HEART-LUNG TRANSPLANTATION
Overall
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
0
50
100
150
200
250
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Nu
mb
er o
f T
ran
spla
nts
NUMBER OF HEART-LUNG TRANSPLANTS REPORTED BY YEAR
ISHLT 2008NOTE: 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.
J Heart Lung Transplant 2008;27: 937-983
AVERAGE CENTER VOLUMEHeart-Lung Transplants: January 1, 1998 - June 30, 2007
47
32
94 10
5
10
15
20
25
30
35
40
45
50
1 2 3 4-9 10+
Average number of heart-lung transplants per year
Nu
mb
er
of
ce
nte
rs
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY CENTER VOLUME
Heart-Lung Transplants: January 1, 1998 - June 30, 2007
0
5
10
15
20
25
30
35
40
1 2 3 4-9 10+
Average number of heart-lung transplants per year
Pe
rce
nta
ge
of
he
art
-lu
ng
tra
ns
pla
nts
s
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME
Lung Transplants: January 1, 1998 - June 30, 2007
0
10
20
30
40
1-4 5-9 10-19 20-29 30-39 40-49 50+
Average number of lung transplants per year
Pe
rce
nta
ge
of
he
art
-lu
ng
tra
ns
pla
nts
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1982 - June 2006)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years
N=3,272
Half-life = 3.1 yearsConditional Half-life = 8.9 years
Su
rviv
al (
%)
ISHLT 2008
N at risk at 20 years = 18
J Heart Lung Transplant 2008;27: 937-983
HEART-LUNG TRANSPLANTATION
Adult Recipients
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
Acquired heart disease
4%Congenital heart disease
34%
COPD/Alpha-16%
CF14%
PPH25%
Re-transplant2%
OTHER12%
IPF3%
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (January 1982 - June 2007)
“Other” includes cancer, LAM, OB, sarcoidosis, bronchiectasis
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2007)
Diagnosis N (%)
Congenital Heart Disease 869 (34.4%)
Primary Pulmonary Hypertension 633 (25.0%)
Cystic Fibrosis 354 (14.0%)
Acquired Heart Disease 91 ( 3.6%)
COPD/Emphysema 96 ( 3.8%)
Idiopathic Pulmonary Fibrosis 72 ( 2.8%)
Alpha-1 52 ( 2.1%)
Re-Transplant: Not Obliterative Bronchiolitis 31 ( 1.2%)
Sarcoidosis 35 ( 1.4%)
Re-Transplant: Obliterative Bronchiolitis 24 ( 0.9%)
Bronchiectasis 20 ( 0.8%)
Obliterative Bronchiolitis (not Re-Transplant)
8 ( 0.3%)
Other 243 ( 9.6%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1982-1995 1996-1999 2000-6/2007
% o
f T
ran
sp
lan
ts
Other
Re-TX
PPH
IPF
CF
Acquired Heart Disease
Congenital Heart Disease
COPD/Alpha-1
“Other” includes OB (non-ReTX), Bronchiectasis, Sarcoidosis
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT HEART-LUNG TRANSPLANTATIONIndications By Year (%)
0
20
40
60
80
100
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Transplant Year
% o
f T
ran
spla
nts
Congenital Heart Disease Primary Pulmonary HypertensionCystic Fibrosis COPD/Alpha-1Acquired Heart Disease
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT HEART-LUNG TRANSPLANTATIONIndications By Year (Number)
0
50
100
150
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Transplant Year
Nu
mb
er o
f T
ran
spla
nts
Congenital Heart Disease Primary Pulmonary HypertensionCystic Fibrosis COPD/Alpha-1Acquired Heart Disease
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Europe North America Other
% o
f T
ran
sp
lan
ts
18 - 34 years 35 - 49 years 50 - 59 years 60+ years
ADULT HEART-LUNG TRANSPLANTS:AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2007
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f T
ran
spla
nts
-
Acquired heart disease Congenital heart disease Cystic Fibrosis IPF PPH Other
ADULT HEART-LUNG TRANSPLANTS:DIAGNOSIS DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2007
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f D
on
ors
6-11 12-17 18-34 35-49 50-59 60+
ADULT HEART-LUNG TRANSPLANTS:DONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2007
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for Adult Recipients
(Transplants: January 1982 - June 2006)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years
N=2,639
Half-life = 3.5 YearsConditional Half-life = 9.1 Years
Su
rviv
al (
%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for Adult Recipients by Era
(Transplants: January 1982 - June 2006)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
1982-1995 (N=1,660)
1996-1999 (N=497)
2000-6/2006 (N=482)
Half-life (Years): 1982-1995 = 3.0; 1996-1999 = 3.5; 2000-6/2006 =6.0 Conditional Half-life (Years): 1982-1995 = 8.7; 1996-1999 = 9.7; 2000-6/2006 = n/a
Su
rviv
al (
%)
ISHLT 2008
P-value comparing all: 0.0004
J Heart Lung Transplant 2008;27: 937-983
ADULT HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2006)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years
Su
rviv
al (
%)
Other Congenital (N = 181)Eisenmenger's Syndrome (N = 521)PPH (N = 404)
Congenital vs. Eisenmenger's: p = 0.0005Congenital vs. PPH: p = 0.0075Eisenmenger's vs. PPH: p = 0.3317
HALF-LIFE Congenital: 1.2 Years; Eisenmenger's: 5.8 Years; PPH: 4.3 Years
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year
(Transplants: January 1990 – June 2006)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years
Su
rviv
al
(%)
Other Congenital (N = 93)Eisenmenger's Syndrome (N = 348)PPH (N = 269)
HALF-LIFE Congenital Years: n.a.;Eisenmenger's: 10.6 Years; PPH: 9.7 Years
Congenital vs. Eisenmenger's: p = 0.7095Congenital vs. PPH: p = 0.5755Eisenmenger's vs. PPH: p = 0.2025
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT HEART-LUNG RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: April 1994 – June 2007)
0%
20%
40%
60%
80%
100%
1 Year (N = 263) 3 Years (N = 212) 5 Years (N = 180) 7 Years (N = 150)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT HEART-LUNG RECIPIENTSEmployment Status of Surviving Recipients
(Follow-ups: April 1994 – June 2007)
0%
20%
40%
60%
80%
100%
1 Year (N = 297) 3 Years (N = 207) 5 Years (N = 196) 7 Years (N = 146)
Working (FT/PTstatus unknown)
Retired
Not Working
Working Part Time
Working Full Time
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2007)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N = 352)
Between 2 and 3Years (N = 249)
Between 4 and 5Years (N = 215)
Between 6 and 7Years (N = 182)
No Hospitalization Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection Only Hospitalized, Infection Only
Hospitalized, Rejection and Infection
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
Any Induction (N = 120) Polyclonal ALG/ATG (N = 54) OKT3 (N = 5) IL2R-antagonist (N = 51)
% o
f p
ati
en
tsADULT HEART-LUNG RECIPIENTS
Induction ImmunosuppressionFor transplants between January 2001 through June 2007
ISHLT 2008
Analysis is limited to patients who were alive at the time of the follow-up
J Heart Lung Transplant 2008;27: 937-983
0
10
20
30
40
50
60
70
80
Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist
% o
f p
ati
en
ts
2000 2001 2002 20032004 2005 2006
ADULT HEART-LUNG RECIPIENTSInduction Immunosuppression (Transplants: January 2000 - December 2006)
ISHLT 2008
Analysis is limited to patients who were alive at the time of the follow-up
J Heart Lung Transplant 2008;27: 937-983
0
10
20
30
40
50
60
70
80
% o
f p
ati
en
ts
ADULT HEART-LUNG RECIPIENTSInduction Immunosuppression (Transplants: January 2000 - December 2006)
ISHLT 2008
Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist
Analysis is limited to patients who were alive at the time of the follow-up
J Heart Lung Transplant 2008;27: 937-983
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
atie
nts
Year 1 (N = 125) Year 5 (N = 86)
ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2001 through June 2007
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2008
Analysis is limited to patients who were alive at the time of the follow-up
J Heart Lung Transplant 2008;27: 937-983
0%
20%
40%
60%
80%
100%
Year 1 (N = 127) Year 5 (N = 91)
% o
f P
ati
en
ts
Other
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine + MMF
Cyclosporine + AZA
ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression Drug Combinations at Time of Follow-up
For follow-ups between January 2001 through June 2007
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2008
Analysis is limited to patients who were alive at the time of the follow-up
J Heart Lung Transplant 2008;27: 937-983
POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994 - June 2007)
Outcome Within 1
Year Total number with known response
Hypertension 56.7% (N = 344)
Renal Dysfunction 18.0% (N = 350)
Abnormal Creatinine < 2.5 mg/dl 11.1% Creatinine > 2.5 mg/dl 2.9% Chronic Dialysis 3.7% Renal transplant 0.3%
Hyperlipidemia 23.20% (N = 367)
Diabetes 16.90% (N = 354)
Coronary Artery Vasculopathy 2.80% (N = 287)
Bronchiolitis Obliterans 8.70% (N = 335)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant
(Follow-ups: April 1994 - June 2007)
Outcome Within 5
Years
Total number with known response
Hypertension 89.3% (N = 121)
Renal Dysfunction 28.5% (N = 130)
Abnormal Creatinine < 2.5 mg/dl 19.20% Creatinine > 2.5 mg/dl 8.50% Chronic Dialysis 0.80% Renal Transplant 0%
Hyperlipidemia 66.70% (N = 129)
Diabetes 21.60% (N = 125)
Coronary Artery Vasculopathy 8.50% (N = 71)
Bronchiolitis Obliterans 26.20% (N = 103)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
Freedom from Coronary Artery Vasculopathy
For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2007)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
% F
ree
fro
m C
AV
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
Freedom from Bronchiolitis Obliterans For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2007)
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
% F
ree
fro
m B
ron
ch
ioli
tis
Ob
lite
ran
s
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
Freedom from Severe Renal Dysfunction*For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2007)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
% F
ree
fro
m S
ev
ere
Re
na
l Dy
sfu
nc
tio
n
*Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994-June 2007)
Malignancy/Type 1-Year Survivors
5-Year Survivors
10-Year Survivors
No Malignancy 330 (92.7%) 114 (88.4%) 22 (84.6%)
Malignancy (all types combined) 26 (7.3%) 15 (11.6%) 4 (15.4%)
Malignancy Type*
Skin 2 4 4
Lymph 18 6 1
Other 2 3 3
Type Not Reported 4 2 0
ISHLT 2008
* Recipients may have experienced more than one type of malignancy so sum of individual malignancy types may be greater than total number with malignancy.
J Heart Lung Transplant 2008;27: 937-983
Freedom from MalignancyFor Adult Heart-Lung Recipients (Follow-ups: April 1994- June 2007)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
% F
ree
from
Mal
igna
ncy
All malignancy
Lymph
Skin
Other
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2007)
CAUSE OF DEATH 0-30 Days
(N = 269)
31 Days - 1 Year (N = 209)
>1 Year - 3 Years (N = 181)
>3 Years - 5 Years (N = 130)
>5 Years
(N = 249)
BRONCHIOLITIS 0 4 (1.9%) 39 (21.5%) 25 (19.2%) 38 (15.3%)
ACUTE REJECTION 3 (1.1%) 6 (2.9%) 2 (1.1%) 0 1 (0.4%)
LYMPHOMA 0 9 (4.3%) 11 (6.1%) 5 (3.8%) 4 (1.6%)
MALIGNANCY, OTHER 0 2 (1.0%) 6 (3.3%) 3 (2.3%) 12 (4.8%)
CMV 0 1 (0.5%) 0 1 (0.8%) 0
INFECTION, NON-CMV 51 (19.0%) 76 (36.4%) 61 (33.7%) 42 (32.3%) 76 (30.5%)
GRAFT FAILURE 79 (29.4%) 49 (23.4%) 29 (16.0%) 25 (19.2%) 50 (20.1%)
CARDIOVASCULAR 23 (8.6%) 9 (4.3%) 10 (5.5%) 9 (6.9%) 14 (5.6%)
TECHNICAL 53 (19.7%) 6 (2.9%) 1 (0.6%) 1 (0.8%) 0
OTHER 60 (22.3%) 47 (22.5%) 22 (12.2%) 19 (14.6%) 54 (21.7%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
HEART-LUNG TRANSPLANTATION
Pediatric Recipients
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNGRECIPIENTS (Transplants: January 1982 - June 2007)
0
50
100
150
200
250
300
<1 1-5 yrs 6-11 yrs 12-17 yrs
Recipient Age (Years)
Nu
mb
er o
f T
ran
spla
nts
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January 1982 - June 2007)
341
91
50 2240
50
100
150
200
250
300
350
0-11 yrs 12-17 yrs 18-34 35-49 50-59
Donor Age (Years)
Nu
mb
er o
f T
ran
spla
nts
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS
By Year of Transplant
0
5
10
15
20
25
30
35
40
45
50
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
12-17 Years1-11 Years
<1 Year
Nu
mb
er o
f T
ran
spla
nts
ISHLT 2008
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.
Transplants between January 1984 and June 2007J Heart Lung Transplant 2008;27: 937-983
AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS
By Era of Transplant
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1982-1995 1996-6/2007
12-17 Years
1-11 Years
<1 Year
Per
cen
tag
e o
f T
ran
spla
nts
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS
ISHLT 2008
NEED TO UPDATE
0
5
10
15
20
25
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Transplant Year
# P
edia
tric
Tra
nsp
lan
t C
ente
rs
Transplants between January 1984 and June 2007
J Heart Lung Transplant 2008;27: 937-983
NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS
Stratified by center volume
0
5
10
15
20
25
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Transplant Year
# P
edia
tric
Tra
nsp
lan
t C
ente
rs
1-4/yr 5-9/yr
10-19/yr 20-29/yr
ISHLT 2008
Transplants between January 1984 and June 2007J Heart Lung Transplant 2008;27: 937-983
9%
27%
18%
17%
1%
4%19%
2%
3%
Acquired Heart Disease
CF
Congenital (other)Eisenmenger's Syndrome
IPF
Other
PPHRetx: Non-OB
Retx: OB
DIAGNOSIS IN PEDIATRIC HEART –LUNG TRANSPLANT RECIPIENTS (Age: 12-17 Years)
0
25
50
75
100
% o
f C
ases
Cystic Fibrosis Congenital PPH
“Other” includes Bronchiectasis, Alpha-1, and OB (non-ReTX)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f T
ran
sp
lan
ts
0-5 years 6-11 years 12-17 years
PEDIATRIC HEART-LUNG TRANSPLANTS:AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2007
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f T
ran
sp
lan
ts-
Congenital heart disease Cystic Fibrosis PPH Other
PEDIATRIC HEART-LUNG TRANSPLANTS:DIAGNOSIS DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2007
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f Do
no
rs
0-5 6-11 12-17 18-34 35-49
PEDIATRIC HEART-LUNG TRANSPLANTS:DONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2007
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2006)
0
25
50
75
100
0 1 2 3 4 5 6 7 8
Years
Su
rviv
al (
%)
Congenital (N = 76)Eisenmenger's Syndrome (N = 50)PPH (N=78)
HALF-LIFE Congenital: 2.4 Years; Eisenmenger's: 2.6 Years; PPH: 3.3 Years
Congenital vs. Eisenmenger's: p = 0.6766Congenital vs. PPH: p = 0.4697Eisenmenger's vs. PPH: p =0.7507
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1982 - June 2006)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Years
Sur
viva
l (%
)
.
< 1 (N = 19)
1-11 (N = 211)
12-17 (N = 293)
Overall (N =523)
Half-life <1: 0.2 Years; 1-11: 3.0 Years; 12-17: 3.3 Years
P-values 0-<1 vs. 1-11: p = 0.0014; 0-<1 vs. 12-17: p=0.0009; 1-11 vs. 12-17: p=0.1232
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2006)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14Years
1982-1988 (N=110)
1989-1993 (N=180)
1994-1998 (N=127)
1999-6/2006 (N=104)
Half-life 1982-1988: 1.9; 1989-1993: 3.0; 1994-1998: 3.2; 1999-6/2006: 3.8
P-values 82-88 vs. 89-93: 0.4722; 82-88 vs. 94-98: 0.5852; 82-88 vs. 99-6/2006:0.0498; 89-93 vs. 94-98:0.9756; 89-93 vs. 99-6/2006: 0.2199; 94-98 vs. 99-6/2006: 0.2053
Su
rviv
al (
%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2006)
Conditional on Survival to 1 Year
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14Years
1982-1988 (N=61) 1989-1993 (N=111)
1994-1998 (N=78) 1999-6/2006 (N= 65)
Conditional HALF-LIFE 1982-1988: 8.0; 1989-1993: 7.2; 1994-1998: 5.9; 1999-6/2006: n/a
P-values 82-88 vs. 89-93: 0.6096; 82-88 vs. 94-98: 0.4825; 82-88 vs. 99-6/2006: 0.5409; 89-93 vs. 94-98: 0.9302;89-93 vs. 99-6/2006: 0.3785; 94-98 vs. 99-6/2006: 0.3181
Su
rviv
al (
%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2007)
CAUSE OF DEATH 0-30 Days (N = 37)
31 Days - 1 Year (N = 48 )
>1 Year - 3 Years (N = 41 )
>3 Years - 5 Years (N = 30 )
>5 Years (N = 39)
BRONCHIOLITIS 2 (4.2%) 20 (48.8%) 10 (33.3%) 8 (20.5%)
ACUTE REJECTION 2 (4.2%) 1 (2.4%)
MALIGNANCY, OTHER 1 (3.3%)
INFECTION, NON-CMV6 (16.2%) 16 (33.3%) 4 (9.8%) 1 (3.3%) 13 (33.3%)
GRAFT FAILURE 16 (43.2%) 9 (18.8%) 13 (31.7%) 14 (46.7%) 9 (23.1%)
CARDIOVASCULAR 2 (5.4%) 3 (6.3%) 2 (6.7%) 2 (5.1%)
TECHNICAL 6 (16.2%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: April 1994 - June 2007)
CAUSE OF DEATH 0-30 Days (N = 31)
31 Days - 1 Year (N = 34)
>1 Year - 3 Years (N = 35)
>3 Years - 5 Years (N = 26)
>5 Years
(N = 39)
BRONCHIOLITIS 1 (2.9%) 17 (48.6%) 9 (34.6%) 8 (20.5%)
ACUTE REJECTION 1 (2.9%) 1 (2.9%)
MALIGNANCY, OTHER 1 (3.8%)
INFECTION, NON-CMV 4 (12.9%) 12 (35.3%) 4 (11.4%) 1 (3.8%) 13 (33.3%)
GRAFT FAILURE 14 (45.2%) 6 (17.6%) 10 (28.6%) 12 (46.2%) 9 (23.1%)
CARDIOVASCULAR 2 (6.5%) 2 (5.9%) 1 (3.8%) 2 (5.1%)
TECHNICAL 4 (12.9%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983