) for double lung, idiopathic pulmonary fibrosis (32.7%) for single lung and congenital heart disease (24.7%) for heart-lung. 3. US heart transplant recipients were predominately male (77%), between 50-64 years old (51.4%) and White (81.7%). In contrast, US lung transplant recipients are predominantly female (51.3%), between 50-64 years of age (44.7%) and White (89.7%). No meaningful variance from the US recipient demographic profile was noted for the non-US recipients during the same time period. 4. Pediatric recipients (< 18 years of age) received 10.9% of the reported heart transplants and 6.5% of reported lung transplants. 5. One-year survival for thoracic transplants performed in the US was 83.2% for heart, 70.6% for lung and 62.5%. Five-year survival for US thoracic transplants was 70% for heart and 49.1% for lung. 6. Long-term patient survival rates were: 22.3% at 18 years for heart, 20% at 9 years for lung and 25% at 12 years for heart-lung recipients. 7. The most important risk factor for mortality of US heart recipients at one month, one and 5 years after transplantation was receipt of a previous heart transplant. Significant short-term risk factors included donor age, recipient age and ischemic time. Substantial long-term risk factors include older donor age, donor race and recipient race. 8. The factors having the most significant impact on lung mortality at all time points were related to either the patient's medical condition (e.g., in the ICU prior to transplant, requiring mechanical ventilation) or diagnosis. 9. Mechanical ventilation and previous transplant had the largest impact on heart-lung mortality. 10. For heart and lung recipients, the major cause of hospitalization during the first posttransplant year was infection.

1. The number of heart transplant operations performed in the US decreased by 52 procedures between 1996 (2,344) and 1997 (2,292). The number of lung transplants increased by 118 in 1997 (928). 2. The most frequently reported indication for heart transplantation in the US was coronary artery disease (44.9%). For other thoracic transplants, the most frequently reported indications included cystic fibrosis (36.8%) for double-lung, emphysema/COPD (53.8%) for single-lung and congenital disease (33.9%) for heart-lung transplants. The most frequently reported diagnoses for thoracic transplantation outside the US included cardiomyopathy (50.4%) for heart, cystic fibrosis (31.3%) for double-lung, idiopathic pulmonary fibrosis (32.4%) for single-lung and primary pulmonary hypertension (23.3%) for heart-lung transplants. 3. US heart transplant recipients were predominately male (77.4%), over age 50 (55.9%) and white (82.1%). In contrast, US lung transplant recipients were predominantly female (51.9%), between ages 35-64 (73.4%) and white (89.5%). No meaningful variance from the US recipient demographic profile was noted for the non-US recipients during the same time period. 4. Mean ischemic time showed minimal change for hearts (2 minutes), a sharp increase for heart-lungs (29.5 minutes) and a decrease for lungs (11 minutes) from 1997-1998. 5. The one-year survival rates for thoracic transplants performed in the US were 83.2% for heart, 75.7% for lung and 34.1% for heart-lung in 1997. Five-year survival rates for US thoracic transplants were 66% for heart and 46.4% for lung for transplants performed in 1993. 6. Long-term patient survival rates were: 29.5% at 14 years for heart, 19.4% at 9 years for lung and 26.2% at 11 years for heart-lung recipients. 7. The most important risk factor for mortality of US heart recipients at one month, one year and conditionally at 5 years after transplantation was receipt of a previous heart transplant. Significant short-term risk factors included recipient age and ischemic time. Substantial long-term risk factors included older donor age and donor race. 8. The factors having the most significant impact on lung mortality at all time points were related to either the patient's medical condition (e.g.x, in the ICU prior to transplant, requiring mechanical ventilation) or diagnosis. 9. Mechanical ventilation and previous transplant had the largest impact on heart-lung mortality. 10. For heart and lung recipients, the major cause of rehospitalization during the first year after transplantation was infection alone.

1. The number of heart transplant operations performed in the United States has decreased by 16 procedures between 1995 (2,360) and 1996 (2,344). Following a period of rapid growth from 1990 (203) through 1995 (871), there was a decrease of 71 lung transplant procedures between 1995 (871) and 1996 (800). 2. The most frequently reported indication for heart transplantation in the US was coronary artery disease (44.88%). For other thoracic transplants, the most frequently reported indications included cystic fibrosis (31.85%) for double lung, emphysema/COPD (55.88%) for single lung and congenital heart disease (48.72%) for heart-lung transplants. The most frequently reported diagnoses for thoracic transplantation outside the US included cardiomyopathy (47.4%) for heart, cystic fibrosis (33.0%) for double lung, idiopathic pulmonary fibrosis (29.1%) for single lung and primary pulmonary hypertension (23.4%) for heart-lung transplants. 3. US heart transplant recipients were predominantly male (77.6%), older than age 50 (55.4%) and white (82.3%). In contrast, US lung transplant recipients were predominantly female (52.1%), aged 35-64 (73.5%) and white (89.5%). No significant variance from the US recipient demographic profile was noted for non-US recipients in this analysis. 4. The mean donor age for heart and lung transplants has risen slightly with an increase in mean age of 3.12 years for heart donors and 4.72 years for lung donors from 1987-1997. 5. The one-year survival rate for thoracic transplants performed in the US was 84.8% for heart, 70.1% for lung and 73.4% for heart-lung in 1996. Five-year survival for US thoracic transplants was 66.5% for heart and 43.2% for lung transplants performed in 1992. 6. There was little change in heart transplant survival based on transplant era (1987-89, 1990-92 and 1993-95). Lung recipients transplanted in the 1993-95 era showed a 16% increase in survival compared with those transplanted in the 1987-89 era at the 48-month time point. 7. The most important risk factor for US heart recipients at one month, one year, and conditionally at 5 years after transplantation was receipt of a previous heart transplant. Other substantial long-term risk factors included donor age and non-white, non-black recipient. 8. The most important risk factors for mortality in US lung recipients were the order of the transplant (primary or repeat) and the patient's medical condition at time of transplant. Diagnosis, recipient age and recipient race were highly influential risk factors for conditional 5-year mortality. 9. For heart and lung recipients, the major cause of hospitalization during the first 2 years after transplantation was infection.

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.

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.

1. The frequency of heart and lung transplantation has increased dramatically over time. The number of heart transplants increased 170% between 1968 and 1981. Exponential increases began in 1982 and increased through 1990, as evidenced by a 1,835% growth in the number of procedures performed during those years. In more recent years, heart transplant numbers have leveled off, with only an 8% increase in the last 3 years. Lung transplant procedures have grown significantly in the short period of time between 1987 (n = 18) and 1993 (n = 669). 2. Since the beginning of the ISHLT Registry in 1968 the number of thoracic transplant programs has increased 7,767%, from 3 to 236. 3. The most frequently reported indications for thoracic transplantation include: coronary artery disease (43.4%) for heart, cystic fibrosis (39.5%) for double-lung, emphysema/COPD (40.2%) for single-lung and primary pulmonary hypertension (38.3%) for heart-lung. 4. The majority of heart transplant recipients are at least 18 years old (89.5%), male (78.2%), and White (83.8%). The majority of lung transplant recipients are at least 18 years old (93.7%), female (53.2%), and White (91.3%). 5. One-year survival over time has almost doubled for all types of thoracic transplantation, with increases from 47.7% in 1968-79 to 81.6% in 1993 for heart; 35.3% in 1987 to 67.1% in 1993 for lung; and 40% in the early 1980s to 73% in 1993 for heart-lung. 6. Long-term 10-year survival rates were 33.5% for heart and 5.6% for heart-lung transplant recipients. Five-year survival for lung recipients was 37%. 7. Male-to-male donor-to-recipient gender-match heart transplant patients exhibited slightly higher survival (4-5%) than other match pairs from one to 5 years posttransplant. Female-to-male combinations in lung transplant recipients exhibited slightly higher survival (4-8%) at 3 years than other match pairs. 8. There was no significant difference in 5-year survival for donor hearts procured from local, intraregional, or interregional sources. Lungs procured from interregional sources exhibited an 8-10% advantage over local and intraregionally procured organs at 3 years posttransplant.

1. In 1992, there were 2,171 heart, 48 heart-lung, and 535 lung transplants performed in the United States. The number of lung transplants increased by about 32% over 1991, whereas heart transplants only increased by about 2% over 1991. The number of heart-lung transplants decreased in 1992. 2. The number of programs performing heart and lung transplants has continued to increase: about 16% in heart and about 280% in lung, since 1988. 3. The most frequently reported primary indications for transplant were: coronary artery disease (44%) and cardiomyopathy (41%) in heart; cystic fibrosis (40%) in double lungs; emphysema/COPD (35%) in single lungs; and congenital/Eisenmenger's syndrome (36%) in heart-lung. 4. Between 1988 and 1992, the following groups showed significant increases for heart and lung transplants: pediatric transplants, non-White recipients, non-White donors, older donors, and local utilization. 5. For the entire period covered by this report, overall one-year patient survival rates were: heart 82.3%, single lung 70.1%, double lung 66.4%, and heart-lung 58.7%. There has been little change in one-year heart transplant survival rates during this time. Survival rates for lung and heart-lung transplants increased dramatically between 1988 and 1990, but have declined slightly since then.

1. In 1991 there were 2,127 heart, 402 lung, and 51 heart-lung transplants performed in the United States. These numbers reflect increases of 27% for heart, over 1000% for lung, and a decrease of 31% for heart-lung transplants since 1988. 2. The number of programs performing heart transplants has increased by 16% since 1988, whereas the number of programs performing lung transplants has tripled over that time. 3. The most frequent primary indications for thoracic transplantation were: cardiomyopathy (45%) and coronary artery disease (41%) for heart; primary pulmonary hypertension (43%) and congenital/Eisenmenger's for heart-lung; and emphysema/chronic obstructive pulmonary disease (28%) and Alpha-1 antitrypsin deficiency (20%) for lung. 4. Average cold ischemic time increased gradually between 1988 and 1991: 2.7 hours for hearts transplanted in 1991 compared with 3.3 hours for heart-lungs, and 4.3 for lungs. 5. Between 1988 and December 1991, the following percentages increased significantly: pediatric heart and lung transplantations; non-White thoracic transplant recipients and donors; the use of thoracic organs from younger (< or = 5 yrs) as well as older (> or = 45 yrs) donors; and local utilization of thoracic organs. 6. For the entire period covered by this report, 1-year recipient survival rates were: heart 81.6%, heart-lung 55.4%, and lung 67.2%. Patient survival was significantly lower in heart retransplants or when the primary indication for transplantation was the treatment of congenital disease. Between 1988 and 1991, 1-year survival appeared to have increased significantly for heart-lung and lung recipients.