HEART-LUNG TRANSPLANTATION

Pediatric Recipients

2014JHLT. 2014 Oct; 33(10): 1025-1033

Table of Contents

Donor, recipient and center characteristics:

slides 3-15

Post transplant – survival and other outcomes:

slides 16-23

2014JHLT. 2014 Oct; 33(10): 1025-1033

Donor, Recipient and Center Characteristics

2014JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung TransplantsRecipient Age Distribution

(Transplants: January 1982 – June 2013)

<1 1-5 6-10 11-170

50

100

150

200

250

300

350

400

450

500

21

110128

434

Recipient Age (Years)

Nu

mb

er

of

Tra

ns

pla

nts

2014JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung TransplantsDonor Age Distribution

(Transplants: January 1982 – June 2013)

0-10 11-17 18-34 35-49 50-59 60+0

50

100

150

200

250

300

350

400

343

158

58 40

7 1

Donor Age (Years)

Nu

mb

er

of

Tra

ns

pla

nts

2014JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung TransplantsAge Distribution by Year

19841986

19881990

19921994

19961998

20002002

20042006

20082010

20120

5

10

15

20

25

30

35

40

45

50

55

60

65

11-17 years

6-10 years

1-5 years

<1 year

Nu

mb

er

of

Tra

ns

pla

nts

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 pediatric heart-lung transplants worldwide has declined in recent years.

2014JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung Retransplantsby Year of Retransplant

Only patients who were less than 18 years old at the time of retransplant are included.2014

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

0

1

2

3

4

5

6

7

8

0

2

4

6

8

10

12

14

16

N %

Year of retransplant

Nu

mb

er o

f re

tran

spla

nts

% o

f re

tran

spla

nts

JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung Retransplants(Retransplants: January 1984 – June 2013)

0-<1 month 1-<12 months 12-<36 months 36+ months Not reported0

2

4

6

8

10

12

14

Time Between Previous and Current Transplant

Nu

mb

er

of

Re

tra

ns

pla

nts

Analysis includes deceased and living donor transplants.

2014JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung TransplantsAge Distribution by Era of Transplant

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1982-1999 2000-6/2013

11-17 years

6-10 years

1-5 years

<1 Year

% o

f T

ran

sp

lan

ts

2014JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung TransplantsNumber of Centers Reporting Transplants by Location

(Transplants: January 1984 – December 2012)

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

0

5

10

15

20

25

30

Others

North America

Europe

Transplant Year

N o

f P

ed

iatr

ic T

ran

sp

lan

t C

en

ters

2014JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung TransplantsNumber of Centers Reporting Transplants

by Center Volume

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

0

5

10

15

20

25

30

1-4/yr 5-9/yr

10-19/yr 20-29/yr

Transplant Year

N o

f P

ed

iatr

ic T

ran

sp

lan

t C

en

ters

2014JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung TransplantsDiagnosis Distribution (Transplants: January 1986 – December 2012)

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

0

25

50

75

100Cystic Fibrosis Congenital IPAH

% o

f C

as

es

NOTE: Unknown diagnoses were excluded from this tabulation.

4%

28%22%

12%

2%24%

2% 2%4%

Acquired Heart DiseaseCFCongenital (other)Eisenmenger's SyndromeIPFIPAHRetx: Non-OBRetx: OBOther

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

2014 For some retransplants diagnosis other than retransplant is reported, so the total percentage of retransplants may be greater.JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung TransplantsAge Distribution by Location

(Transplants: January 2000 – June 2013)

Europe North America Other0%

20%

40%

60%

80%

100%

<1 year 1-5 years 6-10 years 11-17 years

% o

f T

ran

sp

lan

ts

2014JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung TransplantsDiagnosis Distribution by Location(Transplants: January 2000 – June 2013)

Europe North America Other0%

20%

40%

60%

80%

100%

Congenital heart disease Cystic Fibrosis IPAH Other

% o

f T

ran

sp

lan

ts

2014JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung Transplants Donor Age Distribution by Location(Transplants: January 2000 – June 2013)

Europe North America Other0%

20%

40%

60%

80%

100%

0-10 years 11-17 years 18-34 years 35-49 years 50-59 years 60+ years

% o

f D

on

ors

2014JHLT. 2014 Oct; 33(10): 1025-1033

Post Transplant: Survival and Other Outcomes

2014JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung TransplantsKaplan-Meier Survival by Diagnosis

(Transplants: January 1990 – June 2012)

0 1 2 3 4 5 6 7 8 9 10 11 12 130

25

50

75

100

Congenital (N = 98)

Eisenmenger's Syndrome (N = 51)

IPAH (N = 113)

Years

Su

rviv

al (

%)

No pair-wise comparisons were statistically signifi-cant at p<0.05.

Median survival (years): Congenital=2.4; Eisenmenger's=2.6; IPAH=4.7

2014JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung TransplantsKaplan-Meier Survival (Transplants: January 1982 – June 2012)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 200

25

50

75

100< 1 (N = 21)

1-5 (N = 105)

6-10 (N = 127)

11-17 (N = 423)

Years

Su

rviv

al (

%)

<1 vs. 6-10: p=0.0014<1 vs. 11-17: p=0.0033All other pair-wise comparisons were not significant at p<0.05.

Median survival (years): <1=0.2; 1-5=1.4; 6-10=3.6; 11-17=3.5

2014JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung TransplantsKaplan-Meier Survival by Era

(Transplants: January 1982 – June 2012)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 200

25

50

75

100

1982-1989 (N = 182)1990-1996 (N = 270)1997-2003 (N = 136)2004-6/2012 (N = 88)

Years

Su

rviv

al (

%)

No pair-wise comparisons were statistically significant at p<0.05.

Median survival (years): 1982-1989=1.9; 1990-1996=3.1; 1997-2003=3.0; 2004-6/2012= 5.3

2014JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung TransplantsKaplan-Meier Survival by Era Conditional on Survival to

1 Year (Transplants: January 1982 – June 2012)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 200

25

50

75

100

1982-1989 (N = 100) 1990-1996 (N = 179)1997-2003 (N = 82) 2004-6/2012 (N = 66)

Years

Su

rviv

al (

%) No pair-wise comparisons were statisti-

cally significant at p<0.05.

Conditional median survival (years): 1982-1989=10.4; 1990-1996=6.1; 1997-2003=13.8; 2004-6/2012=8.5

2014JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung TransplantsCause of Death (Deaths: January 1992 – June 2013)

CAUSE OF DEATH 0-30 Days (N = 51)

31 Days - 1 Year (N = 62)

>1 Year - 3 Years(N = 59)

>3 Years - 5 Years (N = 39)

>5 Years(N = 69)

BRONCHIOLITIS 0 3 (4.8%) 28 (47.5%) 16 (41.0%) 18 (26.1%)

ACUTE REJECTION 0 2 (3.2%) 1 (1.7%) 1 (2.6%) 2 (2.9%)

LYMPHOMA 0 2 (3.2%) 1 (1.7%) 1 (2.6%) 0

MALIGNANCY, OTHER 0 1 (1.6%) 1 (1.7%) 1 (2.6%) 2 (2.9%)

CMV 0 2 (3.2%) 0 0 0

INFECTION, NON-CMV 8 (15.7%) 19 (30.6%) 4 (6.8%) 2 (5.1%) 17 (24.6%)

GRAFT FAILURE 17 (33.3%) 12 (19.4%) 15 (25.4%) 12 (30.8%) 13 (18.8%)

CARDIOVASCULAR 3 (5.9%) 3 (4.8%) 3 (5.1%) 2 (5.1%) 6 (8.7%)

TECHNICAL 11 (21.6%) 0 3 (5.1%) 2 (5.1%) 0

OTHER 12 (23.5%) 18 (29.0%) 3 (5.1%) 2 (5.1%) 11 (15.9%)

2014JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung TransplantsCause of Death (Deaths: April 1994 – June 2013)

CAUSE OF DEATH 0-30 Days(N = 43)

31 Days - 1 Year (N = 46)

>1 Year - 3 Years (N = 48)

>3 Years - 5 Years (N = 34)

>5 Years (N = 69)

BRONCHIOLITIS 0 1 (2.2%) 22 (45.8%) 14 (41.2%) 18 (26.1%)

ACUTE REJECTION 0 1 (2.2%) 1 (2.1%) 1 (2.9%) 2 (2.9%)

LYMPHOMA 0 2 (4.3%) 1 (2.1%) 1 (2.9%) 0

MALIGNANCY, OTHER 0 1 (2.2%) 1 (2.1%) 1 (2.9%) 2 (2.9%)

CMV 0 1 (2.2%) 0 0 0

INFECTION, NON-CMV 5 (11.6%) 15 (32.6%) 4 (8.3%) 2 (5.9%) 17 (24.6%)

GRAFT FAILURE 15 (34.9%) 9 (19.6%) 12 (25.0%) 11 (32.4%) 13 (18.8%)

CARDIOVASCULAR 3 (7.0%) 2 (4.3%) 3 (6.3%) 1 (2.9%) 6 (8.7%)

TECHNICAL 9 (20.9%) 0 1 (2.1%) 1 (2.9%) 0

OTHER 11 (25.6%) 14 (30.4%) 3 (6.3%) 2 (5.9%) 11 (15.9%)

2014JHLT. 2014 Oct; 33(10): 1025-1033

Pediatric Heart-Lung TransplantsRelative Incidence of Leading Causes of Death

(Deaths: April 1994 – June 2013)

0-30 Days(N = 43)

31 Days - 1 Year (N =46)

>1 Year - 3 Years (N = 48)

>3 Years - 5 Years (N = 34)

>5 Years(N = 69)

0

10

20

30

40

50

60

Bronchiolitis Infection (Non-CMV) Graft Failure Cardiovascular

% o

f D

ea

ths

2014JHLT. 2014 Oct; 33(10): 1025-1033