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
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% |
|