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ISHLT International Registry for Heart and Lung Transplantation—Into the Fourth Decade, From Strength to Strength

2013; Elsevier BV; Volume: 32; Issue: 10 Linguagem: Inglês

10.1016/j.healun.2013.08.009

ISSN

1557-3117

Autores

Josef Stehlik, Jeffrey D. Hosenpud, Leah B. Edwards, Marshall I. Hertz, Mandeep R. Mehra,

Tópico(s)

Organ Transplantation Techniques and Outcomes

Resumo

This year, the ISHLT International Registry for Heart and Lung Transplantation enters into its fourth decade. With data from more than 160,000 thoracic transplant recipients, the Registry is the largest repository of heart and lung transplant data in the world. The Registry has had an interesting and somewhat tumultuous history. One of the authors, Jeffrey Hosenpud was directly involved in its earliest times. His first direct involvement was in 1988 when, after performing a transplant in a patient with amyloid light-chain (AL) amyloidosis—at the time considered an absolute contraindication to transplantation, he wanted to know if there were other patients who had received transplants for that disease. Hosenpud flew to San Diego to meet with Dr Mike Kaye, the first Registry director, and "queried" the Registry, which was an Excel spreadsheet with about half the patient data entered, and several boxes of index cards that were gone through by hand. Despite the not quite optimal organization of the data, several other patients with AL-chain amyloidosis were identified, and this series was ultimately published.1Hosenpud J.D. Uretsky B.F. Griffith B.P. et al.Successful intermediate-term outcome for patients with cardiac amyloidosis undergoing heart transplantation: results of a multicenter survey.J Heart Transplant. 1990; 9: 346-350PubMed Google Scholar In the United States, the United Network for Organ Sharing (UNOS) was awarded the government contract for the Organ Procurement and Transplantation Network (OPTN) in 1986 and the Scientific Registry of Transplant Recipients (SRTR) contract in 1987. Kaye was instrumental in developing the data collection instrument for the UNOS Thoracic Registry (basing it primarily on the ISHLT Registry) and coordinated data submission to the Registry through UNOS. As submission of data to UNOS was mandated in the United States, the quality of the ISHLT Registry data also immediately improved. Unfortunately, the relationship between UNOS and the Registry was not all honey and roses: Conflicts arose regarding additional data collection, timely submission of data from UNOS to the Registry, cost, and oversight issues. This friction ultimately led the ISHLT Board to sever relations with UNOS in 1990, and ISHLT began the process of getting United States centers to once again submit data separately. As the UNOS Scientific Advisory Committee Vice Chair, Hosenpud was the de facto UNOS Thoracic Registry Director starting in 1991. He received an unexpected call from the ISHLT President Dr Billingham expressing regret about the separation of the 2 registries. There was also resistance from United States transplant centers regarding the request to submit similar data to 2 registries. Billingham wondered if the relationship could be repaired and requested a "secret" meeting in Chicago, which included Billingham, ISHLT Board Member John B. O'Connell, UNOS Executive Director Gene Pierce, UNOS Assistant Executive Director Walter Graham, and Hosenpud. They agreed to work behind the scenes to bring the 2 organizations and registries back together, which was ultimately accomplished. Hosenpud was appointed the ISHLT Registry Director in 1993, and his first official accomplishment was obtaining additional funding from the ISHLT to contract with UNOS for all data collection and a yearly data analysis and slide generation. ISHLT Registry data were electronically integrated and maintained separately from UNOS data as a unique database. The first report and slides analyzed and generated in collaboration with UNOS was the 1994 Registry report.2Hosenpud J.D. Novick R.J. Breen T.J. Daily O.P. The Registry of the International Society for Heart and Lung Transplantation: eleventh official report—1994.J Heart Lung Transplant. 1994; 13: 561-570PubMed Google Scholar In 1997, Dr Mark Boucek was named the Associate Registry Director, with responsibility for pediatric data, and separate pediatric and adult Registry reports were initiated. Under the tenure of Marshall Hertz, the Registry Steering Committee was expanded, and generation of separate organ-specific reports was initiated. Over the coming years, collaborative efforts were established between the Registry and 6 other data exchange organizations around the world that now submit data to ISHLT through regular data transfers (Appendix). Additional countries in Europe, Asia, North and South America, and Africa, where centralized data submission is not (yet) possible, participate in the Registry individually, through Web-based data entry. More than 280 centers from 33 countries currently participate in the Registry. The above retrospective, and conclusion of another decade of work, provides an opportunity to pinpoint the factors that have contributed to the Registry's success. We believe the following have been key in this process:1.Operation of the Registry by an international professional society that represents multiple stakeholders in thoracic transplantation. The ISHLT has provided not only the logical "home" for the Registry but also the logistical and financial support that has shielded the Registry from financial and other uncertainties of the ever-changing health care environment.2.Inclusion of both the pediatric and adult populations.3.Aggressive pursuit of truly international participation (Figure 1).4.Flexibility of the Registry in allowing different arrangements for data entry while maintaining the necessary quality standards. The Registry has developed mechanisms for efficient data entry from individual centers, for transfer of data from national registries, and for transfer of data from registries of country collectives.3Stehlik J. Edwards L.B. Rowe A. et al.ISHLT International Registry for Heart and Lung Transplantation—three decades of scientific contributions.Transplant Rev. 2013; 27: 38-42Abstract Full Text Full Text PDF Scopus (13) Google Scholar5.Establishing a clear governance and workforce structure through the Registry Steering Committee (Table 1), with defined responsibilities and expectations.Table 1Steering Committee and Staff of the ISHLT International Registry for Heart and Lung TransplantationSteering CommitteePosition Josef Stehlik, MDMedical Director Jason Christie, MDAssociate Director, Lung Transplantation Roger Yusen, MDaNewly appointed members of the Steering Committee.Associate Director, Lung Transplantation Christian Benden, MDAssociate Director, Pediatric Lung Transplantation Lars Lund, MDaNewly appointed members of the Steering Committee.Associate Director, Heart Transplantation Anne Dipchand, MDAssociate Director, Pediatric Heart Transplantation Richard Kirk, MDAssociate Director, Pediatric Heart Transplantation Axel Rahmel, MDAssociate Director, OEO and Transplant Center Relations FabienneDobbels, PhDAssociate Director, Outcomes Analysis Leah Edwards, PhDAssociate Director, Data Analysis Amanda RoweISHLT Executive DirectorStaff Kathryn Philibin, RNISHLT Registry Administrator Frank GilgDirector, TII Informatix Jaime WilliamsonData Analyst Anna Kucheryavaya, MSAssistant Biostatistician Susan GroffISHLT Support Coordinator Jo SmithISHLT Support CoordinatorISHLT, International Society for Heart and Lung Transplantation; OEO, organ exchange organization.a Newly appointed members of the Steering Committee. Open table in a new tab 6.Maintaining strong statistical core, directed by Leah Edwards, PhD, which provides year-round support to Registry work.7.Partnership with the Journal of Heart and Lung Transplantation. The Registry reports provide the readers with yearly updates on the developments in the field of thoracic transplantation, and the Registry output is thus widely disseminated.4Benden C. Edwards L.B. Kucheryavaya A.Y. et al.The Registry of the International Society for Heart and Lung Transplantation: fifteenth pediatric lung and heart-lung transplantation report—2012.J Heart Lung Transplant. 2012; 31: 1087-1095Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar, 5Christie J.D. Edwards L.B. Kucheryavaya A.Y. et al.The Registry of the International Society for Heart and Lung Transplantation: 29th adult lung and heart-lung transplant report-2012.J Heart Lung Transplant. 2012; 31: 1073-1086Abstract Full Text Full Text PDF PubMed Scopus (449) Google Scholar, 6Kirk R. Dipchand A.I. Edwards L.B. et al.The Registry of the International Society for Heart and Lung Transplantation: fifteenth pediatric heart transplantation report—2012.J Heart Lung Transplant. 2012; 31: 1065-1072Abstract Full Text Full Text PDF PubMed Scopus (92) Google Scholar, 7Stehlik J. Edwards L.B. Kucheryavaya A.Y. et al.The Registry of the International Society for Heart and Lung Transplantation: 29th official adult heart transplant report—2012.J Heart Lung Transplant. 2012; 31: 1052-1064Abstract Full Text Full Text PDF PubMed Scopus (440) Google Scholar The Registry slides, available to ISHLT members, are abundantly used in scientific presentations. The high—and currently increasing—rate of citations of the ISHLT reports and other Registry studies in peer reviewed publications demonstrates the widespread and growing importance of the Registry data to our field. For illustration, the single 2001 Registry report8Hosenpud J.D. Bennett L.E. Keck B.M. Boucek M.M. Novick R.J. The Registry of the International Society for Heart and Lung Transplantation: eighteenth Official Report-2001.J Heart Lung Transplant. 2001; 20: 805-815Abstract Full Text Full Text PDF PubMed Scopus (394) Google Scholar has since received 676 citations, a rate of 56 citations per year. The 2010 Registry report series, consisting of an introduction and 4 organ-specific reports,9Aurora P. Edwards L.B. Kucheryavaya A.Y. et al.The Registry of the International Society for Heart and Lung Transplantation: thirteenth official pediatric lung and heart-lung transplantation report—2010.J Heart Lung Transplant. 2010; 29: 1129-1141Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar, 10Kirk R. Edwards L.B. Kucheryavaya A.Y. et al.The Registry of the International Society for Heart and Lung Transplantation: thirteenth official pediatric heart transplantation report—2010.J Heart Lung Transplant. 2010; 29: 1119-1128Abstract Full Text Full Text PDF PubMed Scopus (105) Google Scholar, 11Christie J.D. Edwards L.B. Kucheryavaya A.Y. et al.The Registry of the International Society for Heart and Lung Transplantation: twenty-seventh official adult lung and heart-lung transplant report—2010.J Heart Lung Transplant. 2010; 29: 1104-1118Abstract Full Text Full Text PDF PubMed Scopus (399) Google Scholar, 12Stehlik J. Edwards L.B. Kucheryavaya A.Y. et al.The Registry of the International Society for Heart and Lung Transplantation: twenty-seventh official adult heart transplant report—2010.J Heart Lung Transplant. 2010; 29: 1089-1103Abstract Full Text Full Text PDF PubMed Scopus (392) Google Scholar, 13Hertz M.I. Aurora P. Christie J.D. et al.Scientific Registry of the International Society for Heart and Lung Transplantation: introduction to the 2010 annual reports.J Heart Lung Transplant. 2010; 29: 1083-1088Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar has been cited 608 times, at a running rate of 202 citations per year. Similarly, the Registry data analyses have influenced formulation of recommendations in clinical practice guidelines, further impacting clinical care.14Costanzo M.R. Dipchand A. Starling R. et al.The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients.J Heart Lung Transplant. 2010; 29: 914-956Abstract Full Text Full Text PDF PubMed Scopus (1036) Google Scholar, 15Heart Failure Society of AmericaSurgical approaches to the treatment of heart failure.J Card Fail. 2010; 12: e76-e79Abstract Full Text Full Text PDF Google Scholar, 16Kobashigawa J. Crespo-Leiro M.G. Ensminger S.M. et al.Report from a consensus conference on antibody-mediated rejection in heart transplantation.J Heart Lung Transplant. 2011; 30: 252-269Abstract Full Text Full Text PDF PubMed Scopus (264) Google Scholar, 17Mehra M.R. Crespo-Leiro M.G. Dipchand A. et al.International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy-2010.J Heart Lung Transplant. 2010; 29: 717-727Abstract Full Text Full Text PDF PubMed Scopus (548) Google Scholar, 18Mehra M.R. Kobashigawa J. Starling R. et al.Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates—2006.J Heart Lung Transplant. 2006; 25: 1024-1042Abstract Full Text Full Text PDF PubMed Scopus (738) Google Scholar, 19Tait B.D. Susal C. Gebel H.M. et al.Consensus guidelines on the testing and clinical management issues associated with HLA and non-HLA antibodies in transplantation.Transplantation. 2013; 95: 19-47Crossref PubMed Scopus (580) Google Scholar, 20Zaroff J.G. Rosengard B.R. Armstrong W.F. et al.Maximizing use of organs recovered from the cadaver donor: cardiac recommendations (1), March 28–29, 2001, Crystal City, Va.J Heart Lung Transplant. 2002; 21: 1153-1160Abstract Full Text Full Text PDF Scopus (34) Google Scholar, 21Zaroff J.G. Rosengard B.R. Armstrong W.F. et al.Consensus conference report: maximizing use of organs recovered from the cadaver donor: cardiac recommendations, March 28–29, 2001, Crystal City, Va.Circulation. 2002; 106: 836-841Crossref PubMed Scopus (343) Google Scholar ISHLT, International Society for Heart and Lung Transplantation; OEO, organ exchange organization. After 3 decades, the Registry remains very relevant to our everyday practice, and this has been further boosted by recent developments in our field. The expanding use of mechanical circulatory assist in advanced heart failure, clinical application of ex vivo organ perfusion, increasing acceptance of donation after circulatory death (DCD) in lung transplantation, successful implementation of ABO-incompatible transplantation, and other emerging clinical approaches are changing the questions we ask of the Registry. Further, the rapid global growth of heart and lung transplantation represents additional opportunities for expanding the Registry and starting new collaborations. Now under the direction of Josef Stehlik, the Registry continues to evolve, and innovative approaches to answer the needs of the thoracic transplant community are being pursued. Examples of recent and planned Registry work include:•Presentation of results from a DCD Mini-registry at the 2013 ISHLT Annual Scientific Sessions in Montreal.22Cypel M. Levvey B. Van Raemdonck D. et al.Favorable outcomes of donation after cardiac death in lung transplantation: a multicenter study.J Heart Lung Transplant. 2013; 32: S15Abstract Full Text PDF Google Scholar The "mini-registry" approach allows investigators from a group of centers with a special interest in a particular clinical question to design a focused database where supplementary data pertinent to the topic of interest are collected on existing transplants in the Registry, so that detailed follow-up information is already available for these patients in the main Registry. Centers from Canada, Europe, Australia, and the United States are currently participating in the DCD Mini-registry.•We continue to promote the Transplant Registry Early Career Awards, which provide an opportunity for junior investigators to obtain access to Registry data while receiving financial support to conduct the analyses. This is also a natural way for junior members to network with members of the Registry steering committee and other ISHLT content experts and so become involved in the Society's core activities. This mechanism has funded 12 junior investigators since 2007 (Table 2), and 2 presented their work at the annual sessions this year.23Lowery E.M. Grim S. Mahoney E. et al.Increased incidence of PTLD in adult lung transplant recipients with cystic fibrosis: analysis of the International Society for Heart and Lung Transplantation Registry.J Heart Lung Transplant. 2013; 32: S145Abstract Full Text PDF Google Scholar, 24Wever-Pinzon O. Lund L.H. Edwards L.B. et al.Impact of recipient age on differential causes of heart transplant mortality.Is it time to personalize post-transplant management? J Heart Lung Transplant. 2013; 32: S13Abstract Full Text Full Text PDF Google Scholar We would like to encourage junior investigators, especially those from non-North American programs, to explore the data elements posted on the Registry Web site and consider submitting an application for a 2014 Award (http://www.ishlt.org/awards/awardTxRegistry.asp, deadline in January 2014).Table 2Transplant Registry Early Career Award Recipients2007InstitutionResearchBeth D. Kaufman, MDThe Children's Hospital of Philadelphia, Philadelphia, PAInfluence of Nutritional Status on Outcomes in Pediatric Heart Transplantation2008 Cynthia Gries, MD, MScUniversity of Washington, Seattle, WADevelopment of a Predictive Model for Long Term Survival in Lung Transplantation Scott Halpern, MD, PhDUniversity of Pennsylvania, Philadelphia, PADecision Analysis of Single versus Double Lung Transplant for Patients with COPD Josef Stehlik, MD, MPHUniversity of Utah School of Medicine, Salt Lake City, UTInteractions Among Donor and Recipient Characteristics and Their Impact on Post-Transplant Survival2010 Jennifer Conway, MD, FRCPCHospital for Sick Children, Toronto, CanadaSurvival Outcomes and Long Term Morbidities in Children Undergoing Retransplantation Kiran K. Khush, MD, MASStanford University School of Medicine, Stanford, CADoes Sex Matter? Investigating the Impact of Donor and Recipient Sex on Outcomes After Heart Transplantation2011 Jose Nativi, MDUniversity of Utah, Salt Lake City, UTPost Transplant Outcomes of Patients Requiring Biventricular Mechanical Bridge to Transplant2012 Erin M. Lowery, MDLoyola University Medical Center, Maywood, ILRisk Factors for the Development of PTLD in Patients with Cystic Fibrosis Following Lung Transplantation Omar Wever-Pinzon, MDUniversity of Utah, Salt Lake City, UTImpact of Recipient Age on Differential Causes of Heart Transplant Mortality2013 Chesney Castleberry, MDCincinnati Children's Hospital, Cincinnati, OHmTOR Inhibitors in Pediatric Heart Transplantation: Do the potential benefits outweigh the risks? Aaron Healy, MDUniversity of Utah, Salt Lake City, UTPredictors of Post-Transplant Outcomes in Patients Bridged to Transplantation with Continuous-Flow LVADs Eugene DePasquale, MDUCLA, Los Angeles, CAInfluence of Chronic Kidney Disease Stage on Patient Selection for Heart and Heart-Kidney TransplantationCOPD, chronic obstructive pulmonary disease; LVAD, left ventricular assist device; mTOR, mammalian target of rapamycin; PTLD, post-transplant lymphoproliferative disorder. Open table in a new tab •Thoracic transplantation is gradually gaining ground in regions that have not traditionally been among the core geographic areas in our field. The ISHLT is greatly interested in the active participation of transplant professionals from these countries in our Society. The Registry provides a platform for international collaborations and for learning from each other's experiences. Last year we welcomed new centers from Brazil, Estonia, Poland, Turkey, and Iran to the family of more than 280 centers from 33 countries worldwide that participate in the Registry. Continued efforts will be directed at further expansion of the Registry's member base.•This year we introduce a new feature to our annual Reports. In addition to providing the core information regarding demographics, immunosuppression, and outcomes, a focus theme will explore a defined topic in more detail every year. The 2013 report explores age as an important donor and recipient variable and its effect on the transplant process and outcomes. In addition to information presented in the printed version of the reports published in this issue of the Journal, an online Registry data set, complete with a brand new Registry logo (Figure 2), also offers a number of expanded focus theme analyses.25International Society for Heart and Lung Transplantation. Registries Slides. http://www.ishlt.org/registries. Accessed August 1, 2013.Google Scholar COPD, chronic obstructive pulmonary disease; LVAD, left ventricular assist device; mTOR, mammalian target of rapamycin; PTLD, post-transplant lymphoproliferative disorder. We hope we are starting off another successful decade for the Registry. We sincerely thank ISHLT members, staff at participating hospitals, and staff at data exchange organizations for their active support (Appendix 1). Without this enthusiastic support the ISHLT International Registry for Heart and Lung Transplantation would have long departed. The authors thank Dr Michael Kaye, the first Registry director, for his important contributions. All relevant disclosures for the authors are on file with the ISHLT and can be made available for review by contacting the Executive Director of the ISHLT. Tabled 1Country (ISO code)CenterArgentina (ARG)Fundacion FavaloroHospital ItalianoAustraliaaData provided via Australia and New Zealand Cardiothoracic Transplant Registry (ANZCOTR). (AUS)St. Vincent's HospitalThe Royal Children's HospitalThe Prince Charles HospitalThe Alfred HospitalRoyal Perth HospitalAustriabData provided via Eurotransplant (ET). (AUT)Allgemeines Krankenhaus WienUniversitätsklinik InnsbruckLandeskrankenhaus GrazBelgium bData provided via Eurotransplant (ET). (BEL)Hôpital Erasme BruxellesUniversitair Ziekenhuis AntwerpenOnze Lieve Vrouw Ziekenhuis AalstUniversitair Ziekenhuis GentCentre Hospitalier Universitaire LiègeCliniques Universitaires, Université Catholique de LouvainUZ Gasthuisberg LeuvenBrazil (BRA)Heart Institute—Universidade de São PauloHospital de MessejanaReal Hospital Português de Beneficiéncia em PernambucoInstituto de Cardiologia do Distrito FederalCanada (CAN)Royal Victoria HospitalThe Toronto General HospitalQuebec Heart Institute—Laval HospitalOttawa Heart InstituteUniversity of Alberta Hospitals/Walter C. Mackenzie Health SciencesThe Hospital For Sick ChildrenChile (CHL)Instituto Nacional del ToraxColombia (COL)Clinica CardiovascularFundacion Valle Del LiliFundacion Cardioinfantil—Instituto de CardiologiaFundacion Cardiovascular de ColombiaFundacion Clinica ShaioCroatia2Hosenpud J.D. Novick R.J. Breen T.J. Daily O.P. The Registry of the International Society for Heart and Lung Transplantation: eleventh official report—1994.J Heart Lung Transplant. 1994; 13: 561-570PubMed Google Scholar (HRV)University Clinical Hospital ZagrebUniversity Hospital DubravaThe Czech Republic (CZE)University Hospital MotolDenmark3Stehlik J. Edwards L.B. Rowe A. et al.ISHLT International Registry for Heart and Lung Transplantation—three decades of scientific contributions.Transplant Rev. 2013; 27: 38-42Abstract Full Text Full Text PDF Scopus (13) Google Scholar (DNK)Skejby University HospitalRigshospitalet, National University HospitalEstonia (EST)Tartu University HospitalFinlandcData provided via Scandiatransplant. (FIN)Helsinki University Central HospitalChildren's Hospital, University of HelsinkiFrancedData provided via L'Agence de la Biomédicine. (FRA)Marseille Sainte Marguerite (APM) (A)—Chirurgie ThoraciqueMarseille Timone adultes (APM) (A)—Chirurgie CardiaqueMarseille Timone enfants (APM) (A+P)—Chirurgie Cardio-VasculaireCaen (A)—Chirurgie CardiaqueDijon (A)—Chirurgie CardiaqueToulouse (A)—Chirurgie ThoraciqueToulouse (A)—Chirurgie Cardio-VasculaireBordeaux (A+P)—Unite de Transplantation CardiaqueBordeaux (A+P)—Chirurgie ThoraciqueMontpellier (A)—Unite de Transpl. Cardio-thoraciqueRennes (A)—Centre Cardio-PneumologiqueTours (A+P)—Chirurgie CardiaqueGrenoble (A)—Chirurgie CardiaqueGrenoble (A)—PneumologieNantes (A+P)—Chirurgie Cardio-VasculaireNancy (A+P)—Chirurgie Cardio-PulmonaireLille (A+P)—Chirurgie Cardio-VasculaireClermont-Ferrand (A)—Chirurgie CardiaqueStrasbourg (A)—Chirurgie ThoraciqueStrasbourg (A)—Chirurgie Cardio-PulmonaireLyon (A+P)—Pole de Transplantation PulmonaireLyon I (HCL) (A+P)—Pole de Transplantation CardiaqueLyon II (HCL) (A)—Pole De Transplantation CardiaqueParis Pitié-Salpêtrière (AP-HP) (A+P)—Chirurgie Cardio-VasculaireParis Necker Enfants Malades (AP-HP) (A+P)—Cardiologie PediatriqueClichy Beaujon (AP-HP) (A)—Pneumologie B et Transplantation PulmonaireParis Bichat (AP-HP) (A)—Chirurgie Cardio-VasculaireParis Georges Pompidou (AP-HP) (A)—Transplantation CardiaqueParis Georges Pompidou (AP-HP) (A+P)—Transplantation Pulmonaire et Cardio-PulmonaireRouen (A+P)—Chirurgie Thoracique Et Cardio-VasculaireLimoges (A)—Chirurgie CardiaqueSuresnes Foch (A)—Chirurgie ThoraciqueLe Plessis-Robinson Marie-Lannelongue (A+P)—Chirurgie CardiaqueLe Plessis-Robinson Marie-Lannelongue (A+P)—Chirurgie Thoracique Cardio-VasculaireCréteil Henri Mondor (AP-HP) (A)—Chirurgie Cardio-VasculaireGermanybData provided via Eurotransplant (ET). (DEU)Universität des Saarlandes Homburg/SaarHerzzentrum Dresden GmbHDeutsches Herzzentrum BerlinUniversitätsklinik KölnUniversität Leipzig—HerzzentrumKerckhoff Klinik, Bad NauheimKlinikum der Universität RegensburgHerzzentrum Nordrhein-Westfalen Bad OeynhausenUniversitätsklinikum EssenJohannes Gutenberg Universität MainzHeinrich-Heine-Universität DüsseldorfUniversitätsklinikum MünsterRuprecht-Karls-Universität HeidelbergMedizinische Hochschule HannoverUniversitätsklinikum GöttingenUniversitätsklinikum AachenKlinikum der Justus-Liebig-Universität GiessenUniversitätsklinikum Schleswig-Holstein KielFriedrich Schiller Universität JenaFriedrich Alexander Universität ErlangenUniversitätsklinikum WürzburgLudwig Maximilians Universität MünchenUniversitätsklinikum HamburgKlinikum der Albert-Ludwigs-Universität Freiburg im BreisgauIran (IRN)Cardiac Surgery and Transplantation Research CenterIrelandeData provided via United Kingdom Transplant Support Service Authority (UKTSSA). (IRL)Mater HospitalIsrael (ISR)Rabin Medical Center (Belinson Campus)Sheba Medical CenterItaly (ITA)Policlinico S. Orsola—Universitadegli StudiJapan (JPN)Tohoku University HospitalOsaka University HospitalKyoto University HospitalSaitama Medical School HospitalNetherlandsbData provided via Eurotransplant (ET). (NLD)Universitair Medisch Centrum UtrechtErasmus Medisch Centrum RotterdamUniversitair Medisch Centrum GroningenNew Zealand (NZL)Auckland City HospitalNorwaycData provided via Scandiatransplant. (NOR)Rikshospitalet—National Hospital of NorwayPoland (POL)Regional Pulmonary HospitalThe Republic of Korea (KOR)Gangnam Severance HospitalSloveniabData provided via Eurotransplant (ET). (SVN)University Medical Center LjubljanaSouth Africa (ZAF)Milpark HospitalSpain (ESP)Complejo Hospitalario Universitario Juan CanalejofLung data provided via Organización Nacional de Trasplantes (ONT)., gHeart data provided directly to ISHLT Registry.Hospital Universitario Marques de ValdecillafLung data provided via Organización Nacional de Trasplantes (ONT)., hHeart data provided via Registro Español de Trasplante Cardíaco.Hospital de Bellvitge. BarcelonahHeart data provided via Registro Español de Trasplante Cardíaco.Hospital Virgen Del Rocio, SevillahHeart data provided via Registro Español de Trasplante Cardíaco.Hospital Santa Creu I Sant Pau, BarcelonahHeart data provided via Registro Español de Trasplante Cardíaco.Hospital Universitario 12 de OctubrefLung data provided via Organización Nacional de Trasplantes (ONT)., hHeart data provided via Registro Español de Trasplante Cardíaco.Hospital Universitario Reina SofiafLung data provided via Organización Nacional de Trasplantes (ONT)., hHeart data provided via Registro Español de Trasplante Cardíaco.Hospital Gregorio Marañón, MadridhHeart data provided via Registro Español de Trasplante Cardíaco.Hospital Universitario Puerta de HierrofLung data provided via Organización Nacional de Trasplantes (ONT).Hospital Universitari I Politècnic La Fe, ValenciafLung data provided via Organización Nacional de Trasplantes (ONT)., hHeart data provided via Registro Español de Trasplante Cardíaco.Hospital Clinic I Provincial, BarcelonahHeart data provided via Registro Español de Trasplante Cardíaco.Hospital Universitario Vall D'HebronfLung data provided via Organización Nacional de Trasplantes (ONT)., hHeart data provided via Registro Español de Trasplante Cardíaco.Hospital Central de AsturiasgHeart data provided directly to ISHLT Registry.Hospital La Paz. Madrid. NiñoshHeart data provided via Registro Español de Trasplante Cardíaco.Hospital Virgen de La Arrixaca, MurciahHeart data provided via Registro Español de Trasplante Cardíaco.Hospital Miguel Servet, ZaragozahHeart data provided via Registro Español de Trasplante Cardíaco.Hospital Clínico, ValladolidhHeart data provided via Registro Español de Trasplante Cardíaco.SwedencData provided via Scandiatransplant. (SWE)Sahlgrenska University HospitalUniversity Hospital of LundSwitzerland (CHE)University Hospital ZurichCentre Hospitalier Universitaire VaudoisTurkey (TUR)Heart Center, Ankara UniversityHospital of Akdeniz UniversityUnited KingdomeData provided via United Kingdom Transplant Support Service Authority (UKTSSA). (UK)Great Ormand Street Hospital for ChildrenUniversity of Glasgow/Glasgow Royal InfirmaryThe Freeman HospitalHarefield HospitalWythenshawe HospitalQueen Elizabeth HospitalPapworth HospitalUnited StatesiData provided via United Network for Organ Sharing (UNOS). (USA)University of Alabama Hospital, Birmingham, AlabamaBaptist Medical Center, Little Rock, ArkansasArkansas Children's Hospital, Little Rock, ArkansasMayo Clinic Hospital, Phoenix, ArizonaPhoenix Children's Hospital, Phoenix, ArizonaSt. Joseph's Hospital and Medical Center, Phoenix, ArizonaUniversity Medical Center, University of Arizona, Tucson, ArizonaChildren's Hospital Los Angeles, Los Angeles, CaliforniaCedars-Sinai Medical Center, Los Angeles, CaliforniaLoma Linda University Medical Center, Loma Linda, CaliforniaLucile Salter Packard Children's Hospital, Palo Alto, CaliforniaCalifornia Pacific Medical Center, San Francisco, CaliforniaUniversity of California San Diego Medical Center, San Diego, CaliforniaUniversity of California San Francisco Medical Center, San Francisco, CaliforniaSutter Memorial Hospital, Sacramento, CaliforniaSharp Memorial Hospital, San Diego, CaliforniaStanford University Medical Center, Stanford, CaliforniaUniversity of California Los Angeles Medical Center, Los Angeles, CaliforniaKeck Hospital of University of Southern California, Los Angeles, CaliforniaChildren's Hospital Colorado, Aurora, ColoradoUniversity of Colorado Hospital/Health Sciences Center, Aurora, ColoradoHartford Hospital, Hartford, ConnecticutYale New Haven Hospital, New Haven, ConnecticutWashington Hospital Center, Washington, District of ColumbiaAlfred I duPont Hospital for Children, Wilmington, DelawareAll Children's Hospital, St. Petersburg, FloridaFlorida Hospital Medical Center, Orlando, FloridaMemorial Regional/Joe DiMaggio Children's Hospital, Hollywood, FloridaJackson Memorial Hospital, Miami, FloridaMayo Clinic Florida, Jacksonville, FloridaTampa General Hospital, Tampa, FloridaShands Hospital at University of FL, Gainesville, FloridaChildren's Healthcare of Atlanta, Atlanta, GAEmory University Hospital, Atlanta, GAPiedmont Hospital, Atlanta, GASt. Joseph's Hospital of Atlanta, Atlanta, GAUniversity of Iowa Hospital and Clinics, Iowa City, IAAdvocate Christ Medical Center, Oak Lawn, IllinoisAnn and Robert H. Lurie Children's Hospital, Chicago, IllinoisLoyola University Medical Center, Maywood, IllinoisNorthwestern Memorial Hospital, Chicago, IllinoisRush University Medical Center, Chicago, IllinoisUniversity of Chicago Medical Center, Chicago, IllinoisIndiana University Health, Indianapolis, IndianaLutheran Hospital of Ft Wayne, Ft Wayne, IndianaSt. Vincent Hospital and Health Care Center, Indianapolis, IndianaJewish Hospital, Louisville, KentuckyKosair Children's Hospital, Louisville, KentuckyUniversity of Kentucky Medical Center, Lexington, KentuckyOchsner Foundation Hospital, New Orleans, LouisianaTulane Medical Center, New Orleans, LouisianaBoston Children's Hospital, Boston, MassachusettsMassachusetts General Hospital, Boston, MassachusettsTufts Medical Center, Boston, MassachusettsBrigham and Women's Hospital, Boston, MassachusettsJohns Hopkins Hospital, Baltimore, MarylandUniversity of Maryland Medical System, Baltimore, MarylandChildren's Hospital of Michigan, Detroit, MichiganHenry Ford Hospital, Detroit, MichiganSpeCenterum Health, Grand Rapids, MichiganUniversity of Michigan Medical Center, Ann Arbor, MichiganAbbott Northwestern Hospital, Minneapolis, MinnesotaSt. Mary's Hospital (Mayo Clinic), Rochester, MinnesotaUniversity of Minnesota Medical Center, Minneapolis, MinnesotaBarnes-Jewish Hospital, St. Louis, MissouriCardinal Glennon Children's Hospital, St. Louis, MissouriSt. Louis Children's Hospital, St. Louis, MissouriSt. Luke's Hospital of Kansas City, Kansas City, MissouriUniversity of MS Medical Center, Jackson, MississippiNorth Carolina Baptist Hospital, Winston-Salem, North CarolinaCarolinas Medical Center, Charlotte, North CarolinaDuke University Hospital, Durham, North CarolinaUniversity of North Carolina Hospitals, Chapel Hill, North CarolinaThe Nebraska Medical Center, Omaha, NebraskaNewark Beth Israel Medical Center, Newark, New JerseyRobert Wood Johnson University Hospital, New Brunswick, New JerseyNew York-Presbyterian/Columbia, New York, New YorkStrong Memorial Hospital, Rochester, New YorkMontefiore Medical Center, Bronx, New YorkMount Sinai Medical Center, New York, New YorkWestchester Medical Center, Valhalla, New YorkCleveland Clinic Foundation, Cleveland, OhioNationwide Children's Hospital, Columbus, OhioChildren's Hospital Medical Center, Cincinnati, OhioOhio State University Medical Center, Columbus, OhioUniversity Hospital of Cleveland, Cleveland, OhioIntegris Baptist Medical Center, Oklahoma City, OklahomaProvidence Portland Medical Center, Portland, OregonOregon Health and Science University, Portland, OregonAllegheny General Hospital, Pittsburgh, PennsylvaniaChildren's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PennsylvaniaChildren's Hospital of Philadelphia, Philadelphia, PennsylvaniaPenn State Milton S Hershey Medical Center, Hershey, PennsylvaniaHahnemann University Hospital, Philadelphia, PennsylvaniaUniversity of Pittsburgh Medical Center, Pittsburgh, PennsylvaniaThomas Jefferson University Hospital, Philadelphia, PennsylvaniaTemple University Hospital, Philadelphia, PennsylvaniaThe Hospital of the University of PA, Philadelphia, PennsylvaniaCardiovascular Center of Puerto Rico, San Juan, Puerto RicoMedical University of South Carolina, Charleston, South CarolinaBaptist Memorial Hospital, Memphis, TennesseeSt. Thomas Hospital, Nashville, TennesseeVanderbilt University Medical Center, Nashville, TennesseeUniversity Hospital, San Antonio, TexasChildren's Medical Center of Dallas, Dallas, TexasSeton Medical Center, Austin, TexasMedical City Dallas Hospital, Dallas, TexasSt Luke's Episcopal Hospital, Houston, TexasMethodist Specialty and Transplant Hospital, San Antonio, TexasUniversity of Texas Medical Branch, Galveston, TexasThe Methodist Hospital, Houston, TexasUniversity Hospital—St. Paul, Dallas, TexasScott and White Memorial Hospital, Temple, TexasTexas Children's Hospital, Houston, TexasBaylor University Medical Center, Dallas, TexasIntermountain Medical Center, Murray, UtahUniversity of Utah Health Sciences Center, Salt Lake City, UtahPrimary Children's Medical Center, Salt Lake City, UtahInova Fairfax Hospital, Falls Church, VirginiaMCV Hospitals, Richmond, VirginiaMcGuire Virginia Medical Center, Richmond, VirginiaSentara Norfolk General Hospital, Norfolk, VirginiaUniversity of Virginia HSC, Charlottesville, VirginiaSeattle Children's Hospital, Seattle, WashingtonSacred Heart Medical Center, Spokane, WashingtonUniversity of Washington Medical Center, Seattle, WashingtonChildren's Hospital of Wisconsin, Milwaukee, WisconsinFroedtert Memorial Lutheran Hospital, Milwaukee, WisconsinAurora St. Luke's Medical Center, Milwaukee, WisconsinUniversity of Wisconsin Hospital and Clinics, Madison, WisconsinA, adult; P, pediatric; ISO, International Organization for Standardization.a Data provided via Australia and New Zealand Cardiothoracic Transplant Registry (ANZCOTR).b Data provided via Eurotransplant (ET).c Data provided via Scandiatransplant.d Data provided via L'Agence de la Biomédicine.e Data provided via United Kingdom Transplant Support Service Authority (UKTSSA).f Lung data provided via Organización Nacional de Trasplantes (ONT).g Heart data provided directly to ISHLT Registry.h Heart data provided via Registro Español de Trasplante Cardíaco.i Data provided via United Network for Organ Sharing (UNOS). Open table in a new tab A, adult; P, pediatric; ISO, International Organization for Standardization.

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