HEART-LUNG TRANSPLANTATION Overall ISHLT 2005 J Heart Lung Transplant 2005;24: 945-982.
HEART-LUNG TRANSPLANTATION
description
Transcript of HEART-LUNG TRANSPLANTATION
HEART-LUNG TRANSPLANTATION
Overall
2011ISHLTISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
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NUMBER OF HEART-LUNG TRANSPLANTS REPORTED BY YEAR
NOTE: This figure includes only the heart-lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of heart-lung transplants worldwide has declined in recent years.
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
AVERAGE CENTER VOLUMEHeart-Lung Transplants: January 1, 1998 - June 30, 2010
60
35
11 80
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1/year 2/year 3/year 4-9/yearAverage number of heart-lung transplants per year
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ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY CENTER VOLUME
Heart-Lung Transplants: January 1, 1998 - June 30, 2010
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Average number of heart-lung transplants per year
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ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME
Lung Transplants: January 1, 1998 - June 30, 2010
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10
15
20
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30
35
40
1-4 5-9 10-19 20-29 30-39 40-49 50+
Average number of lung transplants per year
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ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for All Ages (Transplants: January 1982 - June 2009)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Years
Su
rviv
al (
%)
Half-life = 4.8 yearsConditional Half-life = 12 years
N=3,957
N at risk at 22 years = 48
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
HEART-LUNG TRANSPLANTATION
Adult Recipients
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Acquired heart disease
5%
Congenital heart disease
36%
COPD/Alpha-16%
CF14%
IPAH28%
Re-transplant2%
Other6%
IPF4%
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (January 1982 - June 2010)
“Other” includes cancer, LAM, OB, sarcoidosis, bronchiectasis
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2010)
Diagnosis N (%)
Congenital Heart Disease 1,116 (35.9%)
Idiopathic Pulmonary Arterial Hypertension 857 (27.5%)
Cystic Fibrosis 444 (14.3%)
Acquired Heart Disease 150 ( 4.8%)
COPD/Emphysema 132 ( 4.2%)
Idiopathic Pulmonary Fibrosis 113 ( 3.6%)
Alpha-1 60 ( 1.9%)
Sarcoidosis 50 ( 1.6%)
Re-Transplant: Not Obliterative Bronchiolitis 36 ( 1.2%)
Re-Transplant: Obliterative Bronchiolitis 28 ( 0.9%)
Bronchiectasis 24 ( 0.8%)
Obliterative Bronchiolitis (not Re-Transplant) 22 ( 0.7%)
Other 80 ( 2.6%)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA (Transplants: January 1982 - June 2010)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1982-1995(N=1,651)
1996-1999(N=549)
2000-6/2010(N=912)
% o
f T
ran
sp
lan
ts
Other
Sarcoidosis
Re-TX
IPAH
IPF
CF
COPD/Alpha-1
Congenital Heart Disease
Acquired Heart Disease
“Other” includes OB (non-ReTX) and Bronchiectasis
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART-LUNG TRANSPLANTATIONMajor Indications By Year (%)
0
20
40
60
80
100
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Transplant Year
% o
f T
ran
spla
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Congenital Heart Disease IPAHCystic Fibrosis COPD/Alpha-1Retransplant Acquired Heart Disease
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART-LUNG TRANSPLANTATIONMajor Indications By Year (Number)
0
25
50
75
100
125
150
175
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Transplant Year
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Congenital Heart Disease IPAH Cystic Fibrosis
COPD/Alpha-1 Retransplant Acquired Heart Disease
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
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18 - 34 years 35 - 49 years 50 - 59 years 60+ years
ADULT HEART-LUNG TRANSPLANTS:AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0%
20%
40%
60%
80%
100%
Europe North America Other
Acquired heart disease Congenital heart disease Cystic Fibrosis IPF IPAH Other
% o
f T
ran
sp
lan
tsADULT HEART-LUNG TRANSPLANTS:DIAGNOSIS DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2010
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f D
on
ors
6-11 12-17 18-34 35-49 50-59 60+
ADULT HEART-LUNG TRANSPLANTS:DONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2010
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for Adult Recipients
(Transplants: January 1982 - June 2009)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Years
Su
rviv
al
(%)
Half-life = 5 YearsConditional Half-life = 12 Years
N=3,303
N at risk at 22 years = 42
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for Adult Recipients by Era
(Transplants: January 1982 - June 2009)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
1982-1995 (N=1,940)
1996-1999 (N=572)
2000-6/2009 (N=791)
Su
rviv
al
(%)
P-value comparing all: 0.2944
Half-life (Years): 1982-1995 = 4.8; 1996-1999 = 5.0; 2000-6/2009 = 5.5 Conditional Half-life (Years): 1982-1995 = 13; 1996-1999 = 11; 2000-6/2009 = 10
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2009)
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25
50
75
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years
Su
rviv
al (
%)
Other Congenital (N = 294)Eisenmenger's Syndrome (N = 588)IPAH (N = 578)
Congenital vs. Eisenmenger's: p = 0.0103Congenital vs. IPAH: p = 0.0350Eisenmenger's vs. IPAH: p = 0.3050
HALF-LIFE Congenital: 3.7 Years; Eisenmenger's: 6.5 Years; IPAH: 5.0 Years
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year
(Transplants: January 1990 – June 2009)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years
Su
rviv
al
(%)
Other Congenital (N = 163)
Eisenmenger's Syndrome (N = 399)
IPAH (N = 409)
HALF-LIFE Congenital Years: 13.6;Eisenmenger's: 11.4 Years; IPAH: 10.1 Years
Congenital vs. Eisenmenger's: p = 0.6674Congenital vs. IPAH: p = 0.1964Eisenmenger's vs. IPAH: p = 0.0121
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART-LUNG RECIPIENTS Cross-Sectional Analysis
Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2010)
0%
20%
40%
60%
80%
100%
1 Year (N = 264) 3 Years (N = 212) 5 Years (N = 181)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART-LUNG RECIPIENTS Functional Status of Surviving Recipients
US Recipients Only(Follow-ups: March 2005 - June 2010)
0%
20%
40%
60%
80%
100%
1 Year (N = 118) 2 Years (N = 88) 3 Years (N = 83)
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART-LUNG RECIPIENTSEmployment Status of Surviving Recipients
(Follow-ups: April 1994 – June 2010)
0%
20%
40%
60%
80%
100%
1 Year (N = 332) 3 Years (N = 242) 5 Years (N = 214)
Working (FT/PTstatus unknown)
Retired
Not Working
Working Part Time
Working Full Time
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2010)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N = 415) Between 2 and 3 Years (N =301)
Between 4 and 5 Years (N =246)
No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Only Hospitalized, Infection OnlyHospitalized, Rejection and Infection
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0
10
20
30
40
50
60
70
Any Induction (N =166)
Polyclonal ALG/ATG(N = 64)
OKT3 (N = 5) IL-2R Antagonist (N =82)
% o
f p
ati
en
tsADULT HEART-LUNG RECIPIENTS
Induction ImmunosuppressionFor transplants between January 2001 through June 2010
ISHLT 2011 Analysis is limited to patients who were alive at the time of the discharge
ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
% o
f p
ati
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ts
Any Induction Polyclonal ALG/ATG
OKT3 IL-2R Antagonist
ADULT HEART-LUNG RECIPIENTSInduction Immunosuppression (Transplants: January 2000 - December 2009)
ISHLT 2011 Analysis is limited to patients who were alive at the time of the discharge
ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0
10
20
30
40
50
60
70
80
90
% o
f p
ati
en
ts
ADULT HEART-LUNG RECIPIENTSInduction Immunosuppression (Transplants: January 2000 - December 2009)
Any Induction Polyclonal ALG/ATG OKT3 IL-2R Antagonist
ISHLT 2011 Analysis is limited to patients who were alive at the time of the discharge
ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0
20
40
60
80
100
Cyclosporine Tacrolimus Sirolimus MMF Azathioprine Prednisone
% o
f P
atie
nts
Year 1 (N = 181) Year 5 (N = 115)
ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2001 through June 2010
NOTE: Different patients are analyzed in Year 1 and Year 5
Analysis is limited to patients who were alive at the time of the follow-up
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0%
20%
40%
60%
80%
100%
Year 1 (N = 181) Year 5 (N = 115)
% o
f P
ati
en
ts
Other
None
Tacrolimus
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine + MMF
Cyclosporine + AZA
ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression Drug Combinations at Time of Follow-up
For follow-ups between January 2001 through June 2010
NOTE: Different patients are analyzed in Year 1 and Year 5
Analysis is limited to patients who were alive at the time of the follow-up
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994 - June 2010)
Outcome Within 1
Year Total number with known response
Hypertension 58.5% (N = 386)
Renal Dysfunction 18.4% (N = 412)
Abnormal Creatinine < 2.5 mg/dl 12.1% Creatinine > 2.5 mg/dl 2.9% Chronic Dialysis 3.2% Renal Transplant 0.2%
Hyperlipidemia 26.4% (N = 406)
Diabetes 19.1% (N = 414)
Coronary Artery Vasculopathy 3.1% (N = 327)
Bronchiolitis Obliterans Syndrome 8.5% (N = 388)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant
(Follow-ups: April 1994 - June 2010)
Outcome Within 5
Years
Total number with known response
Hypertension 87.6% (N = 137)
Renal Dysfunction 26.3% (N = 160)
Abnormal Creatinine < 2.5 mg/dl 18.8% Creatinine > 2.5 mg/dl 6.3% Chronic Dialysis 1.3% Renal Transplant 0.0%
Hyperlipidemia 68.8% (N = 144)
Diabetes 26.1% (N = 153)
Coronary Artery Vasculopathy 7.2% (N = 83)
Bronchiolitis Obliterans Syndrome 27.9% (N = 129)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Freedom from Coronary Artery Vasculopathy and Bronchiolitis Obliterans Syndrome
For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2010)
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
Freedom from Coronary Artery Vasculopathy
Freedom from Bronchiolitis Obliterans Syndrome
% F
ree
fro
m C
AV
an
d B
ron
ch
iolit
is
Ob
lite
ran
s S
yn
dro
me
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Freedom from Coronary Artery Vasculopathy For Adult Heart-Lung Recipients By Diagnosis Type
(Follow-ups: April 1994-June 2010)
50
60
70
80
90
100
0 1 2 3 4
Years
% F
ree
fro
m C
AV
Heart (N=186)
Lung (N=54)
Heart/Lung (N=79)
P-value comparing all = 0.4542
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Freedom from Bronchiolitis Obliterans Syndrome For Adult Heart-Lung Recipients By Diagnosis Type
(Follow-ups: April 1994-June 2010)
50
60
70
80
90
100
0 1 2 3 4
Years
Heart (N=215)
Lung (N=64)
Heart/Lung (N=102)
% F
ree
fro
m B
ron
ch
iolit
is O
blit
era
ns
S
yn
dro
me
P-value comparing all = 0.7620
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Freedom from Severe Renal Dysfunction*For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2010)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
% F
ree
fro
m S
ev
ere
Re
na
l Dy
sfu
nc
tio
n
*Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994-June 2010)
Malignancy/Type 1-Year Survivors
5-Year Survivors
10-Year Survivors
No Malignancy 394 (93.8%) 143 (88.8%) 43 (86%)
Malignancy (all types combined) 26 (6.2%) 18 (11.2%) 7 (14%)
Malignancy Type*
Skin 2 5 7
Lymph 18 6 0
Other 4 5 0
Type Not Reported 2 2 0
* Recipients may have experienced more than one type of malignancy so sum of individual malignancy types may be greater than total number with malignancy.
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Freedom from MalignancyFor Adult Heart-Lung Recipients (Follow-ups: April 1994- June 2010)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
% F
ree
fro
m M
alig
na
nc
y
All malignancyLymphSkinOther
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2010)
CAUSE OF DEATH 0-30 Days
(N = 321)
31 Days - 1 Year (N = 249)
>1 Year - 3 Years (N = 223)
>3 Years - 5 Years (N = 151)
>5 Years
(N = 391)
BRONCHIOLITIS 0 6 (2.4%) 50 (22.4%) 32 (21.2%) 66 (16.9%)
ACUTE REJECTION 3 (0.9%) 8 (3.2%) 4 (1.8%) 1 (0.7%) 2 (0.5%)
LYMPHOMA 0 8 (3.2%) 11 (4.9%) 8 (5.3%) 11 (2.8%)
MALIGNANCY, OTHER 0 4 (1.6%) 12 (5.4%) 5 (3.3%) 30 (7.7%)
CMV 0 1 (0.4%) 0 1 (0.7%) 1 (0.3%)
INFECTION, NON-CMV 52 (16.2%) 80 (32.1%) 67 (30.0%) 42 (27.8%) 96 (24.6%)
GRAFT FAILURE 92 (28.7%) 54 (21.7%) 34 (15.2%) 27 (17.9%) 54 (13.8%)
CARDIOVASCULAR 25 (7.8%) 11 (4.4%) 20 (9.0%) 13 (8.6%) 45 (11.5%)
TECHNICAL 71 (22.1%) 9 (3.6%) 2 (0.9%) 1 (0.7%) 3 (0.8%)
OTHER 78 (24.3%) 68 (27.3%) 23 (10.3%) 21 (13.9%) 83 (21.2%)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death
(Deaths: January 1992 - June 2010)
0
10
20
30
40
50
0-30 Days (N =321)
31 Days – 1Year (N =241)
>1 Year – 3Years (N = 223)
>3 Years – 5Years (N = 151)
>5 Years (N =391 )
Bronchiolitis Infection (non-CMV) Graft Failure
Cardiovascular Technical
Pe
rce
nta
ge
of
De
ath
s
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
HEART-LUNG TRANSPLANTATION
Pediatric Recipients
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNGRECIPIENTS (Transplants: January 1982 - June 2010)
0
50
100
150
200
250
300
350
400
<1 1-5 yrs 6-11 yrs 12-17 yrs
Recipient Age (Years)
Nu
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ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January 1982 - June 2010)
372
108
56 6370
50
100
150
200
250
300
350
400
0-11 yrs 12-17 yrs 18-34 35-49 50-59
Donor Age (Years)
Nu
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ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS
By Year of Transplant
05
101520253035404550556065
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
12-17 Years1-11 Years
<1 Year
Nu
mb
er o
f T
ran
spla
nts
NOTE: This figure includes only the heart-lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of pediatric heart-lung transplants worldwide has declined in recent years.
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS
By Era of Transplant
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1982-1995 1996-6/2010
12-17 Years
1-11 Years
<1 Year
Per
cen
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ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS
NEED TO UPDATE
0
5
10
15
20
25
30
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Transplant Year
# P
edia
tric
Tra
nsp
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ente
rs
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS
Stratified by center volume
0
5
10
15
20
25
30
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Transplant Year
# P
edia
tric
Tra
nsp
lan
t C
ente
rs
1-4/yr 5-9/yr
10-19/yr 20-29/yr
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
4%
28%22%
13%
2%
4%25%
2%
2%
Acquired Heart Disease
CF
Congenital (other)Eisenmenger's Syndrome
IPF
Other
PPHRetx: Non-OB
Retx: OB
DIAGNOSIS IN PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS (Transplants: 1986-2009)
0
25
50
75
100
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
% o
f C
as
es
Cystic Fibrosis Congenital IPAH
“Other” includes Bronchiectasis, Alpha-1, and OB (non-ReTX)
NOTE: Unknown diagnoses were excluded from this tabulation.ISHLT 2011ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f T
ran
sp
lan
ts
0-5 years 6-11 years 12-17 years
PEDIATRIC HEART-LUNG TRANSPLANTS:AGE DISTRIBUTION BY LOCATIONTransplants between January 2000 and June 2010
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0%
20%
40%
60%
80%
100%
Europe North America Other
Congenital heart disease Cystic Fibrosis IPAH Other
% o
f T
ran
sp
lan
tsPEDIATRIC HEART-LUNG TRANSPLANTS:
DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f D
on
ors
0-5 6-11 12-17 18-34 35-49
PEDIATRIC HEART-LUNG TRANSPLANTS:DONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2010
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PEDIATRIC HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2009)
0
25
50
75
100
0 1 2 3 4 5 6 7
Years
Su
rviv
al
(%)
Congenital (N = 94)
Eisenmenger's Syndrome (N = 48)
IPAH (N = 101)
HALF-LIFE Congenital: 2.1 Years; Eisenmenger's: 2.7 Years; IPAH: 4.7 Years
Congenital vs. Eisenmenger's: p = 0.2696Congenital vs. IPAH: p = 0.0582Eisenmenger's vs. IPAH: p = 0.6870
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1982 - June 2009)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Years
Su
rviv
al
(%)
< 1 (N = 21)
1-11 (N = 256) 12-17 (N = 356)
Overall (N = 633)
Half-life <1: 0.4 Years;1-11: 4.2 Years; 12-17: 5.5 Years
0-<1 vs. 1-11: p = 0.0013; 0-<1 vs. 12-17: p < 0.0005; 1-11 vs. 12-17: p = 0.1578
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2009)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years
1982-1988 (N=120)
1989-1993 (N=223)
1994-1998 (N=138)1999-6/2009 (N=152)
Half-life 1982-1988: 2.6; 1989-1993: 5.5; 1994-1998: 4.4; 1999-6/2009: 4.2
82-88 vs. 89-93: p = 0.0721; 82-88 vs. 94-98: p = 0.7781; 82-88 vs. 99-6/2009: p = 0.1852; 89-93 vs. 94-98: p = 0.0628; 89-93 vs. 99-6/2009: p = 0.5594; 94-98 vs. 99-6/2009: p = 0.5168
Su
rviv
al
(%)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2009)
Conditional on Survival to 1 Year
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13Years
1982-1988 (N=61) 1989-1993 (N=111)
1994-1998 (N=77) 1999-6/2009 (N=90)
Conditional HALF-LIFE 1982-1988: 13.1; 1989-1993: 14.9; 1994-1998: 8.9; 1999-6/2009: na
82-88 vs. 89-93: p = 0.8445; 82-88 vs. 94-98: p = 0.2269; 82-88 vs. 99-6/2009: p = 0.4863; 89-93 vs. 94-98: p = 0.0518;89-93 vs. 99-6/2009: p = 0.2227; 94-98 vs. 99-6/2009: p = 0.9637
Su
rviv
al
(%)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2010)
CAUSE OF DEATH0-30 Days (N = 43)
31 Days - 1 Year (N = 54 )
>1 Year - 3 Years (N = 51 )
>3 Years - 5 Years (N = 28 )
>5 Years (N = 66)
BRONCHIOLITIS 0 2 (3.7%) 23 (45.1%) 10 (35.7%) 13 (19.7%)
ACUTE REJECTION 0 2 (3.7%) 1 (2.0%) 1 (3.6%) 1 (1.5%)
LYMPHOMA 0 2 (3.7%) 2 (3.9%) 1 (3.6%) 2 (3.0%)
MALIGNANCY, OTHER 0 2 (3.7%) 0 1 (3.6%) 4 (6.1%)
CMV 0 2 (3.7%) 0 0 0
INFECTION, NON-CMV 7 (16.3%) 17 (31.5%) 6 (11.8%) 0 18 (27.3%)
GRAFT FAILURE 18 (41.9%) 10 (18.5%) 14 (27.5%) 12 (42.9%) 11 (16.7%)
CARDIOVASCULAR 2 (4.7%) 3 (5.6%) 1 (2.0%) 2 (7.1%) 5 (7.6%)
TECHNICAL 9 (20.9%) 0 0 0 2 (3.0%)
OTHER 7 (16.3%) 14 (25.9%) 4 (7.8%) 1 (3.6%) 10 (15.2%)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: April 1994 - June 2010)
CAUSE OF DEATH0-30 Days
(N = 35)31 Days - 1
Year (N = 41)>1 Year - 3
Years (N = 44)>3 Years - 5
Years (N = 25)>5 Years
(N = 66)
BRONCHIOLITIS 0 1 (2.4%) 19 (43.2%) 9 (36.0%) 13 (19.7%)
ACUTE REJECTION 0 1 (2.4%) 1 (2.3%) 1 (4.0%) 1 (1.5%)
LYMPHOMA 0 2 (4.9%) 2 (4.5%) 1 (4.0%) 2 (3.0%)
MALIGNANCY, OTHER 0 2 (4.9%) 0 1 (4.0%) 4 (6.1%)
CMV 0 1 (2.4%) 0 0 0
INFECTION, NON-CMV 4 (11.4%) 14 (34.1%) 6 (13.6%) 0 18 (27.3%)
GRAFT FAILURE 15 (42.9%) 7 (17.1%) 11 (25.0%) 11 (44.0%) 11 (16.7%)
CARDIOVASCULAR 2 (5.7%) 2 (4.9%) 1 (2.3%) 1 (4.0%) 5 (7.6%)
TECHNICAL 7 (20.0%) 0 0 0 2 (3.0%)
OTHER 7 (20.0%) 11 (26.8%) 4 (9.1%) 1 (4.0%) 10 (15.2%)
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death
(Deaths: April 1994 - June 2010)
0
10
20
30
40
50
0-30 Days (N =35)
31 Days – 1Year (N =41)
>1 Year – 3Years (N = 44)
>3 Years – 5Years (N = 25)
>5 Years (N =66)
Bronchiolitis Graft Failure Cardiovascular Infection (Non-CMV)
Pe
rce
nta
ge
of
De
ath
s
ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132