J Heart Lung Transplant 2009;28: 989-1049
LUNG TRANSPLANTATION
Pediatric Recipients
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
RECIPIENT AGE DISTRIBUTION FOR PEDIATRIC LUNG RECIPIENTS - NUMBER
(Transplants: January 1986 - June 2008)
0
100
200
300
400
500
600
700
800
900
1000
1986-1995 (N=306) 1996-6/2008 (N=972)
Nu
mb
er
of
Tra
ns
pla
nts
<1 1-5 6-11 12-17
ISHLT Analysis includes living donor transplants 2009
J Heart Lung Transplant 2009;28: 989-1049
RECIPIENT AGE DISTRIBUTION FOR PEDIATRIC LUNG RECIPIENTS - PERCENTAGE
(Transplants: January 1986 - June 2008)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1986-1995 (N=306) 1996-6/2008 (N=972)
% o
f T
ran
sp
lan
ts
12-17
6-11
1-5
<1
ISHLT Analysis includes living donor transplants 2009
J Heart Lung Transplant 2009;28: 989-1049
DONOR TYPE DISTRIBUTION BY YEAR OF TRANSPLANT FOR PEDIATRIC LUNG RECIPIENTS
(Transplants: 1986-2007)
0
10
20
30
40
50
60
70
80
90
100
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Transplant Year
Nu
mb
er
of
Tra
ns
pla
nts
Living
Deceased
ISHLTNOTE: 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
2009
J Heart Lung Transplant 2009;28: 989-1049
DONOR TYPE DISTRIBUTION BY RECIPIENT AGE GROUP WITHIN ERA FOR PEDIATRIC LUNG RECIPIENTS (Transplants: January 1986 - June 2008)
0
100
200
300
400
500
600
700
0-5 years 6-11 years 12-17 years 0-5 years 6-11 years 12-17 years
Recipient Age (Years)
Nu
mb
er
of
Tra
ns
pla
nts
LivingDeceased
1986-1995 1996-6/2008
ISHLT Analysis includes living donor transplants 2009
J Heart Lung Transplant 2009;28: 989-1049
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC
LUNG RECIPIENTS (Transplants: January 1986 - June 2008)
553
239
188
131
47
4
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Donor Age (Years)
Nu
mb
er
of
Tra
ns
pla
nts
60+
50-59
35-49
18-34
12-17
0-11
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
AGE DISTRIBUTION OF PEDIATRIC LUNG RECIPIENTS
By Year of Transplant
1 3 4 6
20
48 51 48
82
73
86 87
67 6762
6973
77
87 8793
43
0
20
40
60
80
100
12-17 Years
1-11 Years
<1 Year
Nu
mb
er o
f T
ran
spla
nts
ISHLT
Analysis includes living donor transplants 2009
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.
J Heart Lung Transplant 2009;28: 989-1049
NUMBER OF CENTERS REPORTING PEDIATRIC LUNG TRANSPLANTS
0
10
20
30
40
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Transplant Year
Nu
mb
er
of
Ce
nte
rs R
ep
ort
ing
P
ed
iatr
ic T
ran
sp
lan
ts
ISHLT
Analysis includes living donor transplants 2009
J Heart Lung Transplant 2009;28: 989-1049
NUMBER OF CENTERS REPORTING PEDIATRIC LUNG TRANSPLANTS BY CENTER VOLUME
0
10
20
30
40
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Transplant Year
Nu
mb
er
of
Ce
nte
rs R
ep
ort
ing
P
ed
iatr
ic T
ran
sp
lan
ts
20+ transplants
10-19 transplants
5-9 transplants
1-4 transplants
ISHLT
Analysis includes living donor transplants 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATION: Indications (Transplants: January 1990 – June 2008)
DIAGNOSIS AGE: < 1 Year
AGE: 1-5 Years
AGE: 6-11 Years
AGE: 12-17 Years
Cystic Fibrosis 2 2.4% 5 5.1% 124 53.0% 547 69.2%
Idiopathic Pulmonary Arterial Hypertension
11 13.4% 22 22.2% 25 10.7% 60 7.6%
Re-Transplant: Obliterative Bronchiolitis 6 6.1% 8 3.4% 25 3.2%
Congenital Heart Disease 21 25.6% 8 8.1% 4 1.7% 10 1.3%
Idiopathic Pulmonary Fibrosis 4 4.9% 8 8.1% 10 4.3% 26 3.3%
Obliterative Bronchiolitis (Not Re-TX) 9 9.1% 10 4.3% 29 3.7%
Re-Transplant: Not OB 3 3.7% 2 2.0% 7 3.0% 18 2.3%
Interstitial Pneumonitis 6 7.3% 11 11.1% 1 0.4% 5 0.6%
Pulmonary Vascular Disease 8 9.8% 5 5.1% 7 3.0% 1 0.2%
Eisenmenger’s Syndrome 1 1.2% 5 5.1% 5 2.1% 6 0.8%
Pulmonary Fibrosis, Other 1 1.2% 1 1.0% 7 3.0% 11 1.4%
Surfactant Protein B Deficiency 11 13.4% 4 4.0%
COPD/Emphysema 5 6.1% 2 2.0% 2 0.9% 6 0.8%
Bronchopulmonary Dysplasia 2 2.4% 2 2.0% 6 2.6%
Bronchiectasis 4 1.7% 9 1.1%
Other 7 8.5% 9 9.1% 14 6.0% 39 4.9%
ISHLT
Analysis includes living donor transplants 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATION:Other Indications (Transplants: January 1990 – June 2006)
DIAGNOSIS AGE: < 1 Year
AGE: 1-5 Years
AGE: 6-11 Years
AGE: 12-17 Years
Alpha - 1 - Antitrypsin Deficiency 1 0.2%
ARDS/Pneumonia 1 1.2% 1 0.5%
BOOP 1 0.2%
Dilated Myopathy: Adriamycin 1 0.2%
Graft-Vs-Host Disease (GVHD) 1 1.2% 2 0.3%
Idiopathic Pulmonary Hemosiderosis 2 0.3%
Inhalation Burns/Trauma 1 0.2%
Portopulmonary Hypertension 1 1.2%
Pulmonary Veno-Occlusive Disease 1 0.2%
Restrictive Lung Disease 1 1.2%
Rheumatoid Disease 1 1.2%
Scleroderma 1 0.2%
Secondary Pulmonary Hypertension 2 3.2%
Other Lung Disease 4 0.6%
ISHLT Last updated based on data as of December 2006
Analysis includes living donor transplants 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATION: Other Indications (Transplants: January 1990 – June 2006)
DIAGNOSIS(continued)
AGE: < 1 Year
AGE: 1-5 Years
AGE: 6-11 Years
AGE: 12-17 Years
Other – Specify: 3 4.8% 2 2.5% 2 1.0% 3 0.5%
Chronic Interstitial Pneumonia 1
Chronic Lung Disease Unknown Etiology
1
Diaphragmatic Hernia 1
End Stage Interstitial Lung Disease 1
Pulmonary 1
Pulmonary Interstitial Emphysema 1
Respiratory Failure 1
TALC/Pneumoconiosis/Berylliososis 1
Unknown 1 1
ISHLT Last updated based on data as of December 2006
Analysis includes living donor transplants 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATION: Other Indications (Transplants: January 1990 – June 2006)
DIAGNOSIS(continued)
AGE: < 1 Year
AGE: 1-5 Years
AGE: 6-11 Years
AGE: 12-17 Years
Lung Disease: Other Specify 2 1.0% 3 0.5%
Miscellaneous Lung: Not Specified 2
Pulmonary Lymphangectasia 1
Not Reported 1 1
Other 1 0.5% 6 0.9%
Congenital Anomaly 1
Langerhans -Histiocytosis 1
Not Reported 1 4
ISHLT Last updated based on data as of December 2006
Analysis includes living donor transplants 2009
J Heart Lung Transplant 2009;28: 989-1049
DIAGNOSIS IN PEDIATRIC LUNG RECIPIENTSBY YEAR OF TRANSPLANT
Age: 12-17 Years
0
25
50
75
100
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
% o
f T
ran
sp
lan
ts
IPAH Cystic Fibrosis
ISHLT
Analysis includes living donor transplants 2009
J Heart Lung Transplant 2009;28: 989-1049
0%
20%
40%
60%
80%
100%
Europe (N=181) North America (N=443) Other (N=35)
% o
f T
ran
sp
lan
ts
0-5 years 6-11 years 12-17 years
PEDIATRIC LUNG TRANSPLANTS:AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2008
ISHLT
Analysis includes living donor transplants 2009
J Heart Lung Transplant 2009;28: 989-1049
0%
20%
40%
60%
80%
100%
Europe (N=171) North America (N=443) Other (N=35)
% o
f T
ran
sp
lan
ts-
Cystic Fibrosis IPAH IPF OB Other Congenital heart disease Re-TX
PEDIATRIC LUNG TRANSPLANTS:DIAGNOSIS DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2008
ISHLT
NOTE: Unknown diagnoses were excluded from this tabulation.
Total number of transplants reported:Europe = 171North America = 443Other = 35
Analysis includes living donor transplants
2009
J Heart Lung Transplant 2009;28: 989-1049
0%
20%
40%
60%
80%
100%
Europe (N=181) North America (N=407) Other (N=35)
% o
f D
on
ors
0-5 6-11 12-17 18-34 35-49 50-59 60+
PEDIATRIC LUNG TRANSPLANTS:DONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2008
ISHLT
NOTE: Transplants with unknown donor age and living donor transplants were excluded from this tabulation.
Total number of transplants reported:Europe = 181North America = 443Other = 352009
J Heart Lung Transplant 2009;28: 989-1049
LUNG TRANSPLANTATIONKaplan-Meier Survival by Age Group
(Transplants: January 1990 - June 2007)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Years
Su
rviv
al
(%)
Adult (N=25,234)
Pediatric (N=1,071)
HALF-LIFE Adult = 5.2 Years; Pediatric = 4.5 Years
P = 0.9674
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type
(Transplants: January 1990 - June 2007)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14Years
Su
rviv
al
(%)
Single Lung (N=70)
Bilateral/Double Lung (N=1,000)
HALF-LIFE Single Lung: 2.4 Years; Bilateral/double Lung: 4.7 Years
P < .0001
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATIONKaplan-Meier Survival for Congenital Diagnoses
(Transplants: January 1990 – June 2007)
0
25
50
75
100
0 1 2 3 4 5Years
Su
rviv
al
(%)
Eisenmenger's Syndrome (N=15)
Other Congenital Heart Disease (N=41)
Eisenmenger's + Other Congenital Heart Disease (N=56)
N at risk = 7
N at risk = 12
N at risk = 16
Eisenmenger’s vs. Other: p = 0.4444
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATIONKaplan-Meier Survival by Age Group
(Transplants: January 1990 - June 2007)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10 11 12
Years
Su
rviv
al
(%)
<1 Year (N=79)
1-11 Years (N=308)
12-17 Years (N=684)
<1 year vs. 1-11 years: p = 0.2992<1 year vs. 12-17 years: p = 0.96421-11 years vs. 12-17 years: p = 0.0652
HALF-LIFE<1 Year: 6.4 Years1-11 Years: 5.7 Years12-17 Years: 4.2 Years
N at risk = 9N at risk = 13
N at risk = 14
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATIONConditional Kaplan-Meier Survival by Age Group
(Transplants: January 1990 - June 2007)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10 11 12
Years
Su
rviv
al
(%)
<1 Year (N=48)1-11 Years (N=220)
12-17 Years (N=472)
<1 year vs. 1-11 year: p = 0.5558<1 year vs. 12-17 years: p = 0.12221-11 years vs. 12-17 years: p =0.0952
N at risk = 9
N at risk = 13
N at risk = 14
CONDITIONAL HALF-LIFE<1 Year: 8.8 Years1-11 Years: 10.5 Years12-17 Years: 6.1 Years
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1988 - June 2007)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Years
Su
rviv
al
(%)
1988-1994 (N=208)
1995-2001 (N=450)
2002-6/2007 (N=423)
HALF-LIFEUnconditional 1988-1994: 2.8 Years; 1995-2001: 4.5 Years; 2002-6/2007: 4.8Conditional 1988-1994: 7.1 Years; 1995-2001: 6.9 Years; 2002-6/2007: na
1988-1994 vs. 1995-2001: p = 0.04271988-1994 vs. 2002-6/2007: p = 0.00041995-2001 vs. 2002-6/2007: p = 0.1545
N at risk = 26
N at risk = 15
N at risk = 15
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATIONKaplan-Meier Survival by Donor Type for Recipients Age 12-17 Years
(Transplants: January 1990 - June 2007)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
Deceased Donor (N = 684)
Living Donor (N = 75)
p = 0.3990
N at risk = 9
N at risk = 30
HALF-LIFEDeceased: 4.2 YearsLiving: 3.7 Years
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
0
2
4
6
8
10
12
14
16
18
0-<1 month 1-<12 months 12-<36 months 36+ months Not reported
Nu
mb
er o
f R
e-T
ran
spla
nts
PEDIATRIC LUNG RE-TRANSPLANTS Between January 1994 and June 2008
ISHLTTime Between Previous and Current Transplant
2009
J Heart Lung Transplant 2009;28: 989-1049
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5
Years
Su
rviv
al
(%)
N at risk at 5 years = 7
PEDIATRIC LUNG RETRANSPLANTSSurvival for Transplants Performed Between January 1994 and June 2007
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: April 1994-June 2008)
0%
20%
40%
60%
80%
100%
1 Year (N = 325) 3 Years (N = 205) 5 Years (N = 127) 7 Years (N=56)
No Activity Limitations Performs with Assistance Total Assistance
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG RECIPIENTS Functional Status of Surviving Recipients
For the Same Patients(Follow-ups: April 1994-June 2008)
0%
20%
40%
60%
80%
100%
1 Year (N = 82) 3 Years (N = 82) 5 Years (N = 82)
No Activity Limitations Performs with Assistance Total Assistance
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2008)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N =537)
Between 2 and 3Years (N = 312)
Between 4 and 5Years (N = 191)
Between 6 and 7Years (N = 96)
No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Hospitalized, Infection OnlyHospitalized, Rejection + Infection
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2008)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N =537)
Between 1 and 3Years (N = 281)
Between 3 and 5Years (N = 173)
Between 5 and 7Years (N = 86)
No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Hospitalized, Infection OnlyHospitalized, Rejection + Infection
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
0
10
20
30
40
50
60
Any Induction (N = 189) Polyclonal ALG/ATG (N = 49) IL2R-antagonist (N = 137)
% o
f p
ati
en
tsPEDIATRIC LUNG RECIPIENTS
Induction ImmunosuppressionFor transplants between January 2001 and June 2008
ISHLT
Analysis is limited to patients who were alive at the time of the follow-up2009
J Heart Lung Transplant 2009;28: 989-1049
0
10
20
30
40
50
60
70
Any Induction Polyclonal ALG/ATG IL2R-antagonist
% o
f p
ati
en
ts
2001 20022003 20042005 20062007 1/2008-6/2008
PEDIATRIC LUNG RECIPIENTSInduction Immunosuppression (Transplants: January 2001 - June 2007)
ISHLT
Analysis is limited to patients who were alive at the time of the follow-up2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATIONKaplan-Meier Survival Stratified by Induction Use
(Transplants: January 2001 - June 2007)
0
25
50
75
100
0 1 2 3 4 5
Years
Su
rviv
al
(%)
Induction (N = 166)
No Induction (N = 125)
p = 0.8009
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
atie
nts
Year 1 (N = 272) Year 5 (N = 117)
PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2001 – June 2008)
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT
Analysis is limited to patients who were alive at the time of the follow-up2009
J Heart Lung Transplant 2009;28: 989-1049
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
(Follow-ups: January 2001 – June 2008)
1 Year Follow-up (N = 272) 5 Year Follow-up (N = 117)NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT
NOTE: 4% of patients were on both calcineurin inhibitors at different point during the year; these patients are not counted in either group. And 1% (2 patients) was on neither drugs during the year. In the 5-year tabulations, 13% were reported to be on both drugs during the year and 1% (1 patient) was reported to be on neither drugs.
Analysis is limited to patients who were alive at the time of the follow-up
2009
J Heart Lung Transplant 2009;28: 989-1049
0%
20%
40%
60%
80%
100%
Year 1 (N = 272) Year 5 (N = 117)
% o
f P
ati
en
ts
Other
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine + MMF
Cyclosporine + AZA
PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up Report
(Follow-ups: January 2001 – June 2008)
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT
Analysis is limited to patients who were alive at the time of the follow-up2009
J Heart Lung Transplant 2009;28: 989-1049
POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994 - June 2008)
Outcome Within 1
Year
Total number with known response
Hypertension 42.8% (N = 523)
Renal Dysfunction 10.5% (N = 531)
Abnormal Creatinine < 2.5 mg/dl 7.5% Creatinine > 2.5 mg/dl 2.1% Chronic Dialysis 0.6% Renal Transplant 0.4%
Hyperlipidemia 4.8% (N = 541)
Diabetes 27.1% (N = 531)
Bronchiolitis Obliterans Syndrome 14.0% (N = 501)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 5 Years Post-Transplant
(Follow-ups: April 1994 - June 2008)
Outcome Within 5
Years Total number with known response
Hypertension 69.2% (N = 130)
Renal Dysfunction 21.6% (N = 134) Abnormal Creatinine < 2.5 mg/dl 14.9% Creatinine > 2.5 mg/dl 3.7% Chronic Dialysis 2.2% Renal Transplant 0.7%
Hyperlipidemia 11.1% (N = 135)
Diabetes 33.1% (N = 133)
Bronchiolitis Obliterans Syndrome 36.6% (N = 101)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 7 Years Post-Transplant
(Follow-ups: April 1994 - June 2008)
Outcome Within 7
Years
Total number with known response
Hypertension 70.7% (N = 58)
Renal Dysfunction 34.80% (N = 66)
Abnormal Creatinine < 2.5 mg/dl 22.7% Creatinine > 2.5 mg/dl 4.5% Chronic Dialysis 0.0% Renal Transplant 7.6%
Hyperlipidemia 4.7% (N = 64)
Diabetes 34.4% (N = 61)
Bronchiolitis Obliterans Syndrome 35.9% (N = 39)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
Freedom from Bronchiolitis Obliterans Syndrome For Pediatric Lung Recipients (Follow-ups: April 1994 - June 2008)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
% F
ree
fro
m B
ron
ch
iolit
is O
blit
era
ns
S
yn
dro
me
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
Freedom from Bronchiolitis Obliterans Syndrome For Pediatric Lung Recipients by Induction Use
(Follow-ups: April 1994 - June 2008)
0
25
50
75
100
0 1 2 3 4 5 6 7
Years
Induction (N = 183)
No Induction (N =293)
p =0.6595
% F
ree
fro
m B
ron
ch
iolit
is O
blit
era
ns
S
yn
dro
me
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
Freedom from Severe Renal Dysfunction*For Pediatric Lung Recipients (Follow-ups: April 1994 - June 2008)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
% F
ree
fro
m S
ev
ere
Re
na
l Dy
sfu
nc
tio
n
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
MALIGNANCY POST-LUNG TRANSPLANTATION FOR PEDIATRICSCumulative Incidence for Survivors (Follow-ups: April 1994 - June 2008)
Malignancy/Type 1-Year Survivors
5-Year Survivors
7-Year Survivors
No Malignancy 511 (94.1%) 119 (86.9%) 60 (89.6%)
Malignancy (all types combined)
32 (5.9%) 18 (13.1%) 7 (10.4%)
Malignancy Type
Lymph 29 18 7
Other 2 1 0
”Other” includes Liver and primitive neuroectodermal tumor.
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
Freedom from MalignancyFor Pediatric Lung Recipients (Follow-ups: April 1994 - June 2008)
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
All malignancy Lymph Skin Other% F
ree
fro
m M
alig
na
nc
y
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANT RECIPIENTS: Cause Of Death(Deaths: January 1992- June 2008)
CAUSE OF DEATH0-30 Days
(N =67)31 Days - 1 Year
(N = 118)
>1 Year - 3 Years
(N = 136)
>3 Years - 5 Years
(N = 68)
>5 Years
(N = 51)
BRONCHIOLITIS 11 (9.3%) 53 (39.0%) 28 (41.2%) 22 (43.1%)
ACUTE REJECTION 2 (3.0%) 3 (2.5%) 1 (1.5%)
LYMPHOMA 6 (5.1%) 4 (2.9%) 2 (2.9%) 4 (7.8%)
MALIGNANCY, NON-LYMPHOMA
1 (0.7%) 1 (1.8%)
CMV 5 (4.2%)
INFECTION, NON-CMV 10 (14.9%) 41 (34.7%) 24 (17.6%) 15 (22.1%) 5 (9.8%)
GRAFT FAILURE 20 (29.9%) 22 (18.6%) 35 (25.7%) 11 (16.2%) 12 (23.5%)
CARDIOVASCULAR 10 (14.9%) 6 (5.1%) 2 (1.5%)
TECHNICAL 10 (14.9%) 3 (2.5%)
MULTIPLE ORGAN FAILURE
5 (7.5%) 8 (6.8%) 7 (5.1%) 3 (4.4%) 3 (5.9%)
OTHER 10 (14.9%) 13 (11.0%) 10 (7.4%) 8 (11.8%) 5 (9.8%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANT RECIPIENTS: Other Cause Of Death(Deaths: January 1992- June 2006)
CAUSE OF DEATH0-30 Days
(N =72)
31 Days - 1 Year
(N = 107)
>1 Year - 3 Years
(N = 111)
>3 Years - 5 Years
(N = 56)
>5 Years
(N = 38)
Graft Failure: Graft Infection 4 (5.6%) 3 2.8%) 4 (3.6%) 2 (5.3%)
Graft Failure: Recurrent Disease 1 (0.9%) 1 (2.6%)
Pulm: Pulmonary Embolism 1 (1.4%) 1 (1.8%)
Cerebrovascular: Hemorrhage (Non-Stroke) 3 4.2%) 3 (2.8%)
Cerebrovascular: Brain Anoxia 1 (1.4%) 1 (0.9%) 1 (0.9%)
Cerebrovascular: Other Specify 3 4.2%)
Hemorrhage: Gastrointestinal 1 (0.9%)
Hemorrhage: Respiratory 1 (0.9%) 1 (1.8%)
Renal Failure 1 (2.6%)
Non-Compliance 1 (0.9%) 1 (1.8%)
Primary Organ Failure 1 (1.4%)
Thromboembolic Disease 1 (0.9%)
Hus Hemolytic Uremic Syndrome 1 (1.8%)
Respiratory Failure 1 (1.8%)
ISHLT Last updated based on data as of December 2006
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death
(Deaths: January 1992 - June 2008)
0
10
20
30
40
50
0-30 Days (N = 67)
31 Days – 1Year (N = 118)
>1 Year – 3Years (N =136)
>3 Years – 5Years (N = 68)
>5 Years (N = 51 )
Bronchiolitis Infection (non-CMV)
Graft Failure Cardiovascular
Multiple Organ Failure
Pe
rce
nta
ge
of
De
ath
s
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
N=738
VARIABLE N Relative
Risk P-value
95% Confidence Interval
On ventilator 108 3.62 <0.0001 2.41 5.42
Year of Transplant: 1990-98 vs. 1999-6/2007 346 1.94 <0.0001 1.42 2.64
Pediatric transplant volume >5 transplants within 1 year
312 0.71 0.0475 0.51 1.00
ISHLT
PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1990-6/2007) Risk Factors For 1 Year Mortality/Graft Failure
2009
J Heart Lung Transplant 2009;28: 989-1049
N=527
VARIABLE N Relative
Risk P-value
95% Confidence Interval
On ventilator 81 2.46 <0.001 1.73 3.50
Year of Transplant: 1990-98 vs. 1999-6/2003 346 1.48 0.0018 1.16 1.89
Age: 1-11 Year vs. 12-17 Years 180 0.76 0.0465 0.58 1.00
Age: <1 Year vs. 12-17 Years 54 0.55 0.0104 0.35 0.87
ISHLT
PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1990-6/2003) Risk Factors For 5 Year Mortality/Graft Failure
2009