LUNG TRANSPLANTATION

Pediatric Recipients

JHLT. 2013 Oct; 32(10): 989-997

2013

Donor, Recipient and Center Characteristics

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsRecipient Age Distribution – Number

(Transplants: January 1986 – June 2012)

1986-1999 (N=675) 2000-6/2012 (N=1,200)0

200

400

600

800

1,000

1,200

1,400

<1 1-5 6-10 11-17

Num

ber o

f Tra

nspl

ants

Analysis includes deceased and living donor transplants.

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsRecipient Age Distribution – Percentage

(Transplants: January 1986 – June 2012)

1986-1999 (N=675) 2000-6/2012 (N=1,200)0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

11-17 6-10

1-5 <1

% o

f Tra

nspl

ants

Analysis includes deceased and living donor transplants.

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsDonor Type Distribution by Transplant Year

(Transplants: January 1986 – December 2011)

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

0

20

40

60

80

100

120

140

LivingDeceased

Num

ber o

f Tra

nspl

ants

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 deceased and living donor transplants.JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsDonor Type Distribution by Recipient Age Group Within Era

(Transplants: January 1986 – June 2012)

<1 year 1 - 5 years

6 - 10 years

11 - 17 years

<1 year 1 - 5 years

6 - 10 years

11 - 17 years

0100200300400500600700800900

1,000

LivingDeceased

Recipient Age (Years)

Num

ber o

f Tra

nspl

ants

1986-1999 2000-6/2012

Analysis includes deceased and living donor transplants.

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsDonor Age Distribution

(Transplants: January 1986 – June 2012)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

663

431

298

228

9512

60+ years

50 - 59 years

35 - 49 years

18 - 34 years

11 - 17 years

0 - 10 years

Donor Age (Years)

% o

f Tra

nspl

ants

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsDonor and Recipient Age (Transplants: January 2000 – June 2012)

<1 year 1 - 5 years 6 - 10 years 11 - 17 years0%

20%

40%

60%

80%

100%0-10 years 11-17 years 18-34 years 35-49 years 50-59 years 60+ years

Recipient Age

% o

f Tra

nspl

ants

Donor Age:

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsRecipient Age Distribution by Year of Transplant

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

0102030405060708090

100110120130140

1 3 5 7

23

45 48 49 52

96

82

95 96

73 73 72 74 78

8997

103108

114

125 125

107

Total11-17 years6-10 years1-5 years

Num

ber o

f Tra

nspl

ants

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.

Analysis includes deceased and living donor transplants.JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsNumber of Centers Reporting Transplants by Location

(Transplants: January 1986 – 2011)

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

05

10152025303540455055

OthersNorth AmericaEurope

Transplant Year

Num

ber o

f Cen

ters

Analysis includes deceased and living donor transplants.

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsNumber of Centers Reporting Transplants by Center Volume

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

0

5

10

15

20

25

30

35

40

45

50

5520+ transplants10-19 transplants5-9 transplants1-4 transplants

Transplant Year

Num

ber o

f Cen

ters

Analysis includes deceased and living donor transplants.

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsNumber of Transplants by Center Volume

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

0

20

40

60

80

100

120

14020+ transplants10-19 transplants5-9 transplants1-4 transplants

Transplant Year

Num

ber o

f Tra

nspl

ants

Analysis includes deceased and living donor transplants.

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsIndications by Age Group (Transplants: January 1990 – June 2012)

Diagnosis < 1 Year 1-5 Years 6-10 Years 11-17 YearsCystic Fibrosis 1 1.0% 6 4.8% 140 53.0% 916 70.6%Idiopathic Pulmonary Arterial Hypertension 12 12.5% 28 22.4% 23 8.7% 101 7.8%Re-Transplant: Obliterative Bronchiolitis     7 5.6% 9 3.4% 39 3.0%Congenital Heart Disease 16 16.7% 10 8.0% 4 1.5% 11 0.8%Idiopathic Pulmonary Fibrosis 10 10.4% 21 16.8% 15 5.7% 43 3.3%Obliterative Bronchiolitis (Not Re-TX)     10 8.0% 18 6.8% 55 4.2%Re-Transplant: Not OB 3 3.1% 4 3.2% 8 3.0% 30 2.3%Interstitial Pneumonitis 1 1.0% 2 1.6% 2 0.8%  1  0.1%Pulmonary Vascular Disease 8 8.3% 7 5.6% 4 1.5% 1 0.1%Eisenmenger’s Syndrome 1 1.0% 5 4.0% 3 1.1% 9 0.7%Pulmonary Fibrosis, Other 7 7.3% 11 8.8% 14 5.3% 29 2.2%Surfactant Protein B Deficiency 16 16.7% 3 2.4%        COPD/Emphysema 4 4.2% 2 1.6% 2 0.8% 10 0.8%Bronchopulmonary Dysplasia 3 3.1% 3 2.4% 6 2.3% 3 0.2%Bronchiectasis 1 1.0%     3 1.1% 17 1.3%Other 13 13.5% 6 4.8% 13 4.9% 32 2.5%

Analysis includes deceased and living donor transplants.

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsDiagnosis by Year Of Transplant

Age: 11-17 Years

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0

25

50

75

100IPAH Cystic Fibrosis

Years

% o

f Tra

nspl

ants

Analysis includes deceased and living donor transplants.

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsAge Distribution by Location

(Transplants: January 2000 – June 2012)

Europe (N=460) North America (N=661) Other (N=79)0%

20%

40%

60%

80%

100%

<1 year 1 - 5 years 6 - 10 years 11 - 17 years

% o

f Tra

nspl

ants

Analysis includes deceased and living donor transplants.

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsDiagnosis Distribution by Location(Transplants: January 2000 – June 2012)

Europe (N=433) North America (N=660) Other (N=67)0%

20%

40%

60%

80%

100%Cystic Fibrosis IPAH IPF OB Other Congenital heart disease Re-TX

% o

f Tra

nspl

ants

Analysis includes deceased and living donor transplants.

NOTE: Unknown diagnoses were excluded from this tabulationTotal number of transplants reported:Europe = 460North America = 661Other = 79

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Transplants Donor Age Distribution by Location

(Transplants: January 2000 – June 2012)

Europe (N=454) North America (N=625) Other (N=70)0%

20%

40%

60%

80%

100%0 - 10 years 11 - 17 years 18 - 34 years 35 - 49 years 50 - 59 years 60+ years

% o

f Don

ors

NOTE: Transplants with unknown donor age and living donor transplants were excluded from this tabulation.

Total number of transplants reported:Europe = 460North America = 661Other = 79JHLT. 2013 Oct; 32(10): 989-997

2013

Post-Transplant:Survival and Other Outcomes

JHLT. 2013 Oct; 32(10): 989-997

2013

Lung TransplantsKaplan-Meier Survival by Recipient Age Group

(Transplants: January 1990 – June 2011)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 180

25

50

75

100

Adult (N=39,582) Pediatric (N=1,650)

Years

Surv

ival

(%)

Median survival (years): Adult = 5.4; Pediatric = 4.9

p-value = 0.3459

JHLT. 2013 Oct; 32(10): 989-997

2013

Lung TransplantsKaplan-Meier Survival by Recipient Age Group and Procedure

Type (Transplants: January 1990 – June 2011)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170

25

50

75

100Adult, Single (N=16,255)Adult, Bilateral (N=23,309)Pediatric (N=1,650)

Years

Surv

ival

(%)

Median survival (years): Adult, Single = 4.5; Adult, Double = 6.8; Pediatric = 4.9

Adult, Double vs. Adult, Single: p < 0.0001Adult, Double vs. Pediatric: p = 0.0029Adult, Single vs. Pediatric: p < 0.0001

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsKaplan-Meier Survival by Procedure Type

(Transplants: January 1990 – June 2011)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

25

50

75

100

Single Lung (N=94)

Bilateral/Double Lung (N=1,553)

Years

Surv

ival

(%)

Median survival (years): Single Lung = 1.9; Bilateral/Double Lung = 5.4

p < 0.0001

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsKaplan-Meier Survival by Diagnosis

(Transplants: January 1990 – June 2011)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170

25

50

75

100

Cystic Fibrosis (N=987)Non-Cystic Fibrosis (N=689)

Years

Surv

ival

(%)

Median survival (years): Cystic Fibrosis = 4.7; Non-Cystic Fibrosis = 4.7

p = 0.2084

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsKaplan-Meier Survival for Congenital Diagnoses

(Transplants: January 1990 – June 2011)

0 1 2 3 4 5 60

25

50

75

100

Eisenmenger's Syndrome (N=16)

Other Congenital Heart Disease (N=37)

Eisenmenger's + Other Congenital Heart Disease (N=53)

Years

Surv

ival

(%)

N at risk = 10

N at risk = 12

N at risk = 12

Eisenmenger’s vs. Other: p = 0.4779

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsKaplan-Meier Survival by Recipient Age Group

(Transplants: January 1990 – June 2011)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

25

50

75

100<1 Year (N=94)1-5 years (N=124)6-10 years (N=243)11-17 years (N=1,189)

Years

Surv

ival

(%)

N at risk = 12N at risk = 19

N at risk = 10

Median survival (years):<1 year = 6.41-5 years = 6.76-10 years = 6.011-17 years = 4.6

Pair-wise comparisons were not significant at p < 0.05

N at risk = 29

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsConditional Kaplan-Meier Survival by Recipient Age Group

(Transplants: January 1990 – June 2011)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

25

50

75

100<1 year (N=59)1-5 years (N=89)6-10 years (N=179)11-17 years (N=859)

Years

Surv

ival

(%)

N at risk = 12N at risk =

19

N at risk = 10

Conditional median survival (years):<1 year = 8.81-5 years = 10.56-10 years = 8.711-17 years = 7.7

Pair-wise comparisons were not significant at p < 0.05

N at risk = 29

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsKaplan-Meier Survival by Era

(Transplants: January 1988 – June 2011)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

25

50

75

100

1988-1999 (N=602)

2000-6/2011 (N=1,060)

Years

Surv

ival

(%)

N at risk = 46

N at risk = 10

Median survival (years):Unconditional 1988-1999 = 3.3; 2000-6/2011 = 5.8Conditional 1988-1999 = 7.2; 2000-6/2011 = 8.7

p < 0.0001

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsKaplan-Meier Survival by Donor Age for Recipients Age 11-17

Years (Transplants: January 1990 – June 2011)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

25

50

75

100

0-10 years (N=236)11-17 years (N=372)18-34 years (N=267)

Years

Surv

ival

(%)

N at risk = 12

N at risk = 15

Median survival (years):0-10 years=5.411-17 years=4.618-34 years=4.135-49 years=4.550+ years=4.5

No pair-wise comparisons were significant at p < 0.05

N at risk = 11

N at risk = 18

N at risk = 14

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsKaplan-Meier Survival by Donor Type for Recipients Age 11-

17 Years (Transplants: January 1990 – June 2011)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

25

50

75

100

Deceased Donor (N=1,189)Living Donor (N=85)

Years

Surv

ival

(%)

N at risk = 29

N at risk = 11

Median survival (years):Deceased = 4.6Living = 3.8 p = 0.1786

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Re-transplants(Re-transplants: January 1994 – June 2012)

0-<1 month 1-<12 months 12-<36 months 36+ months Not reported0

5

10

15

20

25

30

35

Time Between Previous and Current Transplant

Num

ber o

f Re-

Tran

spla

nts

Analysis includes deceased and living donor transplants.

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Re-transplantsKaplan-Meier Survival by Transplant Type

(Transplants: January 1994 – June 2011)

0 1 2 3 4 5 60

20

40

60

80

100Retransplant (N = 103)Primary (N = 2,232)

Years

Surv

ival

(%)

N at risk = 15

N at risk = 504

p = 0.0026

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Re-transplantsSurvival by Inter-Transplant Interval (Transplants: January 1988 – June 2011)

0 1 2 3 4 50

20

40

60

80

100

<1 Year (N=33)1+ Year (N=67)

Years

Surv

ival

(%)

N at risk = 10

N at risk = 14

p = 0.1227

Analysis includes deceased and living donor transplants. Only patients who were less than 18 years old at the time of re-transplant are included.

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Re-transplantsSurvival by Diagnosis

(Transplants: January 1988 – June 2011)

0 1 2 3 4 50

20

40

60

80

100

Obliterative Bronchiolitis (N=57)

Non Obliterative Bronchiolitis (N=68)

Years

Surv

ival

(%)

N at risk = 15

N at risk = 12

p = 0.7631

Analysis includes deceased and living donor transplants. Only patients who were less than 18 years old at the time of re-transplant are included.

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsFunctional Status of Surviving Recipients

(Follow-ups: March 2005 – June 2012)

0%

20%

40%

60%

80%

100%

1 Year (N=338) 2 Years (N=279) 3 Years (N=216)

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsRehospitalization Post-transplant of Surviving Recipients

(Follow-ups: April 1994 – June 2012)

0%

20%

40%

60%

80%

100%

Up to 1 Year (N=741) Between 2 and 3

Years (N=449) Between 4 and 5 Years (N=282)

No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Hospitalized, Infection OnlyHospitalized, Rejection + Infection

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsRehospitalization Post-transplant of Surviving Recipients

(Follow-ups: April 1994 – June 2012)

0%

20%

40%

60%

80%

100%

Up to 1 Year (N=741)

Between 1 and 3 Years (N=404) Between 3 and 5

Years (N=250)

No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Hospitalized, Infection OnlyHospitalized, Rejection + Infection

JHLT. 2013 Oct; 32(10): 989-997

2013

Induction and Maintenance Immunosuppression

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsInduction Immunosuppression

(Transplants: January 2001 – June 2012)

Any Induction (N = 368) Polyclonal ALG/ATG (N = 72)

IL-2R Antagonist (N = 293)0

10

20

30

40

50

60

70

% o

f pat

ient

s

Analysis is limited to patients who were alive at the time of the discharge

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsInduction Immunosuppression

(Transplants: January 2001 – June 2012)

Analysis is limited to patients who were alive at the time of the discharge

20012003

20052007

20092011

20022004

20062008

2010

1/12-6/122001

20032005

20072009

20110

10

20

30

40

50

60

70

80

% o

f pat

ient

s

Any Induction Polyclonal ALG/ATG IL-2R Antagonist

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsKaplan-Meier Survival Stratified by Induction Use

(Transplants: January 2001 – June 2011)

0 1 2 3 4 5 6 70

25

50

75

100

Induction (N = 336)No Induction (N = 213)

Years

Surv

ival

(%)

Median survival (years):Induction = 6.5No Induction = 6.2

p = 0.9059

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsMaintenance Immunosuppression at Time of Follow-up

(Follow-ups: January 2001 – June 2012)

Cy-closporine

Tacrolimus Sirolimus/Everolimus

MMF/MPA Azathioprine Prednisone0

20

40

60

80

100Year 1 (N = 463) Year 5 (N = 211)

% o

f pat

ient

s

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

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsMaintenance Immunosuppression at Time of Follow-up

(Follow-ups: January 2001 – June 2012)

Calcineurin Inhibitor

CellCycle Prednisone Calcineurin Inhibitor

CellCycle Prednisone0

20

40

60

80

100

% o

f Pat

ient

s

NOTE: Different patients are analyzed in Year 1 and Year 5

Tac

CyA

Tac

CyAAZA AZA

MMF/MPA MMF/

MPA

1 Year Follow-up (N = 463) 5 Year Follow-up (N = 211)

Analysis is limited to patients who were alive at the time of the follow-up

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 0.4% (2 patients) was on neither drug during the 1-year. In the 5-year tabulations, 0.5% were reported to be on both drugs during the year and 1.4% (3 patients) was reported to be on neither drugs.

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Transplants Maintenance Immunosuppression Drug Combinations at

Time of Follow-up (Follow-ups: January 2001 – June 2012)

0%

20%

40%

60%

80%

100%

Year 1 (N = 463) Year 5 (N = 211)

Other

Tacrolimus + Sirolimus/Everolimus

Tacrolimus

Tacrolimus + MMF/MPA

Tacrolimus + AZA

Cyclosporine + MMF/MPA

Cyclosporine + AZA

% o

f Pat

ient

s

Analysis is limited to patients who were alive at the time of the follow-up

NOTE: Different patients are analyzed in Year 1 and Year 5

JHLT. 2013 Oct; 32(10): 989-997

2013

Post-Transplant Morbidities

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsCumulative Morbidity Rates in Survivors within 1 Year Post-

Transplant (Follow-ups: April 1994 – June 2012)

Outcome Within 1 Year

Total number with known response

Hypertension 41.7% (N = 701)

Renal Dysfunction 9.5% (N = 723)

Abnormal Creatinine ≤ 2.5 mg/dl 6.6%  

Creatinine > 2.5 mg/dl 1.9%  

Chronic Dialysis 0.7%  

Renal Transplant 0.3%  

Hyperlipidemia 5.1% (N = 720)

Diabetes 23.3% (N = 724)

Bronchiolitis Obliterans Syndrome 12.8% (N = 674)

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsCumulative Morbidity Rates in Survivors within 5 Years Post-

Transplant (Follow-ups: April 1994 – June 2012)

Outcome Within 5 Years

Total number with known response

Hypertension 69.1% (N = 194)

Renal Dysfunction 31.7% (N = 205)

Abnormal Creatinine ≤ 2.5 mg/dl 23.9%  

Creatinine > 2.5 mg/dl 4.9%  

Chronic Dialysis 1.5%  

Renal Transplant 1.5%  

Hyperlipidemia 17.2% (N = 198)

Diabetes 36.2% (N = 207)

Bronchiolitis Obliterans Syndrome 34.6% (N = 159)

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsCumulative Morbidity Rates in Survivors within 7 Years Post-

Transplant (Follow-ups: April 1994 – June 2012)

Outcome Within 7 Years

Total number with known response

Renal Dysfunction 43.2% (N = 111)

Abnormal Creatinine ≤ 2.5 mg/dl 33.3%  

Creatinine > 2.5 mg/dl 6.3%  

Chronic Dialysis 0.0%  

Renal Transplant 3.6%  

Bronchiolitis Obliterans Syndrome 43.8% (N = 73)

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsFreedom from Bronchiolitis Obliterans Syndrome

(Follow-ups: April 1994 – June 2012)

0 1 2 3 4 5 6 7 8 90

10

20

30

40

50

60

70

80

90

100

Years

% F

ree

from

Bro

nchi

oliti

s O

blit-

eran

s Sy

ndro

me

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Transplants Freedom from Bronchiolitis Obliterans Syndrome

by Age Group (Follow-ups: April 1994 – June 2012)

0 1 2 3 4 5 6 7 80

10

20

30

40

50

60

70

80

90

100

<1 year (N=58)1-5 Years (N=72)6-10 Years (N=115)11-17 years (N=433)

Years

% F

ree

from

Bro

nchi

oliti

s O

blit-

eran

s Sy

ndro

me

No pair-wise comparisons were significant at p < 0.05

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsFreedom from Bronchiolitis Obliterans Syndrome

by Diagnosis (Follow-ups: April 1994 – June 2012)

0 1 2 3 4 5 6 70

10

20

30

40

50

60

70

80

90

100

Cystic Fibrosis (N=360)

IPAH (N=64)

Years

% F

ree

from

Bro

nchi

oliti

s O

blit-

eran

s Sy

ndro

me

p = 0.0684

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsFreedom from Bronchiolitis Obliterans Syndromeby Induction Use (Follow-ups: April 1994 – June 2012)

0 1 2 3 4 5 60

10

20

30

40

50

60

70

80

90

100

Induction (N = 304)No Induction (N = 343)

Years

% F

ree

from

Bro

nchi

oliti

s O

blit-

eran

s Sy

ndro

me

p = 0.4159

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsFreedom from Severe Renal Dysfunction*

(Follow-ups: April 1994 – June 2012)

0 1 2 3 4 5 6 7 8 9 1050

60

70

80

90

100

Years

% F

ree

from

Sev

ere

Ren

al D

ysfu

nctio

n

*Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsCumulative Post-Transplant Malignancy Rates in Survivors

(Follow-ups: April 1994 – June 2012)

Malignancy/Type 1-Year Survivors

5-Year Survivors

7-Year Survivors

No Malignancy 694 (94.3%) 192 (89.3%) 106 (91.4%)

Malignancy (all types combined) 42 (5.7%) 23 (10.7%) 10 (8.6%)

Malignancy Type*

Lymphoma 39 22 10

Other 2 1 0

Type Not Reported 1 0 0

* Recipients may have experienced more than one type of malignancy so sum of individual malignancy types may be greater than total number with malignancy.

”Other” includes Liver and primitive neuroectodermal tumor.

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsFreedom from Malignancy (Follow-ups: April 1994 – June 2012)

0 1 2 3 4 5 6 7 8 9 1050

60

70

80

90

100

All malignancyLymphomaSkinOther

Years

% F

ree

from

Mal

igna

ncy

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsCause of Death (Deaths: January 1992 – June 2012)

CAUSE OF DEATH 0-30 Days (N =123)

31 Days - 1 Year (N=171)

>1 Year - 3 Years (N=225)

>3 Years - 5 Years

(N=104)>5 Years

(N=97)

BRONCHIOLITIS   17 (9.9%) 85 (37.8%) 40 (38.5%) 46 (47.4%)

ACUTE REJECTION 3 (2.4%) 4 (2.3%) 2 (0.9%) 2 (1.9%)  

LYMPHOMA   8 (4.7%) 7 (3.1%) 4 (3.8%) 5 (5.2%)

MALIGNANCY, NON-LYMPHOMA   2 (1.2%) 1 (0.4%)   3 (3.1%)

CMV   6(3.5%)      

INFECTION, NON-CMV 16 (13.0%) 56 (32.7%) 35 (15.6%) 19 (18.3%) 9 (9.3%)

GRAFT FAILURE 36 (29.3%) 33 (19.3%) 55 (24.4%) 22 (21.2%) 19 (19.6%)

CARDIOVASCULAR 19 (15.4%) 7 (4.1%) 3 (1.3%) 1 (1.0%)  1 (1.0%)

TECHNICAL 14 (11.4%) 5 (2.9%) 6 (2.7%) 3 (2.9%) 1 (1.0%)

MULTIPLE ORGAN FAILURE 13 (10.6%) 21 (12.3%) 11 (4.9%) 4 (3.8%) 5 (5.2%)

OTHER 22 (17.9%) 12 (7.0%) 20 (8.9%) 9 (8.7%) 8 (8.2%)

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung TransplantsRelative Incidence of Leading Causes of Death

(Deaths: January 1992 – June 2012)

0-30 days (N=123)

31 days–1 year (N=171)

>1 year–3 years (N=225)

>3 years–5 years (N=104)

>5 years (N=97)

0

10

20

30

40

50 Bronchiolitis Infection (non-CMV)Graft Failure CardiovascularMultiple Organ Failure

% o

f Dea

ths

JHLT. 2013 Oct; 32(10): 989-997

2013

Multivariable Analyses

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Transplants (April 1994 – June 2011)Risk Factors For 1 Year Mortality/Graft Failure

VARIABLE N Hazard Ratio

P-value 95% Confidence Interval

On ventilator 141 3.13 <.0001 2.03 - 4.81

Year of transplant: 4/1994-2001 vs. 2002-6/2011 330 1.82 0.0004 1.30 - 2.53

Donor CMV+/Recipient CMV- 261 1.49 0.0135 1.09 - 2.06

Chronic steroid use 309 1.41 0.0391 1.02 - 1.96

N = 833

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Transplants (April 1994 – June 2011)Risk Factors For 1 Year Mortality/Graft Failure

Continuous Factors (see figures)

Recipient age (borderline)

Pediatric transplant center volume (borderline)

Bilirubin (borderline)

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Transplants (April 1994 – June 2011) Risk Factors For 1 Year Mortality/Graft Failure

Recipient Age

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170.0

0.5

1.0

1.5

2.0

Recipient Age

Haz

ard

Rat

io o

f 1 Y

ear M

orta

lity p = 0.0620

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Transplants (April 1994 – June 2011) Risk Factors For 1 Year Mortality/Graft Failure

Center Volume Pediatric Transplants

0 1 2 3 4 5 6 7 8 9 100.0

0.5

1.0

1.5

2.0

Center Volume (cases per year)

Haz

ard

Rat

io o

f 1 Y

ear M

orta

lity p = 0.0716

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Transplants (April 1994 – June 2011) Risk Factors For 1 Year Mortality/Graft Failure

Recipient Bilirubin

0.0 0.5 1.0 1.50.0

0.5

1.0

1.5

2.0

Bilirubin (mg/dl)

Haz

ard

Rat

io o

f 1 Y

ear M

orta

lity p = 0.0924

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Transplants (April 1994 – June 2007)Risk Factors For 5 Year Mortality/Graft Failure

VARIABLE N Hazard Ratio

P-value 95% Confidence Interval

On ventilator 97 1.92 0.0014 1.29 - 2.87

Year of transplant: 4/1994-2001 vs. 2002-6/2007 330 1.37 0.0095 1.08 - 1.73

Chronic steroid use 234 1.32 0.0151 1.06 - 1.66

N = 620

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Transplants (April 1994 – June 2007)Risk Factors For 5 Year Mortality/Graft Failure

Continuous Factors (see figures)

Recipient age

Pediatric transplant center volume

Height difference

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Transplants (April 1994 – June 2007)Risk Factors For 5 Year Mortality/Graft Failure

Recipient Age

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170.0

0.5

1.0

1.5

2.0

Recipient Age

Haz

ard

Rat

io o

f 5 Y

ear M

orta

lity

p = 0.0079

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Transplants (April 1994 – June 2007)Risk Factors For 5 Year Mortality/Graft Failure

Center Volume Pediatric Transplants

0 1 2 3 4 5 6 7 8 9 100.0

0.5

1.0

1.5

2.0

Center Volume (cases per year)

Haz

ard

Rat

io o

f 5 Y

ear M

orta

lity

p = 0.0022

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Transplants (April 1994 – June 2007)Risk Factors For 5 Year Mortality/Graft Failure

Height Difference

-15 -10 -5 0 5 10 15 200.0

0.5

1.0

1.5

2.0

Donor Height - Recipient Height (cm)

Haz

ard

Rat

io o

f 5 Y

ear M

orta

lity

p = 0.0075

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Transplants (January 1992 – June 2002)Risk Factors For 10 Year Mortality/Graft Failure

VARIABLE N Hazard Ratio

P-value 95% Confidence Interval

On ventilator 71 2.20 0.0003 1.44 - 3.36

Chronic steroid use 110 1.37 0.0185 1.05 - 1.78

Donor cause of death = anoxia 45 1.37 0.0923 0.95 - 1.98

N = 422

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Transplants (January 1992 – June 2002)Risk Factors For 10 Year Mortality/Graft Failure

Continuous Factors (see figures)

Recipient age

Pediatric transplant center volume

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Transplants (January 1992 – June 2002)Risk Factors For 10 Year Mortality/Graft Failure

Recipient Age

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170.0

0.5

1.0

1.5

2.0

Recipient Age

Haz

ard

Rat

io o

f 10

Year

Mor

talit

y

p = 0.0269

JHLT. 2013 Oct; 32(10): 989-997

2013

Pediatric Lung Transplants (January 1992 – June 2002)Risk Factors For 10 Year Mortality/Graft Failure

Center Volume Pediatric Transplants

0 1 2 3 4 5 6 7 8 9 100.0

0.5

1.0

1.5

2.0

Center Volume (cases per year)

Haz

ard

Rat

io o

f 10

Year

Mor

talit

y

p = 0.0430

JHLT. 2013 Oct; 32(10): 989-997

2013