LUNG TRANSPLANTATION
Pediatric Recipients
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
RECIPIENT AGE DISTRIBUTION FOR
PEDIATRIC LUNG RECIPIENTS - NUMBER
(Transplants: January 1986 - June 2010)
1400
Number of Transplants
1200
<1
1-5
6-11
12-17
1000
800
600
400
200
0
1986-1995 (N=329)
ISHLT
1996-6/2010 (N=1,335)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Analysis includes living donor transplants
RECIPIENT AGE DISTRIBUTION FOR
PEDIATRIC LUNG RECIPIENTS - PERCENTAGE
(Transplants: January 1986 - June 2010)
100%
90%
80%
% of Transplants
12-17
70%
60%
6-11
50%
1-5
40%
30%
<1
20%
10%
0%
1986-1995 (N=329)
ISHLT
1996-6/2010 (N=1,335)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Analysis includes living donor transplants
DONOR TYPE DISTRIBUTION BY YEAR OF
TRANSPLANT FOR PEDIATRIC LUNG RECIPIENTS
(Transplants: 1986-2009)
130
120
100
90
80
70
60
50
40
30
20
10
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
Number of Transplants
110
Living
Deceased
Transplant Year
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
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
DONOR TYPE DISTRIBUTION BY RECIPIENT AGE
GROUP WITHIN ERA FOR PEDIATRIC LUNG
RECIPIENTS (Transplants: January 1986 - June 2010)
1000
Number of Transplants
900
800
Living
Deceased
700
600
500
400
300
200
100
0
0-5 years
6-11 years
12-17
years
0-5 years
1986-1995
6-11 years
12-17
years
1996-6/2010
Recipient Age (Years)
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Analysis includes living donor transplants
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC
LUNG RECIPIENTS (Transplants: January 1986 - June 2010)
100%
76
9
90%
189
% of Transplants
80%
268
70%
60+
50-59
60%
325
50%
35-49
18-34
40%
12-17
30%
658
20%
10%
0%
Donor Age (Years)
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
0-11
130
120
110
100
90
80
70
60
50
40
30
20
10
0
127
12-17 Years
1-11 Years
108
96
97
95 96
112
102
89
<1 Year
82
73 73 72 74
78
49 52
48
45
23
1
3
5
7
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 LUNG
RECIPIENTS: By Year of Transplant
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.
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Analysis includes living donor transplants
NUMBER OF CENTERS REPORTING
PEDIATRIC LUNG TRANSPLANTS
40
30
20
10
0
19
86
19
87
19
8
19 8
89
19
90
19
91
19
9
19 2
93
19
94
19
9
19 5
96
19
97
19
98
19
9
20 9
00
20
01
20
02
20
03
20
04
20
05
20
0
20 6
07
20
08
20
09
Number of Centers Reporting
Pediatric Transplants
50
Transplant Year
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Analysis includes living donor transplants
NUMBER OF CENTERS REPORTING
PEDIATRIC LUNG TRANSPLANTS BY CENTER VOLUME
20+ transplants
10-19 transplants
40
5-9 transplants
1-4 transplants
30
20
10
0
19
86
19
8
19 7
88
19
89
19
90
19
91
19
9
19 2
93
19
9
19 4
95
19
96
19
97
19
9
19 8
99
20
0
20 0
01
20
0
20 2
03
20
04
20
0
20 5
06
20
0
20 7
08
20
09
Number of Centers Reporting
Pediatric Transplants
50
Transplant Year
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Analysis includes living donor transplants
130
120
110
100
90
80
70
20+ transplants
10-19 transplants
5-9 transplants
1-4 transplants
60
50
40
30
20
10
0
19
86
19
8
19 7
8
19 8
89
19
9
19 0
9
19 1
92
19
9
19 3
94
19
95
19
96
19
97
19
9
19 8
9
20 9
00
20
0
20 1
02
20
0
20 3
04
20
05
20
0
20 6
0
20 7
08
20
09
Number of Transplants
NUMBER OF PEDIATRIC LUNG TRANSPLANTS
BY CENTER VOLUME
Transplant Year
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Analysis includes living donor transplants
PEDIATRIC LUNG TRANSPLANTATION:
Indications (Transplants: January 1990 – June 2010)
AGE: < 1
Year
DIAGNOSIS
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%
7
6.3%
9
3.0%
34
3.1%
Re-Transplant: Obliterative Bronchiolitis
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%
10
9.0%
19
6.4%
45
4.2%
27
2.5%
Obliterative Bronchiolitis (Not Re-TX)
Re-Transplant: Not OB
3
3.5%
4
3.6%
8
2.7%
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
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%
12
4.0%
26
2.4%
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
6
5.4%
0.4%
1
0.1%
Analysis includes living donor transplants
DIAGNOSIS IN PEDIATRIC LUNG RECIPIENTS
BY YEAR OF TRANSPLANT
Age: 12-17 Years
100
% of Transplants
IPAH
Cystic Fibrosis
75
50
25
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Analysis includes living donor transplants
PEDIATRIC 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 (N=359)
ISHLT
North America (N=576)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Other (N=54)
Analysis includes living donor transplants
PEDIATRIC LUNG TRANSPLANTS:
DIAGNOSIS DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2010
Cystic Fibrosis
IPAH
IPF
OB
Other
Congenital heart disease
Re-TX
% of Transplants-
100%
80%
60%
40%
20%
0%
Europe (N=331)
North America (N=576)
Other (N=47)
NOTE: Unknown diagnoses were excluded from this tabulation.
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Total number of transplants reported:
Europe = 359
North America = 576
Other = 54
Analysis includes living donor transplants
PEDIATRIC LUNG TRANSPLANTS:
DONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2010
0-5
6-11
12-17
18-34
35-49
50-59
60+
100%
% of Donors
80%
60%
40%
20%
0%
Europe (N=354)
North America (N=540)
Other (N=53)
NOTE: Transplants with unknown donor age and living donor transplants were
excluded from this tabulation.
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Total number of transplants reported:
Europe = 359
North America = 576
Other = 54
LUNG TRANSPLANTATION
Kaplan-Meier Survival by Recipient Age Group
(Transplants: January 1990 - June 2009)
100
P = 0.0420
Adult (N=31,794)
Pediatric (N=1,353)
Survival (%)
75
50
25
HALF-LIFE Adult = 5.4 Years; Pediatric = 5.5 Years
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
PEDIATRIC LUNG TRANSPLANTATION
Kaplan-Meier Survival by Procedure Type
(Transplants: January 1990 - June 2009)
100
Single Lung
P < .0001
Bilateral/Double Lung (N=1,267)
75
Survival (%)
(N=84)
50
25
HALF-LIFE Single Lung: 2.2 Years; Bilateral/double Lung: 5.7 Years
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
14
PEDIATRIC LUNG TRANSPLANTATION
Kaplan-Meier Survival for Congenital Diagnoses
(Transplants: January 1990 – June 2009)
100
Eisenmenger’s vs. Other: p = 0.4357
Survival (%)
75
N at risk = 17
N at risk = 13
N at risk = 10
50
Eisenmenger's Syndrome (N=15)
25
Other Congenital Heart Disease (N=31)
Eisenmenger's + Other Congenital Heart Disease (N=46)
0
0
1
2
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
3
4
PEDIATRIC LUNG TRANSPLANTATION
Kaplan-Meier Survival by Recipient Age Group
(Transplants: January 1990 - June 2009)
100
<1 year vs. 1-11 years: p = 0.0987
<1 year vs. 12-17 years: p = 0.6665
1-11 years vs. 12-17 years: p = 0.0219
<1 Year
75
(N=83)
Survival (%)
1-11 Years (N=365)
12-17 Years (N=905)
50
N at risk = 26
N at risk = 11
25
HALF-LIFE
<1 Year: 6.4 Years
1-11 Years: 7.3 Years
12-17 Years: 4.7 Years
N at risk = 42
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 LUNG TRANSPLANTATION
Conditional Kaplan-Meier Survival by Recipient Age Group
(Transplants: January 1990 - June 2009)
100
<1 year vs. 1-11 year: p = 0.9598
<1 year vs. 12-17 years: p = 0.2727
1-11 years vs. 12-17 years: p =0.0254
Survival (%)
75
N at risk = 26
CONDITIONAL HALF-LIFE
<1 Year: 8.8 Years
1-11 Years: 11.2 Years
12-17 Years: 7.7 Years
50
N at risk = 11
N at risk = 42
25
<1 Year
(N=51)
1-11 Years (N=267)
12-17 Years (N=650)
0
0
1
2
ISHLT
3
4
5
6
7
Years
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
8
9
10
11
12
13
PEDIATRIC LUNG TRANSPLANTATION
Kaplan-Meier Survival by Era
(Transplants: January 1988 - June 2009)
100
HALF-LIFE
Unconditional 1988-1994: 5.2 Years; 1995-2001: 4.7 Years; 2002-6/2009: 5.7
Conditional
1988-1994: 13.6 Years; 1995-2001: 7.8 Years; 2002-6/2009: na
Survival (%)
80
1988-1994 vs. 1995-2001: p = 0.6966
1988-1994 vs. 2002-6/2009: p = 0.0631
1995-2001 vs. 2002-6/2009: p = 0.0552
60
N at risk = 30
N at risk = 42
40
1988-1994 (N=210)
20
N at risk = 20
1995-2001 (N=501)
2002-6/2009 (N=653)
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
14
PEDIATRIC LUNG TRANSPLANTATION
Kaplan-Meier Survival by Donor Type for Recipients Age 12-17 Years
(Transplants: January 1990 - June 2009)
100
p = 0.0677
Survival (%)
75
HALF-LIFE
Deceased: 4.7 Years
Living: 3.7 Years
50
N at risk = 71
N at risk = 21
25
Deceased Donor (N = 905)
Living Donor (N = 78)
0
0
1
ISHLT
2
3
4
5
Years
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
6
7
8
9
10
PEDIATRIC LUNG RE-TRANSPLANTS
Between January 1994 and June 2010
Number of Re-Transplants
30
25
20
15
10
5
0
0-<1 month
1-<12 months
12-<36 months
36+ months
Not reported
Time Between Previous and Current Transplant
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Analysis includes living donor transplants
PEDIATRIC LUNG RETRANSPLANTS
Survival for Transplants Performed Between January 1994 and June 2009
100
90
Survival (%)
80
70
60
N at risk at 5 years = 17
50
40
30
20
10
0
0
1
2
3
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
4
5
PEDIATRIC LUNG RETRANSPLANTS
STRATIFIED BY INTER-TRANSPLANT INTERVAL
Survival for Transplants Performed Between January 1988 and June 2009
100
90
p = 0.1510
Survival (%)
80
70
60
N at risk = 10
50
40
N at risk = 11
30
20
<1 Year (N = 30)
10
1+ Year (N = 59)
0
0
1
2
3
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
4
5
Analysis includes living donor
transplants. Only patients who were
less than 18 years old at the time of
re-transplant are included.
PEDIATRIC LUNG RETRANSPLANTS
STRATIFIED BY DIAGNOSIS
Survival for Transplants Performed Between January 1988 and June 2009
100
90
p = 0.8536
Survival (%)
80
70
60
50
N at risk = 10
40
30
N at risk = 12
20
Obliterative Bronchiolitis (N = 51)
10
Non Obliterative Bronchiolitis (N = 57)
0
0
1
2
3
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
4
Analysis includes living donor
transplants. Only patients who were
less than 18 years old at the time of
re-transplant are included.
5
PEDIATRIC 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 Assistance
Total Assistance
0%
1 Year (N = 328)
ISHLT
3 Years (N = 206)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
5 Years (N = 127)
PEDIATRIC 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 = 237)
ISHLT
2 Years (N = 194)
3 Years (N = 159)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PEDIATRIC LUNG RECIPIENTS
Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2010)
100%
80%
60%
40%
20%
No Hospitalization
Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection
Hospitalized, Rejection + Infection
Hospitalized, Infection Only
0%
Up to 1 Year (N=626)
ISHLT
Between 2 and 3 Years
(N=383)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Between 4 and 5 Years
(N=226)
PEDIATRIC LUNG RECIPIENTS
Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2010)
100%
80%
60%
40%
20%
No Hospitalization
Hospitalized, Rejection
Hospitalized, Rejection + Infection
Hospitalized, Not Rejection/Not Infection
Hospitalized, Infection Only
0%
Up to 1 Year (N=626)
ISHLT
Between 1 and 3 Years
(N=348)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Between 3 and 5 Years
(N=207)
PEDIATRIC LUNG RECIPIENTS
Induction Immunosuppression
For transplants between January 2001 and June 2010
70
60
% of patients
50
40
30
20
10
0
Any Induction (N = 282)
ISHLT
Polyclonal ALG/ATG (N = 65)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
IL-2R Antagonist (N = 214)
Analysis is limited to patients who were alive
at the time of the discharge
PEDIATRIC LUNG RECIPIENTS
Induction Immunosuppression (Transplants: January 2001 - June 2010)
80
2001
2003
2005
2007
2009
70
% of patients
60
2002
2004
2006
2008
1/2010-6/2010
50
40
30
20
10
0
Any Induction
ISHLT
Polyclonal ALG/ATG
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
IL-2R Antagonist
Analysis is limited to patients who were alive
at the time of the discharge
PEDIATRIC LUNG TRANSPLANTATION
Kaplan-Meier Survival Stratified by Induction Use
(Transplants: January 2001 - June 2009)
100
p = 0.8136
Survival (%)
75
50
HALF-LIFE
Induction: 6.1 Years
No Induction: 5.1 Years
25
Induction (N = 230)
No Induction (N = 160)
0
0
1
2
3
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
4
5
PEDIATRIC LUNG RECIPIENTS
Maintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2001 – June 2010)
100
Year 1 (N = 348)
Year 5 (N = 153)
% 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
PEDIATRIC LUNG RECIPIENTS
Maintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2001 – June 2010)
100
% of Patients
80
60
Tac
Tac
MMF
MMF
40
20
0
CyA
CyA
Calcineurin
Inhibitor
AZA
CellCycle
Calcineurin
Inhibitor
Prednisone
1 Year Follow-up (N = 348)
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
2011
AZA
CellCycle
Prednisone
5 Year Follow-up (N = 153)
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.
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PEDIATRIC LUNG RECIPIENTS
Maintenance Immunosuppression Drug Combinations at Time of Follow-up Report
(Follow-ups: January 2001 – June 2010)
100%
Other
% of Patients
80%
Tacrolimus + MMF
60%
Tacrolimus + AZA
40%
Cyclosporine + MMF
20%
Cyclosporine + AZA
0%
Year 1 (N = 348)
Year 5 (N = 153)
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-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS
Cumulative Prevalence in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994 - June 2010)
Within 1
Year
Total number with
known response
Hypertension
42.2%
(N = 604)
Renal Dysfunction
Abnormal Creatinine < 2.5 mg/dl
Creatinine > 2.5 mg/dl
Chronic Dialysis
Renal Transplant
10.2%
7.3%
1.9%
0.6%
0.3%
(N = 618)
Hyperlipidemia
4.8%
(N = 622)
Diabetes
24.7%
(N = 619)
Bronchiolitis Obliterans Syndrome
13.7%
(N = 577)
Outcome
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS
Cumulative Prevalence in Survivors within 5 Years Post-Transplant
(Follow-ups: April 1994 - June 2010)
Within 5
Years
Total number with
known response
Hypertension
68.8%
(N = 160)
Renal Dysfunction
Abnormal Creatinine < 2.5 mg/dl
Creatinine > 2.5 mg/dl
Chronic Dialysis
Renal Transplant
20.1%
13.6%
3.0%
2.4%
1.2%
(N = 169)
Hyperlipidemia
14.5%
(N = 165)
Diabetes
34.3%
(N = 166)
Bronchiolitis Obliterans Syndrome
36.4%
(N = 129)
Outcome
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS
Cumulative Prevalence in Survivors within 7 Years Post-Transplant
(Follow-ups: April 1994 - June 2010)
Outcome
Renal Dysfunction
Within 7
Years
Total number with
known response
31.0%
(N = 84)
21.4%
3.6%
0.0%
6.0%
Abnormal Creatinine < 2.5 mg/dl
Creatinine > 2.5 mg/dl
Chronic Dialysis
Renal Transplant
Diabetes
33.9%
(N = 62)
Bronchiolitis Obliterans Syndrome
46.0%
(N = 50)
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Freedom from Bronchiolitis Obliterans Syndrome
For Pediatric Lung Recipients
(Follow-ups: April 1994 - June 2010)
% Free from Bronchiolitis Obliterans
Syndrome
100
90
80
70
60
50
40
30
20
10
0
0
1
2
3
4
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
5
6
7
Freedom from Bronchiolitis Obliterans Syndrome
Stratified by Age Group
For Pediatric Lung Recipients
(Follow-ups: April 1994 - June 2010)
% Free from Bronchiolitis Obliterans
Syndrome
100
90
p = 0.0434
80
70
60
50
40
<1 Year (N=50)
30
1-11 Years (N=187)
20
12-17 Years (N=344)
10
0
0
ISHLT
1
2
3
Years
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
4
5
6
Freedom from Bronchiolitis Obliterans Syndrome
Stratified by Diagnosis
For Pediatric Lung Recipients
(Follow-ups: April 1994 - June 2010)
% Free from Bronchiolitis Obliterans
Syndrome
100
90
p = 0.1604
80
70
60
50
40
Cystic Fibrosis (N=315)
30
20
IPAH (N=58)
10
0
0
ISHLT
1
2
3
Years
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
4
5
Freedom from Bronchiolitis Obliterans Syndrome
For Pediatric Lung Recipients by Induction Use
(Follow-ups: April 1994 - June 2010)
% Free from Bronchiolitis Obliterans
Syndrome
100
p = 0.7123
75
50
25
Induction (N = 229)
No Induction (N =323)
0
0
1
2
3
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
4
5
6
Freedom from Severe Renal Dysfunction*
% Free from Severe Renal Dysfunction
For Pediatric Lung Recipients (Follow-ups: April 1994 - June 2010)
100
90
80
70
60
50
40
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221
μmol/L), dialysis or renal transplant
30
20
10
0
0
1
2
3
4
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
5
6
7
8
MALIGNANCY POST-LUNG TRANSPLANTATION FOR PEDIATRICS
Cumulative Incidence for Survivors (Follow-ups: April 1994 - June 2010)
Malignancy/Type
No Malignancy
Malignancy (all types combined)
Malignancy
Type*
1-Year
Survivors
5-Year
Survivors
7-Year
Survivors
596 (94.5%)
152 (88.4%)
77 (89.5%)
35 (5.5%)
20 (11.6%)
9 (10.5%)
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.
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
Freedom from Malignancy
For Pediatric Lung Recipients (Follow-ups: April 1994 - June 2010)
% Free from Malignancy
100
90
80
70
60
All malignancy
Lymph
Skin
Other
50
0
1
2
3
4
5
Years
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
6
7
8
9
PEDIATRIC LUNG TRANSPLANT RECIPIENTS: Cause Of Death
(Deaths: January 1992- June 2010)
31 Days - 1 Year
(N = 135)
>1 Year - 3 Years
(N = 176)
>3 Years - 5 Years
(N = 83)
>5 Years
(N = 82)
13 (9.6%)
70 (39.8%)
34 (41.0%)
34 (41.5%)
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, NONLYMPHOMA
1 (0.7%)
1 (0.6%)
2 (2.4%)
3 (3.7%)
CMV
5 (3.7%)
CAUSE OF DEATH
0-30 Days
(N =97)
BRONCHIOLITIS
ACUTE REJECTION
3 (3.1%)
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%)
8 (8.2%)
13 (9.6%)
9 (5.1%)
3 (3.6%)
7 (8.5%)
17 (17.5%)
11 (8.1%)
14 (8.0%)
8 (9.6%)
6 (7.3%)
MULTIPLE ORGAN
FAILURE
OTHER
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PEDIATRIC LUNG TRANSPLANT RECIPIENTS:
Relative Incidence of Leading Causes of Death
(Deaths: January 1992 - June 2010)
50
Bronchiolitis
Graft Failure
Multiple Organ Failure
Infection (non-CMV)
Cardiovascular
Percentage of Deaths
40
30
20
10
0
0-30 Days
(N = 97)
ISHLT
31 Days – 1
Year (N = 135)
>1 Year – 3
Years (N =176)
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
>3 Years – 5
Years (N = 83)
>5 Years
(N = 82 )
PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1992-6/2009)
Risk Factors For 1 Year Mortality/Graft Failure
VARIABLE
N
Relative
Risk
P-value
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
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
95% Confidence
Interval
PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1992-6/2009)
Risk Factors For 1 Year Mortality/Graft Failure
Continuous Factors (see figures)
Pediatric transplant center volume
Recipient age (borderline)
N=795
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1992-6/2009)
Risk Factors For 1 Year Mortality/Graft Failure
Relative Risk of 1 Year Mortality
Center Volume Pediatric Transplants
2
p = 0.0143
1.5
1
0.5
0
0
5
10
Center Volume (cases per year)
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
15
20
PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1992-6/2009)
Risk Factors For 1 Year Mortality/Graft Failure
Relative Risk of 1 Year Mortality
Recipient Age
2
p = 0.0738
1.5
1
0.5
0
0
1
2
3
4
5
6
7
8
9
10
Recipient Age
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
11 12
13
14
15 16
17
PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1992-6/2005)
Risk Factors For 5 Year Mortality/Graft Failure
VARIABLE
N
Relative
Risk
Single lung transplant
15
2.45
0.0032
1.35 - 4.45
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
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
P-value
95% Confidence
Interval
PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1992-6/2005)
Risk Factors For 5 Year Mortality/Graft Failure
Continuous Factors (see figures)
Recipient age
Height difference (borderline)
N=583
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1992-6/2005)
Risk Factors For 5 Year Mortality/Graft Failure
Relative Risk of 5 Year Mortality
Recipient Age
2
p = 0.0179
1.5
1
0.5
0
0
1
2
3
4
5
6
7
8
9
10
Recipient Age
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
11 12
13
14
15 16
17
PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1992-6/2005)
Risk Factors For 5 Year Mortality/Graft Failure
Relative Risk of 5 Year Mortality
Height Difference
2
p = 0.0999
1.5
1
0.5
0
-15
-10
-5
0
5
10
Donor Height - Recipient Height (cm)
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
15
20
PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1990-6/2000)
Risk Factors For 10 Year Mortality/Graft Failure
VARIABLE
N
Relative Risk
P-value
On ventilator
66
2.12
<.0001
1.48 - 3.03
Single lung transplant
25
1.97
0.0085
1.19 - 3.25
N=380
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
95% Confidence
Interval
PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1990-6/2000)
Risk Factors For 10 Year Mortality/Graft Failure
Continuous Factors (see figures)
Recipient age
N=380
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1990-6/2000)
Risk Factors For 10 Year Mortality/Graft Failure
Relative Risk of 10 Year Mortality
Recipient Age
2
p = 0.0195
1.5
1
0.5
0
0
1
2
3
4
5
6
7
8
9
10
Recipient Age
ISHLT
2011
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132
11 12
13
14
15 16
17