Chapter 4 Heart Transplantation

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1 Chapter 4 Heart Transplantation

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3 Chapter 4 Heart Transplantation 4 Heart Transplantation Heart transplantation is the treatment of last resort for people with heart failure. In Canada, heart transplants are the third most common organ transplant operation, after kidney and liver transplants. This section discusses the trends in heart transplantation procedures and outcomes in Canada over the decade from 2004 to There were 167 people on the waiting list for a heart transplant in Between 2004 and 2013, there were 1,675 heart transplants registered in CORR, including 59 re-transplants. The number of transplants performed each year fluctuated from a low of 143 in 2004 to a high of 192 in Children accounted for 19% (299) of all first graft heart transplants over the decade. The largest number of first transplants was performed on recipients between age 35 and 59 (807), followed by those age 60 and older (337) (Table 41). The crude RPMP for heart transplants varied from 4.6 to 6.8 across Canada (Figure 14). Persons on the waiting list for a heart transplant are categorized according to their medical status at the time of transplant. Status 1 and 2 patients are classified as non-urgent and may be at home or in hospital. Status 3, 3B and 4 patients are in the most urgent need of a transplant. Status 3A and 3B patients may be in the ICU or on inotropic drugs to strengthen heart muscle contractions, while Status 4 patients are already in the ICU with ventilator support. With the exception of 2008, more than half of all heart transplants have been classified as urgent in the last decade (Figure 15). Survival rates generally showed continued improvement for much of the period under examination (Figure 16). In 2010, 82% of recipients survived the first three years, and five-year survival also improved from 75% to 90% between 2004 and In 2013, there were 2,611 Canadians living with a heart transplant. Table 40: Heart Transplant Waiting List at December 31 and Deaths, Canada, 2004 to * 2013* Total Age Age ,196 Waiting List ,341 Deaths on Waiting List * Results are supplemented with data from Transplant Québec. For more details see Section 1.2. s Transplant Québec. Statistiques officielles February Accessed January 8,

4 Canadian Organ Replacement Register Annual Report: Treatment of End-Stage Organ Failure in Canada, 2004 to 2013 Table 41: Heart Transplants by Year, Age Group and Re-Transplants, Canada, 2004 to 2013 (Number) Pediatric: Age 0 17 Adults: Age 18+ Age <1 Age 1 10 Age Age Age Age Total Re-Transplants Total ,675 Table 42: Primary Diagnosis* for Heart Transplant Recipients, Canada, 2004 to 2013 (Percentage) Age <1 Age 1 10 Age Age Age Age 60+ Total Congenital Cardiomyopathy Unspecified Dilated Cardiomyopathy Idiopathic Cardiomyopathy Ischemic Cardiomyopathy Unknown/Not Reported Other* Total * For a list of all primary diagnoses captured by CORR, see Appendix F. 74

5 Chapter 4 Heart Transplantation Figure 14: Heart Transplant Recipients by Province of Residence, Canada, 2013 (Crude Rate per Million Population) Data from the Atlantic provinces was combined, as was data from Saskatchewan and Manitoba, because of small numbers. Figure 15: Distribution of Heart Transplants by Medical Status* at Transplant, Canada, 2004 to 2013 * Status 1: At home; Status 2: Hospitalized; Status 3: Hospitalized in ICU receiving inotropes, younger than age 6 months or with rapid deterioration; Status 4: In ICU with mechanical/ventilatory support; Unknown: Status not provided. 75

6 Canadian Organ Replacement Register Annual Report: Treatment of End-Stage Organ Failure in Canada, 2004 to 2013 Figure 16: Unadjusted Three-Month and One-, Three- and Five-Year Patient Survival Rates for Heart Transplant Recipients,, Canada, 2004 to 2013 (Percentage) Table 43: Prevalent Heart Transplant Patients, by Province of Treatment/Follow-Up, 2004 to 2013 (Number) B.C Alta Sask Man. 5 <5 <5 <5 <5 < Ont ,040 Que N.S Canada 1,800 1,878 1,949 2,032 2,135 2,245 2,343 2,417 2,503 2,611 Cell values from 1 to 4 are suppressed in accordance with CIHI s privacy policy. 76

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