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LUNG TRANSPLANTATION Pediatric Recipients ISHLT 2006 J Heart Lung Transplant 2006;25:904-911.

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Presentation on theme: "LUNG TRANSPLANTATION Pediatric Recipients ISHLT 2006 J Heart Lung Transplant 2006;25:904-911."— Presentation transcript:

1 LUNG TRANSPLANTATION Pediatric Recipients ISHLT 2006 J Heart Lung Transplant 2006;25:

2 RECIPIENT AGE DISTRIBUTION FOR PEDIATRIC LUNG RECIPIENTS - NUMBER (Transplants: January June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

3 RECIPIENT AGE DISTRIBUTION FOR PEDIATRIC LUNG RECIPIENTS - PERCENTAGE (Transplants: January June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

4 DONOR TYPE DISTRIBUTION BY YEAR OF TRANSPLANT FOR PEDIATRIC LUNG RECIPIENTS (Transplants: ) ISHLT 2006 NOTE: This figure includes only the lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of lung transplants worldwide has declined in recent years. J Heart Lung Transplant 2006;25:

5 DONOR TYPE DISTRIBUTION BY RECIPIENT AGE GROUP WITHIN ERA FOR PEDIATRIC LUNG RECIPIENTS (Transplants: January June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

6 AGE DISTRIBUTION FOR DONORS OF PEDIATRIC LUNG RECIPIENTS (Transplants: January June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

7 AGE DISTRIBUTION OF PEDIATRIC LUNG RECIPIENTS By Year of Transplant Number of Transplants ISHLT J Heart Lung Transplant 2006;25:

8 NUMBER OF CENTERS REPORTING PEDIATRIC LUNG TRANSPLANTS ISHLT 2006 J Heart Lung Transplant 2006;25:

9 PEDIATRIC LUNG TRANSPLANTATION: Indications (Transplants: January June 2005) DIAGNOSIS AGE: < 1 Year AGE: 1-5 Years AGE: 6-11 Years AGE: Years Cystic Fibrosis 22.80% % % Primary Pulmonary Hypertension % % %438.20% Re-Transplant: Obliterative Bronchiolitis 68.30%84.40%193.60% Congenital Heart Disease %79.70%21.10%51.00% Idiopathic Pulmonary Fibrosis 79.70%63.30%173.20% Obliterative Bronchiolitis (Not Re-TX) 45.60%73.90%163.10% Re-Transplant: Not OB 35.40%11.40%73.90%152.90% Interstitial Pneumonitis % % 40.80% Pulmonary Vascular Disease %45.60%63.30% Eisenmengers Syndrome 11.80%56.90%52.80%51.00% Pulmonary Fibrosis, Other 11.80%11.40%31.70%9 Surfactant Protein B Deficiency %11.40% COPD/Emphysema 11.40%21.10%40.80% Bronchopulmonary Dysplasia 11.80%11.40%52.80% Bronchiectasis 31.70%30.60% Other 35.40%79.70%63.30%183.40% ISHLT 2006 J Heart Lung Transplant 2006;25:

10 DIAGNOSIS IN PEDIATRIC LUNG RECIPIENTS BY YEAR OF TRANSPLANT Age: Years ISHLT 2006 J Heart Lung Transplant 2006;25:

11 PEDIATRIC LUNG RE-TRANSPLANTS Between January 1994 and June 2005 ISHLT 2006 Time Between Previous and Current Transplant J Heart Lung Transplant 2006;25:

12 PEDIATRIC LUNG RE-TRANSPLANTS Between January 1994 and June 2004 Stratified by Time Between Previous and Current Transplant ISHLT 2006 J Heart Lung Transplant 2006;25:

13 LUNG TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: January June 2004) P = 0.72 ISHLT 2006 J Heart Lung Transplant 2006;25:

14 PEDIATRIC LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January June 2004) P = ISHLT 2006 J Heart Lung Transplant 2006;25:

15 PEDIATRIC LUNG TRANSPLANTATION Kaplan-Meier Survival for Congenital Diagnosis (Transplants: January 1990 – June 2004) ISHLT 2006 J Heart Lung Transplant 2006;25:

16 PEDIATRIC LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type Diagnosis: Primary Pulmonary Hypertension (Transplants: January June 2004) P = ISHLT 2006 J Heart Lung Transplant 2006;25:

17 PEDIATRIC LUNG TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: January June 2004) ISHLT 2006 J Heart Lung Transplant 2006;25:

18 PEDIATRIC LUNG TRANSPLANTATION Conditional Kaplan-Meier Survival by Age Group (Transplants: January June 2004) HALF-LIFE <1 Year: 8.8 Years 1-11 Years: n.c Years: 6.1 Years ISHLT 2006 J Heart Lung Transplant 2006;25:

19 PEDIATRIC LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January June 2004) ISHLT 2006 J Heart Lung Transplant 2006;25:

20 PEDIATRIC LUNG TRANSPLANTATION Kaplan-Meier Survival by Donor Type for Recipients Age Years (Transplants: January June 2004) HALF-LIFE Deceased: 4.0 Years Living: 3.8 Years ISHLT 2006 J Heart Lung Transplant 2006;25:

21 PEDIATRIC LUNG RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994-June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

22 PEDIATRIC LUNG RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

23 PEDIATRIC LUNG RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

24 PEDIATRIC LUNG RECIPIENTS Induction Immunosuppression For transplants between January 2001 and June 2005 ISHLT 2006 J Heart Lung Transplant 2006;25:

25 PEDIATRIC LUNG RECIPIENTS Induction Immunosuppression (Transplants: January June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

26 PEDIATRIC LUNG TRANSPLANTATION Kaplan-Meier Survival Stratified by Induction Use (Transplants: January June 2004) ISHLT 2006 J Heart Lung Transplant 2006;25:

27 PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (F ollow-ups: January 2001 and June 2005) NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT 2006 J Heart Lung Transplant 2006;25:

28 PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January 2001 and June 2005) 1 Year Follow-up (N = 154)5 Year Follow-up (N = 83) NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT 2006 J Heart Lung Transplant 2006;25:

29 PEDIATRIC LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up Report (Follow-ups: January 2001 and June 2005) NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT 2006 J Heart Lung Transplant 2006;25:

30 POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

31 POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 5 Years Post-Transplant (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

32 POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 7 Years Post-Transplant (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

33 Freedom from Bronchiolitis Obliterans For Pediatric Lung Recipients (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

34 FREEDOM FROM BRONCHIOLITIS OBLITERANS For Pediatric Lung Recipients by Induction Use (Transplants: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

35 Freedom from Severe Renal Dysfunction* For Pediatric Lung Recipients (Follow-ups: April June 2005) * Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant ISHLT 2006 J Heart Lung Transplant 2006;25:

36 MALIGNANCY POST-LUNG TRANSPLANTATION FOR PEDIATRICS Cumulative Incidence for Survivors (Follow-ups: April June 2005) Malignancy/Type1-Year Survivors 5-Year Survivors 7-Year Survivors No Malignancy429 (94.5%)91 (89.2%)42 (91.3%) Malignancy (all types combined) 25 (5.5%)11 (10.8%)4 (8.7%) Malignancy Type Lymph22104 Other310 Other includes Liver and primitive neuroectodermal tumor. ISHLT 2006 J Heart Lung Transplant 2006;25:

37 Freedom from Malignancy For Pediatric Lung Recipients (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

38 PEDIATRIC LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January June 2005) CAUSE OF DEATH 0-30 Days (N =70 ) 31 Days - 1 Year (N = 102) >1 Year - 3 Years (N = 103) >3 Years - 5 Years (N = 48) >5 Years (N = 30) BRONCHIOLITIS 9 (8.8%)39 (37.9%)21 (43.8%)12 (40.0%) ACUTE REJECTION 3 (4.3%)4 (3.9%)1 (2.1%) LYMPHOMA 3 (2.9%)4 (3.9%)1 (2.1%)3 (10.0%) MALIGNANCY, NON- LYMPHOMA 1 (2.1%) CMV 7 (6.9%) INFECTION, NON-CMV 9 (12.9%)38 (37.3%)23 (22.3%)13 (27.1%)2 (6.7%) GRAFT FAILURE 23 (32.9%)19 (18.6%)17 (16.5%)4 (8.3%)6 (20.0%) CARDIOVASCULAR 9 (12.9%)3 (2.9%)2 (1.9%) TECHNICAL 9 (12.9%)1 (1.0%) MULTIPLE ORGAN FAILURE 4 (5.7%)10 (9.8%)9 (8.7%)3 (6.3%)3 (10.0%) OTHER 13 (18.6%)8 (7.8%)9 (8.7%)4 (8.3%)4 (13.3%) ISHLT 2006 J Heart Lung Transplant 2006;25:


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