1 / 30

Intermacs and the Scientific Registry of Transplant Recipients (SRTR)

Intermacs and the Scientific Registry of Transplant Recipients (SRTR). José A. Tallaj, MD Division of Cardiovascular Disease Birmingham VA Medical Center The University of Alabama at Birmingham. Disclosure Information. Nothing to disclose. ISHLT 2014. Trolley Problem by Phillipa Foot.

gbueche
Download Presentation

Intermacs and the Scientific Registry of Transplant Recipients (SRTR)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Intermacs and the Scientific Registry of Transplant Recipients (SRTR) José A. Tallaj, MD Division of Cardiovascular Disease Birmingham VA Medical Center The University of Alabama at Birmingham

  2. Disclosure Information • Nothing to disclose

  3. ISHLT 2014

  4. Trolley Problem by Phillipa Foot

  5. Study Question To VAD or to Transplant In a similar group of patients, which therapy would lead to a better survival

  6. Background • Heart Transplantation (HxTxp) and Mechanical Circulatory Support (MCS) are acceptable therapies for patients with end-stage heart disease • Both improve survival • Both improve QOL • HxTxp has long-term outcomes • 60% at 10 years • MCS is a relatively young field

  7. Background VAD technology is improving rapidly. The expectation is that it will continue to improve over time. The question becomes, which therapy leads to a better survival.

  8. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) • North American national registry for MCS devices • Durable, approved devices • Enrollment started 2006 • > 16,000 patients enrolled • >13,500 continuous flow devices

  9. Scientific Registry for Transplant Recipients (SRTR) National database of transplant statistics, collected by the Organ Procurement and Transplantation Network (OPTN), and administered by the Chronic Disease Research Group (CDRG) of the Minneapolis Medical Research Foundation (MMRF) Supports ongoing evaluation of the scientific and clinical status of solid organ transplantation Started in 1988 62,500 heart transplants recipients

  10. SRTR Survival 2007-09 1 yr - 88.8%, 3-yr - 82.1% 5-yr - 75.9% 07/12-12/14 1 yr - 90.6%, 3-yr - 84.5% American Journal of Transplantationpages 115-140, 11 JAN 2016 DOI: 10.1111/ajt.13670http://onlinelibrary.wiley.com/doi/10.1111/ajt.13670/full#ajt13670-fig-0016

  11. Adult and Pediatric Heart TransplantsKaplan-Meier Survival(Transplants: January 1982 – June 2013) N = 112,521 N at risk at 30 years = 16 2015 JHLT. 2014 Oct; 33(10): 996-1008 JHLT. 2015 Oct; 34(10): 1244-1254

  12. Adult and Pediatric Heart TransplantsKaplan-Meier Survival by Age Group (Transplants: January 1982 – June 2013) p < 0.0001 2015 JHLT. 2014 Oct; 33(10): 1009-1024 JHLT. 2015 Oct; 34(10): 1244-1254

  13. INTERMACS

  14. INTERMACS

  15. INTERMACS

  16. 2007-09 1 yr - 88.8%, 3-yr - 82.1% 5-yr - 75.9% 07/12-12/14 1 yr - 90.6% 3-yr - 84.5%

  17. Methods Merge Intermacs and SRTR database Continuous flow devices only All, DTs or BTTs SRTR data gathering is not as extensive or detailed

  18. VAD vs Transplant Listed Transplant VAD

  19. VAD vs Transplant Listed Transplant VAD “Intention” to transplant vs VAD therapy

  20. VAD vs Transplant Listed Transplant VAD “Intention” to transplant vs VAD therapy

  21. VAD vs Transplant Listed Transplant VAD Transplant vs VAD therapy

  22. VAD vs Transplant Listed Transplant VAD Transplant vs VAD therapy

  23. Propensity Score Match • Demographics • Co-morbidities • Cr, TB • Severity of illness • Intermacs profile • N properly matched • 200 enough?

  24. Questions to be answered • Subgroup analysis • Which patients do better with Txp or MCS? • Co-morbidities • BiVADs • Intention of Txp vs intention LVAD • N properly matched • 200 enough?

  25. To VAD or to Transplant

  26. To VAD or to Transplant

  27. To VAD or to Transplant

  28. Limitations • SRTR database is not as detailed • Regional preference • Patient characteristic bias • Patients as own control • Involved multiple agencies • Open conversation

  29. Future Directions • Ethics of randomized trial • Further subgroup analysis • Pilot for further merges • Pediatric • International (ISHLT) • ? CTRD-like database • Medical management (MEDAMACS)

  30. HF Medical Rx Recovery Progression Palliation MCS Transplant

More Related