Pediatric Heart-Lung Transplantation Insights 2015
Explore the characteristics, age distribution, retransplants, and outcomes of pediatric heart-lung transplants from 1985 to 2014. Gain valuable insights for pediatric recipients and centers involved in these procedures.
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HEART-LUNG TRANSPLANTATION Pediatric Recipients 2015 JHLT. 2015 Oct; 34(10): 1255-1263
Table of Contents Donor, recipient and center characteristics: slides 3-15 Post transplant survival and other outcomes: slides 16-22 Early Graft Failure (EGF): slides 23-24 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Donor, Recipient and Center Characteristics 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Transplants Recipient Age Distribution (Transplants: January 1985 June 2014) 500 440 450 400 Number of Transplants 350 300 250 200 131 150 109 100 50 19 0 <1 1-5 Recipient Age (Years) 6-10 11-17 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Transplants Donor Age Distribution (Transplants: January 1985 June 2014) 400 342 350 Number of Transplants 300 250 200 161 150 100 62 40 50 7 1 0 0-10 11-17 18-34 Donor Age (Years) 35-49 50-59 60+ 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Transplants Age Distribution by Year 65 60 11-17 years 6-10 years 1-5 years <1 year 55 50 Number of Transplants 45 40 35 30 25 20 15 10 5 0 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. 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Retransplants by Year of Retransplant 6 18 N % 16 5 Number of Retransplants 14 % of Retransplants 4 12 10 3 8 2 6 4 1 2 0 0 Year of Retransplant 2015 Only patients who were less than 18 years old at the time of retransplant are included. JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Retransplants (Retransplants: January 1985 June 2014) 10 9 Number of Retransplants 8 7 6 5 4 3 2 1 0 0 - <1 month 1 - <12 months 12 - <36 months 36+ Not Reported months Time Between Previous and Current Transplant 2015 Analysis includes deceased and living donor transplants. JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Transplants Age Distribution by Era of Transplant 100% 90% 11-17 years 80% 6-10 years 70% % of Transplants 1-5 years 60% <1 year 50% 40% 30% 20% 10% 0% 1985-1999 2008-6/2014 2000-2007 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Transplants Number of Centers Reporting Transplants by Location (Transplants: January 1984 December 2013) 30 N of Pediatric Transplant Centers Others 25 North America Europe 20 15 10 5 0 Transplant Year 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Transplants Number of Centers Reporting Transplants by Center Volume 30 N of Pediatric Transplant Centers 1-4/yr 5-9/yr 25 10-19/yr 20-29/yr 20 15 10 5 0 Transplant Year 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Transplants Diagnosis Distribution (Transplants: January 1986 December 2013) 25% Acquired Heart Disease CF Congenital (other) Eisenmenger's Syndrome IPF IPAH Retx: Non-OB Retx: OB Other Other includes Bronchiectasis, Alpha-1, and OB (non-Retx). 2% 1% 2% 5% 12% 4% 22% 27% 100 % of Cases Cystic Fibrosis Congenital IPAH 75 50 25 0 NOTE: Unknown diagnoses were excluded from this tabulation. For some retransplants, a diagnosis other than retransplant is reported, so the total percentage of retransplants may be greater. 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Transplants Age Distribution by Location (Transplants: January 2000 June 2014) <1 year 1-5 years 6-10 years 11-17 years 100% 80% % of Transplants 60% 40% 20% 0% Europe North America Other 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Transplants Diagnosis Distribution by Location (Transplants: January 2000 June 2014) Congenital heart disease Cystic Fibrosis IPAH Other 100% 80% % of Transplants 60% 40% 20% 0% Europe North America Other 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Transplants Donor Age Distribution by Location (Transplants: January 2000 June 2014) 0-10 years 11-17 years 18-34 years 35-49 years 50-59 years 60+ years 100% 80% % of Donors 60% 40% 20% 0% Europe North America Other 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Post Transplant: Survival and Other Outcomes 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Transplants Kaplan-Meier Survival by Diagnosis (Transplants: January 1990 June 2013) 100 Congenital (N = 100) Eisenmenger's Syndrome (N = 53) 80 IPAH (N = 120) Median survival (years): Congenital=2.1; Eisenmenger's=2.6; IPAH=4.7 Survival (%) 60 40 20 No pair-wise comparisons were statistically significant at p<0.05. 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Years 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Transplants Kaplan-Meier Survival by Age Group (Transplants: January 1982 June 2013) 100 <1 (N = 19) <1 vs. 1-5: p=0.0409 <1 vs. 6-10: p=0.0006 <1 vs. 11-17: p=0.0015 All other pair-wise comparisons were not significant at p<0.05. 1-5 (N = 108) 80 6-10 (N = 128) 11-17 (N = 433) Survival (%) 60 40 20 Median survival (years): <1=0.2; 1-5=1.5; 6-10=3.4; 11-17=3.3 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Years 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Transplants Kaplan-Meier Survival by Era (Transplants: January 1985 June 2013) 100 1985-1989 (N=180) 1990-1999 (N=343) 2000-2005 (N=90) 2006-6/2013 (N=75) 80 Survival (%) 60 No pair-wise comparisons were statistically significant at p<0.05. 40 20 Median survival (years): 1985-1989=1.7; 1990-1999=3.0; 2000-2005=4.6; 2006-6/2013=5.1 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Years 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Transplants Kaplan-Meier Survival by Era Conditional on Survival to 1 Year (Transplants: January 1985 June 2013) 100 1985-1989 (N=98) 1990-1999 (N=225) 2000-2005 (N=60) 2006-6/2013 (N=53) 80 Survival (%) 60 No pair-wise comparisons were statistically significant at p<0.05. 40 20 Conditional median survival (years): 1985-1989=8.6; 1990-1999=6.7; 2000-2005=11.4; 2006-6/2013=NA 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Years 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Transplants Cause of Death (Deaths: January 2000 June 2014) 0-30 Days (N = 26) 31 Days - 1 Year (N = 19) >1 Year - 3 Years (N = 24) >3 Years - 5 Years (N = 13) >5 Years (N = 53) CAUSE OF DEATH 0 0 10 (41.7%) 4 (30.8%) 12 (22.6%) BRONCHIOLITIS 2 (7.7%) 0 1 (4.2%) 1 (7.7%) 1 (1.9%) ACUTE REJECTION 0 1 (5.3%) 0 1 (7.7%) 0 LYMPHOMA 0 1 (5.3%) 1 (4.2%) 0 2 (3.8%) MALIGNANCY, OTHER 2 (7.7%) 5 (26.3%) 1 (4.2%) 2 (15.4%) 12 (22.6%) CMV 6 (23.1%) 2 (10.5%) 7 (29.2%) 3 (23.1%) 10 (18.9%) INFECTION, NON-CMV 2 (7.7%) 1 (5.3%) 2 (8.3%) 1 (7.7%) 6 (11.3%) GRAFT FAILURE 6 (23.1%) 0 0 0 0 CARDIOVASCULAR 8 (30.8%) 9 (47.4%) 2 (8.3%) 1 (7.7%) 10 (18.9%) TECHNICAL 0 0 10 (41.7%) 4 (30.8%) 12 (22.6%) OTHER 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Transplants Relative Incidence of Leading Causes of Death (Deaths: January 2000 June 2014) 60 Bronchiolitis Infection (Non-CMV) Graft Failure Cardiovascular 50 40 % of Deaths 30 20 10 0 0-30 Days (N = 26) 31 Days - 1 Year (N = 19) >1 Year - 3 Years (N = 24) >3 Years - 5 Years (N = 13) >5 Years (N = 53) 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
Early Graft Failure (EGF) 2015 JHLT. 2015 Oct; 34(10): 1255-1263
Pediatric Heart-Lung Transplants Number of Transplants by Status at 30 Days (Primary Transplants: January 2005 December 2013) 100 90 80 Number of Transplants 72 70 60 50 40 30 20 10 10 5 0 EGF Non-EGF early failures* Alive with the functioning graft without EGF at 30 days * Non-EGF early failures include non-EGF retransplants and deaths within 30 days 2015 JHLT. 2014 Oct; 33(10): 1025-1033 JHLT. 2015 Oct; 34(10): 1255-1263
