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Heart

OPTN/SRTR 2015 Annual Data Report: Heart

Abstract

The number of heart transplant candidates and transplants performed continued to rise each year. In 2015, 2819 heart transplants were performed. In addition, the number of new adult candidates on the waiting list increased 51% since 2004. The number of adult heart transplant survivors continued to increase, and in 2015, 29,172 recipients were living with heart transplants. Patient mortality following transplant has declined. The number of pediatric candidates and transplants performed also increased. New listings for pediatric heart transplants increased from 451 in 2004 to 644 in 2015. The number of pediatric heart transplants performed each year increased from 297 in 2004 to 460 in 2015. Among pediatric patients who underwent transplant in 2014, death occurred in 7.2% at 6 months and 9.6% at 1 year.

Introduction

Heart transplant continues to afford advanced heart failure patients the best option for long-term survival. The number of heart transplant candidates who are listed and the number of heart transplants performed continue to increase. Mechanical circulatory support has provided attractive alternatives for heart failure patients who do not qualify for transplant and a mechanism for longer survival while awaiting transplant for those who do. The number of left ventricular assist devices (LVADs) implanted worldwide exceeds 20,000, and the number of candidates and recipients with VADs has increased dramatically. More patients are undergoing transplant at higher urgency categories and waiting times are increasing. Despite this, posttransplant survival is improving and waitlist mortality has declined. Recent efforts to revise the heart allocation system are anticipated to provide better risk stratification and affect the waiting time of the most critically ill patients. In this report, we highlight the most significant trends in heart transplant over the past decade.

Adult Heart Transplant

Waitlist Trends: New Listings, Time to Transplant, and Waitlist Mortality

The number of candidates awaiting heart transplant has steadily increased since 2007 (Figure HR 2). Between 2004 and 2015, the number of new active listings increased by 51% (Figure HR 1). The number of candidates actively awaiting heart transplant on December 31 increased 90% from 1525 in 2004 to 2904 in 2015; however, the number of inactive candidates decreased 39% during that period (Figure HR 2). The heart transplant waiting list is aging, with a slow but steady increase in numbers of candidates aged 65 years or older. In 2015, 18% of candidates were aged 65 years or older; however, most were aged 50 to 65 years (Figure HR 3). Ethnic diversity is increasing. In 2004, 74.3% of candidates were white. In 2015, the proportion of white candidates declined to 62.6% due to increased proportions of all ethnic groups, but most notably of black candidates, whose proportion increased from 15.4% in 2004 to 24.9% in 2015 (Figure HR 4). Cardiomyopathy remained the most prevalent indication for transplant and its proportion increased to 57.8% of candidates in 2015 (Figure HR 5). The proportion of candidates on the waiting list for less than 1 year has fluctuated, peaking at 64.8% in 2009 and declining since to 59.9%, while the proportion on the list for 1 to 2 years increased to 20.1% (Figure HR 6). Similar fluctuations occurred for candidates listed for 2 to 4 years, with a slight overall increase, but a continuing decrease in those listed for 5 or more years. The trends among candidates at the highest urgency categories continued to be remarkable. The proportion of status 1A and 1B candidates has almost doubled since 2004 (Figure HR 7). In 2015, 43.9% of candidates were status 1A and 30.9% were status 1B, compared with 22.0% and 15.8%, respectively, in 2004. Status 2 candidates have declined from 37.3% to 17.3%. Inactive candidates were much rarer, only 8.0% in 2015. Sex distribution remained stable (Figure HR 9), while use of VADs, as reported at listing, continued to increase, to 29.4% of candidates in 2015, compared with only 18.1% in 2010 (Figure HR 8).

Over the past decade, heart transplant rates (Figure HR 11, Figure HR 12, Figure HR 13) peaked at 149 transplants per 100 waitlist years in 2007, and gradually declined to 79.3 in 2015, with similar trends in many subgroups (Figure HR 13). Candidates aged 65 years or older underwent transplant at a higher rate, 84.8 per 100 waitlist years, than the other age groups (Figure HR 11). The transplant rate was lowest among candidates aged 18 to 34 years. In 2015, wide variability remained in transplant rates by blood type (Figure HR 12). Candidates with blood type AB underwent heart transplant at a rate of 281.8 per 100 waitlist years, more than 5-fold higher than for those with blood type O, 55.5 per 100 waitlist years. Candidates with blood type A underwent transplant at a rate of 99.7 per 100 waitlist years. Finally, although transplant rates have declined among all status groups since 2006, the gap has widened between status 1A and 1B candidates (Figure HR 13). In 2015, the transplant rate among status 1A candidates was 406.1 per 100 waitlist years, compared with 43.1 for status 1B candidates and 7.0 for candidates listed as status 2. Geographic variability in access to donor hearts persisted. On average, 51.1% of candidates listed in 2014 underwent transplant in less than 1 year; however, the proportion of candidates undergoing transplant within this time frame varied from 14.3% to 100% depending on the donation service area (DSA) (Figure HR 20). Among DSAs with more than 10 candidates, the proportion of candidates undergoing transplant in less than 1 year ranged from 18.8% to 69.8%.

Of candidates listed in 2012, 54.3% underwent transplant during the first year on the waiting list, 30.7% were still waiting, and 7.8% had died (Figure HR 14). At 3 years, 10.1% had died, 13.5% had been removed from the list, 67.0% had undergone transplant, and 9.4% were still waiting.

In 2004, approximately 50% of candidates had undergone transplant within 6 months of listing; however, in 2014, this proportion declined to only 36.8% (Figure HR 19). Among candidates listed in 2014, 48.2% had undergone transplant within a year, compared with 60.2% of candidates listed in 2004. Despite a decline in 2006-2007, the median time to transplant has increased substantially since 2004-2005, from 5.3 months to 12.4 months in 2014-2015 (Figure HR 15). Women waited 9.9 months and men almost 3 months longer. Candidates with blood type AB waited 2.9 months and those with blood type O 22.3 months (Figure HR 16). Candidates listed as status 1A waited 3.7 months; those listed as status 1B waited substantially longer, 11.4 months (Figure HR 17). Time to transplant also varied by body mass index (BMI); candidates with BMI ≥ 31 kg/m2 waited 20.5 months, and those with BMI 23 kg/m2 or less waited 6.4 months (Figure HR 18). Candidates with BMI 24-26 kg/m2 waited a median of 9.8 months.

Pretransplant mortality continued to decline and reached 10.6 per 100 waitlist years in 2014-2015 (Figure HR 21). While pretransplant mortality declined in most subgroups over the past 10 years, increases occurred in the most recent era for candidates aged 50-64 years, candidates with congenital heart disease (Figure HR 24), inactive candidates (Figure HR 25), and women (Figure HR 23). Inactive candidates make up one of the few subgroups with fairly consistent increases in pretransplant mortality over the past 10 years, 26.8 deaths per 100 waitlist years in 2014-2015, compared with 15.5 in 2004-2005. In the most recent 2-year period, the pretransplant mortality rate was lowest for candidates aged 18 to 34 years, 8.5 per 100 waitlist years. Of note, pretransplant mortality among candidates with VADs at listing has steadily declined and was 8.5 deaths per 100 waitlist years in 2014-2015, compared with 11.4 among candidates without VADs (Figure HR 26). This should be interpreted cautiously, however, since candidates without a VAD at listing may have received one after listing. Also notable, pretransplant mortality among status 1A candidates reached a low of 16.4 deaths per 100 waitlist years, still substantially higher than among status 1B (4.5) and 2 (3.5) candidates. The high mortality among inactive candidates suggests that many were too ill to be made active. As with time to transplant, pretransplant mortality varied geographically. Pretransplant mortality based on DSA ranged from 2.9 to 22.8 deaths per 100 waitlist years (Figure HR 27). Deaths within 6 months of removal from the waiting lists have fluctuated, peaking at 33.4% in 2013 and declining to 21.4% in 2015 (Figure HR 28). The overall increase since 2005 is mostly due to increases in death after removal among inactive candidates; this group has made up over half of the deaths after removal (data not shown). Candidates at status 1A at the time of removal had the highest percentage of deaths within 6 months after removal.

In 2015, similar to 2005, the typical heart transplant candidate was white, male, and aged 50-64 years (Table HR 1). Since 2005, however, candidates have been more likely to be diagnosed with cardiomyopathy, be listed as status 1A or 1B, and have a VAD. In 2015, 43.8% of candidates were listed as status 1B, compared with 11.3% in 2005. The proportion of candidates listed as status 1A increased from 1.9% to 10.0% during this time. The number of candidates with VADs increased from 138 in 2005 to 1174 in 2015.

Donor Trends

Overall, the deceased heart donor rate was 2.8 per 1000 deaths, but it varied by state, ranging from 0.09 to 4.94 per 1000 deaths (Figure HR 31). Forty-nine percent of donors were aged 18 to 34 years (Figure HR 29). Rates of hearts recovered for transplant but not transplanted reached a nadir in 2008-2011 and have trended up since (Figure HR 32). In 2014-2015, 1.1% of recovered hearts were not transplanted. The upswing is most notable among age groups 18 to 34 and 50 years or older.

Head trauma remained the most common cause of death among heart donors; however, an increasing proportion of deaths were due to anoxia, 33% in 2015 (Figure HR 33). Since 2004, anoxia has tripled in prevalence as cause of death, surpassing cerebrovascular accident and stroke.

Overall Trends in Heart Transplant

In 2015, 2819 heart transplants were performed, 460 of which were in pediatric recipients, an increase of 37.2% since 2004 (Figure HR 34). Although recipients aged 50 to 64 years made up the greatest proportion of heart transplant recipients, a relatively large increase occurred since 2014 among recipients aged 35 to 49 years (Figure HR 35). Increases occurred in all subgroups since 2004, except for recipients with valvular heart disease for whom, despite yearly variation, the overall trend was downward (Figure HR 38).

Recipient Characteristics

In 2015, most heart transplant recipients were aged 50-64 years; however, the proportion aged 65 years or older increased to 18.9%, compared with 11.4% in 2005 (Table HR 5). The typical recipient was white, male, with blood type A or O, representing no substantial change since 2005. However, a greater proportion of recipients were non-white, and more recipients underwent transplant at status 1A than in 2005. The proportion of recipients who underwent transplant at status 2 declined precipitously from 28.8% in 2005 to 2.6% in 2015. VADs at transplant were much more prevalent in 2015 than in 2005, 48.4% vs. 28.9%. In addition, coronary artery disease was less prevalent among recipients in 2015 than in 2005. Most patients had private payers; however, in 2005 56.9% of recipients had private payers and 48.7% in 2015, due to more recipients with Medicare. Retransplant declined since 2005 to 2.9% of heart transplants in 2015. Heart-lung transplants declined, but the number of heart-kidney transplants increased from 53 to 140 and the number of heart-liver transplants from 5 to 27. Waiting time increased, as evidenced by a shift in the proportion of recipients who waited longer than 6 months. The number and proportion of patients on any form of life support increased from 1547 (76.8%) in 2005 to 1990 (84.4%) in 2015 (Table HR 4). Most patients on life support had either intravenous inotropes or LVADs. In 2015, the proportion of recipients with an LVAD at transplant increased to 44.8%. Intra-aortic balloon pumps also increased from 5.0% to 7.0%, extracorporeal membrane oxygenation was similar at 1.0% both years, and the proportion of total artificial hearts increased from 1.3% to 1.7%. Ventilator use declined from 2.9% to 1.0%

Posttransplant Survival and Morbidity

One-year survival for patients who underwent heart transplant 2008-2010 was 89.6%, 3-year survival was 82.9%, and 5-year survival 77.0% (Figure HR 47). One-year survival among many subgroups was similar to overall survival but tended to be lower among recipients who were aged 65 years or older (Figure HR 45), black (Figure HR 46), or status 2 at transplant (Figure HR 50). After the first year posttransplant, however, survival declined more rapidly for recipients aged 18 to 35 years, black recipients, and retransplant recipients. By 5 years, survival was 73.8% for recipients aged 18 to 34 years, 72.2% for black recipients, and 74.5% among retransplant recipients. Survival did not differ meaningfully between the medical urgency categories at any time, but tended to be lower for status 2 recipients. Since 2004, patient death after transplant decreased overall at 6 months and at 1, 3, and 5 years, despite slight increases in 6-month and 1- and 3-year mortality between 2013 and 2014 (Figure HR 51). The number of heart transplant survivors has increased since 2004. On June 30, 2015, 29,172 heart transplant recipients were alive with a functioning graft; most had undergone transplant at age 50 years or older (Figure HR 52).

The incidence of acute rejection in the first year posttransplant decreased from 25.1% among recipients who underwent transplant 2009-2010 to 23.0% among recipients who underwent transplant 2013-2014 (Figure HR 53). Acute rejection was least prevalent in recipients aged 65 years or older, occurring in only 18.3%, and most prevalent in recipients aged 18 to 34 years, 30.2%. Posttransplant lymphoproliferative disorder (PTLD) remained uncommon, with an overall cumulative incidence of only 1% by 5 years posttransplant (Figure HR 54). The most common documented causes of death in the first posttransplant year were infection, cardiovascular/cerebrovascular disease, and graft failure (Figure HR 55). By the second year, cardiovascular/cerebrovascular disease was the leading documented cause of death through year 5 (Figure HR 56). Malignancy was relatively infrequent as a cause of death, 1.7% of deaths at 5 years.

Pediatric Heart Transplant

Pediatric Waitlist Trends

In 2015, the number of new pediatric candidates added to the heart transplant waiting list continued its increase to the highest number yet, 644, with few at inactive status (Figure HR 57). At year-end 2015, 370 candidates listed before their eighteenth birthdays were awaiting heart transplant, 62.4% active (Figure HR 58). The largest pediatric age group on the waiting list in 2015 was 11 to 17 years (34.0%), followed by ages younger than 1 year (25.8%), 1 to 5 years (24.2%), and 6 to 10 years (16.0%) (Figure HR 59). Over half of heart transplant candidates were white, 21.2% were Hispanic, 17.3% were black, and 5.2% were Asian (Figure HR 60). The proportion of waitlist candidates aged younger than 1 year almost doubled from 7.6% on December 31, 2005, to 14.0% on December 31, 2015 (Table HR 7). The proportion of male candidates remained high, 60.7%. The proportion of Hispanic candidates increased from 16.4% on December 31, 2005, to 24.9% on December 31, 2015. For candidates waiting on December 31, 2015, congenital defect was the leading cause of heart disease (53.6%). Thirty-three percent of candidates were listed as status 1A in 2015, compared with only 10.5% in 2005. Increases in status 1B listings were also increased, from 7.1% in 2005 to 13.4% in 2015.. The percentage of candidates using VADs at the time of listing increased from 2.1% in 2005 to 4.4% in 2015. Listings for heart-only transplants increased from 90.3% in 2005 to 98.4% in 2015, and listings for heart-lung and heart-kidney transplants decreased to less than 1%. Among candidates removed from the waiting list in 2015, 463 (72.9%) were removed due to undergoing transplant, 80 (12.6%) died, 48 (7.6%) were removed due to improved condition, and 24 (3.8%) were considered too sick to undergo transplant (Table HR 9).

Nearly 75% of candidates newly listed in 2012 underwent transplant within 3 years, 9.7% died, 11.7% were removed from the list, and 4.3% were still waiting (Figure HR 64). The rate of heart transplants among active pediatric waitlist candidates decreased from a peak of almost 300 per 100 waitlist years in 2006 to 189 per 100 waitlist years in 2015, likely attributable to a growing waiting list. Transplant rates varied by age, with the highest rates for candidates aged younger than 1 year, at 401 transplants per 100 waitlist years in 2015, followed by candidates aged 11 to 17 years, at 187 transplants per 100 waitlist years (Figure HR 65). Pretransplant mortality remained stable at 21.8 deaths per 100 waitlist years in 2014-2015 (Figure HR 66). The pretransplant mortality rate was highest for candidates aged younger than 1 year, at 42.9 deaths per 100 waitlist years in 2014-2015, followed by candidates aged 1 to 5 years at 18.5, 6 to 10 years at 16.8, and 11 to 17 years at 8.3. Regarding cause of disease, pretransplant mortality was highest for candidates with dilated myopathy/myocarditis or congenital defects (Figure HR 68). Pretransplant mortality was highest for status 1A candidates (34.1 deaths per 100 waitlist years) and inactive candidates (32.0), compared with 4.3 and 0.6 for status 1B and status 2 candidates, respectively (Figure HR 69).

Pediatric Transplant

The number of pediatric heart transplants performed each year increased from 297 in 2004 to 460 in 2015 (Figure HR 70). In 2015, 36 of 127 total heart transplant centers performed pediatric heart transplants exclusively, compared with 23 centers in 2004 (Figure HR 71). Over the past decade, the age, sex, and race of pediatric heart transplant recipients changed little. Congenital defects remained the most common primary cause of disease, affecting 45.3% of recipients who underwent transplant in 2012-2015. The proportion of ABO-incompatible transplants in 2012-2015 was 3.7%, increased from 1.7% a decade earlier. The proportion of patients who underwent transplant as status 1A increased from 72.0% in 2002-2005 to 88.6% in 2012-2015. VAD use tripled from only 8.8% of transplant recipients in 2002-2005 to 24.6% in 2012-2015 (Table HR 10).

Pediatric Immunosuppression and Outcomes

In 2015, the most common induction therapy was T-cell depleting agents, used in 64.2% of heart transplant recipients, followed by interleukin-2 receptor antagonists (IL-2-RA) in 14.4%. No induction therapy was reported in 22.8% of recipients (Figure HR 72). Regarding induction use by panel-reactive antibody (PRA), T-cell depleting agents were generally used more frequently for the most sensitized patients, while IL-2-RA was used less frequently for sensitized patients (Figure HR 77). The initial immunosuppression agents used most commonly in 2015 were tacrolimus (88.7%, Figure HR 73), mycophenolate (93.1%, Figure HR 74), and steroids (60.0%, Figure HR 76). In 2014, mammalian target of rapamycin inhibitors were used in only 1.2% of recipients at the time of transplant, but use increased to 13.8% at 1 year posttransplant (Figure HR 75). Among patients who underwent transplant in 2014, steroid use was 67.2% at transplant and 58.7% at 1 year posttransplant (Figure HR 76).

Among pediatric heart transplant recipients from 2011 to 2015, 46.5% were cytomegalovirus (CMV) negative and 43.4% were Epstein-Barr virus (EBV) negative (Table HR 12). The combination of a CMV-positive donor and CMV-negative recipient occurred in 23.5% of transplants; for EBV, this occurred in 29.7% of transplants.

Recipient death occurred in 7.2% at 6 months and 9.6% at 1 year among heart transplants performed in 2014, in 10.6% at 3 years for transplants performed in 2012, in 14.9% at 5 years for transplants performed in 2010, and in 33.6% at 10 years for transplants performed in 2005 (Figure HR 81). Overall, 1-year and 5-year patient survival were 88.7% and 77.2%, respectively, among recipients who underwent transplant in 2003-2010 (Figure HR 82). By age, 5-year patient survival was 71.2% for recipients aged younger than 1 year, 78.4% for ages 1 to 5 years, 87.5% for ages 6 to 10 years, and 77.4% for ages 11 to 17 years (Figure HR 82). The leading identified causes of death in the first 5 years posttransplant were graft failure (5.4%) and cardio/cerebrovascular disease (4.8%) (Figure HR 84).

The incidence of PTLD among EBV-negative recipients was 5.5% at 5 years posttransplant, compared with 2.5% among EBV-positive recipients (Figure HR 80). The overall incidence of first acute rejection in the first posttransplant year was 17.8% in 2013-2014 (Figure HR 79). By age, the highest incidence of rejection was 25.6% in the group aged 6 to 10 years.

Figure List

Waiting list

Figure HR 1. New adult candidates added to the heart transplant waiting list
Figure HR 2. Adults listed for heart transplant on December 31 each year
Figure HR 3. Distribution of adults waiting for heart transplant by age
Figure HR 4. Distribution of adults waiting for heart transplant by race
Figure HR 5. Distribution of adults waiting for heart transplant by diagnosis
Figure HR 6. Distribution of adults waiting for heart transplant by waiting time
Figure HR 7. Distribution of adults waiting for heart transplant by medical urgency
Figure HR 8. Distribution of adults waiting for heart transplant by VAD status at listing
Figure HR 9. Distribution of adults waiting for heart transplant by sex
Figure HR 10. Distribution of adults waiting for heart transplant by blood type
Figure HR 11. Deceased donor heart transplant rates among active adult waitlist candidates by age
Figure HR 12. Deceased donor heart transplant rates among active adult waitlist candidates by blood type
Figure HR 13. Deceased donor heart transplant rates among active adult waitlist candidates by medical urgency
Figure HR 14. Three-year outcomes for adults waiting for heart transplant, new listings in 2012
Figure HR 15. Median months to heart transplant for waitlisted adults by sex
Figure HR 16. Median months to heart transplant for waitlisted adults by blood type
Figure HR 17. Median months to heart transplant for waitlisted adults by medical urgency at listing
Figure HR 18. Median months to heart transplant for waitlisted adults by BMI at listing
Figure HR 19. Percentage of adults who underwent deceased donor heart transplant within a given time period of listing
Figure HR 20. Percentage of adults who underwent deceased donor heart transplant within 1 year of listing in 2014 by DSA
Figure HR 21. Pretransplant mortality rates among adults waitlisted for heart transplant by age
Figure HR 22. Pretransplant mortality rates among adults waitlisted for heart transplant by race
Figure HR 23. Pretransplant mortality rates among adults waitlisted for heart transplant by sex
Figure HR 24. Pretransplant mortality rates among adults waitlisted for heart transplant by diagnosis
Figure HR 25. Pretransplant mortality rates among adults waitlisted for heart transplant by medical urgency
Figure HR 26. Pretransplant mortality rates among adults waitlisted for heart transplant by VAD at listing
Figure HR 27. Pretransplant mortality rates among adults waitlisted for heart transplant in 2014-2015, by DSA
Figure HR 28. Deaths within six months after removal among adult heart walitlist candidates

Deceased donation

Figure HR 29. Deceased heart donors by age
Figure HR 30. Deceased heart donors by race
Figure HR 31. Deceased donor heart donation rates (per 1000 deaths) by state, 2012-2014
Figure HR 32. Rates of hearts recovered for transplant and not transplanted by age
Figure HR 33. Cause of death among deceased heart donors

Transplant

Figure HR 34. Total heart transplants
Figure HR 35. Total heart transplants by age
Figure HR 36. Total heart transplants by sex
Figure HR 37. Total heart transplants by race
Figure HR 38. Total heart transplants by diagnosis
Figure HR 39. Induction agent use in adult heart transplant recipients
Figure HR 40. Calcineurin inhibitor use in adult heart transplant recipients
Figure HR 41. Anti-metabolite use in adult heart transplant recipients
Figure HR 42. mTOR inhibitor use in adult heart transplant recipients
Figure HR 43. Steroid use in adult heart transplant recipients
Figure HR 44. Total HLA A, B, and DR mismatches among adult deceased donor heart transplant recipients, 2011-2015

Outcomes

Figure HR 45. Patient survival among adult heart transplant recipients, 2008-2010, by age
Figure HR 46. Patient survival among adult heart transplant recipients, 2008-2010, by race
Figure HR 47. Patient survival among adult heart transplant recipients, 2008-2010, by sex
Figure HR 48. Patient survival among adult heart transplant recipients, 2008-2010, by circulatory support
Figure HR 49. Patient survival among adult heart transplant recipients, 2008-2010, by first vs. retransplant
Figure HR 50. Patient survival among adult heart transplant recipients, 2008-2010, by medical urgency
Figure HR 51. Patient death among adult heart transplant recipients
Figure HR 52. Recipients alive with a functioning heart graft on June 30 of the year, by age at transplant
Figure HR 53. Incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by age
Figure HR 54. Incidence of PTLD among adult heart transplant recipients by recipient EBV status at transplant, 2009-2013
Figure HR 55. One-year cumulative incidence of death by cause among adult heart recipients, 2013-2014
Figure HR 56. Five-year cumulative incidence of death by cause among adult heart recipients, 2009-2010

Pediatric transplant

Figure HR 57. New pediatric candidates added to the heart transplant waiting list
Figure HR 58. Pediatric candidates listed for heart transplant on December 31 each year
Figure HR 59. Distribution of pediatric candidates waiting for heart transplant by age
Figure HR 60. Distribution of pediatric candidates waiting for heart transplant by race
Figure HR 61. Distribution of pediatric candidates waiting for heart transplant by diagnosis
Figure HR 62. Distribution of pediatric candidates waiting for heart transplant by waiting time
Figure HR 63. Distribution of pediatric candidates waiting for heart transplant by medical urgency
Figure HR 64. Three-year outcomes for newly listed pediatric candidates waiting for heart transplant, 2012
Figure HR 65. Heart transplant rates among active pediatric waitlist candidates by age
Figure HR 66. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by age
Figure HR 67. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by race
Figure HR 68. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by diagnosis
Figure HR 69. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by medical urgency
Figure HR 70. Pediatric heart transplants by age
Figure HR 71. Number of centers performing pediatric and adult heart transplants by center's age mix
Figure HR 72. Induction agent use in pediatric heart transplant recipients
Figure HR 73. Calcineurin inhibitor use in pedatric heart transplant recipients
Figure HR 74. Anti-metabolite use in pedatric heart transplant recipients
Figure HR 75. mTOR inhibitor use in pediatric heart transplant recipients
Figure HR 76. Steroid use in pedatric heart transplant recipients
Figure HR 77. Induction use by CPRA among pediatric heart transplant recipients, 2011-2015
Figure HR 78. Total HLA A, B, and DR mismatches among pediatric deceased donor heart transplant recipients, 2011-2015
Figure HR 79. Incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by age
Figure HR 80. Incidence of PTLD among pediatric heart transplant recipients by recipient EBV status at transplant, 2003-2013
Figure HR 81. Patient death among pediatric heart transplant recipients
Figure HR 82. Patient survival among pediatric deceased donor heart transplant recipients, 2003-2010, by age
Figure HR 83. One-year cumulative incidence of death by cause among pediatric heart recipients, 2013-2014
Figure HR 84. Five-year cumulative incidence of death by cause among pediatric heart recipients, 2009-2010

Table List

Waiting list

Table HR 1. Characteristics of adults on the heart transplant waiting list on December 31, 2005 and December 31, 2015
Table HR 2. Heart transplant waitlist activity among adults
Table HR 3. Removal reason among adult heart transplant candidates

Transplant

Table HR 4. Adult heart recipients on circulatory support before transplant
Table HR 5. Characteristics of adult heart transplant recipients, 2005 and 2015
Table HR 6. Adult heart donor-recipient serology matching, 2011-2015

Pediatric transplant

Table HR 7. Characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2005 and December 31, 2015
Table HR 8. Heart transplant waitlist activity among pediatric candidates
Table HR 9. Removal reason among pediatric heart transplant candidates
Table HR 10. Characteristics of pediatric heart transplant recipients, 2002-2005 and 2012-2015
Table HR 11. Pediatric heart recipients on circulatory support before transplant
Table HR 12. Pediatric heart donor-recipient serology matching, 2011-2015

A line plot for new adult candidates added to the heart transplant waiting list; the active category increases by 50.9% from 2318 candidates at 2004 to 3498 candidates at 2015; the inactive category increases by 61.0% from 77 candidates at 2004 to 124 candidates at 2015; and the all category increases by 51.2% from 2395 candidates at 2004 to 3622 candidates at 2015.

Figure HR 1. New adult candidates added to the heart transplant waiting list
A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Candidates concurrently listed at multiple centers are counted once. Active and inactive patients are included.


A line plot for adults listed for heart transplant on december 31 each year; the active category increases by 90.4% from 1525 candidates at 2004 to 2904 candidates at 2015; the inactive category decreases by 38.7% from 1448 candidates at 2004 to 887 candidates at 2015; and the all category increases by 27.5% from 2973 candidates at 2004 to 3791 candidates at 2015.

Figure HR 2. Adults listed for heart transplant on December 31 each year
Candidates concurrently listed at multiple centers are counted once. Those with concurrent listings and active at any program are considered active.


A line plot for distribution of adults waiting for heart transplant by age; the 18 to 34 category decreases by 12.3% from 11.6 percent at 2004 to 10.2 percent at 2015; the 35 to 49 category is 24.5 percent at 2004 and remains relatively constant with a value of 22.7 percent at 2015; the 50 to 64 category is 52.8 percent at 2004 and remains relatively constant with a value of 49.1 percent at 2015; and the greater than or equal to 65 category increases by 62.2% from 11.1 percent at 2004 to 18 percent at 2015.

Figure HR 3. Distribution of adults waiting for heart transplant by age
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Age is determined at the later of listing date or January 1 of the given year. Active and inactive candidates are included.


A line plot for distribution of adults waiting for heart transplant by race; the white category decreases by 15.8% from 74.3 percent at 2004 to 62.6 percent at 2015; the black category increases by 62.1% from 15.4 percent at 2004 to 24.9 percent at 2015; the hispanic category increases by 13.8% from 7.4 percent at 2004 to 8.4 percent at 2015; the asian category increases by 45.9% from 2.4 percent at 2004 to 3.4 percent at 2015; and the other/unknown category increases by 15.7% from 0.6 percent at 2004 to 0.7 percent at 2015.

Figure HR 4. Distribution of adults waiting for heart transplant by race
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive candidates are included.


A line plot for distribution of adults waiting for heart transplant by diagnosis; the cad category decreases by 21.1% from 42.2 percent at 2004 to 33.3 percent at 2015; the cardiomyopathy category increases by 27.2% from 45.4 percent at 2004 to 57.8 percent at 2015; the congenital category decreases by 13.4% from 3.8 percent at 2004 to 3.3 percent at 2015; the valvular category decreases by 55.8% from 2.5 percent at 2004 to 1.1 percent at 2015; and the other/unknown category decreases by 25.5% from 6.1 percent at 2004 to 4.5 percent at 2015.

Figure HR 5. Distribution of adults waiting for heart transplant by diagnosis
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive patients are included. CAD, coronary artery disease.


A line plot for distribution of adults waiting for heart transplant by waiting time; the less than 1 year category increases by 18.7% from 50.5 percent at 2004 to 59.9 percent at 2015; the 1 to less than 2 category increases by 45.6% from 13.8 percent at 2004 to 20.1 percent at 2015; the 2 to less than 3 category is 8.3 percent at 2004 and remains relatively constant with a value of 8.7 percent at 2015; the 3 to less than 4 category decreases by 33.5% from 6.6 percent at 2004 to 4.4 percent at 2015; the 4 to less than 5 category decreases by 54.2% from 5.4 percent at 2004 to 2.5 percent at 2015; and the greater than or equal to 5 category decreases by 71.1% from 15.5 percent at 2004 to 4.5 percent at 2015.

Figure HR 6. Distribution of adults waiting for heart transplant by waiting time
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Time on the waiting list is determined at the earlier of December 31 or removal from the waiting list. Active and inactive candidates are included.


A line plot for distribution of adults waiting for heart transplant by medical urgency; the status 1a category increases by 99.7% from 22 percent at 2004 to 43.9 percent at 2015; the status 1b category increases by 95.2% from 15.8 percent at 2004 to 30.9 percent at 2015; the status 2 category decreases by 53.6% from 37.3 percent at 2004 to 17.3 percent at 2015; and the inactive category decreases by 68.1% from 24.9 percent at 2004 to 8 percent at 2015.

Figure HR 7. Distribution of adults waiting for heart transplant by medical urgency
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Medical urgency status is the most severe during the year. Active and inactive patients are included.


A line plot for distribution of adults waiting for heart transplant by vad status at listing; the no vad category decreases by 23.0% from 91.7 percent at 2004 to 70.6 percent at 2015; and the vad category increases by 253.5% from 8.3 percent at 2004 to 29.4 percent at 2015.

Figure HR 8. Distribution of adults waiting for heart transplant by VAD status at listing
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive patients are included. VAD, ventricular assist device.


A line plot for distribution of adults waiting for heart transplant by sex; the male category is 75.4 percent at 2004 and remains relatively constant with a value of 75.5 percent at 2015; and the female category is 24.6 percent at 2004 and remains relatively constant with a value of 24.5 percent at 2015.

Figure HR 9. Distribution of adults waiting for heart transplant by sex
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive patients are included.


A line plot for distribution of adults waiting for heart transplant by blood type; the a category is 34.4 percent at 2004 and remains relatively constant with a value of 33.9 percent at 2015; the b category increases by 14.8% from 11.4 percent at 2004 to 13.1 percent at 2015; the ab category increases by 28.6% from 2.9 percent at 2004 to 3.7 percent at 2015; and the o category is 51.3 percent at 2004 and remains relatively constant with a value of 49.3 percent at 2015.

Figure HR 10. Distribution of adults waiting for heart transplant by blood type
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive patients are included.


A line plot for deceased donor heart transplant rates among active adult waitlist candidates by age; the 18 to 34 category decreases by 32.8% from 106.9 transplants per 100 wait-list years at 2004 to 71.8 transplants per 100 wait-list years at 2015; the 35 to 49 category decreases by 28.3% from 106.6 transplants per 100 wait-list years at 2004 to 76.4 transplants per 100 wait-list years at 2015; the 50 to 64 category decreases by 20.6% from 101.2 transplants per 100 wait-list years at 2004 to 80.3 transplants per 100 wait-list years at 2015; and the greater than or equal to 65 category decreases by 26.2% from 114.8 transplants per 100 wait-list years at 2004 to 84.8 transplants per 100 wait-list years at 2015.

Figure HR 11. Deceased donor heart transplant rates among active adult waitlist candidates by age
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active wait time in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year. Rates with less than 10 patient-years of exposure are not shown.


A line plot for deceased donor heart transplant rates among active adult waitlist candidates by blood type; the a category decreases by 32.2% from 147.1 transplants per 100 wait-list years at 2004 to 99.7 transplants per 100 wait-list years at 2015; the b category decreases by 33.8% from 166.7 transplants per 100 wait-list years at 2004 to 110.3 transplants per 100 wait-list years at 2015; the ab category decreases by 23.4% from 368.1 transplants per 100 wait-list years at 2004 to 281.8 transplants per 100 wait-list years at 2015; and the o category decreases by 18.5% from 68.1 transplants per 100 wait-list years at 2004 to 55.5 transplants per 100 wait-list years at 2015.

Figure HR 12. Deceased donor heart transplant rates among active adult waitlist candidates by blood type
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active wait time in a given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for deceased donor heart transplant rates among active adult waitlist candidates by medical urgency; the status 1a category decreases by 55.8% from 919.6 transplants per 100 wait-list years at 2004 to 406.1 transplants per 100 wait-list years at 2015; the status 1b category decreases by 77.0% from 187.6 transplants per 100 wait-list years at 2004 to 43.1 transplants per 100 wait-list years at 2015; the status 2 category decreases by 82.1% from 39.2 transplants per 100 wait-list years at 2004 to 7 transplants per 100 wait-list years at 2015; and the all category decreases by 24.0% from 104.3 transplants per 100 wait-list years at 2004 to 79.3 transplants per 100 wait-list years at 2015.

Figure HR 13. Deceased donor heart transplant rates among active adult waitlist candidates by medical urgency
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active wait time in a given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for three-year outcomes for adults waiting for heart transplant, new listings in 2012; the still waiting category decreases by 90.6% from 99.9 percent at 0 Months postlisting to 9.4 percent at 36 Months postlisting; the removed from list category increases by 40800.0% from 0 percent at 0 Months postlisting to 13.5 percent at 36 Months postlisting; the died category increases by 15150.0% from 0.1 percent at 0 Months postlisting to 10.1 percent at 36 Months postlisting; and the dd transplant category increases by 202500.0% from 0 percent at 0 Months postlisting to 67 percent at 36 Months postlisting.

Figure HR 14. Three-year outcomes for adults waiting for heart transplant, new listings in 2012
Adults waiting for heart transplant and first listed in 2012. Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. DD, deceased donor.


A line plot for median months to heart transplant for waitlisted adults by sex; the male category increases by 142.6% from 5.6 median months to transplant at 2004-2005 to 13.5 median months to transplant at 2014-2015; the female category increases by 102.7% from 4.9 median months to transplant at 2004-2005 to 9.9 median months to transplant at 2014-2015; and the all category increases by 133.5% from 5.3 median months to transplant at 2004-2005 to 12.4 median months to transplant at 2014-2015.

Figure HR 15. Median months to heart transplant for waitlisted adults by sex
Observations censored on December 31, 2015; Kaplan-Meier competing risk methods used to estimate time to transplant. Analysis performed per candidate, not per listing. If an estimate is not plotted, 50% of the cohort listed in that year had not undergone transplant by the censoring date. Only the first transplant is counted.


A line plot for median months to heart transplant for waitlisted adults by blood type; the a category increases by 145.6% from 3.3 median months to transplant at 2004-2005 to 8.1 median months to transplant at 2014-2015; the b category increases by 136.3% from 3.3 median months to transplant at 2004-2005 to 7.7 median months to transplant at 2014-2015; the ab category increases by 89.1% from 1.5 median months to transplant at 2004-2005 to 2.9 median months to transplant at 2014-2015; and the o category increases by 100.6% from 11.1 median months to transplant at 2004-2005 to 22.3 median months to transplant at 2014-2015.

Figure HR 16. Median months to heart transplant for waitlisted adults by blood type
Observations censored on December 31, 2015; Kaplan-Meier competing risk methods used to estimate time to transplant. Analysis performed per candidate, not per listing. If an estimate is not plotted, 50% of the cohort listed in that year had not undergone transplant by the censoring date. Only the first transplant is counted.


A line plot for median months to heart transplant for waitlisted adults by medical urgency at listing; the status 1a category increases by 94.8% from 1.9 median months to transplant at 2004-2005 to 3.7 median months to transplant at 2014-2015; the status 1b category increases by 319.3% from 2.7 median months to transplant at 2004-2005 to 11.4 median months to transplant at 2014-2015; and the status 2 category increases by 136.6% from 9.7 median months to transplant at 2004-2005 to 22.9 median months to transplant at 2014-2015.

Figure HR 17. Median months to heart transplant for waitlisted adults by medical urgency at listing
Observations censored on December 31, 2015; Kaplan-Meier competing risk methods used to estimate time to transplant. Analysis performed per candidate, not per listing. If an estimate is not plotted, 50% of the cohort listed in that year had not undergone transplant by the censoring date. Only the first transplant is counted.


A line plot for median months to heart transplant for waitlisted adults by bmi at listing; the less than or equal to 23 kg/m2 category increases by 98.0% from 3.2 median months to transplant at 2004-2005 to 6.4 median months to transplant at 2014-2015; the 24 to 26 category increases by 168.5% from 3.6 median months to transplant at 2004-2005 to 9.8 median months to transplant at 2014-2015; the 27 to 30 category increases by 116.5% from 6 median months to transplant at 2004-2005 to 12.9 median months to transplant at 2014-2015; and the greater than or equal to 31 category increases by 90.2% from 10.8 median months to transplant at 2004-2005 to 20.5 median months to transplant at 2014-2015.

Figure HR 18. Median months to heart transplant for waitlisted adults by BMI at listing
Observations censored on December 31, 2015; Kaplan-Meier competing risk methods used to estimate time to transplant. Analysis performed per candidate, not per listing. If an estimate is not plotted, 50% of the cohort listed in that year had not undergone transplant by the censoring date. Only the first transplant is counted.


A line plot for percentage of adults who underwent deceased donor heart transplant within a given time period of listing; the 3 to month category decreases by 29.6% from 37.3 percent at 2004 to 26.3 percent at 2014; the 6 to month category decreases by 25.3% from 49.2 percent at 2004 to 36.8 percent at 2014; the 1 to year category decreases by 20.0% from 60.2 percent at 2004 to 48.2 percent at 2014; the 3 to year category is 67.5 percent at 2004 and remains relatively constant with a value of 66.1 percent at 2012; the 5 to year category is 68.4 percent at 2004 and remains relatively constant with a value of 67.2 percent at 2010; and the 10 to year category is 69 percent at 2004 and remains relatively constant with a value of 72.2 percent at 2005.

Figure HR 19. Percentage of adults who underwent deceased donor heart transplant within a given time period of listing
Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal.


A map of percentage of adults who underwent deceased donor heart transplant within 1 year of listing in 2014 by dsa, the values range from 14.29 to 100.00.

Figure HR 20. Percentage of adults who underwent deceased donor heart transplant within 1 year of listing in 2014 by DSA
Candidates listed concurrently in a single DSA are counted once in that DSA, from the time of earliest listing to the time of latest removal; candidates listed in multiple DSAs are counted separately per DSA.


A line plot for pretransplant mortality rates among adults waitlisted for heart transplant by age; the 18 to 34 category decreases by 45.8% from 15.7 deaths per 100 wait-list years at 2004-2005 to 8.5 deaths per 100 wait-list years at 2014-2015; the 35 to 49 category decreases by 35.3% from 13.9 deaths per 100 wait-list years at 2004-2005 to 9 deaths per 100 wait-list years at 2014-2015; the 50 to 64 category decreases by 19.5% from 14.1 deaths per 100 wait-list years at 2004-2005 to 11.4 deaths per 100 wait-list years at 2014-2015; the greater than or equal to 65 category decreases by 36.5% from 18.5 deaths per 100 wait-list years at 2004-2005 to 11.7 deaths per 100 wait-list years at 2014-2015; and the all category decreases by 28.3% from 14.7 deaths per 100 wait-list years at 2004-2005 to 10.6 deaths per 100 wait-list years at 2014-2015.

Figure HR 21. Pretransplant mortality rates among adults waitlisted for heart transplant by age
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown. Age is determined at the later of listing date or January 1 of the given year.


A line plot for pretransplant mortality rates among adults waitlisted for heart transplant by race; the white category decreases by 28.6% from 14.9 deaths per 100 wait-list years at 2004-2005 to 10.6 deaths per 100 wait-list years at 2014-2015; the black category decreases by 32.6% from 14.8 deaths per 100 wait-list years at 2004-2005 to 10 deaths per 100 wait-list years at 2014-2015; the hispanic category decreases by 19.0% from 13.3 deaths per 100 wait-list years at 2004-2005 to 10.8 deaths per 100 wait-list years at 2014-2015; and the asian category decreases by 17.0% from 15.8 deaths per 100 wait-list years at 2004-2005 to 13.1 deaths per 100 wait-list years at 2014-2015.

Figure HR 22. Pretransplant mortality rates among adults waitlisted for heart transplant by race
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for pretransplant mortality rates among adults waitlisted for heart transplant by sex; the male category decreases by 29.8% from 14.5 deaths per 100 wait-list years at 2004-2005 to 10.2 deaths per 100 wait-list years at 2014-2015; and the female category decreases by 23.4% from 15.5 deaths per 100 wait-list years at 2004-2005 to 11.9 deaths per 100 wait-list years at 2014-2015.

Figure HR 23. Pretransplant mortality rates among adults waitlisted for heart transplant by sex
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for pretransplant mortality rates among adults waitlisted for heart transplant by diagnosis; the cad category decreases by 28.8% from 14.6 deaths per 100 wait-list years at 2004-2005 to 10.4 deaths per 100 wait-list years at 2014-2015; the cardiomyopathy category decreases by 27.5% from 13.5 deaths per 100 wait-list years at 2004-2005 to 9.8 deaths per 100 wait-list years at 2014-2015; the congential category is 15.2 deaths per 100 wait-list years at 2004-2005 and remains relatively constant with a value of 13.7 deaths per 100 wait-list years at 2014-2015; the valvular category is 16.1 deaths per 100 wait-list years at 2004-2005 and remains relatively constant with a value of 15.2 deaths per 100 wait-list years at 2014-2015; and the other/unknown category decreases by 25.9% from 24 deaths per 100 wait-list years at 2004-2005 to 17.8 deaths per 100 wait-list years at 2014-2015.

Figure HR 24. Pretransplant mortality rates among adults waitlisted for heart transplant by diagnosis
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown. CAD, coronary artery disease.


A line plot for pretransplant mortality rates among adults waitlisted for heart transplant by medical urgency; the status 1a category decreases by 83.3% from 98.6 deaths per 100 wait-list years at 2004-2005 to 16.4 deaths per 100 wait-list years at 2014-2015; the status 1b category decreases by 79.8% from 22.3 deaths per 100 wait-list years at 2004-2005 to 4.5 deaths per 100 wait-list years at 2014-2015; the status 2 category decreases by 47.7% from 6.7 deaths per 100 wait-list years at 2004-2005 to 3.5 deaths per 100 wait-list years at 2014-2015; and the inactive category increases by 72.2% from 15.5 deaths per 100 wait-list years at 2004-2005 to 26.8 deaths per 100 wait-list years at 2014-2015.

Figure HR 25. Pretransplant mortality rates among adults waitlisted for heart transplant by medical urgency
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for pretransplant mortality rates among adults waitlisted for heart transplant by vad at listing; the no vad category decreases by 12.4% from 13.1 deaths per 100 wait-list years at 2004-2005 to 11.4 deaths per 100 wait-list years at 2014-2015; and the vad at listing category decreases by 82.1% from 47.3 deaths per 100 wait-list years at 2004-2005 to 8.5 deaths per 100 wait-list years at 2014-2015.

Figure HR 26. Pretransplant mortality rates among adults waitlisted for heart transplant by VAD at listing
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown. VAD, ventricular assist device.


A map of pretransplant mortality rates among adults waitlisted for heart transplant in 2014-2015, by dsa, the values range from 2.93 to 22.80.

Figure HR 27. Pretransplant mortality rates among adults waitlisted for heart transplant in 2014-2015, by DSA
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for deaths within six months after removal among adult heart walitlist candidates; the all category increases by 45.8% from 14.7 percent at 2004 to 21.4 percent at 2015; the status 1a category decreases by 33.3% from 72.2 percent at 2004 to 48.1 percent at 2015; the status 1b category decreases by 58.4% from 62.5 percent at 2004 to 26 percent at 2015; the status 2 category decreases by 29.1% from 15.4 percent at 2004 to 10.9 percent at 2015; and the inactive category increases by 137.2% from 8.3 percent at 2004 to 19.7 percent at 2015.

Figure HR 28. Deaths within six months after removal among adult heart walitlist candidates
Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.


A line plot for deceased heart donors by age; the less than 18 category decreases by 16.4% from 22.1 percent at 2004 to 18.5 percent at 2015; the 18 to 34 category increases by 10.1% from 44 percent at 2004 to 48.5 percent at 2015; the 35 to 49 category is 25 percent at 2004 and remains relatively constant with a value of 26.1 percent at 2015; and the greater than or equal to 50 category decreases by 22.0% from 8.9 percent at 2004 to 7 percent at 2015.

Figure HR 29. Deceased heart donors by age
Deceased donors whose hearts were recovered for transplant.


A line plot for deceased heart donors by race; the white category is 67.3 percent at 2004 and remains relatively constant with a value of 60.6 percent at 2015; the black category increases by 48.5% from 12.7 percent at 2004 to 18.8 percent at 2015; the hispanic category is 16.8 percent at 2004 and remains relatively constant with a value of 17.7 percent at 2015; and the other/unknown category decreases by 10.7% from 3.1 percent at 2004 to 2.8 percent at 2015.

Figure HR 30. Deceased heart donors by race
Deceased donors whose hearts were recovered for transplant.


A map of deceased donor heart donation rates (per 1000 deaths) by state, 2012-2014, the values range from 0.09 to 4.94.

Figure HR 31. Deceased donor heart donation rates (per 1000 deaths) by state, 2012-2014
Numerator: Deceased donors aged < 70 years, by state of death, whose heart was recovered for transplant from 2012 through 2014. Denominator: US deaths aged < 70 years, by state of death, from 2012 through 2014. State death data by age obtained through agreement with NAPHSIS (http://www.naphsis.org/programs/vital-statistics-data-research-request-process).


A line plot for rates of hearts recovered for transplant and not transplanted by age; the less than 18 category is 1.2 percent at 2004-2005 and remains relatively constant with a value of 1.2 percent at 2014-2015; the 18 to 34 category decreases by 19.4% from 1.2 percent at 2004-2005 to 1 percent at 2014-2015; the 35 to 49 category increases by 11.9% from 2.7 percent at 2004-2005 to 3.1 percent at 2014-2015; and the greater than or equal to 50 category is 1.2 percent at 2004-2005 and remains relatively constant with a value of 1.1 percent at 2014-2015.

Figure HR 32. Rates of hearts recovered for transplant and not transplanted by age
Percentages of hearts not transplanted out of all hearts recovered for transplant.


A line plot for cause of death among deceased heart donors; the anoxia category increases by 193.3% from 11.2 percent at 2004 to 33 percent at 2015; the cva/stroke category decreases by 31.1% from 23.4 percent at 2004 to 16.1 percent at 2015; the head trauma category decreases by 23.1% from 62.9 percent at 2004 to 48.4 percent at 2015; the cns tumor category decreases by 55.8% from 1 percent at 2004 to 0.4 percent at 2015; and the other category increases by 42.7% from 1.5 percent at 2004 to 2.1 percent at 2015.

Figure HR 33. Cause of death among deceased heart donors
Deceased donors whose hearts were transplanted. CNS, central nervous system; CVA, cerebrovascular accident.


A line plot for total heart transplants; the age less than 18 category increases by 54.9% from 297 transplants at 2004 to 460 transplants at 2015; the age greater than or equal to 18 category increases by 34.2% from 1758 transplants at 2004 to 2359 transplants at 2015; and the all category increases by 37.2% from 2055 transplants at 2004 to 2819 transplants at 2015.

Figure HR 34. Total heart transplants
All heart transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for total heart transplants by age; the less than 18 category increases by 54.9% from 297 transplants at 2004 to 460 transplants at 2015; the 18 to 34 category is 224 transplants at 2004 and remains relatively constant with a value of 227 transplants at 2015; the 35 to 49 category increases by 21.6% from 416 transplants at 2004 to 506 transplants at 2015; the 50 to 64 category increases by 25.8% from 937 transplants at 2004 to 1179 transplants at 2015; and the greater than or equal to 65 category increases by 147.0% from 181 transplants at 2004 to 447 transplants at 2015.

Figure HR 35. Total heart transplants by age
All heart transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for total heart transplants by sex; the male category increases by 35.7% from 1482 transplants at 2004 to 2011 transplants at 2015; and the female category increases by 41.0% from 573 transplants at 2004 to 808 transplants at 2015.

Figure HR 36. Total heart transplants by sex
All heart transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for total heart transplants by race; the white category increases by 19.3% from 1448 transplants at 2004 to 1728 transplants at 2015; the black category increases by 79.5% from 341 transplants at 2004 to 612 transplants at 2015; the hispanic category increases by 68.4% from 187 transplants at 2004 to 315 transplants at 2015; the asian category increases by 128.8% from 59 transplants at 2004 to 135 transplants at 2015; and the other/unknown category increases by 45.0% from 20 transplants at 2004 to 29 transplants at 2015.

Figure HR 37. Total heart transplants by race
All heart transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for total heart transplants by diagnosis; the cad category is 773 transplants at 2004 and remains relatively constant with a value of 831 transplants at 2015; the cardiomyopathy category increases by 63.0% from 993 transplants at 2004 to 1619 transplants at 2015; the congenital category increases by 48.5% from 196 transplants at 2004 to 291 transplants at 2015; the valvular category decreases by 47.7% from 44 transplants at 2004 to 23 transplants at 2015; and the other/unknown category increases by 12.2% from 49 transplants at 2004 to 55 transplants at 2015.

Figure HR 38. Total heart transplants by diagnosis
All heart transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients. CAD, coronary artery disease.


A line plot for induction agent use in adult heart transplant recipients; the il2 to ra category is 26.9 percent at 2004 and remains relatively constant with a value of 27.9 percent at 2015; the t to cell depleting category is 23.8 percent at 2004 and remains relatively constant with a value of 25.3 percent at 2015; and the none category decreases by 10.4% from 52.7 percent at 2004 to 47.2 percent at 2015.

Figure HR 39. Induction agent use in adult heart transplant recipients
Immunosuppression at transplant reported to the OPTN. IL2-RA, interleukin-2 receptor antagonist.


A line plot for calcineurin inhibitor use in adult heart transplant recipients; the cyclosporine category decreases by 94.1% from 49.1 percent at 2004 to 2.9 percent at 2015; and the tacrolimus category increases by 100.0% from 46.3 percent at 2004 to 92.5 percent at 2015.

Figure HR 40. Calcineurin inhibitor use in adult heart transplant recipients
Immunosuppression at transplant reported to the OPTN.


A line plot for anti-metabolite use in adult heart transplant recipients; the azathioprine category decreases by 86.6% from 6.8 percent at 2004 to 0.9 percent at 2015; and the mycophenolate category is 87.9 percent at 2004 and remains relatively constant with a value of 94.1 percent at 2015.

Figure HR 41. Anti-metabolite use in adult heart transplant recipients
Immunosuppression at transplant reported to the OPTN. Mycophenolate includes mycophenolate mofetil and mycophenolate sodium.


A line plot for mtor inhibitor use in adult heart transplant recipients; the at transplant category decreases by 92.4% from 5.1 percent at 2004 to 0.4 percent at 2015; and the 1 year posttransplant category decreases by 36.2% from 12.7 percent at 2004 to 8.1 percent at 2014.

Figure HR 42. mTOR inhibitor use in adult heart transplant recipients
Immunosuppression at transplant reported to the OPTN. One-year posttransplant data are limited to patients alive with graft function at 1 year posttransplant. mTOR, mammalian target of rapamycin.


A line plot for steroid use in adult heart transplant recipients; the at transplant category is 92.2 percent at 2004 and remains relatively constant with a value of 89 percent at 2015; and the 1 year posttransplant category decreases by 13.9% from 92.7 percent at 2004 to 79.8 percent at 2014.

Figure HR 43. Steroid use in adult heart transplant recipients
Immunosuppression at transplant reported to the OPTN. One-year posttransplant data are limited to patients alive with graft function at 1 year posttransplant.


A bar plot for total hla a, b, and dr mismatches among adult deceased donor heart transplant recipients, 2011-2015, the 0 group is 0.12 percent; the 1 group is 0.36 percent; the 2 group is 2.88 percent; the 3 group is 10.30 percent; the 4 group is 23.77 percent; the 5 group is 33.80 percent; the 6 group is 20.48 percent; and the unk. group is 8.29 percent.

Figure HR 44. Total HLA A, B, and DR mismatches among adult deceased donor heart transplant recipients, 2011-2015
Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2015.


A line plot for patient survival among adult heart transplant recipients, 2008-2010, by age; the 18 to 34 category decreases by 26.2% from 100 percent at 0 Months post-transplant to 73.8 percent at 60 Months post-transplant; the 35 to 49 category decreases by 21.5% from 100 percent at 0 Months post-transplant to 78.5 percent at 60 Months post-transplant; the 50 to 64 category decreases by 22.3% from 100 percent at 0 Months post-transplant to 77.7 percent at 60 Months post-transplant; and the greater than or equal to 65 category decreases by 25.1% from 100 percent at 0 Months post-transplant to 74.9 percent at 60 Months post-transplant.

Figure HR 45. Patient survival among adult heart transplant recipients, 2008-2010, by age
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.


A line plot for patient survival among adult heart transplant recipients, 2008-2010, by race; the white category decreases by 21.9% from 100 percent at 0 Months post-transplant to 78.1 percent at 60 Months post-transplant; the black category decreases by 27.8% from 100 percent at 0 Months post-transplant to 72.2 percent at 60 Months post-transplant; the hispanic category decreases by 20.8% from 100 percent at 0 Months post-transplant to 79.2 percent at 60 Months post-transplant; the asian category decreases by 22.4% from 100 percent at 0 Months post-transplant to 77.6 percent at 60 Months post-transplant; and the other/unknown category decreases by 23.3% from 100 percent at 0 Months post-transplant to 76.7 percent at 60 Months post-transplant.

Figure HR 46. Patient survival among adult heart transplant recipients, 2008-2010, by race
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.


A line plot for patient survival among adult heart transplant recipients, 2008-2010, by sex; the female category decreases by 22.8% from 100 percent at 0 Months post-transplant to 77.2 percent at 60 Months post-transplant; the male category decreases by 23.1% from 100 percent at 0 Months post-transplant to 76.9 percent at 60 Months post-transplant; and the all category decreases by 23.0% from 100 percent at 0 Months post-transplant to 77 percent at 60 Months post-transplant.

Figure HR 47. Patient survival among adult heart transplant recipients, 2008-2010, by sex
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.


A line plot for patient survival among adult heart transplant recipients, 2008-2010, by circulatory support; the vad category decreases by 23.8% from 100 percent at 0 Months post-transplant to 76.2 percent at 60 Months post-transplant; the iabp category decreases by 23.6% from 100 percent at 0 Months post-transplant to 76.4 percent at 60 Months post-transplant; and the neither category decreases by 22.4% from 100 percent at 0 Months post-transplant to 77.6 percent at 60 Months post-transplant.

Figure HR 48. Patient survival among adult heart transplant recipients, 2008-2010, by circulatory support
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered. Ventricular assist device (VAD) status at time of transplant. IABP, intra-aortic balloon pump.


A line plot for patient survival among adult heart transplant recipients, 2008-2010, by first vs. retransplant; the first tx category decreases by 23.0% from 100 percent at 0 Months post-transplant to 77 percent at 60 Months post-transplant; and the re to tx category decreases by 25.5% from 100 percent at 0 Months post-transplant to 74.5 percent at 60 Months post-transplant.

Figure HR 49. Patient survival among adult heart transplant recipients, 2008-2010, by first vs. retransplant
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.


A line plot for patient survival among adult heart transplant recipients, 2008-2010, by medical urgency; the status 1a category decreases by 23.0% from 100 percent at 0 Months post-transplant to 77 percent at 60 Months post-transplant; the status 1b category decreases by 22.7% from 100 percent at 0 Months post-transplant to 77.3 percent at 60 Months post-transplant; and the status 2 category decreases by 24.1% from 100 percent at 0 Months post-transplant to 75.9 percent at 60 Months post-transplant.

Figure HR 50. Patient survival among adult heart transplant recipients, 2008-2010, by medical urgency
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.


A line plot for patient death among adult heart transplant recipients; the 6 to month category decreases by 39.8% from 14.2 percent at 1992 to 8.6 percent at 2014; the 1 to year category decreases by 42.0% from 18.1 percent at 1992 to 10.5 percent at 2014; the 3 to year category decreases by 39.2% from 26.8 percent at 1992 to 16.3 percent at 2012; the 5 to year category decreases by 36.7% from 33.9 percent at 1992 to 21.5 percent at 2010; and the 10 to year category decreases by 24.7% from 54.5 percent at 1992 to 41.1 percent at 2005.

Figure HR 51. Patient death among adult heart transplant recipients
All adult recipients of deceased donor hearts, including multi-organ transplants. Patients are followed until the earlier of death or December 31, 2015. Estimates computed with Cox proportional hazards models adjusted for age, sex, and race.


A line plot for recipients alive with a functioning heart graft on june 30 of the year, by age at transplant; the less than 18 category increases by 85.4% from 2.5 patients (in thousands) at 2004 to 4.7 patients (in thousands) at 2015; the 18 to 49 category increases by 33.5% from 6.7 patients (in thousands) at 2004 to 8.9 patients (in thousands) at 2015; the greater than or equal to 50 category increases by 35.6% from 11.5 patients (in thousands) at 2004 to 15.5 patients (in thousands) at 2015; and the all category increases by 41.1% from 20.7 patients (in thousands) at 2004 to 29.2 patients (in thousands) at 2015.

Figure HR 52. Recipients alive with a functioning heart graft on June 30 of the year, by age at transplant
Recipients are assumed to be alive with function unless a death or graft failure is recorded. A recipient may experience a graft failure and be removed from the cohort, undergo retransplant, and re-enter the cohort.


A bar plot for incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by age, the 18 to 34 age group is 30.11 percent for 2009-10, 32.58 percent for 2011 to 12, and 30.24 percent for 2013 to 14; the 35 to 49 age group is 29.43 percent for 2009-10, 27.33 percent for 2011 to 12, and 26.22 percent for 2013 to 14; the 50 to 64 age group is 23.10 percent for 2009-10, 22.61 percent for 2011 to 12, and 21.98 percent for 2013 to 14; the greater than or equal to 65 age group is 22.17 percent for 2009-10, 18.77 percent for 2011 to 12, and 18.33 percent for 2013 to 14; and the all age group is 25.15 percent for 2009-10, 24.02 percent for 2011 to 12, and 22.98 percent for 2013 to 14.

Figure HR 53. Incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by age
Acute rejection is defined as a record of acute or hyperacute rejection, as reported on the OPTN Transplant Recipient Registration or Transplant Recipient Follow-up Form. Only the first rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier competing risk method.


A line plot for incidence of ptld among adult heart transplant recipients by recipient ebv status at transplant, 2009-2013; the ebv to category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; the ebv+ category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; the ebv unknown category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; and the all category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant.

Figure HR 54. Incidence of PTLD among adult heart transplant recipients by recipient EBV status at transplant, 2009-2013
Cumulative incidence is estimated using the Kaplan-Meier competing risk method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.


A line plot for one-year cumulative incidence of death by cause among adult heart recipients, 2013-2014; the graft failure category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant; the infection category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant; the cardio/cerebrovascular category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant; the malignancy category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant; and the respiratory category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant.

Figure HR 55. One-year cumulative incidence of death by cause among adult heart recipients, 2013-2014
Primary cause of death is as reported on the OPTN Transplant Recipient Registration and Follow-up Forms. Other causes of death include hemorrhage, trauma, nonadherence, unspecified other, unknown, etc. Cumulative incidence is estimated using Kaplan-Meier competing risk methods.


A line plot for five-year cumulative incidence of death by cause among adult heart recipients, 2009-2010; the graft failure category is 0 percent at 0 and is percent at 5; the infection category is 0 percent at 0 and is percent at 5; the cardio/cerebrovascular category is 0 percent at 0 and is percent at 5; the malignancy category is 0 percent at 0 and is percent at 5; and the respiratory category is 0 percent at 0 and is percent at 5.

Figure HR 56. Five-year cumulative incidence of death by cause among adult heart recipients, 2009-2010
Primary cause of death is as reported on the OPTN Transplant Recipient Registration and Follow-up Forms. Other causes of death include hemorrhage, trauma, nonadherence, unspecified other, unknown, etc. Cumulative incidence is estimated using Kaplan-Meier competing risk methods.


A line plot for new pediatric candidates added to the heart transplant waiting list; the active category increases by 40.2% from 448 candidates at 2004 to 628 candidates at 2015; the inactive category increases by 433.3% from 3 candidates at 2004 to 16 candidates at 2015; and the all category increases by 42.8% from 451 candidates at 2004 to 644 candidates at 2015.

Figure HR 57. New pediatric candidates added to the heart transplant waiting list
A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Candidates concurrently listed at multiple centers are counted once. Active and inactive patients are included. Age determined at listing.


A line plot for pediatric candidates listed for heart transplant on december 31 each year; the active category increases by 75.0% from 132 candidates at 2004 to 231 candidates at 2015; the inactive category decreases by 23.2% from 181 candidates at 2004 to 139 candidates at 2015; and the all category increases by 18.2% from 313 candidates at 2004 to 370 candidates at 2015.

Figure HR 58. Pediatric candidates listed for heart transplant on December 31 each year
Candidates concurrently listed at multiple centers are counted once. Those with concurrent listings and active at any program are considered active.


A line plot for distribution of pediatric candidates waiting for heart transplant by age; the less than 1 category is 23.7 percent at 2004 and remains relatively constant with a value of 25.8 percent at 2015; the 1 to 5 category is 25.4 percent at 2004 and remains relatively constant with a value of 24.2 percent at 2015; the 6 to 10 category is 15.6 percent at 2004 and remains relatively constant with a value of 16 percent at 2015; and the 11 to 17 category is 35.4 percent at 2004 and remains relatively constant with a value of 34 percent at 2015.

Figure HR 59. Distribution of pediatric candidates waiting for heart transplant by age
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Age is determined at the later of listing date or January 1 of the given year. Active and inactive candidates are included.


A line plot for distribution of pediatric candidates waiting for heart transplant by race; the white category is 57.5 percent at 2004 and remains relatively constant with a value of 53.8 percent at 2015; the black category decreases by 18.0% from 21.1 percent at 2004 to 17.3 percent at 2015; the hispanic category increases by 31.2% from 16.1 percent at 2004 to 21.2 percent at 2015; the asian category increases by 41.8% from 3.6 percent at 2004 to 5.2 percent at 2015; and the other/unknown category increases by 52.7% from 1.7 percent at 2004 to 2.6 percent at 2015.

Figure HR 60. Distribution of pediatric candidates waiting for heart transplant by race
Candidates waiting for transplant any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive candidates are included.


A line plot for distribution of pediatric candidates waiting for heart transplant by diagnosis; the congenital category is 44.6 percent at 2004 and remains relatively constant with a value of 48.6 percent at 2015; the dilated cm: idiopathic category decreases by 20.4% from 24.6 percent at 2004 to 19.6 percent at 2015; the restrictive cm: idiopathic category increases by 27.3% from 3.5 percent at 2004 to 4.5 percent at 2015; the dilated cm: myocarditis category is 3.3 percent at 2004 and remains relatively constant with a value of 3 percent at 2015; and the other/unknown category is 24.1 percent at 2004 and remains relatively constant with a value of 24.4 percent at 2015.

Figure HR 61. Distribution of pediatric candidates waiting for heart transplant by diagnosis
Candidates waiting for transplant any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive candidates are included. CM, cardiomyopathy.


A line plot for distribution of pediatric candidates waiting for heart transplant by waiting time; the less than 1 year category increases by 11.6% from 68.3 percent at 2004 to 76.2 percent at 2015; the 1 to less than 2 category increases by 30.6% from 8.1 percent at 2004 to 10.5 percent at 2015; the 2 to less than 4 category decreases by 27.7% from 9.8 percent at 2004 to 7.1 percent at 2015; and the greater than or equal to 4 category decreases by 55.0% from 13.9 percent at 2004 to 6.3 percent at 2015.

Figure HR 62. Distribution of pediatric candidates waiting for heart transplant by waiting time
Candidates waiting for transplant any time in the given year. Candidates listed concurrently at multiple centers are counted once. Time on the waiting list is determined at the earlier of December 31 or removal from the waiting list. Active and inactive candidates are included.


A line plot for distribution of pediatric candidates waiting for heart transplant by medical urgency; the status 1a category increases by 41.6% from 48.9 percent at 2004 to 69.2 percent at 2015; the status 1b category increases by 26.0% from 7.8 percent at 2004 to 9.8 percent at 2015; the status 2 category decreases by 47.6% from 20.3 percent at 2004 to 10.6 percent at 2015; and the inactive category decreases by 55.1% from 23 percent at 2004 to 10.3 percent at 2015.

Figure HR 63. Distribution of pediatric candidates waiting for heart transplant by medical urgency
Candidates waiting for transplant any time in the given year. Candidates listed concurrently at multiple centers are counted once. Medical urgency status is the most severe during the year. Active and inactive patients are included.


A line plot for three-year outcomes for newly listed pediatric candidates waiting for heart transplant, 2012; the still waiting category decreases by 95.7% from 99.6 percent at 0 Months postlisting to 4.3 percent at 36 Months postlisting; the removed from list category increases by 6200.0% from 0.2 percent at 0 Months postlisting to 11.7 percent at 36 Months postlisting; the died category increases by 5100.0% from 0.2 percent at 0 Months postlisting to 9.7 percent at 36 Months postlisting; and the dd transplant category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting.

Figure HR 64. Three-year outcomes for newly listed pediatric candidates waiting for heart transplant, 2012
Candidates aged 0-11 who joined the heart or heart-lung waitlist in 2012. Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. DD, deceased donor.


A line plot for heart transplant rates among active pediatric waitlist candidates by age; the less than 1 category increases by 14.4% from 350.6 transplants per 100 wait-list years at 2004 to 400.9 transplants per 100 wait-list years at 2015; the 1 to 5 category decreases by 43.6% from 291.5 transplants per 100 wait-list years at 2004 to 164.4 transplants per 100 wait-list years at 2015; the 6 to 10 category decreases by 41.0% from 230.7 transplants per 100 wait-list years at 2004 to 136.1 transplants per 100 wait-list years at 2015; the 11 to 17 category decreases by 14.8% from 219.2 transplants per 100 wait-list years at 2004 to 186.7 transplants per 100 wait-list years at 2015; and the all category decreases by 22.5% from 244 transplants per 100 wait-list years at 2004 to 189 transplants per 100 wait-list years at 2015.

Figure HR 65. Heart transplant rates among active pediatric waitlist candidates by age
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active waiting in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year. Rates with less than 10 patient-years of exposure are not shown.


A line plot for pretransplant mortality rates among pediatrics waitlisted for heart transplant by age; the less than 1 category decreases by 38.8% from 70.1 deaths per 100 wait-list years at 2004-2005 to 42.9 deaths per 100 wait-list years at 2014-2015; the 1 to 5 category is 17.1 deaths per 100 wait-list years at 2004-2005 and remains relatively constant with a value of 18.5 deaths per 100 wait-list years at 2014-2015; the 6 to 10 category decreases by 11.5% from 19 deaths per 100 wait-list years at 2004-2005 to 16.8 deaths per 100 wait-list years at 2014-2015; the 11 to 17 category decreases by 55.3% from 18.5 deaths per 100 wait-list years at 2004-2005 to 8.3 deaths per 100 wait-list years at 2014-2015; and the all category decreases by 22.5% from 28.2 deaths per 100 wait-list years at 2004-2005 to 21.8 deaths per 100 wait-list years at 2014-2015.

Figure HR 66. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by age
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year. Rates with less than 10 patient-years of exposure are not shown.


A line plot for pretransplant mortality rates among pediatrics waitlisted for heart transplant by race; the white category is 22.3 deaths per 100 wait-list years at 2004-2005 and remains relatively constant with a value of 24 deaths per 100 wait-list years at 2014-2015; the black category decreases by 24.9% from 39.6 deaths per 100 wait-list years at 2004-2005 to 29.8 deaths per 100 wait-list years at 2014-2015; the hispanic category decreases by 68.6% from 37.6 deaths per 100 wait-list years at 2004-2005 to 11.8 deaths per 100 wait-list years at 2014-2015; and the other/unknown category decreases by 53.9% from 40.2 deaths per 100 wait-list years at 2004-2005 to 18.5 deaths per 100 wait-list years at 2014-2015.

Figure HR 67. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by race
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for pretransplant mortality rates among pediatrics waitlisted for heart transplant by diagnosis; the congenital category decreases by 19.3% from 38.8 deaths per 100 wait-list years at 2004-2005 to 31.3 deaths per 100 wait-list years at 2014-2015; the dilated cm: idiopathic category decreases by 44.9% from 15.9 deaths per 100 wait-list years at 2004-2005 to 8.8 deaths per 100 wait-list years at 2014-2015; the restrictive cm: idiopathic category decreases by 27.2% from 20.2 deaths per 100 wait-list years at 2004-2005 to 14.7 deaths per 100 wait-list years at 2014-2015; the dilated cm: myocarditis category increases by 231.7% from 11.8 deaths per 100 wait-list years at 2004-2005 to 39 deaths per 100 wait-list years at 2014-2015; and the other/unknown category decreases by 55.5% from 27.8 deaths per 100 wait-list years at 2004-2005 to 12.4 deaths per 100 wait-list years at 2014-2015.

Figure HR 68. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by diagnosis
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown. CM, cardiomyopathy.


A line plot for pretransplant mortality rates among pediatrics waitlisted for heart transplant by medical urgency; the status 1a category decreases by 67.8% from 106.1 deaths per 100 wait-list years at 2004-2005 to 34.1 deaths per 100 wait-list years at 2014-2015; the status 1b category decreases by 84.1% from 27.3 deaths per 100 wait-list years at 2004-2005 to 4.3 deaths per 100 wait-list years at 2014-2015; the status 2 category decreases by 94.9% from 12.5 deaths per 100 wait-list years at 2004-2005 to 0.6 deaths per 100 wait-list years at 2014-2015; and the inactive category increases by 61.0% from 19.9 deaths per 100 wait-list years at 2004-2005 to 32 deaths per 100 wait-list years at 2014-2015.

Figure HR 69. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by medical urgency
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for pediatric heart transplants by age; the less than 1 category increases by 76.4% from 72 transplants at 2004 to 127 transplants at 2015; the 1 to 5 category increases by 46.7% from 75 transplants at 2004 to 110 transplants at 2015; the 6 to 10 category increases by 62.2% from 45 transplants at 2004 to 73 transplants at 2015; the 11 to 17 category increases by 42.9% from 105 transplants at 2004 to 150 transplants at 2015; and the all category increases by 54.9% from 297 transplants at 2004 to 460 transplants at 2015.

Figure HR 70. Pediatric heart transplants by age
All pediatric heart transplant recipients, including retransplant, and multi-organ recipients.


A line plot for number of centers performing pediatric and adult heart transplants by center

Figure HR 71. Number of centers performing pediatric and adult heart transplants by center's age mix
Adult centers transplanted only recipients aged 18 years or older. Functionally adult centers transplant 80% adults or more, and the remainder were children aged 15-17 years. Mixed included adults and children of any age groups. Child only centers transplanted recipeints aged 0-17 years, and small number of adults up to age 21 years.


A line plot for induction agent use in pediatric heart transplant recipients; the il2 to ra category is 13.3 percent at 2004 and remains relatively constant with a value of 14.4 percent at 2015; the t to cell depleting category increases by 118.4% from 29.4 percent at 2004 to 64.2 percent at 2015; and the none category decreases by 60.5% from 57.7 percent at 2004 to 22.8 percent at 2015.

Figure HR 72. Induction agent use in pediatric heart transplant recipients
Immunosuppression at transplant reported to the OPTN. IL2-RA, interleukin-2 receptor antagonist.


A line plot for calcineurin inhibitor use in pedatric heart transplant recipients; the cyclosporine category decreases by 82.9% from 49.3 percent at 2004 to 8.4 percent at 2015; and the tacrolimus category increases by 89.4% from 46.9 percent at 2004 to 88.7 percent at 2015.

Figure HR 73. Calcineurin inhibitor use in pedatric heart transplant recipients
Immunosuppression at transplant reported to the OPTN.


A line plot for anti-metabolite use in pedatric heart transplant recipients; the azathioprine category decreases by 91.0% from 26.9 percent at 2004 to 2.4 percent at 2015; and the mycophenolate category increases by 29.9% from 71.7 percent at 2004 to 93.1 percent at 2015.

Figure HR 74. Anti-metabolite use in pedatric heart transplant recipients
Immunosuppression at transplant reported to the OPTN. Mycophenolate includes mycophenolate mofetil and mycophenolate sodium.


A line plot for mtor inhibitor use in pediatric heart transplant recipients; the at transplant category decreases by 77.7% from 5.9 percent at 2004 to 1.3 percent at 2015; and the 1 year posttransplant category increases by 21.6% from 11.3 percent at 2004 to 13.8 percent at 2014.

Figure HR 75. mTOR inhibitor use in pediatric heart transplant recipients
Immunosuppression at transplant reported to the OPTN. One-year posttransplant data are limited to patients alive with graft function at 1 year posttransplant. mTOR, mammalian target of rapamycin.


A line plot for steroid use in pedatric heart transplant recipients; the at transplant category decreases by 22.8% from 77.6 percent at 2004 to 60 percent at 2015; and the 1 year posttransplant category decreases by 23.4% from 76.6 percent at 2004 to 58.7 percent at 2014.

Figure HR 76. Steroid use in pedatric heart transplant recipients
Immunosuppression at transplant reported to the OPTN. One-year posttransplant data are limited to patients alive with graft function at 1 year posttransplant.


A bar plot for induction use by cpra among pediatric heart transplant recipients, 2011-2015, the 0% group is 24.04 percent; the 1-19% group is 21.62 percent; the 20-79% group is 20.48 percent; the 80-100% group is 12.90 percent; and the unknown group is 10.99 percent.

Figure HR 77. Induction use by CPRA among pediatric heart transplant recipients, 2011-2015
Collection of calculated PRA (CPRA) began March 31, 2015. Prior to that, PRA class I and II values were used. IL2-RA, interleukin-2 receptor antagonist.


A bar plot for total hla a, b, and dr mismatches among pediatric deceased donor heart transplant recipients, 2011-2015, the 0 group is 0.10 percent; the 1 group is 0.59 percent; the 2 group is 1.97 percent; the 3 group is 9.62 percent; the 4 group is 22.29 percent; the 5 group is 32.25 percent; the 6 group is 20.36 percent; and the unk. group is 12.82 percent.

Figure HR 78. Total HLA A, B, and DR mismatches among pediatric deceased donor heart transplant recipients, 2011-2015
Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2015.


A bar plot for incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by age, the <6 group is 14.70 percent; the 6-10 group is 32.38 percent; the 11-17 group is 20.34 percent; and the all group is 19.11 percent.

Figure HR 79. Incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by age
Acute rejection is defined as a record of acute or hyperacute rejection, as reported on the OPTN Transplant Recipient Registration Form or Transplant Recipient Follow-up Form. Only the first rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier competing risk method.


A line plot for incidence of ptld among pediatric heart transplant recipients by recipient ebv status at transplant, 2003-2013; the ebv to category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; the ebv+ category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; the ebv unknown category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; and the all category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant.

Figure HR 80. Incidence of PTLD among pediatric heart transplant recipients by recipient EBV status at transplant, 2003-2013
Cumulative incidence is estimated using the Kaplan-Meier competing risk method. Posttransplant lymphoproliferative disorder (PTLD) is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or on the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus.


A line plot for patient death among pediatric heart transplant recipients; the 6 to month category decreases by 64.5% from 20.2 percent at 1992 to 7.2 percent at 2014; the 1 to year category decreases by 57.8% from 22.8 percent at 1992 to 9.6 percent at 2014; the 3 to year category decreases by 64.1% from 29.4 percent at 1992 to 10.6 percent at 2012; the 5 to year category decreases by 55.5% from 33.5 percent at 1992 to 14.9 percent at 2010; and the 10 to year category decreases by 16.6% from 40.2 percent at 1992 to 33.6 percent at 2005.

Figure HR 81. Patient death among pediatric heart transplant recipients
All pediatric recipients of deceased donor hearts, including multi-organ transplants. Patients are followed until the earlier of death or December 31, 2015. Estimates computed with Cox proportional hazards models adjusted for age, sex, and race.


A line plot for patient survival among pediatric deceased donor heart transplant recipients, 2003-2010, by age; the less than 1 category decreases by 28.8% from 100 percent at 0 Months post-transplant to 71.2 percent at 60 Months post-transplant; the 1 to 5 category decreases by 21.6% from 100 percent at 0 Months post-transplant to 78.4 percent at 60 Months post-transplant; the 6 to 10 category decreases by 12.5% from 100 percent at 0 Months post-transplant to 87.5 percent at 60 Months post-transplant; the 11 to 17 category decreases by 22.6% from 100 percent at 0 Months post-transplant to 77.4 percent at 60 Months post-transplant; and the all category decreases by 22.8% from 100 percent at 0 Months post-transplant to 77.2 percent at 60 Months post-transplant.

Figure HR 82. Patient survival among pediatric deceased donor heart transplant recipients, 2003-2010, by age
Recipient survival estimated using unadjusted Kaplan-Meier methods.


A line plot for one-year cumulative incidence of death by cause among pediatric heart recipients, 2013-2014; the graft failure category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant; the infection category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant; the cardio/cerebrovascular category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant; the malignancy category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant; and the respiratory category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant.

Figure HR 83. One-year cumulative incidence of death by cause among pediatric heart recipients, 2013-2014
Primary cause of death is as reported on the OPTN Transplant Recipient Registration and Follow-up Forms. Other causes of death include hemorrhage, trauma, nonadherence, unspecified other, unknown, etc. Cumulative incidence is estimated using Kaplan-Meier competing risk methods.


A line plot for five-year cumulative incidence of death by cause among pediatric heart recipients, 2009-2010; the graft failure category is 0 percent at 0 and is percent at 5; the infection category is 0 percent at 0 and is percent at 5; the cardio/cerebrovascular category is 0 percent at 0 and is percent at 5; the malignancy category is 0 percent at 0 and is percent at 5; and the respiratory category is 0 percent at 0 and is percent at 5.

Figure HR 84. Five-year cumulative incidence of death by cause among pediatric heart recipients, 2009-2010
Primary cause of death is as reported on the OPTN Transplant Recipient Registration and Follow-up Forms. Other causes of death include hemorrhage, trauma, nonadherence, unspecified other, unknown, etc. Cumulative incidence is estimated using Kaplan-Meier competing risk methods.


Table HR 1 Characteristics of adults on the heart transplant waiting list on December 31, 2005 and December 31, 2015
Candidates waiting for transplant on December 31, 2005, and December 31, 2015, regardless of first listing date; active/inactive status is on this date, and multiple listings are not counted. VAD, ventricular assist device.
Characteristic 2005, N 2005, Percent 2015, N 2015, Percent
Age: 18-34 years 296 10.9% 384 10.1%
Age: 35-49 years 627 23.1% 888 23.4%
Age: 50-64 years 1415 52.2% 1847 48.7%
Age: ≥65 years 374 13.8% 672 17.7%
Sex: Female 645 23.8% 880 23.2%
Sex: Male 2067 76.2% 2911 76.8%
Race/ethnicity: White 1976 72.9% 2347 61.9%
Race/ethnicity: Black 439 16.2% 987 26.0%
Race/ethnicity: Hispanic 221 8.1% 331 8.7%
Race/ethnicity: Asian 57 2.1% 105 2.8%
Race/ethnicity: Other/unknown 19 0.7% 21 0.6%
Diagnosis: Coronary artery disease 1112 41.0% 1256 33.1%
Diagnosis: Cardiomyopathy 1213 44.7% 2181 57.5%
Diagnosis: Congenital disease 153 5.6% 141 3.7%
Diagnosis: Valvular disease 77 2.8% 43 1.1%
Diagnosis: Other/unknown 157 5.8% 170 4.5%
Transplant history: First 2628 96.9% 3681 97.1%
Transplant history: Retransplant 84 3.1% 110 2.9%
Blood type: A 814 30.0% 1186 31.3%
Blood type: B 257 9.5% 446 11.8%
Blood type: AB 49 1.8% 79 2.1%
Blood type: O 1592 58.7% 2080 54.9%
Wait time: < 1 year 919 33.9% 1919 50.6%
Wait time: 1-< 2 years 391 14.4% 884 23.3%
Wait time: 2-< 3 years 312 11.5% 415 10.9%
Wait time: 3-< 4 years 224 8.3% 214 5.6%
Wait time: 4-< 5 years 181 6.7% 128 3.4%
Wait time: ≥ 5 years 685 25.3% 231 6.1%
Medical urgency: Status 1A 52 1.9% 380 10.0%
Medical urgency: Status 1B 306 11.3% 1659 43.8%
Medical urgency: Status 2 904 33.3% 865 22.8%
Inactive status 1450 53.5% 887 23.4%
VAD at listing 138 5.1% 1174 31.0%
Tx type: Heart only 2553 94.1% 3531 93.1%
Tx type: Heart-kidney 47 1.7% 179 4.7%
Tx type: Heart-lung 102 3.8% 48 1.3%
Tx type: Other 10 0.4% 33 0.9%
All candidates 2712 100.0% 3791 100.0%



Table HR 2 Heart transplant waitlist activity among adults
Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. Candidates who are listed, undergo transplant, and are relisted are counted more than once. Candidates are not considered to be on the list on the day they are removed; counts on January 1 may differ from counts on December 31 of the prior year. Candidates listed for multi-organ transplants are included.
Waiting list state 2013 2014 2015
Patients at start of year 3058 3339 3626
Patients added during year 3304 3613 3622
Patients removed during year 3018 3318 3457
Patients at end of year 3344 3634 3791



Table HR 3 Removal reason among adult heart transplant candidates
Removal reason as reported to the OPTN. Candidates with death dates that precede removal dates are assumed to have died waiting.
Removal reason 2013 2014 2015
Deceased donor transplant 2109 2229 2330
Patient died 345 375 393
Patient refused transplant 14 22 24
Improved, transplant not needed 146 201 162
Too sick for transplant 223 271 300
Other 181 220 248



Table HR 4 Adult heart recipients on circulatory support before transplant
Patients may have more than one type of circulatory support.
Support 2010, N 2010, Percent 2015, N 2015, Percent
Any life support 1547 76.8% 1990 84.4%
Intravenous inotropes 744 36.9% 856 36.3%
Left ventricular assist device 717 35.6% 1056 44.8%
Intra-aortic balloon pump 101 5.0% 165 7.0%
Ventilator 59 2.9% 23 1.0%
Right ventricular assist device 57 2.8% 51 2.2%
Total artificial heart 26 1.3% 41 1.7%
Extra corporeal membrane oxygenation 20 1.0% 23 1.0%
Inhaled NO 9 0.4% 3 0.1%
Prostaglandins 3 0.1% 2 0.1%



Table HR 5 Characteristics of adult heart transplant recipients, 2005 and 2015
Adult heart transplant recipients, including retransplants. Ventricular assist device (VAD) information is from the OPTN Transplant Recipient Registration Form and includes left VAD, right VAD, total artificial heart, and left + right VAD. Collection of calculated PRA (CPRA) began March 31, 2015. Prior to that, PRA class I and II values were used.
Characteristic 2005, N 2005, Percent 2015, N 2015, Percent
Age: 18-34 years 253 13.7% 227 9.6%
Age: 35-49 years 415 22.5% 506 21.4%
Age: 50-64 years 964 52.4% 1179 50.0%
Age: ≥65 years 209 11.4% 447 18.9%
Sex: Female 451 24.5% 611 25.9%
Sex: Male 1390 75.5% 1748 74.1%
Race/ethnicity: White 1326 72.0% 1483 62.9%
Race/ethnicity: Black 298 16.2% 539 22.8%
Race/ethnicity: Hispanic 142 7.7% 212 9.0%
Race/ethnicity: Asian 61 3.3% 107 4.5%
Race/ethnicity: Other/unknown 14 0.8% 18 0.8%
Diagnosis: Coronary artery disease 816 44.3% 825 35.0%
Diagnosis: Cardiomyopathy 872 47.4% 1400 59.3%
Diagnosis: Congenital disease 64 3.5% 75 3.2%
Diagnosis: Valvular disease 45 2.4% 23 1.0%
Diagnosis: Other/unknown 44 2.4% 36 1.5%
Transplant history: First 1773 96.3% 2291 97.1%
Transplant history: Retransplant 68 3.7% 68 2.9%
Blood type: A 785 42.6% 912 38.7%
Blood type: B 260 14.1% 367 15.6%
Blood type: AB 91 4.9% 151 6.4%
Blood type: O 705 38.3% 929 39.4%
Insurance: Private 1047 56.9% 1149 48.7%
Insurance: Medicare 481 26.1% 819 34.7%
Insurance: Medicaid 217 11.8% 285 12.1%
Insurance: Other government 68 3.7% 68 2.9%
Insurance: Unknown 28 1.5% 38 1.6%
Wait time: < 31 days 558 30.3% 553 23.4%
Wait time: 31-60 days 261 14.2% 311 13.2%
Wait time: 61-90 days 168 9.1% 206 8.7%
Wait time: 3-< 6 months 310 16.8% 394 16.7%
Wait time: 6-< 12 months 266 14.4% 403 17.1%
Wait time: 1-< 2 years 141 7.7% 321 13.6%
Wait time: 2-< 3 years 59 3.2% 99 4.2%
Wait time: ≥ 3 years 78 4.2% 72 3.1%
Medical urgency: Status 1A 609 33.1% 1565 66.3%
Medical urgency: Status 1B 702 38.1% 732 31.0%
Medical urgency: Status 2 530 28.8% 62 2.6%
On VAD 476 25.9% 1141 48.4%
Tx type: Heart only 1752 95.2% 2180 92.4%
Tx type: Heart-lung 30 1.6% 12 0.5%
Tx type: Heart-kidney 53 2.9% 140 5.9%
Tx type: Heart-liver 5 0.3% 27 1.1%
Tx type: Other 1 0.1% 0 0.0%
HLA mismatches: 0 1 0.1% 1 0.0%
HLA mismatches: 1 5 0.3% 7 0.3%
HLA mismatches: 2 44 2.4% 73 3.1%
HLA mismatches: 3 169 9.2% 259 11.0%
HLA mismatches: 4 418 22.7% 564 23.9%
HLA mismatches: 5 590 32.0% 796 33.7%
HLA mismatches: 6 328 17.8% 485 20.6%
HLA mismatches: Unknown 286 15.5% 174 7.4%
CPRA: < 1% 1101 59.8% 1260 53.4%
CPRA: 1-< 20% 309 16.8% 313 13.3%
CPRA: 20-< 80% 217 11.8% 337 14.3%
CPRA: 80-< 98% 42 2.3% 62 2.6%
CPRA: 98-100% 48 2.6% 19 0.8%
CPRA: Unknown 124 6.7% 368 15.6%
All recipients 1841 100.0% 2359 100.0%



Table HR 6 Adult heart donor-recipient serology matching, 2011-2015
Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. If all fields are unknown, incomplete, or pending, the person is categorized as unknown for that serology; otherwise, serology is assumed negative. CMV, cytomegalovirus; EBV, Epstein-Barr virus; HB, hepatitis B; HCV, hepatitis C virus; HIV, human immunodeficiency virus.
Donor Recipient CMV EBV HIV
D- R- 12.3% 0.7% 95.3%
D- R+ 17.8% 4.5% 0.2%
D- R unk 8.3% 0.6% 3.9%
D+ R- 18.9% 10.8% 0.0%
D+ R+ 29.4% 71.9% 0.0%
D+ R unk 13.0% 11.3% 0.0%
D unk R- 0.1% 0.0% 0.6%
D unk R+ 0.1% 0.2% 0.0%
D unk R unk 0.1% 0.0% 0.0%



Table HR 7 Characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2005 and December 31, 2015
Candidates aged younger than 18 years waiting for transplant on December 31, 2005, and December 31, 2015, regardless of first listing date; active/inactive status is on this date, and multiple listings are not counted. CM, cardiomyopathy; VAD, ventricular assist device.
Characteristic 2005, N 2005, Percent 2015, N 2015, Percent
Age: < 1 year 18 7.6% 45 14.0%
Age: 1-5 years 80 33.6% 100 31.2%
Age: 6-10 years 61 25.6% 68 21.2%
Age: 11-17 years 79 33.2% 108 33.6%
Sex: Female 93 39.1% 126 39.3%
Sex: Male 145 60.9% 195 60.7%
Race/ethnicity: White 146 61.3% 158 49.2%
Race/ethnicity: Black 40 16.8% 64 19.9%
Race/ethnicity: Hispanic 39 16.4% 80 24.9%
Race/ethnicity: Asian 10 4.2% 9 2.8%
Race/ethnicity: Other/unknown 3 1.3% 10 3.1%
Diagnosis: Congenital defect 97 40.8% 172 53.6%
Diagnosis: Idiopathic dilated CM 67 28.2% 58 18.1%
Diagnosis: Familial dilated CM 2 0.8% 9 2.8%
Diagnosis: Idiopathic restrictive CM 7 2.9% 16 5.0%
Diagnosis: Myocarditis 15 6.3% 5 1.6%
Diagnosis: Other/unknown 50 21.0% 61 19.0%
Transplant history: First 222 93.3% 304 94.7%
Transplant history: Retransplant 16 6.7% 17 5.3%
Blood type: A 80 33.6% 97 30.2%
Blood type: B 21 8.8% 38 11.8%
Blood type: AB 5 2.1% 5 1.6%
Blood type: O 132 55.5% 181 56.4%
Wait time: < 1 year 103 43.3% 200 62.3%
Wait time: 1-< 2 years 38 16.0% 55 17.1%
Wait time: 2-< 3 years 21 8.8% 28 8.7%
Wait time: 3-< 4 years 19 8.0% 15 4.7%
Wait time: 4-< 5 years 12 5.0% 6 1.9%
Wait time: ≥ 5 years 45 18.9% 17 5.3%
Medical urgency: Status 1A 25 10.5% 105 32.7%
Medical urgency: Status 1B 17 7.1% 43 13.4%
Medical urgency: Status 2 54 22.7% 57 17.8%
Inactive status 142 59.7% 116 36.1%
VAD at listing 5 2.1% 14 4.4%
Tx type: Heart only 215 90.3% 316 98.4%
Tx type: Heart-kidney 1 0.4% 3 0.9%
Tx type: Heart-lung 22 9.2% 1 0.3%
Tx type: Other 0 0.0% 1 0.3%
All candidates 238 100.0% 321 100.0%



Table HR 8 Heart transplant waitlist activity among pediatric candidates
Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. Candidates who are listed, undergo transplant, and are relisted are counted more than once. Candidates are not considered to be on the list on the day they are removed; counts on January 1 may differ from counts on December 31 of the prior year. Candidates listed for multi-organ transplants are included.
Waiting list state 2013 2014 2015
Patients at start of year 328 349 361
Patients added during year 591 593 644
Patients removed during year 568 579 635
Patients at end of year 351 363 370



Table HR 9 Removal reason among pediatric heart transplant candidates
Removal reason as reported to the OPTN. Candidates with death dates that precede removal dates are assumed to have died waiting.
Removal reason 2013 2014 2015
Deceased donor transplant 418 422 463
Patient died 53 77 80
Patient refused transplant 2 1 3
Improved, transplant not needed 47 43 48
Too sick for transplant 30 29 24
Other 18 7 17



Table HR 10 Characteristics of pediatric heart transplant recipients, 2002-2005 and 2012-2015
Heart transplant recipients, including retransplants. Collection of calculated PRA (CPRA) began March 31, 2015. Prior to that, measured PRA values were used. CM, cardiomyopathy; VAD, ventricular assist device.
Characteristic 2002-05, N 2002-05, Percent 2012-15, N 2012-15, Percent
Age: < 1 year 307 25.5% 470 28.4%
Age: 1-5 years 270 22.4% 385 23.3%
Age: 6-10 years 183 15.2% 250 15.1%
Age: 11-17 years 443 36.8% 548 33.2%
Sex: Female 568 47.2% 749 45.3%
Sex: Male 635 52.8% 904 54.7%
Race/ethnicity: White 678 56.4% 891 53.9%
Race/ethnicity: Black 256 21.3% 323 19.5%
Race/ethnicity: Hispanic 189 15.7% 321 19.4%
Race/ethnicity: Asian 56 4.7% 77 4.7%
Race/ethnicity: Other/unknown 24 2.0% 41 2.5%
Diagnosis: Congenital defect 540 44.9% 748 45.3%
Diagnosis: Idiopathic dilated CM 381 31.7% 443 26.8%
Diagnosis: Familial dilated CM 41 3.4% 76 4.6%
Diagnosis: Idiopathic restrictive CM 72 6.0% 91 5.5%
Diagnosis: Myocarditis 30 2.5% 64 3.9%
Diagnosis: Other/unknown 139 11.6% 231 14.0%
Transplant history: First 1110 92.3% 1563 94.6%
Transplant history: Retransplant 93 7.7% 90 5.4%
Blood type: A 489 40.6% 599 36.2%
Blood type: B 147 12.2% 226 13.7%
Blood type: AB 46 3.8% 66 4.0%
Blood type: O 521 43.3% 762 46.1%
ABO: Compatible/identical 1183 98.3% 1592 96.3%
ABO: Incompatible 20 1.7% 61 3.7%
Insurance: Private 606 50.4% 725 43.9%
Insurance: Medicaid 500 41.6% 766 46.3%
Insurance: Other government 63 5.2% 121 7.3%
Insurance: Unknown 34 2.8% 41 2.5%
Wait time: < 31 days 523 43.5% 485 29.3%
Wait time: 31-60 days 235 19.5% 310 18.8%
Wait time: 61-90 days 134 11.1% 228 13.8%
Wait time: 3-< 6 months 177 14.7% 321 19.4%
Wait time: 6-< 12 months 77 6.4% 197 11.9%
Wait time: 1-< 2 years 37 3.1% 75 4.5%
Wait time: 2-< 3 years 11 0.9% 21 1.3%
Wait time: ≥ 3 years 9 0.7% 16 1.0%
Medical urgency: Status 1A 866 72.0% 1465 88.6%
Medical urgency: Status 1B 143 11.9% 134 8.1%
Medical urgency: Status 2 194 16.1% 54 3.3%
On VAD 106 8.8% 407 24.6%
Tx type: Heart only 1171 97.3% 1627 98.4%
Tx type: Heart-lung 22 1.8% 18 1.1%
Tx type: Heart-kidney 9 0.7% 4 0.2%
Tx type: Heart-liver 0 0.0% 4 0.2%
Tx type: Other 1 0.1% 0 0.0%
CPRA: < 1% 633 52.6% 754 45.6%
CPRA: 1-< 20% 171 14.2% 278 16.8%
CPRA: 20-< 80% 104 8.6% 331 20.0%
CPRA: 80-< 98% 46 3.8% 89 5.4%
CPRA: 98-100% 37 3.1% 46 2.8%
CPRA: Unknown 212 17.6% 155 9.4%
All recipients 1203 100.0% 1653 100.0%



Table HR 11 Pediatric heart recipients on circulatory support before transplant
Patients may have more than one type of circulatory support.
Support 2010, N 2010, Percent 2015, N 2015, Percent
Any life support 236 65.6% 316 68.7%
Intravenous inotropes 178 49.4% 224 48.7%
Left ventricular assist device 62 17.2% 99 21.5%
Ventilator 58 16.1% 61 13.3%
Right ventricular assist device 24 6.7% 15 3.3%
Extra corporeal membrane oxygenation 16 4.4% 18 3.9%
Prostaglandins 6 1.7% 9 2.0%
Inhaled NO 3 0.8% 1 0.2%
Intra-aortic balloon pump 1 0.3% 0 0.0%
Total artificial heart 0 0.0% 2 0.4%



Table HR 12 Pediatric heart donor-recipient serology matching, 2011-2015
Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Translant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. If all fields are unknown, incomplete, or pending, the person is categorized as unknown for that serology; otherwise, serology is assumed negative. CMV, cytomegalovirus; EBV, Epstein-Barr virus.
Donor Recipient CMV EBV
D- R- 22.5% 13.3%
D- R+ 14.7% 14.0%
D- R unk 11.0% 1.2%
D+ R- 23.5% 29.7%
D+ R+ 16.9% 38.5%
D+ R unk 10.7% 3.0%
D unk R- 0.5% 0.4%
D unk R+ 0.1% 0.0%
D unk R unk 0.1% 0.0%