LUNG TRANSPLANTATION Pediatric Recipients ISHLT 2012 J Heart Lung Transplant Oct; 31(10):

RECIPIENT AGE DISTRIBUTION FOR PEDIATRIC LUNG RECIPIENTS - NUMBER (Transplants: January June 2011) ISHLT 2012 Analysis includes living donor transplants J Heart Lung Transplant Oct; 31(10):

RECIPIENT AGE DISTRIBUTION FOR PEDIATRIC LUNG RECIPIENTS – PERCENTAGE (Transplants: January June 2011) ISHLT 2012 Analysis includes living donor transplants J Heart Lung Transplant Oct; 31(10):

DONOR TYPE DISTRIBUTION BY YEAR OF TRANSPLANT FOR PEDIATRIC LUNG RECIPIENTS (Transplants: ) ISHLT 2012 NOTE: 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 J Heart Lung Transplant Oct; 31(10):

DONOR TYPE DISTRIBUTION BY RECIPIENT AGE GROUP WITHIN ERA FOR PEDIATRIC LUNG RECIPIENTS (Transplants: January 1986 – June 2011) ISHLT 2012 Analysis includes living donor transplants J Heart Lung Transplant Oct; 31(10):

AGE DISTRIBUTION FOR DONORS OF PEDIATRIC LUNG RECIPIENTS (Transplants: January June 2011) ISHLT 2012 J Heart Lung Transplant Oct; 31(10):

AGE DISTRIBUTION OF PEDIATRIC LUNG RECIPIENTS BY YEAR OF TRANSPLANT ISHLT 2012 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. Analysis includes living donor transplants J Heart Lung Transplant Oct; 31(10):

NUMBER OF CENTERS REPORTING PEDIATRIC LUNG TRANSPLANTS ISHLT 2012 Analysis includes living donor transplants J Heart Lung Transplant Oct; 31(10):

NUMBER OF CENTERS REPORTING PEDIATRIC LUNG TRANSPLANTS BY CENTER VOLUME ISHLT 2012 Analysis includes living donor transplants J Heart Lung Transplant Oct; 31(10):

NUMBER OF PEDIATRIC LUNG TRANSPLANTS BY CENTER VOLUME ISHLT 2012 Analysis includes living donor transplants J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANTS: Indications (Transplants: January June 2011) ISHLT 2012 Diagnosis AGE: < 1 Year AGE: 1-5 Years AGE: 6-11 Years AGE: Years Cystic Fibrosis 11.1%65.0% % % Idiopathic Pulmonary Arterial Hypertension %2722.5%319.7%837.2% Re-Transplant: Obliterative Bronchiolitis 75.8%92.8%353.0% Congenital Heart Disease %97.5%41.3%100.9% Idiopathic Pulmonary Fibrosis 99.9%2117.5%154.7%393.4% Obliterative Bronchiolitis (Not Re-TX) 108.3%237.2%494.2% Re-Transplant: Not OB 33.3%4 92.8%302.6% Interstitial Pneumonitis 11.1%21.7%30.9% Pulmonary Vascular Disease 88.8%75.8%41.3%10.1% Eisenmenger’s Syndrome 11.1%54.2%51.6%70.6% Pulmonary Fibrosis, Other 66.6%86.7%165.0%242.1% Surfactant Protein B Deficiency %32.5% COPD/Emphysema 44.4%21.7%30.9%90.8% Bronchopulmonary Dysplasia 33.3%32.5%72.2%20.2% Bronchiectasis 11.1% 61.9%141.2% Other %65.0%123.8%272.3% Analysis includes living donor transplants J Heart Lung Transplant Oct; 31(10):

DIAGNOSIS IN PEDIATRIC LUNG RECIPIENTS BY YEAR OF TRANSPLANT Age: Years ISHLT 2012 Analysis includes living donor transplants J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANTS Age Distribution by Location ( Transplants: January 2000 – June 2011) ISHLT 2012 Analysis includes living donor transplants J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANTS Diagnosis Distribution by Location (Transplants: January 2000 – June 2011) ISHLT 2012 Analysis includes living donor transplants NOTE: Unknown diagnoses were excluded from this tabulation Total number of transplants reported: Europe = 410 North America = 619 Other = 66 J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANTS Donor Age Distribution by Location (Transplants: January 2000 – June 2011) ISHLT 2012 NOTE: Transplants with unknown donor age and living donor transplants were excluded from this tabulation. Total number of transplants reported: Europe = 410 North America = 619 Other = 66 J Heart Lung Transplant Oct; 31(10):

LUNG TRANSPLANTS Kaplan-Meier Survival by Recipient Age Group (Transplants: January June 2010) ISHLT 2012 p = J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANTS Kaplan-Meier Survival by Procedure Type (Transplants: January June 2010) ISHLT 2012 p < J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANTS Kaplan-Meier Survival for Congenital Diagnoses (Transplants: January June 2010) ISHLT 2012 Eisenmenger’s vs. Other: p = J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANTS Kaplan-Meier Survival by Recipient Age Group (Transplants: January June 2010) ISHLT 2012 <1 year vs years: p = <1 year vs years: p = years vs years: p = J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANTS Conditional Kaplan-Meier Survival by Recipient Age Group (Transplants: January June 2010) ISHLT 2012 <1 year vs years: p = <1 year vs years: p = years vs years: p = J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANTS Kaplan-Meier Survival by Era (Transplants: January June 2010) ISHLT vs : p = vs /2010: p < vs /2010: p = J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANTS Kaplan-Meier Survival by Donor Type for Recipients Age Years (Transplants: January June 2010) ISHLT 2012 p = J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG RE-TRANSPLANTS Between January 1994 and June 2011 ISHLT 2012 Analysis includes living donor transplants J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG RE-TRANSPLANTS Survival for Transplants Performed Between January 1994 and June 2010 ISHLT 2012 J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG RE-TRANSPLANTS Survival for Transplants Performed Between January 1988 and June 2010 Stratified by Inter-Transplant Interval ISHLT 2012 Analysis includes living donor transplants. Only patients who were less than 18 years old at the time of re- transplant are included. J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG RE-TRANSPLANTS Survival for Transplants Performed Between January 1988 and June 2010 Stratified by Diagnosis ISHLT 2012 Analysis includes living donor transplants. Only patients who were less than 18 years old at the time of re- transplant are included. J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG RECIPIENTS Cross-Sectional Analysis Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2011) ISHLT 2012 J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG RECIPIENTS Functional Status of Surviving Recipients US Recipients Only (Follow-ups: March 2005 – June 2011) ISHLT 2012 J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April 1994 – June 2011) ISHLT 2012 J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April 1994 – June 2011) ISHLT 2012 J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG RECIPIENTS Induction Immunosuppression (T ransplants: January 2001 – June 2011) ISHLT 2012 Analysis is limited to patients who were alive at the time of the discharge J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2001 – June 30, 2011) ISHLT 2012 Analysis is limited to patients who were alive at the time of the discharge J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANTS Kaplan-Meier Survival Stratified by Induction Use (Transplants: January June 2010) ISHLT 2012 p = J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January 2001 – June 2011) ISHLT 2012 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January 2001 – June 2011) ISHLT 2012 Analysis is limited to patients who were alive at the time of the follow-up NOTE: 0.2% of patients were on both calcineurin inhibitors at different point during the 1-year; these patients are not counted in either group. And 0.5% (2 patients) was on neither drug during the 1-year. In the 5-year tabulations, 0.6% were reported to be on both drugs during the year and 1.7% (3 patients) was reported to be on neither drugs. J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up (Follow-ups: January 2001 – June 2011) ISHLT 2012 Analysis is limited to patients who were alive at the time of the follow-up NOTE: Different patients are analyzed in Year 1 and Year 5 J Heart Lung Transplant Oct; 31(10):

POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Morbidity Rates in Survivors within 1 Year Post- Transplant (Follow-ups: April June 2011) ISHLT 2012 Outcome Within 1 Year Total number with known response Hypertension41.7%(N = 664) Renal Dysfunction10.0%(N = 683) Abnormal Creatinine < 2.5 mg/dl6.9% Creatinine > 2.5 mg/dl2.0% Chronic Dialysis0.7% Renal Transplant0.3% Hyperlipidemia5.1%(N = 683) Diabetes23.5%(N = 684) Bronchiolitis Obliterans Syndrome13.2%(N = 638) J Heart Lung Transplant Oct; 31(10):

POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Morbidity Rates in Survivors within 5 Years Post- Transplant (Follow-ups: April June 2011) ISHLT 2012 Outcome Within 5 Years Total number with known response Hypertension69.8%(N = 179) Renal Dysfunction32.8%(N = 189) Abnormal Creatinine < 2.5 mg/dl24.3% Creatinine > 2.5 mg/dl5.3% Chronic Dialysis1.6% Renal Transplant1.6% Hyperlipidemia15.8%(N = 184) Diabetes36.8%(N = 190) Bronchiolitis Obliterans Syndrome35.9%(N = 145) J Heart Lung Transplant Oct; 31(10):

POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Morbidity Rates in Survivors within 7 Years Post- Transplant (Follow-ups: April June 2011) ISHLT 2012 Outcome Within 7 Years Total number with known response Renal Dysfunction41.3%(N = 92) Abnormal Creatinine < 2.5 mg/dl29.3% Creatinine > 2.5 mg/dl7.6% Chronic Dialysis0.0% Renal Transplant4.3% Diabetes33.9%(N = 62) Bronchiolitis Obliterans Syndrome44.6%(N = 56) J Heart Lung Transplant Oct; 31(10):

Freedom from Bronchiolitis Obliterans Syndrome For Pediatric Lung Recipients (Follow-ups: April 1994-June 2011) ISHLT 2012 J Heart Lung Transplant Oct; 31(10):

Freedom from Bronchiolitis Obliterans Syndrome For Pediatric Lung Recipients by Age Group (Follow-ups: April 1994-June 2011) ISHLT 2012 p = J Heart Lung Transplant Oct; 31(10):

Freedom from Bronchiolitis Obliterans Syndrome For Pediatric Lung Recipients by Diagnosis (Follow-ups: April 1994-June 2011) ISHLT 2012 p = J Heart Lung Transplant Oct; 31(10):

Freedom from Bronchiolitis Obliterans Syndrome For Pediatric Lung Recipients by Induction Use (Follow-ups: April 1994-June 2011) ISHLT 2012 p = J Heart Lung Transplant Oct; 31(10):

Freedom from Severe Renal Dysfunction* For Pediatric Lung Recipients (Follow-ups: April 1994-June 2011) ISHLT 2012 J Heart Lung Transplant Oct; 31(10):

MALIGNANCY POST-LUNG TRANSPLANT FOR PEDIATRICS Cumulative Morbidity Rates in Survivors (Follow-ups: April 1994-June 2011) ISHLT 2012 Malignancy/Type 1-Year Survivors 5-Year Survivors 7-Year Survivors No Malignancy 657 (94.4%)175 (88.8%)87 (90.6%) Malignancy (all types combined) 39 (5.6%)22 (11.2%)9 (9.4%) Malignancy Type* Lymphoma Other 210 Type Not Reported 100 * Recipients may have experienced more than one type of malignancy so sum of individual malignancy types may be greater than total number with malignancy. ”Other” includes Liver and primitive neuroectodermal tumor. J Heart Lung Transplant Oct; 31(10):

Freedom from Malignancy For Pediatric Lung Recipients (Follow-ups: April June 2011) ISHLT 2012 J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANT RECIPIENTS Cause of Death (Deaths: January June 2011) ISHLT 2012 CAUSE OF DEATH 0-30 Days (N =114) 31 Days - 1 Year (N = 159) >1 Year - 3 Years (N = 209) >3 Years - 5 Years (N = 92) >5 Years (N = 84) BRONCHIOLITIS 16 (10.1%)80 (38.3%)36 (39.1%)38 (45.2%) ACUTE REJECTION 3 (2.6%)3 (1.9%)2 (1.0%)2 (2.2%) LYMPHOMA 8 (5.0%)7 (3.3%)4 (4.3%)5 (6.0%) MALIGNANCY, NON-LYMPHOMA 1 (0.6%)1 (0.5%) 3 (3.6%) CMV 5 (3.1%) INFECTION, NON-CMV 15 (13.2%)53 (33.3%)32 (15.3%)18 (19.6%)9 (10.7%) GRAFT FAILURE 35 (30.7%)31 (19.5%)49 (23.4%)20 (21.7%)17 (20.2%) CARDIOVASCULAR 18 (15.8%)6 (3.8%)3 (1.4%)1 (1.1%) TECHNICAL 13 (11.4%)5 (3.1%)6 (2.9%)3 (3.3%)1 (1.2%) MULTIPLE ORGAN FAILURE 11 (9.6%)19 (11.9%)10 (4.8%)3 (3.3%)6 (7.1%) OTHER 19 (16.7%)12 (7.5%)19 (9.1%)5 (5.4%)5 (6.0%) J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANT RECIPIENTS Relative Incidence of Leading Causes of Death (Deaths: January June 2011) ISHLT 2012 J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1993-6/2010) Risk Factors For 1 Year Mortality/Graft Failure ISHLT 2012 VARIABLENRelative Risk P-value95% Confidence Interval Single lung transplant On ventilator < Year of transplant: vs / Donor CMV+/Recipient CMV Chronic steroid use N = 826 J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1993-6/2010) Risk Factors For 1 Year Mortality/Graft Failure ISHLT 2012 Continuous Factors (see figures) Pediatric transplant center volume (borderline) J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1993-6/2010) Risk Factors For 1 Year Mortality/Graft Failure Center Volume Pediatric Transplants ISHLT 2012 p = J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1993-6/2006) Risk Factors For 5 Year Mortality/Graft Failure ISHLT 2012 VARIABLENRelative Risk P-value95% Confidence Interval Single lung transplant On ventilator Chronic steroid use Year of transplant: vs / N = 609 J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1993-6/2006) Risk Factors For 5 Year Mortality/Graft Failure ISHLT 2012 Continuous Factors (see figures) Recipient age Pediatric transplant center volume J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1993-6/2006) Risk Factors For 5 Year Mortality/Graft Failure Recipient Age ISHLT 2012 p = J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1993-6/2006) Risk Factors For 5 Year Mortality/Graft Failure Center Volume Pediatric Transplants ISHLT 2012 p = J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1991-6/2001) Risk Factors For 10 Year Mortality/Graft Failure ISHLT 2012 VARIABLENRelative Risk P-value95% Confidence Interval On ventilator < Single lung transplant Donor cause of death = anoxia N = 369 J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1991-6/2001) Risk Factors For 10 Year Mortality/Graft Failure ISHLT 2012 Continuous Factors (see figures) Recipient age Pediatric transplant center volume (borderline) J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1991-6/2001) Risk Factors For 10 Year Mortality/Graft Failure Recipient Age ISHLT 2012 p = J Heart Lung Transplant Oct; 31(10):

PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1991-6/2001) Risk Factors For 10 Year Mortality/Graft Failure Center Volume Pediatric Transplants ISHLT 2012 p = J Heart Lung Transplant Oct; 31(10):