HEART-LUNG TRANSPLANTATION

HEART-LUNG TRANSPLANTATION

Overall

ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

0

50

100

150

200

250

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Nu

mb

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spla

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NUMBER OF HEART-LUNG TRANSPLANTS REPORTED BY YEAR

ISHLT 2008NOTE: 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 heart-lung transplants worldwide has declined in recent years.

J Heart Lung Transplant 2008;27: 937-983

AVERAGE CENTER VOLUMEHeart-Lung Transplants: January 1, 1998 - June 30, 2007

47

32

94 10

5

10

15

20

25

30

35

40

45

50

1 2 3 4-9 10+

Average number of heart-lung transplants per year

Nu

mb

er

of

ce

nte

rs


DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY CENTER VOLUME

Heart-Lung Transplants: January 1, 1998 - June 30, 2007

0

5

10

15

20

25

30

35

40

1 2 3 4-9 10+

Average number of heart-lung transplants per year

Pe

rce

nta

ge

of

he

art

-lu

ng

tra

ns

pla

nts

s


DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME

Lung Transplants: January 1, 1998 - June 30, 2007

0

10

20

30

40

1-4 5-9 10-19 20-29 30-39 40-49 50+

Average number of lung transplants per year

Pe

rce

nta

ge

of

he

art

-lu

ng

tra

ns

pla

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HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1982 - June 2006)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Years

N=3,272

Half-life = 3.1 yearsConditional Half-life = 8.9 years

Su

rviv

al (

%)

ISHLT 2008

N at risk at 20 years = 18



Adult Recipients


Acquired heart disease

4%Congenital heart disease

34%

COPD/Alpha-16%

CF14%

PPH25%

Re-transplant2%

OTHER12%

IPF3%

DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (January 1982 - June 2007)

“Other” includes cancer, LAM, OB, sarcoidosis, bronchiectasis


DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2007)

Diagnosis N (%)

Congenital Heart Disease 869 (34.4%)

Primary Pulmonary Hypertension 633 (25.0%)

Cystic Fibrosis 354 (14.0%)

Acquired Heart Disease 91 ( 3.6%)

COPD/Emphysema 96 ( 3.8%)

Idiopathic Pulmonary Fibrosis 72 ( 2.8%)

Alpha-1 52 ( 2.1%)

Re-Transplant: Not Obliterative Bronchiolitis 31 ( 1.2%)

Sarcoidosis 35 ( 1.4%)

Re-Transplant: Obliterative Bronchiolitis 24 ( 0.9%)

Bronchiectasis 20 ( 0.8%)

Obliterative Bronchiolitis (not Re-Transplant)

8 ( 0.3%)

Other 243 ( 9.6%)


DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1982-1995 1996-1999 2000-6/2007

% o

f T

ran

sp

lan

ts

Other

Re-TX

PPH

IPF

CF

Acquired Heart Disease

Congenital Heart Disease

COPD/Alpha-1

“Other” includes OB (non-ReTX), Bronchiectasis, Sarcoidosis


ADULT HEART-LUNG TRANSPLANTATIONIndications By Year (%)

0

20

40

60

80

100

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Transplant Year

% o

f T

ran

spla

nts

Congenital Heart Disease Primary Pulmonary HypertensionCystic Fibrosis COPD/Alpha-1Acquired Heart Disease


ADULT HEART-LUNG TRANSPLANTATIONIndications By Year (Number)

0

50

100

150

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Transplant Year

Nu

mb

er o

f T

ran

spla

nts

Congenital Heart Disease Primary Pulmonary HypertensionCystic Fibrosis COPD/Alpha-1Acquired Heart Disease


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Europe North America Other

% o

f T

ran

sp

lan

ts

18 - 34 years 35 - 49 years 50 - 59 years 60+ years

ADULT HEART-LUNG TRANSPLANTS:AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2007


0%

20%

40%

60%

80%

100%


% o

f T

ran

spla

nts

-

Acquired heart disease Congenital heart disease Cystic Fibrosis IPF PPH Other

ADULT HEART-LUNG TRANSPLANTS:DIAGNOSIS DISTRIBUTION BY LOCATION

Transplants between January 2000 and June 2007


0%

20%

40%

60%

80%

100%


% o

f D

on

ors

6-11 12-17 18-34 35-49 50-59 60+

ADULT HEART-LUNG TRANSPLANTS:DONOR AGE DISTRIBUTION BY LOCATION



HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for Adult Recipients

(Transplants: January 1982 - June 2006)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Years

N=2,639

Half-life = 3.5 YearsConditional Half-life = 9.1 Years

Su

rviv

al (

%)


HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival for Adult Recipients by Era

(Transplants: January 1982 - June 2006)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Years

1982-1995 (N=1,660)

1996-1999 (N=497)

2000-6/2006 (N=482)

Half-life (Years): 1982-1995 = 3.0; 1996-1999 = 3.5; 2000-6/2006 =6.0 Conditional Half-life (Years): 1982-1995 = 8.7; 1996-1999 = 9.7; 2000-6/2006 = n/a

Su

rviv

al (

%)

ISHLT 2008

P-value comparing all: 0.0004


ADULT HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2006)

0

25

50

75

100

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

Su

rviv

al (

%)

Other Congenital (N = 181)Eisenmenger's Syndrome (N = 521)PPH (N = 404)

Congenital vs. Eisenmenger's: p = 0.0005Congenital vs. PPH: p = 0.0075Eisenmenger's vs. PPH: p = 0.3317

HALF-LIFE Congenital: 1.2 Years; Eisenmenger's: 5.8 Years; PPH: 4.3 Years


ADULT HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year

(Transplants: January 1990 – June 2006)

0

25

50

75

100

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

Su

rviv

al

(%)

Other Congenital (N = 93)Eisenmenger's Syndrome (N = 348)PPH (N = 269)

HALF-LIFE Congenital Years: n.a.;Eisenmenger's: 10.6 Years; PPH: 9.7 Years

Congenital vs. Eisenmenger's: p = 0.7095Congenital vs. PPH: p = 0.5755Eisenmenger's vs. PPH: p = 0.2025


ADULT HEART-LUNG RECIPIENTS Functional Status of Surviving Recipients

(Follow-ups: April 1994 – June 2007)

0%

20%

40%

60%

80%

100%

1 Year (N = 263) 3 Years (N = 212) 5 Years (N = 180) 7 Years (N = 150)

No Activity Limitations Performs with Some Assistance Requires Total Assistance


ADULT HEART-LUNG RECIPIENTSEmployment Status of Surviving Recipients

(Follow-ups: April 1994 – June 2007)

0%

20%

40%

60%

80%

100%

1 Year (N = 297) 3 Years (N = 207) 5 Years (N = 196) 7 Years (N = 146)

Working (FT/PTstatus unknown)

Retired

Not Working

Working Part Time

Working Full Time


ADULT HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients

(Follow-ups: April 1994 - June 2007)

0%

20%

40%

60%

80%

100%

Up to 1 Year (N = 352)

Between 2 and 3Years (N = 249)



No Hospitalization Hospitalized, Not Rejection/Not Infection

Hospitalized, Rejection Only Hospitalized, Infection Only

Hospitalized, Rejection and Infection


0

5

10

15

20

25

30

35

40

45

50

55

60

65

70

Any Induction (N = 120) Polyclonal ALG/ATG (N = 54) OKT3 (N = 5) IL2R-antagonist (N = 51)

% o

f p

ati

en

tsADULT HEART-LUNG RECIPIENTS

Induction ImmunosuppressionFor transplants between January 2001 through June 2007

ISHLT 2008

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


0

10

20

30

40

50

60

70

80

Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist

% o

f p

ati

en

ts

2000 2001 2002 20032004 2005 2006

ADULT HEART-LUNG RECIPIENTSInduction Immunosuppression (Transplants: January 2000 - December 2006)

ISHLT 2008



0

10

20

30

40

50

60

70

80

% o

f p

ati

en

ts

ADULT HEART-LUNG RECIPIENTSInduction Immunosuppression (Transplants: January 2000 - December 2006)

ISHLT 2008

Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist



0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

atie

nts

Year 1 (N = 125) Year 5 (N = 86)

ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up

For follow-ups between January 2001 through June 2007

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

ISHLT 2008



0%

20%

40%

60%

80%

100%

Year 1 (N = 127) Year 5 (N = 91)

% o

f P

ati

en

ts

Other

Tacrolimus + MMF

Tacrolimus + AZA

Cyclosporine + MMF

Cyclosporine + AZA

ADULT HEART-LUNG RECIPIENTSMaintenance Immunosuppression Drug Combinations at Time of Follow-up

For follow-ups between January 2001 through June 2007

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

ISHLT 2008



POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant


Outcome Within 1

Year Total number with known response

Hypertension 56.7% (N = 344)

Renal Dysfunction 18.0% (N = 350)

Abnormal Creatinine < 2.5 mg/dl 11.1% Creatinine > 2.5 mg/dl 2.9% Chronic Dialysis 3.7% Renal transplant 0.3%

Hyperlipidemia 23.20% (N = 367)

Diabetes 16.90% (N = 354)

Coronary Artery Vasculopathy 2.80% (N = 287)

Bronchiolitis Obliterans 8.70% (N = 335)


POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant


Outcome Within 5

Years

Total number with known response

Hypertension 89.3% (N = 121)

Renal Dysfunction 28.5% (N = 130)

Abnormal Creatinine < 2.5 mg/dl 19.20% Creatinine > 2.5 mg/dl 8.50% Chronic Dialysis 0.80% Renal Transplant 0%

Hyperlipidemia 66.70% (N = 129)

Diabetes 21.60% (N = 125)

Coronary Artery Vasculopathy 8.50% (N = 71)

Bronchiolitis Obliterans 26.20% (N = 103)


Freedom from Coronary Artery Vasculopathy

For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2007)

50

60

70

80

90

100

0 1 2 3 4 5 6

Years

% F

ree

fro

m C

AV


Freedom from Bronchiolitis Obliterans For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2007)

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

% F

ree

fro

m B

ron

ch

ioli

tis

Ob

lite

ran

s


Freedom from Severe Renal Dysfunction*For Adult Heart-Lung Recipients (Follow-ups: April 1994-June 2007)

50

60

70

80

90

100

0 1 2 3 4 5 6

Years

% F

ree

fro

m S

ev

ere

Re

na

l Dy

sfu

nc

tio

n

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


MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994-June 2007)

Malignancy/Type 1-Year Survivors

5-Year Survivors

10-Year Survivors

No Malignancy 330 (92.7%) 114 (88.4%) 22 (84.6%)

Malignancy (all types combined) 26 (7.3%) 15 (11.6%) 4 (15.4%)

Malignancy Type*

Skin 2 4 4

Lymph 18 6 1

Other 2 3 3

Type Not Reported 4 2 0

ISHLT 2008

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


Freedom from MalignancyFor Adult Heart-Lung Recipients (Follow-ups: April 1994- June 2007)

50

60

70

80

90

100

0 1 2 3 4 5 6

Years

% F

ree

from

Mal

igna

ncy

All malignancy

Lymph

Skin

Other


ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2007)

CAUSE OF DEATH 0-30 Days

(N = 269)

31 Days - 1 Year (N = 209)

>1 Year - 3 Years (N = 181)

>3 Years - 5 Years (N = 130)

>5 Years

(N = 249)

BRONCHIOLITIS 0 4 (1.9%) 39 (21.5%) 25 (19.2%) 38 (15.3%)

ACUTE REJECTION 3 (1.1%) 6 (2.9%) 2 (1.1%) 0 1 (0.4%)

LYMPHOMA 0 9 (4.3%) 11 (6.1%) 5 (3.8%) 4 (1.6%)

MALIGNANCY, OTHER 0 2 (1.0%) 6 (3.3%) 3 (2.3%) 12 (4.8%)

CMV 0 1 (0.5%) 0 1 (0.8%) 0

INFECTION, NON-CMV 51 (19.0%) 76 (36.4%) 61 (33.7%) 42 (32.3%) 76 (30.5%)

GRAFT FAILURE 79 (29.4%) 49 (23.4%) 29 (16.0%) 25 (19.2%) 50 (20.1%)

CARDIOVASCULAR 23 (8.6%) 9 (4.3%) 10 (5.5%) 9 (6.9%) 14 (5.6%)

TECHNICAL 53 (19.7%) 6 (2.9%) 1 (0.6%) 1 (0.8%) 0

OTHER 60 (22.3%) 47 (22.5%) 22 (12.2%) 19 (14.6%) 54 (21.7%)



Pediatric Recipients


AGE DISTRIBUTION OF PEDIATRIC HEART-LUNGRECIPIENTS (Transplants: January 1982 - June 2007)

0

50

100

150

200

250

300

<1 1-5 yrs 6-11 yrs 12-17 yrs

Recipient Age (Years)

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AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January 1982 - June 2007)

341

91

50 2240

50

100

150

200

250

300

350

0-11 yrs 12-17 yrs 18-34 35-49 50-59

Donor Age (Years)

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AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS

By Year of Transplant

0

5

10

15

20

25

30

35

40

45

50

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

12-17 Years1-11 Years

<1 Year

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spla

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ISHLT 2008

NOTE: This figure includes only the heart 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.

Transplants between January 1984 and June 2007J Heart Lung Transplant 2008;27: 937-983

AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS

By Era of Transplant

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1982-1995 1996-6/2007

12-17 Years

1-11 Years

<1 Year

Per

cen

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spla

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NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS

ISHLT 2008

NEED TO UPDATE

0

5

10

15

20

25

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Transplant Year

# P

edia

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Tra

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t C

ente

rs



NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS

Stratified by center volume

0

5

10

15

20

25

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Transplant Year

# P

edia

tric

Tra

nsp

lan

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ente

rs

1-4/yr 5-9/yr

10-19/yr 20-29/yr

ISHLT 2008

Transplants between January 1984 and June 2007J Heart Lung Transplant 2008;27: 937-983

9%

27%

18%

17%

1%

4%19%

2%

3%

Acquired Heart Disease

CF

Congenital (other)Eisenmenger's Syndrome

IPF

Other

PPHRetx: Non-OB

Retx: OB

DIAGNOSIS IN PEDIATRIC HEART –LUNG TRANSPLANT RECIPIENTS (Age: 12-17 Years)

0

25

50

75

100

% o

f C

ases

Cystic Fibrosis Congenital PPH

“Other” includes Bronchiectasis, Alpha-1, and OB (non-ReTX)


0%

20%

40%

60%

80%

100%


% o

f T

ran

sp

lan

ts

0-5 years 6-11 years 12-17 years

PEDIATRIC HEART-LUNG TRANSPLANTS:AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2007


0%

20%

40%

60%

80%

100%


% o

f T

ran

sp

lan

ts-

Congenital heart disease Cystic Fibrosis PPH Other

PEDIATRIC HEART-LUNG TRANSPLANTS:DIAGNOSIS DISTRIBUTION BY LOCATION



0%

20%

40%

60%

80%

100%


% o

f Do

no

rs

0-5 6-11 12-17 18-34 35-49

PEDIATRIC HEART-LUNG TRANSPLANTS:DONOR AGE DISTRIBUTION BY LOCATION



PEDIATRIC HEART-LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2006)

0

25

50

75

100

0 1 2 3 4 5 6 7 8

Years

Su

rviv

al (

%)

Congenital (N = 76)Eisenmenger's Syndrome (N = 50)PPH (N=78)

HALF-LIFE Congenital: 2.4 Years; Eisenmenger's: 2.6 Years; PPH: 3.3 Years

Congenital vs. Eisenmenger's: p = 0.6766Congenital vs. PPH: p = 0.4697Eisenmenger's vs. PPH: p =0.7507


PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1982 - June 2006)

0

25

50

75

100

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

Years

Sur

viva

l (%

)

.

< 1 (N = 19)

1-11 (N = 211)

12-17 (N = 293)

Overall (N =523)

Half-life <1: 0.2 Years; 1-11: 3.0 Years; 12-17: 3.3 Years

P-values 0-<1 vs. 1-11: p = 0.0014; 0-<1 vs. 12-17: p=0.0009; 1-11 vs. 12-17: p=0.1232


PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2006)

0

25

50

75

100

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

1982-1988 (N=110)

1989-1993 (N=180)

1994-1998 (N=127)

1999-6/2006 (N=104)

Half-life 1982-1988: 1.9; 1989-1993: 3.0; 1994-1998: 3.2; 1999-6/2006: 3.8

P-values 82-88 vs. 89-93: 0.4722; 82-88 vs. 94-98: 0.5852; 82-88 vs. 99-6/2006:0.0498; 89-93 vs. 94-98:0.9756; 89-93 vs. 99-6/2006: 0.2199; 94-98 vs. 99-6/2006: 0.2053

Su

rviv

al (

%)


PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2006)

Conditional on Survival to 1 Year

0

20

40

60

80

100

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

1982-1988 (N=61) 1989-1993 (N=111)

1994-1998 (N=78) 1999-6/2006 (N= 65)

Conditional HALF-LIFE 1982-1988: 8.0; 1989-1993: 7.2; 1994-1998: 5.9; 1999-6/2006: n/a

P-values 82-88 vs. 89-93: 0.6096; 82-88 vs. 94-98: 0.4825; 82-88 vs. 99-6/2006: 0.5409; 89-93 vs. 94-98: 0.9302;89-93 vs. 99-6/2006: 0.3785; 94-98 vs. 99-6/2006: 0.3181

Su

rviv

al (

%)


PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2007)

CAUSE OF DEATH 0-30 Days (N = 37)

31 Days - 1 Year (N = 48 )

>1 Year - 3 Years (N = 41 )

>3 Years - 5 Years (N = 30 )

>5 Years (N = 39)

BRONCHIOLITIS 2 (4.2%) 20 (48.8%) 10 (33.3%) 8 (20.5%)

ACUTE REJECTION 2 (4.2%) 1 (2.4%)

MALIGNANCY, OTHER 1 (3.3%)

INFECTION, NON-CMV6 (16.2%) 16 (33.3%) 4 (9.8%) 1 (3.3%) 13 (33.3%)

GRAFT FAILURE 16 (43.2%) 9 (18.8%) 13 (31.7%) 14 (46.7%) 9 (23.1%)

CARDIOVASCULAR 2 (5.4%) 3 (6.3%) 2 (6.7%) 2 (5.1%)

TECHNICAL 6 (16.2%)


PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: April 1994 - June 2007)

CAUSE OF DEATH 0-30 Days (N = 31)

31 Days - 1 Year (N = 34)

>1 Year - 3 Years (N = 35)

>3 Years - 5 Years (N = 26)

>5 Years

(N = 39)

BRONCHIOLITIS 1 (2.9%) 17 (48.6%) 9 (34.6%) 8 (20.5%)

ACUTE REJECTION 1 (2.9%) 1 (2.9%)

MALIGNANCY, OTHER 1 (3.8%)

INFECTION, NON-CMV 4 (12.9%) 12 (35.3%) 4 (11.4%) 1 (3.8%) 13 (33.3%)

GRAFT FAILURE 14 (45.2%) 6 (17.6%) 10 (28.6%) 12 (46.2%) 9 (23.1%)

CARDIOVASCULAR 2 (6.5%) 2 (5.9%) 1 (3.8%) 2 (5.1%)

TECHNICAL 4 (12.9%)


HEART-LUNG TRANSPLANTATION

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