HEART-LUNG TRANSPLANTATION
Overall
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
NUMBER OF HEART-LUNG
TRANSPLANTS REPORTED BY YEAR
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
04
20
0
20 5
0
20 6
0
20 7
08
Number of Transplants
250
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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
Heart-Lung Transplants: January 1, 1998 - June 30, 2009
50
50
Number of centers
45
40
40
35
30
25
30
49
20
20
36
15
10
10
5
8
0
1
2
3
4
1
4-9
10+
0
Average number of heart-lung transplants per year
Number of centers
ISHLT
Percentage of transplants
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Percentage of heart-lung transplants
55
DISTRIBUTION OF HEART-LUNG
TRANSPLANTS BY CENTER VOLUME
Percentage of heart-lung transplants
Heart-Lung Transplants: January 1, 1998 - June 30, 2009
40
35
30
25
20
15
10
5
0
2
1
3
4-9
Average number of heart-lung transplants per year
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
10+
DISTRIBUTION OF HEART-LUNG
TRANSPLANTS BY LUNG CENTER VOLUME
Lung Transplants: January 1, 1998 - June 30, 2009
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
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
50+
HEART-LUNG TRANSPLANTATION
Kaplan-Meier Survival for All Ages
(Transplants: January 1990 - June 2008)
100
Half-life = 3.1 years
Conditional Half-life = 9.1 years
80
Survival (%)
N=3,406
60
40
N at risk at 20 years = 36
20
0
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20
Years
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
HEART-LUNG TRANSPLANTATION
Adult Recipients
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
DIAGNOSIS IN ADULT HEART-LUNG
TRANSPLANTS (January 1982 - June 2009)
CF
14%
IPF
3%
IPAH
27%
COPD/Alpha-1
6%
“Other” includes cancer,
Re-transplant LAM, OB, sarcoidosis,
bronchiectasis
2%
Other
6%
Acquired
heart disease
5%
Congenital
heart disease
37%
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS
(Transplants: January 1982 - June 2009)
N (%)
Diagnosis
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%)
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA
(Transplants: January 1982 - June 2009)
100%
Other
80%
% of Transplants
Re-TX
IPAH
60%
IPF
CF
40%
COPD/Alpha-1
Congenital Heart Disease
20%
Acquired Heart Disease
0%
1982-1995
1996-1999
2000-6/2009
“Other” includes OB (non-ReTX), Bronchiectasis, Sarcoidosis
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
ADULT HEART-LUNG TRANSPLANTATION
Major Indications By Year (%)
Congenital Heart Disease
Cystic Fibrosis
Retransplant
100
IPAH
COPD/Alpha-1
60
40
20
Transplant Year
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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
% of Transplants
80
ADULT HEART-LUNG TRANSPLANTATION
Major Indications By Year (Number)
175
Congenital Heart Disease
IPAH
Cystic Fibrosis
COPD/Alpha-1
Retransplant
125
100
75
50
25
ISHLT
Transplant Year
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2009
18 - 34 years
35 - 49 years
50 - 59 years
60+ years
% of Transplants
100%
80%
60%
40%
20%
0%
Europe
ISHLT
North America
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Other
ADULT HEART-LUNG TRANSPLANTS:
DIAGNOSIS DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2009
Acquired heart disease
Congenital heart disease
Cystic Fibrosis
IPF
IPAH
% of Transplants
100%
80%
60%
40%
20%
0%
Europe
ISHLT
North America
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Other
Other
ADULT HEART-LUNG TRANSPLANTS:
DONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2009
6-11
12-17
18-34
35-49
50-59
60+
100%
% of Donors
80%
60%
40%
20%
0%
Europe
ISHLT
North America
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Other
HEART-LUNG TRANSPLANTATION
Kaplan-Meier Survival for Adult Recipients
(Transplants: January 1982 - June 2008)
100
Half-life = 3.6 Years
Conditional Half-life = 9.5
Years
Survival (%)
80
N=2,774
60
40
N at risk at 20 years = 28
20
0
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20
Years
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
HEART-LUNG TRANSPLANTATION
Kaplan-Meier Survival for Adult Recipients by Era
(Transplants: January 1982 - June 2008)
100
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
Survival (%)
80
60
40
1982-1995 (N=1,648)
20
1996-1999 (N=498)
P-value comparing all: 0.0002
2000-6/2008 (N=628)
0
0
1
2
3
4
5
Years
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
6
7
8
9
10
ADULT HEART-LUNG TRANSPLANTATION
Kaplan-Meier Survival By Diagnosis
(Transplants: January 1990 – June 2008)
100
Other Congenital (N = 248)
Eisenmenger's Syndrome (N = 535)
IPAH (N = 496)
Survival (%)
75
HALF-LIFE Congenital: 1.9 Years;
Eisenmenger's: 6.3 Years; IPAH: 3.8 Years
50
25
Congenital vs. Eisenmenger's: p = 0.0026
Congenital vs. IPAH: p = 0.1519
Eisenmenger's vs. IPAH: p = 0.0282
0
0
1
2
3
4
5
6
7
8
Years
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2008)
100
Other Congenital (N = 130)
Eisenmenger's Syndrome (N = 356)
IPAH (N = 327)
Survival (%)
75
50
HALF-LIFE Congenital Years: 13.6;
Eisenmenger's: 10.8 Years; IPAH: 9.1
Years
25
Congenital vs. Eisenmenger's: p = 0.6373
Congenital vs. IPAH: p = 0.1180
Eisenmenger's vs. IPAH: p = 0.0038
0
0
1
2
3
4
5
6
7
8
Years
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
9
10
11
12
13
14
15
ADULT HEART-LUNG RECIPIENTS
Cross-Sectional Analysis
Functional Status of Surviving Recipients
(Follow-ups: April 1994 – June 2009)
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)
5 Years (N = 180)
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
7 Years (N = 153)
ADULT HEART-LUNG RECIPIENTS
Longitudinal Analysis
Functional Status of Surviving Recipients
For the Same Patients
(Follow-ups: April 1994 – June 2009)
100%
80%
60%
40%
20%
No Activity Limitations
Performs with Some Assistance
0%
1 Year (N = 102)
ISHLT
3 Years (N = 102)
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
5 Years (N = 102)
ADULT HEART-LUNG RECIPIENTS
Functional Status of Surviving Recipients
US Recipients Only
(Follow-ups: March 2005 - June 2009)
100%
10%
80%
20%
30%
40%
60%
50%
60%
40%
70%
80%
20%
90%
100%
0%
1 Year (N = 95)
ISHLT
2 Years (N = 77)
3 Years (N = 70)
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
ADULT HEART-LUNG RECIPIENTS
Employment Status of Surviving Recipients
100%
(Follow-ups: April 1994 – June 2009)
80%
Working (FT/PT
status unknown)
Retired
60%
Not Working
40%
Working Part Time
Working Full Time
20%
0%
1 Year (N = 315) 3 Years (N = 233) 5 Years (N = 206) 7 Years (N = 157)
ISHLT
2010
J 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)
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 = 392)
ISHLT
Between 2 and 3 Years
(N = 288)
Between 4 and 5 Years
(N = 228)
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Between 6 and 7 Years
(N = 193)
ADULT HEART-LUNG RECIPIENTS
Induction Immunosuppression
For transplants between January 2001 through June 2009
70
60
% of patients
50
40
30
20
10
0
Any Induction (N =
149)
ISHLT
Polyclonal ALG/ATG
(N = 60)
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
OKT3 (N = 5)
IL2R-antagonist (N =
71)
Analysis is limited to patients who were
alive at the time of the follow-up
ADULT HEART-LUNG RECIPIENTS
Induction Immunosuppression (Transplants: January 2000 - December 2008)
90
2000
2003
2006
80
2001
2004
2007
2002
2005
2008
% of patients
70
60
50
40
30
20
10
0
Any Induction
ISHLT
Polyclonal ALG/ATG
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
OKT3
IL2R-antagonist
Analysis is limited to patients who were
alive at the time of the follow-up
ADULT HEART-LUNG RECIPIENTS
Induction Immunosuppression (Transplants: January 2000 - December 2008)
90
80
% of patients
70
60
50
40
30
20
10
0
00 01 02 03 04 05 06 07 08
00 01 02 03 04 05 06 07 08
00 01 02 03 04 05 06 07 08
00 01 02 03 04 05 06 07 08
20 20 20 20 20 20 20 20 20
20 20 20 20 20 20 20 20 20
20 20 20 20 20 20 20 20 20
20 20 20 20 20 20 20 20 20
Any Induction
ISHLT
Polyclonal ALG/ATG
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
OKT3
IL2R-antagonist
Analysis is limited to patients who were
alive at the time of the follow-up
ADULT HEART-LUNG RECIPIENTS
Maintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2001 through June 2009
100
Year 1 (N = 157)
Year 5 (N = 98)
% of Patients
80
60
40
20
0
Cyclosporine
Tacrolimus
Rapamycin
MMF
Azathioprine
Prednisone
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2009
100%
Other
% of Patients
80%
Tacrolimus + MMF
60%
Tacrolimus + AZA
40%
Cyclosporine + MMF
20%
Cyclosporine + AZA
0%
Year 1 (N = 157)
Year 5 (N = 98)
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2009)
Within 1
Year
Total number with
known response
Hypertension
57.2%
(N = 374)
Renal Dysfunction
Abnormal Creatinine < 2.5 mg/dl
Creatinine > 2.5 mg/dl
Chronic Dialysis
Renal transplant
18.1%
11.6%
2.8%
3.4%
0.3%
(N = 387)
Hyperlipidemia
25.6%
(N = 395)
Diabetes
18.7%
(N = 390)
Coronary Artery Vasculopathy
2.9%
(N = 311)
Bronchiolitis Obliterans Syndrome
8.7%
(N = 368)
Outcome
ISHLT
2010
J 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)
Within 5
Years
Total number with
known response
Hypertension
88.2%
(N = 127)
Renal Dysfunction
Abnormal Creatinine < 2.5 mg/dl
Creatinine > 2.5 mg/dl
Chronic Dialysis
Renal Transplant
28.7%
21.0%
6.3%
1.4%
0.0%
(N = 143)
Hyperlipidemia
67.2%
(N = 134)
Diabetes
23.4%
(N = 137)
Coronary Artery Vasculopathy
8.0%
(N = 75)
Bronchiolitis Obliterans Syndrome
27.2%
(N = 114)
Outcome
ISHLT
2010
J 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)
100
% Free from CAV
90
80
70
60
50
0
1
2
3
4
Years
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
5
6
7
Freedom from Coronary Artery Vasculopathy
For Adult Heart-Lung Recipients By Diagnosis Type
(Follow-ups: April 1994-June 2009)
100
% Free from CAV
90
80
70
Heart (N=184)
Lung (N=54)
60
Heart/Lung
(N=68)
P-value comparing all = 0.2078
50
0
1
2
Years
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
3
4
Freedom from Bronchiolitis Obliterans Syndrome
For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2009)
% Free from Bronchiolitis Obliterans
Syndrome
100
90
80
70
60
50
40
0
ISHLT
1
2
3
Years
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
4
5
6
7
Freedom from Bronchiolitis Obliterans Syndrome
For Adult Heart-Lung Recipients By Diagnosis Type
(Follow-ups: April 1994-June 2009)
% Free from Bronchiolitis Obliterans
Syndrome
100
Heart (N=211)
Lung (N=61)
Heart/Lung (N=91)
90
80
70
60
P-value comparing all = 0.7771
50
0
1
2
3
Years
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
4
5
Freedom from Severe Renal Dysfunction*
% Free from Severe Renal Dysfunction
For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2009)
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
Years
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
4
5
6
MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTS
Cumulative Prevalence in Survivors (Follow-ups: April 1994-June 2009)
Malignancy/Type
1-Year
Survivors
5-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*
10-Year
Survivors
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.
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Freedom from Malignancy
For Adult Heart-Lung Recipients (Follow-ups: April 1994- June 2009)
% Free from Malignancy
100
90
80
All malignancy
Lymph
Skin
Other
70
60
50
0
1
2
3
4
Years
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
5
6
7
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)
0
5 (2.2%)
41 (21.0%)
28 (20.4%)
48 (16.6%)
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%)
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%)
BRONCHIOLITIS
ACUTE REJECTION
CARDIOVASCULAR
ISHLT
2010
J 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)
50
Bronchiolitis
Infection (non-CMV)
Cardiovascular
Technical
Graft Failure
Percentage of Deaths
40
30
20
10
0
0-30 Days (N =
289)
ISHLT
31 Days – 1
Year (N =226)
>1 Year – 3
Years (N = 195)
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
>3 Years – 5
Years (N = 137)
>5 Years (N =
290 )
HEART-LUNG TRANSPLANTATION
Pediatric Recipients
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG
RECIPIENTS (Transplants: January 1982 - June 2009)
Number of Transplants
350
300
250
200
150
100
50
0
<1
ISHLT
1-5 yrs
6-11 yrs
Recipient Age (Years)
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
12-17 yrs
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEARTLUNG RECIPIENTS (Transplants: January 1982 - June 2009)
400
Number of Transplants
350
354
300
250
200
150
100
99
50
52
0
0-11 yrs
ISHLT
12-17 yrs
18-34
Donor Age (Years)
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
27
35-49
3
50-59
AGE DISTRIBUTION OF
PEDIATRIC HEART-LUNG RECIPIENTS
By Year of Transplant
50
12-17 Years
1-11 Years
<1 Year
40
35
30
25
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
Number of Transplants
45
ISHLT
2010
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.
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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
1996-6/2009
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
NUMBER OF CENTERS REPORTING
PEDIATRIC HEART-LUNG TRANSPLANTS
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
# Pediatric Transplant Centers
25
Transplant Year
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
NUMBER OF CENTERS REPORTING
PEDIATRIC HEART-LUNG TRANSPLANTS
Stratified by center volume
20
1-4/yr
5-9/yr
10-19/yr
20-29/yr
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
# Pediatric Transplant Centers
25
Transplant Year
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
DIAGNOSIS IN PEDIATRIC HEART-LUNG
TRANSPLANT RECIPIENTS (Transplants: 1986-2008)
25%
“Other” includes
Bronchiectasis,
Alpha-1, and OB
(non-ReTX)
5%
2%
2%
1%
5%
13%
22%
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
% of Cases
24%
Acquired Heart Disease
CF
Congenital (other)
Eisenmenger's Syndrome
IPF
Other
PPH
Retx: Non-OB
Retx: OB
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
NOTE: Unknown diagnoses were excluded
from this tabulation.
PEDIATRIC HEART-LUNG TRANSPLANTS:
AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2009
0-5 years
6-11 years
12-17 years
% of Transplants
100%
80%
60%
40%
20%
0%
Europe
ISHLT
North America
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Other
PEDIATRIC HEART-LUNG TRANSPLANTS:
DIAGNOSIS DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2009
Congenital heart disease
Cystic Fibrosis
IPAH
Other
% of Transplants
100%
80%
60%
40%
20%
0%
Europe
ISHLT
North America
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Other
PEDIATRIC HEART-LUNG TRANSPLANTS:
DONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2009
0-5
6-11
12-17
18-34
35-49
100%
% of Donors
80%
60%
40%
20%
0%
Europe
ISHLT
North America
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Other
PEDIATRIC HEART-LUNG TRANSPLANTATION
(Transplants: January 1990 – June 2008)
Kaplan-Meier Survival By Diagnosis
100
Congenital (N = 85)
Eisenmenger's Syndrome (N = 44)
IPAH (N = 91)
Survival (%)
75
HALF-LIFE Congenital: 2.4 Years;
Eisenmenger's: 2.6 Years; IPAH: 4.4 Years
50
25
Congenital vs. Eisenmenger's: p = 0.6598
Congenital vs. IPAH: p = 0.1562
Eisenmenger's vs. IPAH: p = 0.4204
0
0
1
2
3
4
Years
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
5
6
7
8
PEDIATRIC HEART-LUNG TRANSPLANTATION
Kaplan-Meier Survival (Transplants: January 1982 - June 2008)
100
< 1 (N = 20)
1-11 (N = 217)
12-17 (N = 302)
Overall (N = 539)
0-<1 vs. 1-11: p = 0.0003;
0-<1 vs. 12-17: p < 0.0001;
1-11 vs. 12-17: p = 0.0580
Survival (%)
75
Half-life <1: 0.2 Years;
1-11: 3.0 Years; 12-17: 3.6 Years
50
25
0
0
1
2
3
4
5
6
7
8
Years
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
9
10
11
12
13
14
15
PEDIATRIC HEART-LUNG TRANSPLANTATION
Kaplan-Meier Survival by Era
(Transplants: January 1982 - June 2008)
100
1982-1988 (N=110)
1989-1993 (N=178)
1994-1998 (N=124)
1999-6/2008 (N=127)
Survival (%)
75
Half-life 1982-1988: 1.9; 1989-1993: 3.0;
1994-1998: 3.3; 1999-6/2008: 4.7
50
25
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
0
0
1
2
3
4
5
6
7
Years
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
8
9
10
11
12
13
14
PEDIATRIC HEART-LUNG TRANSPLANTATION
Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2008)
Conditional on Survival to 1 Year
100
1982-1988 (N=61)
1989-1993 (N=111)
1994-1998 (N=77)
1999-6/2008 (N=90)
Survival (%)
80
Conditional HALF-LIFE 1982-1988:
10.1; 1989-1993: 7.4; 1994-1998: 6.4;
1999-6/2008: 8.4
60
40
20
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
0
0
1
2
3
4
5
6
7
Years
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
8
9
10
11
12
13
14
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS:
Cause of Death (Deaths: January 1992 - June 2009)
CAUSE OF DEATH
0-30 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%)
ISHLT
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS:
Cause of Death (Deaths: April 1994 - June 2009)
0-30 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%)
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%)
CAUSE OF DEATH
CARDIOVASCULAR
ISHLT
2010
J 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)
Bronchiolitis
Graft Failure
Cardiovascular
Infection (Non-CMV)
Percentage of Deaths
50
40
30
20
10
0
0-30 Days (N =
32)
ISHLT
31 Days – 1
Year (N =36)
>1 Year – 3
Years (N = 41)
2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
>3 Years – 5
Years (N = 24)
>5 Years (N =
48 )