HEART-LUNG TRANSPLANTATION
Overall
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
NUMBER OF HEART-LUNG
TRANSPLANTS REPORTED BY YEAR
300
200
150
100
50
0
19
8
19 2
8
19 3
8
19 4
8
19 5
8
19 6
8
19 7
8
19 8
8
19 9
9
19 0
9
19 1
9
19 2
9
19 3
9
19 4
9
19 5
9
19 6
9
19 7
9
19 8
9
20 9
0
20 0
0
20 1
0
20 2
0
20 3
0
20 4
0
20 5
0
20 6
0
20 7
0
20 8
09
Number of Transplants
250
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
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.
AVERAGE CENTER VOLUME
60
55
50
45
40
35
30
25
20
15
10
5
0
60
35
1/year
2/year
11
8
3/year
4-9/year
Average number of heart-lung transplants per year
Number of centers
ISHLT
Percentage of transplants
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
60
55
50
45
40
35
30
25
20
15
10
5
0
%of heart-lung transplants
Number of centers
Heart-Lung Transplants: January 1, 1998 - June 30, 2010
DISTRIBUTION OF HEART-LUNG
TRANSPLANTS BY CENTER VOLUME
Percentage of heart-lung transplants
Heart-Lung Transplants: January 1, 1998 - June 30, 2010
40
35
30
25
20
15
10
5
0
3
2
1
Average number of heart-lung transplants per year
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
4-9
DISTRIBUTION OF HEART-LUNG
TRANSPLANTS BY LUNG CENTER VOLUME
Lung Transplants: January 1, 1998 - June 30, 2010
Percentage of heart-lung transplants
40
35
30
25
20
15
10
5
0
1-4
5-9
10-19
20-29
30-39
40-49
Average number of lung transplants per year
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
50+
HEART-LUNG TRANSPLANTATION
Kaplan-Meier Survival for All Ages
(Transplants: January 1982 - June 2009)
100
Half-life = 4.8 years
Conditional Half-life = 12 years
80
Survival (%)
N=3,957
60
40
N at risk at 22 years = 48
20
0
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
HEART-LUNG TRANSPLANTATION
Adult Recipients
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
DIAGNOSIS IN ADULT HEART-LUNG
TRANSPLANTS (January 1982 - June 2010)
CF
14%
IPF
4%
IPAH
28%
COPD/Alpha-1
6%
“Other” includes cancer,
LAM, OB, sarcoidosis,
Re-transplant bronchiectasis
2%
Other
6%
Acquired
heart disease
5%
Congenital
heart disease
36%
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS
(Transplants: January 1982 - June 2010)
N (%)
Diagnosis
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
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA
(Transplants: January 1982 - June 2010)
100%
90%
Other
80%
% of Transplants
Sarcoidosis
70%
Re-TX
60%
IPAH
50%
IPF
40%
CF
30%
COPD/Alpha-1
20%
Congenital Heart Disease
10%
Acquired Heart Disease
0%
1982-1995
(N=1,651)
1996-1999
(N=549)
2000-6/2010
(N=912)
“Other” includes OB (non-ReTX) and Bronchiectasis
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART-LUNG TRANSPLANTATION
Major Indications By Year (%)
100
Congenital Heart Disease
Cystic Fibrosis
Retransplant
IPAH
COPD/Alpha-1
Acquired Heart Disease
60
40
20
0
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
% of Transplants
80
Transplant Year
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART-LUNG TRANSPLANTATION
Major Indications By Year (Number)
175
Congenital Heart Disease
IPAH
Cystic Fibrosis
COPD/Alpha-1
Retransplant
Acquired Heart Disease
125
100
75
50
25
ISHLT
Transplant Year
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
20
09
20
08
20
07
20
06
20
05
20
04
20
03
20
02
20
01
20
00
19
99
19
98
19
97
19
96
19
95
19
94
19
93
19
92
19
91
0
19
90
Number of Transplants
150
ADULT HEART-LUNG TRANSPLANTS:
AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2010
18 - 34 years
35 - 49 years
50 - 59 years
60+ years
% of Transplants
100%
80%
60%
40%
20%
0%
Europe
ISHLT
North America
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Other
ADULT HEART-LUNG TRANSPLANTS:
DIAGNOSIS DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2010
Acquired heart disease
Congenital heart disease
Cystic Fibrosis
IPF
IPAH
% of Transplants
100%
80%
60%
40%
20%
0%
Europe
ISHLT
North America
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Other
Other
ADULT HEART-LUNG TRANSPLANTS:
DONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2010
6-11
12-17
18-34
35-49
50-59
60+
100%
% of Donors
80%
60%
40%
20%
0%
Europe
ISHLT
North America
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Other
HEART-LUNG TRANSPLANTATION
Kaplan-Meier Survival for Adult Recipients
(Transplants: January 1982 - June 2009)
100
Half-life = 5 Years
Conditional Half-life = 12 Years
Survival (%)
80
N=3,303
60
40
N at risk at 22 years = 42
20
0
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
HEART-LUNG TRANSPLANTATION
Kaplan-Meier Survival for Adult Recipients by Era
(Transplants: January 1982 - June 2009)
100
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
Survival (%)
80
60
40
1982-1995 (N=1,940)
20
1996-1999 (N=572)
P-value comparing all: 0.2944
2000-6/2009 (N=791)
0
0
1
2
3
4
5
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
6
7
8
9
10
ADULT HEART-LUNG TRANSPLANTATION
Kaplan-Meier Survival By Diagnosis
(Transplants: January 1990 – June 2009)
100
Other Congenital (N = 294)
Eisenmenger's Syndrome (N = 588)
IPAH (N = 578)
Survival (%)
75
HALF-LIFE Congenital: 3.7 Years;
Eisenmenger's: 6.5 Years; IPAH: 5.0 Years
50
25
Congenital vs. Eisenmenger's: p = 0.0103
Congenital vs. IPAH: p = 0.0350
Eisenmenger's vs. IPAH: p = 0.3050
0
0
1
2
3
4
5
6
7
8
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
9
10
11
12
13
14
15
ADULT HEART-LUNG TRANSPLANTATION
Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year
(Transplants: January 1990 – June 2009)
100
Other Congenital (N = 163)
Eisenmenger's Syndrome (N = 399)
IPAH (N = 409)
Survival (%)
75
50
HALF-LIFE Congenital Years: 13.6;
Eisenmenger's: 11.4 Years; IPAH: 10.1
Years
25
Congenital vs. Eisenmenger's: p = 0.6674
Congenital vs. IPAH: p = 0.1964
Eisenmenger's vs. IPAH: p = 0.0121
0
0
1
2
3
4
5
6
7
8
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
9
10
11
12
13
14
15
ADULT HEART-LUNG RECIPIENTS
Cross-Sectional Analysis
Functional Status of Surviving Recipients
(Follow-ups: April 1994 – June 2010)
100%
80%
60%
40%
20%
No Activity Limitations
Performs with Some Assistance
Requires Total Assistance
0%
1 Year (N = 264)
ISHLT
3 Years (N = 212)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
5 Years (N = 181)
ADULT HEART-LUNG RECIPIENTS
Functional Status of Surviving Recipients
US Recipients Only
(Follow-ups: March 2005 - June 2010)
100%
10%
80%
20%
30%
40%
60%
50%
60%
40%
70%
80%
20%
90%
100%
0%
1 Year (N = 118)
ISHLT
2 Years (N = 88)
3 Years (N = 83)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
ADULT HEART-LUNG RECIPIENTS
Employment Status of Surviving Recipients
(Follow-ups: April 1994 – June 2010)
100%
80%
Working (FT/PT
status unknown)
Retired
60%
Not Working
40%
Working Part Time
Working Full Time
20%
0%
1 Year (N = 332)
ISHLT
3 Years (N = 242)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
5 Years (N = 214)
ADULT HEART-LUNG RECIPIENTS:
Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2010)
100%
80%
60%
40%
20%
No Hospitalization
Hospitalized, Rejection Only
Hospitalized, Rejection and Infection
Hospitalized, Not Rejection/Not Infection
Hospitalized, Infection Only
0%
Up to 1 Year (N = 415)
ISHLT
Between 2 and 3 Years
301)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
(N =
Between 4 and 5 Years
246)
(N =
ADULT HEART-LUNG RECIPIENTS
Induction Immunosuppression
For transplants between January 2001 through June 2010
70
60
% of patients
50
40
30
20
10
0
Any Induction (N =
166)
ISHLT
Polyclonal ALG/ATG
(N = 64)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
OKT3 (N = 5)
IL-2R Antagonist (N =
82)
Analysis is limited to patients who were alive
at the time of the discharge
ADULT HEART-LUNG RECIPIENTS
Induction Immunosuppression (Transplants: January 2000 - December 2009)
100
90
Any Induction
OKT3
Polyclonal ALG/ATG
IL-2R Antagonist
80
% of patients
70
60
50
40
30
20
10
0
2000
2001
ISHLT
2002
2003
2004
2005
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
2006
2007
2008
2009
Analysis is limited to patients who were alive
at the time of the discharge
ADULT HEART-LUNG RECIPIENTS
Induction Immunosuppression (Transplants: January 2000 - December 2009)
90
80
% of patients
70
60
50
40
30
20
10
0
00 01 02 03 04 05 06 07 08 09 000001002003004005006007008009 000001002003004005006007008009 000001002003004005006007008009
20 20 20 20 20 20 20 20 20 20
2 2 2 2 2 2 2 2 2 2
2 2 2 2 2 2 2 2 2 2
2 2 2 2 2 2 2 2 2 2
Any Induction
ISHLT
Polyclonal ALG/ATG
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
OKT3
IL-2R Antagonist
Analysis is limited to patients who were alive
at the time of the discharge
ADULT HEART-LUNG RECIPIENTS
Maintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2001 through June 2010
100
Year 1 (N = 181)
Year 5 (N = 115)
% of Patients
80
60
40
20
0
Cyclosporine
Tacrolimus
Sirolimus
MMF
Azathioprine
Prednisone
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Analysis is limited to patients who were
alive at the time of the follow-up
ADULT HEART-LUNG RECIPIENTS
Maintenance Immunosuppression Drug Combinations at Time of Follow-up
For follow-ups between January 2001 through June 2010
100%
Other
80%
% of Patients
None
Tacrolimus
60%
Tacrolimus + MMF
40%
Tacrolimus + AZA
Cyclosporine + MMF
20%
Cyclosporine + AZA
0%
Year 1 (N = 181)
Year 5 (N = 115)
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Analysis is limited to patients who were
alive at the time of the follow-up
POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS
Cumulative Prevalence in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994 - June 2010)
Within 1
Year
Total number with
known response
Hypertension
58.5%
(N = 386)
Renal Dysfunction
Abnormal Creatinine < 2.5 mg/dl
Creatinine > 2.5 mg/dl
Chronic Dialysis
Renal Transplant
18.4%
12.1%
2.9%
3.2%
0.2%
(N = 412)
Hyperlipidemia
26.4%
(N = 406)
Diabetes
19.1%
(N = 414)
Coronary Artery Vasculopathy
3.1%
(N = 327)
Bronchiolitis Obliterans Syndrome
8.5%
(N = 388)
Outcome
ISHLT
2011
J 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)
Within 5
Years
Total number with
known response
Hypertension
87.6%
(N = 137)
Renal Dysfunction
Abnormal Creatinine < 2.5 mg/dl
Creatinine > 2.5 mg/dl
Chronic Dialysis
Renal Transplant
26.3%
18.8%
6.3%
1.3%
0.0%
(N = 160)
Hyperlipidemia
68.8%
(N = 144)
Diabetes
26.1%
(N = 153)
Coronary Artery Vasculopathy
7.2%
(N = 83)
Bronchiolitis Obliterans Syndrome
27.9%
(N = 129)
Outcome
ISHLT
2011
J 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)
% Free from CAV and Bronchiolitis
Obliterans Syndrome
100
90
80
70
60
Freedom from Coronary Artery Vasculopathy
50
Freedom from Bronchiolitis Obliterans Syndrome
40
0
1
2
3
4
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
5
6
7
Freedom from Coronary Artery Vasculopathy
For Adult Heart-Lung Recipients By Diagnosis Type
(Follow-ups: April 1994-June 2010)
100
% Free from CAV
90
80
70
Heart (N=186)
Lung (N=54)
60
Heart/Lung (N=79)
P-value comparing all = 0.4542
50
0
1
2
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
3
4
Freedom from Bronchiolitis Obliterans Syndrome
For Adult Heart-Lung Recipients By Diagnosis Type
% Free from Bronchiolitis Obliterans
Syndrome
(Follow-ups: April 1994-June 2010)
100
Heart (N=215)
Lung (N=64)
Heart/Lung (N=102)
90
80
70
60
P-value comparing all = 0.7620
50
0
1
2
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
3
4
Freedom from Severe Renal Dysfunction*
% Free from Severe Renal Dysfunction
For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2010)
100
90
80
70
*Severe renal dysfunction = Creatinine > 2.5 mg/dl
(221 μmol/L), dialysis or renal transplant
60
50
0
1
2
3
4
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
5
6
7
8
MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTS
Cumulative Prevalence in Survivors (Follow-ups: April 1994-June 2010)
Malignancy/Type
1-Year
Survivors
5-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*
10-Year
Survivors
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
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Freedom from Malignancy
For Adult Heart-Lung Recipients (Follow-ups: April 1994- June 2010)
% Free from Malignancy
100
90
80
All malignancy
Lymph
Skin
Other
70
60
50
0
1
2
3
4
5
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
6
7
8
9
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)
0
6 (2.4%)
50 (22.4%)
32 (21.2%)
66 (16.9%)
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%)
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%)
BRONCHIOLITIS
ACUTE REJECTION
CARDIOVASCULAR
ISHLT
2011
J 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)
50
Bronchiolitis
Infection (non-CMV)
Cardiovascular
Technical
Graft Failure
Percentage of Deaths
40
30
20
10
0
0-30 Days (N =
321)
ISHLT
31 Days – 1
Year (N =241)
>1 Year – 3
Years (N = 223)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
>3 Years – 5
Years (N = 151)
>5 Years (N =
391 )
HEART-LUNG TRANSPLANTATION
Pediatric Recipients
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG
RECIPIENTS (Transplants: January 1982 - June 2010)
400
Number of Transplants
350
300
250
200
150
100
50
0
<1
ISHLT
1-5 yrs
6-11 yrs
Recipient Age (Years)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
12-17 yrs
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEARTLUNG RECIPIENTS (Transplants: January 1982 - June 2010)
400
Number of Transplants
350
372
300
250
200
150
100
108
50
56
37
6
35-49
50-59
0
0-11 yrs
ISHLT
12-17 yrs
18-34
Donor Age (Years)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
65
60
55
50
45
40
35
30
25
20
15
10
5
0
12-17 Years
1-11 Years
<1 Year
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
Number of Transplants
AGE DISTRIBUTION OF
PEDIATRIC HEART-LUNG RECIPIENTS
By Year of Transplant
ISHLT
2011
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.
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
AGE DISTRIBUTION OF
PEDIATRIC HEART-LUNG RECIPIENTS
By Era of Transplant
Percentage of Transplants
100%
12-17 Years
90%
1-11 Years
80%
<1 Year
70%
60%
50%
40%
30%
20%
10%
0%
1982-1995
ISHLT
1996-6/2010
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
NUMBER OF CENTERS REPORTING
PEDIATRIC HEART-LUNG TRANSPLANTS
25
20
15
10
NEED TO UPDATE
5
0
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
# Pediatric Transplant Centers
30
Transplant Year
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
NUMBER OF CENTERS REPORTING
PEDIATRIC HEART-LUNG TRANSPLANTS
Stratified by center volume
25
1-4/yr
5-9/yr
10-19/yr
20-29/yr
20
15
10
5
0
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
# Pediatric Transplant Centers
30
Transplant Year
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
DIAGNOSIS IN PEDIATRIC HEART-LUNG
TRANSPLANT RECIPIENTS (Transplants: 1986-2009)
“Other” includes
Bronchiectasis,
Alpha-1, and OB
(non-ReTX)
4%
2%
2%
2%
13%
22%
4%
28%
Acquired Heart Disease
CF
Congenital (other)
Eisenmenger's Syndrome
IPF
Other
PPH
Retx: Non-OB
Retx: OB
100
Cystic Fibrosis
75
Congenital
IPAH
50
25
0
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
% of Cases
25%
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
NOTE: Unknown diagnoses were excluded
from this tabulation.
PEDIATRIC HEART-LUNG TRANSPLANTS:
AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2010
0-5 years
6-11 years
12-17 years
% of Transplants
100%
80%
60%
40%
20%
0%
Europe
ISHLT
North America
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Other
PEDIATRIC HEART-LUNG TRANSPLANTS:
DIAGNOSIS DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2010
Congenital heart disease
Cystic Fibrosis
Other
IPAH
% of Transplants
100%
80%
60%
40%
20%
0%
Europe
ISHLT
North America
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Other
PEDIATRIC HEART-LUNG TRANSPLANTS:
DONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2010
0-5
6-11
12-17
18-34
35-49
100%
% of Donors
80%
60%
40%
20%
0%
Europe
ISHLT
North America
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Other
PEDIATRIC HEART-LUNG TRANSPLANTATION
(Transplants: January 1990 – June 2009)
Kaplan-Meier Survival By Diagnosis
100
Congenital (N = 94)
Eisenmenger's Syndrome (N = 48)
IPAH (N = 101)
Survival (%)
75
HALF-LIFE Congenital: 2.1 Years;
Eisenmenger's: 2.7 Years; IPAH: 4.7 Years
50
25
Congenital vs. Eisenmenger's: p = 0.2696
Congenital vs. IPAH: p = 0.0582
Eisenmenger's vs. IPAH: p = 0.6870
0
0
1
2
3
4
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
5
6
7
PEDIATRIC HEART-LUNG TRANSPLANTATION
Kaplan-Meier Survival (Transplants: January 1982 - June 2009)
100
< 1 (N = 21)
1-11 (N = 256)
12-17 (N = 356)
Overall (N = 633)
0-<1 vs. 1-11: p = 0.0013;
0-<1 vs. 12-17: p < 0.0005;
1-11 vs. 12-17: p = 0.1578
Survival (%)
75
Half-life <1: 0.4 Years;
1-11: 4.2 Years; 12-17: 5.5 Years
50
25
0
0
1
2
3
4
5
6
7
8
9
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
10 11 12 13 14 15 16 17 18
PEDIATRIC HEART-LUNG TRANSPLANTATION
Kaplan-Meier Survival by Era
(Transplants: January 1982 - June 2009)
100
1982-1988 (N=120)
1989-1993 (N=223)
1994-1998 (N=138)
1999-6/2009 (N=152)
Survival (%)
75
Half-life 1982-1988: 2.6; 1989-1993: 5.5;
1994-1998: 4.4; 1999-6/2009: 4.2
50
25
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
0
0
1
2
3
4
5
6
7
8
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
9
10
11
12
13
14
15
PEDIATRIC HEART-LUNG TRANSPLANTATION
Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2009)
Conditional on Survival to 1 Year
100
1982-1988 (N=61)
1989-1993 (N=111)
1994-1998 (N=77)
1999-6/2009 (N=90)
Survival (%)
80
Conditional HALF-LIFE 1982-1988:
13.1; 1989-1993: 14.9; 1994-1998: 8.9;
1999-6/2009: na
60
40
20
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
0
0
1
2
3
4
5
6
7
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
8
9
10
11
12
13
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS:
Cause of Death (Deaths: January 1992 - June 2010)
0-30 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%)
CAUSE OF DEATH
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS:
Cause of Death (Deaths: April 1994 - June 2010)
0-30 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
4 (11.4%)
14 (34.1%)
6 (13.6%)
0
18 (27.3%)
15 (42.9%)
7 (17.1%)
11 (25.0%)
11 (44.0%)
11 (16.7%)
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%)
CAUSE OF DEATH
INFECTION, NON-CMV
GRAFT FAILURE
CARDIOVASCULAR
ISHLT
2011
J 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)
Bronchiolitis
Graft Failure
Cardiovascular
Infection (Non-CMV)
Percentage of Deaths
50
40
30
20
10
0
0-30 Days (N =
35)
ISHLT
31 Days – 1
Year (N =41)
>1 Year – 3
Years (N = 44)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
>3 Years – 5
Years (N = 25)
>5 Years (N =
66)