HEART-LUNG TRANSPLANTATION Overall 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141.

HEART-LUNG TRANSPLANTATION

Overall

2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

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

2007

2008

Nu

mb

er

of

Tra

ns

pla

nts

NUMBER OF HEART-LUNG TRANSPLANTS REPORTED BY YEAR

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 VOLUMEHeart-Lung Transplants: January 1, 1998 - June 30, 2009

49

36

84 1

0

5

10

15

20

25

30

35

40

45

50

55

1 2 3 4-9 10+Average number of heart-lung transplants per year

Nu

mb

er

of

ce

nte

rs

0

10

20

30

40

50

Number of centers Percentage of transplants

Pe

rce

nta

ge

of

he

art

-lu

ng

tra

ns

pla

nts


DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY CENTER VOLUME

Heart-Lung Transplants: January 1, 1998 - June 30, 2009

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


DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME

Lung Transplants: January 1, 1998 - June 30, 2009

0

5

10

15

20

25

30

35

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


HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for All Ages (Transplants: January 1990 - June 2008)

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

Su

rviv

al (

%)

Half-life = 3.1 yearsConditional Half-life = 9.1 years

N=3,406

N at risk at 20 years = 36



Adult Recipients


Acquired heart disease

5%

Congenital heart disease

37%

COPD/Alpha-16%

CF14%

IPAH27%

Re-transplant2%

Other6%

IPF3%

DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (January 1982 - June 2009)

“Other” includes cancer, LAM, OB, sarcoidosis, bronchiectasis


DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2009)

Diagnosis N (%)

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%)


DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA (Transplants: January 1982 - June 2009)

0%

20%

40%

60%

80%

100%

1982-1995 1996-1999 2000-6/2009

% o

f T

ran

sp

lan

ts

Other

Re-TX

IPAH

IPF

CF

COPD/Alpha-1

Congenital Heart Disease

Acquired Heart Disease

“Other” includes OB (non-ReTX), Bronchiectasis, Sarcoidosis


ADULT HEART-LUNG TRANSPLANTATIONMajor Indications 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

2007

2008

Transplant Year

% o

f T

ran

sp

lan

ts

Congenital Heart Disease IPAHCystic Fibrosis COPD/Alpha-1Retransplant


ADULT HEART-LUNG TRANSPLANTATIONMajor Indications By Year (Number)

0

25

50

75

100

125

150

175

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Transplant Year

Nu

mb

er

of

Tra

ns

pla

nts

Congenital Heart Disease IPAH Cystic Fibrosis COPD/Alpha-1 Retransplant


0%

20%

40%

60%

80%

100%

Europe North America Other

% o

f T

ran

spla

nts

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 2009


0%

20%

40%

60%

80%

100%


Acquired heart disease Congenital heart disease Cystic Fibrosis IPF IPAH Other

% o

f T

ran

sp

lan

tsADULT HEART-LUNG TRANSPLANTS:DIAGNOSIS DISTRIBUTION BY LOCATION

Transplants between January 2000 and June 2009


0%

20%

40%

60%

80%

100%


% 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



HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for Adult Recipients

(Transplants: January 1982 - June 2008)

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

Su

rviv

al

(%)

Half-life = 3.6 YearsConditional Half-life = 9.5 Years

N=2,774

N at risk at 20 years = 28


HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for Adult Recipients by Era

(Transplants: January 1982 - June 2008)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Years

1982-1995 (N=1,648)

1996-1999 (N=498)

2000-6/2008 (N=628)

Su

rviv

al

(%)

P-value comparing all: 0.0002

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


ADULT HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2008)

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 = 248)Eisenmenger's Syndrome (N = 535)IPAH (N = 496)

Congenital vs. Eisenmenger's: p = 0.0026Congenital vs. IPAH: p = 0.1519Eisenmenger's vs. IPAH: p = 0.0282

HALF-LIFE Congenital: 1.9 Years; Eisenmenger's: 6.3 Years; IPAH: 3.8 Years


ADULT HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year

(Transplants: January 1990 – June 2008)

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 = 130)

Eisenmenger's Syndrome (N = 356)

IPAH (N = 327)

HALF-LIFE Congenital Years: 13.6;Eisenmenger's: 10.8 Years; IPAH: 9.1 Years



ADULT HEART-LUNG RECIPIENTS Cross-Sectional Analysis

Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2009)

0%

20%

40%

60%

80%

100%

1 Year (N = 264) 3 Years (N = 212) 5 Years (N = 180) 7 Years (N = 153)

No Activity Limitations Performs with Some Assistance Requires Total Assistance


ADULT HEART-LUNG RECIPIENTSLongitudinal Analysis

Functional Status of Surviving Recipients For the Same Patients

(Follow-ups: April 1994 – June 2009)

0%

20%

40%

60%

80%

100%

1 Year (N = 102) 3 Years (N = 102) 5 Years (N = 102)

No Activity Limitations Performs with Some Assistance


ADULT HEART-LUNG RECIPIENTS Functional Status of Surviving Recipients

US Recipients Only(Follow-ups: March 2005 - June 2009)

0%

20%

40%

60%

80%

100%

1 Year (N = 95) 2 Years (N = 77) 3 Years (N = 70)

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


ADULT HEART-LUNG RECIPIENTSEmployment Status of Surviving Recipients

(Follow-ups: April 1994 – June 2009)

0%

20%

40%

60%

80%

100%

1 Year (N = 315) 3 Years (N = 233) 5 Years (N = 206) 7 Years (N = 157)

Working (FT/PTstatus unknown)

Retired

Not Working

Working Part Time

Working Full Time


ADULT HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients

(Follow-ups: April 1994 - June 2009)

0%

20%

40%

60%

80%

100%

Up to 1 Year (N = 392)

Between 2 and 3 Years (N = 288)



No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Only Hospitalized, Infection OnlyHospitalized, Rejection and Infection


0

10

20

30

40

50

60

70

Any Induction (N =149)

Polyclonal ALG/ATG(N = 60)

OKT3 (N = 5) IL2R-antagonist (N =71)

% o

f p

ati

en

tsADULT HEART-LUNG RECIPIENTS

Induction ImmunosuppressionFor transplants between January 2001 through June 2009

Analysis is limited to patients who were alive at the time of the follow-up2010ISHLT

J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

0

10

20

30

40

50

60

70

80

90

Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist

% o

f p

ati

en

ts

2000 2001 20022003 2004 20052006 2007 2008

ADULT HEART-LUNG RECIPIENTSInduction Immunosuppression (Transplants: January 2000 - December 2008)



0

10

20

30

40

50

60

70

80

90

% o

f p

ati

en

ts

ADULT HEART-LUNG RECIPIENTSInduction Immunosuppression (Transplants: January 2000 - December 2008)

Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist



0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

atie

nts

Year 1 (N = 157) Year 5 (N = 98)

ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up

For follow-ups between January 2001 through June 2009

NOTE: Different patients are analyzed in Year 1 and Year 5



0%

20%

40%

60%

80%

100%

Year 1 (N = 157) Year 5 (N = 98)

% 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 2009

NOTE: Different patients are analyzed in Year 1 and Year 5



POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant


Outcome Within 1

Year Total number with known response

Hypertension 57.2% (N = 374)

Renal Dysfunction 18.1% (N = 387)

Abnormal Creatinine < 2.5 mg/dl 11.6% Creatinine > 2.5 mg/dl 2.8% Chronic Dialysis 3.4% Renal transplant 0.3%

Hyperlipidemia 25.6% (N = 395)

Diabetes 18.7% (N = 390)

Coronary Artery Vasculopathy 2.9% (N = 311)

Bronchiolitis Obliterans Syndrome 8.7% (N = 368)


POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant


Outcome Within 5

Years

Total number with known response

Hypertension 88.2% (N = 127)

Renal Dysfunction 28.7% (N = 143)

Abnormal Creatinine < 2.5 mg/dl 21.0% Creatinine > 2.5 mg/dl 6.3% Chronic Dialysis 1.4% Renal Transplant 0.0%

Hyperlipidemia 67.2% (N = 134)

Diabetes 23.4% (N = 137)

Coronary Artery Vasculopathy 8.0% (N = 75)

Bronchiolitis Obliterans Syndrome 27.2% (N = 114)


Freedom from Coronary Artery Vasculopathy For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2009)

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

% F

ree

fro

m C

AV


Freedom from Coronary Artery Vasculopathy For Adult Heart-Lung Recipients By Diagnosis Type

(Follow-ups: April 1994-June 2009)

50

60

70

80

90

100

0 1 2 3 4

Years

% F

ree

fro

m C

AV

Heart (N=184)

Lung (N=54)

Heart/Lung(N=68)

P-value comparing all = 0.2078


Freedom from Bronchiolitis Obliterans Syndrome For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2009)

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7Years

% F

ree

fro

m B

ron

ch

iolit

is O

blit

era

ns

S

yn

dro

me


Freedom from Bronchiolitis Obliterans Syndrome For Adult Heart-Lung Recipients By Diagnosis Type

(Follow-ups: April 1994-June 2009)

50

60

70

80

90

100

0 1 2 3 4 5

Years

Heart (N=211)Lung (N=61)Heart/Lung (N=91)

% F

ree

fro

m B

ron

ch

iolit

is O

blit

era

ns

S

yn

dro

me

P-value comparing all = 0.7771


Freedom from Severe Renal Dysfunction*For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2009)

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


MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994-June 2009)

Malignancy/Type 1-Year Survivors

5-Year Survivors

10-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*

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.


Freedom from MalignancyFor Adult Heart-Lung Recipients (Follow-ups: April 1994- June 2009)

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

% F

ree

fro

m M

alig

na

nc

y

All malignancyLymphSkinOther


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)

BRONCHIOLITIS 0 5 (2.2%) 41 (21.0%) 28 (20.4%) 48 (16.6%)

ACUTE REJECTION 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%)

CARDIOVASCULAR 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%)


ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death

(Deaths: January 1992 - June 2009)

0

10

20

30

40

50

0-30 Days (N =289)

31 Days – 1Year (N =226)

>1 Year – 3Years (N = 195)

>3 Years – 5Years (N = 137)

>5 Years (N =290 )

Bronchiolitis Infection (non-CMV) Graft Failure

Cardiovascular Technical

Pe

rce

nta

ge

of

De

ath

s



Pediatric Recipients


AGE DISTRIBUTION OF PEDIATRIC HEART-LUNGRECIPIENTS (Transplants: January 1982 - June 2009)

0

50

100

150

200

250

300

350

<1 1-5 yrs 6-11 yrs 12-17 yrs

Recipient Age (Years)

Nu

mb

er o

f T

ran

spla

nts


AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January 1982 - June 2009)

354

99

52 3270

50

100

150

200

250

300

350

400

0-11 yrs 12-17 yrs 18-34 35-49 50-59

Donor Age (Years)

Nu

mb

er o

f T

ran

spla

nts


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

2008

12-17 Years1-11 Years

<1 Year

Nu

mb

er o

f T

ran

spla

nts

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.


AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS

By Era of Transplant

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1982-1995 1996-6/2009

12-17 Years

1-11 Years

<1 Year

Per

cen

tag

e o

f T

ran

spla

nts


NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS

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

2008

Transplant Year

# P

edia

tric

Tra

nsp

lan

t C

ente

rs


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

2008

Transplant Year

# P

edia

tric

Tra

nsp

lan

t C

ente

rs

1-4/yr 5-9/yr

10-19/yr 20-29/yr


5%

22%

24%

13%

1%

5%25%

2%

2%

Acquired Heart Disease

CF

Congenital (other)Eisenmenger's Syndrome

IPF

Other

PPHRetx: Non-OB

Retx: OB

DIAGNOSIS IN PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS (Transplants: 1986-2008)

0

25

50

75

100

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

% o

f C

as

es

Cystic Fibrosis Congenital IPAH

“Other” includes Bronchiectasis, Alpha-1, and OB (non-ReTX)

NOTE: Unknown diagnoses were excluded from this tabulation.2010ISHLT


0%

20%

40%

60%

80%

100%


% 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 2009


0%

20%

40%

60%

80%

100%


Congenital heart disease Cystic Fibrosis IPAH Other

% o

f T

ran

sp

lan

tsPEDIATRIC HEART-LUNG TRANSPLANTS:

DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009


0%

20%

40%

60%

80%

100%


% o

f D

on

ors

0-5 6-11 12-17 18-34 35-49

PEDIATRIC HEART-LUNG TRANSPLANTS:DONOR AGE DISTRIBUTION BY LOCATION



PEDIATRIC HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2008)

0

25

50

75

100

0 1 2 3 4 5 6 7 8

Years

Su

rviv

al

(%)

Congenital (N = 85)

Eisenmenger's Syndrome (N = 44)

IPAH (N = 91)

HALF-LIFE Congenital: 2.4 Years; Eisenmenger's: 2.6 Years; IPAH: 4.4 Years



PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1982 - June 2008)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Years

Su

rviv

al

(%)

< 1 (N = 20)

1-11 (N = 217) 12-17 (N = 302)

Overall (N = 539)

Half-life <1: 0.2 Years;1-11: 3.0 Years; 12-17: 3.6 Years

0-<1 vs. 1-11: p = 0.0003; 0-<1 vs. 12-17: p < 0.0001; 1-11 vs. 12-17: p = 0.0580


PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2008)

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=178)

1994-1998 (N=124)1999-6/2008 (N=127)

Half-life 1982-1988: 1.9; 1989-1993: 3.0; 1994-1998: 3.3; 1999-6/2008: 4.7

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

Su

rviv

al

(%)


PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2008)

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=77) 1999-6/2008 (N=90)

Conditional HALF-LIFE 1982-1988: 10.1; 1989-1993: 7.4; 1994-1998: 6.4; 1999-6/2008: 8.4

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

Su

rviv

al

(%)


PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2009)

CAUSE OF DEATH0-30 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%)


PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: April 1994 - June 2009)

CAUSE OF DEATH0-30 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%)

CARDIOVASCULAR 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%)


PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death

(Deaths: April 1994 - June 2009)

0

10

20

30

40

50

0-30 Days (N =32)

31 Days – 1Year (N =36)

>1 Year – 3Years (N = 41)

>3 Years – 5Years (N = 24)

>5 Years (N =48 )

Bronchiolitis Graft Failure Cardiovascular Infection (Non-CMV)

Pe

rce

nta

ge

of

De

ath

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HEART-LUNG TRANSPLANTATION Overall 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141.

Documents

ishlt j heart lung transplant

distribution of heart

number of heart

heart disease133

adult recipients transplants

congenital heart disease972

ishlt transplant registry

diagnosis transplants