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Heart

OPTN/SRTR 2016 Annual Data Report: Heart

Abstract

In 2016, 3209 heart transplants were performed in the United States. New, active listings increased 57% since 2005. The number of adult heart transplant survivors continued to increase, and in 2016, 30,622 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 454 in 2005 to 624 in 2016. The number of pediatric heart transplants performed each year increased from 319 in 2005 to 445 in 2016. Among pediatric patients who underwent transplant in 2015, death occurred in 5.9% at 6 months and 7.2% at 1 year.

Introduction

Since the first heart transplant was performed in the US in 1968, heart transplantation has transitioned from a high-risk experimental procedure to a lifesaving surgery that affords good outcomes and longevity for patients with end-stage heart failure. Survival after heart transplant continues to improve. In addition, patients are surviving long enough to undergo transplant in large part due to mechanical circulatory support. Ventricular assist devices (VADs) have evolved substantially and are currently designed to improve function and longevity. The improved devices and their acceptance as safe bridges to transplant correspond to an increase in the number of candidates listed with mechanical circulatory support. Over one-half of adult heart transplant recipients in 2016 had a VAD at the time of transplant. The proportion of patients undergoing transplant as status 1A and with a VAD has increased substantially. In 2016, the OPTN Board of Directors approved revisions to the heart allocation policy that were designed to more equitably stratify patients and to account for various management strategies. These modifications to the policy will be implemented in 2018. In this report, we discuss the most significant trends in heart transplantation over the past decade.

Adult Heart Transplant

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

Between 2005 and 2016, the number of new active listings for heart transplant increased 57%, from 2240 to 3521 (Figure HR 1). The number of candidates actively awaiting heart transplant increased dramatically over the same period, from 1262 to 2862 (Figure HR 2), an increase of 127%, suggesting that transplant rates have not increased at the same rate as listings. The most remarkable demographic trends in heart transplant include the following: a steady increase in the proportion of heart transplant candidates aged 65 years or older, from 11.9% in 2005 to 18.0% in 2016, with a slight decrease in all other age groups (Figure HR 3); an increase in the proportion of black candidates from 16.4% to 24.9% (Figure HR 4); a decline in the proportion of candidates with coronary artery disease as the etiology for transplant from 41.4% to 32.0%, and an increase in cardiomyopathy from 45.5% to 58.1% (Figure HR 5). The proportion of candidates with extended waiting times decreased. In 2005, 16.2% of candidates waited 5 or more years; this proportion gradually declined to 4.3% in 2016 (Figure HR 6). The proportion of candidates awaiting transplant as status 1A doubled to 44.5% in 2016 (Figure HR 7). The proportion of status 1B candidates increased similarly, while those waiting at status 2 declined from 33.4% to 16.2%. The proportion of candidates with VADs at listing more than tripled in this time period, from 8.9% to 31.7% (Figure HR 8). Notably, sex distribution did not change (Figure HR 9).

Between 2005 and 2016, overall heart transplant rates declined 27.8% from 129.0 to 93.1 per 100 waitlist years (Figure HR 13). Similar reductions occurred for all age groups, blood types, and status groups (Figure HR 11, Figure HR 12, Figure HR 13). Transplant rates peaked for all groups in 2006 and 2007, and reached a nadir in 2014 and 2015. The highest transplant rates were consistently for candidates aged 65 years or older (113.1 per 100 waitlist years), in blood group AB (302.5 per 100 waitlist years), and at status 1A (488.1 per 100 waitlist years). Transplant rates by age group were similar, but varied widely by blood type and medical urgency status. Blood type O candidates underwent transplant at a rate of 64.7 per 100 waitlist years in 2016, nearly half the rate of blood type A and B candidates and 20% of the rate of blood type AB candidates. By status group, transplant rates for status 1B and status 2 candidates declined substantially, from 216.4 to 48.6 per 100 waitlist years, and from 51.0 to 7.4 per 100 waitlist years, respectively.

Concurrent events that may have affected this trend include the OPTN policy allowing patients with LVADs to be listed as status 1A for 30 days; the OPTN broader sharing policy, which changed the heart allocation sequence to prioritize zone A status 1A and 1B candidates over local status 2 candidates, approved by the OPTN Board of Directors in 2002 and 2006, respectively; and the 2008 Food and Drug Administration approval of the HeartMate II LVAD as a bridge to transplant. The broader sharing policy may have resulted in more higher-urgency candidates undergoing transplant. LVADs offer stability on the waiting list, which may have resulted in increased selectivity in choosing organs. The median waiting time in 2015-2016 was 9.4 months, an increase from 4.2 months in 2005-2006 (Figure HR 15). Waiting times peaked in 2013-2014, then declined again. In 2015-2016, median waiting time was longest for blood type O candidates, 17.2 months (Figure HR 16), and 13.6 months for candidates with body mass index ≥ 31 kg/m2 (Figure HR 18). Women waited on average 7.5 months, and men 10.0 months (Figure HR 15). Status 2 candidates had the longest median waiting times, 23.6 months in 2013-2014; fewer than half of status 2 candidates underwent transplant in 2015-2016, and median waiting time was not observed (Figure HR 17). Geographic variability in access to donor hearts remained. Overall, 51.1% of candidates listed in 2015 underwent transplant within 1 year (Figure HR 19); however, the proportion of candidates undergoing transplant within this time frame varied from 15.4% to 100% depending on the donation service area (DSA) (Figure HR 20). Among the 52 DSAs with more than 10 candidates, the proportion of candidates undergoing transplant in less than 1 year ranged from 18.8% to 69.8%.

Among candidates listed in 2013, 51.9% underwent transplant during the first year on the waiting list, 32.7% were still waiting, 8.1% were removed from the list, and 7.2% had died (Figure HR 14). At 3 years, 9.5% had died, 15.6% had been removed from the list, 65.6% had undergone transplant, and 9.4% were still waiting. Thus, within 3 years, most patients undergo transplant and less than 10% die on the waiting list.

Since 2005, pretransplant mortality on the waiting list steadily declined, from 14.6 to 9.7 deaths per 100 waitlist years in 2015-2016. Declines occurred in all age groups and racial/ethnic groups except Asians, whose mortality declined to 9.2 deaths per 100 waitlist years in 2011-2012 and increased to 13.0 deaths per 100 waitlist years in 2015-2016 (Figure HR 21, Figure HR 22). Pretransplant mortality declined notably for candidates with VADs at listing, from 43.2 to 8.0 deaths per 100 waitlist years, lower than the pretransplant mortality among candidates without VADs (10.4 deaths per 100 waitlist years) (Figure HR 26). Pretransplant mortality declined precipitously among status 1A and 1B candidates, from 76.9 deaths per 100 wait-list years in 2005-2006 to 17.3 in 2015-2016, and from 21.3 deaths per 100 waitlist years to 3.4, respectively (Figure HR 25). Of note, pretransplant mortality for status 2 candidates was similar to that for status 1B candidates, 3.1 and 3.4 deaths per 100 waitlist years in 2015-2016, respectively. Inactive candidates made up one of the few subgroups with fairly consistent increases in pretransplant mortality over the past 10 years, 25.3 deaths per 100 waitlist years in 2015-2016, compared with 16.4 in 2005-2006. Among candidates with known indications for transplant, pretransplant mortality was highest for those with valvular heart disease (Figure HR 24).

Wide variation in pretransplant mortality by DSA persisted, ranging from 3.4 to 19.9 deaths per 100 waitlist years (Figure HR 27). Deaths within 6 months of removal from the waiting list fluctuated over the past decade, peaking at 33.4% in 2013 and declining to 21.8% in 2016 (Figure HR 28). Mortality within 6 months of removal from the waiting list remained highest for candidates listed as status 1A.

Donor Trends

The overall deceased heart donation rate was 2.9 per 1000 deaths, but it varied by state, ranging from 0.37 to 6.16 per 1000 deaths (Figure HR 31). Almost half of donors, 49.8%, were aged 18 to 34 years (Figure HR 29) and 63.1% were white (Figure HR 30). Rates of hearts recovered for transplant but not transplanted reached a nadir in 2009-2010 and have trended upward since (Figure HR 32). In 2015-2016, 1.0% of recovered hearts were not transplanted. The increase is most notable for donors aged 50 years or older.

Head trauma remained the most common cause of death among heart donors, although the proportion declined substantially since 2005, from 63.2% of deceased donors to 45.5% in 2016. Donation after deaths due to anoxia tripled since 2005, to 36.0% of heart donors in 2016 (Figure HR 33).

Overall Trends in Heart Transplant

In 2016, 3209 heart transplants were performed; 445 were in pediatric recipients and 2764 in adult recipients (Figure HR 34). Overall, heart transplants increased in all age groups, but recipients aged 65 years or older represent a growing proportion, from 9.7% in 2005 to 17.4% in 2016 (Figure HR 35). The proportion of recipients who underwent transplant as status 1A increased from 39.5% in 2005 to 69.1%in 2016. In 2005, 26.3% of recipients were status 2, but only 2.3% in 2016; 75 underwent transplant as status 2 (Figure HR 39). In 2016, most heart transplant recipients were aged 50-64 years (Figure HR 35). The typical recipient remained white, male, with blood type A or O, although increasing proportions of recipients are non-white.

In 2016, 52.2% of recipients received induction therapy (Figure HR 40). In 2005, 40.4% of recipients were receiving cyclosporine at the time of transplant; this declined to 2.3% in 2016, and was largely replaced by tacrolimus, used by 93.1% of recipients (Figure HR 41).

Transplant program volume has grown since 2005; the median transplant volume increased from 12 transplants per year in 2005 to 21 in 2016. Although numbers of transplants performed have generally increased, 25% of programs still perform 10 per year or fewer. Most programs perform between 11 and 64 transplants per year (Figure HR 47). In 2016, 41.1% of transplants were performed at programs in the 25th-75th volume percentile and 41.6% at programs in the 75th-95th percentile (Figure HR 48).

Posttransplant Survival and Morbidity

Overall one-year survival for patients who underwent heart transplant in 2009-2011 was 90.1%, 3-year survival was 83.5%, and 5-year survival 78.3% (Figure HR 51). One-year survival among most subgroups was similar, but tended to be lower among recipients aged 65 years or older (Figure HR 49) and black recipients (Figure HR 50). Conversely, 1-year survival was higher for recipients aged 18-34 years (94.4%) and Asians (92.1%). By 5 years, survival was 76.6% for recipients aged 65 years or older and 73.8% for black recipients. Notably, although similar to recipients with ventricular assist devices at 1 and 3 years, survival for recipients with intra-aortic balloon pumps declined after year 3 to 75.3% at year 5 (Figure HR 52). Survival did not differ meaningfully between the medical urgency categories at any time, but tended to be lower for status 1A recipients at years 3 and 5 (Figure HR 54). Survival after heart transplant continued to improve. Since 2005, 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 2011 and 2014 (Figure HR 55). The number of heart transplant survivors has increased since 2005. On June 30, 2016, 30,622 heart transplant recipients were alive with a functioning graft; most had undergone transplant at age 50 years or older (Figure HR 56).

The incidence of acute rejection in the first year posttransplant decreased from 23.8% among recipients who underwent transplant 2010-2011 to 23.3% among recipients who underwent transplant in 2014-2015 (Figure HR 57). Acute rejections in recipients aged 65 years or older increased slightly since 2010-2011. Posttransplant lymphoproliferative disorder (PTLD) remained uncommon, with an overall cumulative incidence of only 1.1% by 5 years posttransplant (Figure HR 58). The most common documented cause of death in the first posttransplant year was infection (Figure HR 59). By the second year, cardiovascular/cerebrovascular disease was the leading documented cause of death through year 5 (Figure HR 60). Malignancy was relatively infrequent as a cause of death, 1.6% of deaths at 5 years.

Pediatric Heart Transplant

Pediatric Waitlist Trends

In 2016, 624 new pediatric candidates were added to the heart transplant waiting list, with few at inactive status (Figure HR 61). At year-end 2016, 367 candidates listed before their eighteenth birthdays were awaiting heart transplant, 69.8% active (Figure HR 62). Over the past decade, the number of candidates listed as inactive status decreased from 178 in 2006 to 111 in 2016. The largest pediatric age group on the waiting list in 2016 was 11-17 years (34.2%), followed by ages younger than 1 year (27.7%), 1-5 years (23.4%), and 6-10 years (14.7%) (Figure HR 63). Over half of heart transplant candidates were white, 20.7% were Hispanic, 20.6% were black, and 3.0% were Asian (Figure HR 64). Considering trends over time, the proportion of waitlist candidates aged younger than 1 year increased from 12.4% on December 31, 2006, to 16.2% on December 31, 2016 (Table HR 11). The proportion of male candidates remained high, 55.7%. The proportion of white candidates decreased from 60.2% on December 31, 2006, to 51.4% on December 31, 2016. For candidates waiting on December 31, 2016, congenital defect was the leading cause of heart disease (55.4%), up from 39.4% in 2006 (Table HR 12). The proportion of status 1A candidates at any time during the year increased from 49.5% in 2006 to 69.2% in 2015, then decreased to 60.8% in 2016 (Figure HR 67). The proportion of status 1B candidates increased from 9.8% in 2015 to 14.3% in 2016. The differences in status 1A and 1B listing percentages from 2015 to 2016 are likely due to changes to pediatric heart allocation policy implemented in March 2016. The percentage of candidates using VADs at the time of listing increased from 3.2% in 2006 to 6.1% in 2016 (Table HR 12). Proportions of heart-only candidates increased from 91.2% at year-end 2006 to 99.4% at year-end 2016, and candidates for heart-lung and heart-kidney transplants decreased to less than 1% (Table HR 13). Among the 627 candidates removed from the waiting list in 2016, 460 (73.4%) were removed due to undergoing transplant, 60 (9.6%) died, 59 (9.4%) were removed due to improved condition, and 29 (4.6%) were considered too sick to undergo transplant (Table HR 15).

Just over 70% of candidates newly listed in 2013 underwent transplant within 3 years, 10.7% died, 13.7% were removed from the list, and 4.6% were still waiting (Figure HR 68). The rate of heart transplants among active pediatric waitlist candidates decreased from a peak of almost 300 per 100 waitlist years in 2006 to 183 per 100 waitlist years in 2016 (Figure HR 69). Transplant rates varied by age, with the highest rates for candidates aged younger than 1 year, at 309 transplants per 100 waitlist years in 2016, followed by candidates aged 11-17 years, at 189 transplants per 100 waitlist years (Figure HR 69). Pretransplant mortality slowly declined from 27.1 deaths per 100 waitlist years in 2005-2006 to 19.1 in 2015-2016 (Figure HR 70). The pretransplant mortality rate was highest for candidates aged younger than 1 year, at 56.8 deaths per 100 waitlist years in 2015-2016, an increase from its nadir of 44.9 in 2013-2014; pretransplant mortality was 14.6 deaths per 100 waitlist years for candidates aged 1-5 years, 14.1 for ages 6-10 years, and 8.2 for ages 11-17 years (Figure HR 70). By race, pretransplant mortality was highest in 2015-2016 for white candidates at 23.4 deaths per 100 waitlist years, followed by black and Hispanic candidates at 17.6 and 9.4, respectively (Figure HR 71). Regarding cause of disease, pretransplant mortality was highest for candidates with dilated myopathy/myocarditis or congenital defects (Figure HR 72). By status, pretransplant mortality was highest for status 1A candidates (33.0 deaths per 100 waitlist years) and inactive candidates (27.8), compared with 3.0 and 1.8 for status 1B and status 2 candidates, respectively (Figure HR 73).

Pediatric Transplant

Pediatric transplant recipients are those aged 18 years or younger at the time of transplant; the category excludes candidates listed before their 18th birthdays who underwent transplanted afterward. The number of pediatric heart transplants performed each year increased from 319 in 2005 to 445 in 2016 (Figure HR 74). In 2016, 26 of 135 total heart transplant programs performed pediatric heart transplants exclusively, 78 performed adult heart transplants, and 27 performed both adult and pediatric heart transplants (Fig HR 75). In 2016, 8.5% of transplants in recipients aged younger than 15 years were performed at programs with volume of 5 or fewer pediatric transplants in that year (Fig HR 76). Over the past decade, the age, sex, and race of pediatric heart transplant recipients changed little (Table HR 16). Congenital defects remained the most common primary cause of disease, affecting 48.1% of recipients who underwent transplant in 2014-2016 (Table HR 17). The proportion of ABO-incompatible transplants in 2014-2016 was 5.4%, increased from 2.7% a decade earlier (Table HR 18). The proportion of patients who underwent transplant as status 1A increased from 71.6% in 2004-2006 to 84.8% in 2014-2016. VAD use doubled from 10.5% of transplant recipients in 2004-2006 to 23.7% in 2014-2016 (Table HR 17).

Pediatric Immunosuppression and Outcomes

In 2016, the most common induction therapy was T-cell depleting agents, used in 70.2% of heart transplant recipients, followed by interleukin-2 receptor antagonists (IL-2-RA) in 9.3%. No induction therapy was reported in 21.8% of recipients (Figure HR 77). 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 82). The initial immunosuppression agents used most commonly in 2016 were tacrolimus (93.2%, Figure HR 78), mycophenolate (93.4%, Figure HR 79), and steroids (63.0%, Figure HR 81). In 2014, mammalian target of rapamycin inhibitors were used in only 1.8% of recipients at the time of transplant, but use increased to 11.2% at 1 year posttransplant (Figure HR 80). Among patients who underwent transplant in 2015, steroid use was 60.2% at transplant and 60.0% at 1 year posttransplant (Figure HR 81).

Among pediatric heart transplant recipients 2014-2015, the rate of acute rejection in the first year was 20.2% overall with the highest rate observed, 24.0%, in the 6-10 year age group; rates of rejection were 20.9% for ages 11-17 years and 18.7% for ages younger than 6 years (Figure HR 84). Among pediatric heart transplant recipients 2012-2016, 34.7% were cytomegalovirus (CMV) negative and 44.5% were Epstein-Barr virus (EBV) negative (Table HR 20). The combination of a CMV-positive donor and CMV-negative recipient occurred in 17.0% of transplants; for EBV, this occurred in 29.0% of transplants (Table HR 20).

Recipient death occurred in 6.5% at 6 months and in 8.4% at 1 year among heart transplants performed in 2014-2015, in 10.2% at 3 years for transplants performed in 2012-2013, in 16.2% at 5 years for transplants performed in 2010-2011, and in 34.1% at 10 years for transplants performed in 2004-2005 (Figure HR 86). Overall, 1-year and 5-year patient survival was 89.3% and 78.7%, respectively, among recipients who underwent transplant in 2004-2011 (Figure HR 87). By age, 5-year patient survival was 73.7% for recipients aged younger than 1 year, 79.9% for ages 1-5 years, 87.5% for ages 6-10 years, and 78.9% for ages 11-17 years (Figure HR 87). The leading identified causes of death in the first 5 years posttransplant were cardio/cerebrovascular disease (4.6%) and graft failure (3.3%) (Figure HR 89).

The incidence of PTLD among EBV-negative recipients was 5.2% at 5 years posttransplant, compared with 2.6% among EBV-positive recipients (Figure HR 85).

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 2013
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 2015 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 2015-2016, by DSA
Figure HR 28. Deaths within six months after removal among adult heart waitlist 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, 2013-2015
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. Total heart transplants by medical urgency
Figure HR 40. Induction agent use in adult heart transplant recipients
Figure HR 41. Calcineurin inhibitor use in adult heart transplant recipients
Figure HR 42. Anti-metabolite use in adult heart transplant recipients
Figure HR 43. mTOR inhibitor use in adult heart transplant recipients
Figure HR 44. Steroid use in adult heart transplant recipients
Figure HR 45. Total HLA A, B, and DR mismatches among adult deceased donor heart transplant recipients, 2012-2016
Figure HR 46. Status of adult heart transplant recipients, 2014-2016, by age
Figure HR 47. Annual adult heart transplant center volumes, by percentile
Figure HR 48. Distribution of adult heart transplants by percentile of center volume

Outcomes

Figure HR 49. Patient survival among adult heart transplant recipients, 2009-2011, by age
Figure HR 50. Patient survival among adult heart transplant recipients, 2009-2011, by race
Figure HR 51. Patient survival among adult heart transplant recipients, 2009-2011, by sex
Figure HR 52. Patient survival among adult heart transplant recipients, 2009-2011, by circulatory support
Figure HR 53. Patient survival among adult heart transplant recipients, 2009-2011, by first vs. retransplant
Figure HR 54. Patient survival among adult heart transplant recipients, 2009-2011, by medical urgency
Figure HR 55. Patient death among adult heart transplant recipients
Figure HR 56. Recipients alive with a functioning heart graft on June 30 of the year, by age at transplant
Figure HR 57. Incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by age
Figure HR 58. Incidence of PTLD among adult heart transplant recipients by recipient EBV status at transplant, 2010-2014
Figure HR 59. One-year cumulative incidence of death by cause among adult heart recipients, 2014-2015
Figure HR 60. Five-year cumulative incidence of death by cause among adult heart recipients, 2010-2011

Pediatric transplant

Figure HR 61. New pediatric candidates added to the heart transplant waiting list
Figure HR 62. Pediatric candidates listed for heart transplant on December 31 each year
Figure HR 63. Distribution of pediatric candidates waiting for heart transplant by age
Figure HR 64. Distribution of pediatric candidates waiting for heart transplant by race
Figure HR 65. Distribution of pediatric candidates waiting for heart transplant by diagnosis
Figure HR 66. Distribution of pediatric candidates waiting for heart transplant by waiting time
Figure HR 67. Distribution of pediatric candidates waiting for heart transplant by medical urgency
Figure HR 68. Three-year outcomes for newly listed pediatric candidates waiting for heart transplant, 2013
Figure HR 69. Heart transplant rates among active pediatric waitlist candidates by age
Figure HR 70. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by age
Figure HR 71. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by race
Figure HR 72. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by diagnosis
Figure HR 73. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by medical urgency
Figure HR 74. Pediatric heart transplants by age
Figure HR 75. Number of centers performing pediatric and adult heart transplants by center's age mix
Figure HR 76. Pediatric heart recipients at programs that perform 5 or fewer pediatric transplants annually
Figure HR 77. Induction agent use in pediatric heart transplant recipients
Figure HR 78. Calcineurin inhibitor use in pediatric heart transplant recipients
Figure HR 79. Anti-metabolite use in pediatric heart transplant recipients
Figure HR 80. mTOR inhibitor use in pediatric heart transplant recipients
Figure HR 81. Steroid use in pediatric heart transplant recipients
Figure HR 82. Induction use by C/PRA among pediatric heart transplant recipients, 2012-2016
Figure HR 83. Total HLA A, B, and DR mismatches among pediatric deceased donor heart transplant recipients, 2012-2016
Figure HR 84. Incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by age
Figure HR 85. Incidence of PTLD among pediatric heart transplant recipients by recipient EBV status at transplant, 2004-2014
Figure HR 86. Patient death among pediatric heart transplant recipients
Figure HR 87. Patient survival among pediatric deceased donor heart transplant recipients, 2004-2011, by age
Figure HR 88. One-year cumulative incidence of death by cause among pediatric heart recipients, 2014-2015
Figure HR 89. Five-year cumulative incidence of death by cause among pediatric heart recipients, 2010-2011

Table List

Waiting list

Table HR 1. Demographic characteristics of adults on the heart transplant waiting list on December 31, 2006 and December 31, 2016
Table HR 2. Clinical characteristics of adults on the heart transplant waiting list on December 31, 2006 and December 31, 2016
Table HR 3. Listing characteristics of adults on the heart transplant waiting list on December 31, 2006 and December 31, 2016
Table HR 4. Heart transplant waitlist activity among adults
Table HR 5. Removal reason among adult heart transplant candidates

Transplant

Table HR 6. Adult heart recipients on circulatory support before transplant
Table HR 7. Demographic characteristics of adult heart transplant recipients, 2006 and 2016
Table HR 8. Clinical characteristics of adult heart transplant recipients, 2006 and 2016
Table HR 9. Transplant characteristics of adult heart transplant recipients, 2006 and 2016
Table HR 10. Adult heart donor-recipient serology matching, 2012-2016

Pediatric transplant

Table HR 11. Demographic characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2006, December 31, 2011, and December 31, 2016
Table HR 12. Clinical characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2006, December 31, 2011, and December 31, 2016
Table HR 13. Listing characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2006, December 31, 2011, and December 31, 2016
Table HR 14. Heart transplant waitlist activity among pediatric candidates
Table HR 15. Removal reason among pediatric heart transplant candidates
Table HR 16. Demographic characteristics of pediatric heart transplant recipients, 2004-2006 and 2014-2016
Table HR 17. Clinical characteristics of pediatric heart transplant recipients, 2004-2006 and 2014-2016
Table HR 18. Transplant characteristics of pediatric heart transplant recipients, 2004-2006 and 2014-2016
Table HR 19. Pediatric heart recipients on circulatory support before transplant
Table HR 20. Pediatric heart donor-recipient serology matching, 2012-2016

A line plot for new adult candidates added to the heart transplant waiting list; the active category increases by 57.2% from 2240 candidates at 2005 to 3521 candidates at 2016; the inactive category increases by 12.4% from 97 candidates at 2005 to 109 candidates at 2016; and the all category increases by 55.3% from 2337 candidates at 2005 to 3630 candidates at 2016.

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 126.8% from 1262 candidates at 2005 to 2862 candidates at 2016; the inactive category decreases by 46.9% from 1450 candidates at 2005 to 770 candidates at 2016; and the all category increases by 33.9% from 2712 candidates at 2005 to 3632 candidates at 2016.

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 12.0% from 12.4 percent at 2005 to 10.9 percent at 2016; the 35 to 49 category is 23.7 percent at 2005 and remains relatively constant with a value of 22.3 percent at 2016; the 50 to 64 category is 52 percent at 2005 and remains relatively constant with a value of 48.9 percent at 2016; and the greater than or equal to 65 category increases by 51.0% from 11.9 percent at 2005 to 18 percent at 2016.

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 14.6% from 72.7 percent at 2005 to 62.1 percent at 2016; the black category increases by 52.4% from 16.4 percent at 2005 to 24.9 percent at 2016; the hispanic category increases by 14.8% from 7.8 percent at 2005 to 8.9 percent at 2016; the asian category increases by 32.5% from 2.5 percent at 2005 to 3.4 percent at 2016; and the other/unknown category is 0.6 percent at 2005 and remains relatively constant with a value of 0.7 percent at 2016.

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 22.8% from 41.4 percent at 2005 to 32 percent at 2016; the cardiomyopathy category increases by 27.6% from 45.5 percent at 2005 to 58.1 percent at 2016; the congenital category decreases by 19.1% from 4.6 percent at 2005 to 3.7 percent at 2016; the valvular category decreases by 53.0% from 2.5 percent at 2005 to 1.2 percent at 2016; and the other/unknown category decreases by 15.2% from 5.9 percent at 2005 to 5 percent at 2016.

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 11.5% from 53.1 percent at 2005 to 59.2 percent at 2016; the 1 to less than 2 category increases by 58.4% from 12.1 percent at 2005 to 19.1 percent at 2016; the 2 to less than 3 category increases by 16.5% from 8.5 percent at 2005 to 10 percent at 2016; the 3 to less than 4 category decreases by 17.7% from 5.7 percent at 2005 to 4.7 percent at 2016; the 4 to less than 5 category decreases by 38.3% from 4.4 percent at 2005 to 2.7 percent at 2016; and the greater than or equal to 5 category decreases by 73.2% from 16.2 percent at 2005 to 4.3 percent at 2016.

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 96.1% from 22.7 percent at 2005 to 44.5 percent at 2016; the status 1b category increases by 68.5% from 18.5 percent at 2005 to 31.3 percent at 2016; the status 2 category decreases by 51.7% from 33.4 percent at 2005 to 16.2 percent at 2016; and the inactive category decreases by 68.2% from 25.3 percent at 2005 to 8.1 percent at 2016.

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 25.0% from 91.1 percent at 2005 to 68.3 percent at 2016; and the vad category increases by 256.1% from 8.9 percent at 2005 to 31.7 percent at 2016.

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 75.5 percent at 2005 and remains relatively constant with a value of 75.5 percent at 2016; and the female category is 24.5 percent at 2005 and remains relatively constant with a value of 24.5 percent at 2016.

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 34.3 percent at 2005 and remains relatively constant with a value of 34 percent at 2016; the b category increases by 15.7% from 11.4 percent at 2005 to 13.2 percent at 2016; the ab category increases by 30.8% from 2.8 percent at 2005 to 3.7 percent at 2016; and the o category is 51.5 percent at 2005 and remains relatively constant with a value of 49 percent at 2016.

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 37.8% from 142.4 transplants per 100 waitlist years at 2005 to 88.6 transplants per 100 waitlist years at 2016; the 35 to 49 category decreases by 40.1% from 130.6 transplants per 100 waitlist years at 2005 to 78.3 transplants per 100 waitlist years at 2016; the 50 to 64 category decreases by 21.5% from 120.8 transplants per 100 waitlist years at 2005 to 94.9 transplants per 100 waitlist years at 2016; and the greater than or equal to 65 category decreases by 28.5% from 158.2 transplants per 100 waitlist years at 2005 to 113.1 transplants per 100 waitlist years at 2016.

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 41.0% from 208.2 transplants per 100 waitlist years at 2005 to 122.9 transplants per 100 waitlist years at 2016; the b category decreases by 43.3% from 216 transplants per 100 waitlist years at 2005 to 122.4 transplants per 100 waitlist years at 2016; the ab category decreases by 39.4% from 499.5 transplants per 100 waitlist years at 2005 to 302.5 transplants per 100 waitlist years at 2016; and the o category decreases by 16.3% from 77.3 transplants per 100 waitlist years at 2005 to 64.7 transplants per 100 waitlist years at 2016.

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 48.0% from 938.9 transplants per 100 waitlist years at 2005 to 488.1 transplants per 100 waitlist years at 2016; the status 1b category decreases by 77.5% from 216.4 transplants per 100 waitlist years at 2005 to 48.6 transplants per 100 waitlist years at 2016; the status 2 category decreases by 85.5% from 51 transplants per 100 waitlist years at 2005 to 7.4 transplants per 100 waitlist years at 2016; and the all category decreases by 27.8% from 129 transplants per 100 waitlist years at 2005 to 93.1 transplants per 100 waitlist years at 2016.

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 2013; the still waiting category decreases by 90.6% from 100 percent at 0 Months postlisting to 9.4 percent at 36 Months postlisting; the removed from list category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting; the died category increases by 31400.0% from 0 percent at 0 Months postlisting to 9.5 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 14. Three-year outcomes for adults waiting for heart transplant, new listings in 2013
Adults waiting for heart transplant and first listed in 2013. 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 136.5% from 4.2 months at 2005-2006 to 10 months at 2015-2016; the female category increases by 81.7% from 4.1 months at 2005-2006 to 7.5 months at 2015-2016; and the all category increases by 120.9% from 4.2 months at 2005-2006 to 9.4 months at 2015-2016.

Figure HR 15. Median months to heart transplant for waitlisted adults by sex
Observations censored on December 31, 2016; 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 126.5% from 2.7 months at 2005-2006 to 6.2 months at 2015-2016; the b category increases by 153.5% from 2.8 months at 2005-2006 to 7.2 months at 2015-2016; the ab category increases by 78.3% from 1.2 months at 2005-2006 to 2.2 months at 2015-2016; and the o category increases by 98.5% from 8.6 months at 2005-2006 to 17.1 months at 2015-2016.

Figure HR 16. Median months to heart transplant for waitlisted adults by blood type
Observations censored on December 31, 2016; 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 75.0% from 1.4 months at 2005-2006 to 2.5 months at 2015-2016; the status 1b category increases by 264.1% from 2.4 months at 2005-2006 to 8.7 months at 2015-2016; and the status 2 category increases by 193.9% from 8 months at 2005-2006 to 23.6 months at 2013-2014.

Figure HR 17. Median months to heart transplant for waitlisted adults by medical urgency at listing
Observations censored on December 31, 2016; 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 106.3% from 2.6 months at 2005-2006 to 5.4 months at 2015-2016; the 24 to 26 category increases by 162.9% from 3.2 months at 2005-2006 to 8.4 months at 2015-2016; the 27 to 30 category increases by 112.6% from 4.4 months at 2005-2006 to 9.4 months at 2015-2016; and the greater than or equal to 31 category increases by 63.9% from 8.3 months at 2005-2006 to 13.6 months at 2015-2016.

Figure HR 18. Median months to heart transplant for waitlisted adults by BMI at listing
Observations censored on December 31, 2016; 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 32.5% from 41.3 percent at 2005 to 27.9 percent at 2015; the 6 to month category decreases by 27.0% from 54.3 percent at 2005 to 39.6 percent at 2015; the 1 to year category decreases by 19.8% from 63.8 percent at 2005 to 51.1 percent at 2015; the 3 to year category is 70.8 percent at 2005 and remains relatively constant with a value of 63.9 percent at 2013; the 5 to year category is 71.8 percent at 2005 and remains relatively constant with a value of 69.5 percent at 2011; and the 10 to year category is 72.2 percent at 2005 and remains relatively constant with a value of 72.6 percent at 2006.

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 2015 by dsa, the values range from 15.38 to 100.00.

Figure HR 20. Percentage of adults who underwent deceased donor heart transplant within 1 year of listing in 2015 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 42.2% from 16.3 deaths per 100 waitlist years at 2005-2006 to 9.5 deaths per 100 waitlist years at 2015-2016; the 35 to 49 category decreases by 37.7% from 13.6 deaths per 100 waitlist years at 2005-2006 to 8.4 deaths per 100 waitlist years at 2015-2016; the 50 to 64 category decreases by 30.5% from 14.4 deaths per 100 waitlist years at 2005-2006 to 10 deaths per 100 waitlist years at 2015-2016; the greater than or equal to 65 category decreases by 33.6% from 16.1 deaths per 100 waitlist years at 2005-2006 to 10.7 deaths per 100 waitlist years at 2015-2016; and the all category decreases by 33.8% from 14.6 deaths per 100 waitlist years at 2005-2006 to 9.7 deaths per 100 waitlist years at 2015-2016.

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 29.4% from 14.5 deaths per 100 waitlist years at 2005-2006 to 10.2 deaths per 100 waitlist years at 2015-2016; the black category decreases by 45.2% from 15.3 deaths per 100 waitlist years at 2005-2006 to 8.4 deaths per 100 waitlist years at 2015-2016; the hispanic category decreases by 42.6% from 14.7 deaths per 100 waitlist years at 2005-2006 to 8.5 deaths per 100 waitlist years at 2015-2016; and the asian category decreases by 13.1% from 15 deaths per 100 waitlist years at 2005-2006 to 13 deaths per 100 waitlist years at 2015-2016.

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 32.6% from 14.6 deaths per 100 waitlist years at 2005-2006 to 9.8 deaths per 100 waitlist years at 2015-2016; and the female category decreases by 37.8% from 14.6 deaths per 100 waitlist years at 2005-2006 to 9.1 deaths per 100 waitlist years at 2015-2016.

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 35.3% from 14 deaths per 100 waitlist years at 2005-2006 to 9.1 deaths per 100 waitlist years at 2015-2016; the cardiomyopathy category decreases by 35.9% from 14.1 deaths per 100 waitlist years at 2005-2006 to 9.1 deaths per 100 waitlist years at 2015-2016; the congential category decreases by 27.6% from 14.2 deaths per 100 waitlist years at 2005-2006 to 10.3 deaths per 100 waitlist years at 2015-2016; the valvular category is 13.3 deaths per 100 waitlist years at 2005-2006 and remains relatively constant with a value of 12.2 deaths per 100 waitlist years at 2015-2016; and the other/unknown category decreases by 11.7% from 23.3 deaths per 100 waitlist years at 2005-2006 to 20.6 deaths per 100 waitlist years at 2015-2016.

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 77.5% from 76.9 deaths per 100 waitlist years at 2005-2006 to 17.3 deaths per 100 waitlist years at 2015-2016; the status 1b category decreases by 84.1% from 21.3 deaths per 100 waitlist years at 2005-2006 to 3.4 deaths per 100 waitlist years at 2015-2016; the status 2 category decreases by 46.7% from 5.8 deaths per 100 waitlist years at 2005-2006 to 3.1 deaths per 100 waitlist years at 2015-2016; and the inactive category increases by 54.3% from 16.4 deaths per 100 waitlist years at 2005-2006 to 25.3 deaths per 100 waitlist years at 2015-2016.

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 19.6% from 13 deaths per 100 waitlist years at 2005-2006 to 10.4 deaths per 100 waitlist years at 2015-2016; and the vad at listing category decreases by 81.6% from 43.2 deaths per 100 waitlist years at 2005-2006 to 8 deaths per 100 waitlist years at 2015-2016.

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 2015-2016, by dsa, the values range from 3.35 to 19.90.

Figure HR 27. Pretransplant mortality rates among adults waitlisted for heart transplant in 2015-2016, by DSA
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Patients censored at waitlist removal. 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 waitlist candidates; the all category increases by 13.2% from 19.3 percent at 2005 to 21.8 percent at 2016; the status 1a category increases by 10.9% from 60.9 percent at 2005 to 67.5 percent at 2016; the status 1b category decreases by 66.7% from 41.4 percent at 2005 to 13.8 percent at 2016; the status 2 category decreases by 68.2% from 15.7 percent at 2005 to 5 percent at 2016; and the inactive category increases by 33.1% from 15.6 percent at 2005 to 20.7 percent at 2016.

Figure HR 28. Deaths within six months after removal among adult heart waitlist 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 14.0% from 20.5 percent at 2005 to 17.6 percent at 2016; the 18 to 34 category is 46.6 percent at 2005 and remains relatively constant with a value of 49.8 percent at 2016; the 35 to 49 category is 25 percent at 2005 and remains relatively constant with a value of 24.8 percent at 2016; and the greater than or equal to 50 category is 8 percent at 2005 and remains relatively constant with a value of 7.7 percent at 2016.

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 65.7 percent at 2005 and remains relatively constant with a value of 63.1 percent at 2016; the black category increases by 25.5% from 14.3 percent at 2005 to 18 percent at 2016; the hispanic category is 17.4 percent at 2005 and remains relatively constant with a value of 15.9 percent at 2016; and the other/unknown category increases by 14.7% from 2.6 percent at 2005 to 3 percent at 2016.

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, 2013-2015, the values range from 0.37 to 6.16.

Figure HR 31. Deceased donor heart donation rates (per 1000 deaths) by state, 2013-2015
Numerator: Deceased donors aged < 70 years, by state of death, whose heart was recovered for transplant from 2013 through 2015. Denominator: US deaths aged < 70 years, by state of death, from 2013 through 2015. State death data by age obtained through agreement with NAPHSIS (https://www.naphsis.org/research-requests).


A line plot for rates of hearts recovered for transplant and not transplanted by age; the less than 18 category decreases by 54.4% from 1.4 percent at 2005-2006 to 0.6 percent at 2015-2016; the 18 to 34 category is 1 percent at 2005-2006 and remains relatively constant with a value of 0.9 percent at 2015-2016; the 35 to 49 category decreases by 45.9% from 1.4 percent at 2005-2006 to 0.8 percent at 2015-2016; the greater than or equal to 50 category increases by 48.7% from 2.2 percent at 2005-2006 to 3.3 percent at 2015-2016; and the all category decreases by 21.0% from 1.3 percent at 2005-2006 to 1 percent at 2015-2016.

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 189.5% from 12.4 percent at 2005 to 36 percent at 2016; the cva/stroke category decreases by 28.1% from 21.3 percent at 2005 to 15.3 percent at 2016; the head trauma category decreases by 28.1% from 63.2 percent at 2005 to 45.5 percent at 2016; the cns tumor category decreases by 69.4% from 1.3 percent at 2005 to 0.4 percent at 2016; and the other category increases by 68.0% from 1.7 percent at 2005 to 2.8 percent at 2016.

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 39.5% from 319 transplants at 2005 to 445 transplants at 2016; the age greater than or equal to 18 category increases by 50.1% from 1841 transplants at 2005 to 2764 transplants at 2016; and the all category increases by 48.6% from 2160 transplants at 2005 to 3209 transplants at 2016.

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 39.5% from 319 transplants at 2005 to 445 transplants at 2016; the 18 to 34 category increases by 17.0% from 253 transplants at 2005 to 296 transplants at 2016; the 35 to 49 category increases by 30.6% from 415 transplants at 2005 to 542 transplants at 2016; the 50 to 64 category increases by 41.9% from 964 transplants at 2005 to 1368 transplants at 2016; and the greater than or equal to 65 category increases by 167.0% from 209 transplants at 2005 to 558 transplants at 2016.

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 47.9% from 1550 transplants at 2005 to 2292 transplants at 2016; and the female category increases by 50.3% from 610 transplants at 2005 to 917 transplants at 2016.

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 30.5% from 1511 transplants at 2005 to 1972 transplants at 2016; the black category increases by 85.8% from 381 transplants at 2005 to 708 transplants at 2016; the hispanic category increases by 111.0% from 172 transplants at 2005 to 363 transplants at 2016; the asian category increases by 73.7% from 76 transplants at 2005 to 132 transplants at 2016; and the other/unknown category increases by 70.0% from 20 transplants at 2005 to 34 transplants at 2016.

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 increases by 12.3% from 822 transplants at 2005 to 923 transplants at 2016; the cardiomyopathy category increases by 82.4% from 1036 transplants at 2005 to 1890 transplants at 2016; the congenital category increases by 45.6% from 204 transplants at 2005 to 297 transplants at 2016; the valvular category decreases by 28.3% from 46 transplants at 2005 to 33 transplants at 2016; and the other/unknown category increases by 26.9% from 52 transplants at 2005 to 66 transplants at 2016.

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 total heart transplants by medical urgency; the status 1a category increases by 159.8% from 853 transplants at 2005 to 2216 transplants at 2016; the status 1b category increases by 24.2% from 739 transplants at 2005 to 918 transplants at 2016; and the status 2 category decreases by 86.8% from 568 transplants at 2005 to 75 transplants at 2016.

Figure HR 39. Total heart transplants by medical urgency
All heart transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for induction agent use in adult heart transplant recipients; the il2 to ra category is 30.1 percent at 2005 and remains relatively constant with a value of 29.5 percent at 2016; the t to cell depleting category is 22.7 percent at 2005 and remains relatively constant with a value of 22.7 percent at 2016; and the none category is 49 percent at 2005 and remains relatively constant with a value of 48.4 percent at 2016.

Figure HR 40. 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 94.3% from 40.4 percent at 2005 to 2.3 percent at 2016; and the tacrolimus category increases by 69.3% from 55 percent at 2005 to 93.1 percent at 2016.

Figure HR 41. 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 87.8% from 6.4 percent at 2005 to 0.8 percent at 2016; and the mycophenolate category is 88.9 percent at 2005 and remains relatively constant with a value of 93.9 percent at 2016.

Figure HR 42. 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 83.9% from 3.7 percent at 2005 to 0.6 percent at 2016; and the 1 year posttransplant category is 10.5 percent at 2005 and remains relatively constant with a value of 9.7 percent at 2015.

Figure HR 43. 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 93.8 percent at 2005 and remains relatively constant with a value of 89.5 percent at 2016; and the 1 year posttransplant category decreases by 12.8% from 93.7 percent at 2005 to 81.6 percent at 2015.

Figure HR 44. 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, 2012-2016, the 0 group is 0.12 percent; the 1 group is 0.39 percent; the 2 group is 2.70 percent; the 3 group is 10.33 percent; the 4 group is 23.89 percent; the 5 group is 33.82 percent; the 6 group is 20.52 percent; and the unk. group is 8.23 percent.

Figure HR 45. Total HLA A, B, and DR mismatches among adult deceased donor heart transplant recipients, 2012-2016
Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2016.


A bar plot for status of adult heart transplant recipients, 2014-2016, by age, the 1a status is 31.08 percent for <50, 68.92 percent for greater than or equal to 50, 36.88 percent for greater than or equal to 60, and 18.64 percent for greater than or equal to 65; the 1b status is 29.19 percent for <50, 70.81 percent for greater than or equal to 50, 39.91 percent for greater than or equal to 60, and 21.84 percent for greater than or equal to 65; and the 2 status is 22.32 percent for <50, 77.68 percent for greater than or equal to 50, 43.78 percent for greater than or equal to 60, and 27.04 percent for greater than or equal to 65.

Figure HR 46. Status of adult heart transplant recipients, 2014-2016, by age
Age categories are not exclusive. All recipients aged 65 or older, for example, are also included among those aged 60 or older and 50 or older.


A line plot for annual adult heart transplant center volumes, by percentile; the 5th category is 1 transplants per center at 2005 and remains relatively constant with a value of 1 transplants per center at 2016; the 25th category increases by 66.7% from 6 transplants per center at 2005 to 10 transplants per center at 2016; the median category increases by 75.0% from 12 transplants per center at 2005 to 21 transplants per center at 2016; the 75th category increases by 84.2% from 19 transplants per center at 2005 to 35 transplants per center at 2016; and the 95th category increases by 25.5% from 51 transplants per center at 2005 to 64 transplants per center at 2016.

Figure HR 47. Annual adult heart transplant center volumes, by percentile
Annual volume data are limited to recipients aged 18 or older.


A line plot for distribution of adult heart transplants by percentile of center volume; the less than or equal to 25th category is 5.4 percent at 2005 and remains relatively constant with a value of 5.1 percent at 2016; the greater than 25th to 75th category is 37.7 percent at 2005 and remains relatively constant with a value of 41.1 percent at 2016; the greater than 75th to 95th category is 38.1 percent at 2005 and remains relatively constant with a value of 41.6 percent at 2016; and the greater than 95th category decreases by 35.3% from 18.8 percent at 2005 to 12.2 percent at 2016.

Figure HR 48. Distribution of adult heart transplants by percentile of center volume
Percentiles are based on annual volume data among recipients aged 18 or older.


A line plot for patient survival among adult heart transplant recipients, 2009-2011, by age; the 18 to 34 category decreases by 22.3% from 100 percent at 0 Months post-transplant to 77.7 percent at 60 Months post-transplant; the 35 to 49 category decreases by 21.3% from 100 percent at 0 Months post-transplant to 78.7 percent at 60 Months post-transplant; the 50 to 64 category decreases by 21.2% from 100 percent at 0 Months post-transplant to 78.8 percent at 60 Months post-transplant; and the greater than or equal to 65 category decreases by 23.4% from 100 percent at 0 Months post-transplant to 76.6 percent at 60 Months post-transplant.

Figure HR 49. Patient survival among adult heart transplant recipients, 2009-2011, 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, 2009-2011, by race; the white category decreases by 21.0% from 100 percent at 0 Months post-transplant to 79 percent at 60 Months post-transplant; the black category decreases by 26.2% from 100 percent at 0 Months post-transplant to 73.8 percent at 60 Months post-transplant; the hispanic category decreases by 18.2% from 100 percent at 0 Months post-transplant to 81.8 percent at 60 Months post-transplant; the asian category decreases by 17.4% from 100 percent at 0 Months post-transplant to 82.6 percent at 60 Months post-transplant; and the other/unknown category decreases by 18.4% from 100 percent at 0 Months post-transplant to 81.6 percent at 60 Months post-transplant.

Figure HR 50. Patient survival among adult heart transplant recipients, 2009-2011, 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, 2009-2011, by sex; the female category decreases by 21.6% from 100 percent at 0 Months post-transplant to 78.4 percent at 60 Months post-transplant; the male category decreases by 21.8% from 100 percent at 0 Months post-transplant to 78.2 percent at 60 Months post-transplant; and the all category decreases by 21.7% from 100 percent at 0 Months post-transplant to 78.3 percent at 60 Months post-transplant.

Figure HR 51. Patient survival among adult heart transplant recipients, 2009-2011, 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, 2009-2011, by circulatory support; the vad category decreases by 22.2% from 100 percent at 0 Months post-transplant to 77.8 percent at 60 Months post-transplant; the iabp category decreases by 24.7% from 100 percent at 0 Months post-transplant to 75.3 percent at 60 Months post-transplant; and the neither category decreases by 21.2% from 100 percent at 0 Months post-transplant to 78.8 percent at 60 Months post-transplant.

Figure HR 52. Patient survival among adult heart transplant recipients, 2009-2011, 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, 2009-2011, by first vs. retransplant; the first tx category decreases by 21.8% from 100 percent at 0 Months post-transplant to 78.2 percent at 60 Months post-transplant; and the re to tx category decreases by 18.8% from 100 percent at 0 Months post-transplant to 81.2 percent at 60 Months post-transplant.

Figure HR 53. Patient survival among adult heart transplant recipients, 2009-2011, 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, 2009-2011, by medical urgency; the status 1a category decreases by 22.5% from 100 percent at 0 Months post-transplant to 77.5 percent at 60 Months post-transplant; the status 1b category decreases by 21.0% from 100 percent at 0 Months post-transplant to 79 percent at 60 Months post-transplant; and the status 2 category decreases by 20.0% from 100 percent at 0 Months post-transplant to 80 percent at 60 Months post-transplant.

Figure HR 54. Patient survival among adult heart transplant recipients, 2009-2011, 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 47.8% from 12.9 percent at 1998 to 6.7 percent at 2015; the 1 to year category decreases by 46.7% from 15.5 percent at 1998 to 8.2 percent at 2015; the 3 to year category decreases by 35.8% from 22.5 percent at 1998 to 14.5 percent at 2013; the 5 to year category decreases by 31.2% from 29.5 percent at 1998 to 20.3 percent at 2011; and the 10 to year category decreases by 13.3% from 47.5 percent at 1998 to 41.2 percent at 2006.

Figure HR 55. 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, 2016. 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 84.4% from 2.7 patients (in thousands) at 2005 to 5 patients (in thousands) at 2016; the 18 to 49 category increases by 35.3% from 6.8 patients (in thousands) at 2005 to 9.3 patients (in thousands) at 2016; the greater than or equal to 50 category increases by 39.1% from 11.8 patients (in thousands) at 2005 to 16.4 patients (in thousands) at 2016; and the all category increases by 43.7% from 21.3 patients (in thousands) at 2005 to 30.6 patients (in thousands) at 2016.

Figure HR 56. 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 33.69 percent for 2010-11, 29.44 percent for 2012 to 13, and 28.25 percent for 2014 to 15; the 35 to 49 age group is 26.99 percent for 2010-11, 27.39 percent for 2012 to 13, and 25.97 percent for 2014 to 15; the 50 to 64 age group is 21.98 percent for 2010-11, 22.46 percent for 2012 to 13, and 22.33 percent for 2014 to 15; the greater than or equal to 65 age group is 18.42 percent for 2010-11, 19.01 percent for 2012 to 13, and 20.31 percent for 2014 to 15; and the all age group is 23.80 percent for 2010-11, 23.60 percent for 2012 to 13, and 23.27 percent for 2014 to 15.

Figure HR 57. 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, 2010-2014; 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 58. Incidence of PTLD among adult heart transplant recipients by recipient EBV status at transplant, 2010-2014
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, 2014-2015; 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 59. One-year cumulative incidence of death by cause among adult heart recipients, 2014-2015
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, 2010-2011; 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 60. Five-year cumulative incidence of death by cause among adult heart recipients, 2010-2011
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 37.1% from 445 candidates at 2005 to 610 candidates at 2016; the inactive category increases by 55.6% from 9 candidates at 2005 to 14 candidates at 2016; and the all category increases by 37.4% from 454 candidates at 2005 to 624 candidates at 2016.

Figure HR 61. 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 146.2% from 104 candidates at 2005 to 256 candidates at 2016; the inactive category decreases by 38.3% from 180 candidates at 2005 to 111 candidates at 2016; and the all category increases by 29.2% from 284 candidates at 2005 to 367 candidates at 2016.

Figure HR 62. 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 increases by 17.0% from 23.6 percent at 2005 to 27.7 percent at 2016; the 1 to 5 category is 22.1 percent at 2005 and remains relatively constant with a value of 23.4 percent at 2016; the 6 to 10 category decreases by 10.9% from 16.5 percent at 2005 to 14.7 percent at 2016; and the 11 to 17 category is 37.8 percent at 2005 and remains relatively constant with a value of 34.2 percent at 2016.

Figure HR 63. 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 decreases by 12.7% from 60.2 percent at 2005 to 52.5 percent at 2016; the black category is 20.5 percent at 2005 and remains relatively constant with a value of 20.6 percent at 2016; the hispanic category increases by 56.3% from 13.2 percent at 2005 to 20.7 percent at 2016; the asian category decreases by 29.6% from 4.3 percent at 2005 to 3 percent at 2016; and the other/unknown category increases by 76.9% from 1.8 percent at 2005 to 3.2 percent at 2016.

Figure HR 64. 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 increases by 19.3% from 42.2 percent at 2005 to 50.3 percent at 2016; the dilated cm: idiopathic category decreases by 29.9% from 26.1 percent at 2005 to 18.3 percent at 2016; the restrictive cm: idiopathic category increases by 48.6% from 3.2 percent at 2005 to 4.8 percent at 2016; the dilated cm: myocarditis category decreases by 50.2% from 3.6 percent at 2005 to 1.8 percent at 2016; and the other/unknown category is 24.9 percent at 2005 and remains relatively constant with a value of 24.8 percent at 2016.

Figure HR 65. 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 is 70 percent at 2005 and remains relatively constant with a value of 75.7 percent at 2016; the 1 to less than 2 category increases by 22.4% from 8 percent at 2005 to 9.8 percent at 2016; the 2 to less than 4 category increases by 20.9% from 7.4 percent at 2005 to 8.9 percent at 2016; and the greater than or equal to 4 category decreases by 62.0% from 14.5 percent at 2005 to 5.5 percent at 2016.

Figure HR 66. 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 15.3% from 52.8 percent at 2005 to 60.8 percent at 2016; the status 1b category increases by 86.3% from 7.7 percent at 2005 to 14.3 percent at 2016; the status 2 category decreases by 22.0% from 17 percent at 2005 to 13.3 percent at 2016; and the inactive category decreases by 48.4% from 22.6 percent at 2005 to 11.6 percent at 2016.

Figure HR 67. 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, 2013; the still waiting category decreases by 95.4% from 99.8 percent at 0 Months postlisting to 4.6 percent at 36 Months postlisting; the removed from list category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting; the died category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting; and the dd transplant category increases by 41900.0% from 0.2 percent at 0 Months postlisting to 71.1 percent at 36 Months postlisting.

Figure HR 68. Three-year outcomes for newly listed pediatric candidates waiting for heart transplant, 2013
Pediatric candidates who joined the waitlist in 2013. 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 decreases by 13.1% from 355.4 transplants per 100 waitlist years at 2005 to 308.9 transplants per 100 waitlist years at 2016; the 1 to 5 category decreases by 28.6% from 245.8 transplants per 100 waitlist years at 2005 to 175.6 transplants per 100 waitlist years at 2016; the 6 to 10 category decreases by 40.5% from 185.1 transplants per 100 waitlist years at 2005 to 110.1 transplants per 100 waitlist years at 2016; the 11 to 17 category decreases by 28.6% from 264.9 transplants per 100 waitlist years at 2005 to 189 transplants per 100 waitlist years at 2016; and the all category decreases by 27.3% from 251.2 transplants per 100 waitlist years at 2005 to 182.7 transplants per 100 waitlist years at 2016.

Figure HR 69. 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 13.1% from 65.4 deaths per 100 waitlist years at 2005-2006 to 56.8 deaths per 100 waitlist years at 2015-2016; the 1 to 5 category decreases by 10.9% from 16.4 deaths per 100 waitlist years at 2005-2006 to 14.6 deaths per 100 waitlist years at 2015-2016; the 6 to 10 category decreases by 21.2% from 17.9 deaths per 100 waitlist years at 2005-2006 to 14.1 deaths per 100 waitlist years at 2015-2016; the 11 to 17 category decreases by 56.4% from 18.7 deaths per 100 waitlist years at 2005-2006 to 8.2 deaths per 100 waitlist years at 2015-2016; and the all category decreases by 29.6% from 27.2 deaths per 100 waitlist years at 2005-2006 to 19.1 deaths per 100 waitlist years at 2015-2016.

Figure HR 70. 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 23.1 deaths per 100 waitlist years at 2005-2006 and remains relatively constant with a value of 23.4 deaths per 100 waitlist years at 2015-2016; the black category decreases by 46.9% from 33.2 deaths per 100 waitlist years at 2005-2006 to 17.6 deaths per 100 waitlist years at 2015-2016; the hispanic category decreases by 72.7% from 34.5 deaths per 100 waitlist years at 2005-2006 to 9.4 deaths per 100 waitlist years at 2015-2016; and the other/unknown category decreases by 51.0% from 39.6 deaths per 100 waitlist years at 2005-2006 to 19.4 deaths per 100 waitlist years at 2015-2016.

Figure HR 71. 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 30.2% from 35.4 deaths per 100 waitlist years at 2005-2006 to 24.7 deaths per 100 waitlist years at 2015-2016; the dilated cm: idiopathic category decreases by 45.4% from 16.5 deaths per 100 waitlist years at 2005-2006 to 9 deaths per 100 waitlist years at 2015-2016; the restrictive cm: idiopathic category decreases by 52.9% from 23.6 deaths per 100 waitlist years at 2005-2006 to 11.1 deaths per 100 waitlist years at 2015-2016; the dilated cm: myocarditis category increases by 66.3% from 15.3 deaths per 100 waitlist years at 2005-2006 to 25.5 deaths per 100 waitlist years at 2015-2016; and the other/unknown category decreases by 46.9% from 28.5 deaths per 100 waitlist years at 2005-2006 to 15.1 deaths per 100 waitlist years at 2015-2016.

Figure HR 72. 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 72.0% from 117.8 deaths per 100 waitlist years at 2005-2006 to 33 deaths per 100 waitlist years at 2015-2016; the status 1b category decreases by 70.6% from 10.4 deaths per 100 waitlist years at 2005-2006 to 3 deaths per 100 waitlist years at 2015-2016; the status 2 category decreases by 80.4% from 9.1 deaths per 100 waitlist years at 2005-2006 to 1.8 deaths per 100 waitlist years at 2015-2016; and the inactive category increases by 49.1% from 18.6 deaths per 100 waitlist years at 2005-2006 to 27.8 deaths per 100 waitlist years at 2015-2016.

Figure HR 73. 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 60.5% from 81 transplants at 2005 to 130 transplants at 2016; the 1 to 5 category increases by 48.5% from 68 transplants at 2005 to 101 transplants at 2016; the 6 to 10 category increases by 22.2% from 45 transplants at 2005 to 55 transplants at 2016; the 11 to 17 category increases by 27.2% from 125 transplants at 2005 to 159 transplants at 2016; and the all category increases by 39.5% from 319 transplants at 2005 to 445 transplants at 2016.

Figure HR 74. 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 75. 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 pediatric heart recipients at programs that perform 5 or fewer pediatric transplants annually; the age less than 10 category decreases by 25.4% from 7.8 percent at 2005 to 5.8 percent at 2016; the age less than 15 category decreases by 43.2% from 15 percent at 2005 to 8.5 percent at 2016; and the age less than 18 category decreases by 48.8% from 21.9 percent at 2005 to 11.2 percent at 2016.

Figure HR 76. Pediatric heart recipients at programs that perform 5 or fewer pediatric transplants annually
Age groups are cumulative.


A line plot for induction agent use in pediatric heart transplant recipients; the il2 to ra category decreases by 53.4% from 20 percent at 2005 to 9.3 percent at 2016; the t to cell depleting category increases by 108.6% from 33.7 percent at 2005 to 70.2 percent at 2016; and the none category decreases by 54.5% from 48 percent at 2005 to 21.8 percent at 2016.

Figure HR 77. 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 pediatric heart transplant recipients; the cyclosporine category decreases by 82.6% from 32.7 percent at 2005 to 5.7 percent at 2016; and the tacrolimus category increases by 52.8% from 61 percent at 2005 to 93.2 percent at 2016.

Figure HR 78. Calcineurin inhibitor use in pediatric heart transplant recipients
Immunosuppression at transplant reported to the OPTN.


A line plot for anti-metabolite use in pediatric heart transplant recipients; the azathioprine category decreases by 86.6% from 22 percent at 2005 to 3 percent at 2016; and the mycophenolate category increases by 34.7% from 69.3 percent at 2005 to 93.4 percent at 2016.

Figure HR 79. Anti-metabolite use in pediatric 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 77.3% from 8 percent at 2005 to 1.8 percent at 2016; and the 1 year posttransplant category decreases by 15.8% from 13.4 percent at 2005 to 11.2 percent at 2015.

Figure HR 80. 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 pediatric heart transplant recipients; the at transplant category decreases by 14.2% from 73.3 percent at 2005 to 63 percent at 2016; and the 1 year posttransplant category decreases by 14.5% from 70.2 percent at 2005 to 60 percent at 2015.

Figure HR 81. Steroid 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.


A bar plot for induction use by c/pra among pediatric heart transplant recipients, 2012-2016, the 0% group is 21.37 percent; the 1-19% group is 17.71 percent; the 20-79% group is 16.24 percent; the 80-100% group is 10.64 percent; and the unknown group is 7.33 percent.

Figure HR 82. Induction use by C/PRA among pediatric heart transplant recipients, 2012-2016
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, 2012-2016, the 0 group is 0.10 percent; the 1 group is 0.62 percent; the 2 group is 2.05 percent; the 3 group is 9.34 percent; the 4 group is 22.21 percent; the 5 group is 33.17 percent; the 6 group is 20.50 percent; and the unk. group is 12.01 percent.

Figure HR 83. Total HLA A, B, and DR mismatches among pediatric deceased donor heart transplant recipients, 2012-2016
Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2016.


A bar plot for incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by age, the < 6 group is 16.32 percent; the 6-10 group is 27.55 percent; the 11-17 group is 23.74 percent; and the all group is 20.41 percent.

Figure HR 84. 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, 2004-2014; 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 85. Incidence of PTLD among pediatric heart transplant recipients by recipient EBV status at transplant, 2004-2014
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 50.0% from 13.1 percent at 1998-1999 to 6.5 percent at 2014-2015; the 1 to year category decreases by 44.5% from 15.2 percent at 1998-1999 to 8.4 percent at 2014-2015; the 3 to year category decreases by 52.4% from 21.4 percent at 1998-1999 to 10.2 percent at 2012-2013; the 5 to year category decreases by 42.7% from 28.2 percent at 1998-1999 to 16.2 percent at 2010-2011; and the 10 to year category decreases by 17.9% from 41.6 percent at 1998-1999 to 34.1 percent at 2004-2005.

Figure HR 86. 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, 2016. 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, 2004-2011, by age; the less than 1 category decreases by 26.3% from 100 percent at 0 Months post-transplant to 73.7 percent at 60 Months post-transplant; the 1 to 5 category decreases by 20.1% from 100 percent at 0 Months post-transplant to 79.9 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 21.1% from 100 percent at 0 Months post-transplant to 78.9 percent at 60 Months post-transplant; and the all category decreases by 21.3% from 100 percent at 0 Months post-transplant to 78.7 percent at 60 Months post-transplant.

Figure HR 87. Patient survival among pediatric deceased donor heart transplant recipients, 2004-2011, 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, 2014-2015; 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 88. One-year cumulative incidence of death by cause among pediatric heart recipients, 2014-2015
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, 2010-2011; 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 89. Five-year cumulative incidence of death by cause among pediatric heart recipients, 2010-2011
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 Demographic characteristics of adults on the heart transplant waiting list on December 31, 2006 and December 31, 2016
Candidates waiting for transplant on December 31, 2006, and December 31, 2016, regardless of first listing date; multiple listings are collapsed.
Characteristic 2006, N 2006, Percent 2016, N 2016, Percent
Age: 18-34 years 265 10.4% 398 11.0%
Age: 35-49 years 602 23.6% 863 23.8%
Age: 50-64 years 1335 52.3% 1715 47.2%
Age: ≥ 65 years 349 13.7% 656 18.1%
Sex: Female 617 24.2% 858 23.6%
Sex: Male 1934 75.8% 2774 76.4%
Race/ethnicity: White 1885 73.9% 2227 61.3%
Race/ethnicity: Black 410 16.1% 964 26.5%
Race/ethnicity: Hispanic 182 7.1% 320 8.8%
Race/ethnicity: Asian 54 2.1% 102 2.8%
Race/ethnicity: Other/unknown 20 0.8% 19 0.5%
All candidates 2551 100.0% 3632 100.0%



Table HR 2 Clinical characteristics of adults on the heart transplant waiting list on December 31, 2006 and December 31, 2016
Candidates waiting for transplant on December 31, 2006, and December 31, 2016, regardless of first listing date; multiple listings are collapsed. VAD, ventricular assist device.
Characteristic 2006, N 2006, Percent 2016, N 2016, Percent
Diagnosis: Coronary artery disease 1063 41.7% 1148 31.6%
Diagnosis: Cardiomyopathy 1147 45.0% 2094 57.7%
Diagnosis: Congenital disease 135 5.3% 175 4.8%
Diagnosis: Valvular disease 70 2.7% 36 1.0%
Diagnosis: Other/unknown 136 5.3% 179 4.9%
Blood type: A 741 29.0% 1095 30.1%
Blood type: B 257 10.1% 420 11.6%
Blood type: AB 57 2.2% 86 2.4%
Blood type: O 1496 58.6% 2031 55.9%
Medical urgency: Status 1A 66 2.6% 391 10.8%
Medical urgency: Status 1B 266 10.4% 1626 44.8%
Medical urgency: Status 2 911 35.7% 845 23.3%
Inactive status 1308 51.3% 770 21.2%
VAD at listing 145 5.7% 1166 32.1%
All candidates 2551 100.0% 3632 100.0%



Table HR 3 Listing characteristics of adults on the heart transplant waiting list on December 31, 2006 and December 31, 2016
Candidates waiting for transplant on December 31, 2006, and December 31, 2016, regardless of first listing date; multiple listings are collapsed.
Characteristic 2006, N 2006, Percent 2016, N 2016, Percent
Transplant history: First 2478 97.1% 3515 96.8%
Transplant history: Retransplant 73 2.9% 117 3.2%
Wait time: < 1 year 919 36.0% 1826 50.3%
Wait time: 1-< 2 years 347 13.6% 785 21.6%
Wait time: 2-< 3 years 247 9.7% 449 12.4%
Wait time: 3-< 4 years 212 8.3% 225 6.2%
Wait time: 4-< 5 years 171 6.7% 126 3.5%
Wait time: ≥ 5 years 655 25.7% 221 6.1%
Tx type: Heart only 2378 93.2% 3362 92.6%
Tx type: Heart-kidney 58 2.3% 191 5.3%
Tx type: Heart-lung 104 4.1% 47 1.3%
Tx type: Other 11 0.4% 32 0.9%
All candidates 2551 100.0% 3632 100.0%



Table HR 4 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 2014 2015 2016
Patients at start of year 3339 3625 3787
Patients added during year 3613 3622 3630
Patients removed during year 3319 3456 3785
Patients at end of year 3633 3791 3632



Table HR 5 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 2014 2015 2016
Deceased donor transplant 2228 2331 2734
Patient died 377 393 322
Patient refused transplant 22 24 25
Improved, transplant not needed 201 162 187
Too sick for transplant 271 299 264
Other 220 247 252



Table HR 6 Adult heart recipients on circulatory support before transplant
Patients may have more than one type of circulatory support.
Support 2011, N 2011, Percent 2016, N 2016, Percent
Any life support 1553 78.7% 2372 85.8%
Intravenous inotropes 757 38.3% 974 35.2%
Left ventricular assist device 729 36.9% 1347 48.7%
Intra-aortic balloon pump 96 4.9% 211 7.6%
Right ventricular assist device 68 3.4% 39 1.4%
Ventilator 53 2.7% 36 1.3%
Total artificial heart 31 1.6% 38 1.4%
Extra corporeal membrane oxygenation 14 0.7% 33 1.2%
Prostaglandins 10 0.5% 0 0.0%
Inhaled NO 4 0.2% 3 0.1%



Table HR 7 Demographic characteristics of adult heart transplant recipients, 2006 and 2016
Adult heart transplant recipients, including retransplants.
Characteristic 2006, N 2006, Percent 2016, N 2016, Percent
Age: 18-34 years 234 12.3% 296 10.7%
Age: 35-49 years 453 23.8% 542 19.6%
Age: 50-64 years 973 51.1% 1368 49.5%
Age: ≥65 years 243 12.8% 558 20.2%
Sex: Female 432 22.7% 722 26.1%
Sex: Male 1471 77.3% 2042 73.9%
Race/ethnicity: White 1333 70.0% 1744 63.1%
Race/ethnicity: Black 340 17.9% 620 22.4%
Race/ethnicity: Hispanic 156 8.2% 261 9.4%
Race/ethnicity: Asian 63 3.3% 120 4.3%
Race/ethnicity: Other/unknown 11 0.6% 19 0.7%
Insurance: Private 1056 55.5% 1205 43.6%
Insurance: Medicare 536 28.2% 1082 39.1%
Insurance: Medicaid 227 11.9% 325 11.8%
Insurance: Other government 55 2.9% 96 3.5%
Insurance: Unknown 29 1.5% 56 2.0%
All recipients 1903 100.0% 2764 100.0%



Table HR 8 Clinical characteristics of adult heart transplant recipients, 2006 and 2016
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 2006, N 2006, Percent 2016, N 2016, Percent
Diagnosis: Coronary artery disease 796 41.8% 917 33.2%
Diagnosis: Cardiomyopathy 951 50.0% 1680 60.8%
Diagnosis: Congenital disease 70 3.7% 79 2.9%
Diagnosis: Valvular disease 48 2.5% 33 1.2%
Diagnosis: Other/unknown 38 2.0% 55 2.0%
Blood type: A 813 42.7% 1094 39.6%
Blood type: B 265 13.9% 427 15.4%
Blood type: AB 83 4.4% 158 5.7%
Blood type: O 742 39.0% 1085 39.3%
Medical urgency: Status 1A 705 37.0% 1863 67.4%
Medical urgency: Status 1B 799 42.0% 837 30.3%
Medical urgency: Status 2 399 21.0% 64 2.3%
On VAD 457 24.0% 1438 52.0%
CPRA: < 1% 1171 61.5% 1335 48.3%
CPRA: 1-< 20% 341 17.9% 329 11.9%
CPRA: 20-< 80% 195 10.2% 475 17.2%
CPRA: 80-< 98% 52 2.7% 88 3.2%
CPRA: 98-100% 30 1.6% 48 1.7%
CPRA: Unknown 114 6.0% 489 17.7%
All recipients 1903 100.0% 2764 100.0%



Table HR 9 Transplant characteristics of adult heart transplant recipients, 2006 and 2016
Adult heart transplant recipients, including retransplants.
Characteristic 2006, N 2006, Percent 2016, N 2016, Percent
Wait time: < 31 days 676 35.5% 649 23.5%
Wait time: 31-60 days 302 15.9% 339 12.3%
Wait time: 61-90 days 196 10.3% 214 7.7%
Wait time: 3-< 6 months 300 15.8% 463 16.8%
Wait time: 6-< 12 months 219 11.5% 447 16.2%
Wait time: 1-< 2 years 125 6.6% 390 14.1%
Wait time: ≥ 2 years 85 4.5% 262 9.5%
Transplant history: First 1837 96.5% 2691 97.4%
Transplant history: Retransplant 66 3.5% 73 2.6%
Tx type: Heart only 1835 96.4% 2589 93.7%
Tx type: Heart-lung 24 1.3% 17 0.6%
Tx type: Heart-kidney 39 2.0% 139 5.0%
Tx type: Heart-liver 4 0.2% 18 0.7%
Tx type: Other 1 0.1% 1 0.0%
All recipients 1903 100.0% 2764 100.0%



Table HR 10 Adult heart donor-recipient serology matching, 2012-2016
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; HIV, human immunodeficiency virus.
Donor Recipient CMV EBV HIV
D- R- 9.1% 0.7% 95.6%
D- R+ 12.7% 5.0% 0.3%
D- R unk 16.6% 0.6% 3.1%
D+ R- 13.5% 9.8% 0.0%
D+ R+ 21.3% 75.3% 0.0%
D+ R unk 26.4% 8.4% 0.0%
D unk R- 0.1% 0.0% 1.1%
D unk R+ 0.1% 0.2% 0.0%
D unk R unk 0.3% 0.0% 0.0%



Table HR 11 Demographic characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2006, December 31, 2011, and December 31, 2016
Candidates aged younger than 18 years waiting for transplant on December 31 of given year, regardless of first listing date; multiple listings are collapsed. Age calculated at snapshot.
Characteristic 2006, N 2006, Percent 2016, N 2016, Percent
Age: < 1 year 31 12.4% 53 16.2%
Age: 1-5 years 74 29.5% 102 31.2%
Age: 6-10 years 67 26.7% 69 21.1%
Age: 11-17 years 79 31.5% 103 31.5%
Sex: Female 114 45.4% 145 44.3%
Sex: Male 137 54.6% 182 55.7%
Race/ethnicity: White 151 60.2% 168 51.4%
Race/ethnicity: Black 44 17.5% 68 20.8%
Race/ethnicity: Hispanic 43 17.1% 66 20.2%
Race/ethnicity: Asian 10 4.0% 14 4.3%
Race/ethnicity: Other/unknown 3 1.2% 11 3.4%
All candidates 251 100.0% 327 100.0%



Table HR 12 Clinical characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2006, December 31, 2011, and December 31, 2016
Candidates aged younger than 18 years waiting for transplant on December 31, 2006, and December 31, 2016, regardless of first listing date; multiple listings are collapsed. CM, cardiomyopathy; VAD, ventricular assist device.
Characteristic 2006, N 2006, Percent 2016, N 2016, Percent
Diagnosis: Congenital defect 99 39.4% 181 55.4%
Diagnosis: Idiopathic dilated CM 62 24.7% 51 15.6%
Diagnosis: Familial dilated CM 2 0.8% 7 2.1%
Diagnosis: Idiopathic restrictive CM 14 5.6% 19 5.8%
Diagnosis: Myocarditis 14 5.6% 4 1.2%
Diagnosis: Other/unknown 60 23.9% 65 19.9%
Blood type: A 76 30.3% 82 25.1%
Blood type: B 17 6.8% 54 16.5%
Blood type: AB 7 2.8% 6 1.8%
Blood type: O 151 60.2% 185 56.6%
Medical urgency: Status 1A 33 13.1% 76 23.2%
Medical urgency: Status 1B 27 10.8% 67 20.5%
Medical urgency: Status 2 52 20.7% 93 28.4%
Inactive status 139 55.4% 91 27.8%
VAD at listing 8 3.2% 20 6.1%
All candidates 251 100.0% 327 100.0%



Table HR 13 Listing characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2006, December 31, 2011, and December 31, 2016
Candidates aged younger than 18 years waiting for transplant on December 31, 2006, and December 31, 2016, regardless of first listing date; multiple listings are collapsed.
Characteristic 2006, N 2006, Percent 2016, N 2016, Percent
Transplant history: First 230 91.6% 307 93.9%
Transplant history: Retransplant 21 8.4% 20 6.1%
Wait time: < 1 year 124 49.4% 203 62.1%
Wait time: 1-< 2 years 31 12.4% 53 16.2%
Wait time: 2-< 3 years 25 10.0% 33 10.1%
Wait time: 3-< 4 years 10 4.0% 14 4.3%
Wait time: 4-< 5 years 14 5.6% 13 4.0%
Wait time: ≥ 5 years 47 18.7% 11 3.4%
Tx type: Heart only 229 91.2% 325 99.4%
Tx type: Heart-kidney 3 1.2% 1 0.3%
Tx type: Heart-lung 18 7.2% 1 0.3%
Tx type: Other 1 0.4% 0 0.0%
All candidates 251 100.0% 327 100.0%



Table HR 14 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 2014 2015 2016
Patients at start of year 349 361 368
Patients added during year 593 644 626
Patients removed during year 579 635 627
Patients at end of year 363 370 367



Table HR 15 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 2014 2015 2016
Deceased donor transplant 422 463 460
Patient died 77 81 60
Patient refused transplant 1 3 2
Improved, transplant not needed 43 48 59
Too sick for transplant 29 23 29
Other 7 17 17



Table HR 16 Demographic characteristics of pediatric heart transplant recipients, 2004-2006 and 2014-2016
Heart transplant recipients, including retransplants.
Characteristic 2004-06, N 2004-06, Percent 2014-16, N 2014-16, Percent
Age: < 1 year 245 26.1% 377 28.7%
Age: 1-5 years 217 23.2% 308 23.4%
Age: 6-10 years 128 13.7% 184 14.0%
Age: 11-17 years 347 37.0% 446 33.9%
Sex: Female 439 46.9% 578 44.0%
Sex: Male 498 53.1% 737 56.0%
Race/ethnicity: White 520 55.5% 694 52.8%
Race/ethnicity: Black 235 25.1% 241 18.3%
Race/ethnicity: Hispanic 125 13.3% 285 21.7%
Race/ethnicity: Asian 39 4.2% 57 4.3%
Race/ethnicity: Other/unknown 18 1.9% 38 2.9%
Insurance: Private 480 51.2% 552 42.0%
Insurance: Medicaid 384 41.0% 625 47.5%
Insurance: Other government 51 5.4% 100 7.6%
Insurance: Unknown 22 2.3% 38 2.9%
All recipients 937 100.0% 1315 100.0%



Table HR 17 Clinical characteristics of pediatric heart transplant recipients, 2004-2006 and 2014-2016
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 2004-06, N 2004-06, Percent 2014-16, N 2014-16, Percent
Diagnosis: Congenital defect 410 43.8% 632 48.1%
Diagnosis: Idiopathic dilated CM 286 30.5% 322 24.5%
Diagnosis: Familial dilated CM 33 3.5% 70 5.3%
Diagnosis: Idiopathic restrictive CM 51 5.4% 67 5.1%
Diagnosis: Myocarditis 25 2.7% 36 2.7%
Diagnosis: Other/unknown 132 14.1% 188 14.3%
Blood type: A 349 37.2% 485 36.9%
Blood type: B 116 12.4% 183 13.9%
Blood type: AB 39 4.2% 48 3.7%
Blood type: O 433 46.2% 599 45.6%
Medical urgency: Status 1A 671 71.6% 1115 84.8%
Medical urgency: Status 1B 116 12.4% 162 12.3%
Medical urgency: Status 2 150 16.0% 38 2.9%
On VAD 98 10.5% 312 23.7%
CPRA: < 1% 496 52.9% 556 42.3%
CPRA: 1-< 20% 154 16.4% 219 16.7%
CPRA: 20-< 80% 94 10.0% 279 21.2%
CPRA: 80-< 98% 30 3.2% 68 5.2%
CPRA: 98-100% 35 3.7% 28 2.1%
CPRA: Unknown 128 13.7% 165 12.5%
All recipients 937 100.0% 1315 100.0%



Table HR 18 Transplant characteristics of pediatric heart transplant recipients, 2004-2006 and 2014-2016
Heart transplant recipients, including retransplants.
Characteristic 2004-06, N 2004-06, Percent 2014-16, N 2014-16, Percent
Wait time: < 31 days 428 45.7% 362 27.5%
Wait time: 31-60 days 184 19.6% 256 19.5%
Wait time: 61-90 days 98 10.5% 187 14.2%
Wait time: 3-< 6 months 133 14.2% 270 20.5%
Wait time: 6-< 12 months 56 6.0% 143 10.9%
Wait time: 1-< 2 years 23 2.5% 61 4.6%
Wait time: ≥ 2 years 15 1.6% 36 2.7%
ABO: Compatible/identical 912 97.3% 1244 94.6%
ABO: Incompatible 25 2.7% 71 5.4%
Transplant history: First 871 93.0% 1251 95.1%
Transplant history: Retransplant 66 7.0% 64 4.9%
Tx type: Heart only 910 97.1% 1300 98.9%
Tx type: Heart-lung 17 1.8% 10 0.8%
Tx type: Heart-kidney 7 0.7% 4 0.3%
Tx type: Heart-liver 2 0.2% 1 0.1%
Tx type: Other 1 0.1% 0 0.0%
All recipients 937 100.0% 1315 100.0%



Table HR 19 Pediatric heart recipients on circulatory support before transplant
Patients may have more than one type of circulatory support.
Support 2011, N 2011, Percent 2016, N 2016, Percent
Any life support 263 70.1% 339 76.2%
Intravenous inotropes 210 56.0% 235 52.8%
Ventilator 68 18.1% 74 16.6%
Left ventricular assist device 67 17.9% 100 22.5%
Right ventricular assist device 22 5.9% 14 3.1%
Extra corporeal membrane oxygenation 20 5.3% 17 3.8%
Prostaglandins 5 1.3% 18 4.0%
Intra-aortic balloon pump 1 0.3% 1 0.2%
Inhaled NO 1 0.3% 6 1.3%



Table HR 20 Pediatric heart donor-recipient serology matching, 2012-2016
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.
Donor Recipient CMV EBV
D- R- 17.3% 15.1%
D- R+ 10.7% 14.6%
D- R unk 21.1% 1.0%
D+ R- 17.0% 29.0%
D+ R+ 12.7% 37.4%
D+ R unk 20.4% 2.5%
D unk R- 0.4% 0.4%
D unk R+ 0.0% 0.1%
D unk R unk 0.4% 0.0%