LUNG TRANSPLANTATION Pediatric Recipients 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10):...

LUNG TRANSPLANTATION

Pediatric Recipients

2011ISHLTISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

RECIPIENT AGE DISTRIBUTION FOR PEDIATRIC LUNG RECIPIENTS - NUMBER

(Transplants: January 1986 - June 2010)

0

200

400

600

800

1000

1200

1400

1986-1995 (N=329) 1996-6/2010 (N=1,335)

Nu

mb

er o

f T

ran

spla

nts

<1 1-5 6-11 12-17

Analysis includes living donor transplants ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

RECIPIENT AGE DISTRIBUTION FOR PEDIATRIC LUNG RECIPIENTS - PERCENTAGE


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1986-1995 (N=329) 1996-6/2010 (N=1,335)

% o

f T

ran

sp

lan

ts

12-17

6-11

1-5

<1


DONOR TYPE DISTRIBUTION BY YEAR OF TRANSPLANT FOR PEDIATRIC LUNG RECIPIENTS

(Transplants: 1986-2009)

0

10

20

30

40

50

60

70

80

90

100

110

120

130

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

Nu

mb

er

of

Tra

ns

pla

nts

LivingDeceased

NOTE: This figure includes only the lung transplants that are reported to the ISHLT Transplant Registry. As such, the presented data may not mirror the changes in the number of lung transplants performed worldwide.

Analysis includes living donor transplants

ISHLT 2011ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

DONOR TYPE DISTRIBUTION BY RECIPIENT AGE GROUP WITHIN ERA FOR PEDIATRIC LUNG RECIPIENTS (Transplants: January 1986 - June 2010)

0

100

200

300

400

500

600

700

800

900

1000

0-5 years 6-11 years 12-17years

0-5 years 6-11 years 12-17years

Recipient Age (Years)

Nu

mb

er

of

Tra

ns

pla

nts

Living

Deceased

1986-1995 1996-6/2010


AGE DISTRIBUTION FOR DONORS OF PEDIATRIC LUNG RECIPIENTS (Transplants: January 1986 - June 2010)

658

325

268

189

76

9

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Donor Age (Years)

% o

f T

ran

sp

lan

ts

60+

50-59

35-49

18-34

12-17

0-11


AGE DISTRIBUTION OF PEDIATRIC LUNG RECIPIENTS: By Year of Transplant

1 3 5 7

23

45 48 49

96

82

95 96

73 73 72 7478

8997

102108

112

127

52

0

10

20

30

40

50

60

70

80

90

100

110

120

130

12-17 Years

1-11 Years

<1 Year

Nu

mb

er

of

Tra

ns

pla

nts


NOTE: This figure includes only the pediatric lung transplants that are reported to the ISHLT Transplant Registry. Therefore, these numbers should not be interpreted as the rate of change in pediatric lung procedures performed worldwide.


NUMBER OF CENTERS REPORTING PEDIATRIC LUNG TRANSPLANTS

0

10

20

30

40

50

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

Nu

mb

er

of

Ce

nte

rs R

ep

ort

ing

P

ed

iatr

ic T

ran

sp

lan

ts


NUMBER OF CENTERS REPORTING PEDIATRIC LUNG TRANSPLANTS BY CENTER VOLUME

0

10

20

30

40

50

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

Nu

mb

er

of

Ce

nte

rs R

ep

ort

ing

P

ed

iatr

ic T

ran

sp

lan

ts

20+ transplants

10-19 transplants

5-9 transplants

1-4 transplants


NUMBER OF PEDIATRIC LUNG TRANSPLANTSBY CENTER VOLUME

0

10

20

30

40

50

60

70

80

90

100

110

120

130

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

20+ transplants

10-19 transplants

5-9 transplants

1-4 transplants

Nu

mb

er

of

Tra

ns

pla

nts


PEDIATRIC LUNG TRANSPLANTATION: Indications (Transplants: January 1990 – June 2010)

DIAGNOSIS AGE: < 1 Year

AGE: 1-5 Years

AGE: 6-11 Years

AGE: 12-17 Years

Cystic Fibrosis 1 1.2% 5 4.5% 167 56.0% 775 71.7%

Idiopathic Pulmonary Arterial Hypertension 12 14.0% 25 22.5% 30 10.1% 75 6.9%

Re-Transplant: Obliterative Bronchiolitis 7 6.3% 9 3.0% 34 3.1%

Congenital Heart Disease 13 15.1% 8 7.2% 4 1.3% 9 0.8%

Idiopathic Pulmonary Fibrosis 9 10.5% 20 18.0% 13 4.4% 38 3.5%

Obliterative Bronchiolitis (Not Re-TX) 10 9.0% 19 6.4% 45 4.2%

Re-Transplant: Not OB 3 3.5% 4 3.6% 8 2.7% 27 2.5%

Interstitial Pneumonitis 1 1.2% 2 1.8% 2 0.7%

Pulmonary Vascular Disease 8 9.3% 7 6.3% 3 1.0%

Eisenmenger’s Syndrome 1 1.2% 5 4.5% 5 1.7% 7 0.6%

Pulmonary Fibrosis, Other 5 5.8% 5 4.5% 12 4.0% 22 2.0%

Surfactant Protein B Deficiency 15 17.4% 3 2.7% 1 0.4% 1 0.1%

COPD/Emphysema 4 4.7% 2 1.8% 3 1.0% 9 0.8%

Bronchopulmonary Dysplasia 2 2.3% 2 1.8% 6 2.0% 1 0.1%

Bronchiectasis 1 1.2% 5 1.7% 13 1.2%

Other 11 12.8% 6 5.4% 12 4.0% 26 2.4%


DIAGNOSIS IN PEDIATRIC LUNG RECIPIENTSBY YEAR OF TRANSPLANT

Age: 12-17 Years

0

25

50

75

100

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

% o

f T

ran

sp

lan

ts

IPAH Cystic Fibrosis


0%

20%

40%

60%

80%

100%

Europe (N=359) North America (N=576) Other (N=54)

% o

f T

ran

sp

lan

ts

0-5 years 6-11 years 12-17 years

PEDIATRIC LUNG TRANSPLANTS:AGE DISTRIBUTION BY LOCATIONTransplants between January 2000 and June 2010


0%

20%

40%

60%

80%

100%


% o

f T

ran

sp

lan

ts-

Cystic Fibrosis IPAH IPF OB Other Congenital heart disease Re-TX

PEDIATRIC LUNG TRANSPLANTS:DIAGNOSIS DISTRIBUTION BY LOCATION

Transplants between January 2000 and June 2010

NOTE: Unknown diagnoses were excluded from this tabulation.

Total number of transplants reported:Europe = 359North America = 576Other = 54



0%

20%

40%

60%

80%

100%


% o

f D

on

ors

0-5 6-11 12-17 18-34 35-49 50-59 60+

PEDIATRIC LUNG TRANSPLANTS:DONOR AGE DISTRIBUTION BY LOCATION

Transplants between January 2000 and June 2010

NOTE: Transplants with unknown donor age and living donor transplants were excluded from this tabulation.

Total number of transplants reported:Europe = 359North America = 576Other = 54


LUNG TRANSPLANTATIONKaplan-Meier Survival by Recipient Age Group


0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17Years

Su

rviv

al

(%)

Adult (N=31,794)

Pediatric (N=1,353)

HALF-LIFE Adult = 5.4 Years; Pediatric = 5.5 Years

P = 0.0420


PEDIATRIC LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type


0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14Years

Su

rviv

al

(%)

Single Lung (N=84)

Bilateral/Double Lung (N=1,267)

HALF-LIFE Single Lung: 2.2 Years; Bilateral/double Lung: 5.7 Years

P < .0001


PEDIATRIC LUNG TRANSPLANTATIONKaplan-Meier Survival for Congenital Diagnoses

(Transplants: January 1990 – June 2009)

0

25

50

75

100

0 1 2 3 4Years

Su

rviv

al

(%)

Eisenmenger's Syndrome (N=15)

Other Congenital Heart Disease (N=31)

Eisenmenger's + Other Congenital Heart Disease (N=46)

N at risk = 10N at risk = 13

N at risk = 17

Eisenmenger’s vs. Other: p = 0.4357


PEDIATRIC LUNG TRANSPLANTATIONKaplan-Meier Survival by Recipient Age Group


0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13

Years

Su

rviv

al

(%)

<1 Year (N=83)

1-11 Years (N=365)

12-17 Years (N=905)

<1 year vs. 1-11 years: p = 0.0987<1 year vs. 12-17 years: p = 0.66651-11 years vs. 12-17 years: p = 0.0219

HALF-LIFE<1 Year: 6.4 Years1-11 Years: 7.3 Years12-17 Years: 4.7 Years

N at risk = 11

N at risk = 26

N at risk = 42


PEDIATRIC LUNG TRANSPLANTATIONConditional Kaplan-Meier Survival by Recipient Age Group


0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13

Years

Su

rviv

al

(%)

<1 Year (N=51)1-11 Years (N=267)

12-17 Years (N=650)

<1 year vs. 1-11 year: p = 0.9598<1 year vs. 12-17 years: p = 0.27271-11 years vs. 12-17 years: p =0.0254

N at risk = 11

N at risk = 26

N at risk = 42

CONDITIONAL HALF-LIFE<1 Year: 8.8 Years1-11 Years: 11.2 Years12-17 Years: 7.7 Years


PEDIATRIC LUNG TRANSPLANTATION Kaplan-Meier Survival by Era


0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Years

Su

rviv

al (

%)

1988-1994 (N=210)

1995-2001 (N=501)

2002-6/2009 (N=653)

HALF-LIFEUnconditional 1988-1994: 5.2 Years; 1995-2001: 4.7 Years; 2002-6/2009: 5.7Conditional 1988-1994: 13.6 Years; 1995-2001: 7.8 Years; 2002-6/2009: na

1988-1994 vs. 1995-2001: p = 0.69661988-1994 vs. 2002-6/2009: p = 0.06311995-2001 vs. 2002-6/2009: p = 0.0552

N at risk = 20

N at risk = 42

N at risk = 30


PEDIATRIC LUNG TRANSPLANTATIONKaplan-Meier Survival by Donor Type for Recipients Age 12-17 Years


0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

Deceased Donor (N = 905)

Living Donor (N = 78)

p = 0.0677

N at risk = 21

N at risk = 71

HALF-LIFEDeceased: 4.7 YearsLiving: 3.7 Years


0

5

10

15

20

25

30

0-<1 month 1-<12 months 12-<36 months 36+ months Not reported

Nu

mb

er

of

Re

-Tra

ns

pla

nts

Time Between Previous and Current Transplant

PEDIATRIC LUNG RE-TRANSPLANTS Between January 1994 and June 2010


0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5

Years

Su

rviv

al

(%)

N at risk at 5 years = 17

PEDIATRIC LUNG RETRANSPLANTSSurvival for Transplants Performed Between January 1994 and June 2009


0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5

Years

Su

rviv

al

(%)

<1 Year (N = 30)

1+ Year (N = 59)

N at risk = 10

N at risk = 11

p = 0.1510

PEDIATRIC LUNG RETRANSPLANTSSTRATIFIED BY INTER-TRANSPLANT INTERVAL

Survival for Transplants Performed Between January 1988 and June 2009

ISHLT 2011

Analysis includes living donor transplants. Only patients who were less than 18 years old at the time of re-transplant are included.

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5

Years

Su

rviv

al

(%)

Obliterative Bronchiolitis (N = 51)

Non Obliterative Bronchiolitis (N = 57)

N at risk = 12

N at risk = 10

p = 0.8536

PEDIATRIC LUNG RETRANSPLANTSSTRATIFIED BY DIAGNOSIS

Survival for Transplants Performed Between January 1988 and June 2009

ISHLT 2011

Analysis includes living donor transplants. Only patients who were less than 18 years old at the time of re-transplant are included.


PEDIATRIC LUNG RECIPIENTSCross-Sectional Analysis

Functional Status of Surviving Recipients(Follow-ups: April 1994-June 2010)

0%

20%

40%

60%

80%

100%

1 Year (N = 328) 3 Years (N = 206) 5 Years (N = 127)

No Activity Limitations Performs with Assistance Total Assistance


PEDIATRIC 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 = 237) 2 Years (N = 194) 3 Years (N = 159)

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


PEDIATRIC 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=626) Between 2 and 3 Years(N=383)

Between 4 and 5 Years(N=226)

No Hospitalization Hospitalized, Not Rejection/Not Infection

Hospitalized, Rejection Hospitalized, Infection Only

Hospitalized, Rejection + Infection


PEDIATRIC LUNG RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients


0%

20%

40%

60%

80%

100%

Up to 1 Year (N=626) Between 1 and 3 Years(N=348)

Between 3 and 5 Years(N=207)

No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Hospitalized, Infection OnlyHospitalized, Rejection + Infection


0

10

20

30

40

50

60

70

Any Induction (N = 282) Polyclonal ALG/ATG (N = 65) IL-2R Antagonist (N = 214)

% o

f p

ati

en

tsPEDIATRIC LUNG RECIPIENTS

Induction ImmunosuppressionFor transplants between January 2001 and June 2010

Analysis is limited to patients who were alive at the time of the discharge


0

10

20

30

40

50

60

70

80

Any Induction Polyclonal ALG/ATG IL-2R Antagonist

% o

f p

atie

nts

2001 20022003 20042005 20062007 20082009 1/2010-6/2010

PEDIATRIC LUNG RECIPIENTSInduction Immunosuppression (Transplants: January 2001 - June 2010)

Analysis is limited to patients who were alive at the time of the discharge


PEDIATRIC LUNG TRANSPLANTATIONKaplan-Meier Survival Stratified by Induction Use


0

25

50

75

100

0 1 2 3 4 5

Years

Su

rviv

al

(%)

Induction (N = 230)

No Induction (N = 160)

p = 0.8136

HALF-LIFEInduction: 6.1 YearsNo Induction: 5.1 Years


0

20

40

60

80

100

Cyclosporine Tacrolimus Sirolimus MMF Azathioprine Prednisone

% o

f P

atie

nts

Year 1 (N = 348) Year 5 (N = 153)

PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up

(Follow-ups: January 2001 – 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


0

20

40

60

80

100

CalcineurinInhibitor

CellCycle Prednisone CalcineurinInhibitor

CellCycle Prednisone

% o

f P

atie

nts

CyA

TacTac

CyAAZA AZA

MMFMMF

PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up


1 Year Follow-up (N = 348) 5 Year Follow-up (N = 153)NOTE: Different patients are analyzed in Year 1 and Year 5

NOTE: 5% of patients were on both calcineurin inhibitors at different point during the 1-year; these patients are not counted in either group. And 0.3% (1 patient) was on neither drug during the 1-year. In the 5-year tabulations, 13% were reported to be on both drugs during the year and 1% (2 patients) was reported to be on neither drugs.



0%

20%

40%

60%

80%

100%

Year 1 (N = 348) Year 5 (N = 153)

% o

f P

ati

en

ts

Other

Tacrolimus + MMF

Tacrolimus + AZA

Cyclosporine + MMF

Cyclosporine + AZA

PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up Report


NOTE: Different patients are analyzed in Year 1 and Year 5



POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 1 Year Post-Transplant


Outcome Within 1

Year

Total number with known response

Hypertension 42.2% (N = 604)

Renal Dysfunction 10.2% (N = 618)

Abnormal Creatinine < 2.5 mg/dl 7.3% Creatinine > 2.5 mg/dl 1.9% Chronic Dialysis 0.6% Renal Transplant 0.3%

Hyperlipidemia 4.8% (N = 622)

Diabetes 24.7% (N = 619)

Bronchiolitis Obliterans Syndrome 13.7% (N = 577)


POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 5 Years Post-Transplant


Outcome Within 5

Years Total number with known response

Hypertension 68.8% (N = 160)

Renal Dysfunction 20.1% (N = 169) Abnormal Creatinine < 2.5 mg/dl 13.6% Creatinine > 2.5 mg/dl 3.0% Chronic Dialysis 2.4% Renal Transplant 1.2%

Hyperlipidemia 14.5% (N = 165)

Diabetes 34.3% (N = 166)



POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 7 Years Post-Transplant


Outcome Within 7

Years Total number with known response

Renal Dysfunction 31.0% (N = 84)

Abnormal Creatinine < 2.5 mg/dl 21.4% Creatinine > 2.5 mg/dl 3.6% Chronic Dialysis 0.0% Renal Transplant 6.0%

Diabetes 33.9% (N = 62)



Freedom from Bronchiolitis Obliterans Syndrome For Pediatric Lung Recipients (Follow-ups: April 1994 - June 2010)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

% F

ree

fro

m B

ron

ch

iolit

is O

blit

era

ns

S

yn

dro

me


Freedom from Bronchiolitis Obliterans SyndromeStratified by Age Group

For Pediatric Lung Recipients (Follow-ups: April 1994 - June 2010)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6

Years

<1 Year (N=50)

1-11 Years (N=187)

12-17 Years (N=344)

% F

ree

fro

m B

ron

ch

iolit

is O

blit

era

ns

S

yn

dro

me

p = 0.0434


Freedom from Bronchiolitis Obliterans SyndromeStratified by Diagnosis

For Pediatric Lung Recipients (Follow-ups: April 1994 - June 2010)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5

Years

Cystic Fibrosis (N=315)

IPAH (N=58)

% F

ree

fro

m B

ron

ch

iolit

is O

blit

era

ns

S

yn

dro

me

p = 0.1604


Freedom from Bronchiolitis Obliterans Syndrome For Pediatric Lung Recipients by Induction Use


0

25

50

75

100

0 1 2 3 4 5 6

Years

Induction (N = 229)

No Induction (N =323)

p = 0.7123

% F

ree

fro

m B

ron

ch

iolit

is O

blit

era

ns

S

yn

dro

me


Freedom from Severe Renal Dysfunction*For Pediatric Lung Recipients (Follow-ups: April 1994 - June 2010)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8

Years

* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant

% F

ree

fro

m S

ev

ere

Re

na

l Dy

sfu

nc

tio

n


MALIGNANCY POST-LUNG TRANSPLANTATION FOR PEDIATRICSCumulative Incidence for Survivors (Follow-ups: April 1994 - June 2010)

Malignancy/Type 1-Year Survivors

5-Year Survivors

7-Year Survivors

No Malignancy 596 (94.5%) 152 (88.4%) 77 (89.5%)

Malignancy (all types combined) 35 (5.5%) 20 (11.6%) 9 (10.5%)

Malignancy Type*

Lymph 32 20 9

Other 2 1 0

Type Not Reported 1 0 0

”Other” includes Liver and primitive neuroectodermal tumor.

* Recipients may have experienced more than one type of malignancy so sum of individual malignancy types may be greater than total number with malignancy.


Freedom from MalignancyFor Pediatric 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

All malignancy Lymph Skin Other% F

ree

fro

m M

alig

na

nc

y


PEDIATRIC LUNG TRANSPLANT RECIPIENTS: Cause Of Death(Deaths: January 1992- June 2010)

CAUSE OF DEATH0-30 Days

(N =97)31 Days - 1 Year

(N = 135)

>1 Year - 3 Years

(N = 176)

>3 Years - 5 Years

(N = 83)

>5 Years

(N = 82)

BRONCHIOLITIS 13 (9.6%) 70 (39.8%) 34 (41.0%) 34 (41.5%)

ACUTE REJECTION 3 (3.1%) 3 (2.2%) 1 (0.6%) 2 (2.4%) 3 (3.7%)

LYMPHOMA 7 (5.2%) 5 (2.8%) 4 (4.8%) 5 (6.1%)

MALIGNANCY, NON-LYMPHOMA

1 (0.7%) 1 (0.6%) 2 (2.4%) 3 (3.7%)

CMV 5 (3.7%)

INFECTION, NON-CMV 13 (13.4%) 46 (34.1%) 26 (14.8%) 17 (20.5%) 11 (13.4%)

GRAFT FAILURE 30 (30.9%) 27 (20.0%) 45 (25.6%) 11 (13.3%) 14 (17.1%)

CARDIOVASCULAR 15 (15.5%) 6 (4.4%) 4 (2.3%) 1 (1.2%) 1 (1.2%)

TECHNICAL 11 (11.3%) 3 (2.2%) 1 (0.6%) 1 (1.2%) 1 (1.2%)

MULTIPLE ORGAN FAILURE

8 (8.2%) 13 (9.6%) 9 (5.1%) 3 (3.6%) 7 (8.5%)

OTHER 17 (17.5%) 11 (8.1%) 14 (8.0%) 8 (9.6%) 6 (7.3%)


PEDIATRIC 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 = 97)

31 Days – 1Year (N = 135)

>1 Year – 3Years (N =176)

>3 Years – 5Years (N = 83)

>5 Years (N = 82 )

Bronchiolitis Infection (non-CMV)

Graft Failure Cardiovascular

Multiple Organ Failure

Pe

rce

nta

ge

of

De

ath

s


N=795

PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1992-6/2009) Risk Factors For 1 Year Mortality/Graft Failure

ISHLT 2011

VARIABLE N Relative Risk

P-value 95% Confidence Interval

Single lung transplant 15 3.15 0.0026 1.49 - 6.63

On ventilator 124 3.14 <.0001 2.08 - 4.75

Year of transplant: 1992-1999 vs. 2000-6/2009 329 2.08 <.0001 1.50 - 2.90

Donor CMV+/Recipient CMV- 252 1.31 0.0920 0.96 - 1.79


N=795


ISHLT 2011

Continuous Factors (see figures)

Pediatric transplant center volume

Recipient age (borderline)


0

0.5

1

1.5

2

0 5 10 15 20

Center Volume (cases per year)

Rel

ativ

e R

isk

of

1 Y

ear

Mo

rtal

ity

p = 0.0143


Center Volume Pediatric Transplants


0

0.5

1

1.5

2

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Recipient Age

Rel

ativ

e R

isk

of

1 Y

ear

Mo

rtal

ity

p = 0.0738


Recipient Age


N=583


ISHLT 2011

VARIABLE N Relative Risk

P-value 95% Confidence Interval


On ventilator 88 2.27 <.0001 1.53 - 3.36

Year of transplant: 1992-1999 vs. 2000-6/2005 329 1.59 <.0001 1.26 - 2.01


N=583


ISHLT 2011


Recipient age

Height difference (borderline)


0

0.5

1

1.5

2

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Recipient Age

Rel

ativ

e R

isk

of

5 Y

ear

Mo

rtal

ity

p = 0.0179


Recipient Age



Height Difference

0

0.5

1

1.5

2

-15 -10 -5 0 5 10 15 20

Donor Height - Recipient Height (cm)

p = 0.0999

Rel

ativ

e R

isk

of

5 Y

ear

Mo

rtal

ity


N=380


ISHLT 2011

VARIABLE N Relative Risk P-value 95% Confidence Interval

On ventilator 66 2.12 <.0001 1.48 - 3.03



N=380


ISHLT 2011


Recipient age


0

0.5

1

1.5

2

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Recipient Age

Rel

ativ

e R

isk

of

10 Y

ear

Mo

rtal

ity

p = 0.0195


Recipient Age


LUNG TRANSPLANTATION Pediatric Recipients 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10):...

Documents

Transcript of LUNG TRANSPLANTATION Pediatric Recipients 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10):...