Trends in Recipient Characteristics and Outcomes of Pediatric Lung Transplantation

Trends in Recipient Characteristics and Outcomes of Pediatric Lung Transplantation
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This study delves into the recipient characteristics and outcomes of pediatric lung transplantation over different eras, examining survival rates, freedom from BOS, and multivariable Cox analyses. It showcases trends from 1992 to 2018, highlighting factors such as geographic location, age, gender, blood type, previous surgeries, and medical conditions like CMV antibody status. The data offers valuable insights for understanding the impact of recipient variables on transplant success.

  • Pediatric Lung Transplantation
  • Recipient Characteristics
  • Transplant Outcomes
  • Trends
  • Survival Analysis
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  1. FOCUS THEME: TRENDS IN RECIPIENT CHARACTERISTICS AND IMPACT ON OUTCOMES LUNG TRANSPLANTATION Pediatric Recipients 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  2. Table of Contents Characteristics of Recipients of Deceased Donor Transplants by Transplant Year/Era: slides 3-10 Kaplan-Meier Survival Analyses: slides 11-26 Survival within 12 months: slides 11-17 Survival within 5 years conditional on survival to 1 year: slides 18-24 Freedom from BOS conditional on survival to discharge: slides 25-26 Multivariable Cox Analyses: slides 27-37 Mortality within 12 months: slides 27-30 Mortality within 5 years conditional on survival to 1 year: slides 31-34 BOS conditional on survival to discharge: slides 35-37 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  3. Recipient Characteristics by Transplant Era/Year 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  4. Pediatric Lung Transplants Recipient Characteristics (Transplants: Jan 1992 Jun 2018) Jan 1992-Dec 2000 (N = 592) Jan 2001-Dec 2009 (N = 824) Jan 2010-Jun 2018 (N = 907) P-value Geographic location: - Europe 188 (31.8%) 312 (37.9%) 395 (43.6%) - North America 391 (66.0%) 457 (55.5%) 417 (46.0%) <0.0001 - Other 13 (2.2%) 55 (6.7%) 95 (10.5%) Age (years) <0.0001 13 (0 - 17) 14 (1 - 17) 14.0 (1 - 17) Male 0.8071 43.1% 41.6% 390 (43.0%) Weight (kg) 0.6623 47.0 (40.0 - 70.4) 47.6 (40.3 - 70.0) 48.0 (40.0 - 70.3) Height (cm) BMI (kg/m ) 0.5553 0.5297 160.0 (144.0 - 173.0) 18.4 (15.7 - 26.9) 160.0 (149.0 - 175.0) 18.9 (16.1 - 25.1) 158.0 (147.3 - 175.3) 18.8 (15.7 - 26.4) Blood type: - A 41.9% 41.3% 44.8% - AB 5.5% 4.7% 4.5% 0.463 - B 10.4% 12.9% 10.1% - O 42.1% 41.1% 40.6% Continuous factors are expressed as median (5th 95th percentiles) Summary statistics included transplants with known/non-missing data 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  5. Pediatric Lung Transplants (Transplants: Jan 1992 Jun 2018) Recipient Characteristics Jan 1992-Dec 2000 (N = 592) Jan 2001-Dec 2009 (N = 824) Jan 2010-Jun 2018 (N = 907) P-value <0.0001 PRA 20% 3.2% 3.9% 13.0% 0.2741 PRA 80% 1.7% 2.7% 1.0% CMV antibody positive 0.0042 26.7% 34.1% 38.0% EBV antibody positive 0.4293 44.4% 1 54.4% 52.7% Hep B antibody positive 0.0583 1.2% 2 4.7% 4.1% Hep C antibody positive 0.3872 0.8% 2 0.9% 0.2% History of malignancy 0.172 2.7% 2 5.5% 5.2% 29.2% 2 Previous lung surgery 0.003 19.6% 14.6% Ventilator use 36.6% 37.1% 42.2% 0.0615 ECMO use 18.8% 14.2% 19.6% <0.0001 Hospitalized 1.3% 1.2% 9.8% 0.1921 2021 Summary statistics included transplants with non-missing data 1 Based on Oct 1999 Dec 2000 transplants 2 Based on Apr 1994 Dec 2000 transplants JHLT. 2021 Oct; 40(10): 1023-1072

  6. Pediatric Lung Transplants (Transplants: Jan 1992 Jun 2018) Recipient Characteristics Jan 1992-Dec 2000 (N = 592) Jan 2001-Dec 2009 (N = 824) Jan 2010-Jun 2018 (N = 907) P-value Bilirubin (mg/dl) 0.4 (0.1 - 1.4)1 0.3 (0.1 - 1.1) 0.3 (0.1 - 1.2) <0.0001 Creatinine (mg/dl) 0.5 (0.2 - 1.1)1 0.5 (0.2 - 1.0) 0.4 (0.1 - 0.8) <0.0001 GFR (mL/min/1.73 m ) * 105.3 (57.1 - 175.9) 1 113.6 (65.7 - 211.3) 134.0 (69.9 - 293.0) <0.0001 PCW mean (mmHg) 9.0 (1.0 - 22.0) 1 10.0 (4.0 - 20.0) 11.0 (5.0 - 21.0) <0.0001 PA mean (mmHg) 50.0 (20.0 - 80.0) 1 30.0 (17.0 - 71.0) 30.0 (13.0 - 75.0) 0.0095 PVR (Wood units) 4.2 (2.2 - 18.8) 1 3.6 (2.0 - 10.0) 3.9 (2.0 - 16.5) <0.0001 FEV1% predicted 27.0 (15.0 - 81.0) 26.0 (13.0 - 79.0) 26.0 (12.0 - 81.0) <0.0001 FVC% predicted 42.0 (20.0 - 89.0) 40.0 (20.0 - 85.0) 40.0 (15.0 - 81.0) <0.0001 * GFR was estimated using the modified Schwartz formula 2021 Summary statistics included transplants with known/non-missing data 1 Based on Apr 1994 Dec 2000 transplants JHLT. 2021 Oct; 40(10): 1023-1072

  7. Pediatric Lung Transplants Recipient Blood Type Distribution by Location and Era (Transplants: Jan 1992 Jun 2018) Blood Type: A AB B O 100% 90% 80% 70% % of transplants 60% 50% 40% 30% 20% 10% 0% 1992-2000 2001-2009 Europe 2010-2018 1992-2000 2001-2009 North America 2010-2018 1992-2000 2001-2009 Other 2010-2018 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  8. Pediatric Lung Transplants Recipient Diagnosis Distribution by Location and Era (Transplants: Jan 1992 Jun 2018) 100% 90% Other 80% Retransplant 70% % of transplants 60% IPF 50% 40% COPD 30% 20% CF 10% 0% 1992-2000 2001-2009 2010-2018 Europe 1992-2000 2001-2009 2010-2018 North America 1992-2000 2001-2009 2010-2018 Other 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  9. Pediatric Lung Transplants Donor-Recipient Sex Distribution by Location and Era (Transplants: Jan 1992 Jun 2018) 100% 90% Male-Male 80% 70% % of transplants Male-Female 60% 50% 40% Female-Male 30% 20% Female-Female 10% 0% 1992-2000 2001-2009 2010-2018 Europe 1992-2000 2001-2009 2010-2018 North America 1992-2000 2001-2009 2010-2018 Other 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  10. Pediatric Lung Transplants Median Recipient BMI by Location (Transplants: Jan 1992 Jun 2018) Median Recipient GFR* by Location Median Recipient Age by Location (Transplants: Jan 1992 Jun 2018) (Transplants: Jan 1994 Jun 2018) Europe North America Other Overall 30 20 180 170 28 19 160 26 18 Median eGFR (mL/min/1.73m ) 150 Median Age (years) 24 17 140 Median BMI (kg/m2) 130 22 16 120 20 15 110 18 14 100 16 90 13 80 14 12 70 12 11 60 10 10 50 * GFR was estimated using the modified Schwartz formula 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  11. Survival Analyses Kaplan-Meier Survival Within 12 Months 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  12. Pediatric Lung Transplants Kaplan-Meier Survival within 12 Months by Era (Transplants: Jan 2000 Jun 2017) 2000-2005 (N=441) 2006-2011 (N=663) 2012-2017 (N=577) 100 90 80 70 Survival (%) 60 50 40 30 No pairwise comparisons were significant at p < 0.05 except 2000-2005 vs. 2012-2017 20 10 0 0 1 2 3 4 5 6 7 8 9 10 11 12 Months 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  13. Pediatric Lung Transplants Kaplan-Meier Survival within 12 Months by Location and Era (Transplants: Jan 2000 - Jun 2017) Transplant Era: 2000-2005 2006-2011 2012-2017 100 100 100 90 90 90 80 80 80 70 70 70 60 60 60 Survival (%) 50 50 50 40 40 40 No pairwise comparisons were significant at p < 0.05 except 2000-2005 vs. 2012-2017 No pairwise comparisons were significant at p < 0.05 No pairwise comparisons were significant at p < 0.05 30 30 30 20 20 20 10 10 10 0 0 0 0 1 2 3 4 5 6 7 8 9 10 11 12 0 1 2 3 4 5 6 7 8 9 10 11 12 0 1 2 3 4 5 6 7 8 9 10 11 12 Months Europe Months Other Months North America 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  14. Pediatric Lung Transplants Kaplan-Meier Survival within 12 Months by Location and Recipient Age (Transplants: Jan 2000 - Jun 2017) 0-5 Years 6-10 Years 11-17 Years Recipient Age: 100 100 100 90 90 90 80 80 80 70 70 70 60 60 60 Survival (%) 50 50 50 40 40 40 No pairwise comparisons were significant at p < 0.05 No pairwise comparisons were significant at p < 0.05 p = 0.959 30 30 30 20 20 20 10 10 10 0 0 0 0 1 2 3 4 5 6 7 8 9 10 11 12 0 1 2 3 4 5 6 7 8 9 10 11 12 0 1 2 3 4 5 6 7 8 9 10 11 12 Months Europe Months Other Months North America 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  15. Pediatric Lung Transplants Kaplan-Meier Survival within 12 Months by Recipient Age and Era (Transplants: Jan 2000 - Jun 2017) 2000-2005 2006-2011 2012-2017 Transplant Era: 100 100 100 90 90 90 80 80 80 70 70 70 60 Survival (%) 60 60 50 50 50 40 40 40 All pairwise comparisons were significant at p < 0.05 except 2006-2011 vs. 2012-2017 No pairwise comparisons were significant at p < 0.05 No pairwise comparisons were significant at p < 0.05 30 30 30 20 20 20 10 10 10 0 0 0 0 1 2 3 4 5 6 7 8 9 10 11 12 0 1 2 3 4 5 6 Months 7 8 9 10 11 12 0 1 2 3 4 5 Months 6 7 8 9 10 11 12 Months Age 6-10 years Age 11-17 years Age 0-5 years 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  16. Pediatric Lung Transplants Kaplan-Meier Survival within 12 Months By Recipient Diagnosis (Transplants: Jan 2000 - Jun 2017) By Recipient GFR* (Transplants: Jan 2000 - Jun 2017) * GFR was estimated using the modified Schwartz formula 100 100 90 90 80 80 70 70 60 60 Axis Title Survival (%) 50 50 The following pairwise comparisons were significant at p < 0.05: - Retransplant vs. CF - Retransplant vs. Other p = 0.0001 40 40 30 30 20 <90 mL/min/1.73 m 20 90 mL/min/1.73 m CF IPF Retransplant Other 10 10 0 0 0 1 2 3 4 5 6 7 8 9 10 11 12 0 1 2 3 4 5 Months 6 7 8 9 10 11 12 Months 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  17. Pediatric Lung Transplants Kaplan-Meier Survival within 12 Months By Procedure Type (Transplants: Jan 2000 - Jun 2017) By Recipient History of Malignancy (Transplants: Jan 2000 - Jun 2017) 100 100 90 90 80 80 70 70 60 60 Survival (%) Survival (%) 50 50 40 40 p < 0.0001 p = 0.9987 30 30 20 20 Yes No Single Lung Bilateral/Double Lung 10 10 0 0 0 1 2 3 4 5 6 7 8 9 10 11 12 0 1 2 3 4 5 6 7 8 9 10 11 12 Months Months 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  18. Survival Analyses Kaplan-Meier Survival Within 5 Years Conditional on Survival to 1 Year 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  19. Pediatric Lung Transplants Kaplan-Meier Survival within 5 Years Conditional on Survival to 1 Year By Era (Transplants: Jan 1996 - Jun 2013) 1996-2001 (N=299) 2002-2007 (N=419) 2008-2013 (N=505) 100 90 80 70 Survival (%) 60 50 40 No pairwise comparisons were significant at p < 0.05 except 1996-2001 vs. 2008-2013 30 20 10 0 0 1 2 3 4 5 Years 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  20. Pediatric Lung Transplants Kaplan-Meier Survival within 5 Years Conditional on Survival to 1 Year by Location and Era (Transplants: Jan 1996 - Jun 2013) 1996-2001 2002-2007 2008-2013 Transplant Era: 100 100 100 90 90 90 80 80 80 70 70 70 60 60 60 Survival (%) 50 50 50 40 40 40 30 30 30 No pairwise comparisons were significant at p < 0.05 No pairwise comparisons were significant at p < 0.05 p = 0.193 20 20 20 10 10 10 0 0 0 0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5 Years Years Europe Years Other* North America 2021 * There were no transplants during 1996-2001 in Other location JHLT. 2021 Oct; 40(10): 1023-1072

  21. Pediatric Lung Transplants Kaplan-Meier Survival within 5 Years Conditional on Survival to 1 Year by Location and Recipient Age (Transplants: Jan 1996 - Jun 2013) 0-5 Years 6-10 Years 11-17 Years Recipient Age: 100 100 90 90 80 80 70 70 Survival (%) 60 60 Survival (%) 50 50 40 40 30 30 No pairwise comparisons were significant at p < 0.05 No pairwise comparisons were significant at p < 0.05 20 20 10 10 0 0 0 1 2 3 4 5 0 1 2 3 4 5 Years Years Europe North America 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  22. Pediatric Lung Transplants Kaplan-Meier Survival within 5 Years Conditional on Survival to 1 Year by Recipient Age and Era (Transplants: Jan 1996 - Jun 2013) 1996-2001 2002-2007 2008-2013 Transplant Era: 100 100 100 90 90 90 80 80 80 70 70 70 60 60 60 Survival (%) 50 50 50 40 40 40 30 30 30 No pairwise comparisons were significant at p < 0.05 No pairwise comparisons were significant at p < 0.05 No pairwise comparisons were significant at p < 0.05 20 20 20 10 10 10 0 0 0 0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5 Years Years Years Recipient 11-17 years Recipient 0-5 years Recipient 6-10 years 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  23. Pediatric Lung Transplants Kaplan-Meier Survival within 5 Years Conditional on Survival to 1 Year By Recipient Diagnosis Transplants: Jan 1996 Jun 2013 By Recipient GFR Transplants: Jan 1996 Jun 2013 * GFR was estimated using the modified Schwartz formula 100 100 90 90 80 80 70 70 Survival (%) 60 60 50 Survival (%) 50 40 40 p = 0.2021 No pairwise comparisons were significant at p < 0.05 30 30 <90 mL/min/1.73 m 90 mL/min/1.73 m 20 20 CF IPF Retransplant Other 10 10 0 0 0 1 2 3 4 5 0 1 2 3 4 5 Years Years 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  24. Pediatric Lung Transplants Kaplan-Meier Survival within 5 Years Conditional on Survival to 1 Year By Recipient Procedure Type (Transplants: Jan 1996 - Jun 2013) By Recipient History of Malignancy (Transplants: Jan 1996 - Jun 2013) 100 100 90 90 80 80 70 70 60 60 Survival (%) Survival (%) 50 50 p = 0.3728 p = 0.2603 40 40 30 30 Single Lung Bilateral/Double Lung Yes No 20 20 10 10 0 0 0 1 2 3 4 5 0 1 2 3 4 5 Years Years 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  25. Survival Analyses Kaplan-Meier Freedom from BOS Conditional on Survival to Discharge 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  26. Pediatric Lung Transplants Freedom from BOS Conditional on Survival to Discharge By Era (Transplants: Jan 1996 - Jun 2013) By Recipient Age (Transplants: Jan 1996 - Jun 2013) 100 100 90 90 80 80 Freedom from BOS (%) Freedom from BOS (%) 70 70 60 60 50 50 40 40 No pairwise comparisons were significant at p < 0.05 except recipient 0-5 years vs. 11-17 years = No pairwise comparisons were significant at p < 0.05 = 30 30 20 20 1996-2001 2002-2007 2008-2013 0-5 Years 6-10 Years 11-17 Years 10 10 0 0 0 1 2 3 4 5 0 1 2 3 4 5 Years Years 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  27. Multivariable Cox Analyses Mortality within 12 Months 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  28. Pediatric Lung Transplants (2000-6/2017) Statistically Significant Categorical Risk Factors For 1-Year Mortality with 95% Confidence Limits (N = 1,681) 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  29. Pediatric Lung Transplants (2000-6/2017) Statistically Significant Risk Factors For 1-Year Mortality Continuous Factors (see figures) Donor age (years) 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  30. Pediatric Lung Transplants (2000-6/2017) Statistically Significant Risk Factors For 1-Year Mortality with 95% Confidence Limits Donor age (years) 4.0 Hazard Ratio of 1-Year Mortality 3.5 p = 0.0185 3.0 2.5 2.0 1.5 1.0 0.5 0.0 0 5 10 15 20 25 30 35 40 45 50 Donor age (years) (N = 1,681) 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  31. Multivariable Analyses Mortality within 5 Years Conditional on Survival to 1 Year 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  32. Pediatric Lung Transplants (1996-6/2013) Statistically Significant Categorical Risk Factors For 5-Year Mortality Conditional on 1 Year Survival with 95% Confidence Limits (N = 1,226) 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  33. Pediatric Lung Transplants (1996-6/2013) Statistically Significant Risk Factors For 5-Year Mortality Conditional on Survival to 1 Year Continuous Factors (see figures) Recipient age (years) 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  34. Pediatric Lung Transplants (1996-6/2013) Statistically Significant Risk Factors For 5-Year Mortality Conditional on 1-Year Survival with 95% Confidence Limits Recipient age (years) 2.0 Hazard Ratio of 5-Year Mortality p < 0.0001 1.5 1.0 0.5 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Recipient age (years) (N = 1,226) 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  35. Multivariable Cox Analyses BOS within 5 Years Conditional on Survival to Discharge 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  36. Pediatric Lung Transplants (1996-6/2013) Statistically Significant Risk Factors For BOS within 5 Years Conditional on Survival to Discharge Continuous Factor (see figure) Recipient age (years) (N = 666) 2021 JHLT. 2021 Oct; 40(10): 1023-1072

  37. Pediatric Lung Transplants (1996-6/2013) Statistically Significant Risk Factors For BOS within 5 Years Conditional on Survival to Discharge with 95% Confidence Limits Recipient age (years) 2.0 p = 0.0220 Hazard Ratio of 5-Year BOS 1.5 1.0 0.5 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Recipient age (years) (N = 666) 2021 JHLT. 2021 Oct; 40(10): 1023-1072

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