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Heart

OPTN/SRTR 2017 Annual Data Report: Heart

Abstract

In 2017, 3273 heart transplants were performed in the United States. New listings continued to increase, and 3769 new adults were listed for heart transplant in 2017. Over the past decade, posttransplant mortality has declined. The number of new pediatric listings increased over the past decade, as did the number of pediatric heart transplants, although some fluctuation has occurred more recently. New listings for pediatric heart transplants increased from 481 in 2007 to 623 in 2017. The number of pediatric heart transplants performed each year increased from 330 in 2007 to 432 in 2017, slightly fewer than in 2016. Short-term and long-term mortality improved. Among pediatric patients who underwent transplant between 2015-2016, 4.8% had died by 6 months and 6.2% by 1 year.

Introduction

The most significant occurrence in heart transplantation in recent years was approval of the new heart allocation policy in 2016 and its implementation in October 2018. This new algorithm attempts to address broader sharing and risk stratification through development of a 6-status system that combines Zone A and donation service area (DSA) as the first point of allocation for higher urgency statuses. This important new development also increased the data that OPTN will collect, with the goal of providing a dynamic policy that can continue to evolve over time. In addition, mechanical circulatory support technology continues to improve, with newer pumps designed to decrease risk of thrombosis. These improvements, if they result in better patient outcomes, will likely affect future heart allocation policy. In this iteration of the annual data report, we review the significant trends in heart transplantation in 2017.

Adult Heart Transplant

Waitlist Trends

Between 2006 and 2017, the number of new active listings for heart transplant increased 49%, from 2424 to 3623 (Figure HR 1). Despite a decline between 2015 and 2017, the number of candidates actively awaiting heart transplant increased dramatically since 2006, from 1243 to 2727 (Figure HR 2), an increase of 119%, suggesting that transplant rates have not increased at the same rate as listings. The most remarkable demographic trends in heart transplantation include the following: a continued increase in the proportion of heart transplant candidates aged 65 years or older to 18.5% in 2017 (Figure HR 3); an increase in the proportion of racial/ethnic minorities, with black candidates comprising 25.5% of patients awaiting heart transplant (Figure HR 5); and a continued increase in patients with non-ischemic cardiomyopathy (Figure HR 6). The proportion of candidates with extended waiting times decreased. In 2006, 15.9% of candidates waited 5 years or more; this proportion gradually declined to 4.1% in 2017 (Figure HR 7). The proportion of candidates awaiting transplant as status 1A increased to 45.0% in 2017 (Figure HR 8). The proportion of status 1B candidates increased similarly, while the proportion waiting as status 2 declined from 29.8% to 15.7%. The proportion of candidates with ventricular assist devices (VADs) at listing increased from 9.1% in 2006 to 32.6% in 2017(Figure HR 9). Sex distribution has not changed (Figure HR 4). In 2017, 85.1% of candidates resided in a metropolitan area (Table HR 1). The number of candidates listed for heart-kidney transplant increased from 69 to 208 between 2007 and 2017, and the proportion of heart-lung candidates declined to 1.2% (Table HR 3). The number of patients receiving circulatory support prior to transplant increased from 1610 in 2012 to 2427 in 2017 (Table HR 6). Of these, 47.6% had left VADs (LVADs), which increased by 594 over the 5-year period. The number of patients receiving IV inotropes increased by 224 and the number of those with intra-aortic balloon pumps (IABPs) increased by 115. The number of patients with extracorporeal membrane oxygenation increased notably, from 15 to 32.

Between 2006 and 2017, heart transplant rates fluctuated, but overall remained the same, 77.2 per 100 waitlist-years (Figure HR 14). The decade low of 61.5 per 100 waitlist-years occurred in 2015, and was followed by an increase; this trend was similar for all age groups, racial/ethnic groups, blood types, and status groups (Figure HR 11, Figure HR 12, Figure HR 13, Figure HR 14). Transplant rates peaked for most groups in 2006 and 2007, and reached a nadir in 2014 and 2015. Transplant rates by age group remained similar, but varied widely by blood type and medical urgency status. By age, 2017 transplant rates were highest for patients aged 65 or older and lowest for those aged 35-49 years, 66.6 per 100 waitlist-years. Between 2006 and 2010, transplant rates were highest for patients aged 18-34 yeas, but this shifted in 2011. Transplant rates have consistently been highest for candidates with blood type AB (208.8 per 100 waitlist-years) and for those listed as status 1A (277.3 per 100 waitlist-years). In 2017, blood type O candidates underwent transplant at a rate of 52.9 per 100 waitlist-years, nearly half the rate of blood type A and B candidates and 25% of the rate of blood type AB candidates. Candidates with blood type A underwent transplant at a rate of 105.7 per 100 waitlist-years, higher than in previous years, and higher than candidates with blood type B. Transplant rates declined substantially for all status groups between 2006 and 2015, but in 2017 appeared to be increasing again. In 2017, candidates residing in non-metropolitan areas underwent transplant at slightly higher rates than those in metropolitan areas, 80.5 per 100 waitlist-years vs. 76.8 (Figure HR 15). Although trends based on candidate distance from the donor hospital have been similar over the past decade, in 2017 candidates residing 150-250 nautical miles (NM) from the donor hospital underwent transplant at the highest rate, 92.8 per 100 waitlist-years, and those residing 100-150 NM away at the lowest rate, 67.2 per 100 waitlist-years (Figure HR 16).

Multiple factors have contributed to the trends in transplant rates over the past decade, and the variations may have been affected by policy changes and by changes in program practices in response to policy changes and evolving mechanical circulatory support. The median waiting time in 2016-2017 was 7.9 months, an increase from 4.0 months in 2006-2007 (Figure HR 18). Waiting times peaked in 2014-2015, then declined again. In 2016-2017, median waiting time was longest for blood type O candidates, 13.8 months (Figure HR 19), and candidates with body mass index ? 31 kg/m2, 12.2 months (Figure HR 21). Women waited on average 6.1 months, and men 8.4 months (Figure HR 18). Status 2 candidates had the longest median waiting times, 17.7 months in 2016-2017 (Figure HR 20). Over the past decade, the proportion of candidates undergoing transplant within 1 year of listing declined overall, but appears to be increasing since 2014. Of candidates listed in 2016, 56.3% underwent transplant within 1 year (Figure HR 22). Geographic variability in transplant rates persisted, and in 2017, the proportion of candidates undergoing transplant within 1 year varied from 23.1% to 94.1% depending on DSA (Figure HR 23). Similar variability occurred by state, ranging from 20.0% to 100% (Figure HR 24).

Among candidates listed in 2014, 48.6% underwent transplant during the first year on the waiting list, 33.8% were still waiting, 9.4% were removed from the list, and 8.2% had died (Figure HR 17). At 3 years, 63.1% had undergone transplant, 9.7% were still waiting, 17.4% had been removed from the list, and 9.8% had died. Despite slight increases since 2016 in proportions of patients who were still waiting, who were removed from the list, or who died, most patients undergo transplant within 3 years, and less than 10.0% die on the waiting list. Between 2015 and 2017, fewer patients were removed from the waiting list due to death and more were removed due to undergoing transplant (Table HR 5).

Since 2006-2007, pretransplant mortality declined, from 16.3 to 12 deaths per 100 waitlist-years in 2016-2017 (Figure HR 25). Declines occurred in all age and racial/ethnic groups, with the most notable declines for candidates aged 18-34 years and black and Hispanic candidates (Figure HR 25, Figure HR 26). Pretransplant mortality declined notably for candidates with VADs at listing, from 47.8 to 11.8 deaths per 100 waitlist-years, now making pretransplant mortality nearly identical for candidates with and without VADs at listing (Figure HR 30). Pretransplant mortality rates were highest for candidates listed as status 1A, but declined dramatically since 2005-2006, from 91.9 to 30.4 deaths per 100 waitlist-years (Figure HR 29). Similarly, pretransplant mortality among candidates listed as status 1B declined from 36.3 to 8.1 deaths per 100 waitlist-years. Pretransplant mortality was slightly higher for candidates residing in nonmetropolitan areas than for those in metropolitan areas (Figure HR 31).

Pretransplant mortality varied by DSA from 2.1 to 23.9 deaths per 100 waitlist-years (Figure HR 33). Among candidates removed from the waiting list for reasons other than transplant, 18.4% died within 6 months of removal. The proportion of deaths within 6 months of removal from the waiting list fluctuated over the past decade, peaking at 33.2% in 2013 (Figure HR 34). In 2017, 87 patients died within 6 months of removal from the waiting list. In 2017, 48.5% of candidates listed as status 1A died within 6 months of removal, reflecting the acuity of illness. The percentage of candidates aged 18-34 years who died within 6 months decreased notably, from 21.0% in 2006 to 6.8% in 2017, and the percentage of candidates aged 65 years or older who died within 6 months of removal increased from 20.0% in 2006 to 25.7% in 2017 (Figure HR 35).

Donor Trends

Deceased donor heart donations continued to increase, with 3272 donors in 2017, the highest number to date, and an increase of 45% since 2006. The majority of these, 51.6%, were from donors aged 18-34 years (Figure HR 37), increasing from 1087 in 2007 to 1687 in 2017 (Figure HR 36). The rate of discards reached a nadir of 0.6% between 2008 and 2011 and has trended upward since, with a slight downtrend in 2016-2017 (Figure HR 40). In 2016-2017, 1.0% of recovered hearts were not transplanted. The discard rate was highest among donors age 50 years or older, 2.7%. In 2016-2017, hearts from Public Health Service high-risk donors were discarded at a lower rate, 0.8%, than hearts from donors not considered high risk, 1.1% (Figure HR 41).

The largest proportion of heart donor deaths, 47.1%, were caused by head trauma, despite head trauma declining in prevalence from 63.3% in 2006. Anoxia continued to increase as a cause of death among heart donors, and was 37.2% in 2017 from 14.0% in 2006 (Figure HR 42). While pediatric organs can be donated to adults, the proportion of pediatric hearts transplanted into an adult is low, varying by state from 0% to 1% in 2017 (Figure HR 39).

Overall Trends in Heart Transplant

In 2017, 3273 heart transplants were performed, an increase of 64 since 2016; 432 transplants occurred in pediatric recipients and 2841 in adult recipients (Figure HR 43). Over the past decade, adult heart transplants reached a nadir in 2008, and have been increasing since, while pediatric transplants increased until 2015 and have declined by 28 since (Figure HR 43). The number of heart transplants increased in all age groups, but the distribution increased more for recipients aged 65 years or older (Figure HR 44). Transplants increased in all racial/ethnic groups (Figure HR 46). In 2017, 66.4% of adult heart transplants were performed in candidates listed as status 1A, compared with 44.4% in 2007 (Table HR 8). In 2017, 85.0% of recipients resided in a metropolitan area; 60.4% of recipients lived within 50 miles of the transplant program (Table HR 7). In 2017, 49.4% of recipients had LVADs. Although 25.2% of patients underwent transplant within 31 days of listing in 2017, the proportion who underwent transplant after waiting 1 year or more increased over the past decade: 21.7% in 2017 vs. 11.4% in 2007 (Table HR 9). Dual organ transplant remained a small proportion of heart transplants. The proportion of heart-lung transplants declined from 1.5% to 0.9% between 2007 and 2017, heart-kidney transplants increased to 6.5% from 2.8%, and heart-liver transplants increased from 0.5 to 1.0% (Table HR 9).

Use of induction therapy has changed little since 2006. In 2017, 52.4% of adult heart transplant recipients received either IL2-RA or T-cell depleting therapy (Figure HR 49). In 2017, 95.2% of recipients received a tacrolimus-based immunosuppression regimen, while 3.6% received other regimens (Figure HR 50).

Transplant program volume has increased since 2006, with 50% of programs performing at least 20 transplants per year in 2017 (Figure HR 53). In 2006, the median volume was 12 transplants per year. The proportion of transplants performed at higher- and lower-volume programs has shifted since 2006. In 2006, 10.8% of heart transplants were performed at programs with fewer than 10 transplants per year, compared with 3.6% in 2017. In contrast, 15.0% of transplants in 2006 were performed at programs with 60 or more transplants per year, compared with 21.1% in 2017 (Figure HR 54).

Posttransplant Survival and Morbidity

Overall 1-year survival for patients who underwent heart transplant in 2010-2012 was 90.5%, 3-year survival was 84.1%, and 5-year survival was 79.1% (Figure HR 57). One-year survival in most subgroups was similar, but tended to be lower among recipients aged 65 years or older (Figure HR 55) and black recipients (Figure HR 56). Asian recipients tended to have better survival at all time points. Survival at 1, 3, and 5 years was similar between recipients with VADs and those without circulatory support; however, survival was lower at 1, 3, and 5 years for recipients with IABPs, 88.4%, 80.4%, and 75.0%, respectively. This reduction in survival for patients with IABPs occurred as early as 1 month posttransplant (Figure HR 58). Survival among new transplants and re-transplants was similar, except at 5 years, when survival was slightly better for recipients undergoing re-transplant, 83.1% vs. 79.1% (Figure HR 59). Survival was lower for recipients in non-metropolitan areas than for those in metropolitan areas (Figure HR 61). Finally, while recipients residing 250 miles or farther from the transplant program fared similarly to other recipients early after transplant, at 1, 3, and 5 years, their survival tended to be lower compared with survival of recipients living closer to the transplant program. Five-year survival in this group was 74.2%, lowest of all groups, followed by black recipients and recipients with IABPs (Figure HR 62). Since 2006, patient death after transplant has decreased overall at 6 months and at 1, 3, and 5 years, despite slight increases between 2011 and 2014 (Figure HR 63). The number of heart transplant survivors has increased by approximately 10,000 since 2006. On June 30, 2017, 32,210 heart transplant recipients were alive with a functioning graft. Most survivors had undergone transplant at age 50 years or older (Figure HR 64).

The incidence of acute rejection in the first year posttransplant was 25.4% for recipients undergoing transplant in 2015-2016 (Figure HR 65). Posttransplant lymphoproliferative disorder (PTLD) remained uncommon, with an overall cumulative incidence of only 1.1% by 5 years posttransplant (Figure HR 67). The incidence was comparatively higher in recipients who were Epstein-Barre virus (EBV) seronegative, 1.1%, 1.9%, and 2.6% at 1, 3, and 5 years, respectively. The most common documented cause of death in the first posttransplant year was infection (Figure HR 68); however, by the second year, cardiovascular/cerebrovascular disease emerged as the leading documented cause of death through year 5 (Figure HR 69). Malignancy was a relatively infrequent cause of death, 1.4% of deaths at 5 years.

Pediatric Heart Transplant

Pediatric Waitlist Trends

In 2017, 623 new pediatric candidates were added to the heart transplant waiting list, with few at inactive status (Figure HR 70). At year-end 2017, 384 candidates listed before their eighteenth birthdays were awaiting heart transplant, 68.0% active (Figure HR 71). Over the past decade, the number of candidates with inactive status at year-end decreased from 164 in 2007 to 123 in 2017. The largest pediatric age group on the waiting list in 2017 was ages 11-17 years (34.4%), followed by ages younger than 1 year (27.0%), 1-5 years (24.8%), and 6-10 years (13.7%) (Figure HR 72). Almost half of heart transplant candidates were white, 21.5% were Hispanic, 21.4% were black, and 4.4% were Asian (Figure HR 73). Considering trends over time, the proportion of waitlist candidates aged younger than 1 year increased from 9.6% on December 31, 2007, to 13.5% on December 31, 2017; the proportion of candidates aged 6-10 years decreased from 23.7% to 16.7% over the same time period (Table HR 11). The proportion of white candidates decreased from 61.4% on December 31, 2007, to 47.7% on December 31, 2017. For candidates waiting on December 31, 2017, congenital defect was the leading cause of heart disease (57.5%), increased from 45.0% in 2007 (Table HR 12). The proportion of status 1B candidates increased from 9.2% in 2007 to 20.7% in 2017. The differences in status 1A and 1B listing percentages are likely due in part to changes to pediatric heart allocation policy implemented in 2016. The percentage of candidates using VADs at the time of listing increased from 2.8% in 2007 to 8.0% in 2017 (Table HR 12). Proportions of heart-only candidates increased from 91.2% at year-end 2007 to 98.9% at year-end 2017 (Table HR 13). Among the 606 candidates removed from the waiting list in 2017 (Table HR 14), 444 (73.3%) were removed due to undergoing transplant, 67 (11.1%) died, 54 (8.9%) were removed due to improved condition, and 28 (4.6%) were considered too sick to undergo transplant (Table HR 15).

Just over 70% of candidates newly listed in 2014 underwent transplant within 3 years, 12.1% died, 11.1% were removed from the list, and 5.1% were still waiting (Figure HR 78). The rate of heart transplants among pediatric waitlist candidates was 114.9 per 100 waitlist-years in 2017 (Figure HR 79). Transplant rates varied by age; rates were highest for candidates aged younger than 1 year, at 192.0 transplants per 100 waitlist-years in 2017, followed by candidates aged 11-17 years, at 119.3 transplants per 100 waitlist-years (Figure HR 79). Pretransplant mortality decreased by half over the past decade; 23.5 deaths per 100 waitlist-years in 2006-2007 to 11.9 deaths per 100 waitlist-years in 2016-2017 (Figure HR 82). By age, pretransplant mortality rates were highest for candidates aged younger than 1 year, at 41.2 deaths per 100 waitlist-years in 2016-2017. Rates were 7.2 deaths per 100 waitlist-years for candidates aged 1-5 years, 5.1 for ages 6-10 years, and 7.6 for ages 11-17 years (Figure HR 82). By medical urgency status, pretransplant mortality was highest for status 1A (40.3 deaths per 100 waitlist-years) and 1B (15.0) candidates, compared with 5.5 for status 2 candidates (Figure HR 85).

Pediatric Trends in Heart Transplant

Pediatric transplant recipients are defined as those aged 18 years or younger at the time of transplant. The number of pediatric heart transplants performed each year increased from 321 in 2006 to 432 in 2017 (Figure HR 88). In 2017, 27 of 136 total heart transplant programs performed pediatric heart transplants exclusively, 86 performed adult heart transplants, and 23 performed both adult and pediatric heart transplants (Figure HR 89). In 2017, 9.3% of transplants in recipients aged younger than 10 years were performed at programs with volume of five or fewer pediatric transplants in that year (Figure HR 90). Over the past decade, the age and sex of pediatric heart transplant recipients changed little (Table HR 16).The proportion of recipients who were white or black decreased and the proportion who were Hispanic increased (Table HR 16). Congenital defects remained the most common primary cause of disease, affecting 49.4% of recipients who underwent transplant in 2015-2017 (Table HR 17). The proportion of patients who underwent transplant as status 1A increased from 74.8% in 2005-2007 to 82.9% in 2015-2017. VAD use doubled from 12.8% of transplant recipients in 2005-2007 to 25.0% in 2015-2017 (Table HR 17). The proportion of ABO-incompatible transplants in 2015-2017 was 7.5%, increased from 3.1% a decade earlier (Table HR 18).

In 2017, use of T-cell depleting agents for induction continued to increase, to 72.0% of heart transplant recipients; use of interleukin-2 receptor antagonists decreased to 9.4% (Figure HR 91). The initial immunosuppression regimen used most commonly in 2017 was tacrolimus, mycophenolate (MMF), and steroid (54.2%), followed by tacrolimus and MMF in 37.5% (Figure HR 92).

Pediatric Posttransplant Survival and Morbidity

Among pediatric heart transplant recipients 2015-2016, the rate of acute rejection in the first year was 19.3% overall; the highest rate observed was 21.7% in the 6-10 year age group, and the lowest 17.5% in recipients aged younger than 6 years (Figure HR 96). Among pediatric heart transplant recipients 2013-2017, 60.6% were cytomegalovirus (CMV) negative and 43.8% were EBV negative (Table HR 20). The combination of a CMV-positive donor and CMV-negative recipient occurred in 28.5% of transplants; for EBV, this combination occurred in 27.9% of transplants (Table HR 20).

Recipient death occurred in 4.8% of patients at 6 months posttransplant and in 6.2% at 1 year posttransplant among heart transplants performed in 2015-2016, in 12.0% at 3 years post-transplant for transplants performed in 2013-2014, in 15.2% at 5 years posttransplant for transplants performed in 2011-2012, and in 28.8% at 10 years posttransplant for transplants performed in 2007-2008 (Figure HR 98). Overall, 1-year and 5-year patient survival were 89.8% and 80.1%, respectively, among recipients who underwent transplant in 2005-2012 (Figure HR 99). By age, 5-year patient survival was 75.3% for recipients aged younger than 1 year, 81.5% for ages 1-5 years, 87.7% for ages 6-10 years, and 80.4% for ages 11-17 years (Figure HR 99). The leading identified causes of death in the first 12 months posttransplant were graft failure (1.5%) and cardio/cerebrovascular disease (1.5%) (Figure HR 100). At 5 years posttransplant, the leading causes were cardio/cerebrovascular disease (3.5%) and graft failure (3.5%) (Figure HR 101).

The overall incidence of PTLD was 4.0% at 5 years posttransplant, with 5.5% among EBV-negative recipients and 2.7% among EBV-positive recipients (Figure HR 97).

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 sex
Figure HR 5. Distribution of adults waiting for heart transplant by race
Figure HR 6. Distribution of adults waiting for heart transplant by diagnosis
Figure HR 7. Distribution of adults waiting for heart transplant by waiting time
Figure HR 8. Distribution of adults waiting for heart transplant by medical urgency
Figure HR 9. Distribution of adults waiting for heart transplant by VAD status at listing
Figure HR 10. Distribution of adults waiting for heart transplant by blood type
Figure HR 11. Deceased donor heart transplant rates among adult waitlist candidates by age
Figure HR 12. Deceased donor heart transplant rates among adult waitlist candidates by race
Figure HR 13. Deceased donor heart transplant rates among adult waitlist candidates by blood type
Figure HR 14. Deceased donor heart transplant rates among adult waitlist candidates by medical urgency
Figure HR 15. Deceased donor heart transplant rates among waitlist candidates by metropolitan vs. non-metropolitan residence
Figure HR 16. Deceased donor heart transplant rates among waitlist candidates by distance from listing center
Figure HR 17. Three-year outcomes for adults waiting for heart transplant, new listings in 2014
Figure HR 18. Median months to heart transplant for waitlisted adults by sex
Figure HR 19. Median months to heart transplant for waitlisted adults by blood type
Figure HR 20. Median months to heart transplant for waitlisted adults by medical urgency at listing
Figure HR 21. Median months to heart transplant for waitlisted adults by BMI at listing
Figure HR 22. Percentage of adults who underwent deceased donor heart transplant within a given time period of listing
Figure HR 23. Percentage of adults who underwent deceased donor heart transplant within 1 year of listing in 2016 by DSA
Figure HR 24. Percentage of adults who underwent deceased donor heart transplant within 1 year of listing in 2016 by state
Figure HR 25. Pretransplant mortality rates among adults waitlisted for heart transplant by age
Figure HR 26. Pretransplant mortality rates among adults waitlisted for heart transplant by race
Figure HR 27. Pretransplant mortality rates among adults waitlisted for heart transplant by sex
Figure HR 28. Pretransplant mortality rates among adults waitlisted for heart transplant by diagnosis
Figure HR 29. Pretransplant mortality rates among adults waitlisted for heart transplant by medical urgency
Figure HR 30. Pretransplant mortality rates among adults waitlisted for heart transplant by VAD at listing
Figure HR 31. Pretransplant mortality rates among adults waitlisted for heart by metropolitan vs. non-metropolitan residence
Figure HR 32. Pretransplant mortality rates among adults waitlisted for heart, by distance from listing center
Figure HR 33. Pretransplant mortality rates among adults waitlisted for heart transplant in 2016-2017, by DSA
Figure HR 34. Deaths within six months after removal among adult heart waitlist candidates, by status at removal
Figure HR 35. Deaths within six months after removal among adult heart waitlist candidates, by age at removal

Deceased donation

Figure HR 36. Deceased heart donor count by age
Figure HR 37. Distribution of deceased heart donors by age
Figure HR 38. Distribution of deceased heart donors by race
Figure HR 39. Percent of pediatric heart donors allocated to adult recipients
Figure HR 40. Rates of hearts recovered for transplant and not transplanted by donor age
Figure HR 41. Rates of hearts recovered for transplant and not transplanted, by donor risk of disease transmission
Figure HR 42. Cause of death among deceased heart donors

Transplant

Figure HR 43. Total heart transplants
Figure HR 44. Total heart transplants by age
Figure HR 45. Total heart transplants by sex
Figure HR 46. Total heart transplants by race
Figure HR 47. Total heart transplants by diagnosis
Figure HR 48. Total heart transplants by medical urgency
Figure HR 49. Induction agent use in adult heart transplant recipients
Figure HR 50. Immunosuppression regimen use in adult heart transplant recipients
Figure HR 51. Total HLA A, B, and DR mismatches among adult deceased donor heart transplant recipients, 2013-2017
Figure HR 52. Status of adult heart transplant recipients, 2015-2017, by age
Figure HR 53. Annual adult heart transplant center volumes, by percentile
Figure HR 54. Distribution of adult heart transplants by annual center volume

Outcomes

Figure HR 55. Patient survival among adult heart transplant recipients, 2010-2012, by age
Figure HR 56. Patient survival among adult heart transplant recipients, 2010-2012, by race
Figure HR 57. Patient survival among adult heart transplant recipients, 2010-2012, by sex
Figure HR 58. Patient survival among adult heart transplant recipients, 2010-2012, by circulatory support
Figure HR 59. Patient survival among adult heart transplant recipients, 2010-2012, by first vs. retransplant
Figure HR 60. Patient survival among adult heart transplant recipients, 2010-2012, by medical urgency
Figure HR 61. Patient survival among adult heart transplant recipients, 2010-2012, by metropolitan vs. non-metropolitan recipient residence
Figure HR 62. Patient survival among adult heart transplant recipients, 2010-2012, by recipients' distance from transplant center
Figure HR 63. Patient death among adult heart transplant recipients
Figure HR 64. Recipients alive with a functioning heart graft on June 30 of the year, by age at transplant
Figure HR 65. Incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by age, 2015-2016
Figure HR 66. Incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by induction status, 2015-2016
Figure HR 67. Incidence of PTLD among adult heart transplant recipients by recipient EBV status at transplant, 2011-2015
Figure HR 68. One-year cumulative incidence of death by cause among adult heart recipients, 2015-2016
Figure HR 69. Five-year cumulative incidence of death by cause among adult heart recipients, 2011-2012

Pediatric transplant

Figure HR 70. New pediatric candidates added to the heart transplant waiting list
Figure HR 71. Pediatric candidates listed for heart transplant on December 31 each year
Figure HR 72. Distribution of pediatric candidates waiting for heart transplant by age
Figure HR 73. Distribution of pediatric candidates waiting for heart transplant by race
Figure HR 74. Distribution of pediatric candidates waiting for heart transplant by diagnosis
Figure HR 75. Distribution of pediatric candidates waiting for heart transplant by sex
Figure HR 76. Distribution of pediatric candidates waiting for heart transplant by waiting time
Figure HR 77. Distribution of pediatric candidates waiting for heart transplant by medical urgency
Figure HR 78. Three-year outcomes for newly listed pediatric candidates waiting for heart transplant, 2014
Figure HR 79. Heart transplant rates among pediatric waitlist candidates by age
Figure HR 80. Deceased donor heart transplant rates among pediatric waitlist candidates by metropolitan vs. non-metropolitan residence
Figure HR 81. Deceased donor heart transplant rates among pediatric waitlist candidates by distance from listing center
Figure HR 82. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by age
Figure HR 83. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by race
Figure HR 84. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by diagnosis
Figure HR 85. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by medical urgency
Figure HR 86. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by metropolitan vs. non-metropolitan residence
Figure HR 87. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by distance from listing center
Figure HR 88. Pediatric heart transplants by recipient age
Figure HR 89. Number of centers performing pediatric and adult heart transplants by center's age mix
Figure HR 90. Pediatric heart recipients at programs that perform 5 or fewer pediatric transplants annually
Figure HR 91. Induction agent use in pediatric heart transplant recipients
Figure HR 92. Immunosuppression regimen use in pediatric heart transplant recipients
Figure HR 93. Induction use by C/PRA among pediatric heart transplant recipients, 2013-2017
Figure HR 94. Total HLA A, B, and DR mismatches among pediatric deceased donor heart transplant recipients, 2013-2017
Figure HR 95. Incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by induction status, 2015-2016
Figure HR 96. Incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by age, 2015-2016
Figure HR 97. Incidence of PTLD among pediatric heart transplant recipients by recipient EBV status at transplant, 2004-2014
Figure HR 98. Patient death among pediatric heart transplant recipients
Figure HR 99. Patient survival among pediatric deceased donor heart transplant recipients, 2005-2012, by recipient age
Figure HR 100. One-year cumulative incidence of death by cause among pediatric heart recipients, 2015-2016
Figure HR 101. Five-year cumulative incidence of death by cause among pediatric heart recipients, 2011-2012

Table List

Waiting list

Table HR 1. Demographic characteristics of adults on the heart transplant waiting list on December 31, 2007 and December 31, 2017
Table HR 2. Clinical characteristics of adults on the heart transplant waiting list on December 31, 2007 and December 31, 2017
Table HR 3. Listing characteristics of adults on the heart transplant waiting list on December 31, 2007 and December 31, 2017
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, 2007 and 2017
Table HR 8. Clinical characteristics of adult heart transplant recipients, 2007 and 2017
Table HR 9. Transplant characteristics of adult heart transplant recipients, 2007 and 2017
Table HR 10. Adult heart donor-recipient serology matching, 2013-2017

Pediatric transplant

Table HR 11. Demographic characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2007 and December 31, 2017
Table HR 12. Clinical characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2007 and December 31, 2017
Table HR 13. Listing characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2007 and December 31, 2017
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, 2005-2007 and 2015-2017
Table HR 17. Clinical characteristics of pediatric heart transplant recipients, 2005-2007 and 2015-2017
Table HR 18. Transplant characteristics of pediatric heart transplant recipients, 2005-2007 and 2015-2017
Table HR 19. Pediatric heart recipients on circulatory support before transplant
Table HR 20. Pediatric heart donor-recipient serology matching, 2013-2017

A line plot for new adult candidates added to the heart transplant waiting list; the active category increases by 49.5% from 2424 candidates at 2006 to 3623 candidates at 2017; the inactive category increases by 36.4% from 107 candidates at 2006 to 146 candidates at 2017; and the all category increases by 48.9% from 2531 candidates at 2006 to 3769 candidates at 2017.

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 119.4% from 1243 candidates at 2006 to 2727 candidates at 2017; the inactive category decreases by 38.7% from 1308 candidates at 2006 to 802 candidates at 2017; and the all category increases by 38.3% from 2551 candidates at 2006 to 3529 candidates at 2017.

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 is 11.8 percent at 2006 and remains relatively constant with a value of 10.8 percent at 2017; the 35 to 49 category is 24 percent at 2006 and remains relatively constant with a value of 22.5 percent at 2017; the 50 to 64 category is 51.9 percent at 2006 and remains relatively constant with a value of 48.2 percent at 2017; and the greater than or equal to 65 category increases by 50.6% from 12.3 percent at 2006 to 18.5 percent at 2017.

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 sex; the male category is 76.1 percent at 2006 and remains relatively constant with a value of 74.8 percent at 2017; and the female category is 23.9 percent at 2006 and remains relatively constant with a value of 25.2 percent at 2017.

Figure HR 4. 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 race; the white category decreases by 14.0% from 72.1 percent at 2006 to 62 percent at 2017; the black category increases by 50.8% from 16.9 percent at 2006 to 25.5 percent at 2017; the hispanic category increases by 12.6% from 7.7 percent at 2006 to 8.7 percent at 2017; the asian category increases by 28.8% from 2.5 percent at 2006 to 3.3 percent at 2017; and the other/unknown category decreases by 27.4% from 0.7 percent at 2006 to 0.5 percent at 2017.

Figure HR 5. 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 24.8% from 41.2 percent at 2006 to 31 percent at 2017; the cardiomyopathy category increases by 27.3% from 46.2 percent at 2006 to 58.8 percent at 2017; the congenital category decreases by 11.3% from 4.5 percent at 2006 to 4 percent at 2017; the valvular category decreases by 62.1% from 2.7 percent at 2006 to 1 percent at 2017; and the other/unknown category is 5.4 percent at 2006 and remains relatively constant with a value of 5.2 percent at 2017.

Figure HR 6. 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 is 56.6 percent at 2006 and remains relatively constant with a value of 61.5 percent at 2017; the 1 to less than 2 category increases by 58.9% from 10.9 percent at 2006 to 17.4 percent at 2017; the 2 to less than 3 category increases by 28.9% from 6.8 percent at 2006 to 8.8 percent at 2017; the 3 to less than 4 category is 5.3 percent at 2006 and remains relatively constant with a value of 5.5 percent at 2017; the 4 to less than 5 category decreases by 38.4% from 4.4 percent at 2006 to 2.7 percent at 2017; and the greater than or equal to 5 category decreases by 73.9% from 15.9 percent at 2006 to 4.1 percent at 2017.

Figure HR 7. 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 87.6% from 24 percent at 2006 to 45 percent at 2017; the status 1b category increases by 56.5% from 20.4 percent at 2006 to 31.8 percent at 2017; the status 2 category decreases by 47.3% from 29.8 percent at 2006 to 15.7 percent at 2017; and the inactive category decreases by 71.2% from 25.9 percent at 2006 to 7.5 percent at 2017.

Figure HR 8. 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 25.9% from 90.9 percent at 2006 to 67.4 percent at 2017; and the vad category increases by 257.3% from 9.1 percent at 2006 to 32.6 percent at 2017.

Figure HR 9. 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 blood type; the a category is 34.8 percent at 2006 and remains relatively constant with a value of 34.5 percent at 2017; the b category is 11.5 percent at 2006 and remains relatively constant with a value of 12.6 percent at 2017; the ab category is 3.2 percent at 2006 and remains relatively constant with a value of 3.5 percent at 2017; and the o category is 50.5 percent at 2006 and remains relatively constant with a value of 49.4 percent at 2017.

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 adult waitlist candidates by age; the 18 to 34 category is 77.4 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 76.9 transplants per 100 waitlist years at 2017; the 35 to 49 category is 69.8 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 66.6 transplants per 100 waitlist years at 2017; the 50 to 64 category increases by 10.8% from 70.8 transplants per 100 waitlist years at 2006 to 78.4 transplants per 100 waitlist years at 2017; and the greater than or equal to 65 category increases by 27.3% from 70.3 transplants per 100 waitlist years at 2006 to 89.5 transplants per 100 waitlist years at 2017.

Figure HR 11. Deceased donor heart transplant rates among adult waitlist candidates by age
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of 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 or fewer than 20 candidates at risk are not shown.


A line plot for deceased donor heart transplant rates among adult waitlist candidates by race; the white category increases by 16.9% from 68.1 transplants per 100 waitlist years at 2006 to 79.6 transplants per 100 waitlist years at 2017; the black category decreases by 13.6% from 80 transplants per 100 waitlist years at 2006 to 69.1 transplants per 100 waitlist years at 2017; the hispanic category is 76 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 74.7 transplants per 100 waitlist years at 2017; the asian category is 102.3 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 104.7 transplants per 100 waitlist years at 2017; and the other category increases by 116.5% from 49.4 transplants per 100 waitlist years at 2006 to 107 transplants per 100 waitlist years at 2017.

Figure HR 12. Deceased donor heart transplant rates among adult waitlist candidates by race
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown.


A line plot for deceased donor heart transplant rates among adult waitlist candidates by blood type; the a category is 101.5 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 105.7 transplants per 100 waitlist years at 2017; the b category is 99.9 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 98.6 transplants per 100 waitlist years at 2017; the ab category increases by 26.6% from 164.9 transplants per 100 waitlist years at 2006 to 208.8 transplants per 100 waitlist years at 2017; and the o category increases by 11.1% from 47.7 transplants per 100 waitlist years at 2006 to 52.9 transplants per 100 waitlist years at 2017.

Figure HR 13. Deceased donor heart transplant rates among adult waitlist candidates by blood type
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown.


A line plot for deceased donor heart transplant rates among adult waitlist candidates by medical urgency; the status 1a category decreases by 44.2% from 497 transplants per 100 waitlist years at 2006 to 277.3 transplants per 100 waitlist years at 2017; the status 1b category decreases by 69.3% from 255 transplants per 100 waitlist years at 2006 to 78.3 transplants per 100 waitlist years at 2017; the status 2 category decreases by 45.7% from 65.9 transplants per 100 waitlist years at 2006 to 35.8 transplants per 100 waitlist years at 2017; and the all category is 71.2 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 77.2 transplants per 100 waitlist years at 2017.

Figure HR 14. Deceased donor heart transplant rates among adult waitlist candidates by medical urgency
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately. Medical urgency is assessed at the time of listing. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown.


A line plot for deceased donor heart transplant rates among waitlist candidates by metropolitan vs. non-metropolitan residence; the metropolitan category is 73 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 76.8 transplants per 100 waitlist years at 2017; and the non to metropolitan category increases by 30.1% from 61.8 transplants per 100 waitlist years at 2006 to 80.5 transplants per 100 waitlist years at 2017.

Figure HR 15. Deceased donor heart transplant rates among waitlist candidates by metropolitan vs. non-metropolitan residence
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately. Urban/rural determination is made using the RUCA (Rural-Urban Commuting Area) designation of the candidate's permanent zip code. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown.


A line plot for deceased donor heart transplant rates among waitlist candidates by distance from listing center; the 0 to less than 50 nm category is 74.7 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 75.4 transplants per 100 waitlist years at 2017; the 50 to less than 100 category increases by 21.0% from 68.1 transplants per 100 waitlist years at 2006 to 82.4 transplants per 100 waitlist years at 2017; the 100 to less than 150 category is 68.1 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 67.2 transplants per 100 waitlist years at 2017; the 150 to less than 250 category increases by 27.0% from 73.1 transplants per 100 waitlist years at 2006 to 92.8 transplants per 100 waitlist years at 2017; and the greater than or equal to 250 category increases by 49.5% from 53.4 transplants per 100 waitlist years at 2006 to 79.8 transplants per 100 waitlist years at 2017.

Figure HR 16. Deceased donor heart transplant rates among waitlist candidates by distance from listing center
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately. Distance is nautical miles (NM) between the zip code centroids of the candidate's listing center and candidate's permanent zip code. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown.


A line plot for three-year outcomes for adults waiting for heart transplant, new listings in 2014; the still waiting category decreases by 90.3% from 100 percent at 0 Months postlisting to 9.7 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 35400.0% from 0 percent at 0 Months postlisting to 9.8 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 17. Three-year outcomes for adults waiting for heart transplant, new listings in 2014
Adults waiting for heart transplant and first listed in 2014. 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 109.0% from 4 months at 2006-2007 to 8.4 months at 2016-2017; the female category increases by 55.8% from 3.9 months at 2006-2007 to 6.1 months at 2016-2017; and the all category increases by 98.4% from 4 months at 2006-2007 to 7.9 months at 2016-2017.

Figure HR 18. Median months to heart transplant for waitlisted adults by sex
Observations censored on December 31, 2017; 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 83.3% from 2.8 months at 2006-2007 to 5.1 months at 2016-2017; the b category increases by 130.2% from 2.4 months at 2006-2007 to 5.5 months at 2016-2017; the ab category increases by 63.0% from 0.9 months at 2006-2007 to 1.4 months at 2016-2017; and the o category increases by 76.1% from 7.8 months at 2006-2007 to 13.8 months at 2016-2017.

Figure HR 19. Median months to heart transplant for waitlisted adults by blood type
Observations censored on December 31, 2017; 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 120.7% from 1 months at 2006-2007 to 2.1 months at 2016-2017; the status 1b category increases by 255.3% from 2.1 months at 2006-2007 to 7.6 months at 2016-2017; and the status 2 category increases by 88.8% from 9.4 months at 2006-2007 to 17.7 months at 2016-2017.

Figure HR 20. Median months to heart transplant for waitlisted adults by medical urgency at listing
Observations censored on December 31, 2017; Kaplan-Meier competing risk methods used to estimate time to transplant. Analysis performed per candidate, not per listing. If an estimate is not plotted, 50% of the cohort listed in that year had not undergone transplant by the censoring date. Only the first transplant is counted.


A line plot for median months to heart transplant for waitlisted adults by bmi at listing; the less than or equal to 23 kg/m2 category increases by 98.6% from 2.4 months at 2006-2007 to 4.7 months at 2016-2017; the 24 to 26 category increases by 71.7% from 3.3 months at 2006-2007 to 5.6 months at 2016-2017; the 27 to 30 category increases by 110.8% from 3.9 months at 2006-2007 to 8.3 months at 2016-2017; and the greater than or equal to 31 category increases by 70.5% from 7.1 months at 2006-2007 to 12.2 months at 2016-2017.

Figure HR 21. Median months to heart transplant for waitlisted adults by BMI at listing
Observations censored on December 31, 2017; 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 27.9% from 44.6 percent at 2006 to 32.2 percent at 2016; the 6 to month category decreases by 21.4% from 56.3 percent at 2006 to 44.2 percent at 2016; the 1 to year category decreases by 14.1% from 65.5 percent at 2006 to 56.3 percent at 2016; the 3 to year category decreases by 13.3% from 70.7 percent at 2006 to 61.3 percent at 2014; the 5 to year category is 72 percent at 2006 and remains relatively constant with a value of 68.8 percent at 2012; and the 10 to year category is 72.6 percent at 2006 and remains relatively constant with a value of 73.3 percent at 2007.

Figure HR 22. 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 2016 by dsa, the values range from 23.08 to 94.12.

Figure HR 23. Percentage of adults who underwent deceased donor heart transplant within 1 year of listing in 2016 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 map of percentage of adults who underwent deceased donor heart transplant within 1 year of listing in 2016 by state, the values range from 20.00 to 100.00.

Figure HR 24. Percentage of adults who underwent deceased donor heart transplant within 1 year of listing in 2016 by state
Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal.


A line plot for pretransplant mortality rates among adults waitlisted for heart transplant by age; the 18 to 34 category decreases by 52.6% from 17.5 deaths per 100 waitlist years at 2006-2007 to 8.3 deaths per 100 waitlist years at 2016-2017; the 35 to 49 category decreases by 28.6% from 14.4 deaths per 100 waitlist years at 2006-2007 to 10.3 deaths per 100 waitlist years at 2016-2017; the 50 to 64 category decreases by 25.4% from 16.7 deaths per 100 waitlist years at 2006-2007 to 12.4 deaths per 100 waitlist years at 2016-2017; the greater than or equal to 65 category decreases by 16.4% from 17.6 deaths per 100 waitlist years at 2006-2007 to 14.7 deaths per 100 waitlist years at 2016-2017; and the all category decreases by 26.6% from 16.3 deaths per 100 waitlist years at 2006-2007 to 12 deaths per 100 waitlist years at 2016-2017.

Figure HR 25. 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. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk 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 17.7% from 15.3 deaths per 100 waitlist years at 2006-2007 to 12.6 deaths per 100 waitlist years at 2016-2017; the black category decreases by 43.9% from 19.4 deaths per 100 waitlist years at 2006-2007 to 10.9 deaths per 100 waitlist years at 2016-2017; the hispanic category decreases by 44.6% from 19.4 deaths per 100 waitlist years at 2006-2007 to 10.7 deaths per 100 waitlist years at 2016-2017; the asian category decreases by 16.9% from 13.9 deaths per 100 waitlist years at 2006-2007 to 11.6 deaths per 100 waitlist years at 2016-2017; and the other category decreases by 36.9% from 27.9 deaths per 100 waitlist years at 2006-2007 to 17.6 deaths per 100 waitlist years at 2016-2017.

Figure HR 26. 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. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown.


A line plot for pretransplant mortality rates among adults waitlisted for heart transplant by sex; the male category decreases by 23.8% from 16.2 deaths per 100 waitlist years at 2006-2007 to 12.4 deaths per 100 waitlist years at 2016-2017; and the female category decreases by 34.9% from 16.7 deaths per 100 waitlist years at 2006-2007 to 10.9 deaths per 100 waitlist years at 2016-2017.

Figure HR 27. 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. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown.


A line plot for pretransplant mortality rates among adults waitlisted for heart transplant by diagnosis; the cad category decreases by 24.3% from 16.9 deaths per 100 waitlist years at 2006-2007 to 12.8 deaths per 100 waitlist years at 2016-2017; the cardiomyopathy category decreases by 30.3% from 15.7 deaths per 100 waitlist years at 2006-2007 to 11 deaths per 100 waitlist years at 2016-2017; the congential category decreases by 13.2% from 10.6 deaths per 100 waitlist years at 2006-2007 to 9.2 deaths per 100 waitlist years at 2016-2017; the valvular category increases by 18.0% from 12.5 deaths per 100 waitlist years at 2006-2007 to 14.8 deaths per 100 waitlist years at 2016-2017; and the other/unknown category decreases by 16.7% from 24.4 deaths per 100 waitlist years at 2006-2007 to 20.3 deaths per 100 waitlist years at 2016-2017.

Figure HR 28. 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. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk 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 62.0% from 91.9 deaths per 100 waitlist years at 2006-2007 to 34.9 deaths per 100 waitlist years at 2016-2017; the status 1b category decreases by 73.5% from 36.3 deaths per 100 waitlist years at 2006-2007 to 9.6 deaths per 100 waitlist years at 2016-2017; the status 2 category decreases by 33.5% from 10.9 deaths per 100 waitlist years at 2006-2007 to 7.2 deaths per 100 waitlist years at 2016-2017; and the inactive category increases by 28.9% from 10.5 deaths per 100 waitlist years at 2006-2007 to 13.5 deaths per 100 waitlist years at 2016-2017.

Figure HR 29. 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. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown. Medical urgency is determined at the later of listing date and January 1 of the year.


A line plot for pretransplant mortality rates among adults waitlisted for heart transplant by vad at listing; the no vad category decreases by 16.2% from 14.4 deaths per 100 waitlist years at 2006-2007 to 12.1 deaths per 100 waitlist years at 2016-2017; and the vad at listing category decreases by 75.4% from 47.8 deaths per 100 waitlist years at 2006-2007 to 11.8 deaths per 100 waitlist years at 2016-2017.

Figure HR 30. 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. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown. VAD, ventricular assist device.


A line plot for pretransplant mortality rates among adults waitlisted for heart by metropolitan vs. non-metropolitan residence; the metropolitan category decreases by 28.8% from 16.6 deaths per 100 waitlist years at 2006 to 11.8 deaths per 100 waitlist years at 2016; and the non to metropolitan category decreases by 12.1% from 15.2 deaths per 100 waitlist years at 2006 to 13.4 deaths per 100 waitlist years at 2016.

Figure HR 31. Pretransplant mortality rates among adults waitlisted for heart by metropolitan vs. non-metropolitan residence
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown. Urban/rural determination is made using the RUCA (Rural-Urban Commuting Area) designation of the candidate's permanent zip code.


A line plot for pretransplant mortality rates among adults waitlisted for heart, by distance from listing center; the 0 to less than 50 nm category decreases by 30.2% from 16.4 deaths per 100 waitlist years at 2006 to 11.4 deaths per 100 waitlist years at 2016; the 50 to less than 100 category decreases by 24.7% from 16.6 deaths per 100 waitlist years at 2006 to 12.5 deaths per 100 waitlist years at 2016; the 100 to less than 150 category decreases by 19.3% from 16.5 deaths per 100 waitlist years at 2006 to 13.3 deaths per 100 waitlist years at 2016; the 150 to less than 250 category is 15.6 deaths per 100 waitlist years at 2006 and remains relatively constant with a value of 15.4 deaths per 100 waitlist years at 2016; and the greater than or equal to 250 category decreases by 33.5% from 16.2 deaths per 100 waitlist years at 2006 to 10.8 deaths per 100 waitlist years at 2016.

Figure HR 32. Pretransplant mortality rates among adults waitlisted for heart, by distance from listing center
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown. Distance is nautical miles (NM) between the zip code centroids of the candidate's listing center and candidate's permanent zip code.


A map of pretransplant mortality rates among adults waitlisted for heart transplant in 2016-2017, by dsa, the values range from 2.14 to 23.90.

Figure HR 33. Pretransplant mortality rates among adults waitlisted for heart transplant in 2016-2017, by DSA
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the DSA. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. 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, by status at removal; the all category decreases by 18.0% from 22.5 percent at 2006 to 18.4 percent at 2017; the status 1a category decreases by 31.6% from 70.8 percent at 2006 to 48.5 percent at 2017; the status 1b category decreases by 48.1% from 36.4 percent at 2006 to 18.9 percent at 2017; the status 2 category decreases by 72.3% from 18 percent at 2006 to 5 percent at 2017; and the inactive category is 19.2 percent at 2006 and remains relatively constant with a value of 17.8 percent at 2017.

Figure HR 34. Deaths within six months after removal among adult heart waitlist candidates, by status at removal
Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.


A line plot for deaths within six months after removal among adult heart waitlist candidates, by age at removal; the 0 to 17 category decreases by 42.4% from 18.6 percent at 2006 to 10.7 percent at 2017; the 18 to 34 category decreases by 67.7% from 21 percent at 2006 to 6.8 percent at 2017; the 35 to 49 category is 17.1 percent at 2006 and remains relatively constant with a value of 18.3 percent at 2017; the 50 to 64 category decreases by 32.4% from 25.9 percent at 2006 to 17.5 percent at 2017; and the 65+ category increases by 28.3% from 20 percent at 2006 to 25.7 percent at 2017.

Figure HR 35. Deaths within six months after removal among adult heart waitlist candidates, by age at removal
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 donor count by age; the less than 18 category increases by 13.7% from 474 count at 2006 to 539 count at 2017; the 18 to 34 category increases by 60.5% from 1060 count at 2006 to 1701 count at 2017; the 35 to 49 category increases by 49.4% from 563 count at 2006 to 841 count at 2017; and the greater than or equal to 50 category increases by 25.1% from 179 count at 2006 to 224 count at 2017.

Figure HR 36. Deceased heart donor count by age
Count of deceased donors whose hearts were recovered for transplant, by age at donation.


A line plot for distribution of deceased heart donors by age; the less than 18 category decreases by 20.9% from 20.7 percent at 2006 to 16.4 percent at 2017; the 18 to 34 category increases by 10.1% from 46.8 percent at 2006 to 51.6 percent at 2017; the 35 to 49 category is 24.7 percent at 2006 and remains relatively constant with a value of 25.4 percent at 2017; and the greater than or equal to 50 category decreases by 13.6% from 7.8 percent at 2006 to 6.7 percent at 2017.

Figure HR 37. Distribution of deceased heart donors by age
Deceased donors whose hearts were recovered for transplant.


A line plot for distribution of deceased heart donors by race; the white category is 64.2 percent at 2006 and remains relatively constant with a value of 64.1 percent at 2017; the black category is 15.6 percent at 2006 and remains relatively constant with a value of 16.8 percent at 2017; the hispanic category decreases by 10.4% from 18 percent at 2006 to 16.1 percent at 2017; and the other/unknown category increases by 32.0% from 2.2 percent at 2006 to 2.9 percent at 2017.

Figure HR 38. Distribution of deceased heart donors by race
Deceased donors whose hearts were recovered for transplant.


A map of percent of pediatric heart donors allocated to adult recipients, the values range from 0.00 to 1.00.

Figure HR 39. Percent of pediatric heart donors allocated to adult recipients
Numerator: pediatric heart and heart-lung donors allocated to adult recipients. Denominator: total pediatric heart and heart-lung donors


A line plot for rates of hearts recovered for transplant and not transplanted by donor age; the less than 18 category decreases by 61.1% from 1.4 percent at 2006-2007 to 0.5 percent at 2016-2017; the 18 to 34 category increases by 34.9% from 0.6 percent at 2006-2007 to 0.8 percent at 2016-2017; the 35 to 49 category decreases by 22.4% from 1.4 percent at 2006-2007 to 1.1 percent at 2016-2017; the greater than or equal to 50 category decreases by 15.2% from 3.2 percent at 2006-2007 to 2.7 percent at 2016-2017; and the all category decreases by 15.8% from 1.2 percent at 2006-2007 to 1 percent at 2016-2017.

Figure HR 40. Rates of hearts recovered for transplant and not transplanted by donor age
Percentages of hearts not transplanted out of all hearts recovered for transplant.


A line plot for rates of hearts recovered for transplant and not transplanted, by donor risk of disease transmission; the phs increased risk category decreases by 15.7% from 0.9 percent at 2006-2007 to 0.8 percent at 2016-2017; and the not increased risk category decreases by 11.0% from 1.2 percent at 2006-2007 to 1.1 percent at 2016-2017.

Figure HR 41. Rates of hearts recovered for transplant and not transplanted, by donor risk of disease transmission
"Increased risk" is defined by criteria from the US Public Health Service Guidelines for increased risk for HIV, hepatitis B and hepatitis C transmission.


A line plot for cause of death among deceased heart donors; the anoxia category increases by 165.6% from 14 percent at 2006 to 37.2 percent at 2017; the cva/stroke category decreases by 34.0% from 19.8 percent at 2006 to 13.1 percent at 2017; the head trauma category decreases by 25.6% from 63.3 percent at 2006 to 47.1 percent at 2017; the cns tumor category decreases by 46.9% from 1 percent at 2006 to 0.5 percent at 2017; and the other category increases by 11.9% from 1.9 percent at 2006 to 2.1 percent at 2017.

Figure HR 42. 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 34.6% from 321 transplants at 2006 to 432 transplants at 2017; the age greater than or equal to 18 category increases by 49.3% from 1903 transplants at 2006 to 2841 transplants at 2017; and the all category increases by 47.2% from 2224 transplants at 2006 to 3273 transplants at 2017.

Figure HR 43. 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 34.6% from 321 transplants at 2006 to 432 transplants at 2017; the 18 to 34 category increases by 35.5% from 234 transplants at 2006 to 317 transplants at 2017; the 35 to 49 category increases by 28.0% from 453 transplants at 2006 to 580 transplants at 2017; the 50 to 64 category increases by 40.8% from 973 transplants at 2006 to 1370 transplants at 2017; and the greater than or equal to 65 category increases by 136.2% from 243 transplants at 2006 to 574 transplants at 2017.

Figure HR 44. 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 42.3% from 1644 transplants at 2006 to 2339 transplants at 2017; and the female category increases by 61.0% from 580 transplants at 2006 to 934 transplants at 2017.

Figure HR 45. 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 32.4% from 1519 transplants at 2006 to 2011 transplants at 2017; the black category increases by 84.6% from 415 transplants at 2006 to 766 transplants at 2017; the hispanic category increases by 67.0% from 200 transplants at 2006 to 334 transplants at 2017; the asian category increases by 81.1% from 74 transplants at 2006 to 134 transplants at 2017; and the other/unknown category increases by 75.0% from 16 transplants at 2006 to 28 transplants at 2017.

Figure HR 46. Total heart transplants by race
All heart transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for total heart transplants by diagnosis; the cad category is 800 transplants at 2006 and remains relatively constant with a value of 857 transplants at 2017; the cardiomyopathy category increases by 77.9% from 1118 transplants at 2006 to 1989 transplants at 2017; the congenital category increases by 51.7% from 207 transplants at 2006 to 314 transplants at 2017; the valvular category decreases by 40.8% from 49 transplants at 2006 to 29 transplants at 2017; and the other/unknown category increases by 68.0% from 50 transplants at 2006 to 84 transplants at 2017.

Figure HR 47. 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 141.0% from 927 transplants at 2006 to 2234 transplants at 2017; the status 1b category increases by 12.8% from 846 transplants at 2006 to 954 transplants at 2017; and the status 2 category decreases by 81.2% from 451 transplants at 2006 to 85 transplants at 2017.

Figure HR 48. 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 2006 and remains relatively constant with a value of 28.7 percent at 2017; the t to cell depleting category is 23.6 percent at 2006 and remains relatively constant with a value of 23.6 percent at 2017; and the none category is 47.5 percent at 2006 and remains relatively constant with a value of 48.3 percent at 2017.

Figure HR 49. 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 immunosuppression regimen use in adult heart transplant recipients; the tac mmf steroid category increases by 73.2% from 50.5 percent at 2006 to 87.4 percent at 2017; the tac mmf category increases by 98.1% from 2.9 percent at 2006 to 5.8 percent at 2017; the tac steroid category increases by 50.9% from 1.3 percent at 2006 to 1.9 percent at 2017; the other category decreases by 91.6% from 43.2 percent at 2006 to 3.6 percent at 2017; and the none reported category decreases by 43.4% from 2.1 percent at 2006 to 1.2 percent at 2017.

Figure HR 50. Immunosuppression regimen use in adult heart transplant recipients
Immunosuppression regimen at transplant reported to the OPTN. Tac, tacrolimus. MMF, mycophenolate mofetil.


A bar plot for total hla a, b, and dr mismatches among adult deceased donor heart transplant recipients, 2013-2017, the 0 group is 0.09 percent; the 1 group is 0.40 percent; the 2 group is 2.51 percent; the 3 group is 10.06 percent; the 4 group is 23.81 percent; the 5 group is 34.34 percent; the 6 group is 20.58 percent; and the unk. group is 8.21 percent.

Figure HR 51. Total HLA A, B, and DR mismatches among adult deceased donor heart transplant recipients, 2013-2017
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, 2015-2017, by age, the 1a status is 31.65 percent for <50, 68.35 percent for greater than or equal to 50, 37.18 percent for greater than or equal to 60, and 18.61 percent for greater than or equal to 65; the 1b status is 30.29 percent for <50, 69.71 percent for greater than or equal to 50, 40.28 percent for greater than or equal to 60, and 22.05 percent for greater than or equal to 65; and the 2 status is 21.94 percent for <50, 78.06 percent for greater than or equal to 50, 44.39 percent for greater than or equal to 60, and 25.00 percent for greater than or equal to 65.

Figure HR 52. Status of adult heart transplant recipients, 2015-2017, 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 2006 and remains relatively constant with a value of 1 transplants per center at 2017; the 25th category increases by 136.4% from 5.5 transplants per center at 2006 to 13 transplants per center at 2017; the median category increases by 66.7% from 12 transplants per center at 2006 to 20 transplants per center at 2017; the 75th category increases by 65.0% from 20 transplants per center at 2006 to 33 transplants per center at 2017; and the 95th category increases by 21.8% from 55 transplants per center at 2006 to 67 transplants per center at 2017.

Figure HR 53. 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 annual center volume; the 1 to 9 category decreases by 67.0% from 10.8 percent of transplants at 2006 to 3.6 percent of transplants at 2017; the 10 to 29 category decreases by 18.4% from 49.1 percent of transplants at 2006 to 40.1 percent of transplants at 2017; the 30 to 59 category increases by 40.6% from 25.1 percent of transplants at 2006 to 35.2 percent of transplants at 2017; and the greater than or equal to 60 category increases by 40.5% from 15 percent of transplants at 2006 to 21.1 percent of transplants at 2017.

Figure HR 54. Distribution of adult heart transplants by annual center volume
Based on annual volume data among recipients aged 18 or older.


A line plot for patient survival among adult heart transplant recipients, 2010-2012, by age; the 18 to 34 category decreases by 20.7% from 100 percent at 0 Months post-transplant to 79.3 percent at 60 Months post-transplant; the 35 to 49 category decreases by 20.7% from 100 percent at 0 Months post-transplant to 79.3 percent at 60 Months post-transplant; the 50 to 64 category decreases by 20.2% from 100 percent at 0 Months post-transplant to 79.8 percent at 60 Months post-transplant; and the greater than or equal to 65 category decreases by 23.2% from 100 percent at 0 Months post-transplant to 76.8 percent at 60 Months post-transplant.

Figure HR 55. Patient survival among adult heart transplant recipients, 2010-2012, 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, 2010-2012, by race; the white category decreases by 20.2% from 100 percent at 0 Months post-transplant to 79.8 percent at 60 Months post-transplant; the black category decreases by 25.3% from 100 percent at 0 Months post-transplant to 74.7 percent at 60 Months post-transplant; the hispanic category decreases by 18.4% from 100 percent at 0 Months post-transplant to 81.6 percent at 60 Months post-transplant; the asian category decreases by 16.3% from 100 percent at 0 Months post-transplant to 83.7 percent at 60 Months post-transplant; and the other/unknown category decreases by 12.5% from 100 percent at 0 Months post-transplant to 87.5 percent at 60 Months post-transplant.

Figure HR 56. Patient survival among adult heart transplant recipients, 2010-2012, 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, 2010-2012, by sex; the female category decreases by 20.8% from 100 percent at 0 Months post-transplant to 79.2 percent at 60 Months post-transplant; the male category decreases by 20.9% from 100 percent at 0 Months post-transplant to 79.1 percent at 60 Months post-transplant; and the all category decreases by 20.9% from 100 percent at 0 Months post-transplant to 79.1 percent at 60 Months post-transplant.

Figure HR 57. Patient survival among adult heart transplant recipients, 2010-2012, 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, 2010-2012, by circulatory support; the vad category decreases by 20.7% from 100 percent at 0 Months post-transplant to 79.3 percent at 60 Months post-transplant; the iabp category decreases by 25.0% from 100 percent at 0 Months post-transplant to 75 percent at 60 Months post-transplant; and the neither category decreases by 20.5% from 100 percent at 0 Months post-transplant to 79.5 percent at 60 Months post-transplant.

Figure HR 58. Patient survival among adult heart transplant recipients, 2010-2012, 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, 2010-2012, by first vs. retransplant; the first tx category decreases by 20.9% from 100 percent at 0 Months post-transplant to 79.1 percent at 60 Months post-transplant; and the re to tx category decreases by 16.9% from 100 percent at 0 Months post-transplant to 83.1 percent at 60 Months post-transplant.

Figure HR 59. Patient survival among adult heart transplant recipients, 2010-2012, 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, 2010-2012, by medical urgency; the status 1a category decreases by 22.2% from 100 percent at 0 Months post-transplant to 77.8 percent at 60 Months post-transplant; the status 1b category decreases by 19.2% from 100 percent at 0 Months post-transplant to 80.8 percent at 60 Months post-transplant; and the status 2 category decreases by 18.7% from 100 percent at 0 Months post-transplant to 81.3 percent at 60 Months post-transplant.

Figure HR 60. Patient survival among adult heart transplant recipients, 2010-2012, 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 survival among adult heart transplant recipients, 2010-2012, by metropolitan vs. non-metropolitan recipient residence; the metropolitan category decreases by 20.4% from 100 percent at 0 Months post-transplant to 79.6 percent at 60 Months post-transplant; and the non to metropolitan category decreases by 23.5% from 100 percent at 0 Months post-transplant to 76.5 percent at 60 Months post-transplant.

Figure HR 61. Patient survival among adult heart transplant recipients, 2010-2012, by metropolitan vs. non-metropolitan recipient residence
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, 2010-2012, by recipients

Figure HR 62. Patient survival among adult heart transplant recipients, 2010-2012, by recipients' distance from transplant center
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered. Distance is between the zipcode centroids of the TX center and the recipient's permanent residence, measured in nautical miles (NM).


A line plot for patient death among adult heart transplant recipients; the 6 to month category decreases by 44.6% from 12.4 percent at 2000 to 6.9 percent at 2016; the 1 to year category decreases by 45.3% from 15.5 percent at 2000 to 8.5 percent at 2016; the 3 to year category decreases by 30.3% from 22.2 percent at 2000 to 15.5 percent at 2014; the 5 to year category decreases by 25.3% from 28 percent at 2000 to 20.9 percent at 2012; and the 10 to year category decreases by 17.5% from 46.8 percent at 2000 to 38.6 percent at 2007.

Figure HR 63. 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, 2017. 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 84.0% from 2.8 patients (in thousands) at 2006 to 5.2 patients (in thousands) at 2017; the 18 to 49 category increases by 36.3% from 7.1 patients (in thousands) at 2006 to 9.7 patients (in thousands) at 2017; the greater than or equal to 50 category increases by 42.9% from 12.1 patients (in thousands) at 2006 to 17.3 patients (in thousands) at 2017; and the all category increases by 46.0% from 22.1 patients (in thousands) at 2006 to 32.2 patients (in thousands) at 2017.

Figure HR 64. 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, 2015-2016, the 18-34 group is 31.36 percent; the 35-49 group is 27.19 percent; the 50-64 group is 24.62 percent; the >= 65 group is 22.39 percent; and the all group is 25.40 percent.

Figure HR 65. Incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by age, 2015-2016
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 bar plot for incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by induction status, 2015-2016, the il2-ra group is 29.76 percent; the tcd group is 16.50 percent; and the no agents group is 27.21 percent.

Figure HR 66. Incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by induction status, 2015-2016
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. If a recipient used both IL-2-RA and TCD agents, s/he will contribute to both of those cumulative incidence estimates.


A line plot for incidence of ptld among adult heart transplant recipients by recipient ebv status at transplant, 2011-2015; 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 67. Incidence of PTLD among adult heart transplant recipients by recipient EBV status at transplant, 2011-2015
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, 2015-2016; 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 68. One-year cumulative incidence of death by cause among adult heart recipients, 2015-2016
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, 2011-2012; 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 69. Five-year cumulative incidence of death by cause among adult heart recipients, 2011-2012
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 30.8% from 467 candidates at 2006 to 611 candidates at 2017; the inactive category decreases by 14.3% from 14 candidates at 2006 to 12 candidates at 2017; and the all category increases by 29.5% from 481 candidates at 2006 to 623 candidates at 2017.

Figure HR 70. 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 115.7% from 121 candidates at 2006 to 261 candidates at 2017; the inactive category decreases by 30.9% from 178 candidates at 2006 to 123 candidates at 2017; and the all category increases by 28.4% from 299 candidates at 2006 to 384 candidates at 2017.

Figure HR 71. 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 11.4% from 24.3 percent at 2006 to 27 percent at 2017; the 1 to 5 category is 23.5 percent at 2006 and remains relatively constant with a value of 24.8 percent at 2017; the 6 to 10 category decreases by 12.4% from 15.7 percent at 2006 to 13.7 percent at 2017; and the 11 to 17 category is 36.6 percent at 2006 and remains relatively constant with a value of 34.4 percent at 2017.

Figure HR 72. 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 14.9% from 58.3 percent at 2006 to 49.6 percent at 2017; the black category is 20.2 percent at 2006 and remains relatively constant with a value of 21.4 percent at 2017; the hispanic category increases by 29.0% from 16.7 percent at 2006 to 21.5 percent at 2017; the asian category increases by 42.1% from 3.1 percent at 2006 to 4.4 percent at 2017; and the other/unknown category increases by 78.8% from 1.7 percent at 2006 to 3 percent at 2017.

Figure HR 73. 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 24.0% from 43 percent at 2006 to 53.3 percent at 2017; the dilated cm: idiopathic category decreases by 30.3% from 24.5 percent at 2006 to 17.1 percent at 2017; the restrictive cm: idiopathic category is 4 percent at 2006 and remains relatively constant with a value of 4.2 percent at 2017; the dilated cm: myocarditis category decreases by 27.3% from 4.2 percent at 2006 to 3 percent at 2017; and the other/unknown category is 24.3 percent at 2006 and remains relatively constant with a value of 22.4 percent at 2017.

Figure HR 74. 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 sex; the male category is 55.5 percent at 2006 and remains relatively constant with a value of 56.6 percent at 2017; and the female category is 44.5 percent at 2006 and remains relatively constant with a value of 43.4 percent at 2017.

Figure HR 75. Distribution of pediatric candidates waiting for heart transplant by sex
Candidates waiting for transplant 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 pediatric candidates waiting for heart transplant by waiting time; the less than 1 year category is 69.7 percent at 2006 and remains relatively constant with a value of 75.3 percent at 2017; the 1 to less than 2 category increases by 45.5% from 7.4 percent at 2006 to 10.8 percent at 2017; the 2 to less than 4 category is 8.1 percent at 2006 and remains relatively constant with a value of 8.4 percent at 2017; and the greater than or equal to 4 category decreases by 62.6% from 14.8 percent at 2006 to 5.5 percent at 2017.

Figure HR 76. 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 21.8% from 49.5 percent at 2006 to 60.2 percent at 2017; the status 1b category increases by 39.5% from 11.1 percent at 2006 to 15.4 percent at 2017; the status 2 category decreases by 16.7% from 17.3 percent at 2006 to 14.4 percent at 2017; and the inactive category decreases by 55.3% from 22.1 percent at 2006 to 9.9 percent at 2017.

Figure HR 77. 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, 2014; the still waiting category decreases by 94.9% from 100 percent at 0 Months postlisting to 5.1 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 is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting.

Figure HR 78. Three-year outcomes for newly listed pediatric candidates waiting for heart transplant, 2014
Pediatric candidates who joined the waitlist in 2014. 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 pediatric waitlist candidates by age; the less than 1 category decreases by 44.2% from 343.9 transplants per 100 waitlist years at 2006 to 192 transplants per 100 waitlist years at 2017; the 1 to 5 category is 89.9 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 91.8 transplants per 100 waitlist years at 2017; the 6 to 10 category is 64.5 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 69.7 transplants per 100 waitlist years at 2017; the 11 to 17 category increases by 28.2% from 93 transplants per 100 waitlist years at 2006 to 119.3 transplants per 100 waitlist years at 2017; and the all category is 109.6 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 114.9 transplants per 100 waitlist years at 2017.

Figure HR 79. Heart transplant rates among pediatric waitlist candidates by age
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of 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 or fewer than 20 candidates at risk are not shown.


A line plot for deceased donor heart transplant rates among pediatric waitlist candidates by metropolitan vs. non-metropolitan residence; the metropolitan category is 109.4 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 113.4 transplants per 100 waitlist years at 2017; and the non to metropolitan category is 122.5 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 125.3 transplants per 100 waitlist years at 2017.

Figure HR 80. Deceased donor heart transplant rates among pediatric waitlist candidates by metropolitan vs. non-metropolitan residence
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown.


A line plot for deceased donor heart transplant rates among pediatric waitlist candidates by distance from listing center; the 0 to less than 50 nm category decreases by 10.1% from 131.9 transplants per 100 waitlist years at 2006 to 118.5 transplants per 100 waitlist years at 2017; the 50 to less than 100 category increases by 10.3% from 101 transplants per 100 waitlist years at 2006 to 111.4 transplants per 100 waitlist years at 2017; the 100 to less than 250 category is 95.2 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 99.8 transplants per 100 waitlist years at 2017; and the greater than or equal to 250 category increases by 88.1% from 81.2 transplants per 100 waitlist years at 2006 to 152.8 transplants per 100 waitlist years at 2017.

Figure HR 81. Deceased donor heart transplant rates among pediatric waitlist candidates by distance from listing center
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown. Distance is between the zipcode centroids of the TX center and the recipient's permanent residence, measured in nautical miles (NM).


A line plot for pretransplant mortality rates among pediatrics waitlisted for heart transplant by age; the less than 1 category decreases by 39.6% from 68.2 deaths per 100 waitlist years at 2006-2007 to 41.2 deaths per 100 waitlist years at 2016-2017; the 1 to 5 category decreases by 57.5% from 17 deaths per 100 waitlist years at 2006-2007 to 7.2 deaths per 100 waitlist years at 2016-2017; the 6 to 10 category decreases by 59.0% from 12.5 deaths per 100 waitlist years at 2006-2007 to 5.1 deaths per 100 waitlist years at 2016-2017; the 11 to 17 category decreases by 41.8% from 13.1 deaths per 100 waitlist years at 2006-2007 to 7.6 deaths per 100 waitlist years at 2016-2017; and the all category decreases by 49.4% from 23.5 deaths per 100 waitlist years at 2006-2007 to 11.9 deaths per 100 waitlist years at 2016-2017.

Figure HR 82. 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. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown.


A line plot for pretransplant mortality rates among pediatrics waitlisted for heart transplant by race; the white category decreases by 42.3% from 20 deaths per 100 waitlist years at 2006-2007 to 11.6 deaths per 100 waitlist years at 2016-2017; the black category decreases by 51.0% from 28.7 deaths per 100 waitlist years at 2006-2007 to 14.1 deaths per 100 waitlist years at 2016-2017; the hispanic category decreases by 63.9% from 30.4 deaths per 100 waitlist years at 2006-2007 to 11 deaths per 100 waitlist years at 2016-2017; and the other/unknown category decreases by 58.5% from 26.5 deaths per 100 waitlist years at 2006-2007 to 11 deaths per 100 waitlist years at 2016-2017.

Figure HR 83. 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. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown.


A line plot for pretransplant mortality rates among pediatrics waitlisted for heart transplant by diagnosis; the congenital category decreases by 60.3% from 30.6 deaths per 100 waitlist years at 2006-2007 to 12.1 deaths per 100 waitlist years at 2016-2017; the dilated cm: idiopathic category decreases by 25.6% from 13.6 deaths per 100 waitlist years at 2006-2007 to 10.1 deaths per 100 waitlist years at 2016-2017; the restrictive cm: idiopathic category decreases by 64.9% from 18.8 deaths per 100 waitlist years at 2006-2007 to 6.6 deaths per 100 waitlist years at 2016-2017; the dilated cm: myocarditis category decreases by 40.9% from 9.7 deaths per 100 waitlist years at 2006-2007 to 5.8 deaths per 100 waitlist years at 2016-2017; and the other/unknown category decreases by 40.5% from 24.2 deaths per 100 waitlist years at 2006-2007 to 14.4 deaths per 100 waitlist years at 2016-2017.

Figure HR 84. 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. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. 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 53.3% from 86.3 deaths per 100 waitlist years at 2006-2007 to 40.3 deaths per 100 waitlist years at 2016-2017; the status 1b category increases by 27.0% from 11.8 deaths per 100 waitlist years at 2006-2007 to 15 deaths per 100 waitlist years at 2016-2017; the status 2 category decreases by 45.4% from 10.1 deaths per 100 waitlist years at 2006-2007 to 5.5 deaths per 100 waitlist years at 2016-2017; and the inactive category is 5.4 deaths per 100 waitlist years at 2006-2007 and remains relatively constant with a value of 5.3 deaths per 100 waitlist years at 2016-2017.

Figure HR 85. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by medical urgency
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. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown. Medical urgency status is determined at the later of listing date and January 1 of the given year.


A line plot for pretransplant mortality rates among pediatrics waitlisted for heart transplant by metropolitan vs. non-metropolitan residence; the metropolitan category decreases by 51.2% from 24.3 deaths per 100 waitlist years at 2006 to 11.9 deaths per 100 waitlist years at 2016; and the non to metropolitan category decreases by 44.4% from 21.8 deaths per 100 waitlist years at 2006 to 12.1 deaths per 100 waitlist years at 2016.

Figure HR 86. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by metropolitan vs. non-metropolitan residence
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. 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 distance from listing center; the 0 to less than 50 nm category decreases by 48.9% from 25.2 deaths per 100 waitlist years at 2006 to 12.9 deaths per 100 waitlist years at 2016; the 50 to less than 100 category decreases by 53.7% from 21.9 deaths per 100 waitlist years at 2006 to 10.2 deaths per 100 waitlist years at 2016; the 100 to less than 250 category decreases by 39.8% from 20.1 deaths per 100 waitlist years at 2006 to 12.1 deaths per 100 waitlist years at 2016; and the greater than or equal to 250 category decreases by 65.0% from 28.5 deaths per 100 waitlist years at 2006 to 10 deaths per 100 waitlist years at 2016.

Figure HR 87. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by distance from listing center
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. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown. Medical urgency status is determined at the later of listing date and January 1 of the given year.


A line plot for pediatric heart transplants by recipient age; the less than 1 category increases by 20.7% from 92 transplants at 2006 to 111 transplants at 2017; the 1 to 5 category increases by 44.6% from 74 transplants at 2006 to 107 transplants at 2017; the 6 to 10 category increases by 26.3% from 38 transplants at 2006 to 48 transplants at 2017; the 11 to 17 category increases by 41.9% from 117 transplants at 2006 to 166 transplants at 2017; and the all category increases by 34.6% from 321 transplants at 2006 to 432 transplants at 2017.

Figure HR 88. Pediatric heart transplants by recipient 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 89. 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 is 9.7 percent at 2006 and remains relatively constant with a value of 9.3 percent at 2017; the age less than 15 category decreases by 16.8% from 15.6 percent at 2006 to 13 percent at 2017; and the age less than 18 category decreases by 24.6% from 21.8 percent at 2006 to 16.4 percent at 2017.

Figure HR 90. 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 58.3% from 22.4 percent at 2006 to 9.3 percent at 2017; the t to cell depleting category increases by 93.6% from 37.2 percent at 2006 to 72 percent at 2017; and the none category decreases by 54.8% from 42.9 percent at 2006 to 19.4 percent at 2017.

Figure HR 91. 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 immunosuppression regimen use in pediatric heart transplant recipients; the tac mmf steroid category increases by 61.3% from 33.6 percent at 2006 to 54.2 percent at 2017; the tac mmf category increases by 337.5% from 8.6 percent at 2006 to 37.5 percent at 2017; the tac steroid category decreases by 100.0% from 3.6 percent at 2006 to 0 percent at 2017; the other category decreases by 84.1% from 52.5 percent at 2006 to 8.3 percent at 2017; and the none reported category decreases by 100.0% from 1.8 percent at 2006 to 0 percent at 2017.

Figure HR 92. Immunosuppression regimen use in pediatric heart transplant recipients
Immunosuppression regimen at transplant reported to the OPTN. Tac, tacrolimus. MMF, mycophenolate mofetil.


A bar plot for induction use by c/pra among pediatric heart transplant recipients, 2013-2017, the 0% group is 18.29 percent; the 1-19% group is 12.29 percent; the 20-79% group is 11.88 percent; the 80-100% group is 8.08 percent; and the unknown group is 5.24 percent.

Figure HR 93. Induction use by C/PRA among pediatric heart transplant recipients, 2013-2017
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, 2013-2017, the 0 group is 0.05 percent; the 1 group is 0.46 percent; the 2 group is 1.90 percent; the 3 group is 8.90 percent; the 4 group is 23.40 percent; the 5 group is 33.92 percent; the 6 group is 20.85 percent; and the unk. group is 10.52 percent.

Figure HR 94. Total HLA A, B, and DR mismatches among pediatric deceased donor heart transplant recipients, 2013-2017
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 induction status, 2015-2016, the il2-ra group is 32.71 percent; the tcd group is 18.43 percent; and the no agents group is 15.74 percent.

Figure HR 95. Incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by induction status, 2015-2016
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. If a recipient used both IL-2-RA and TCD agents, s/he will contribute to both of those cumulative incidence estimates.


A bar plot for incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by age, 2015-2016, the < 6 group is 17.52 percent; the 6-10 group is 21.71 percent; the 11-17 group is 21.10 percent; and the all group is 19.34 percent.

Figure HR 96. Incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by age, 2015-2016
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 97. 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 60.1% from 11.9 percent at 1999-2000 to 4.8 percent at 2015-2016; the 1 to year category decreases by 53.7% from 13.5 percent at 1999-2000 to 6.2 percent at 2015-2016; the 3 to year category decreases by 37.8% from 19.3 percent at 1999-2000 to 12 percent at 2013-2014; the 5 to year category decreases by 41.4% from 26 percent at 1999-2000 to 15.2 percent at 2011-2012; and the 10 to year category decreases by 32.0% from 42.3 percent at 1999-2000 to 28.7 percent at 2007-2008.

Figure HR 98. 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, 2017. 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, 2005-2012, by recipient age; the less than 1 category decreases by 24.7% from 100 percent at 0 Months post-transplant to 75.3 percent at 60 Months post-transplant; the 1 to 5 category decreases by 18.5% from 100 percent at 0 Months post-transplant to 81.5 percent at 60 Months post-transplant; the 6 to 10 category decreases by 12.3% from 100 percent at 0 Months post-transplant to 87.7 percent at 60 Months post-transplant; the 11 to 17 category decreases by 19.6% from 100 percent at 0 Months post-transplant to 80.4 percent at 60 Months post-transplant; and the all category decreases by 19.9% from 100 percent at 0 Months post-transplant to 80.1 percent at 60 Months post-transplant.

Figure HR 99. Patient survival among pediatric deceased donor heart transplant recipients, 2005-2012, by recipient 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, 2015-2016; 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 100. One-year cumulative incidence of death by cause among pediatric heart recipients, 2015-2016
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, 2011-2012; 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 101. Five-year cumulative incidence of death by cause among pediatric heart recipients, 2011-2012
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, 2007 and December 31, 2017
Candidates waiting for transplant on December 31, 2007, and December 31, 2017, regardless of first listing date; multiple listings are collapsed.
Characteristic 2007, N 2007, Percent 2017, N 2017, Percent
Age: 18-34 years 246 10.2% 387 11.0%
Age: 35-49 years 542 22.4% 829 23.5%
Age: 50-64 years 1276 52.8% 1651 46.8%
Age: ≥ 65 years 353 14.6% 662 18.8%
Sex: Female 595 24.6% 865 24.5%
Sex: Male 1822 75.4% 2664 75.5%
Race/ethnicity: White 1768 73.1% 2146 60.8%
Race/ethnicity: Black 404 16.7% 952 27.0%
Race/ethnicity: Hispanic 177 7.3% 314 8.9%
Race/ethnicity: Asian 49 2.0% 98 2.8%
Race/ethnicity: Other/unknown 19 0.8% 19 0.5%
Geography: Metropolitan 1943 80.4% 3004 85.1%
Geography: Non-metro 474 19.6% 525 14.9%
Distance: < 50 miles 1382 57.2% 2164 61.3%
Distance: 50-<100 miles 418 17.3% 569 16.1%
Distance: 100-<150 miles 239 9.9% 332 9.4%
Distance: 150-<250 miles 179 7.4% 223 6.3%
Distance: ≥ 250 miles 173 7.2% 219 6.2%
Distance: Unknown 26 1.1% 22 0.6%
All candidates 2417 100.0% 3529 100.0%



Table HR 2 Clinical characteristics of adults on the heart transplant waiting list on December 31, 2007 and December 31, 2017
Candidates waiting for transplant on December 31, 2007, and December 31, 2017, regardless of first listing date; multiple listings are collapsed. VAD, ventricular assist device.
Characteristic 2007, N 2007, Percent 2017, N 2017, Percent
Diagnosis: Coronary artery disease 1012 41.9% 1124 31.9%
Diagnosis: Cardiomyopathy 1076 44.5% 2009 56.9%
Diagnosis: Congenital disease 135 5.6% 181 5.1%
Diagnosis: Valvular disease 57 2.4% 34 1.0%
Diagnosis: Other/unknown 137 5.7% 181 5.1%
Blood type: A 762 31.5% 1059 30.0%
Blood type: B 228 9.4% 400 11.3%
Blood type: AB 38 1.6% 69 2.0%
Blood type: O 1389 57.5% 2001 56.7%
Medical urgency: Status 1A 90 3.7% 378 10.7%
Medical urgency: Status 1B 319 13.2% 1555 44.1%
Medical urgency: Status 2 899 37.2% 794 22.5%
Inactive status 1109 45.9% 802 22.7%
VAD at listing 144 6.0% 1191 33.7%
All candidates 2417 100.0% 3529 100.0%



Table HR 3 Listing characteristics of adults on the heart transplant waiting list on December 31, 2007 and December 31, 2017
Candidates waiting for transplant on December 31, 2007, and December 31, 2017, regardless of first listing date; multiple listings are collapsed.
Characteristic 2007, N 2007, Percent 2017, N 2017, Percent
Transplant history: First 2332 96.5% 3404 96.5%
Transplant history: Retransplant 85 3.5% 125 3.5%
Wait time: < 1 year 1019 42.2% 1825 51.7%
Wait time: 1-< 2 years 350 14.5% 722 20.5%
Wait time: 2-< 3 years 187 7.7% 393 11.1%
Wait time: 3-< 4 years 155 6.4% 251 7.1%
Wait time: 4-< 5 years 134 5.5% 119 3.4%
Wait time: ≥ 5 years 572 23.7% 219 6.2%
Tx type: Heart only 2249 93.0% 3243 91.9%
Tx type: Heart-kidney 69 2.9% 208 5.9%
Tx type: Heart-lung 82 3.4% 41 1.2%
Tx type: Other 17 0.7% 37 1.0%
All candidates 2417 100.0% 3529 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 2015 2016 2017
Patients at start of year 3626 3790 3629
Patients added during year 3622 3629 3769
Patients removed during year 3454 3783 3869
Patients at end of year 3794 3636 3529



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 2015 2016 2017
Deceased donor transplant 2331 2734 2811
Patient died 395 324 290
Patient refused transplant 24 25 27
Improved, transplant not needed 161 187 176
Too sick for transplant 297 261 290
Other 246 251 273



Table HR 6 Adult heart recipients on circulatory support before transplant
Patients may have more than one type of circulatory support.
Support 2012, N 2012, Percent 2017, N 2017, Percent
Any life support 1610 79.1% 2427 85.4%
Intravenous inotropes 789 38.8% 1013 35.7%
Left ventricular assist device 759 37.3% 1353 47.6%
Intra-aortic balloon pump 121 5.9% 236 8.3%
Right ventricular assist device 53 2.6% 46 1.6%
Ventilator 22 1.1% 22 0.8%
Total artificial heart 21 1.0% 23 0.8%
Extra corporeal membrane oxygenation 15 0.7% 32 1.1%
Prostaglandins 15 0.7% 1 0.0%
Inhaled NO 4 0.2% 5 0.2%



Table HR 7 Demographic characteristics of adult heart transplant recipients, 2007 and 2017
Adult heart transplant recipients, including retransplants.
Characteristic 2007, N 2007, Percent 2017, N 2017, Percent
Age: 18-34 years 244 12.8% 317 11.2%
Age: 35-49 years 454 23.8% 580 20.4%
Age: 50-64 years 966 50.6% 1370 48.2%
Age: ≥ 65 years 246 12.9% 574 20.2%
Sex: Female 453 23.7% 742 26.1%
Sex: Male 1457 76.3% 2099 73.9%
Race/ethnicity: White 1326 69.4% 1791 63.0%
Race/ethnicity: Black 368 19.3% 676 23.8%
Race/ethnicity: Hispanic 149 7.8% 247 8.7%
Race/ethnicity: Asian 53 2.8% 112 3.9%
Race/ethnicity: Other/unknown 14 0.7% 15 0.5%
Insurance: Private 1032 54.0% 1337 47.1%
Insurance: Medicare 521 27.3% 1033 36.4%
Insurance: Medicaid 267 14.0% 370 13.0%
Insurance: Other government 66 3.5% 88 3.1%
Insurance: Unknown 24 1.3% 13 0.5%
Geography: Metropolitan 1589 83.2% 2414 85.0%
Geography: Non-metro 321 16.8% 427 15.0%
Distance: < 50 miles 1159 60.7% 1717 60.4%
Distance: 50-<100 miles 318 16.6% 489 17.2%
Distance: 100-<150 miles 155 8.1% 223 7.8%
Distance: 150-<250 miles 134 7.0% 231 8.1%
Distance: ≥ 250 miles 117 6.1% 164 5.8%
Distance: Unknown 27 1.4% 17 0.6%
All recipients 1910 100.0% 2841 100.0%



Table HR 8 Clinical characteristics of adult heart transplant recipients, 2007 and 2017
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 2007, N 2007, Percent 2017, N 2017, Percent
Diagnosis: Coronary artery disease 790 41.4% 852 30.0%
Diagnosis: Cardiomyopathy 996 52.1% 1797 63.3%
Diagnosis: Congenital disease 56 2.9% 92 3.2%
Diagnosis: Valvular disease 34 1.8% 29 1.0%
Diagnosis: Other/unknown 34 1.8% 71 2.5%
Blood type: A 782 40.9% 1165 41.0%
Blood type: B 273 14.3% 408 14.4%
Blood type: AB 105 5.5% 162 5.7%
Blood type: O 750 39.3% 1106 38.9%
Medical urgency: Status 1A 848 44.4% 1886 66.4%
Medical urgency: Status 1B 762 39.9% 885 31.2%
Medical urgency: Status 2 300 15.7% 70 2.5%
On VAD 497 26.0% 1404 49.4%
CPRA: < 1% 1241 65.0% 1276 44.9%
CPRA: 1-< 20% 290 15.2% 356 12.5%
CPRA: 20-< 80% 194 10.2% 457 16.1%
CPRA: 80-< 98% 41 2.1% 111 3.9%
CPRA: 98-100% 22 1.2% 38 1.3%
CPRA: Unknown 122 6.4% 603 21.2%
All recipients 1910 100.0% 2841 100.0%



Table HR 9 Transplant characteristics of adult heart transplant recipients, 2007 and 2017
Adult heart transplant recipients, including retransplants.
Characteristic 2007, N 2007, Percent 2017, N 2017, Percent
Wait time: < 31 days 731 38.3% 717 25.2%
Wait time: 31-60 days 268 14.0% 349 12.3%
Wait time: 61-90 days 167 8.7% 232 8.2%
Wait time: 3-< 6 months 287 15.0% 474 16.7%
Wait time: 6-< 12 months 239 12.5% 453 15.9%
Wait time: 1-< 2 years 120 6.3% 354 12.5%
Wait time: ≥ 2 years 98 5.1% 262 9.2%
Transplant history: First 1844 96.5% 2761 97.2%
Transplant history: Retransplant 66 3.5% 80 2.8%
Tx type: Heart only 1818 95.2% 2601 91.6%
Tx type: Heart-lung 28 1.5% 25 0.9%
Tx type: Heart-kidney 53 2.8% 184 6.5%
Tx type: Heart-liver 10 0.5% 28 1.0%
Tx type: Other 1 0.1% 3 0.1%
All recipients 1910 100.0% 2841 100.0%



Table HR 10 Adult heart donor-recipient serology matching, 2013-2017
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- 16.9% 0.7% 96.9%
D- R+ 21.3% 5.4% 0.3%
D- R unk 0.6% 0.5% 2.3%
D+ R- 23.9% 9.1% 0.0%
D+ R+ 36.0% 77.4% 0.0%
D+ R unk 0.8% 6.7% 0.0%
D unk R- 0.2% 0.0% 0.5%
D unk R+ 0.3% 0.2% 0.0%
D unk R unk 0.0% 0.0% 0.0%



Table HR 11 Demographic characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2007 and December 31, 2017
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. Candidates listed as children who turned 18 before the cohort date are excluded.
Characteristic 2007, N 2007, Percent 2017, N 2017, Percent
Age: < 1 year 24 9.6% 47 13.5%
Age: 1-5 years 83 33.3% 123 35.3%
Age: 6-10 years 59 23.7% 58 16.7%
Age: 11-17 years 83 33.3% 120 34.5%
Sex: Female 114 45.8% 143 41.1%
Sex: Male 135 54.2% 205 58.9%
Race/ethnicity: White 153 61.4% 166 47.7%
Race/ethnicity: Black 38 15.3% 73 21.0%
Race/ethnicity: Hispanic 48 19.3% 81 23.3%
Race/ethnicity: Asian 8 3.2% 17 4.9%
Race/ethnicity: Other/unknown 2 0.8% 11 3.2%
Geography: Metropolitan 208 83.5% 291 83.6%
Geography: Non-metro 41 16.5% 57 16.4%
Distance: < 50 miles 123 49.4% 175 50.3%
Distance: 50-<100 miles 48 19.3% 76 21.8%
Distance: 100-<150 miles 25 10.0% 49 14.1%
Distance: 150-<250 miles 26 10.4% 25 7.2%
Distance: ≥ 250 miles 20 8.0% 18 5.2%
Distance: Unknown 7 2.8% 5 1.4%
All candidates 249 100.0% 348 100.0%



Table HR 12 Clinical characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2007 and December 31, 2017
Candidates aged younger than 18 years waiting for transplant on December 31, 2007, and December 31, 2017, regardless of first listing date; multiple listings are collapsed. Candidates listed as children who turned 18 before the cohort date are excluded. CM, cardiomyopathy; VAD, ventricular assist device.
Characteristic 2007, N 2007, Percent 2017, N 2017, Percent
Diagnosis: Congenital defect 112 45.0% 200 57.5%
Diagnosis: Idiopathic dilated CM 56 22.5% 52 14.9%
Diagnosis: Familial dilated CM 3 1.2% 8 2.3%
Diagnosis: Idiopathic restrictive CM 9 3.6% 18 5.2%
Diagnosis: Myocarditis 15 6.0% 7 2.0%
Diagnosis: Other/unknown 54 21.7% 63 18.1%
Blood type: A 66 26.5% 91 26.1%
Blood type: B 25 10.0% 46 13.2%
Blood type: AB 5 2.0% 9 2.6%
Blood type: O 153 61.4% 202 58.0%
Medical urgency: Status 1A 43 17.3% 82 23.6%
Medical urgency: Status 1B 23 9.2% 72 20.7%
Medical urgency: Status 2 52 20.9% 92 26.4%
Inactive status 131 52.6% 102 29.3%
VAD at listing 7 2.8% 28 8.0%
All candidates 249 100.0% 348 100.0%



Table HR 13 Listing characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2007 and December 31, 2017
Candidates aged younger than 18 years waiting for transplant on December 31, 2007, and December 31, 2017, regardless of first listing date; multiple listings are collapsed. Candidates listed as children who turned 18 before the cohort date are excluded.
Characteristic 2007, N 2007, Percent 2017, N 2017, Percent
Transplant history: First 231 92.8% 327 94.0%
Transplant history: Retransplant 18 7.2% 21 6.0%
Wait time: < 1 year 124 49.8% 220 63.2%
Wait time: 1-< 2 years 35 14.1% 56 16.1%
Wait time: 2-< 3 years 23 9.2% 26 7.5%
Wait time: 3-< 4 years 16 6.4% 21 6.0%
Wait time: 4-< 5 years 8 3.2% 9 2.6%
Wait time: ≥ 5 years 43 17.3% 16 4.6%
Tx type: Heart only 227 91.2% 344 98.9%
Tx type: Heart-kidney 3 1.2% 4 1.1%
Tx type: Heart-lung 18 7.2% 0 0.0%
Tx type: Other 1 0.4% 0 0.0%
All candidates 249 100.0% 348 100.0%



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 2015 2016 2017
Patients at start of year 362 369 367
Patients added during year 645 626 623
Patients removed during year 636 627 606
Patients at end of year 371 368 384



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 2015 2016 2017
Deceased donor transplant 464 460 444
Patient died 81 61 67
Patient refused transplant 3 2 0
Improved, transplant not needed 48 60 54
Too sick for transplant 23 28 28
Other 17 16 13



Table HR 16 Demographic characteristics of pediatric heart transplant recipients, 2005-2007 and 2015-2017
Heart transplant recipients, including retransplants.
Characteristic 2005-07, N 2005-07, Percent 2015-17, N 2015-17, Percent
Age: < 1 year 261 26.9% 368 27.5%
Age: 1-5 years 218 22.5% 318 23.8%
Age: 6-10 years 128 13.2% 177 13.2%
Age: 11-17 years 363 37.4% 474 35.5%
Sex: Female 457 47.1% 584 43.7%
Sex: Male 513 52.9% 753 56.3%
Race/ethnicity: White 557 57.4% 693 51.8%
Race/ethnicity: Black 218 22.5% 251 18.8%
Race/ethnicity: Hispanic 135 13.9% 292 21.8%
Race/ethnicity: Asian 44 4.5% 62 4.6%
Race/ethnicity: Other/unknown 16 1.6% 39 2.9%
Insurance: Private 515 53.1% 540 40.4%
Insurance: Medicaid 364 37.5% 667 49.9%
Insurance: Other government 63 6.5% 95 7.1%
Insurance: Unknown 28 2.9% 35 2.6%
Geography: Metropolitan 806 83.1% 1115 83.4%
Geography: Non-metro 164 16.9% 222 16.6%
Distance: < 50 miles 506 52.2% 704 52.7%
Distance: 50-<100 miles 147 15.2% 246 18.4%
Distance: 100-<150 miles 97 10.0% 138 10.3%
Distance: 150-<250 miles 95 9.8% 108 8.1%
Distance: ≥ 250 miles 98 10.1% 110 8.2%
Distance: Unknown 27 2.8% 31 2.3%
All recipients 970 100.0% 1337 100.0%



Table HR 17 Clinical characteristics of pediatric heart transplant recipients, 2005-2007 and 2015-2017
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 2005-07, N 2005-07, Percent 2015-17, N 2015-17, Percent
Diagnosis: Congenital defect 409 42.2% 661 49.4%
Diagnosis: Idiopathic dilated CM 294 30.3% 305 22.8%
Diagnosis: Familial dilated CM 32 3.3% 83 6.2%
Diagnosis: Idiopathic restrictive CM 60 6.2% 61 4.6%
Diagnosis: Myocarditis 31 3.2% 33 2.5%
Diagnosis: Other/unknown 144 14.8% 194 14.5%
Blood type: A 358 36.9% 480 35.9%
Blood type: B 118 12.2% 190 14.2%
Blood type: AB 35 3.6% 42 3.1%
Blood type: O 459 47.3% 625 46.7%
Medical urgency: Status 1A 726 74.8% 1108 82.9%
Medical urgency: Status 1B 129 13.3% 189 14.1%
Medical urgency: Status 2 115 11.9% 40 3.0%
On VAD 124 12.8% 334 25.0%
CPRA: < 1% 547 56.4% 526 39.3%
CPRA: 1-< 20% 157 16.2% 198 14.8%
CPRA: 20-< 80% 96 9.9% 266 19.9%
CPRA: 80-< 98% 31 3.2% 72 5.4%
CPRA: 98-100% 34 3.5% 37 2.8%
CPRA: Unknown 105 10.8% 238 17.8%
All recipients 970 100.0% 1337 100.0%



Table HR 18 Transplant characteristics of pediatric heart transplant recipients, 2005-2007 and 2015-2017
Heart transplant recipients, including retransplants.
Characteristic 2005-07, N 2005-07, Percent 2015-17, N 2015-17, Percent
Wait time: < 31 days 462 47.6% 383 28.6%
Wait time: 31-60 days 177 18.2% 259 19.4%
Wait time: 61-90 days 99 10.2% 190 14.2%
Wait time: 3-< 6 months 135 13.9% 270 20.2%
Wait time: 6-< 12 months 67 6.9% 139 10.4%
Wait time: 1-< 2 years 24 2.5% 66 4.9%
Wait time: ≥ 2 years 6 0.6% 30 2.2%
ABO: Compatible/identical 940 96.9% 1237 92.5%
ABO: Incompatible 30 3.1% 100 7.5%
Transplant history: First 893 92.1% 1274 95.3%
Transplant history: Retransplant 77 7.9% 63 4.7%
Tx type: Heart only 945 97.4% 1323 99.0%
Tx type: Heart-lung 14 1.4% 5 0.4%
Tx type: Heart-kidney 8 0.8% 7 0.5%
Tx type: Heart-liver 2 0.2% 2 0.1%
Tx type: Other 1 0.1% 0 0.0%
All recipients 970 100.0% 1337 100.0%



Table HR 19 Pediatric heart recipients on circulatory support before transplant
Patients may have more than one type of circulatory support.
Support 2012, N 2012, Percent 2017, N 2017, Percent
Any life support 267 71.8% 317 73.4%
Intravenous inotropes 199 53.5% 207 47.9%
Left ventricular assist device 77 20.7% 124 28.7%
Ventilator 64 17.2% 72 16.7%
Extra corporeal membrane oxygenation 19 5.1% 19 4.4%
Right ventricular assist device 18 4.8% 18 4.2%
Prostaglandins 7 1.9% 13 3.0%
Total artificial heart 2 0.5% 1 0.2%
Intra-aortic balloon pump 1 0.3% 2 0.5%
Inhaled NO 1 0.3% 6 1.4%



Table HR 20 Pediatric heart donor-recipient serology matching, 2013-2017
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- 31.3% 15.7%
D- R+ 17.0% 14.6%
D- R unk 0.8% 1.0%
D+ R- 28.5% 27.9%
D+ R+ 20.4% 38.2%
D+ R unk 0.8% 2.2%
D unk R- 0.8% 0.2%
D unk R+ 0.3% 0.1%