Kidney Kidney-Pancreas Pancreas Liver Heart Lung Intestine ,953 1, ,306 3,069 2, ,318 24,175 8, ,642 90,976 28, Organ Centers2008Total Worldwide Transplant Directory Clinical Transplants 2008

KIDNEY Related donor Deceased donor Unrelated live donor LIVER HEART PANCREAS-KIDNEY PANCREAS LUNG BONE MARROW University of Colorado Royal North Shore Hosp Univ de Sao Paulo University of Colorado Stanford University Univ of Cincinnati College Thomas E Starzl Inst The Toronto Hospital Univ Hosp, Leiden Surv yrs Hospital Longest Surviving Transplants-2008 Clinical Transplants 2008

N 37,327 38,377 42,070 T 1/ P<0.001 Deceased donor Kidney Graft Survival by Era Cecka, Clinical Transplants 2008, p. 2

Age demographics of DD recipients with time >65 <19

N 13,992 21,631 30,231 T 1/ Cecka, Clinical Transplants 2008, p. 3 Living donor Kidney Graft Survival by Era

Cecka, Clinical Transplants 2008, p. 4 Sibling Offspring Parent Spouse Unrelated Living Donor Relationships

HLA-ID 1-haplo 2-haplo N 4,665 25,756 16,656 T 1/ Cecka, Clinical Transplants 2008, p. 7 HLA compatibility effect on Living donor GS

0MM 1-4MM 5-6MM N 11,832 41,327 23,609 T 1/ HLA-ABDR P<0.001 Cecka, Clinical Transplants 2008, p

Living donor Deceased donor N 2,375 71,686 Number of Liver Transplants in Adult donor Goh, Clinical Transplants 2008, p. 20

Number of Liver Transplants in Pediatric donor Goh, Clinical Transplants 2008, p. 20 Living donor Deceased donor N 1,145 8,844

Liver graft survival by MELD/PELD scores Goh, Clinical Transplants 2008, p % 84% 70% 59% Percent Graft Survival Months after Transplant 1-year Years after Transplant 5-year p < p < MELD/PELD score <15 (n = 3,855) 15 – 22 (n = 11,294) 23 – 30 (n = 10,305) >30 (n = 5,084)

Graft survival in recipients with Hepatocellular Carcinoma Goh, Clinical Transplants 2008, p. 29 Years after Transplantation 49% 54% Percent Graft Survival HCC T2 (n = 3,457) M/P score (n = 11,294) HCC (n = 4,817) Other cancers (n = 1,048) p < p <

p< Percent Allograft Survival Years after Transplantation N 17,414 11,732 14,760 Everly, Clinical Transplants 2008, p. 38 Heart Allograft survival by transplant Era

Infant, 0-1 yr (n=1,636) Pediatric, 1-18 yr (n=3,959) Elderly, 65+ yr (n=3,100) Adult, yr (n=35,211) Percent Allograft Survival Years after Transplantation Everly, Clinical Transplants 2008, p. 39 Heart Allograft survival by Recip AGE group

Everly, Clinical Transplants 2008, p. 40 PRA<50% (n=8,273) PRA>50% (n=9,141) Log-rank p=NS Percent Allograft Survival Years after Transplantation Heart Allograft survival by PRA

Patient survival for primary deceased donor PAK Living Deceased N yr (%) Gruessner & Sutherland, Clinical Transplants 2008, p.52

SPK PAK PTA N yr (%) Pancreas graft function primary deceased donor Gruessner & Sutherland, Clinical Transplants 2008, p.52

Number of Repeat Transplants, by Organ 1990–2007* Source: SRTR analysis, Jan 2009 *Includes living and deceased donors Kidney Liver Heart Lung Rao & Ojo, Clinical Transplants 2008, p.60

Unadjusted Living and Deceased Donor Graft Survival for First and Second Kidney Transplants, 2002–2007 Source: SRTR analysis, Jan 2009 Rao & Ojo, Clinical Transplants 2008, p.64

Unadjusted Deceased Donor Graft Survival for First and Second Liver Transplants, 2002–2007 Source: SRTR analysis, Jan 2009 Rao & Ojo, Clinical Transplants 2008, p.65

Unadjusted Deceased Donor Graft Survival for First and Second Heart Transplants, 2002–2007 Source: SRTR analysis, Jan 2009 Rao & Ojo, Clinical Transplants 2008, p.65

Unadjusted Deceased Donor Graft Survival for First and Second Lung Transplants, 2002–2007 Source: SRTR analysis, Jan 2009 Rao & Ojo, Clinical Transplants 2008, p.65

Survival (95% CI) N % Live 89.3 (88.1 – 90.4) 4502 DBD 82.1 (81.3 – 82.9) DCD 81.5 (78.1 – 84.4) 1281 Graft survival for kidney only transplants in the UK, 1998 to 2007 P<0.001 % Graft Survival Years Posttransplant Johnson, et al. Clinical Transplants 2008, p.85

Pregnancies in female transplant recipients reported to the NTPR OrganRecipientsPregnanciesOutcomes* Kidney Liver Liver-Kidney467 Pancreas-Kidney Pancreas alone145 Heart Heart-Lung444 Lung Totals * Includes twins and triplets As of January 2009 Coscia, Armenti, et al. Clinical Transplants 2008, p.89

Pregnancies fathered by male transplant recipients reported to the NTPR OrganRecipientsFathered Pregnancies Outcomes* Kidney Liver Liver-Kidney244 Pancreas-Kidney Heart Heart-Lung122 Heart-Lung-Kidney122 Lung333 Totals * Includes twins and triplets As of Jan 2009 Coscia, Armenti, et al. Clinical Transplants 2008, p.90

DQ2 SCr Zhu, Terasaki, et al. Clinical Transplants 2008, p.175 Ascending strength of antibodies in graft-failure patients

DQ7 DQ2 B8 DR7 SCr Donor : A11,-, B8,49, DR7,17, DQ2,7 Recipient: 2,A11,B38,60, DR4,14,DQ5,8 DSA: B8, DR7, DQ2, DQ7 Zhu, Terasaki, et al. Clinical Transplants 2008, p.179 Combined strength of antibodies in graft-failure patients

Zhu, Terasaki, et al. Clinical Transplants 2008, p.184 Time to de novo antibody among all patients

ABCDRB1DRB345DQ PT DN CD52, 27/M, Tx: 5/12/08 Kaneku, Terasaki, et al. Clinical Transplants 2008, p.193 Clonal deletion with no post-tx maintenance for 2 months

ABCDRB1DRB345DQ PT DN CD15, 35/M, Tx: 4/16/08 Kaneku, Terasaki, et al. Clinical Transplants 2008, p.194 Clonal deletion with no post-tx maintenance For 3.5 months

A3101A3303A3301B5801 Reaction strength Single Antigen Beads Specificities Intact antigensDissociated antigens 73I Heavy chain β2β2 Peptide Intact class I antigen Dissociated class I antigen Hundreds Serum A*01011STD A*31012S I D A*3301S I D A*3303S I D B*5801ATY aa & position El-Awar, Terasaki, et al. Clinical Transplants 2008, p.206 Reactivity of anti HLA A-locus alloantibody with intact and dissociated antigens on the SA beads

B5501B8101B8201B4201B0702B6701B5601B5401B0801 Reaction strength Hundreds Single Antigen Beads Specificities Serum 96 Intact antigensDissociated antigens 70Q 66I Peptide Intact class I antigen Dissociated class I antigen Heavy chain β2β B*07021IQ IQ B*4201 I Q B*5401IQ B*5502 I Q B*5501 I Q B*5601IQ B*67011 I Q B*8101IQ B*8201IQ B*0801 I N aa & position El-Awar, Terasaki, et al. Clinical Transplants 2008, p.208 Reactivity of anti HLA B-locus alloantibody with intact and dissociated antigens on the SA beads

CW*1701CW*0602CW*0403CW*1802CW*0702 Hundreds Intact antigensDissociated antigens Single Antigen Beads Specificities Intact class I antigen Dissociated class I antigen 77N 73A Peptide Heavy chain β2β2 Reaction strength MI-CB Cw*010201TS Cw*040101AN Cw*060201AN Cw*1701AN Cw*1802AN Cw*070201AS aa & position El-Awar, Terasaki, et al. Clinical Transplants 2008, p.209 Reactivity of anti HLA C-locus alloantibody with intact and dissociated antigens on the SA beads

B*5401 Epitopes (detected number) Distance （ angstrom ） Amino acid positionAmino Acid # of aa minmax 0204PA PA 0205PAE PAE 0302QIA QIA 0303QIAQ(3) QIAQ Immunogen Number of mismatched pairs Number of allo-sera Antibody production rate (%) Total number of epitopes Kind of epitopes B* %64 Immunogenic amino acids positions for B*54 antibody production PQIAQE B*54 Immunogenic aa position for Ab. production Amino acid position of HLA-B*54 putative epitopes Putative epitopes of anti sera produced by HLA-B54 mismatched mothers Immunogenic aa position for HLA-B*54 mismatched pair Maruya, Terasaki, et al. Clinical Transplants 2008, p.221

Immunogen Number of mismatched pairs Number of allo-sera Antibody production rate Total number of epitopes Kind of epitopes A* %119 A*2601 Immunogenic aa position for Ab. production aa position of HLA- A*2601 putative epitopes Putative epitopes of anti sera produced by HLA-A*2601, A*2602 mismatched mothers Immunogenic aa position for HLA-A*2601, A*2602 mismatched pair Immunogenic amino acids positions for A*2601 antibody production QRRNHTANTDQRTREWAS Maruya, Terasaki, et al. Clinical Transplants 2008, p.221 A*2601 Epitopes (detected number) Distance （ angstrom ） Amino acid position Amino Acids # of aa minmax 0603QRT (3) QRT 0607REW REW 0202QR QR 0304RNH RNH 0309TAN TAN 0310ANT ANT 0102D1 90 D 0801AS AS 0606R1 163 R

Patient 1 25/M Tx: 3/7/08 Idica, Terasaki, et al. Clinical Transplants 2008, p.231 PT DN ABCDRB1DQDRB345Bw Effective removal of donor-specific HLA antibody with Bortezomib

Patient 8 30/M Tx: 6/20/08 Idica, Terasaki, et al. Clinical Transplants 2008, p.234 PT24(9)104044(12) DN 23251(5) BwABCDRB1DQDRB345 Effective removal of donor-specific HLA antibody with Bortezomib

Graft Survival (%) Deceased Donor Transplants Years after Transplant Lentine, et al. Clinical Transplants 2008, p.262 T-neg, B-neg (reference) B-pos, T-neg B-not measurable, T-neg T-pos, B-positive T-positive, B-not measurable Undifferentiated-negative Undifferentiated-positive

Living Donor Transplants Years after Transplant T-neg, B-neg (reference) B-pos, T-neg B-not measurable, T-neg T-pos, B-positive T-positive, B-not measurable Undifferentiated-negative Undifferentiated-positive Lentine, et al. Clinical Transplants 2008, p.262 Graft Survival (%)

5 pioneers in History of Transplantation David H. SachsRobert A. GoodBen Cosimi Jean-Michel Dubernard Herman Waldmann