Pediatric Lung Transplantation Recipients - Insights and Trends

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Explore the age distribution, donor types, and trends in pediatric lung transplant recipients from January 1986 to June 2011. Analysis includes living donor transplants. Discover valuable insights into recipient age groups, donor age distribution, and more.

  • Pediatric
  • Lung Transplantation
  • Recipients
  • Trends
  • Insights
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  1. LUNG TRANSPLANTATION Pediatric Recipients ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  2. RECIPIENT AGE DISTRIBUTION FOR PEDIATRIC LUNG RECIPIENTS - NUMBER (Transplants: January 1986 - June 2011) 1,400 <1 1-5 6-11 12-17 1,200 Number of Transplants 1,000 800 600 400 200 0 1986-1998 (N=602) 1999-6/2011 (N=1,168) ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 Analysis includes living donor transplants 2012

  3. RECIPIENT AGE DISTRIBUTION FOR PEDIATRIC LUNG RECIPIENTS PERCENTAGE (Transplants: January 1986 - June 2011) 100% 90% 80% % of Transplants 70% 12-17 60% 6-11 50% 40% 1-5 30% <1 20% 10% 0% 1986-1998 (N=602) 1999-6/2011 (N=1,168) ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 Analysis includes living donor transplants 2012

  4. DONOR TYPE DISTRIBUTION BY YEAR OF TRANSPLANT FOR PEDIATRIC LUNG RECIPIENTS (Transplants: 1986-2010) 140 Living Deceased 120 Number of Transplants 100 80 60 40 20 0 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. ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012 Analysis includes living donor transplants

  5. DONOR TYPE DISTRIBUTION BY RECIPIENT AGE GROUP WITHIN ERA FOR PEDIATRIC LUNG RECIPIENTS (Transplants: January 1986 June 2011) 900 800 Living Deceased Number of Transplants 700 600 500 400 300 200 100 0 0-5 years 6-11 years 12-17 years 0-5 years 6-11 years 12-17 years 1999-6/2011 1986-1998 Recipient Age (Years) ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012 Analysis includes living donor transplants

  6. AGE DISTRIBUTION FOR DONORS OF PEDIATRIC LUNG RECIPIENTS (Transplants: January 1986 - June 2011) 100% 86 10 90% 211 80% 60+ % of Transplants 281 70% 50-59 60% 35-49 347 50% 18-34 40% 12-17 30% 0-11 689 20% 10% 0% Donor Age (Years) ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  7. AGE DISTRIBUTION OF PEDIATRIC LUNG RECIPIENTS BY YEAR OF TRANSPLANT 140 125126 130 12-17 Years 97103108114 120 Number of Transplants 110 1-11 Years 96 95 96 100 89 <1 Year 90 82 73 73 727478 80 70 60 4548 4952 50 40 30 23 20 7 5 10 3 1 0 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 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012 Analysis includes living donor transplants

  8. NUMBER OF CENTERS REPORTING PEDIATRIC LUNG TRANSPLANTS 55 50 45 Number of Centers 40 35 30 25 20 15 10 5 0 Transplant Year ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012 Analysis includes living donor transplants

  9. NUMBER OF CENTERS REPORTING PEDIATRIC LUNG TRANSPLANTS BY CENTER VOLUME 55 20+ transplants 10-19 transplants 5-9 transplants 1-4 transplants 50 45 Number of Centers 40 35 30 25 20 15 10 5 0 Transplant Year ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012 Analysis includes living donor transplants

  10. NUMBER OF PEDIATRIC LUNG TRANSPLANTS BY CENTER VOLUME 130 20+ transplants 10-19 transplants 5-9 transplants 1-4 transplants 120 110 Number of Transplants 100 90 80 70 60 50 40 30 20 10 0 Transplant Year ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012 Analysis includes living donor transplants

  11. PEDIATRIC LUNG TRANSPLANTS: Indications(Transplants: January 1990 - June 2011) AGE: < 1 Year 1 AGE: 1-5 Years 6 AGE: 6-11 Years 171 AGE: 12-17 Years 826 Diagnosis Cystic Fibrosis Idiopathic Pulmonary Arterial Hypertension Re-Transplant: Obliterative Bronchiolitis Congenital Heart Disease Idiopathic Pulmonary Fibrosis Obliterative Bronchiolitis (Not Re-TX) Re-Transplant: Not OB Interstitial Pneumonitis Pulmonary Vascular Disease Eisenmenger s Syndrome Pulmonary Fibrosis, Other Surfactant Protein B Deficiency COPD/Emphysema Bronchopulmonary Dysplasia Bronchiectasis Other 1.1% 5.0% 53.8% 71.5% 12 13.2% 27 22.5% 31 9.7% 83 7.2% 7 5.8% 9 2.8% 35 3.0% 14 15.4% 9 7.5% 4 1.3% 10 0.9% 9 9.9% 21 17.5% 15 4.7% 39 3.4% 10 8.3% 23 7.2% 49 4.2% 3 3.3% 4 3.3% 9 2.8% 30 2.6% 1 1.1% 2 1.7% 3 0.9% 8 8.8% 7 5.8% 4 1.3% 1 0.1% 1 1.1% 5 4.2% 5 1.6% 7 0.6% 6 6.6% 8 6.7% 16 5.0% 24 2.1% 16 17.6% 3 2.5% 4 4.4% 2 1.7% 3 0.9% 9 0.8% 3 3.3% 3 2.5% 7 2.2% 2 0.2% 1 1.1% 6 1.9% 14 1.2% 12 13.2% 6 5.0% 12 3.8% 27 2.3% ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012 Analysis includes living donor transplants

  12. DIAGNOSIS IN PEDIATRIC LUNG RECIPIENTS BY YEAR OF TRANSPLANT Age: 12-17 Years 100 IPAH Cystic Fibrosis 75 % of Transplants 50 25 0 Years ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012 Analysis includes living donor transplants

  13. PEDIATRIC LUNG TRANSPLANTS Age Distribution by Location (Transplants: January 2000 June 2011) 0-5 years 6-11 years 12-17 years 100% 80% % of Transplants 60% 40% 20% 0% Europe (N=410) North America (N=619) Other (N=66) ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012 Analysis includes living donor transplants

  14. PEDIATRIC LUNG TRANSPLANTS Diagnosis Distribution by Location (Transplants: January 2000 June 2011) Cystic Fibrosis IPAH IPF OB Other Congenital heart disease Re-TX 100% 80% % of Transplants 60% 40% 20% 0% Europe (N=387) North America (N=619) Other (N=57) NOTE: Unknown diagnoses were excluded from this tabulation Total number of transplants reported: Europe = 410 North America = 619 Other = 66 ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012 Analysis includes living donor transplants

  15. PEDIATRIC LUNG TRANSPLANTS Donor Age Distribution by Location (Transplants: January 2000 June 2011) 0-5 6-11 12-17 18-34 35-49 50-59 60+ 100% 80% % of Donors 60% 40% 20% 0% Europe (N=405) North America (N=583) Other (N=58) 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 ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  16. LUNG TRANSPLANTS Kaplan-Meier Survival by Recipient Age Group (Transplants: January 1990 - June 2010) 100 Adult (N=36,015) Pediatric (N=1,543) 75 Survival (%) p = 0.4368 50 25 HALF-LIFE Adult = 5.3 Years; Pediatric = 4.7 Years 0 0 1 2 3 4 5 6 7 8 Years 9 10 11 12 13 14 15 16 17 ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  17. PEDIATRIC LUNG TRANSPLANTS Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 - June 2010) 100 Single Lung (N=92) Bilateral/Double Lung (N=1,449) 75 Survival (%) p < 0.0001 50 25 HALF-LIFE Single Lung: 1.9 Years; Bilateral/Double Lung: 5.3 Years 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Years ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  18. PEDIATRIC LUNG TRANSPLANTS Kaplan-Meier Survival for Congenital Diagnoses (Transplants: January 1990 - June 2010) 100 Eisenmenger s vs. Other: p = 0.5078 75 Survival (%) N at risk = 11 N at risk = 10 50 N at risk = 15 25 Eisenmenger's Syndrome (N=16) Other Congenital Heart Disease (N=34) Eisenmenger's + Other Congenital Heart Disease (N=50) 0 0 1 2 3 4 5 Years ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  19. PEDIATRIC LUNG TRANSPLANTS Kaplan-Meier Survival by Recipient Age Group (Transplants: January 1990 - June 2010) 100 <1 year vs. 1-11 years: p = 0.2101 <1 year vs. 12-17 years: p = 0.9694 1-11 years vs. 12-17 years: p = 0.0106 <1 Year (N=89) 1-11 Years (N=411) 75 12-17 Years (N=1,043) Survival (%) 50 N at risk = 17 HALF-LIFE <1 Year: 6.4 Years 1-11 Years: 6.2 Years 12-17 Years: 4.3 Years N at risk = 10 25 N at risk = 26 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Years ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  20. PEDIATRIC LUNG TRANSPLANTS Conditional Kaplan-Meier Survival by Recipient Age Group (Transplants: January 1990 - June 2010) 100 <1 year vs. 1-11 years: p = 0.7629 <1 year vs. 12-17 years: p = 0.1241 1-11 years vs. 12-17 years: p = 0.0083 75 Survival (%) N at risk = 17 CONDITIONAL HALF-LIFE <1 Year: 8.8 Years 1-11 Years: 10.5 Years 12-17 Years: 6.4 Years 50 N at risk = 10 N at risk = 26 25 <1 Year (N=55) 1-11 Years (N=297) 12-17 Years (N=737) 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Years ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  21. PEDIATRIC LUNG TRANSPLANTS Kaplan-Meier Survival by Era (Transplants: January 1988 - June 2010) 100 HALF-LIFE (Years) Unconditional 1988-1994: 2.5; 1995-2001: 4.0; 2002-6/2010: 5.8 Conditional 1988-1994: 10.4; 1995-2001: 7.3; 2002-6/2010: 8.9 75 1988-1994 vs. 1995-2001: p = 0.0556 1988-1994 vs. 2002-6/2010: p < 0.0001 1995-2001 vs. 2002-6/2010: p = 0.0033 Survival (%) N at risk = 27 50 N at risk = 10 1988-1994 (N=216) 25 1995-2001 (N=511) N at risk = 22 2002-6/2010 (N=828) 0 0 1 2 3 4 5 6 7 Years 8 9 10 11 12 13 14 15 ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  22. PEDIATRIC LUNG TRANSPLANTS Kaplan-Meier Survival by Donor Type for Recipients Age 12-17 Years (Transplants: January 1990 - June 2010) 100 HALF-LIFE Deceased: 4.3 Years Living: 3.8 Years p = 0.2897 75 Survival (%) 50 N at risk = 50 N at risk = 23 25 Deceased Donor (N = 1,043) Living Donor (N = 80) 0 0 1 2 3 4 5 6 7 8 9 10 11 Years ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  23. PEDIATRIC LUNG RE-TRANSPLANTS Between January 1994 and June 2011 35 Number of Re-Transplants 30 25 20 15 10 5 0 0-<1 month 1-<12 months 12-<36 months 36+ months Not reported Time Between Previous and Current Transplant ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012 Analysis includes living donor transplants

  24. PEDIATRIC LUNG RE-TRANSPLANTS Survival for Transplants Performed Between January 1994 and June 2010 100 80 Survival (%) 60 N at risk at 5 years = 18 40 20 0 0 1 2 3 4 5 Years ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  25. PEDIATRIC LUNG RE-TRANSPLANTS Survival for Transplants Performed Between January 1988 and June 2010 Stratified by Inter-Transplant Interval 100 p = 0.1097 80 Survival (%) 60 N at risk = 12 40 N at risk = 13 20 <1 Year (N = 32) 1+ Year (N = 64) 0 0 1 2 3 4 5 Years 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. 2012 Oct; 31(10): 1045-1095 2012

  26. PEDIATRIC LUNG RE-TRANSPLANTS Survival for Transplants Performed Between January 1988 and June 2010 Stratified by Diagnosis 100 p = 0.6119 80 Survival (%) 60 N at risk = 12 40 N at risk = 11 20 Obliterative Bronchiolitis (N = 55) Non Obliterative Bronchiolitis (N = 64) 0 0 1 2 3 4 5 Years 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. 2012 Oct; 31(10): 1045-1095 2012

  27. PEDIATRIC LUNG RECIPIENTS Cross-Sectional Analysis Functional Status of Surviving Recipients (Follow-ups: April 1994 June 2011) 100% 80% 60% 40% No Activity Limitations Performs with Assistance Total Assistance 20% 0% 1 Year (N = 330) 3 Years (N = 206) 5 Years (N = 128) ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  28. PEDIATRIC LUNG RECIPIENTS Functional Status of Surviving Recipients US Recipients Only (Follow-ups: March 2005 June 2011) 100% 10% 20% 80% 30% 40% 60% 50% 60% 40% 70% 80% 20% 90% 100% 0% 2 Years (N = 229) 3 Years (N = 180) 1 Year (N = 298) ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  29. PEDIATRIC LUNG RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April 1994 June 2011) 100% 80% 60% 40% No Hospitalization Hospitalized, Rejection Hospitalized, Rejection + Infection Hospitalized, Not Rejection/Not Infection Hospitalized, Infection Only 20% 0% Up to 1 Year (N=690) Between 2 and 3 Years (N=406) Between 4 and 5 Years (N=251) ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  30. PEDIATRIC LUNG RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April 1994 June 2011) 100% 80% 60% 40% No Hospitalization Hospitalized, Rejection Hospitalized, Rejection + Infection Hospitalized, Not Rejection/Not Infection Hospitalized, Infection Only 20% 0% Up to 1 Year (N=690) Between 1 and 3 Years (N=371) Between 3 and 5 Years (N=231) ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  31. PEDIATRIC LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2001 June 2011) 70 60 50 % of patients 40 30 20 10 0 Any Induction (N = 318) Polyclonal ALG/ATG (N = 70) IL-2R Antagonist (N = 245) ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 Analysis is limited to patients who were alive at the time of the discharge 2012

  32. PEDIATRIC LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2001 June 30, 2011) 90 80 70 60 % of patients 50 40 30 20 10 0 Any Induction Polyclonal ALG/ATG IL-2R Antagonist ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 Analysis is limited to patients who were alive at the time of the discharge 2012

  33. PEDIATRIC LUNG TRANSPLANTS Kaplan-Meier Survival Stratified by Induction Use (Transplants: January 2001 - June 2010) 100 p = 0.8790 75 Survival (%) 50 HALF-LIFE Induction: 6.5 Years No Induction: 6.0 Years 25 Induction (N = 282) No Induction (N = 177) 0 0 1 2 3 4 5 6 Years ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  34. PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January 2001 June 2011) 100 Year 1 (N = 407) Year 5 (N = 178) 80 % of patients 60 40 20 0 Cyclosporine Tacrolimus Sirolimus/ Everolimus MMF/MPA Azathioprine Prednisone NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 Analysis is limited to patients who were alive at the time of the follow-up 2012

  35. PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January 2001 June 2011) 100 80 % of Patients 60 MMF/ MPA Tac MMF/ MPA Tac 40 20 CyA CyA AZA AZA 0 Calcineurin Inhibitor 1 Year Follow-up (N = 407) CellCycle Prednisone Calcineurin Inhibitor 5 Year Follow-up (N = 178) CellCycle Prednisone 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. NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012 Analysis is limited to patients who were alive at the time of the follow-up

  36. PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up (Follow-ups: January 2001 June 2011) 100% Other 80% Tacrolimus + Sirolimus/Everolimus % of Patients Tacrolimus 60% Tacrolimus + MMF/MPA 40% Tacrolimus + AZA Cyclosporine + MMF/MPA 20% Cyclosporine + AZA 0% Year 5 (N = 178) Year 1 (N = 407) NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 Analysis is limited to patients who were alive at the time of the follow-up 2012

  37. POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Morbidity Rates in Survivors within 1 Year Post- Transplant (Follow-ups: April 1994 - June 2011) Within 1 Year Total number with known response Outcome 41.7% (N = 664) Hypertension 10.0% (N = 683) Renal Dysfunction 6.9% 2.0% 0.7% 0.3% Abnormal Creatinine < 2.5 mg/dl Creatinine > 2.5 mg/dl Chronic Dialysis Renal Transplant 5.1% (N = 683) Hyperlipidemia 23.5% (N = 684) Diabetes 13.2% (N = 638) Bronchiolitis Obliterans Syndrome ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  38. POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Morbidity Rates in Survivors within 5 Years Post- Transplant (Follow-ups: April 1994 - June 2011) Within 5 Years Total number with known response Outcome 69.8% (N = 179) Hypertension 32.8% (N = 189) Renal Dysfunction 24.3% 5.3% 1.6% 1.6% Abnormal Creatinine < 2.5 mg/dl Creatinine > 2.5 mg/dl Chronic Dialysis Renal Transplant 15.8% (N = 184) Hyperlipidemia 36.8% (N = 190) Diabetes 35.9% (N = 145) Bronchiolitis Obliterans Syndrome ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  39. POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Morbidity Rates in Survivors within 7 Years Post- Transplant (Follow-ups: April 1994 - June 2011) Within 7 Years Total number with known response Outcome 41.3% (N = 92) Renal Dysfunction 29.3% 7.6% 0.0% 4.3% Abnormal Creatinine < 2.5 mg/dl Creatinine > 2.5 mg/dl Chronic Dialysis Renal Transplant 33.9% (N = 62) Diabetes 44.6% (N = 56) Bronchiolitis Obliterans Syndrome ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  40. Freedom from Bronchiolitis Obliterans Syndrome For Pediatric Lung Recipients (Follow-ups: April 1994-June 2011) 100 90 % Free from Bronchiolitis 80 Obliterans Syndrome 70 60 50 40 30 20 10 0 0 1 2 3 4 5 6 7 8 Years ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  41. Freedom from Bronchiolitis Obliterans Syndrome For Pediatric Lung Recipients by Age Group (Follow-ups: April 1994-June 2011) 100 90 p = 0.0308 % Free from Bronchiolitis 80 Obliterans Syndrome 70 60 50 40 30 <1 Year (N=53) 1-11 Years (N=204) 12-17 Years (N=385) 20 10 0 0 1 2 3 4 5 6 Years ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  42. Freedom from Bronchiolitis Obliterans Syndrome For Pediatric Lung Recipients by Diagnosis (Follow-ups: April 1994-June 2011) 100 90 p = 0.0606 % Free from Bronchiolitis 80 Obliterans Syndrome 70 60 50 40 30 Cystic Fibrosis (N=341) 20 IPAH (N=61) 10 0 0 1 2 3 4 5 6 Years ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  43. Freedom from Bronchiolitis Obliterans Syndrome For Pediatric Lung Recipients by Induction Use (Follow-ups: April 1994-June 2011) 100 90 p = 0.9867 % Free from Bronchiolitis 80 Obliterans Syndrome 70 60 50 40 30 Induction (N = 274) 20 No Induction (N = 339) 10 0 0 1 2 3 4 5 6 Years ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  44. Freedom from Severe Renal Dysfunction* For Pediatric Lung Recipients (Follow-ups: April 1994-June 2011) 100 % Free from Severe Renal Dysfunction 90 80 70 *Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 mol/L), dialysis or renal transplant 60 50 0 1 2 3 4 5 6 7 8 Years ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  45. MALIGNANCY POST-LUNG TRANSPLANT FOR PEDIATRICS Cumulative Morbidity Rates in Survivors (Follow-ups: April 1994-June 2011) 1-Year Survivors 5-Year Survivors 7-Year Survivors Malignancy/Type 657 (94.4%) 175 (88.8%) 87 (90.6%) No Malignancy 39 (5.6%) 22 (11.2%) 9 (9.4%) Malignancy (all types combined) 36 22 9 Malignancy Type* Lymphoma 2 1 0 Other 1 0 0 Type Not Reported 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 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  46. Freedom from Malignancy For Pediatric Lung Recipients (Follow-ups: April 1994- June 2011) 100 % Free from Malignancy 90 80 All malignancy Lymphoma 70 Skin Other 60 50 0 1 2 3 4 5 6 7 8 9 10 Years ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  47. PEDIATRIC LUNG TRANSPLANT RECIPIENTS Cause of Death (Deaths: January 1992 - June 2011) 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) 16 (10.1%) 80 (38.3%) 36 (39.1%) 38 (45.2%) BRONCHIOLITIS 3 (2.6%) 3 (1.9%) 2 (1.0%) 2 (2.2%) ACUTE REJECTION 8 (5.0%) 7 (3.3%) 4 (4.3%) 5 (6.0%) LYMPHOMA 1 (0.6%) 1 (0.5%) 3 (3.6%) MALIGNANCY, NON-LYMPHOMA 5 (3.1%) CMV 15 (13.2%) 53 (33.3%) 32 (15.3%) 18 (19.6%) 9 (10.7%) INFECTION, NON-CMV 35 (30.7%) 31 (19.5%) 49 (23.4%) 20 (21.7%) 17 (20.2%) GRAFT FAILURE 18 (15.8%) 6 (3.8%) 3 (1.4%) 1 (1.1%) CARDIOVASCULAR 13 (11.4%) 5 (3.1%) 6 (2.9%) 3 (3.3%) 1 (1.2%) TECHNICAL 11 (9.6%) 19 (11.9%) 10 (4.8%) 3 (3.3%) 6 (7.1%) MULTIPLE ORGAN FAILURE 19 (16.7%) 12 (7.5%) 19 (9.1%) 5 (5.4%) 5 (6.0%) OTHER ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  48. PEDIATRIC LUNG TRANSPLANT RECIPIENTS Relative Incidence of Leading Causes of Death (Deaths: January 1992 - June 2011) Bronchiolitis Graft Failure Multiple Organ Failure Infection (non-CMV) Cardiovascular 50 40 % of Deaths 30 20 10 0 0-30 Days (N = 114) >5 Years (N = 84 ) 31 Days 1 Year (N = 159) >1 Year 3 Years (N =209) >3 Years 5 Years (N = 92) ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  49. PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1993-6/2010) Risk Factors For 1 Year Mortality/Graft Failure VARIABLE N Relative Risk P-value 95% Confidence Interval 11 3.92 0.002 1.63 - 9.41 Single lung transplant 133 3.17 <.0001 2.10 - 4.77 On ventilator 337 1.67 0.002 1.21 - 2.31 Year of transplant: 1993-2000 vs. 2001-6/2010 262 1.40 0.034 1.03 - 1.91 Donor CMV+/Recipient CMV- Chronic steroid use 299 1.33 0.085 0.96 - 1.84 N = 826 ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

  50. PEDIATRIC LUNG TRANSPLANT RECIPIENTS (1/1993-6/2010) Risk Factors For 1 Year Mortality/Graft Failure Continuous Factors (see figures) Pediatric transplant center volume (borderline) ISHLT J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 2012

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