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LUNG TRANSPLANTATION Pediatric Recipients 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132.

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Presentation on theme: "LUNG TRANSPLANTATION Pediatric Recipients 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132."— Presentation transcript:

1 LUNG TRANSPLANTATION Pediatric Recipients 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

2 RECIPIENT AGE DISTRIBUTION FOR PEDIATRIC LUNG RECIPIENTS - NUMBER (Transplants: January 1986 - June 2010) Analysis includes living donor transplants ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

3 RECIPIENT AGE DISTRIBUTION FOR PEDIATRIC LUNG RECIPIENTS - PERCENTAGE (Transplants: January 1986 - June 2010) Analysis includes living donor transplants ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

4 DONOR TYPE DISTRIBUTION BY YEAR OF TRANSPLANT FOR PEDIATRIC LUNG RECIPIENTS (Transplants: 1986-2009) 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 ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

5 DONOR TYPE DISTRIBUTION BY RECIPIENT AGE GROUP WITHIN ERA FOR PEDIATRIC LUNG RECIPIENTS (Transplants: January 1986 - June 2010) Analysis includes living donor transplants ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

6 AGE DISTRIBUTION FOR DONORS OF PEDIATRIC LUNG RECIPIENTS (Transplants: January 1986 - June 2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

7 AGE DISTRIBUTION OF PEDIATRIC LUNG RECIPIENTS: By Year of Transplant Analysis includes living donor transplants 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 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

8 NUMBER OF CENTERS REPORTING PEDIATRIC LUNG TRANSPLANTS Analysis includes living donor transplants ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

9 NUMBER OF CENTERS REPORTING PEDIATRIC LUNG TRANSPLANTS BY CENTER VOLUME Analysis includes living donor transplants ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

10 NUMBER OF PEDIATRIC LUNG TRANSPLANTS BY CENTER VOLUME Analysis includes living donor transplants ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

11 PEDIATRIC LUNG TRANSPLANTATION: Indications (Transplants: January 1990 – June 2010) DIAGNOSIS AGE: < 1 Year AGE: 1-5 Years AGE: 6-11 Years AGE: 12-17 Years Cystic Fibrosis 11.2%54.5%16756.0%77571.7% Idiopathic Pulmonary Arterial Hypertension 1214.0%2522.5%3010.1%756.9% Re-Transplant: Obliterative Bronchiolitis 76.3%93.0%343.1% Congenital Heart Disease 1315.1%87.2%41.3%90.8% Idiopathic Pulmonary Fibrosis 910.5%2018.0%134.4%383.5% Obliterative Bronchiolitis (Not Re-TX) 109.0%196.4%454.2% Re-Transplant: Not OB 33.5%43.6%82.7%272.5% Interstitial Pneumonitis 11.2%21.8%20.7% Pulmonary Vascular Disease 89.3%76.3%31.0% Eisenmengers Syndrome 11.2%54.5%51.7%70.6% Pulmonary Fibrosis, Other 55.8%54.5%124.0%222.0% Surfactant Protein B Deficiency 1517.4%32.7%10.4%10.1% COPD/Emphysema 44.7%21.8%31.0%90.8% Bronchopulmonary Dysplasia 22.3%21.8%62.0%10.1% Bronchiectasis 11.2% 51.7%131.2% Other 1112.8%65.4%124.0%262.4% Analysis includes living donor transplants ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

12 DIAGNOSIS IN PEDIATRIC LUNG RECIPIENTS BY YEAR OF TRANSPLANT Age: 12-17 Years Analysis includes living donor transplants ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

13 PEDIATRIC LUNG TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010 Analysis includes living donor transplants ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

14 PEDIATRIC LUNG TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010 NOTE: Unknown diagnoses were excluded from this tabulation. Total number of transplants reported: Europe = 359 North America = 576 Other = 54 Analysis includes living donor transplants ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

15 PEDIATRIC LUNG TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010 NOTE: Transplants with unknown donor age and living donor transplants were excluded from this tabulation. Total number of transplants reported: Europe = 359 North America = 576 Other = 54 ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

16 LUNG TRANSPLANTATION Kaplan-Meier Survival by Recipient Age Group (Transplants: January 1990 - June 2009) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

17 PEDIATRIC LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 - June 2009) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

18 PEDIATRIC LUNG TRANSPLANTATION Kaplan-Meier Survival for Congenital Diagnoses (Transplants: January 1990 – June 2009) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

19 PEDIATRIC LUNG TRANSPLANTATION Kaplan-Meier Survival by Recipient Age Group (Transplants: January 1990 - June 2009) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

20 PEDIATRIC LUNG TRANSPLANTATION Conditional Kaplan-Meier Survival by Recipient Age Group (Transplants: January 1990 - June 2009) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

21 PEDIATRIC LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1988 - June 2009) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

22 PEDIATRIC LUNG TRANSPLANTATION Kaplan-Meier Survival by Donor Type for Recipients Age 12-17 Years (Transplants: January 1990 - June 2009) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

23 PEDIATRIC LUNG RE-TRANSPLANTS Between January 1994 and June 2010 Analysis includes living donor transplants ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

24 PEDIATRIC LUNG RETRANSPLANTS Survival for Transplants Performed Between January 1994 and June 2009 ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

25 PEDIATRIC LUNG RETRANSPLANTS STRATIFIED BY INTER-TRANSPLANT INTERVAL Survival for Transplants Performed Between January 1988 and June 2009 ISHLT 2011 Analysis includes living donor transplants. Only patients who were less than 18 years old at the time of re-transplant are included. ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

26 PEDIATRIC LUNG RETRANSPLANTS STRATIFIED BY DIAGNOSIS Survival for Transplants Performed Between January 1988 and June 2009 ISHLT 2011 Analysis includes living donor transplants. Only patients who were less than 18 years old at the time of re-transplant are included. ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

27 PEDIATRIC LUNG RECIPIENTS Cross-Sectional Analysis Functional Status of Surviving Recipients (Follow-ups: April 1994-June 2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

28 PEDIATRIC LUNG RECIPIENTS Functional Status of Surviving Recipients US Recipients Only (Follow-ups: March 2005 - June 2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

29 PEDIATRIC LUNG RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April 1994 - June 2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

30 PEDIATRIC LUNG RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April 1994 - June 2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

31 PEDIATRIC LUNG RECIPIENTS Induction Immunosuppression For transplants between January 2001 and June 2010 Analysis is limited to patients who were alive at the time of the discharge ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

32 PEDIATRIC LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2001 - June 2010) Analysis is limited to patients who were alive at the time of the discharge ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

33 PEDIATRIC LUNG TRANSPLANTATION Kaplan-Meier Survival Stratified by Induction Use (Transplants: January 2001 - June 2009) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

34 PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (F ollow-ups: January 2001 – June 2010) NOTE: Different patients are analyzed in Year 1 and Year 5 Analysis is limited to patients who were alive at the time of the follow-up ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

35 PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January 2001 – June 2010) 1 Year Follow-up (N = 348) 5 Year Follow-up (N = 153) NOTE: Different patients are analyzed in Year 1 and Year 5 NOTE: 5% of patients were on both calcineurin inhibitors at different point during the 1-year; these patients are not counted in either group. And 0.3% (1 patient) was on neither drug during the 1-year. In the 5-year tabulations, 13% were reported to be on both drugs during the year and 1% (2 patients) was reported to be on neither drugs. Analysis is limited to patients who were alive at the time of the follow-up ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

36 PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up Report (Follow-ups: January 2001 – June 2010) NOTE: Different patients are analyzed in Year 1 and Year 5 Analysis is limited to patients who were alive at the time of the follow-up ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

37 POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April 1994 - June 2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

38 POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 5 Years Post-Transplant (Follow-ups: April 1994 - June 2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

39 POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 7 Years Post-Transplant (Follow-ups: April 1994 - June 2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

40 Freedom from Bronchiolitis Obliterans Syndrome For Pediatric Lung Recipients (Follow-ups: April 1994 - June 2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

41 Freedom from Bronchiolitis Obliterans Syndrome Stratified by Age Group For Pediatric Lung Recipients (Follow-ups: April 1994 - June 2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

42 Freedom from Bronchiolitis Obliterans Syndrome Stratified by Diagnosis For Pediatric Lung Recipients (Follow-ups: April 1994 - June 2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

43 Freedom from Bronchiolitis Obliterans Syndrome For Pediatric Lung Recipients by Induction Use (Follow-ups: April 1994 - June 2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

44 Freedom from Severe Renal Dysfunction* For Pediatric Lung Recipients (Follow-ups: April 1994 - June 2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

45 MALIGNANCY POST-LUNG TRANSPLANTATION FOR PEDIATRICS Cumulative Incidence for Survivors (Follow-ups: April 1994 - June 2010) Malignancy/Type1-Year Survivors 5-Year Survivors 7-Year Survivors No Malignancy596 (94.5%)152 (88.4%)77 (89.5%) Malignancy (all types combined)35 (5.5%)20 (11.6%)9 (10.5%) Malignancy Type* Lymph32209 Other210 Type Not Reported100 Other includes Liver and primitive neuroectodermal tumor. * 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 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

46 Freedom from Malignancy For Pediatric Lung Recipients (Follow-ups: April 1994 - June 2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

47 PEDIATRIC LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January 1992- June 2010) CAUSE OF DEATH 0-30 Days (N =97) 31 Days - 1 Year (N = 135) >1 Year - 3 Years (N = 176) >3 Years - 5 Years (N = 83) >5 Years (N = 82) BRONCHIOLITIS 13 (9.6%)70 (39.8%)34 (41.0%)34 (41.5%) ACUTE REJECTION 3 (3.1%)3 (2.2%)1 (0.6%)2 (2.4%)3 (3.7%) LYMPHOMA 7 (5.2%)5 (2.8%)4 (4.8%)5 (6.1%) MALIGNANCY, NON- LYMPHOMA 1 (0.7%)1 (0.6%)2 (2.4%)3 (3.7%) CMV 5 (3.7%) INFECTION, NON-CMV 13 (13.4%)46 (34.1%)26 (14.8%)17 (20.5%)11 (13.4%) GRAFT FAILURE 30 (30.9%)27 (20.0%)45 (25.6%)11 (13.3%)14 (17.1%) CARDIOVASCULAR 15 (15.5%)6 (4.4%)4 (2.3%)1 (1.2%) TECHNICAL 11 (11.3%)3 (2.2%)1 (0.6%)1 (1.2%) MULTIPLE ORGAN FAILURE 8 (8.2%)13 (9.6%)9 (5.1%)3 (3.6%)7 (8.5%) OTHER 17 (17.5%)11 (8.1%)14 (8.0%)8 (9.6%)6 (7.3%) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

48 PEDIATRIC LUNG TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death (Deaths: January 1992 - June 2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

49 N=795 PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1992-6/2009) Risk Factors For 1 Year Mortality/Graft Failure ISHLT 2011 VARIABLENRelative Risk P-value95% Confidence Interval Single lung transplant153.150.00261.49 -6.63 On ventilator1243.14<.00012.08 -4.75 Year of transplant: 1992-1999 vs. 2000-6/20093292.08<.00011.50 -2.90 Donor CMV+/Recipient CMV-2521.310.09200.96 -1.79 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

50 N=795 PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1992-6/2009) Risk Factors For 1 Year Mortality/Graft Failure ISHLT 2011 Continuous Factors (see figures) Pediatric transplant center volume Recipient age (borderline) ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

51 PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1992-6/2009) Risk Factors For 1 Year Mortality/Graft Failure Center Volume Pediatric Transplants ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

52 PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1992-6/2009) Risk Factors For 1 Year Mortality/Graft Failure Recipient Age ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

53 N=583 PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1992-6/2005) Risk Factors For 5 Year Mortality/Graft Failure ISHLT 2011 VARIABLENRelative Risk P-value95% Confidence Interval Single lung transplant152.450.00321.35 -4.45 On ventilator882.27<.00011.53 -3.36 Year of transplant: 1992-1999 vs. 2000-6/20053291.59<.00011.26 -2.01 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

54 N=583 PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1992-6/2005) Risk Factors For 5 Year Mortality/Graft Failure ISHLT 2011 Continuous Factors (see figures) Recipient age Height difference (borderline) ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

55 PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1992-6/2005) Risk Factors For 5 Year Mortality/Graft Failure Recipient Age ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

56 PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1992-6/2005) Risk Factors For 5 Year Mortality/Graft Failure Height Difference ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

57 N=380 PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1990-6/2000) Risk Factors For 10 Year Mortality/Graft Failure ISHLT 2011 VARIABLENRelative RiskP-value95% Confidence Interval On ventilator662.12<.00011.48 -3.03 Single lung transplant251.970.00851.19 -3.25 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

58 N=380 PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1990-6/2000) Risk Factors For 10 Year Mortality/Graft Failure ISHLT 2011 Continuous Factors (see figures) Recipient age ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

59 PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1990-6/2000) Risk Factors For 10 Year Mortality/Graft Failure Recipient Age ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132


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