HEARTLUNG TRANSPLANTATION Overall ISHLT J Heart Lung Transplant

HEART-LUNG TRANSPLANTATION Overall ISHLT J Heart Lung Transplant 2007; 26 2007

NUMBER OF HEART-LUNG TRANSPLANTS REPORTED BY YEAR ISHLT J Heart Lung Transplant 2007; 26 2007 NOTE: 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 heartlung transplants worldwide has declined in recent years.

AVERAGE CENTER VOLUME Heart-Lung Transplants: January 1, 1998 - June 30, 2006 ISHLT J Heart Lung Transplant 2007; 26 2007

DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY CENTER VOLUME Heart-Lung Transplants: January 1, 1998 - June 30, 2006 ISHLT J Heart Lung Transplant 2007; 26 2007

DISTRIBUTION OF HEART-LUNG TRANSPLANTS BY LUNG CENTER VOLUME Lung Transplants: January 1, 1998 - June 30, 2006 ISHLT J Heart Lung Transplant 2007; 26 2007

HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1982 - June 2005) Survival (%) Half-life = 3. 1 years Conditional Half-life = 8. 8 years N=3, 184 N at risk at 20 years = 7 ISHLT J Heart Lung Transplant 2007; 26 2007

HEART-LUNG TRANSPLANTATION Adult Recipients ISHLT J Heart Lung Transplant 2007; 26 2007

DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (January 1982 - June 2006) “Other” includes cancer, LAM, OB, sarcoidosis, bronchiectasis ISHLT J Heart Lung Transplant 2007; 26 2007

DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS (Transplants: January 1982 - June 2006) N (%) Diagnosis Congenital Heart Disease 841 (33. 9%) Primary Pulmonary Hypertension 601 (24. 2%) Cystic Fibrosis 352 (14. 2%) Acquired Heart Disease 110 ( 4. 4%) COPD/Emphysema 92 ( 3. 7%) Idiopathic Pulmonary Fibrosis 71 ( 2. 9%) Alpha-1 53 ( 2. 1%) Re-Transplant: Not Obliterative Bronchiolitis 31 ( 1. 2%) Sarcoidosis 30 ( 1. 2%) Re-Transplant: Obliterative Bronchiolitis 24 ( 1. 0%) Bronchiectasis 18 ( 0. 7%) Obliterative Bronchiolitis (not Re-Transplant) 8 ( 0. 3%) Other ISHLT J Heart Lung Transplant 2007; 26 251 (10. 1%) 2007

DIAGNOSIS IN ADULT HEART-LUNG TRANSPLANTS BY ERA “Other” includes OB (non-Re. TX), Bronchiectasis, Sarcoidosis ISHLT J Heart Lung Transplant 2007; 26 2007

ADULT HEART-LUNG TRANSPLANTATION Indications By Year (%) ISHLT J Heart Lung Transplant 2007; 26 2007

ADULT HEART-LUNG TRANSPLANTATION Indications By Year (Number) ISHLT J Heart Lung Transplant 2007; 26 2007

ADULT HEART-LUNG TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT J Heart Lung Transplant 2007; 26 2007

ADULT HEART-LUNG TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT J Heart Lung Transplant 2007; 26 2007

ADULT HEART-LUNG TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT J Heart Lung Transplant 2007; 26 2007

HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival for Adult Recipients (Transplants: January 1982 - June 2005) Survival (%) Half-life = 3. 4 Years Conditional Half-life = 9. 0 Years N=2, 571 ISHLT J Heart Lung Transplant 2007; 26 2007

HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival for Adult Recipients by Era (Transplants: January 1982 - June 2005) Survival (%) Half-life (Years): 1982 -1995 = 3. 0; 1996 -1999 = 3. 4; 2000 -6/2005 = 5. 2 Conditional Half-life (Years): 1982 -1995 = 8. 9; 1996 -1999 = 9. 5; 2000 -6/2005 = n/a P-value comparing all: 0. 0082 ISHLT J Heart Lung Transplant 2007; 26 2007

ADULT HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis ISHLT J Heart Lung Transplant 2007; 26 2007 (Transplants: January 1990 – June 2005)

ADULT HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2005) ISHLT J Heart Lung Transplant 2007; 26 2007

ADULT HEART-LUNG RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2006) ISHLT J Heart Lung Transplant 2007; 26 2007

ADULT HEART-LUNG RECIPIENTS Employment Status of Surviving Recipients (Follow-ups: April 1994 – June 2006) ISHLT J Heart Lung Transplant 2007; 26 2007

ADULT HEART-LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April 1994 - June 2006) ISHLT J Heart Lung Transplant 2007; 26 2007

ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression For transplants between January 2001 through June 2006 ISHLT J Heart Lung Transplant 2007; 26 2007

ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2000 - December 2005) ISHLT J Heart Lung Transplant 2007; 26 2007

ADULT HEART-LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2000 - December 2005) Any Induction Polyclonal ALG/ATG ISHLT J Heart Lung Transplant 2007; 26 2007 OKT 3 IL 2 R-antagonist

ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2001 through June 2006 ISHLT NOTE: Different patients are analyzed in Year 1 and Year 5 J Heart Lung Transplant 2007; 26 2007

ADULT HEART-LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2001 through June 2006 ISHLT NOTE: Different patients are analyzed in Year 1 and Year 5 J Heart Lung Transplant 2007; 26 2007

POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April 1994 - June 2006) ISHLT J Heart Lung Transplant 2007; 26 2007

POST-HEART-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant (Follow-ups: April 1994 - June 2006) ISHLT J Heart Lung Transplant 2007; 26 2007

Freedom from Coronary Artery Vasculopathy For Adult Heart-Lung Recipients (Follow-ups: April 1994 -June 2006) ISHLT J Heart Lung Transplant 2007; 26 2007

Freedom from Bronchiolitis Obliterans For Adult Heart-Lung Recipients (Follow-ups: April 1994 -June 2006) ISHLT J Heart Lung Transplant 2007; 26 2007

Freedom from Severe Renal Dysfunction* For Adult Heart-Lung Recipients (Follow-ups: April 1994 -June 2006) *Severe renal dysfunction = Creatinine > 2. 5 mg/dl (221 μmol/L), dialysis or renal transplant ISHLT J Heart Lung Transplant 2007; 26 2007

MALIGNANCY POST-HEART-LUNG TRANSPLANT FOR ADULTS Cumulative Prevalence in Survivors (Follow-ups: April 1994 -June 2006) Malignancy/Type No Malignancy (all types combined) Malignancy Type* 1 -Year Survivors 5 -Year Survivors 10 -Year Survivors 308 (92. 2%) 106 (88. 3%) 51 (85%) 26 (7. 8%) 14 (11. 7%) 9 (15%) Skin 2 4 9 Lymph 18 6 2 Other 2 2 1 Type Not Reported 4 2 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. ISHLT J Heart Lung Transplant 2007; 26 2007

Freedom from Malignancy For Adult Heart-Lung Recipients (Follow-ups: April 1994 - June 2006) ISHLT J Heart Lung Transplant 2007; 26 2007

ADULT HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2006) 0 -30 Days (N = 225) 31 Days - 1 Year (N = 145) >1 Year - 3 Years (N = 124) >3 Years - 5 Years (N = 70) >5 Years (N = 129) 0 4 (2. 8%) 34 (27. 4%) 28 (40. 0%) 31 (24. 0%) 3 (1. 3%) 4 (2. 8%) 2 (1. 6%) 0 1 (0. 8%) LYMPHOMA 0 5 (3. 4%) 9 (7. 3%) 3 (4. 3%) 1 (0. 8%) MALIGNANCY, OTHER 0 1 (0. 7%) 6 (4. 8%) 2 (2. 9%) 6 (4. 7%) CMV 0 1 (0. 7%) 0 1 (1. 4%) 0 INFECTION, NON-CMV 40 (17. 8%) 58 (40. 0%) 34 (27. 4%) 7 (10. 0%) 22 (17. 1%) GRAFT FAILURE 69 (30. 7%) 32 (22. 1%) 21 (16. 9%) 11 (15. 7%) 31 (24. 0%) CARDIOVASCULAR 21 (9. 3%) 6 (4. 1%) 6 (4. 8%) 8 (11. 4%) 8 (6. 2%) TECHNICAL 47 (20. 9%) 3 (2. 1%) 1 (0. 8%) 1 (1. 4%) 0 OTHER 45 (20. 0%) 31 (21. 4%) 11 (8. 9%) 9 (12. 9%) 29 (22. 5%) CAUSE OF DEATH BRONCHIOLITIS ACUTE REJECTION ISHLT J Heart Lung Transplant 2007; 26 2007

HEART-LUNG TRANSPLANTATION Pediatric Recipients ISHLT J Heart Lung Transplant 2007; 26 2007

AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS (Transplants: January 1982 - June 2006) ISHLT J Heart Lung Transplant 2007; 26 2007

AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEARTLUNG RECIPIENTS (Transplants: January 1982 - June 2006) ISHLT J Heart Lung Transplant 2007; 26 2007

Number of Transplants AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS By Year of Transplant ISHLT J Heart Lung Transplant 2007; 26 2007 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 heartlung transplants worldwide has declined in recent years.

Percentage of Transplants AGE DISTRIBUTION OF PEDIATRIC HEART-LUNG RECIPIENTS By Era of Transplant ISHLT J Heart Lung Transplant 2007; 26 2007

NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS NEED TO UPDATE ISHLT J Heart Lung Transplant 2007; 26 2007

NUMBER OF CENTERS REPORTING PEDIATRIC HEART-LUNG TRANSPLANTS Stratified by center volume ISHLT J Heart Lung Transplant 2007; 26 2007

DIAGNOSIS IN PEDIATRIC HEART –LUNG TRANSPLANT RECIPIENTS (Age: 11 -17 Years) “Other” includes Bronchiectasis, Alpha-1, and OB (non-Re. TX) ISHLT J Heart Lung Transplant 2007; 26 2007

PEDIATRIC HEART-LUNG TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT J Heart Lung Transplant 2007; 26 2007

PEDIATRIC HEART-LUNG TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT J Heart Lung Transplant 2007; 26 2007

PEDIATRIC HEART-LUNG TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT J Heart Lung Transplant 2007; 26 2007

PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis ISHLT J Heart Lung Transplant 2007; 26 2007 (Transplants: January 1990 – June 2005)

PEDIATRIC HEART-LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1982 - June 2005) ISHLT J Heart Lung Transplant 2007; 26 2007

PEDIATRIC HEART-LUNG TRANSPLANTATION (Transplants: January 1982 - June 2005) Survival (%) Kaplan-Meier Survival by Era ISHLT J Heart Lung Transplant 2007; 26 2007

PEDIATRIC HEART-LUNG TRANSPLANTATION Survival (%) Kaplan-Meier Survival by Era (Transplants: January 1982 - June 2005) Conditional on Survival to 1 Year ISHLT J Heart Lung Transplant 2007; 26 2007

PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2006) CAUSE OF DEATH 0 -30 Days (N = 30) 31 Days - 1 Year (N= 28 ) >1 Year - 3 Years (N= 26 ) >3 Years - 5 Years (N = 19 ) >5 Years (N = 19) BRONCHIOLITIS 1 (3. 6%) 14 (53. 8%) 9 (47. 4%) 7 (36. 8%) ACUTE REJECTION 2 (7. 1%) MALIGNANCY, OTHER 1 (5. 3%) INFECTION, NON-CMV 6 (20. 0%) 9 (32. 1%) 5 (19. 2%) 1 (5. 3%) 5 (26. 3%) GRAFT FAILURE 12 (40. 0%) 2 (7. 1%) 5 (19. 2%) 5 (26. 3%) 3 (15. 8%) CARDIOVASCULAR 2 (6. 7%) 3 (10. 7%) 1 (5. 3%) 2 (10. 5%) TECHNICAL 4 (13. 3%) 1 (3. 6%) ISHLT J Heart Lung Transplant 2007; 26 2007

PEDIATRIC HEART-LUNG TRANSPLANT RECIPIENTS: Cause of Death (Deaths: April 1994 - June 2006) CAUSE OF DEATH 0 -30 Days (N = 26) 31 Days - 1 Year (N = 22) >1 Year - 3 Years (N = 20) >3 Years - 5 Years (N = 17) >5 Years (N = 19) BRONCHIOLITIS 1 (4. 5%) 11 (55. 0%) 8 (47. 1%) 7 (36. 8%) ACUTE REJECTION 1 (4. 5%) MALIGNANCY, OTHER 1 (5. 9%) INFECTION, NON-CMV 4 (15. 4%) 7 (31. 8%) 4 (20. 0%) 1 (5. 9%) 5 (26. 3%) GRAFT FAILURE 12 (46. 2%) 2 (9. 1%) 3 (15. 0%) 5 (29. 4%) 3 (15. 8%) CARDIOVASCULAR 2 (7. 7%) 2 (9. 1%) TECHNICAL 2 (7. 7%) 1 (4. 5%) ISHLT J Heart Lung Transplant 2007; 26 2007 2 (10. 5%)