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Program and OPO Specific Reports , January 2010

Report Published January 2010   
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University of California at Los Angeles Medical Center, Los Angeles, CA(HR)

Comments submitted by program:

Comments General Comments About This Program
University of California at Los Angeles Medical Center, Los Angeles, CA X

General Comments:

The UCLA Heart Transplant Program is one of the largest in the world and prides itself on superior survival, low mortality on the wait list, and the use of innovative and cutting edge approaches in the field of heart failure and transplantation. Our program was the first to develop the alternate list which matches older patients with older donors affording these patients an opportunity to undergo heart transplant with comparable outcomes. Our ventricular assist and total artificial heart program offers the latest in technology for critical patients in need of mechanical support. We have continued to reduce post transplant complications including the incidence of donor heart rejection which is the lowest in the country (currently only 4% of patients experience biopsy proven rejection). This has been achieved from our pioneering work using newer anti-rejection medications and strategies such as the use of statins and plasmapheresis which has contributed to better outcome for all heart transplant recipients. As a result of our low rejection experience, we do not find it necessary to perform heart biopsies after 1 year after heart transplantation. Our commitment and dedication to patient care and research has led to our program achieving a national and international reputation for excellence and high standards. Abbas Ardehali, MD Director UCLA Heart Transplant Program UCLA Pediatric Heart Transplant Program The UCLA Pediatric Heart Transplant Program continues to be one of the largest in the world. We pride ourselves on our excellent results that continue to be above the national average at 30 days and 1 year for patient and graft survival. We perform an ongoing evaluation to assess our short and intermediate term survivals. Through our assessments we can make adjustments through our medical and psychosocial interventions. Continued self evaluation has led to an aggressive immunotherapy program to treat patients with circulating antibodies. We also subsequently introduced a more aggressive immunosuppression protocol for the post OHT patient recognizing the incidence of acute allograft rejection in the immediate post operative period. It became evident that while our immunosuppression regimens could successfully treat these patients thus improving short term survivals, intermediate and long term survivals, continued surveillance was essential. The risk of chronic rejection is still significant in these patients. We continue to improve our means of non invasive monitoring for both humoral and cellular rejection allowing for the marked reduction in endomyocardial biopsies. We also upgraded our maintenance immunosuppression protocols and surveillance regimens in an attempt to balance new findings with advances in immunosuppressive regimens. We are continuosly monitoring the effect of changes in selection criteria and immunosuppression. As a program we have always held a commitment to our patients. Juan C. Alejos MD Medical Director, UCLA Pediatric Heart Transplant Program Brian Reemtsen, MD Surgical Director, UCLA Pediatric Heart Transplant Program
X

General Comments:

The UCLA Heart Transplant Program is one of the largest in the world and prides itself on superior survival, low mortality on the wait list, and the use of innovative and cutting edge approaches in the field of heart failure and transplantation. Our program was the first to develop the alternate list which matches older patients with older donors affording these patients an opportunity to undergo heart transplant with comparable outcomes. Our ventricular assist and total artificial heart program offers the latest in technology for critical patients in need of mechanical support. We have continued to reduce post transplant complications including the incidence of donor heart rejection which is the lowest in the country (currently only 4% of patients experience biopsy proven rejection). This has been achieved from our pioneering work using newer anti-rejection medications and strategies such as the use of statins and plasmapheresis which has contributed to better outcome for all heart transplant recipients. As a result of our low rejection experience, we do not find it necessary to perform heart biopsies after 1 year after heart transplantation. Our commitment and dedication to patient care and research has led to our program achieving a national and international reputation for excellence and high standards. Abbas Ardehali, MD Director UCLA Heart Transplant Program UCLA Pediatric Heart Transplant Program The UCLA Pediatric Heart Transplant Program continues to be one of the largest in the world. We pride ourselves on our excellent results that continue to be above the national average at 30 days and 1 year for patient and graft survival. We perform an ongoing evaluation to assess our short and intermediate term survivals. Through our assessments we can make adjustments through our medical and psychosocial interventions. Continued self evaluation has led to an aggressive immunotherapy program to treat patients with circulating antibodies. We also subsequently introduced a more aggressive immunosuppression protocol for the post OHT patient recognizing the incidence of acute allograft rejection in the immediate post operative period. It became evident that while our immunosuppression regimens could successfully treat these patients thus improving short term survivals, intermediate and long term survivals, continued surveillance was essential. The risk of chronic rejection is still significant in these patients. We continue to improve our means of non invasive monitoring for both humoral and cellular rejection allowing for the marked reduction in endomyocardial biopsies. We also upgraded our maintenance immunosuppression protocols and surveillance regimens in an attempt to balance new findings with advances in immunosuppressive regimens. We are continuosly monitoring the effect of changes in selection criteria and immunosuppression. As a program we have always held a commitment to our patients. Juan C. Alejos MD Medical Director, UCLA Pediatric Heart Transplant Program Brian Reemtsen, MD Surgical Director, UCLA Pediatric Heart Transplant Program

Program Summary
Center: University of California at Los Angeles Medical Center (CAUC)
Organ: HR: Heart
             
  Center Activity (07/01/2008-06/30/2009) Center Region United States   Tables for More Information
Deceased donor transplants (n=number) 76 321 2,176 07C,08C,09C
On waitlist at start (n) 118 301 2,605 01,02,03
On waitlist at end (n) 119 329 2,824 01,02
  Number of new patient registrations (n) 112 503 3,418   01,02
  Waiting List Outcomes ( 07/01/2008-06/30/2009)   Tables for More Information
    Observed Expected Statistical Significance of Difference    
Transplant rate (from deceased donors) among waitlist patients 0.68 0.36 Statistically Higher (b) 03,04,05,06
  Mortality rate while on waitlist 0.13 0.19 Not Significantly Different (a)   03,04
             
  Post-transplant Outcomes ( 07/01/2006-12/31/2008) 1 Year Tables for More Information
    Observed Expected Statistical Significance of Difference    
Adult graft survival (based on 183  transplants) (%) 91.16 86.44 Statistically Higher (b) 10
Adult patient survival (based on 168  transplants) (%) 92.72 87.45 Statistically Higher (b) 11
  Pediatric graft survival (based on 33  transplants) (%) 93.94 92.78 Not Significantly Different (a)   10
Pediatric patient survival (based on 31  transplants) (%) 93.55 92.49 Not Significantly Different (a) 11
The data reported here were prepared by the Scientific Registry of Transplant Recipients (SRTR) under contract with the Health Resources and Services Administration (HRSA).
Note:  Tables referring to small sample sizes should be treated with caution.  Sample sizes can be found in the table referenced in the last column.
The SRTR is administered by the Arbor Research Collaborative for Health with the University of Michigan,
with oversight and funding from the Health Resources and Services Administration.

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