HEART TRANSPLANTATION Overall ISHLT 2006 J Heart Lung Transplant 2006;25:869-79.
HEART-LUNG TRANSPLANTATION Overall 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141.
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Transcript of HEART-LUNG TRANSPLANTATION Overall 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141.
HEART-LUNG TRANSPLANTATION
Overall
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
0
50
100
150
200
250
1982
1983
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
Nu
mb
er
of
Tra
ns
pla
nts
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.
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
AVERAGE CENTER VOLUMEHeart-Lung Transplants: January 1, 1998 - June 30, 2009
49
36
84 1
0
5
10
15
20
25
30
35
40
45
50
55
1 2 3 4-9 10+Average number of heart-lung transplants per year
Nu
mb
er
of
ce
nte
rs
0
10
20
30
40
50
Number of centers Percentage of transplants
Pe
rce
nta
ge
of
he
art
-lu
ng
tra
ns
pla
nts
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY CENTER VOLUME
Heart-Lung Transplants: January 1, 1998 - June 30, 2009
0
5
10
15
20
25
30
35
40
1 2 3 4-9 10+
Average number of heart-lung transplants per year
Pe
rce
nta
ge
of
he
art
-lu
ng
tra
ns
pla
nts
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME
Lung Transplants: January 1, 1998 - June 30, 2009
0
5
10
15
20
25
30
35
40
1-4 5-9 10-19 20-29 30-39 40-49 50+
Average number of lung transplants per year
Pe
rce
nta
ge
of
he
art
-lu
ng
tra
ns
pla
nts
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for All Ages (Transplants: January 1990 - June 2008)
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
Years
Su
rviv
al (
%)
Half-life = 3.1 yearsConditional Half-life = 9.1 years
N=3,406
N at risk at 20 years = 36
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
HEART-LUNG TRANSPLANTATION
Adult Recipients
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Acquired heart disease
5%
Congenital heart disease
37%
COPD/Alpha-16%
CF14%
IPAH27%
Re-transplant2%
Other6%
IPF3%
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (January 1982 - June 2009)
“Other” includes cancer, LAM, OB, sarcoidosis, bronchiectasis
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2009)
Diagnosis N (%)
Congenital Heart Disease 972 (36.5%)
Idiopathic Pulmonary Arterial Hypertension 731 (27.5%)
Cystic Fibrosis 374 (14.0%)
Acquired Heart Disease 133 ( 5.0%)
COPD/Emphysema 101 ( 3.8%)
Idiopathic Pulmonary Fibrosis 82 ( 3.1%)
Alpha-1 53 ( 2.0%)
Sarcoidosis 37 ( 1.4%)
Re-Transplant: Not Obliterative Bronchiolitis 32 ( 1.2%)
Re-Transplant: Obliterative Bronchiolitis 24 ( 0.9%)
Bronchiectasis 21 ( 0.8%)
Obliterative Bronchiolitis (not Re-Transplant) 14 ( 0.5%)
Other 88 ( 3.3%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA (Transplants: January 1982 - June 2009)
0%
20%
40%
60%
80%
100%
1982-1995 1996-1999 2000-6/2009
% o
f T
ran
sp
lan
ts
Other
Re-TX
IPAH
IPF
CF
COPD/Alpha-1
Congenital Heart Disease
Acquired Heart Disease
“Other” includes OB (non-ReTX), Bronchiectasis, Sarcoidosis
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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
Transplant Year
% o
f T
ran
sp
lan
ts
Congenital Heart Disease IPAHCystic Fibrosis COPD/Alpha-1Retransplant
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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
Transplant Year
Nu
mb
er
of
Tra
ns
pla
nts
Congenital Heart Disease IPAH Cystic Fibrosis COPD/Alpha-1 Retransplant
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f T
ran
spla
nts
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 2009
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2009
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2009
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for Adult Recipients
(Transplants: January 1982 - June 2008)
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
Years
Su
rviv
al
(%)
Half-life = 3.6 YearsConditional Half-life = 9.5 Years
N=2,774
N at risk at 20 years = 28
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for Adult Recipients by Era
(Transplants: January 1982 - June 2008)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
1982-1995 (N=1,648)
1996-1999 (N=498)
2000-6/2008 (N=628)
Su
rviv
al
(%)
P-value comparing all: 0.0002
Half-life (Years): 1982-1995 = 3.1; 1996-1999 = 3.4; 2000-6/2008 =6.3 Conditional Half-life (Years): 1982-1995 = 8.9; 1996-1999 = 9.7; 2000-6/2008 = n/a
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
ADULT HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2008)
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 = 248)Eisenmenger's Syndrome (N = 535)IPAH (N = 496)
Congenital vs. Eisenmenger's: p = 0.0026Congenital vs. IPAH: p = 0.1519Eisenmenger's vs. IPAH: p = 0.0282
HALF-LIFE Congenital: 1.9 Years; Eisenmenger's: 6.3 Years; IPAH: 3.8 Years
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
ADULT HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year
(Transplants: January 1990 – June 2008)
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 = 130)
Eisenmenger's Syndrome (N = 356)
IPAH (N = 327)
HALF-LIFE Congenital Years: 13.6;Eisenmenger's: 10.8 Years; IPAH: 9.1 Years
Congenital vs. Eisenmenger's: p = 0.6373Congenital vs. IPAH: p = 0.1180Eisenmenger's vs. IPAH: p = 0.0038
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
ADULT HEART-LUNG RECIPIENTS Cross-Sectional Analysis
Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2009)
0%
20%
40%
60%
80%
100%
1 Year (N = 264) 3 Years (N = 212) 5 Years (N = 180) 7 Years (N = 153)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
ADULT HEART-LUNG RECIPIENTSLongitudinal Analysis
Functional Status of Surviving Recipients For the Same Patients
(Follow-ups: April 1994 – June 2009)
0%
20%
40%
60%
80%
100%
1 Year (N = 102) 3 Years (N = 102) 5 Years (N = 102)
No Activity Limitations Performs with Some Assistance
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
ADULT HEART-LUNG RECIPIENTS Functional Status of Surviving Recipients
US Recipients Only(Follow-ups: March 2005 - June 2009)
0%
20%
40%
60%
80%
100%
1 Year (N = 95) 2 Years (N = 77) 3 Years (N = 70)
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
ADULT HEART-LUNG RECIPIENTSEmployment Status of Surviving Recipients
(Follow-ups: April 1994 – June 2009)
0%
20%
40%
60%
80%
100%
1 Year (N = 315) 3 Years (N = 233) 5 Years (N = 206) 7 Years (N = 157)
Working (FT/PTstatus unknown)
Retired
Not Working
Working Part Time
Working Full Time
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
ADULT HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2009)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N = 392)
Between 2 and 3 Years (N = 288)
Between 4 and 5 Years (N = 228)
Between 6 and 7 Years (N = 193)
No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Only Hospitalized, Infection OnlyHospitalized, Rejection and Infection
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
0
10
20
30
40
50
60
70
Any Induction (N =149)
Polyclonal ALG/ATG(N = 60)
OKT3 (N = 5) IL2R-antagonist (N =71)
% o
f p
ati
en
tsADULT HEART-LUNG RECIPIENTS
Induction ImmunosuppressionFor transplants between January 2001 through June 2009
Analysis is limited to patients who were alive at the time of the follow-up2010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
0
10
20
30
40
50
60
70
80
90
Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist
% o
f p
ati
en
ts
2000 2001 20022003 2004 20052006 2007 2008
ADULT HEART-LUNG RECIPIENTSInduction Immunosuppression (Transplants: January 2000 - December 2008)
Analysis is limited to patients who were alive at the time of the follow-up2010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2008)
Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist
Analysis is limited to patients who were alive at the time of the follow-up2010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
atie
nts
Year 1 (N = 157) Year 5 (N = 98)
ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2001 through June 2009
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-up2010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
0%
20%
40%
60%
80%
100%
Year 1 (N = 157) Year 5 (N = 98)
% o
f P
ati
en
ts
Other
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 2009
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-up2010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994 - June 2009)
Outcome Within 1
Year Total number with known response
Hypertension 57.2% (N = 374)
Renal Dysfunction 18.1% (N = 387)
Abnormal Creatinine < 2.5 mg/dl 11.6% Creatinine > 2.5 mg/dl 2.8% Chronic Dialysis 3.4% Renal transplant 0.3%
Hyperlipidemia 25.6% (N = 395)
Diabetes 18.7% (N = 390)
Coronary Artery Vasculopathy 2.9% (N = 311)
Bronchiolitis Obliterans Syndrome 8.7% (N = 368)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant
(Follow-ups: April 1994 - June 2009)
Outcome Within 5
Years
Total number with known response
Hypertension 88.2% (N = 127)
Renal Dysfunction 28.7% (N = 143)
Abnormal Creatinine < 2.5 mg/dl 21.0% Creatinine > 2.5 mg/dl 6.3% Chronic Dialysis 1.4% Renal Transplant 0.0%
Hyperlipidemia 67.2% (N = 134)
Diabetes 23.4% (N = 137)
Coronary Artery Vasculopathy 8.0% (N = 75)
Bronchiolitis Obliterans Syndrome 27.2% (N = 114)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Freedom from Coronary Artery Vasculopathy For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2009)
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
% F
ree
fro
m C
AV
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Freedom from Coronary Artery Vasculopathy For Adult Heart-Lung Recipients By Diagnosis Type
(Follow-ups: April 1994-June 2009)
50
60
70
80
90
100
0 1 2 3 4
Years
% F
ree
fro
m C
AV
Heart (N=184)
Lung (N=54)
Heart/Lung(N=68)
P-value comparing all = 0.2078
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Freedom from Bronchiolitis Obliterans Syndrome For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2009)
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7Years
% F
ree
fro
m B
ron
ch
iolit
is O
blit
era
ns
S
yn
dro
me
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Freedom from Bronchiolitis Obliterans Syndrome For Adult Heart-Lung Recipients By Diagnosis Type
(Follow-ups: April 1994-June 2009)
50
60
70
80
90
100
0 1 2 3 4 5
Years
Heart (N=211)Lung (N=61)Heart/Lung (N=91)
% F
ree
fro
m B
ron
ch
iolit
is O
blit
era
ns
S
yn
dro
me
P-value comparing all = 0.7771
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Freedom from Severe Renal Dysfunction*For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2009)
50
60
70
80
90
100
0 1 2 3 4 5 6
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
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994-June 2009)
Malignancy/Type 1-Year Survivors
5-Year Survivors
10-Year Survivors
No Malignancy 369 (93.4%) 129 (89.6%) 36 (85.7%)
Malignancy (all types combined) 26 (6.6%) 15 (10.4%) 6 (14.3%)
Malignancy Type*
Skin 2 4 6
Lymph 18 6 0
Other 4 3 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.
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Freedom from MalignancyFor Adult Heart-Lung Recipients (Follow-ups: April 1994- June 2009)
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
% F
ree
fro
m M
alig
na
nc
y
All malignancyLymphSkinOther
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2009)
CAUSE OF DEATH 0-30 Days
(N = 289)
31 Days - 1 Year (N = 226)
>1 Year - 3 Years (N = 195)
>3 Years - 5 Years (N = 137)
>5 Years
(N = 290)
BRONCHIOLITIS 0 5 (2.2%) 41 (21.0%) 28 (20.4%) 48 (16.6%)
ACUTE REJECTION 3 (1.0%) 6 (2.7%) 2 (1.0%) 1 (0.7%) 1 (0.3%)
LYMPHOMA 0 8 (3.5%) 11 (5.6%) 5 (3.6%) 5 (1.7%)
MALIGNANCY, OTHER 0 3 (1.3%) 7 (3.6%) 4 (2.9%) 17 (5.9%)
CMV 0 1 (0.4%) 0 1 (0.7%) 0
INFECTION, NON-CMV 51 (17.6%) 76 (33.6%) 62 (31.8%) 42 (30.7%) 83 (28.6%)
GRAFT FAILURE 83 (28.7%) 50 (22.1%) 32 (16.4%) 25 (18.2%) 51 (17.6%)
CARDIOVASCULAR 24 (8.3%) 10 (4.4%) 16 (8.2%) 10 (7.3%) 21 (7.2%)
TECHNICAL 58 (20.1%) 6 (2.7%) 1 (0.5%) 1 (0.7%) 0
OTHER 70 (24.2%) 61 (27.0%) 23 (11.8%) 20 (14.6%) 64 (22.1%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death
(Deaths: January 1992 - June 2009)
0
10
20
30
40
50
0-30 Days (N =289)
31 Days – 1Year (N =226)
>1 Year – 3Years (N = 195)
>3 Years – 5Years (N = 137)
>5 Years (N =290 )
Bronchiolitis Infection (non-CMV) Graft Failure
Cardiovascular Technical
Pe
rce
nta
ge
of
De
ath
s
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
HEART-LUNG TRANSPLANTATION
Pediatric Recipients
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNGRECIPIENTS (Transplants: January 1982 - June 2009)
0
50
100
150
200
250
300
350
<1 1-5 yrs 6-11 yrs 12-17 yrs
Recipient Age (Years)
Nu
mb
er o
f T
ran
spla
nts
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January 1982 - June 2009)
354
99
52 3270
50
100
150
200
250
300
350
400
0-11 yrs 12-17 yrs 18-34 35-49 50-59
Donor Age (Years)
Nu
mb
er o
f T
ran
spla
nts
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS
By Year of Transplant
0
5
10
15
20
25
30
35
40
45
50
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
12-17 Years1-11 Years
<1 Year
Nu
mb
er o
f T
ran
spla
nts
NOTE: This figure includes only the heart 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.
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS
By Era of Transplant
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1982-1995 1996-6/2009
12-17 Years
1-11 Years
<1 Year
Per
cen
tag
e o
f T
ran
spla
nts
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS
NEED TO UPDATE
0
5
10
15
20
25
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
Transplant Year
# P
edia
tric
Tra
nsp
lan
t C
ente
rs
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS
Stratified by center volume
0
5
10
15
20
25
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
Transplant Year
# P
edia
tric
Tra
nsp
lan
t C
ente
rs
1-4/yr 5-9/yr
10-19/yr 20-29/yr
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
5%
22%
24%
13%
1%
5%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: 1986-2008)
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
% 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.2010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 LOCATION Transplants between January 2000 and June 2009
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2009
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2009
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2008)
0
25
50
75
100
0 1 2 3 4 5 6 7 8
Years
Su
rviv
al
(%)
Congenital (N = 85)
Eisenmenger's Syndrome (N = 44)
IPAH (N = 91)
HALF-LIFE Congenital: 2.4 Years; Eisenmenger's: 2.6 Years; IPAH: 4.4 Years
Congenital vs. Eisenmenger's: p = 0.6598Congenital vs. IPAH: p = 0.1562Eisenmenger's vs. IPAH: p = 0.4204
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1982 - June 2008)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Years
Su
rviv
al
(%)
< 1 (N = 20)
1-11 (N = 217) 12-17 (N = 302)
Overall (N = 539)
Half-life <1: 0.2 Years;1-11: 3.0 Years; 12-17: 3.6 Years
0-<1 vs. 1-11: p = 0.0003; 0-<1 vs. 12-17: p < 0.0001; 1-11 vs. 12-17: p = 0.0580
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2008)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14Years
1982-1988 (N=110)
1989-1993 (N=178)
1994-1998 (N=124)1999-6/2008 (N=127)
Half-life 1982-1988: 1.9; 1989-1993: 3.0; 1994-1998: 3.3; 1999-6/2008: 4.7
82-88 vs. 89-93: p = 0.4026; 82-88 vs. 94-98: p = 0.5852; 82-88 vs. 99-6/2008: p = 0.0454; 89-93 vs. 94-98: p = 0.9297; 89-93 vs. 99-6/2008: p = 0.1717; 94-98 vs. 99-6/2008: p = 0.1901
Su
rviv
al
(%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2008)
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 13 14Years
1982-1988 (N=61) 1989-1993 (N=111)
1994-1998 (N=77) 1999-6/2008 (N=90)
Conditional HALF-LIFE 1982-1988: 10.1; 1989-1993: 7.4; 1994-1998: 6.4; 1999-6/2008: 8.4
82-88 vs. 89-93: p = 0.6493; 82-88 vs. 94-98: p = 0.5156; 82-88 vs. 99-6/2008: p = 0.9621; 89-93 vs. 94-98: p = 0.9637;89-93 vs. 99-6/2008: p = 0.6498; 94-98 vs. 99-6/2008: p = 0.7200
Su
rviv
al
(%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2009)
CAUSE OF DEATH0-30 Days (N = 39)
31 Days - 1 Year (N = 49 )
>1 Year - 3 Years (N = 48 )
>3 Years - 5 Years (N = 27 )
>5 Years (N = 48)
BRONCHIOLITIS 0 2 (4.1%) 23 (47.9%) 10 (37.0%) 10 (20.8%)
ACUTE REJECTION 0 2 (4.1%) 1 (2.1%) 0 0
LYMPHOMA 0 2 (4.1%) 2 (4.2%) 1 (3.7%) 2 (4.2%)
MALIGNANCY, OTHER 0 0 0 1 (3.7%) 0
CMV 0 2 (4.1%) 0 0 0
INFECTION, NON-CMV 7 (17.9%) 16 (32.7%) 4 (8.3%) 0 15 (31.3%)
GRAFT FAILURE 17 (43.6%) 9 (18.4%) 14 (29.2%) 12 (44.4%) 11 (22.9%)
CARDIOVASCULAR 2 (5.1%) 3 (6.1%) 1 (2.1%) 2 (7.4%) 3 (6.3%)
TECHNICAL 6 (15.4%) 0 0 0 0
OTHER 7 (17.9%) 13 (26.5%) 3 (6.3%) 1 (3.7%) 7 (14.6%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: April 1994 - June 2009)
CAUSE OF DEATH0-30 Days
(N = 32)31 Days - 1
Year (N = 36)>1 Year - 3
Years (N = 41)>3 Years - 5
Years (N = 25)>5 Years
(N = 48)
BRONCHIOLITIS 0 1 (2.8%) 19 (46.3%) 9 (37.5%) 10 (20.8%)
ACUTE REJECTION 0 1 (2.8%) 1 (2.4%) 0 0
LYMPHOMA 0 2 (5.6%) 2 (4.9%) 1 (4.2%) 2 (4.2%)
MALIGNANCY, OTHER 0 0 0 1 (4.2%) 0
CMV 0 1 (2.8%) 0 0 0
INFECTION, NON-CMV 4 (12.5%) 13 (36.1%) 4 (9.8%) 0 15 (31.3%)
GRAFT FAILURE 15 (46.9%) 6 (16.7%) 11 (26.8%) 11 (45.8%) 11 (22.9%)
CARDIOVASCULAR 2 (6.3%) 2 (5.6%) 1 (2.4%) 1 (4.2%) 3 (6.3%)
TECHNICAL 4 (12.5%) 0 0 0 0
OTHER 7 (21.9%) 10 (27.8%) 3 (7.3%) 1 (4.2%) 7 (14.6%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death
(Deaths: April 1994 - June 2009)
0
10
20
30
40
50
0-30 Days (N =32)
31 Days – 1Year (N =36)
>1 Year – 3Years (N = 41)
>3 Years – 5Years (N = 24)
>5 Years (N =48 )
Bronchiolitis Graft Failure Cardiovascular Infection (Non-CMV)
Pe
rce
nta
ge
of
De
ath
s
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141