Presentation is loading. Please wait.

Presentation is loading. Please wait.

HEART-LUNG TRANSPLANTATION

Similar presentations


Presentation on theme: "HEART-LUNG TRANSPLANTATION"— Presentation transcript:

1 HEART-LUNG TRANSPLANTATION
Overall ISHLT ISHLT J Heart Lung Transplant Oct; 30 (10): 2011

2 NUMBER OF HEART-LUNG TRANSPLANTS REPORTED BY YEAR
This figure includes only the heart-lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not necessarily be construed as evidence that the number of heart-lung transplants performed worldwide has declined. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 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 heart-lung transplants worldwide has declined in recent years. 2011

3 AVERAGE CENTER VOLUME Heart-Lung Transplants: January 1, 1998 - June 30, 2010
ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

4 DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY CENTER VOLUME Heart-Lung Transplants: January 1, June 30, 2010 ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

5 DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME Lung Transplants: January 1, June 30, 2010 ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

6 HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival for All Ages (Transplants: January June 2009) Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not known for all patients. Therefore, 95% confidence limits are provided about the survival rate estimate; the survival rate shown is the best estimate but the true rate will most likely fall within these limits. The half-life is the estimated time point at which 50% of all of the recipients have died. The conditional half-life is the estimated time point at which 50% of the recipients who survive to at least 1 year have died. Because the decline in survival is greatest during the first year following transplantation, the conditional survival provides a more realistic expectation of survival time for recipients who survive the early post-transplant period. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

7 HEART-LUNG TRANSPLANTATION
Adult Recipients ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

8 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (January 1982 - June 2010)
“Other” includes cancer, LAM, OB, sarcoidosis, bronchiectasis ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

9 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2010)
Congenital Heart Disease 1,116 (35.9%) Idiopathic Pulmonary Arterial Hypertension 857 (27.5%) Cystic Fibrosis 444 (14.3%) Acquired Heart Disease 150 ( 4.8%) COPD/Emphysema 132 ( 4.2%) Idiopathic Pulmonary Fibrosis 113 ( 3.6%) Alpha-1 60 ( 1.9%) Sarcoidosis 50 ( 1.6%) Re-Transplant: Not Obliterative Bronchiolitis 36 ( 1.2%) Re-Transplant: Obliterative Bronchiolitis 28 ( 0.9%) Bronchiectasis 24 ( 0.8%) Obliterative Bronchiolitis (not Re-Transplant) 22 ( 0.7%) Other 80 ( 2.6%) ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

10 DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA (Transplants: January 1982 - June 2010)
“Other” includes OB (non-ReTX) and Bronchiectasis ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

11 ADULT HEART-LUNG TRANSPLANTATION Major Indications By Year (%)
ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

12 ADULT HEART-LUNG TRANSPLANTATION Major Indications By Year (Number)
ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

13 ADULT HEART-LUNG TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010 ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

14 ADULT HEART-LUNG TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010 NOTE: Transplants with unknown diagnoses are excluded from this tabulation. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

15 ADULT HEART-LUNG TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010 NOTE: Transplants with unknown donor ages are excluded from this tabulation. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

16 HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival for Adult Recipients (Transplants: January June 2009) Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not known for all patients. Therefore, 95% confidence limits are provided about the survival rate estimate; the survival rate shown is the best estimate but the true rate will most likely fall within these limits. The half-life is the estimated time point at which 50% of all of the recipients have died. The conditional half-life is the estimated time point at which 50% of the recipients who survive to at least 1 year have died. Because the decline in survival is greatest during the first year following transplantation, the conditional survival provides a more realistic expectation of survival time for recipients who survive the early post-transplant period. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

17 HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival for Adult Recipients by Era (Transplants: January June 2009) Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not known for all patients. Survival rates were compared using the log-rank test statistic. A significant p-value means that at least one of the groups is different than the others but it doesn’t identify which group it is. The half-life is the estimated time point at which 50% of all of the recipients have died. The conditional half-life is the estimated time point at which 50% of the recipients who survive to at least 1 year have died. Because the decline in survival is greatest during the first year following transplantation, the conditional survival provides a more realistic expectation of survival time for recipients who survive the early post-transplant period. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

18 ADULT HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2009) Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not known for all patients. Survival rates were compared using the log-rank test statistic. No adjustments were made for multiple comparisons. The half-life is the estimated time point at which 50% of all of the recipients have died. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

19 ADULT HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2009) Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not known for all patients. Survival rates were compared using the log-rank test statistic. No adjustments were made for multiple comparisons. The half-life is the estimated time point at which 50% of all of the recipients have died. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

20 ADULT HEART-LUNG RECIPIENTS Cross-Sectional Analysis Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2010) This figure shows the functional status reported on the 1-year, 3-year and 5-year annual follow-ups. Because all follow-ups between April 1994 and June 2010 were included, the bars do not include the same patients. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

21 ADULT HEART-LUNG RECIPIENTS Functional Status of Surviving Recipients US Recipients Only (Follow-ups: March June 2010) From March 2005 functional status in US is collected using Karnofsky score for adult recipients and Lansky score for pediatric recipients. This figure shows the functional status reported on the 1-year, 2-year and 3-year annual follow-ups. Because all follow-ups between March 2005 and June 2010 were included, the bars do not include the same patients. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

22 ADULT HEART-LUNG RECIPIENTS Employment Status of Surviving Recipients (Follow-ups: April 1994 – June 2010) This figure shows the employment status reported on the 1-year, 3-year and 5-year annual follow-ups. Because all follow-ups between April 1994 and June 2010 were included, the bars do not include the same patients. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

23 ADULT HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April June 2010) This figure shows the hospitalizations reported on the 1-year, 3-year and 5-year annual follow-ups, representing the hospitalizations between discharge and 1 year, between the 2-year and 3-year follow-up and between the 4-year and 5-year follow-up, respectively. Because all follow-ups between April 1994 and June 2010 were included, the bars do not include the same patients. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

24 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression For transplants between January 2001 through June 2010 ISHLT ISHLT J Heart Lung Transplant Oct; 30 (10): 2011 Analysis is limited to patients who were alive at the time of the discharge

25 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2000 - December 2009)
NOTE: Analysis is limited to the patients who survived discharge ISHLT ISHLT J Heart Lung Transplant Oct; 30 (10): 2011 Analysis is limited to patients who were alive at the time of the discharge

26 ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2000 - December 2009)
NOTE: Analysis is limited to the patients who survived discharge Any Induction Polyclonal ALG/ATG OKT IL-2R Antagonist ISHLT ISHLT J Heart Lung Transplant Oct; 30 (10): 2011 Analysis is limited to patients who were alive at the time of the discharge

27 ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2001 through June 2010 NOTE: Analysis is limited to the patients who were alive at the time of the follow-up This figure shows the maintenance immunosuppression reported as being provided at the time of the 1-year and 5-year annual follow-up forms. To provide a snapshot of current practice, only follow-ups occurring between January 2001 and June 2010 were included. Therefore, this figure does not represent changes in practice between the 1-year follow-up and 5-year follow-up on a cohort of patients. The patients in the 1-year tabulation are not the same patients as in the 5-year tabulation. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT NOTE: Different patients are analyzed in Year 1 and Year 5 2011 Analysis is limited to patients who were alive at the time of the follow-up

28 ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2001 through June 2010 NOTE: Analysis is limited to the patients who were alive at the time of the follow-up This figure shows the maintenance immunosuppression reported as being provided at the time of the 1-year and 5-year annual follow-up forms. To provide a snapshot of current practice, only follow-ups occurring between January 2001 and June 2010 were included. Therefore, this figure does not represent changes in practice between the 1-year follow-up and 5-year follow-up on a cohort of patients. The patients in the 1-year tabulation are not the same patients as in the 5-year tabulation. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT NOTE: Different patients are analyzed in Year 1 and Year 5 2011 Analysis is limited to patients who were alive at the time of the follow-up

29 POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April June 2010) This table shows the percentage of patients experiencing various morbidities as reported on the 1-year annual follow-up form. The percentages are based on patients with known responses. Because the outcomes are reported to be unknown at different rates the number with known responses for each outcome are also provided. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

30 POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant (Follow-ups: April June 2010) This table shows the percentage of patients experiencing various morbidities as reported within 5 years following transplantation. The percentages are based on patients with known responses. To reduce bias, only patients with responses reported on every follow-up through the 5-year annual follow-up were included. Because the outcomes are reported to be unknown at different rates the number with known responses for each outcome are also provided. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

31 Freedom from Coronary Artery Vasculopathy and Bronchiolitis Obliterans Syndrome For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2010) Freedom from CAV and from bronchiolitis obliterans rates were computed using the Kaplan-Meier method. The development of CAV and bronchiolitis obliterans is reported on annual follow-ups; a date of diagnosis is not provided. For this figure the date of follow-up was used as the date of occurrence. Patients were included in the analysis until an unknown response for CAV was reported. Therefore, the rates seen here may differ from those reported in the cumulative prevalence slide which is based on only those patients with known responses for CAV at all follow-up time points. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

32 Freedom from Coronary Artery Vasculopathy For Adult Heart-Lung Recipients By Diagnosis Type (Follow-ups: April 1994-June 2010) P-value comparing all = Freedom from CAV rates were computed using the Kaplan-Meier method. The development of CAV is reported on annual follow-ups; a date of diagnosis is not provided. For this figure the date of follow-up was used as the date of occurrence. Patients were included in the analysis until an unknown response for CAV was reported. Therefore, the rates seen here may differ from those reported in the cumulative prevalence slide which is based on only those patients with known responses for CAV at all follow-up time points. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

33 Freedom from Bronchiolitis Obliterans Syndrome For Adult Heart-Lung Recipients By Diagnosis Type (Follow-ups: April 1994-June 2010) P-value comparing all = Freedom from bronchiolitis obliterans rates were computed using the Kaplan-Meier method. The development of bronchiolitis obliterans is reported on annual follow-ups; a date of diagnosis is not provided. For this figure the date of follow-up was used as the date of occurrence. Patients were included in the analysis until an unknown response for bronchiolitis obliterans was reported. Therefore, the rates seen here may differ from those reported in the cumulative prevalence slide which is based on only those patients with known responses for bronchiolitis obliterans at all follow-up time points. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

34 Freedom from Severe Renal Dysfunction
Freedom from Severe Renal Dysfunction* For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2010) Freedom from severe renal dysfunction rates were computed using the Kaplan-Meier method. The development of severe renal dysfunction is reported on annual follow-ups; a date of diagnosis is not provided. For this figure the date of follow-up was used as the date of occurrence. Patients were included in the analysis until an unknown response for severe renal dysfunction was reported. Therefore, the rates seen here may differ from those reported in the cumulative prevalence slide which is based on only those patients with known responses for severe renal dysfunction at all follow-up time points. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

35 MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTS Cumulative Prevalence in Survivors (Follow-ups: April 1994-June 2010) Malignancy/Type 1-Year Survivors 5-Year Survivors 10-Year Survivors No Malignancy 394 (93.8%) 143 (88.8%) 43 (86%) Malignancy (all types combined) 26 (6.2%) 18 (11.2%) 7 (14%) Malignancy Type* Skin 2 5 7 Lymph 18 6 Other 4 Type Not Reported This table shows the percentage of patients with malignancies reported within 1 year, within 5 years and within 10 years following transplantation. The percentages are based on patients with known responses. To reduce bias, only patients with responses reported on every follow-up through the 5-year (or 10-year) annual follow-up were included in the “5-Year Survivors” (or “10-Year Survivors”) column. * Recipients may have experienced more than one type of malignancy so sum of individual malignancy types may be greater than total number with malignancy. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

36 Freedom from Malignancy For Adult Heart-Lung Recipients (Follow-ups: April 1994- June 2010)
Freedom from malignancy rates were computed using the Kaplan-Meier method. The development of malignancy is reported on annual follow-ups; a date of diagnosis is not provided. For this figure the date of follow-up was used as the date of occurrence. Patients were included in the analysis until an unknown response for malignancy was reported. Therefore, the rates seen here may differ from those reported in the cumulative prevalence slide which is based on only those patients with known responses for malignancy at all follow-up time points. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

37 ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2010)
0-30 Days (N = 321) 31 Days - 1 Year (N = 249) >1 Year - 3 Years (N = 223) >3 Years - 5 Years (N = 151) >5 Years (N = 391) BRONCHIOLITIS 6 (2.4%) 50 (22.4%) 32 (21.2%) 66 (16.9%) ACUTE REJECTION 3 (0.9%) 8 (3.2%) 4 (1.8%) 1 (0.7%) 2 (0.5%) LYMPHOMA 11 (4.9%) 8 (5.3%) 11 (2.8%) MALIGNANCY, OTHER 4 (1.6%) 12 (5.4%) 5 (3.3%) 30 (7.7%) CMV 1 (0.4%) 1 (0.3%) INFECTION, NON-CMV 52 (16.2%) 80 (32.1%) 67 (30.0%) 42 (27.8%) 96 (24.6%) GRAFT FAILURE 92 (28.7%) 54 (21.7%) 34 (15.2%) 27 (17.9%) 54 (13.8%) CARDIOVASCULAR 25 (7.8%) 11 (4.4%) 20 (9.0%) 13 (8.6%) 45 (11.5%) TECHNICAL 71 (22.1%) 9 (3.6%) 2 (0.9%) 3 (0.8%) OTHER 78 (24.3%) 68 (27.3%) 23 (10.3%) 21 (13.9%) 83 (21.2%) Only known causes of death are included in the tabulation. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

38 ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death (Deaths: January June 2010) Only known causes of death are included in the tabulation. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

39 HEART-LUNG TRANSPLANTATION
Pediatric Recipients ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

40 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January 1982 - June 2010)
ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

41 AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January June 2010) NOTE: Transplants where donor age is unknown are excluded from this tabulation. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

42 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS By Year of Transplant
Number of Transplants This figure includes only the pediatric heart-lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not necessarily be construed as evidence that the number of pediatric heart-lung transplants performed worldwide has declined. 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. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

43 AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS By Era of Transplant
Percentage of Transplants This figure includes only the pediatric heart-lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not necessarily be construed as evidence that the number of pediatric heart-lung transplants performed worldwide has declined. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

44 NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS
NEED TO UPDATE ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

45 NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS Stratified by center volume
ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

46 DIAGNOSIS IN PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS (Transplants: 1986-2009)
“Other” includes Bronchiectasis, Alpha-1, and OB (non-ReTX) ISHLT ISHLT J Heart Lung Transplant Oct; 30 (10): NOTE: Unknown diagnoses were excluded from this tabulation. 2011

47 PEDIATRIC HEART-LUNG TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010 ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

48 PEDIATRIC HEART-LUNG TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010 ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

49 PEDIATRIC HEART-LUNG TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010 ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

50 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2009) Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not known for all patients. Survival rates were compared using the log-rank test statistic. No adjustments were made for multiple comparisons. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

51 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1982 - June 2009)
Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not know for all patients. The half-life is the estimated time point at which 50% of all of the recipients have died. Survival rates were compared using the log-rank test statistic. No adjustments were made for multiple comparisons. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

52 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January June 2009) Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not know for all patients. The half-life is the estimated time point at which 50% of all of the recipients have died. The conditional half-life is the estimated time point at which 50% of the recipients who survive to at least 1 year have died. Because the decline in survival is greatest during the first year following transplantation, the conditional survival provides a more realistic expectation of survival time for recipients who survive the early post-transplant period. Survival rates were compared using the log-rank test statistic. No adjustments were made for multiple comparisons. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

53 PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January June 2009) Conditional on Survival to 1 Year Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not know for all patients. The half-life is the estimated time point at which 50% of all of the recipients have died. The conditional half-life is the estimated time point at which 50% of the recipients who survive to at least 1 year have died. Because the decline in survival is greatest during the first year following transplantation, the conditional survival provides a more realistic expectation of survival time for recipients who survive the early post-transplant period. Survival rates were compared using the log-rank test statistic. No adjustments were made for multiple comparisons. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

54 PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2010)
0-30 Days (N = 43) 31 Days - 1 Year (N = 54 ) >1 Year - 3 Years (N = 51 ) >3 Years - 5 Years (N = 28 ) >5 Years (N = 66) BRONCHIOLITIS 2 (3.7%) 23 (45.1%) 10 (35.7%) 13 (19.7%) ACUTE REJECTION 1 (2.0%) 1 (3.6%) 1 (1.5%) LYMPHOMA 2 (3.9%) 2 (3.0%) MALIGNANCY, OTHER 4 (6.1%) CMV INFECTION, NON-CMV 7 (16.3%) 17 (31.5%) 6 (11.8%) 18 (27.3%) GRAFT FAILURE 18 (41.9%) 10 (18.5%) 14 (27.5%) 12 (42.9%) 11 (16.7%) CARDIOVASCULAR 2 (4.7%) 3 (5.6%) 2 (7.1%) 5 (7.6%) TECHNICAL 9 (20.9%) OTHER 14 (25.9%) 4 (7.8%) 10 (15.2%) Only known causes of death are included in the tabulation. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

55 PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: April 1994 - June 2010)
0-30 Days (N = 35) 31 Days - 1 Year (N = 41) >1 Year - 3 Years (N = 44) >3 Years - 5 Years (N = 25) >5 Years (N = 66) BRONCHIOLITIS 1 (2.4%) 19 (43.2%) 9 (36.0%) 13 (19.7%) ACUTE REJECTION 1 (2.3%) 1 (4.0%) 1 (1.5%) LYMPHOMA 2 (4.9%) 2 (4.5%) 2 (3.0%) MALIGNANCY, OTHER 4 (6.1%) CMV INFECTION, NON-CMV 4 (11.4%) 14 (34.1%) 6 (13.6%) 18 (27.3%) GRAFT FAILURE 15 (42.9%) 7 (17.1%) 11 (25.0%) 11 (44.0%) 11 (16.7%) CARDIOVASCULAR 2 (5.7%) 5 (7.6%) TECHNICAL 7 (20.0%) OTHER 11 (26.8%) 4 (9.1%) 10 (15.2%) Only known causes of death are included in the tabulation. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011

56 PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death (Deaths: April June 2010) Only known causes of death are included in the tabulation. ISHLT J Heart Lung Transplant Oct; 30 (10): ISHLT 2011


Download ppt "HEART-LUNG TRANSPLANTATION"

Similar presentations


Ads by Google