Download - 2002 ISHLT J Heart Lung Transplant 2002; 21: 827-840. LUNG TRANSPLANTATION Pediatric Recipients
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
LUNG TRANSPLANTATION
Pediatric Recipients
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
AGE DISTRIBUTION OF PEDIATRIC LUNG RECIPIENTS
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Recipient Age (Years)
Nu
mb
er o
f T
ran
spla
nts
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC LUNG RECIPIENTS (1986-2001)
0
30
60
90
120
150
180
210
240
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18+
Donor Age (Years)
Nu
mb
er o
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spla
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2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
AGE DISTRIBUTION OF PEDIATRIC LUNG RECIPIENTS
By Year of Transplant
0
20
40
60
80
100
11-17 Years1-10 Years
<1 Year
Nu
mb
er o
f T
ran
spla
nts
1 3 4 6
20
4750
4542
8272
85 86
66 67
57
* Numbers may be low due to delayed reporting.
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
NUMBER OF CENTERS REPORTING PEDIATRIC LUNG TRANSPLANTS
0
10
20
30
4019
86
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
*
Transplant Year
Num
ber
of P
edia
tric
Cen
ters
R
epor
ting
* Numbers may be low due to delayed reporting.
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
PEDIATRIC LUNG TRANSPLANTATION: Indications (1991-2001)
DIAGNOSIS AGE: < 1 Year AGE: 1-10 Years
Cystic Fibrosis 55 34.2%
PPH 7 16.7% 24 14.9%
Congenital Heart Disease 14 33.3% 17 10.6%
IPF 12 7.5%
Pulmonary Vascular Disease 6 14.3% 6 3.7%
Re-TX: Non-OB 3 7.1% 8 5.0%
Re-TX: OB 9 5.6%
OB (Non-ReTX) 6 3.7%
Bronchiectasis 2 1.2%
COPD/Emphysema 2 1.2%
Other 11 26.2% 17 10.6%
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
PEDIATRIC LUNG TRANSPLANTATIONIndications by Age (1991-2001)
11%
37%
8%
13%
16%
11%
4%
Congenital Heart Disease Cystic Fibrosis
Idiopathic Pulmonary Fibrosis Other
Primary Pulmonary Hypertension Retransplant/Graft Failure
Pulmonary Vascular Disease
14%
7%
33%
29%
17%
Age <1 Year
Age 1-10 Years
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
3%
66%
3%
13%
9%
6%
Congenital Heat Disease
Cystic Fibrosis
IPF
Other
PPH
ReTX
DIAGNOSIS IN PEDIATRIC LUNG RECIPIENTSAge: 11-17 Years
0
25
50
75
100
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
% o
f Cas
es
PPH Cystic Fibrosis IPF
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
PEDIATRIC LUNG TRANSPLANTATIONActuarial Survival by Procedure Type (1990-2001)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years Post Transplantation
Sur
viva
l (%
)
Single Lung (N=70)
Bilateral/Double Lung (N=567)
P = 0.006
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
PEDIATRIC LUNG TRANSPLANTATIONActuarial Survival by Age Group (1990-2001)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years Post Transplantation
Sur
viva
l (%
)
<1 Year (N=44)
1-10 Years (N=172)
1-11 Years (N=421)
<1 Year: ½-life = 3.5 Years1-10 Years: ½-life = 3.5 Years11-17 Years: ½-life = 3.2 Years
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
PEDIATRIC LUNG TRANSPLANTATIONConditional Actuarial Survival by Age Group (1990-2001)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years Post Transplantation
Sur
viva
l (%
)
<1 Year (N=26)
1-10 Years (N=98)
1-11 Years (N=222)<1 Year: ½-life = 7.1 Years1-10 Years: ½-life = 5.9 Years11-17 Years: ½-life = 5.4 Years
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
PEDIATRIC LUNG TRANSPLANTATION Actuarial Survival by Era (1988-2001)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years Post-Transplantation
1988-1992 (N=127)
1993-1997 (N=326)
1998-2001 (N=276)
Su
rviv
al (
%)
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
PEDIATRIC LUNG TRANSPLANTATIONActuarial Survival by Procedure Type
Diagnosis: PPH (1990-2001)
0
25
50
75
100
0 1 2 3 4 5 6
Years Post-Transplantation
Sur
viva
l (%
)
Single Lung (N = 17) Double Lung (N=52)
P = 0.002
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
PEDIATRIC LUNG RECIPIENTS Functional Status (April 1994-December 2001)
0%
20%
40%
60%
80%
100%
1 Year (N = 263) 3 Years (N = 156) 5 Years (N = 82)
No Activity Limitations Performs with Assistance Total Assistance
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
PEDIATRIC LUNG RECIPIENTS Rehospitalization Post-transplant (April 1994 - December 2001)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N = 299)
Between 2 and 3 Years (N = 170)
Between 4 and 5 Years (N = 87)
No Hospitalization Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection Hospitalized, Infection Only
Hospitalized, Rejection + Infection
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
0
10
20
30
40
50
Any Induction (N = 48)
Polyclonal ATG/ALG (N = 16)
OKT3 (N = 1) IL2-R Antagonist (N = 32)
% o
f p
ati
en
tsPEDIATRIC LUNG RECIPIENTS
Induction ImmunosuppressionFor follow-ups between October 1999 and December 2001
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
atie
nts
Year 1 (N = 78)
Year 5 (N = 41)
PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression at Any Time During Follow-up Period
For follow-ups between October 1999 and December 2001
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
atie
nts
Year 1 (N = 76) Year 5 (N = 39)
PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
For follow-ups between October 1999 and December 2001
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
0
20
40
60
80
100
CalcineurinInhibitor
CellCycle Prednisone CalcineurinInhibitor
CellCycle Prednisone
% o
f P
ati
en
ts
CyA
TacTac
CyAAZA AZA
MMFMMF
PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
For follow-ups between October 1999 and December 2001
1 Year Follow-up (N = 76) 5 Year Follow-up (N = 39)
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
0%
20%
40%
60%
80%
100%
Year 1 (N = 76) Year 5 (N = 39)
% o
f P
atie
nts
None Given
Other
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine + MMF
Cyclosporine + AZA
PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up Report
For follow-ups between October 1999 and December 2001
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
POST-LUNG TRANSPLANT MORBIDITY For Pediatric Recipients (April 1994-December 2000)
Outcome By 1 Year By 5 Years
Hypertension 36.2% (N=298) 71.1% (N=45)
Renal Function (N=300) (N=46) Normal 92.3% 73.9% Renal Dysfunction 5.0% 10.9% Creatinine>2.5 mg/dl 1.3% 8.7% Chronic Dialysis 1.0% 4.3% Renal Transplant 0.3% 2.2%
Hyperlipidemia 0.6% (N=308) 4.3% (N=46)
Diabetes 19.8% (N=298) 28.3% (N=46)
Bronchiolitis Obliterans 14.2% (N=267) 14.8% (N=27)
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
Freedom from Bronchiolitis Obliterans For Pediatric Lung Recipients (April 1994-December 2000)
40
50
60
70
80
90
100
0 12 24 36 48 60
Months
% F
ree
from
Bro
nchi
oliti
s O
blite
rans
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
Freedom from Renal Dysfunction*For Pediatric Lung Recipients (April 1994-December 2000)
50
60
70
80
90
100
0 12 24 36 48 60
Months
% F
reed
om fr
om R
enal
D
ysfu
nctio
n
* Renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
MALIGNANCY POST-LUNG TRANSPLANTATION FOR PEDIATRICSCumulative Incidence for Survivors (April 1994-December 2001)
Malignancy/Type 1-Year Survivors 5-Year Survivors
No Malignancy 288 (93.5%) 45 (91.8%)
Malignancy (all types combined) 20 (6.5%) 4 (8.2%)
Malignancy Type
Lymph 18 4
Other 2
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
Freedom from MalignancyFor Pediatric Lung Recipients (April 1994-December 2000)
50
60
70
80
90
100
0 12 24 36 48 60
Months
% F
ree
fro
m M
alig
nan
cy
All malignancy Lymph Skin Other
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
PEDIATRIC LUNG TRANSPLANTATION Actuarial Survival Based on Rejection within 1st Year (1994-2000)
0
20
40
60
80
100
0 1 2 3 4 5 6 7
Years Post-Transplantation
Rejection within 1st Year (N = 142)
No Rejection within 1st Year (N = 101)
Su
rviv
al (
%)
P= 0.01
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
PEDIATRIC LUNG RECIPIENTSRelationship of Diabetes and Cystic Fibrosis
Transplants: April 1994 – December 2000
Diagnosis
Report of Diabetes Developing Between
Transplant and 1st Year*
Report of Diabetes Developing Between
Transplant and 3rd Year**
No Yes No Yes
Cystic Fibrosis
103
70.1%
44
29.9%
29
55.8%
23
44.2%
Other Diagnosis
137
97.3%
4
2.8%
53
94.6%
3
5.4%
*p < 0.0001 **p < 0.0001
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
PEDIATRIC LUNG RECIPIENTS: Time Of Death (1988-2001)
0%
20%
40%
60%
80%
100%
<1 1-10 11-17Recipient Age (years)
% o
f D
ea
ths
0-30 Days 31 Days -1 Year 1- 3 Years 3 - 5 Years 5+ Years
2002ISHLT
J Heart Lung Transplant 2002; 21: 827-840.
PEDIATRIC LUNG TRANSPLANT RECIPIENTS: Cause of Death (1982-2001)
0%
20%
40%
60%
80%
100%
0-30 Days (N = 45)
31 Days - 1 Year(N=71)
>1 Year - 3Years (N = 66)
>3 Years - 5Years (N = 27)
>5 Years (N = 8)
Per
cent
age
of D
eath
s
Other
Technical
Graft Failure - Other
Primary Graft Failure
Bronchiolitis
Infection, Non-CMV
Acute Rejection
Lymphoma
Cardiac
Timing of Death