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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)
1000
900
<1 1-5 6-11 12-17
800
Number of Transplants
700
600
500
400
300
200
100
0
1986-1995 (N=306) 1996-6/2008 (N=972)
ISHLT 2009 Analysis includes living donor transplants
J Heart Lung Transplant 2009;28: 989-1049
RECIPIENT AGE DISTRIBUTION FOR
PEDIATRIC LUNG RECIPIENTS - PERCENTAGE
(Transplants: January 1986 - June 2008)
100%
90%
80%
12-17
70%
% of Transplants
60% 6-11
50%
40% 1-5
30%
<1
20%
10%
0%
1986-1995 (N=306) 1996-6/2008 (N=972)
ISHLT 2009 Analysis includes living donor transplants
J Heart Lung Transplant 2009;28: 989-1049
DONOR TYPE DISTRIBUTION BY YEAR OF
TRANSPLANT FOR PEDIATRIC LUNG RECIPIENTS
(Transplants: 1986-2007)
100
Living
90 Deceased
80
Number of Transplants
70
60
50
40
30
20
10
0
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
NOTE: This figure includes only the lung transplants that are
Transplant Year reported to the ISHLT Transplant Registry. As such, the
ISHLT 2009
presented data may not mirror the changes in the number of
lung transplants performed worldwide.
J Heart Lung Transplant 2009;28: 989-1049 Analysis includes living donor transplants
DONOR TYPE DISTRIBUTION BY RECIPIENT AGE
GROUP WITHIN ERA FOR PEDIATRIC LUNG
RECIPIENTS (Transplants: January 1986 - June 2008)
700
Living
600 Deceased
Number of Transplants
500
400
300
200
100
0
0-5 years 6-11 years 12-17 years 0-5 years 6-11 years 12-17 years
1986-1995 1996-6/2008
Recipient Age (Years)
ISHLT 2009 Analysis includes living donor transplants
J Heart Lung Transplant 2009;28: 989-1049
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC
LUNG RECIPIENTS (Transplants: January 1986 - June 2008)
100% 47
90% 4 131
80%
188 60+
Number of Transplants
70%
50-59
60% 239
35-49
50%
18-34
40%
12-17
30%
553 0-11
20%
10%
0%
Donor Age (Years)
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
AGE DISTRIBUTION OF
PEDIATRIC LUNG RECIPIENTS
By Year of Transplant
100 93
12-17 Years 86 87 87 87
82
Number of Transplants
80 77
1-11 Years 73 73
67 67 69
<1 Year 62
60
51
48 48
43
40
20
20
4 6
1 3
0
86
87
88
89
90
91
92
93
94
95
96
97
98
99
00
01
02
03
04
05
06
07
19
19
19
19
19
19
19
19
19
19
19
19
19
19
20
20
20
20
20
20
20
20
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 2009 Analysis includes living donor transplants
J Heart Lung Transplant 2009;28: 989-1049
NUMBER OF CENTERS REPORTING
PEDIATRIC LUNG TRANSPLANTS
40
Number of Centers Reporting
30
Pediatric Transplants
20
10
0
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Transplant Year
ISHLT 2009 Analysis includes living donor transplants
J Heart Lung Transplant 2009;28: 989-1049
NUMBER OF CENTERS REPORTING
PEDIATRIC LUNG TRANSPLANTS BY CENTER VOLUME
40
20+ transplants
10-19 transplants
Number of Centers Reporting
5-9 transplants
30
1-4 transplants
Pediatric Transplants
20
10
0
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Transplant Year
ISHLT 2009 Analysis includes living donor transplants
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATION:
Indications (Transplants: January 1990 – June 2008)
DIAGNOSIS AGE: < 1 AGE: 1-5 AGE: 6-11 AGE: 12-17
Year Years Years Years
Cystic Fibrosis 2 2.4% 5 5.1% 124 53.0% 547 69.2%
Idiopathic Pulmonary Arterial 11 13.4% 22 22.2% 25 10.7% 60 7.6%
Hypertension
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%
Analysis includes living donor transplants
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATION:
Other Indications (Transplants: January 1990 – June 2006)
DIAGNOSIS AGE: < 1 AGE: 1-5 AGE: 6-11 AGE: 12-17
Year Years Years 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%
Analysis includes living donor transplants
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049 Last updated based on data as of December 2006
PEDIATRIC LUNG TRANSPLANTATION:
Other Indications (Transplants: January 1990 – June 2006)
DIAGNOSIS AGE: < 1 AGE: 1-5 AGE: 6-11 AGE: 12-17
(continued) Year Years Years Years
Other – Specify: 3 4.8% 2 2.5% 2 1.0% 3 0.5%
Chronic Interstitial Pneumonia 1
Chronic Lung Disease Unknown 1
Etiology
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
Analysis includes living donor transplants
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049 Last updated based on data as of December 2006
PEDIATRIC LUNG TRANSPLANTATION:
Other Indications (Transplants: January 1990 – June 2006)
DIAGNOSIS AGE: < 1 AGE: 1-5 AGE: 6-11 AGE: 12-17
(continued) Year Years Years 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
Analysis includes living donor transplants
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049 Last updated based on data as of December 2006
DIAGNOSIS IN PEDIATRIC LUNG RECIPIENTS
BY YEAR OF TRANSPLANT
Age: 12-17 Years
100
IPAH Cystic Fibrosis
75
% of Transplants
50
25
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
ISHLT 2009 Analysis includes living donor transplants
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTS:
AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2008
0-5 years 6-11 years 12-17 years
100%
80%
% of Transplants
60%
40%
20%
0%
Europe (N=181) North America (N=443) Other (N=35)
ISHLT 2009 Analysis includes living donor transplants
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTS:
DIAGNOSIS DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2008
Cystic Fibrosis IPAH IPF OB Other Congenital heart disease Re-TX
100%
% of Transplants-
80%
60%
40%
20%
0%
Europe (N=171) North America (N=443) Other (N=35)
NOTE: Unknown diagnoses were excluded from this tabulation.
Total number of transplants reported:
Europe = 171
ISHLT 2009 North America = 443
Other = 35
J Heart Lung Transplant 2009;28: 989-1049 Analysis includes living donor transplants
PEDIATRIC LUNG TRANSPLANTS:
DONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2008
0-5 6-11 12-17 18-34 35-49 50-59 60+
100%
80%
% of Donors
60%
40%
20%
0%
Europe (N=181) North America (N=407) Other (N=35)
NOTE: Transplants with unknown donor age and living donor transplants were
excluded from this tabulation.
Total number of transplants reported:
Europe = 181
ISHLT 2009 North America = 443
Other = 35
J Heart Lung Transplant 2009;28: 989-1049
LUNG TRANSPLANTATION
Kaplan-Meier Survival by Age Group
(Transplants: January 1990 - June 2007)
100
P = 0.9674 Adult (N=25,234)
Pediatric (N=1,071)
75
Survival (%)
50
25
HALF-LIFE Adult = 5.2 Years; Pediatric = 4.5 Years
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Years
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATION
Kaplan-Meier Survival by Procedure Type
(Transplants: January 1990 - June 2007)
100
P < .0001 Single Lung (N=70)
Bilateral/Double Lung (N=1,000)
75
Survival (%)
50
25
HALF-LIFE Single Lung: 2.4 Years; Bilateral/double Lung: 4.7 Years
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Years
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATION
Kaplan-Meier Survival for Congenital Diagnoses
(Transplants: January 1990 – June 2007)
100
Eisenmenger’s vs. Other: p = 0.4444
75
N at risk = 12
Survival (%)
N at risk = 7
50
N at risk = 16
Eisenmenger's Syndrome (N=15)
25
Other Congenital Heart Disease (N=41)
Eisenmenger's + Other Congenital Heart Disease (N=56)
0
0 1 2 3 4 5
Years
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATION
Kaplan-Meier Survival by Age Group
(Transplants: January 1990 - June 2007)
100
<1 year vs. 1-11 years: p = 0.2992
<1 year vs. 12-17 years: p = 0.9642
1-11 years vs. 12-17 years: p = 0.0652
75 <1 Year (N=79)
1-11 Years (N=308)
Survival (%)
12-17 Years (N=684)
50
N at risk = 13
N at risk = 9
25 HALF-LIFE N at risk = 14
<1 Year: 6.4 Years
1-11 Years: 5.7 Years
12-17 Years: 4.2 Years
0
0 1 2 3 4 5 6 7 8 9 10 11 12
Years
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATION
Conditional Kaplan-Meier Survival by Age Group
(Transplants: January 1990 - June 2007)
100
<1 year vs. 1-11 year: p = 0.5558
<1 year vs. 12-17 years: p = 0.1222
1-11 years vs. 12-17 years: p =0.0952
75
Survival (%)
N at risk = 13
50 CONDITIONAL HALF-LIFE
<1 Year: 8.8 Years N at risk = 9
1-11 Years: 10.5 Years
12-17 Years: 6.1 Years N at risk = 14
25
<1 Year (N=48)
1-11 Years (N=220)
12-17 Years (N=472)
0
0 1 2 3 4 5 6 7 8 9 10 11 12
Years
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATION
Kaplan-Meier Survival by Era (Transplants: January 1988 - June 2007)
100
HALF-LIFE
Unconditional 1988-1994: 2.8 Years; 1995-2001: 4.5 Years; 2002-6/2007: 4.8
Conditional 1988-1994: 7.1 Years; 1995-2001: 6.9 Years; 2002-6/2007: na
80
1988-1994 vs. 1995-2001: p = 0.0427
1988-1994 vs. 2002-6/2007: p = 0.0004
Survival (%)
1995-2001 vs. 2002-6/2007: p = 0.1545
60
N at risk = 15
40 N at risk = 26
1988-1994 (N=208)
N at risk = 15
20 1995-2001 (N=450)
2002-6/2007 (N=423)
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Years
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATION
Kaplan-Meier Survival by Donor Type for Recipients Age 12-17 Years
(Transplants: January 1990 - June 2007)
100
p = 0.3990
75
HALF-LIFE
Survival (%)
Deceased: 4.2 Years
Living: 3.7 Years
50
N at risk = 30
N at risk = 9
25
Deceased Donor (N = 684)
Living Donor (N = 75)
0
0 1 2 3 4 5 6 7 8 9 10
Years
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG RE-TRANSPLANTS
Between January 1994 and June 2008
18
16
Number of Re-Transplants
14
12
10
8
6
4
2
0
0-<1 month 1-<12 months 12-<36 months 36+ months Not reported
Time Between Previous and Current Transplant
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG RETRANSPLANTS
Survival for Transplants Performed Between January 1994 and June 2007
100
90
80
70
Survival (%)
60
N at risk at 5 years = 7
50
40
30
20
10
0
0 1 2 3 4 5
Years
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG RECIPIENTS
Functional Status of Surviving Recipients
(Follow-ups: April 1994-June 2008)
100%
80%
60%
40%
20% No Activity Limitations Performs with Assistance Total Assistance
0%
1 Year (N = 325) 3 Years (N = 205) 5 Years (N = 127) 7 Years (N=56)
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)
100%
80%
60%
40%
20% No Activity Limitations Performs with Assistance Total Assistance
0%
1 Year (N = 82) 3 Years (N = 82) 5 Years (N = 82)
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)
100%
80%
60%
40%
20% No Hospitalization Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection Hospitalized, Infection Only
Hospitalized, Rejection + Infection
0%
Up to 1 Year (N = Between 2 and 3 Between 4 and 5 Between 6 and 7
537) Years (N = 312) Years (N = 191) Years (N = 96)
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)
100%
80%
60%
40%
20% No Hospitalization Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection Hospitalized, Infection Only
Hospitalized, Rejection + Infection
0%
Up to 1 Year (N = Between 1 and 3 Between 3 and 5 Between 5 and 7
537) Years (N = 281) Years (N = 173) Years (N = 86)
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG RECIPIENTS
Induction Immunosuppression
For transplants between January 2001 and June 2008
60
50
40
% of patients
30
20
10
0
Any Induction (N = 189) Polyclonal ALG/ATG (N = 49) IL2R-antagonist (N = 137)
ISHLT 2009 Analysis is limited to patients who were
alive at the time of the follow-up
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG RECIPIENTS
Induction Immunosuppression (Transplants: January 2001 - June 2007)
70
2001 2002
60 2003 2004
2005 2006
2007 1/2008-6/2008
50
% of patients
40
30
20
10
0
Any Induction Polyclonal ALG/ATG IL2R-antagonist
ISHLT 2009 Analysis is limited to patients who were
alive at the time of the follow-up
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANTATION
Kaplan-Meier Survival Stratified by Induction Use
(Transplants: January 2001 - June 2007)
100
p = 0.8009
75
Survival (%)
50
25
Induction (N = 166)
No Induction (N = 125)
0
0 1 2 3 4 5
Years
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG RECIPIENTS
Maintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2001 – June 2008)
100
Year 1 (N = 272) Year 5 (N = 117)
80
% of Patients
60
40
20
0
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2009 Analysis is limited to patients who were
alive at the time of the follow-up
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG RECIPIENTS
Maintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2001 – June 2008)
100
80
% of Patients
Tac
60 Tac
MMF
MMF
40
20 CyA
AZA
AZA
CyA
0
Calcineurin CellCycle Prednisone Calcineurin CellCycle Prednisone
Inhibitor Inhibitor
1 Year Follow-up (N = 272) 5 Year Follow-up (N = 117)
NOTE: Different patients are analyzed in Year 1 and Year 5
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
ISHLT 2009 tabulations, 13% were reported to be on both drugs during the year and
1% (1 patient) was reported to be on neither drugs.
J Heart Lung Transplant 2009;28: 989-1049 Analysis is limited to patients who were alive at the time of the follow-up
PEDIATRIC LUNG RECIPIENTS
Maintenance Immunosuppression Drug Combinations at Time of Follow-up Report
(Follow-ups: January 2001 – June 2008)
100%
Other
80%
Tacrolimus + MMF
% of Patients
60%
Tacrolimus + AZA
40%
Cyclosporine + MMF
20%
Cyclosporine + AZA
0%
Year 1 (N = 272) Year 5 (N = 117)
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2009 Analysis is limited to patients who were
alive at the time of the follow-up
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)
Within 1 Total number with
Outcome known response
Year
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)
Within 5 Total number with
Outcome
Years 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)
Total number with
Within 7
Outcome known response
Years
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)
100
% Free from Bronchiolitis Obliterans
90
80
70
Syndrome
60
50
40
30
20
10
0
0 1 2 3 4 5 6 7
Years
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)
100
% Free from Bronchiolitis Obliterans
p =0.6595
75
Syndrome
50
25
Induction (N = 183)
No Induction (N =293)
0
0 1 2 3 4 5 6 7
Years
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)
100
% Free from Severe Renal Dysfunction
90
80
70
60
50
40
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221
30 μmol/L), dialysis or renal transplant
20
10
0
0 1 2 3 4 5 6 7
Years
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
MALIGNANCY POST-LUNG TRANSPLANTATION FOR PEDIATRICS
Cumulative Incidence for Survivors (Follow-ups: April 1994 - June 2008)
Malignancy/Type 1-Year 5-Year 7-Year
Survivors Survivors Survivors
No Malignancy 511 (94.1%) 119 (86.9%) 60 (89.6%)
Malignancy (all types 32 (5.9%) 18 (13.1%) 7 (10.4%)
combined)
Malignancy Lymph 29 18 7
Type Other 2 1 0
”Other” includes Liver and primitive neuroectodermal tumor.
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
Freedom from Malignancy
For Pediatric Lung Recipients (Follow-ups: April 1994 - June 2008)
100
% Free from Malignancy
90
80
70
60 All malignancy Lymph Skin Other
50
0 1 2 3 4 5 6 7
Years
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANT RECIPIENTS: Cause Of Death
(Deaths: January 1992- June 2008)
0-30 Days 31 Days - 1 Year >1 Year - 3 Years >3 Years - 5 Years >5 Years
CAUSE OF DEATH
(N =67) (N = 118) (N = 136) (N = 68) (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-
1 (0.7%) 1 (1.8%)
LYMPHOMA
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
5 (7.5%) 8 (6.8%) 7 (5.1%) 3 (4.4%) 3 (5.9%)
FAILURE
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)
31 Days - 1 >1 Year - 3 >3 Years -
0-30 Days >5 Years
CAUSE OF DEATH Year Years 5 Years
(N =72) (N = 38)
(N = 107) (N = 111) (N = 56)
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 2009
J Heart Lung Transplant 2009;28: 989-1049 Last updated based on data as of December 2006
PEDIATRIC LUNG TRANSPLANT RECIPIENTS:
Relative Incidence of Leading Causes of Death
(Deaths: January 1992 - June 2008)
50 Bronchiolitis Infection (non-CMV)
Graft Failure Cardiovascular
Multiple Organ Failure
40
Percentage of Deaths
30
20
10
0
0-30 Days 31 Days – 1 >1 Year – 3 >3 Years – 5 >5 Years
(N = 67) Year (N = 118) Years (N =136) Years (N = 68) (N = 51 )
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1990-6/2007)
Risk Factors For 1 Year Mortality/Graft Failure
Relative 95% Confidence
VARIABLE N P-value
Risk 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
312 0.71 0.0475 0.51 1.00
within 1 year
N=738
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1990-6/2003)
Risk Factors For 5 Year Mortality/Graft Failure
Relative 95% Confidence
VARIABLE N P-value
Risk 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
N=527
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
