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Heart

OPTN/SRTR 2018 Annual Data Report: Heart

Abstract

The new adult heart allocation policy was approved in 2016 and implemented in October 2018, so its effect was not yet evident in 2018 data. However, the more granular data being collected are anticipated to allow for improved analyses. In 2018, new listings continued to increase; 3883 new adult and 685 new pediatric candidates were added. In 2018, 3440 heart transplants were performed, an increase of 167 over 2017; 473 transplants occurred in pediatric recipients and 2967 in adult recipients. Short-term and long-term posttransplant mortality improved. Overall 1-year survival for adults who underwent heart transplant in 2011-2013 was 90.3%, 3-year survival was 84.7%, and 5-year survival was 79.6%. Mortality rates for pediatric recipients were 4.5% at 6 months and in 5.9% at 1 year posttransplant, 12.5% at 3 years for transplants in 2014-2015, 14.8% at 5 years for transplants in 2012-2013, and 29.8% at 10 years for transplants performed in 2008-2009.

Introduction

The new adult heart allocation policy was approved in 2016 and implemented in October 2018. Its goal is to better stratify heart transplant candidates and to broaden sharing for higher urgency statuses to reduce waitlist mortality. While it is too early to discern the impact of the new policy, the more granular data being collected as part of the new system are anticipated to allow for improved analyses of outcomes and risk factors, which will contribute to a more dynamic policy. The current Annual Data Report provides an early glimpse into the distribution of patients under the new allocation system.

Adult Heart Transplant

Waitlist Trends

Between 2009 and 2018, the number of new active listings for heart transplant increased by 33.7%, from 2810 to 3756 (Figure HR 1). The number of candidates actively awaiting heart transplant increased by 39.7% since 2009, from 1858 to 2596 (Figure HR 2); however, since 2015, the number of active patients on the list at the end of the year declined, and the number of inactive patient declined then increased slightly. Some 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 18.7% in 2018 (Figure HR 3); stable proportions of racial/ethnic minorities, with black candidates comprising a slightly smaller proportion of waitlist candidates, 24.8%, and whites candidates a slightly higher proportion, 62.4% (Figure HR 5); and a slight increase in patients with congenital heart disease (Figure HR 6). In 2018, 63% of candidates had been on the waiting list for less than 1 year, a slight increase since 2008. In 2008, 12.9% of candidates had been on the waiting list 5 years or longer; this proportion gradually declined to 4.0% in 2018, the lowest in the past decade (Figure HR 7). The proportion of candidates awaiting transplant as status 1A continued to increase, 48.1% in 2018 (Figure HR 8). The proportion of status 1B candidates increased similarly but reached a plateau over the past 4 years, while the proportion waiting as status 2 declined from 25.7% in 2008 to 14.2% in 2018. Note that new status groups in use as of October, 2018 were converted to former status 1A, 1B and 2 equivalents for the 2018 data point (see Preface). The proportion of candidates with ventricular assist devices (VADs) at listing increased from 11.8% in 2008 to 32.6% in 2018 (Figure HR 9). Sex distribution has not changed appreciably: in 2018, women comprised 26% of heart transplant candidates (Figure HR 4). In 2018, 85.5% of candidates resided in a metropolitan area (Table HR 1).The proportion of candidates within 50 miles of the transplant program increased from 56.3% in 2008 to 62.1% in 2018, and proportions of those at greater distances decreased. Candidates with a prior heart transplant declined from 4.3% in 2008 to 2.9% in 2018 (Table HR 3). In 2018, 206 candidates were listed for heart-kidney transplant, a substantial increase since 2008, while those listed for heart-lung transplants decreased to only 42 (1.23%) in 2018 (Table HR 3).

The distribution of candidates by status on December 31 in 2017 and 2018 is shown in Table HR 4. At the end of 2018, 47.8% of candidates were listed as new status 4, similar to the proportion listed as former status 1B at the end of 2017. Only 7 patients, or 0.2%, were listed as new status 1 (Table HR 4). The number of patients receiving any life support prior to transplant increased from 1791 in 2013 to 2402 in 2018 (Table HR 7). Of these, 43.6% had left VADs (LVADs), an increase of 342 over the 5-year period. While the proportion of LVADs and inotropes declined slightly since 2013, intra-aortic balloon pump (IABP) use increased from 5.7% to 9.1% and extracorporeal membrane oxygenation (ECMO) use increased from 0.7% to 2.0%. In 2018, 270 candidates used IABP, compared with 123 in 2013, and 58 used ECMO, compared with 15 in 2013. Candidates with total artificial hearts and right VADs declined to just 1% and 1.6%, respectively (Table HR 7).

Between 2008 and 2018, heart transplant rates fluctuated, reaching a nadir of 61.5 per 100 waitlist-years in 2015, followed by an increase to a decade high of 82.0 per 100 waitlist-years in 2018 (Figure HR 14). This trend was similar for all age groups, blood types, and status groups (Figure HR 11, Figure HR 13, Figure HR 14). For most groups, transplant rates since 2007 reached a nadir in 2014 and 2015 and have increased since. Trends were similar for black and Hispanic candidates, but transplant rates did not recover at the same magnitude as for other groups and overall declined since 2008. The transplant rate for blacks declined from 82.0 per 100 waitlist-years in 2008 to 69.2 in 2018, and for Hispanics from 90.2 per 100 waitlist-years to 80.Transplant rates increased in all age groups since 2015, but to a greater extent for candidates aged 65 or older. The transplant rate for these candidates exceeded that for all the other age groups, at 109.4 per 100 waitlist-years. Despite the overall increase, the transplant rate remained lowest for candidates aged 35-49 years, 69.6 per 100 waitlist-years.

Transplant rates have consistently been highest for candidates with blood type AB (199.4 per 100 waitlist-years) and for those listed as status 1A (302.2 per 100 waitlist-years). In 2018, blood type O candidates underwent transplant at a rate of 58.0 per 100 waitlist-years, nearly half the rate of blood type A and B candidates and 29% of the rate of blood type AB candidates. Candidates with blood type A underwent transplant at a rate of 106.1 per 100 waitlist-years, higher than in previous years, and higher than candidates with blood type B. Despite a decline in transplant rates between 2007 and 2015, since then, rates have increased for nearly all groups. In 2018, candidates residing in non-metropolitan areas underwent transplant at slightly higher rates than those in metropolitan areas, 84.6 per 100 waitlist-years vs. 81.7 (Figure HR 15). Although trends based on candidate distance from the donor hospital have been similar over the past decade, in 2018, candidates residing 100-<250 nautical miles (NM) from the donor hospital underwent transplant at the highest rate, 85.7 per 100 waitlist-years, and those residing 50-<100 NM away at the lowest rate, 80.4 per 100 waitlist-years (Figure HR 16).

The median waiting time in 2017-2018 was 6.9 months (Figure HR 18). The lowest median time to transplant of the decade occurred in 2007-2008. A peak of 11.6 months occurred in 2013-2014, followed by a gradual decline. In 2017-2018, median waiting time was longest for blood type O candidates, 13.5 months (Figure HR 19); status 2 candidates, 16.72 months; and candidates with body mass index ? 31 kg/m2, 11.2 months (Figure HR 20, Figure HR 21). Waiting time decreased for all status groups and was lowest for status 1A, 1.97 months. Women waited on average 4.9 months, and men 7.9 months (Figure HR 18). Median waiting time was lowest of all groups for candidates with blood type AB, 1.5 months. Since 2007, the proportion of candidates undergoing transplant within 1 year of listing declined overall, but increased from 48.6% in 2014 to 57.2% in 2017. Of candidates listed in 2017, 33.3% underwent transplant within 3 months and 45.5% within 6 months (Figure HR 22). When stratified by donation service area (DSA), the proportion of candidates undergoing transplant within 1 year of listing in 2017 varied from 23.1% to 94.1% (Figure HR 23). Similar variability occurred by state, ranging from 25.0% to 100% (n = 3) (Figure HR 24).

Among candidates listed in 2015, 51.5% underwent transplant during the first year on the waiting list, 31.9% were still waiting, 9.4% were removed from the list, and 7.2% had died (Figure HR 17). At 3 years, 66.0% had undergone transplant, 8.1% were still waiting, 17.4% had been removed from the list, and 8.5% had died.

Since 2007-2008, pretransplant mortality declined from 16.6 to 10.8 deaths per 100 waitlist-years in 2017-2018 (Figure HR 25). Pretransplant mortality declined for all groups except candidates with valvular heart disease, unknown etiology, and unknown ethnicity. Pretransplant mortality was lowest for candidates aged 18-34 years and those listed as status 2, 7.3 deaths per 100 waitlist-years. Pretransplant mortality declined by more than 50% for candidates aged 18-34 years, from 15.4 per 100 wait-list deaths in 2007-2008 to 7.3 in 2017-2018 (Figure HR 25, Figure HR 29). Pretransplant mortality declined substantially over the past decade for black, Hispanic, and Asian candidates. In 2017-2018, pretransplant mortality was lowest for blacks, 9.2 deaths per 100 waitlist-years (Figure HR 26). In 2007-2008, pretransplant mortality for LVAD candidates was more than twice that for non-LVAD candidates, 38.3 vs. 15.0 deaths per 100 waitlist-years. However, pretransplant mortality declined substantially for LVAD candidates, to 10.2 deaths per 100 waitlist-years in 2017-2018. Pretransplant mortality for non-VAD candidates was 11.1 deaths per 100 waitlist-years in 2017-2018. Since 2013-2014, pretransplant mortality has been lower in VAD than in non-VAD candidates (Figure HR 30). Pretransplant mortality rates remained highest among candidates listed as status 1A, as might be expected, but declined dramatically between 2007-2008 and 2009-2010, from 71.9 deaths per 100 waitlist-years to 49.3 (Figure HR 29), followed by a gradual decline to 30.1 in 2017-2018. Similarly, pretransplant mortality among candidates listed as status 1B declined from 32.5 to 8.7 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), and varied by DSA from 3.3 to 25.1 deaths per 100 waitlist-years (Figure HR 34).

Among candidates removed from the waiting list for reasons other than transplant, 16.9% died within 6 months of removal in 2018, although data from only the first half of 2018 were available. The overall trend showed a decline in patients who died within 6 months of removal from the waiting list, despite fluctuation and an increase to 33.2% in 2013 (Figure HR 35). In 2017, 172 patients died within 6 months of removal from the waiting list. In 2017, 47.9% of candidates listed as status 1A died within 6 months of removal. The percentage of candidates aged 18-34 years who died within 6 months followed a similar trend and decreased to 7.7% in 2017, but increased to 19.5% in 2018 (Figure HR 36).

Donor Trends

The number of deceased heart donations continued to increase; 3443 deceased donors in 2018 was the highest number to date, and an increase of 52% since 2007. While the number of donors increased in all age groups over the past decade, the greatest increase was donors aged 18-34 years, from 1039 in 2008 to 1706 in 2018 (Figure HR 37); the highest proportion of donors, 50%, were in this age group (Figure HR 38). Among donors 2014-2018, the number of pediatric heart donors in a DSA ranged from 2 to 164. The proportion of pediatric donor hearts that were transplanted into adults varied by DSA from 0% to 64% (Figure HR 41). The rate of discards, that is, the proportion of recovered hearts that were not transplanted, has fluctuated over the past decade and in 2018 was 0.8% (Figure HR 42). Although discards were highest in age group 50 years or older, they declined in this age group from 3.3% in 2015-2016 to 1.8% in 2017-2018. The discard rate for Public Health Service (PHS) high risk donors was 1.0% compared with 0.7% for non-PHS high risk donors (Figure HR 43).

Head trauma as cause of donor death continued to decline in prevalence and in 2018 was 43.0%. Conversely, anoxia continued to increase in prevalence to 41.6% of donors in 2018, second to head trauma (Figure HR 44). In 2007, anoxia was the cause of death for only 15.0% of donors. The increase in anoxic deaths may be partially attributable to the rise in opioid deaths.

Overall Trends in Heart Transplant

The general trend has been an increase in heart transplants over the past decade (Figure HR 45). In 2018, 3440 heart transplants were performed, an increase of 167 over 2017; 473 transplants occurred in pediatric recipients and 2967 in adult recipients (Figure HR 45). Pediatric heart transplants declined between 2015 and 2017, but increased by 41 since then. In 2018, six fewer transplants were performed in recipients aged 18-34 years, but transplants increased for all other age groups, with the largest number, 1407, in recipients aged 50-64 years (Figure HR 46). In 2018, 2028 heart transplants were performed for cardiomyopathy (Figure HR 49). The number of recipients who underwent transplant at status 1A more than doubled, from 1108 in 2007 to 2439 in 2018, representing 71% of all transplants. The number of status 1B recipients has fluctuated, but decreased from 954 in 2017 to 868 in 2018. Of note, 133 transplants were performed in status 2 patients, the highest since 2011 and an increase of 48 over 2017 (Figure HR 50). Note that new status groups in use as of October, 2018 were converted to former status 1A, 1B and 2 equivalents for the 2018 data point.

In 2018, 84.2% of recipients resided in metropolitan areas, and 61.2% lived within 50 miles of the transplant program (Table HR 8). In 2018, 46.2% of recipients had LVADs. The number of recipients with VADs at the time of transplant increased from 519 in 2013 to 1370 in 2018 (Table HR 9). Although 28.9% of patients underwent transplant within 31 days of listing in 2018, the proportion who waited 1 year or longer increased over the past decade: 18.3% in 2018 vs. 9.5% in 2008 (Table HR 10). Multi-organ transplant accounted for 9.1% of heart transplants; 202 heart-kidney transplants were performed in 2018 compared with 63 in 2008 (Table HR 10).

Use of induction therapy has changed little since 2007. In 2018, 51.7% of adult heart transplant recipients received either IL2-RA or T-cell depleting therapy (Figure HR 51), 96.6% received a tacrolimus-based immunosuppression regimen, and 3.4% received other regimens (Figure HR 52).

In 2018, the median transplant program volume was 19 transplants per year, increased since 2008, but at a plateau since 2015 (Figure HR 54). The percentage transplants performed at low-volume programs (0 to 9 transplants per year) declined to 4.0% in 2018, compared with 10.7% in 2008. The proportion transplants performed at programs with volumes of 60 or more transplants fluctuated, peaking at 21.1% in 2017 and declining to 15.5% in 2018 (Figure HR 55). Overall, however, high-volume programs have increased over the past decade. Between 2007 and 2015, most heart transplants occurred at programs performing 10-29 per year; more recently, this shifted to programs performing 30-59 transplants per year, where 44.6% were performed in 2018 (Table HR 55).

Posttransplant Survival and Morbidity

Overall 1-year survival for patients who underwent heart transplant in 2011-2013 was 90.3%, 3-year survival was 84.7%, and 5-year survival was 79.6% (Figure HR 56). One-year survival in most subgroups was similar, but tended to be lower among recipients aged 65 years or older (Figure HR 56) and Hispanic recipients (Figure HR 57). Survival tended to be better for Asian recipients at all time-points. Survival at 1 year was similar for recipients with VADs, IABPs, and without circulatory support; however, survival was lower at 3 and 5 years for recipients with IABPs, 79.9% and 74.6%, respectively (Figure HR 59). Early survival was lower for re-transplant recipients, but by 5 years was similar to those undergoing a first transplant (Figure HR 60). Survival tended to be worse for recipients residing 250 miles or farther from the transplant program than for those residing closer at 1, 3, and 5 years, and was the lowest 1-, 3-, and 5-year survival of all groups (Figure HR 63). Since 2001, short- and long-term death rates have declined. Among recipients who underwent transplant In 2017, 7.0% died at 6 months and 9.0% died at 1 year (Figure HR 64). Ten-year mortality remained high at 38.2% among those who underwent transplant in 2008, although this has declined from 43.0% among those who underwent transplant in 2001. The number of heart transplant survivors has increased by over 11,000 since 2007. On June 30, 2018, 33,885 heart transplant recipients were alive with a functioning graft, compared with 32,151 in 2017. Most survivors were aged 50 years or older at the time of transplant (Figure HR 65).

The incidence of acute rejection in the first year posttransplant was 27.0% for recipients undergoing transplant in 2016-2017 (Figure HR 66). Rejection occurred more frequently in younger patients, 32.0% of recipients aged 18-34 years compared with 23.1% of those aged 65 years or older. Posttransplant lymphoproliferative disorder (PTLD) occurred in 1.0% of recipients by year 5, but more frequently, 3.5%, in those who were seronegative for Epstein Barr virus (EBV) (Figure HR 68). The most common documented cause of death in the first posttransplant year was cardiovascular/cerebrovascular disease (Figure HR 69), and in years 2 through 5 (Figure HR 70). Malignancy was a relatively infrequent cause of death, 1.4% at 5 years (Figure HR 70).

Pediatric Heart Transplant

Pediatric Waitlist Trends

In 2018, 685 new pediatric candidates were added to the heart transplant waiting list, with few at inactive status (Figure HR 71). At year-end 2018, 395 candidates listed before their eighteenth birthdays were awaiting heart transplant, 73.2% active (Figure HR 72). Over the past decade, the proportion of inactive candidates at year-end decreased from 56.9% in 2007 to 26.8% in 2018. The largest pediatric age group on the waiting list in 2018 was 11-17 years (33.4%), followed by 1-5 years (26.9%), younger than 1 year (26.1%), and 6-10 years (13.6%) (Figure HR 73). Just over half of pediatric heart transplant candidates were white, 20.6% were black, 19.6% were Hispanic, and 4.2% were Asian (Figure HR 74). Over the past decade, the proportion of pediatric heart candidates with congenital defects increased from 41.6% in 2007 to 55.8% in 2018 (Figure HR 75). Considering trends over time, the age and race of waitlisted candidates has remained relatively unchanged (Table HR 13). For candidates waiting on December 31, 2018, congenital defect was the leading cause of heart disease at 62.2%, increased from 48.0% in 2008 (Table HR 14). The proportions of heart transplant candidates listed as status 1B and status 2 increased over the past decade, likely reflecting changes to pediatric heart allocation policy implemented in 2016. The percentage of candidates using VADs at the time of listing remained stable, from 4.0% in 2008 to 6.6% in 2018 (Table HR 14). A smaller proportion of candidates were listed for heart-lung transplant in 2018, 0.6% compared with 5.6 % in 2008 (Table HR 15). Among the 674 candidates removed from the waiting list in 2018, 486 (72.1%) were removed due to undergoing transplant, 77 (11.4%) died, 62 (9.2%) were removed due to improved condition, and 31 (4.6%) were considered too sick to undergo transplant (Table HR 16, Table HR 17).

Just over 70% of pediatric candidates newly listed in 2015 underwent transplant within 3 years, 13.0% died, 11.8% were removed from the list, and 4.2% were still waiting (Figure HR 79). The rate of heart transplants among pediatric waitlist candidates has remained relatively stable over the past decade, and was 117.7 per 100 waitlist-years in 2018 (Figure HR 80). Transplant rates varied by age; rates were highest for candidates aged younger than 1 year, at 183.0 transplants per 100 waitlist-years in 2018, followed by candidates aged 11-17 years, at 117.7 transplants per 100 waitlist-years (Figure HR 80). Pretransplant mortality decreased over the past decade, from 27.6 deaths per 100 waitlist-years in 2007-2008 to 17.6 in 2017-2018 (Figure HR 83). By age, pretransplant mortality rates were highest for candidates aged younger than 1 year, at 41.1 deaths per 100 waitlist-years in 2017-2018, followed by 14.4 deaths per 100 waitlist-years for ages 1-5 years, 11.1 for ages 6-10 years, and 7.1 for ages 11-17 years (Figure HR 83). By medical urgency status, pretransplant mortality was highest for status 1A (46.6 deaths per 100 waitlist-years) and 1B (11.4) candidates, compared with 3.7 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 continued to increase, to 473 in 2018 from 330 in 2007 (Figure HR 89). In 2018, 27 of 138 total heart transplant programs performed pediatric heart transplants exclusively, 77 performed only adult heart transplants, and 26 performed both adult and pediatric heart transplants (Figure HR 90). In 2018, 7.8% 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 91). Over the past decade, the age, sex, and race/ethnicity of pediatric heart transplant recipients changed little (Table HR 18).The proportion of recipients with private insurance decreased over the decade and the proportion with Medicaid increased (Table HR 18). Congenital defects remained the most common primary cause of disease, affecting 50.1% of recipients who underwent transplant in 2016-2018 (Table HR 19). The proportion of patients who underwent transplant at status 1A and 1B increased over the decade, and the proportion at status 2 decreased. VAD use at the time of transplant increased from 13.1% of transplant recipients in 2006-2008 to 28.4% in 2016-2018 (Table HR 19). The proportion of ABO-incompatible transplants in 2016-2018 increased 3-fold to 9.9% from 3.3% a decade earlier (Table HR 20).

In 2018, use of T-cell depleting agents for induction continued to increase, to 74.6% of pediatric heart transplant recipients; use of interleukin-2 receptor antagonists decreased to 8.2% (Figure HR 92). The initial immunosuppression regimen used most commonly shifted in 2018 to more recipients using tacrolimus and MMF (47.5%) with a reciprocal decrease in those using tacrolimus, MMF, and steroid (39.0%) (Figure HR 93).

Pediatric Posttransplant Survival and Morbidity

Among pediatric heart transplant recipients 2016-2017, the rate of acute rejection in the first year was 18.8% overall; the highest rate was 23.4% in recipients aged 11-17 years, and the lowest was 15.8% in recipients aged younger than 6 years (Figure HR 96). Among pediatric heart transplant recipients 2016-2018, the combination of a CMV-positive donor and CMV-negative recipient occurred in 28.1% of transplants; for EBV, this combination occurred in 28.7% of transplants (Table HR 22).

Recipient death occurred in 4.5% of patients at 6 months posttransplant and in 5.9% at 1 year posttransplant among pediatric heart transplants performed in 2016-2017, in 12.5% of patients at 3 years posttransplant for transplants performed in 2014-2015, in 14.8% of patients at 5 years posttransplant for transplants performed in 2012-2013, and in 29.8% of patients at 10 years posttransplant for transplants performed in 2008-2009 (Figure HR 99). Overall, 1-year and 5-year patient survival were 90.9% and 81.5%, respectively, among recipients who underwent transplant in 2006-2013 (Figure HR 100). By age, 5-year patient survival was 76.9% for recipients aged younger than 1 year, 82.9% for ages 1-5 years, 87.1% for ages 6-10 years, and 82.4% for ages 11-17 years (Figure HR 100). The leading identified causes of death in the first 12 months posttransplant among recipients from 2016-2017 were infection (1.4%) and cardio/cerebrovascular disease (1.4%) (Figure HR 101). At 5 years posttransplant, the leading causes were graft failure (3.9%) and cardio/cerebrovascular disease (3.7%) (Figure HR 102).

The overall incidence of PTLD was 4.1% at 5 years posttransplant; incidence was 5.3% among EBV-negative recipients and 3.1% among EBV-positive recipients (Figure HR 98).

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 adult waitlist candidates by metropolitan vs. non-metropolitan residence
Figure HR 16. Deceased donor heart transplant rates among adult waitlist candidates by distance from listing center
Figure HR 17. Three-year outcomes for adults waiting for heart transplant, new listings in 2015
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 2017 by DSA
Figure HR 24. Percentage of adults who underwent deceased donor heart transplant within 1 year of listing in 2017 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, by active/inactive status
Figure HR 34. Pretransplant mortality rates among adults waitlisted for heart transplant in 2017-2018, by DSA
Figure HR 35. Deaths within six months after removal among adult heart waitlist candidates, by status at removal
Figure HR 36. Deaths within six months after removal among adult heart waitlist candidates, by age at removal

Deceased donation

Figure HR 37. Deceased heart donor count by age
Figure HR 38. Distribution of deceased heart donors by age
Figure HR 39. Distribution of deceased heart donors by sex
Figure HR 40. Distribution of deceased heart donors by race
Figure HR 41. Percent of pediatric donor hearts allocated to adult recipients, by DSA of donor hospital, 2014-2018
Figure HR 42. Rates of hearts recovered for transplant and not transplanted by donor age
Figure HR 43. Rates of hearts recovered for transplant and not transplanted, by donor risk of disease transmission
Figure HR 44. Cause of death among deceased heart donors

Transplant

Figure HR 45. Total heart transplants
Figure HR 46. Total heart transplants by age
Figure HR 47. Total heart transplants by sex
Figure HR 48. Total heart transplants by race
Figure HR 49. Total heart transplants by diagnosis
Figure HR 50. Total heart transplants by medical urgency
Figure HR 51. Induction agent use in adult heart transplant recipients
Figure HR 52. Immunosuppression regimen use in adult heart transplant recipients
Figure HR 53. Total HLA A, B, and DR mismatches among adult deceased donor heart transplant recipients, 2014-2018
Figure HR 54. Annual adult heart transplant center volumes, by percentile
Figure HR 55. Distribution of adult heart transplants by annual center volume

Outcomes

Figure HR 56. Patient survival among adult heart transplant recipients, 2011-2013, by age
Figure HR 57. Patient survival among adult heart transplant recipients, 2011-2013, by race
Figure HR 58. Patient survival among adult heart transplant recipients, 2011-2013, by sex
Figure HR 59. Patient survival among adult heart transplant recipients, 2011-2013, by circulatory support
Figure HR 60. Patient survival among adult heart transplant recipients, 2011-2013, by first vs. retransplant
Figure HR 61. Patient survival among adult heart transplant recipients, 2011-2013, by medical urgency
Figure HR 62. Patient survival among adult heart transplant recipients, 2011-2013, by metropolitan vs. non-metropolitan recipient residence
Figure HR 63. Patient survival among adult heart transplant recipients, 2011-2013, by recipients' distance from transplant center
Figure HR 64. Patient death among adult heart transplant recipients
Figure HR 65. Recipients alive with a functioning heart graft on June 30 of the year, by age at transplant
Figure HR 66. Incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by age, 2016-2017
Figure HR 67. Incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by induction agent 2016-2017
Figure HR 68. Incidence of PTLD among adult heart transplant recipients by recipient EBV status at transplant, 2012-2016
Figure HR 69. One-year cumulative incidence of death by cause among adult heart recipients, 2016-2017
Figure HR 70. Five-year cumulative incidence of death by cause among adult heart recipients, 2012-2013

Pediatric transplant

Figure HR 71. New pediatric candidates added to the heart transplant waiting list
Figure HR 72. Pediatric candidates listed for heart transplant on December 31 each year
Figure HR 73. Distribution of pediatric candidates waiting for heart transplant by age
Figure HR 74. Distribution of pediatric candidates waiting for heart transplant by race
Figure HR 75. Distribution of pediatric candidates waiting for heart transplant by diagnosis
Figure HR 76. Distribution of pediatric candidates waiting for heart transplant by sex
Figure HR 77. Distribution of pediatric candidates waiting for heart transplant by waiting time
Figure HR 78. Distribution of pediatric candidates waiting for heart transplant by medical urgency
Figure HR 79. Three-year outcomes for newly listed pediatric candidates waiting for heart transplant, 2015
Figure HR 80. Deceased donor heart transplant rates among pediatric waitlist candidates by age
Figure HR 81. Deceased donor heart transplant rates among pediatric waitlist candidates by metropolitan vs. non-metropolitan residence
Figure HR 82. Deceased donor heart transplant rates among pediatric waitlist candidates by distance from listing center
Figure HR 83. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by age
Figure HR 84. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by race
Figure HR 85. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by diagnosis
Figure HR 86. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by medical urgency
Figure HR 87. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by metropolitan vs. non-metropolitan residence
Figure HR 88. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by distance from listing center
Figure HR 89. Pediatric heart transplants by recipient age
Figure HR 90. Number of centers performing pediatric and adult heart transplants by center's age mix
Figure HR 91. Pediatric heart recipients at programs that perform 5 or fewer pediatric transplants annually
Figure HR 92. Induction agent use in pediatric heart transplant recipients
Figure HR 93. Immunosuppression regimen use in pediatric heart transplant recipients
Figure HR 94. Induction use by C/PRA among pediatric heart transplant recipients, 2014-2018
Figure HR 95. Total HLA A, B, and DR mismatches among pediatric deceased donor heart transplant recipients, 2014-2018
Figure HR 96. Incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by age, 2016-2017
Figure HR 97. Incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by induction agent 2016-2017
Figure HR 98. Incidence of PTLD among pediatric heart transplant recipients by recipient EBV status at transplant, 2006-2016
Figure HR 99. Patient death among pediatric heart transplant recipients
Figure HR 100. Patient survival among pediatric deceased donor heart transplant recipients, 2006-2013, by age
Figure HR 101. One-year cumulative incidence of death by cause among pediatric heart recipients, 2016-2017
Figure HR 102. Five-year cumulative incidence of death by cause among pediatric heart recipients, 2012-2013

Table List

Waiting list

Table HR 1. Demographic characteristics of adults on the heart transplant waiting list on December 31, 2008 and December 31, 2018
Table HR 2. Clinical characteristics of adults on the heart transplant waiting list on December 31, 2008 and December 31, 2018
Table HR 3. Listing characteristics of adults on the heart transplant waiting list on December 31, 2008 and December 31, 2018
Table HR 4. Status of adults on the heart waiting list on December 31, 2017 and December 31, 2018
Table HR 5. Heart transplant waitlist activity among adults
Table HR 6. Removal reason among adult heart transplant candidates

Transplant

Table HR 7. Adult heart recipients on circulatory support before transplant
Table HR 8. Demographic characteristics of adult heart transplant recipients, 2008 and 2018
Table HR 9. Clinical characteristics of adult heart transplant recipients, 2008 and 2018
Table HR 10. Transplant characteristics of adult heart transplant recipients, 2008 and 2018
Table HR 11. Status of adult heart transplant recipients, November-December 2017 and 2018
Table HR 12. Adult heart donor-recipient serology matching, 2016-2018

Pediatric transplant

Table HR 13. Demographic characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2008 and December 31, 2018
Table HR 14. Clinical characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2008 and December 31, 2018
Table HR 15. Listing characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2008 and December 31, 2018
Table HR 16. Heart transplant waitlist activity among pediatric candidates
Table HR 17. Removal reason among pediatric heart transplant candidates
Table HR 18. Demographic characteristics of pediatric heart transplant recipients, 2006-2008 and 2016-2018
Table HR 19. Clinical characteristics of pediatric heart transplant recipients, 2006-2008 and 2016-2018
Table HR 20. Transplant characteristics of pediatric heart transplant recipients, 2006-2008 and 2016-2018
Table HR 21. Pediatric heart recipients on circulatory support before transplant
Table HR 22. Pediatric heart donor-recipient serology matching, 2016-2018

A line plot for new adult candidates added to the heart transplant waiting list; the active category increases by 50.8% from 2490 candidates at 2007 to 3756 candidates at 2018; the inactive category increases by 12.4% from 113 candidates at 2007 to 127 candidates at 2018; and the all category increases by 49.2% from 2603 candidates at 2007 to 3883 candidates at 2018.

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 98.5% from 1308 candidates at 2007 to 2596 candidates at 2018; the inactive category decreases by 27.1% from 1109 candidates at 2007 to 808 candidates at 2018; and the all category increases by 40.8% from 2417 candidates at 2007 to 3404 candidates at 2018.

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 11.4 percent at 2007 and remains relatively constant with a value of 10.7 percent at 2018; the 35 to 49 category is 23.9 percent at 2007 and remains relatively constant with a value of 22.4 percent at 2018; the 50 to 64 category is 51.6 percent at 2007 and remains relatively constant with a value of 48.1 percent at 2018; and the greater than or equal to 65 category increases by 43.3% from 13.1 percent at 2007 to 18.7 percent at 2018.

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 75.7 percent at 2007 and remains relatively constant with a value of 74 percent at 2018; and the female category is 24.3 percent at 2007 and remains relatively constant with a value of 26 percent at 2018.

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 12.8% from 71.5 percent at 2007 to 62.4 percent at 2018; the black category increases by 41.5% from 17.5 percent at 2007 to 24.8 percent at 2018; the hispanic category increases by 14.8% from 7.6 percent at 2007 to 8.8 percent at 2018; the asian category increases by 34.7% from 2.5 percent at 2007 to 3.3 percent at 2018; and the other/unknown category is 0.8 percent at 2007 and remains relatively constant with a value of 0.8 percent at 2018.

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 24.5% from 41.3 percent at 2007 to 31.1 percent at 2018; the cardiomyopathy category increases by 24.0% from 47.2 percent at 2007 to 58.6 percent at 2018; the congenital category is 4 percent at 2007 and remains relatively constant with a value of 4.4 percent at 2018; the valvular category decreases by 55.9% from 2.2 percent at 2007 to 1 percent at 2018; and the other/unknown category is 5.3 percent at 2007 and remains relatively constant with a value of 4.9 percent at 2018.

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 59.3 percent at 2007 and remains relatively constant with a value of 63.1 percent at 2018; the 1 to less than 2 category increases by 50.5% from 11.2 percent at 2007 to 16.8 percent at 2018; the 2 to less than 3 category increases by 49.2% from 5.6 percent at 2007 to 8.3 percent at 2018; the 3 to less than 4 category is 4.7 percent at 2007 and remains relatively constant with a value of 4.7 percent at 2018; the 4 to less than 5 category decreases by 16.4% from 3.6 percent at 2007 to 3 percent at 2018; and the greater than or equal to 5 category decreases by 74.1% from 15.5 percent at 2007 to 4 percent at 2018.

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 69.9% from 28.3 percent at 2007 to 48.1 percent at 2018; the status 1b category increases by 50.4% from 20.1 percent at 2007 to 30.3 percent at 2018; the status 2 category decreases by 50.0% from 28.3 percent at 2007 to 14.2 percent at 2018; and the inactive category decreases by 67.8% from 23.3 percent at 2007 to 7.5 percent at 2018.

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. New status codes in use as of October 18, 2018 were converted to their old status equivalents for the 2018 data point. 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 25.3% from 90.3 percent at 2007 to 67.4 percent at 2018; and the vad category increases by 235.2% from 9.7 percent at 2007 to 32.6 percent at 2018.

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 34.7 percent at 2007 and remains relatively constant with a value of 33.4 percent at 2018; the b category increases by 13.2% from 11.8 percent at 2007 to 13.4 percent at 2018; the ab category is 3.3 percent at 2007 and remains relatively constant with a value of 3.2 percent at 2018; and the o category is 50.2 percent at 2007 and remains relatively constant with a value of 50 percent at 2018.

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 decreases by 19.5% from 89.7 transplants per 100 waitlist years at 2007 to 72.3 transplants per 100 waitlist years at 2018; the 35 to 49 category is 77.2 transplants per 100 waitlist years at 2007 and remains relatively constant with a value of 69.6 transplants per 100 waitlist years at 2018; the 50 to 64 category is 75.6 transplants per 100 waitlist years at 2007 and remains relatively constant with a value of 81.3 transplants per 100 waitlist years at 2018; and the greater than or equal to 65 category increases by 52.5% from 71.7 transplants per 100 waitlist years at 2007 to 109.3 transplants per 100 waitlist years at 2018.

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 17.3% from 73 transplants per 100 waitlist years at 2007 to 85.7 transplants per 100 waitlist years at 2018; the black category decreases by 22.2% from 88.9 transplants per 100 waitlist years at 2007 to 69.2 transplants per 100 waitlist years at 2018; the hispanic category is 83.3 transplants per 100 waitlist years at 2007 and remains relatively constant with a value of 80 transplants per 100 waitlist years at 2018; the asian category increases by 21.7% from 101.2 transplants per 100 waitlist years at 2007 to 123.2 transplants per 100 waitlist years at 2018; and the other category increases by 54.2% from 70.5 transplants per 100 waitlist years at 2007 to 108.7 transplants per 100 waitlist years at 2018.

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 102.2 transplants per 100 waitlist years at 2007 and remains relatively constant with a value of 106.1 transplants per 100 waitlist years at 2018; the b category is 110.3 transplants per 100 waitlist years at 2007 and remains relatively constant with a value of 116.7 transplants per 100 waitlist years at 2018; the ab category decreases by 19.2% from 246.9 transplants per 100 waitlist years at 2007 to 199.4 transplants per 100 waitlist years at 2018; and the o category increases by 10.6% from 52.5 transplants per 100 waitlist years at 2007 to 58 transplants per 100 waitlist years at 2018.

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 41.2% from 514.2 transplants per 100 waitlist years at 2007 to 302.2 transplants per 100 waitlist years at 2018; the status 1b category decreases by 69.7% from 265.7 transplants per 100 waitlist years at 2007 to 80.5 transplants per 100 waitlist years at 2018; the status 2 category decreases by 22.1% from 58.2 transplants per 100 waitlist years at 2007 to 45.3 transplants per 100 waitlist years at 2018; and the all category is 77 transplants per 100 waitlist years at 2007 and remains relatively constant with a value of 82 transplants per 100 waitlist years at 2018.

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. New status codes in use as of October 18, 2018 were converted to their old status equivalents for the 2018 data point. 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 metropolitan vs. non-metropolitan residence; the metropolitan category is 79.1 transplants per 100 waitlist years at 2007 and remains relatively constant with a value of 81.7 transplants per 100 waitlist years at 2018; and the non to metropolitan category increases by 27.8% from 66.2 transplants per 100 waitlist years at 2007 to 84.6 transplants per 100 waitlist years at 2018.

Figure HR 15. Deceased donor heart transplant rates among adult 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 adult waitlist candidates by distance from listing center; the 0 to less than 50 nm category is 82.3 transplants per 100 waitlist years at 2007 and remains relatively constant with a value of 81.8 transplants per 100 waitlist years at 2018; the 50 to less than 100 category increases by 13.3% from 71 transplants per 100 waitlist years at 2007 to 80.4 transplants per 100 waitlist years at 2018; the 100 to less than 250 category increases by 23.3% from 69.5 transplants per 100 waitlist years at 2007 to 85.7 transplants per 100 waitlist years at 2018; and the greater than or equal to 250 category increases by 17.3% from 70.2 transplants per 100 waitlist years at 2007 to 82.4 transplants per 100 waitlist years at 2018.

Figure HR 16. Deceased donor heart transplant rates among adult 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 2015; the still waiting category decreases by 91.9% from 100 percent at 0 Months postlisting to 8.1 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 increases by 238900.0% from 0 percent at 0 Months postlisting to 66 percent at 36 Months postlisting.

Figure HR 17. Three-year outcomes for adults waiting for heart transplant, new listings in 2015
Adults waiting for heart transplant and first listed in 2015. 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 52.9% from 5.2 months at 2007-2008 to 7.9 months at 2017-2018; the female category is 4.5 months at 2007-2008 and remains relatively constant with a value of 4.9 months at 2017-2018; and the all category increases by 39.1% from 5 months at 2007-2008 to 6.9 months at 2017-2018.

Figure HR 18. Median months to heart transplant for waitlisted adults by sex
Observations censored on December 31, 2018; 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 28.7% from 3.5 months at 2007-2008 to 4.6 months at 2017-2018; the b category increases by 57.0% from 2.8 months at 2007-2008 to 4.4 months at 2017-2018; the ab category increases by 69.3% from 0.9 months at 2007-2008 to 1.4 months at 2017-2018; and the o category increases by 30.9% from 10.3 months at 2007-2008 to 13.5 months at 2017-2018.

Figure HR 19. Median months to heart transplant for waitlisted adults by blood type
Observations censored on December 31, 2018; 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 81.8% from 1.1 months at 2007-2008 to 2 months at 2017-2018; the status 1b category increases by 140.5% from 2.9 months at 2007-2008 to 7 months at 2017-2018; and the status 2 category increases by 24.1% from 13.5 months at 2007-2008 to 16.7 months at 2017-2018.

Figure HR 20. Median months to heart transplant for waitlisted adults by medical urgency at listing
Observations censored on December 31, 2018; 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. New status codes in use as of October 18, 2018 were converted to their old status equivalents for the 2018 data point.


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 36.6% from 2.7 months at 2007-2008 to 3.7 months at 2017-2018; the 24 to 26 category increases by 23.8% from 4 months at 2007-2008 to 5 months at 2017-2018; the 27 to 30 category increases by 44.2% from 5.4 months at 2007-2008 to 7.8 months at 2017-2018; and the greater than or equal to 31 category increases by 20.5% from 9.3 months at 2007-2008 to 11.2 months at 2017-2018.

Figure HR 21. Median months to heart transplant for waitlisted adults by BMI at listing
Observations censored on December 31, 2018; 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 25.1% from 44.5 percent at 2007 to 33.3 percent at 2017; the 6 to month category decreases by 18.9% from 56.1 percent at 2007 to 45.5 percent at 2017; the 1 to year category decreases by 11.7% from 64.7 percent at 2007 to 57.2 percent at 2017; the 3 to year category is 72.1 percent at 2007 and remains relatively constant with a value of 66 percent at 2015; the 5 to year category is 73.3 percent at 2007 and remains relatively constant with a value of 68.6 percent at 2013; and the 10 to year category is 73.8 percent at 2007 and remains relatively constant with a value of 72.1 percent at 2008.

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 2017 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 2017 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 2017 by state, the values range from 25.00 to 100.00.

Figure HR 24. Percentage of adults who underwent deceased donor heart transplant within 1 year of listing in 2017 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 15.4 deaths per 100 waitlist years at 2007-2008 to 7.3 deaths per 100 waitlist years at 2017-2018; the 35 to 49 category decreases by 45.0% from 16.6 deaths per 100 waitlist years at 2007-2008 to 9.1 deaths per 100 waitlist years at 2017-2018; the 50 to 64 category decreases by 33.4% from 16.5 deaths per 100 waitlist years at 2007-2008 to 11 deaths per 100 waitlist years at 2017-2018; the greater than or equal to 65 category decreases by 16.5% from 18 deaths per 100 waitlist years at 2007-2008 to 15 deaths per 100 waitlist years at 2017-2018; and the all category decreases by 35.1% from 16.6 deaths per 100 waitlist years at 2007-2008 to 10.8 deaths per 100 waitlist years at 2017-2018.

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 25.3% from 15.1 deaths per 100 waitlist years at 2007-2008 to 11.3 deaths per 100 waitlist years at 2017-2018; the black category decreases by 56.7% from 21.3 deaths per 100 waitlist years at 2007-2008 to 9.2 deaths per 100 waitlist years at 2017-2018; the hispanic category decreases by 40.3% from 18 deaths per 100 waitlist years at 2007-2008 to 10.7 deaths per 100 waitlist years at 2017-2018; the asian category decreases by 47.9% from 22.6 deaths per 100 waitlist years at 2007-2008 to 11.8 deaths per 100 waitlist years at 2017-2018; and the other category increases by 26.2% from 19.7 deaths per 100 waitlist years at 2007-2008 to 24.9 deaths per 100 waitlist years at 2017-2018.

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 30.7% from 16.2 deaths per 100 waitlist years at 2007-2008 to 11.2 deaths per 100 waitlist years at 2017-2018; and the female category decreases by 47.0% from 17.9 deaths per 100 waitlist years at 2007-2008 to 9.5 deaths per 100 waitlist years at 2017-2018.

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 30.6% from 17 deaths per 100 waitlist years at 2007-2008 to 11.8 deaths per 100 waitlist years at 2017-2018; the cardiomyopathy category decreases by 43.7% from 16.4 deaths per 100 waitlist years at 2007-2008 to 9.2 deaths per 100 waitlist years at 2017-2018; the congential category decreases by 13.9% from 13.1 deaths per 100 waitlist years at 2007-2008 to 11.3 deaths per 100 waitlist years at 2017-2018; the valvular category is 13.4 deaths per 100 waitlist years at 2007-2008 and remains relatively constant with a value of 13.6 deaths per 100 waitlist years at 2017-2018; and the other/unknown category is 20.7 deaths per 100 waitlist years at 2007-2008 and remains relatively constant with a value of 21.4 deaths per 100 waitlist years at 2017-2018.

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 58.2% from 71.9 deaths per 100 waitlist years at 2007-2008 to 30.1 deaths per 100 waitlist years at 2017-2018; the status 1b category decreases by 73.1% from 32.5 deaths per 100 waitlist years at 2007-2008 to 8.7 deaths per 100 waitlist years at 2017-2018; the status 2 category decreases by 33.1% from 10.9 deaths per 100 waitlist years at 2007-2008 to 7.3 deaths per 100 waitlist years at 2017-2018; and the inactive category is 11 deaths per 100 waitlist years at 2007-2008 and remains relatively constant with a value of 11.2 deaths per 100 waitlist years at 2017-2018.

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 26.0% from 15 deaths per 100 waitlist years at 2007-2008 to 11.1 deaths per 100 waitlist years at 2017-2018; and the vad at listing category decreases by 73.5% from 38.3 deaths per 100 waitlist years at 2007-2008 to 10.2 deaths per 100 waitlist years at 2017-2018.

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 38.8% from 16.8 deaths per 100 waitlist years at 2007-2008 to 10.3 deaths per 100 waitlist years at 2017-2018; and the non to metropolitan category decreases by 15.5% from 16 deaths per 100 waitlist years at 2007-2008 to 13.5 deaths per 100 waitlist years at 2017-2018.

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 42.1% from 17.7 deaths per 100 waitlist years at 2007-2008 to 10.2 deaths per 100 waitlist years at 2017-2018; the 50 to less than 100 category decreases by 26.7% from 15.5 deaths per 100 waitlist years at 2007-2008 to 11.4 deaths per 100 waitlist years at 2017-2018; the 100 to less than 250 category decreases by 23.6% from 16.3 deaths per 100 waitlist years at 2007-2008 to 12.5 deaths per 100 waitlist years at 2017-2018; and the greater than or equal to 250 category decreases by 25.2% from 12.7 deaths per 100 waitlist years at 2007-2008 to 9.5 deaths per 100 waitlist years at 2017-2018.

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 line plot for pretransplant mortality rates among adults waitlisted for heart, by active/inactive status; the active category decreases by 45.7% from 19.7 deaths per 100 waitlist years at 2007-2008 to 10.7 deaths per 100 waitlist years at 2017-2018; and the inactive category is 11 deaths per 100 waitlist years at 2007-2008 and remains relatively constant with a value of 11.2 deaths per 100 waitlist years at 2017-2018.

Figure HR 33. Pretransplant mortality rates among adults waitlisted for heart, by active/inactive status
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. Status (active/inactive) is assessed on the later of January 1 of the given year and listing date.


A map of pretransplant mortality rates among adults waitlisted for heart transplant in 2017-2018, by dsa, the values range from 3.32 to 25.41.

Figure HR 34. Pretransplant mortality rates among adults waitlisted for heart transplant in 2017-2018, 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 is 18.4 percent at 2007 and remains relatively constant with a value of 16.9 percent at 2018; the status 1a category decreases by 45.3% from 57.1 percent at 2007 to 31.2 percent at 2018; the status 1b category decreases by 61.7% from 57.1 percent at 2007 to 21.9 percent at 2018; the status 2 category decreases by 60.2% from 21.3 percent at 2007 to 8.5 percent at 2018; and the inactive category is 15.1 percent at 2007 and remains relatively constant with a value of 16 percent at 2018.

Figure HR 35. 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 18 to 34 category increases by 34.6% from 14.5 percent at 2007 to 19.5 percent at 2018; the 35 to 49 category decreases by 41.1% from 24 percent at 2007 to 14.1 percent at 2018; the 50 to 64 category is 16.3 percent at 2007 and remains relatively constant with a value of 17.7 percent at 2018; and the greater than or equal to 65 category is 18.9 percent at 2007 and remains relatively constant with a value of 17.1 percent at 2018.

Figure HR 36. 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 all category increases by 52.3% from 2260 count at 2007 to 3443 count at 2018; the less than 18 category increases by 21.4% from 457 count at 2007 to 555 count at 2018; the 18 to 34 category increases by 56.9% from 1087 count at 2007 to 1706 count at 2018; the 35 to 49 category increases by 69.9% from 562 count at 2007 to 955 count at 2018; and the greater than or equal to 50 category increases by 47.4% from 154 count at 2007 to 227 count at 2018.

Figure HR 37. 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 20.3% from 20.2 percent at 2007 to 16.1 percent at 2018; the 18 to 34 category is 48.1 percent at 2007 and remains relatively constant with a value of 49.5 percent at 2018; the 35 to 49 category increases by 11.5% from 24.9 percent at 2007 to 27.7 percent at 2018; and the greater than or equal to 50 category is 6.8 percent at 2007 and remains relatively constant with a value of 6.6 percent at 2018.

Figure HR 38. 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 sex; the male category is 71.9 percent at 2007 and remains relatively constant with a value of 68.3 percent at 2018; and the female category increases by 13.1% from 28.1 percent at 2007 to 31.7 percent at 2018.

Figure HR 39. Distribution of deceased heart donors by sex
Deceased donors whose hearts were recovered for transplant.


A line plot for distribution of deceased heart donors by race; the white category is 63.1 percent at 2007 and remains relatively constant with a value of 62 percent at 2018; the black category increases by 10.4% from 15.8 percent at 2007 to 17.5 percent at 2018; the hispanic category is 18.1 percent at 2007 and remains relatively constant with a value of 17.5 percent at 2018; and the other/unknown category is 2.9 percent at 2007 and remains relatively constant with a value of 3.1 percent at 2018.

Figure HR 40. Distribution of deceased heart donors by race
Deceased donors whose hearts were recovered for transplant.


A map of percent of pediatric donor hearts allocated to adult recipients, by dsa of donor hospital, 2014-2018, the values range from 0.00 to 64.29.

Figure HR 41. Percent of pediatric donor hearts allocated to adult recipients, by DSA of donor hospital, 2014-2018
Numerator: pediatric donor hearts donors allocated to adult recipients. Denominator: total pediatric donor hearts.


A line plot for rates of hearts recovered for transplant and not transplanted by donor age; the less than 18 category is 0.4 percent at 2007-2008 and remains relatively constant with a value of 0.5 percent at 2017-2018; the 18 to 34 category increases by 56.2% from 0.5 percent at 2007-2008 to 0.7 percent at 2017-2018; the 35 to 49 category decreases by 25.7% from 1.3 percent at 2007-2008 to 1 percent at 2017-2018; the greater than or equal to 50 category decreases by 37.3% from 2.8 percent at 2007-2008 to 1.8 percent at 2017-2018; and the all category is 0.8 percent at 2007-2008 and remains relatively constant with a value of 0.8 percent at 2017-2018.

Figure HR 42. 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 33.9% from 1.6 percent at 2007-2008 to 1 percent at 2017-2018; and the not increased risk category is 0.8 percent at 2007-2008 and remains relatively constant with a value of 0.7 percent at 2017-2018.

Figure HR 43. 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 177.3% from 15 percent at 2007 to 41.6 percent at 2018; the cva/stroke category decreases by 36.1% from 20 percent at 2007 to 12.8 percent at 2018; the head trauma category decreases by 30.4% from 61.8 percent at 2007 to 43 percent at 2018; the cns tumor category decreases by 59.9% from 0.8 percent at 2007 to 0.3 percent at 2018; and the other category is 2.4 percent at 2007 and remains relatively constant with a value of 2.3 percent at 2018.

Figure HR 44. 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 43.3% from 330 transplants at 2007 to 473 transplants at 2018; the age greater than or equal to 18 category increases by 55.3% from 1910 transplants at 2007 to 2967 transplants at 2018; and the all category increases by 53.6% from 2240 transplants at 2007 to 3440 transplants at 2018.

Figure HR 45. 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 43.3% from 330 transplants at 2007 to 473 transplants at 2018; the 18 to 34 category increases by 27.5% from 244 transplants at 2007 to 311 transplants at 2018; the 35 to 49 category increases by 29.7% from 454 transplants at 2007 to 589 transplants at 2018; the 50 to 64 category increases by 45.7% from 966 transplants at 2007 to 1407 transplants at 2018; and the greater than or equal to 65 category increases by 168.3% from 246 transplants at 2007 to 660 transplants at 2018.

Figure HR 46. 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 46.4% from 1637 transplants at 2007 to 2397 transplants at 2018; and the female category increases by 73.0% from 603 transplants at 2007 to 1043 transplants at 2018.

Figure HR 47. 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 42.3% from 1512 transplants at 2007 to 2152 transplants at 2018; the black category increases by 74.1% from 428 transplants at 2007 to 745 transplants at 2018; the hispanic category increases by 70.0% from 210 transplants at 2007 to 357 transplants at 2018; the asian category increases by 109.9% from 71 transplants at 2007 to 149 transplants at 2018; and the other/unknown category increases by 94.7% from 19 transplants at 2007 to 37 transplants at 2018.

Figure HR 48. Total heart transplants by race
All heart transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for total heart transplants by diagnosis; the cad category increases by 18.1% from 795 transplants at 2007 to 939 transplants at 2018; the cardiomyopathy category increases by 72.3% from 1177 transplants at 2007 to 2028 transplants at 2018; the congenital category increases by 88.3% from 188 transplants at 2007 to 354 transplants at 2018; the valvular category decreases by 16.2% from 37 transplants at 2007 to 31 transplants at 2018; and the other/unknown category increases by 104.7% from 43 transplants at 2007 to 88 transplants at 2018.

Figure HR 49. 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 120.1% from 1108 transplants at 2007 to 2439 transplants at 2018; the status 1b category is 807 transplants at 2007 and remains relatively constant with a value of 868 transplants at 2018; and the status 2 category decreases by 59.1% from 325 transplants at 2007 to 133 transplants at 2018.

Figure HR 50. Total heart transplants by medical urgency
All heart transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients. Urgency groups for recipients who underwent transplant October 18, 2018 or later were converted to former statuses.


A line plot for induction agent use in adult heart transplant recipients; the il2 to ra category is 27.5 percent at 2007 and remains relatively constant with a value of 28.1 percent at 2018; the t to cell depleting category is 25.1 percent at 2007 and remains relatively constant with a value of 23.6 percent at 2018; and the none category is 48.6 percent at 2007 and remains relatively constant with a value of 49.2 percent at 2018.

Figure HR 51. 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 64.3% from 54.4 percent at 2007 to 89.4 percent at 2018; the tac mmf category is 6.2 percent at 2007 and remains relatively constant with a value of 6 percent at 2018; the tac steroid category decreases by 48.3% from 2.3 percent at 2007 to 1.2 percent at 2018; the other category decreases by 90.8% from 36.5 percent at 2007 to 3.4 percent at 2018; and the none reported category decreases by 100.0% from 0.5 percent at 2007 to 0 percent at 2018.

Figure HR 52. 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, 2014-2018, the 0 group is 0.10 percent; the 1 group is 0.41 percent; the 2 group is 2.52 percent; the 3 group is 10.01 percent; the 4 group is 23.66 percent; the 5 group is 34.15 percent; the 6 group is 20.72 percent; and the unk. group is 8.43 percent.

Figure HR 53. Total HLA A, B, and DR mismatches among adult deceased donor heart transplant recipients, 2014-2018
Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2018.


A line plot for annual adult heart transplant center volumes, by percentile; the 5th category increases by 100.0% from 1 transplants per center at 2007 to 2 transplants per center at 2018; the 25th category increases by 83.3% from 6 transplants per center at 2007 to 11 transplants per center at 2018; the median category increases by 58.3% from 12 transplants per center at 2007 to 19 transplants per center at 2018; the 75th category increases by 60.0% from 20 transplants per center at 2007 to 32 transplants per center at 2018; and the 95th category is 53 transplants per center at 2007 and remains relatively constant with a value of 56 transplants per center at 2018.

Figure HR 54. 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 51.9% from 8.3 percent of transplants at 2007 to 4 percent of transplants at 2018; the 10 to 29 category decreases by 28.4% from 50.2 percent of transplants at 2007 to 35.9 percent of transplants at 2018; the 30 to 59 category increases by 32.6% from 33.7 percent of transplants at 2007 to 44.6 percent of transplants at 2018; and the greater than or equal to 60 category increases by 96.1% from 7.9 percent of transplants at 2007 to 15.5 percent of transplants at 2018.

Figure HR 55. 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, 2011-2013, by age; the 18 to 34 category decreases by 22.5% from 100 percent at 0 Months post-transplant to 77.5 percent at 60 Months post-transplant; the 35 to 49 category decreases by 19.0% from 100 percent at 0 Months post-transplant to 81 percent at 60 Months post-transplant; the 50 to 64 category decreases by 19.5% from 100 percent at 0 Months post-transplant to 80.5 percent at 60 Months post-transplant; and the greater than or equal to 65 category decreases by 23.0% from 100 percent at 0 Months post-transplant to 77 percent at 60 Months post-transplant.

Figure HR 56. Patient survival among adult heart transplant recipients, 2011-2013, 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, 2011-2013, by race; the white category decreases by 19.7% from 100 percent at 0 Months post-transplant to 80.3 percent at 60 Months post-transplant; the black category decreases by 24.3% from 100 percent at 0 Months post-transplant to 75.7 percent at 60 Months post-transplant; the hispanic category decreases by 19.5% from 100 percent at 0 Months post-transplant to 80.5 percent at 60 Months post-transplant; the asian category decreases by 14.1% from 100 percent at 0 Months post-transplant to 85.9 percent at 60 Months post-transplant; and the other/unknown category decreases by 13.2% from 100 percent at 0 Months post-transplant to 86.8 percent at 60 Months post-transplant.

Figure HR 57. Patient survival among adult heart transplant recipients, 2011-2013, 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, 2011-2013, by sex; the female category decreases by 19.6% from 100 percent at 0 Months post-transplant to 80.4 percent at 60 Months post-transplant; the male category decreases by 20.6% from 100 percent at 0 Months post-transplant to 79.4 percent at 60 Months post-transplant; and the all category decreases by 20.4% from 100 percent at 0 Months post-transplant to 79.6 percent at 60 Months post-transplant.

Figure HR 58. Patient survival among adult heart transplant recipients, 2011-2013, 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, 2011-2013, 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 25.4% from 100 percent at 0 Months post-transplant to 74.6 percent at 60 Months post-transplant; and the neither category decreases by 19.6% from 100 percent at 0 Months post-transplant to 80.4 percent at 60 Months post-transplant.

Figure HR 59. Patient survival among adult heart transplant recipients, 2011-2013, 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, 2011-2013, by first vs. retransplant; the first tx category decreases by 20.4% from 100 percent at 0 Months post-transplant to 79.6 percent at 60 Months post-transplant; and the re to tx category decreases by 20.3% from 100 percent at 0 Months post-transplant to 79.7 percent at 60 Months post-transplant.

Figure HR 60. Patient survival among adult heart transplant recipients, 2011-2013, 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, 2011-2013, by medical urgency; the status 1a category decreases by 21.7% from 100 percent at 0 Months post-transplant to 78.3 percent at 60 Months post-transplant; the status 1b category decreases by 18.6% from 100 percent at 0 Months post-transplant to 81.4 percent at 60 Months post-transplant; and the status 2 category decreases by 17.1% from 100 percent at 0 Months post-transplant to 82.9 percent at 60 Months post-transplant.

Figure HR 61. Patient survival among adult heart transplant recipients, 2011-2013, 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, 2011-2013, by metropolitan vs. non-metropolitan recipient residence; the metropolitan category decreases by 20.1% from 100 percent at 0 Months post-transplant to 79.9 percent at 60 Months post-transplant; and the non to metropolitan category decreases by 21.7% from 100 percent at 0 Months post-transplant to 78.3 percent at 60 Months post-transplant.

Figure HR 62. Patient survival among adult heart transplant recipients, 2011-2013, 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, 2011-2013, by recipients

Figure HR 63. Patient survival among adult heart transplant recipients, 2011-2013, 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 39.8% from 11.6 percent at 2001 to 7 percent at 2017; the 1 to year category decreases by 38.6% from 14.6 percent at 2001 to 8.9 percent at 2017; the 3 to year category decreases by 31.2% from 21 percent at 2001 to 14.5 percent at 2015; the 5 to year category decreases by 24.2% from 27.1 percent at 2001 to 20.5 percent at 2013; and the 10 to year category decreases by 11.1% from 43 percent at 2001 to 38.2 percent at 2008.

Figure HR 64. 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, 2018.


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 3 patients (in thousands) at 2007 to 5.5 patients (in thousands) at 2018; the 18 to 49 category increases by 38.2% from 7.3 patients (in thousands) at 2007 to 10.1 patients (in thousands) at 2018; the greater than or equal to 50 category increases by 47.1% from 12.4 patients (in thousands) at 2007 to 18.2 patients (in thousands) at 2018; and the all category increases by 49.1% from 22.7 patients (in thousands) at 2007 to 33.9 patients (in thousands) at 2018.

Figure HR 65. 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, 2016-2017, the 18-34 group is 31.97 percent; the 35-49 group is 29.32 percent; the 50-64 group is 26.44 percent; the >= 65 group is 23.14 percent; and the all group is 26.96 percent.

Figure HR 66. Incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by age, 2016-2017
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 agent 2016-2017, the il2-ra group is 31.43 percent; the tcd group is 17.08 percent; and the no agents group is 29.13 percent.

Figure HR 67. Incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by induction agent 2016-2017
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, 2012-2016; 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 68. Incidence of PTLD among adult heart transplant recipients by recipient EBV status at transplant, 2012-2016
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's 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, 2016-2017; 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 69. One-year cumulative incidence of death by cause among adult heart recipients, 2016-2017
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, 2012-2013; 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 70. Five-year cumulative incidence of death by cause among adult heart recipients, 2012-2013
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 44.4% from 466 candidates at 2007 to 673 candidates at 2018; the inactive category decreases by 20.0% from 15 candidates at 2007 to 12 candidates at 2018; and the all category increases by 42.4% from 481 candidates at 2007 to 685 candidates at 2018.

Figure HR 71. 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 133.1% from 124 candidates at 2007 to 289 candidates at 2018; the inactive category decreases by 35.4% from 164 candidates at 2007 to 106 candidates at 2018; and the all category increases by 37.2% from 288 candidates at 2007 to 395 candidates at 2018.

Figure HR 72. Pediatric candidates listed for heart transplant on December 31 each year
Candidates concurrently listed at multiple centers are counted once. Those with concurrent listings and active at any program are considered active.


A line plot for distribution of pediatric candidates waiting for heart transplant by age; the less than 1 category is 25.5 percent at 2007 and remains relatively constant with a value of 26.1 percent at 2018; the 1 to 5 category increases by 10.7% from 24.3 percent at 2007 to 26.9 percent at 2018; the 6 to 10 category decreases by 15.3% from 16 percent at 2007 to 13.6 percent at 2018; and the 11 to 17 category is 34.2 percent at 2007 and remains relatively constant with a value of 33.4 percent at 2018.

Figure HR 73. 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 11.2% from 58.4 percent at 2007 to 51.8 percent at 2018; the black category increases by 14.0% from 18.1 percent at 2007 to 20.6 percent at 2018; the hispanic category is 18.1 percent at 2007 and remains relatively constant with a value of 19.6 percent at 2018; the asian category is 4.1 percent at 2007 and remains relatively constant with a value of 4.2 percent at 2018; and the other/unknown category increases by 172.3% from 1.4 percent at 2007 to 3.8 percent at 2018.

Figure HR 74. 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 34.0% from 41.6 percent at 2007 to 55.8 percent at 2018; the dilated cm: idiopathic category decreases by 22.1% from 21.3 percent at 2007 to 16.6 percent at 2018; the restrictive cm: idiopathic category decreases by 26.9% from 4.7 percent at 2007 to 3.5 percent at 2018; the dilated cm: myocarditis category decreases by 61.1% from 6 percent at 2007 to 2.3 percent at 2018; and the other/unknown category decreases by 17.0% from 26.4 percent at 2007 to 21.9 percent at 2018.

Figure HR 75. 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 54.7 percent at 2007 and remains relatively constant with a value of 57.3 percent at 2018; and the female category is 45.3 percent at 2007 and remains relatively constant with a value of 42.7 percent at 2018.

Figure HR 76. 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 71.6 percent at 2007 and remains relatively constant with a value of 75.4 percent at 2018; the 1 to less than 2 category increases by 64.7% from 7 percent at 2007 to 11.6 percent at 2018; the 2 to less than 4 category is 7.9 percent at 2007 and remains relatively constant with a value of 7.5 percent at 2018; and the greater than or equal to 4 category decreases by 58.9% from 13.4 percent at 2007 to 5.5 percent at 2018.

Figure HR 77. 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 is 57.4 percent at 2007 and remains relatively constant with a value of 61.9 percent at 2018; the status 1b category increases by 61.6% from 8.5 percent at 2007 to 13.7 percent at 2018; the status 2 category increases by 21.5% from 12.5 percent at 2007 to 15.2 percent at 2018; and the inactive category decreases by 57.6% from 21.6 percent at 2007 to 9.2 percent at 2018.

Figure HR 78. 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, 2015; the still waiting category decreases by 95.8% from 99.8 percent at 0 Months postlisting to 4.2 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 8300.0% from 0.2 percent at 0 Months postlisting to 13 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 79. Three-year outcomes for newly listed pediatric candidates waiting for heart transplant, 2015
Pediatric candidates who joined the waitlist in 2015. 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 deceased donor heart transplant rates among pediatric waitlist candidates by age; the less than 1 category decreases by 37.3% from 291.8 transplants per 100 waitlist years at 2007 to 183 transplants per 100 waitlist years at 2018; the 1 to 5 category is 88.8 transplants per 100 waitlist years at 2007 and remains relatively constant with a value of 91.2 transplants per 100 waitlist years at 2018; the 6 to 10 category increases by 28.7% from 75.1 transplants per 100 waitlist years at 2007 to 96.7 transplants per 100 waitlist years at 2018; the 11 to 17 category increases by 13.3% from 103.9 transplants per 100 waitlist years at 2007 to 117.7 transplants per 100 waitlist years at 2018; and the all category is 115.2 transplants per 100 waitlist years at 2007 and remains relatively constant with a value of 117.7 transplants per 100 waitlist years at 2018.

Figure HR 80. Deceased donor 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 118.5 transplants per 100 waitlist years at 2007 and remains relatively constant with a value of 116.3 transplants per 100 waitlist years at 2018; and the non to metropolitan category increases by 23.0% from 102.1 transplants per 100 waitlist years at 2007 to 125.6 transplants per 100 waitlist years at 2018.

Figure HR 81. 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 is 130.5 transplants per 100 waitlist years at 2007 and remains relatively constant with a value of 120.7 transplants per 100 waitlist years at 2018; the 50 to less than 100 category increases by 19.8% from 87.3 transplants per 100 waitlist years at 2007 to 104.6 transplants per 100 waitlist years at 2018; the 100 to less than 250 category is 105.5 transplants per 100 waitlist years at 2007 and remains relatively constant with a value of 110.3 transplants per 100 waitlist years at 2018; and the greater than or equal to 250 category increases by 39.4% from 118.7 transplants per 100 waitlist years at 2007 to 165.4 transplants per 100 waitlist years at 2018.

Figure HR 82. 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 42.2% from 71.2 deaths per 100 waitlist years at 2007-2008 to 41.1 deaths per 100 waitlist years at 2017-2018; the 1 to 5 category decreases by 49.4% from 28.5 deaths per 100 waitlist years at 2007-2008 to 14.4 deaths per 100 waitlist years at 2017-2018; the 6 to 10 category is 10.9 deaths per 100 waitlist years at 2007-2008 and remains relatively constant with a value of 11.1 deaths per 100 waitlist years at 2017-2018; the 11 to 17 category decreases by 33.8% from 10.7 deaths per 100 waitlist years at 2007-2008 to 7.1 deaths per 100 waitlist years at 2017-2018; and the all category decreases by 36.2% from 27.6 deaths per 100 waitlist years at 2007-2008 to 17.6 deaths per 100 waitlist years at 2017-2018.

Figure HR 83. 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 40.8% from 23.5 deaths per 100 waitlist years at 2007-2008 to 13.9 deaths per 100 waitlist years at 2017-2018; the black category decreases by 32.0% from 33.7 deaths per 100 waitlist years at 2007-2008 to 22.9 deaths per 100 waitlist years at 2017-2018; the hispanic category decreases by 42.0% from 34.7 deaths per 100 waitlist years at 2007-2008 to 20.1 deaths per 100 waitlist years at 2017-2018; and the other/unknown category decreases by 32.6% from 32.3 deaths per 100 waitlist years at 2007-2008 to 21.8 deaths per 100 waitlist years at 2017-2018.

Figure HR 84. 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 50.6% from 39.3 deaths per 100 waitlist years at 2007-2008 to 19.4 deaths per 100 waitlist years at 2017-2018; the dilated cm: idiopathic category decreases by 26.7% from 16.3 deaths per 100 waitlist years at 2007-2008 to 11.9 deaths per 100 waitlist years at 2017-2018; the restrictive cm: idiopathic category decreases by 19.0% from 17.3 deaths per 100 waitlist years at 2007-2008 to 14 deaths per 100 waitlist years at 2017-2018; the dilated cm: myocarditis category decreases by 38.1% from 17.1 deaths per 100 waitlist years at 2007-2008 to 10.6 deaths per 100 waitlist years at 2017-2018; and the other/unknown category decreases by 13.1% from 20.6 deaths per 100 waitlist years at 2007-2008 to 17.9 deaths per 100 waitlist years at 2017-2018.

Figure HR 85. 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 43.7% from 82.7 deaths per 100 waitlist years at 2007-2008 to 46.6 deaths per 100 waitlist years at 2017-2018; the status 1b category decreases by 46.4% from 21.4 deaths per 100 waitlist years at 2007-2008 to 11.4 deaths per 100 waitlist years at 2017-2018; the status 2 category decreases by 66.9% from 11.1 deaths per 100 waitlist years at 2007-2008 to 3.7 deaths per 100 waitlist years at 2017-2018; and the inactive category increases by 18.1% from 4.3 deaths per 100 waitlist years at 2007-2008 to 5.1 deaths per 100 waitlist years at 2017-2018.

Figure HR 86. Pretransplant mortality rates among pediatrics waitlisted for heart transplant by medical urgency
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. 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 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 40.3% from 28.7 deaths per 100 waitlist years at 2007-2008 to 17.1 deaths per 100 waitlist years at 2017-2018; and the non to metropolitan category is 25.1 deaths per 100 waitlist years at 2007-2008 and remains relatively constant with a value of 22.8 deaths per 100 waitlist years at 2017-2018.

Figure HR 87. 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. 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 pediatrics waitlisted for heart transplant by distance from listing center; the 0 to less than 50 nm category decreases by 43.8% from 31 deaths per 100 waitlist years at 2007-2008 to 17.4 deaths per 100 waitlist years at 2017-2018; the 50 to less than 100 category decreases by 31.9% from 22.9 deaths per 100 waitlist years at 2007-2008 to 15.6 deaths per 100 waitlist years at 2017-2018; the 100 to less than 250 category decreases by 10.8% from 20.8 deaths per 100 waitlist years at 2007-2008 to 18.6 deaths per 100 waitlist years at 2017-2018; and the greater than or equal to 250 category decreases by 30.4% from 41 deaths per 100 waitlist years at 2007-2008 to 28.5 deaths per 100 waitlist years at 2017-2018.

Figure HR 88. Pretransplant mortality rates among pediatrics waitlisted for heart transplant 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 between the zipcode centroids of the TX center and the recipient's permanent residence, measured in nautical miles (NM).


A line plot for pediatric heart transplants by recipient age; the less than 1 category increases by 36.4% from 88 transplants at 2007 to 120 transplants at 2018; the 1 to 5 category increases by 50.0% from 76 transplants at 2007 to 114 transplants at 2018; the 6 to 10 category increases by 48.9% from 45 transplants at 2007 to 67 transplants at 2018; the 11 to 17 category increases by 42.1% from 121 transplants at 2007 to 172 transplants at 2018; and the all category increases by 43.3% from 330 transplants at 2007 to 473 transplants at 2018.

Figure HR 89. 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 90. 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 recipients aged 0-17 years, and small number of adults up to age 21 years.


A line plot for pediatric heart recipients at programs that perform 5 or fewer pediatric transplants annually; the age less than 10 category decreases by 26.2% from 10.6 percent at 2007 to 7.8 percent at 2018; the age less than 15 category decreases by 39.0% from 17 percent at 2007 to 10.4 percent at 2018; and the age less than 18 category decreases by 41.0% from 23.6 percent at 2007 to 14 percent at 2018.

Figure HR 91. 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 63.3% from 22.3 percent at 2007 to 8.2 percent at 2018; the t to cell depleting category increases by 67.6% from 44.5 percent at 2007 to 74.6 percent at 2018; and the none category decreases by 49.8% from 35.1 percent at 2007 to 17.6 percent at 2018.

Figure HR 92. 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 decreases by 15.3% from 46 percent at 2007 to 39 percent at 2018; the tac mmf category increases by 315.6% from 11.4 percent at 2007 to 47.5 percent at 2018; the tac steroid category decreases by 100.0% from 2.8 percent at 2007 to 0 percent at 2018; the other category decreases by 64.7% from 38.4 percent at 2007 to 13.6 percent at 2018; and the none reported category decreases by 100.0% from 1.4 percent at 2007 to 0 percent at 2018.

Figure HR 93. 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, 2014-2018, the 0% group is 15.67 percent; the 1-19% group is 10.17 percent; the 20-79% group is 9.88 percent; the 80-100% group is 6.12 percent; and the unknown group is 4.22 percent.

Figure HR 94. Induction use by C/PRA among pediatric heart transplant recipients, 2014-2018
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, 2014-2018, the 0 group is 0.00 percent; the 1 group is 0.54 percent; the 2 group is 2.16 percent; the 3 group is 8.78 percent; the 4 group is 22.30 percent; the 5 group is 35.00 percent; the 6 group is 21.49 percent; and the unk. group is 9.73 percent.

Figure HR 95. Total HLA A, B, and DR mismatches among pediatric deceased donor heart transplant recipients, 2014-2018
Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2018.


A bar plot for incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by age, 2016-2017, the < 6 group is 15.81 percent; the 6-10 group is 17.48 percent; the 11-17 group is 23.38 percent; and the all group is 18.81 percent.

Figure HR 96. Incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by age, 2016-2017
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 bar plot for incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by induction agent 2016-2017, the il2-ra group is 24.39 percent; the tcd group is 18.47 percent; and the no agents group is 18.18 percent.

Figure HR 97. Incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by induction agent 2016-2017
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 pediatric heart transplant recipients by recipient ebv status at transplant, 2006-2016; 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 98. Incidence of PTLD among pediatric heart transplant recipients by recipient EBV status at transplant, 2006-2016
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's disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus.


A line plot for patient survival among pediatric deceased donor heart transplant recipients, 2006-2013, by age; the less than 1 category decreases by 23.1% from 100 percent at 0 Months post-transplant to 76.9 percent at 60 Months post-transplant; the 1 to 5 category decreases by 17.1% from 100 percent at 0 Months post-transplant to 82.9 percent at 60 Months post-transplant; the 6 to 10 category decreases by 12.9% from 100 percent at 0 Months post-transplant to 87.1 percent at 60 Months post-transplant; the 11 to 17 category decreases by 17.6% from 100 percent at 0 Months post-transplant to 82.4 percent at 60 Months post-transplant; and the all category decreases by 18.5% from 100 percent at 0 Months post-transplant to 81.5 percent at 60 Months post-transplant.

Figure HR 100. Patient survival among pediatric deceased donor heart transplant recipients, 2006-2013, by age
Recipient survival estimated using unadjusted Kaplan-Meier methods.


A line plot for one-year cumulative incidence of death by cause among pediatric heart recipients, 2016-2017; 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 101. One-year cumulative incidence of death by cause among pediatric heart recipients, 2016-2017
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, 2012-2013; 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 102. Five-year cumulative incidence of death by cause among pediatric heart recipients, 2012-2013
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, 2008 and December 31, 2018
Candidates waiting for transplant on December 31 of the given year, regardless of first listing date; multiple listings are collapsed. Distance is computed from candidate's home zip code to the transplant center.
Characteristic 2008, N 2008, Percent 2018, N 2018, Percent
Age: 18-34 years 267 10.8% 376 11.0%
Age: 35-49 years 564 22.9% 784 23.0%
Age: 50-64 years 1241 50.3% 1671 49.1%
Age: ≥ 65 years 394 16.0% 573 16.8%
Sex: Female 599 24.3% 825 24.2%
Sex: Male 1867 75.7% 2579 75.8%
Race/ethnicity: White 1807 73.3% 2080 61.1%
Race/ethnicity: Black 447 18.1% 903 26.5%
Race/ethnicity: Hispanic 163 6.6% 304 8.9%
Race/ethnicity: Asian 37 1.5% 93 2.7%
Race/ethnicity: Other/unknown 12 0.5% 24 0.7%
Geography: Metropolitan 1998 81.0% 2910 85.5%
Geography: Non-metro 468 19.0% 494 14.5%
Distance: < 50 miles 1388 56.3% 2114 62.1%
Distance: 50-<100 miles 437 17.7% 543 16.0%
Distance: 100-<150 miles 248 10.1% 325 9.5%
Distance: 150-<250 miles 185 7.5% 219 6.4%
Distance: ≥ 250 miles 181 7.3% 184 5.4%
Distance: Unknown 27 1.1% 19 0.6%
All candidates 2466 100.0% 3404 100.0%



Table HR 2. Clinical characteristics of adults on the heart transplant waiting list on December 31, 2008 and December 31, 2018
Candidates waiting for transplant on December 31 of the given year, regardless of first listing date; multiple listings are collapsed. VAD, ventricular assist device.
Characteristic 2008, N 2008, Percent 2018, N 2018, Percent
Diagnosis: Coronary artery disease 1033 41.9% 1034 30.4%
Diagnosis: Cardiomyopathy 1083 43.9% 1999 58.7%
Diagnosis: Congenital disease 146 5.9% 174 5.1%
Diagnosis: Valvular disease 50 2.0% 34 1.0%
Diagnosis: Other/unknown 154 6.2% 163 4.8%
Blood type: A 779 31.6% 1015 29.8%
Blood type: B 230 9.3% 369 10.8%
Blood type: AB 31 1.3% 66 1.9%
Blood type: O 1426 57.8% 1954 57.4%
VAD at listing 243 9.9% 1166 34.3%
All candidates 2466 100.0% 3404 100.0%



Table HR 3. Listing characteristics of adults on the heart transplant waiting list on December 31, 2008 and December 31, 2018
Candidates waiting for transplant on December 31 of the given year, regardless of first listing date; multiple listings are collapsed.
Characteristic 2008, N 2008, Percent 2018, N 2018, Percent
Transplant history: First 2359 95.7% 3305 97.1%
Transplant history: Retransplant 107 4.3% 99 2.9%
Wait time: < 1 year 1240 50.3% 1772 52.1%
Wait time: 1-< 2 years 417 16.9% 725 21.3%
Wait time: 2-< 3 years 216 8.8% 365 10.7%
Wait time: 3-< 4 years 110 4.5% 210 6.2%
Wait time: 4-< 5 years 89 3.6% 145 4.3%
Wait time: ≥ 5 years 394 16.0% 187 5.5%
Tx type: Heart only 2286 92.7% 3118 91.6%
Tx type: Heart-kidney 84 3.4% 206 6.1%
Tx type: Heart-lung 78 3.2% 42 1.2%
Tx type: Other 18 0.7% 38 1.1%
All candidates 2466 100.0% 3404 100.0%



Table HR 4. Status of adults on the heart waiting list on December 31, 2017 and December 31, 2018
Candidates waiting for transplant on December 31, 2017, and December 31, 2018, regardless of first listing date. Allocation by status 1-6 was implemented October 18, 2018.
Status 2017, N 2017, Percent 2018, N 2018, Percent
Former status 1A 379 10.7% 0 0.0%
Former status 1B 1555 44.0% 0 0.0%
Former status 2 795 22.5% 0 0.0%
New status 1 0 0.0% 7 0.2%
New status 2 0 0.0% 64 1.9%
New status 3 0 0.0% 207 6.1%
New status 4 0 0.0% 1627 47.8%
New status 5 0 0.0% 86 2.5%
New status 6 0 0.0% 605 17.8%
Inactive 802 22.7% 808 23.7%
All 3531 100.0% 3404 100.0%



Table HR 5. 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 2016 2017 2018
Patients at start of year 3790 3629 3522
Patients added during year 3629 3769 3883
Patients removed during year 3783 3867 4001
Patients at end of year 3636 3531 3404



Table HR 6. 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 2016 2017 2018
Deceased donor transplant 2734 2811 2940
Patient died 324 290 268
Patient refused transplant 25 27 26
Improved, transplant not needed 187 176 180
Too sick for transplant 261 290 272
Other 251 271 315



Table HR 7. Adult heart recipients on circulatory support before transplant
Patients may have more than one type of circulatory support.
Support 2013, N 2013, Percent 2018, N 2018, Percent
Any life support 1791 83.6% 2402 81.0%
Left ventricular assist device 953 44.5% 1295 43.6%
Intravenous inotropes 797 37.2% 979 33.0%
Intra-aortic balloon pump 123 5.7% 270 9.1%
Right ventricular assist device 73 3.4% 46 1.6%
Total artificial heart 55 2.6% 31 1.0%
Prostaglandins 27 1.3% 4 0.1%
Ventilator 17 0.8% 30 1.0%
Extra corporeal membrane oxygenation 15 0.7% 58 2.0%
Inhaled NO 3 0.1% 5 0.2%



Table HR 8. Demographic characteristics of adult heart transplant recipients, 2008 and 2018
Heart transplant recipients, including retransplants. Distance is computed from recipient's home zip code to the transplant center.
Characteristic 2008, N 2008, Percent 2018, N 2018, Percent
Age: 18-34 years 213 11.7% 311 10.5%
Age: 35-49 years 427 23.5% 589 19.9%
Age: 50-64 years 925 50.9% 1407 47.4%
Age: ≥ 65 years 253 13.9% 660 22.2%
Sex: Female 454 25.0% 839 28.3%
Sex: Male 1364 75.0% 2128 71.7%
Race/ethnicity: White 1248 68.6% 1906 64.2%
Race/ethnicity: Black 352 19.4% 654 22.0%
Race/ethnicity: Hispanic 149 8.2% 261 8.8%
Race/ethnicity: Asian 55 3.0% 122 4.1%
Race/ethnicity: Other/unknown 14 0.8% 24 0.8%
Insurance: Private 978 53.8% 1348 45.4%
Insurance: Medicare 548 30.1% 1120 37.7%
Insurance: Medicaid 229 12.6% 365 12.3%
Insurance: Other government 45 2.5% 97 3.3%
Insurance: Unknown 18 1.0% 37 1.2%
Geography: Metropolitan 1496 82.3% 2498 84.2%
Geography: Non-metro 322 17.7% 469 15.8%
Distance: < 50 miles 1105 60.8% 1816 61.2%
Distance: 50-<100 miles 290 16.0% 470 15.8%
Distance: 100-<150 miles 176 9.7% 273 9.2%
Distance: 150-<250 miles 131 7.2% 199 6.7%
Distance: ≥ 250 miles 105 5.8% 151 5.1%
Distance: Unknown 11 0.6% 58 2.0%
All recipients 1818 100.0% 2967 100.0%



Table HR 9. Clinical characteristics of adult heart transplant recipients, 2008 and 2018
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 2008, N 2008, Percent 2018, N 2018, Percent
Diagnosis: Coronary artery disease 735 40.4% 932 31.4%
Diagnosis: Cardiomyopathy 962 52.9% 1823 61.4%
Diagnosis: Congenital disease 51 2.8% 117 3.9%
Diagnosis: Valvular disease 41 2.3% 29 1.0%
Diagnosis: Other/unknown 29 1.6% 66 2.2%
Blood type: A 754 41.5% 1144 38.6%
Blood type: B 267 14.7% 485 16.3%
Blood type: AB 100 5.5% 144 4.9%
Blood type: O 697 38.3% 1194 40.2%
On VAD 519 28.5% 1370 46.2%
CPRA: < 1% 1146 63.0% 1339 45.1%
CPRA: 1-< 20% 314 17.3% 334 11.3%
CPRA: 20-< 80% 223 12.3% 480 16.2%
CPRA: 80-< 98% 48 2.6% 107 3.6%
CPRA: 98-100% 17 0.9% 47 1.6%
CPRA: Unknown 70 3.9% 660 22.2%
All recipients 1818 100.0% 2967 100.0%



Table HR 10. Transplant characteristics of adult heart transplant recipients, 2008 and 2018
Heart transplant recipients, including retransplants.
Characteristic 2008, N 2008, Percent 2018, N 2018, Percent
Wait time: < 31 days 615 33.8% 858 28.9%
Wait time: 31-60 days 297 16.3% 431 14.5%
Wait time: 61-90 days 171 9.4% 278 9.4%
Wait time: 3-< 6 months 331 18.2% 443 14.9%
Wait time: 6-< 12 months 231 12.7% 413 13.9%
Wait time: 1-< 2 years 115 6.3% 312 10.5%
Wait time: ≥ 2 years 58 3.2% 232 7.8%
Transplant history: First 1755 96.5% 2873 96.8%
Transplant history: Retransplant 63 3.5% 94 3.2%
Tx type: Heart only 1723 94.8% 2697 90.9%
Tx type: Heart-lung 20 1.1% 25 0.8%
Tx type: Heart-kidney 63 3.5% 202 6.8%
Tx type: Heart-liver 9 0.5% 38 1.3%
Tx type: Other 3 0.2% 5 0.2%
All recipients 1818 100.0% 2967 100.0%



Table HR 11. Status of adult heart transplant recipients, November-December 2017 and 2018
Allocation by status 1-6 was implemented October 18, 2018.
Status 2017, N 2017, Percent 2018, N 2018, Percent
Former status 1A 313 66.3% 1 0.2%
Former status 1B 146 30.9% 0 0.0%
Former status 2 13 2.8% 0 0.0%
New status 1 0 0.0% 36 7.9%
New status 2 0 0.0% 176 38.6%
New status 3 0 0.0% 130 28.5%
New status 4 0 0.0% 91 20.0%
New status 5 0 0.0% 1 0.2%
New status 6 0 0.0% 21 4.6%
All 472 100.0% 456 100.0%



Table HR 12. Adult heart donor-recipient serology matching, 2016-2018
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. CMV, cytomegalovirus; EBV, Epstein-Barr virus; HIV, human immunodeficiency virus.
Donor Recipient CMV EBV HIV
D- R- 17.5% 0.9% 97.1%
D- R+ 20.2% 6.8% 0.4%
D- R unk 0.9% 0.5% 2.2%
D+ R- 24.9% 8.8% 0.0%
D+ R+ 35.0% 77.2% 0.0%
D+ R unk 0.9% 5.5% 0.0%
D unk R- 0.3% 0.0% 0.3%
D unk R+ 0.3% 0.2% 0.0%
D unk R unk 0.0% 0.0% 0.0%



Table HR 13. Demographic characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2008 and December 31, 2018
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. Distance is computed from candidate's home zip code to the transplant center.
Characteristic 2008, N 2008, Percent 2018, N 2018, Percent
Age: < 1 year 47 18.7% 49 14.0%
Age: 1-5 years 79 31.3% 131 37.5%
Age: 6-10 years 56 22.2% 73 20.9%
Age: 11-17 years 70 27.8% 96 27.5%
Sex: Female 115 45.6% 145 41.5%
Sex: Male 137 54.4% 204 58.5%
Race/ethnicity: White 142 56.3% 191 54.7%
Race/ethnicity: Black 53 21.0% 63 18.1%
Race/ethnicity: Hispanic 51 20.2% 69 19.8%
Race/ethnicity: Asian 4 1.6% 8 2.3%
Race/ethnicity: Other/unknown 2 0.8% 18 5.2%
Geography: Metropolitan 217 86.1% 285 81.7%
Geography: Non-metro 35 13.9% 64 18.3%
Distance: < 50 miles 126 50.0% 190 54.4%
Distance: 50-<100 miles 50 19.8% 54 15.5%
Distance: 100-<150 miles 26 10.3% 43 12.3%
Distance: 150-<250 miles 23 9.1% 38 10.9%
Distance: ≥ 250 miles 23 9.1% 19 5.4%
Distance: Unknown 4 1.6% 5 1.4%
All candidates 252 100.0% 349 100.0%



Table HR 14. Clinical characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2008 and December 31, 2018
Candidates aged younger than 18 years waiting for transplant on December 31, 2008, and December 31, 2018, 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 2008, N 2008, Percent 2018, N 2018, Percent
Diagnosis: Congenital defect 121 48.0% 217 62.2%
Diagnosis: Idiopathic dilated CM 60 23.8% 44 12.6%
Diagnosis: Familial dilated CM 2 0.8% 9 2.6%
Diagnosis: Idiopathic restrictive CM 10 4.0% 9 2.6%
Diagnosis: Myocarditis 14 5.6% 8 2.3%
Diagnosis: Other/unknown 45 17.9% 62 17.8%
Blood type: A 74 29.4% 108 30.9%
Blood type: B 35 13.9% 45 12.9%
Blood type: AB 4 1.6% 9 2.6%
Blood type: O 139 55.2% 187 53.6%
Medical urgency: Status 1A 57 22.6% 96 27.5%
Medical urgency: Status 1B 20 7.9% 70 20.1%
Medical urgency: Status 2 49 19.4% 100 28.7%
Inactive status 126 50.0% 83 23.8%
VAD at listing 10 4.0% 23 6.6%
All candidates 252 100.0% 349 100.0%



Table HR 15. Listing characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2008 and December 31, 2018
Candidates aged younger than 18 years waiting for transplant on December 31, 2008, and December 31, 2018, regardless of first listing date; multiple listings are collapsed. Candidates listed as children who turned 18 before the cohort date are excluded.
Characteristic 2008, N 2008, Percent 2018, N 2018, Percent
Transplant history: First 234 92.9% 327 93.7%
Transplant history: Retransplant 18 7.1% 22 6.3%
Wait time: < 1 year 140 55.6% 237 67.9%
Wait time: 1-< 2 years 33 13.1% 51 14.6%
Wait time: 2-< 3 years 19 7.5% 29 8.3%
Wait time: 3-< 4 years 15 6.0% 12 3.4%
Wait time: 4-< 5 years 11 4.4% 9 2.6%
Wait time: ≥ 5 years 34 13.5% 11 3.2%
Tx type: Heart only 236 93.7% 341 97.7%
Tx type: Heart-kidney 1 0.4% 5 1.4%
Tx type: Heart-lung 14 5.6% 2 0.6%
Tx type: Other 1 0.4% 1 0.3%
All candidates 252 100.0% 349 100.0%



Table HR 16. 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 2016 2017 2018
Patients at start of year 369 367 384
Patients added during year 626 623 685
Patients removed during year 627 606 674
Patients at end of year 368 384 395



Table HR 17. 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 2016 2017 2018
Deceased donor transplant 460 444 486
Patient died 61 67 77
Patient refused transplant 2 0 2
Improved, transplant not needed 60 54 62
Too sick for transplant 28 28 31
Other 16 13 16



Table HR 18. Demographic characteristics of pediatric heart transplant recipients, 2006-2008 and 2016-2018
Pediatric heart transplant recipients, including retransplants. Distance is computed from recipient's home zip code to the transplant center.
Characteristic 2006-08, N 2006-08, Percent 2016-18, N 2016-18, Percent
Age: < 1 year 280 27.4% 361 26.7%
Age: 1-5 years 254 24.8% 322 23.9%
Age: 6-10 years 141 13.8% 170 12.6%
Age: 11-17 years 348 34.0% 497 36.8%
Sex: Female 457 44.7% 591 43.8%
Sex: Male 566 55.3% 759 56.2%
Race/ethnicity: White 556 54.3% 694 51.4%
Race/ethnicity: Black 219 21.4% 269 19.9%
Race/ethnicity: Hispanic 176 17.2% 285 21.1%
Race/ethnicity: Asian 51 5.0% 61 4.5%
Race/ethnicity: Other/unknown 21 2.1% 41 3.0%
Insurance: Private 529 51.7% 533 39.5%
Insurance: Medicaid 391 38.2% 688 51.0%
Insurance: Other government 70 6.8% 95 7.0%
Insurance: Unknown 33 3.2% 34 2.5%
Geography: Metropolitan 849 83.0% 1108 82.1%
Geography: Non-metro 174 17.0% 242 17.9%
Distance: < 50 miles 525 51.3% 725 53.7%
Distance: 50-<100 miles 148 14.5% 246 18.2%
Distance: 100-<150 miles 110 10.8% 129 9.6%
Distance: 150-<250 miles 98 9.6% 114 8.4%
Distance: ≥ 250 miles 119 11.6% 104 7.7%
Distance: Unknown 23 2.2% 32 2.4%
All recipients 1023 100.0% 1350 100.0%



Table HR 19. Clinical characteristics of pediatric heart transplant recipients, 2006-2008 and 2016-2018
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 2006-08, N 2006-08, Percent 2016-18, N 2016-18, Percent
Diagnosis: Congenital defect 430 42.0% 677 50.1%
Diagnosis: Idiopathic dilated CM 300 29.3% 291 21.6%
Diagnosis: Familial dilated CM 37 3.6% 77 5.7%
Diagnosis: Idiopathic restrictive CM 65 6.4% 63 4.7%
Diagnosis: Myocarditis 44 4.3% 31 2.3%
Diagnosis: Other/unknown 147 14.4% 211 15.6%
Blood type: A 372 36.4% 472 35.0%
Blood type: B 131 12.8% 193 14.3%
Blood type: AB 37 3.6% 46 3.4%
Blood type: O 483 47.2% 639 47.3%
Medical urgency: Status 1A 788 77.0% 1082 80.1%
Medical urgency: Status 1B 130 12.7% 227 16.8%
Medical urgency: Status 2 105 10.3% 41 3.0%
On VAD 134 13.1% 384 28.4%
CPRA: < 1% 597 58.4% 519 38.4%
CPRA: 1-< 20% 159 15.5% 190 14.1%
CPRA: 20-< 80% 118 11.5% 266 19.7%
CPRA: 80-< 98% 36 3.5% 71 5.3%
CPRA: 98-100% 28 2.7% 51 3.8%
CPRA: Unknown 85 8.3% 253 18.7%
All recipients 1023 100.0% 1350 100.0%



Table HR 20. Transplant characteristics of pediatric heart transplant recipients, 2006-2008 and 2016-2018
Heart transplant recipients, including retransplants.
Characteristic 2006-08, N 2006-08, Percent 2016-18, N 2016-18, Percent
Wait time: < 31 days 468 45.7% 374 27.7%
Wait time: 31-60 days 190 18.6% 234 17.3%
Wait time: 61-90 days 116 11.3% 207 15.3%
Wait time: 3-< 6 months 129 12.6% 274 20.3%
Wait time: 6-< 12 months 76 7.4% 147 10.9%
Wait time: 1-< 2 years 26 2.5% 78 5.8%
Wait time: ≥ 2 years 18 1.8% 36 2.7%
ABO: Compatible/identical 989 96.7% 1216 90.1%
ABO: Incompatible 34 3.3% 134 9.9%
Transplant history: First 958 93.6% 1300 96.3%
Transplant history: Retransplant 65 6.4% 50 3.7%
Tx type: Heart only 997 97.5% 1334 98.8%
Tx type: Heart-lung 16 1.6% 7 0.5%
Tx type: Heart-kidney 7 0.7% 7 0.5%
Tx type: Heart-liver 3 0.3% 2 0.1%
All recipients 1023 100.0% 1350 100.0%



Table HR 21. Pediatric heart recipients on circulatory support before transplant
Patients may have more than one type of circulatory support.
Support 2013, N 2013, Percent 2018, N 2018, Percent
Any life support 318 77.4% 349 73.8%
Intravenous inotropes 221 53.8% 226 47.8%
Left ventricular assist device 107 26.0% 141 29.8%
Ventilator 62 15.1% 59 12.5%
Right ventricular assist device 23 5.6% 27 5.7%
Extra corporeal membrane oxygenation 20 4.9% 16 3.4%
Prostaglandins 7 1.7% 10 2.1%
Inhaled NO 4 1.0% 8 1.7%
Intra-aortic balloon pump 3 0.7% 0 0.0%
Total artificial heart 0 0.0% 3 0.6%



Table HR 22. Pediatric heart donor-recipient serology matching, 2016-2018
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. CMV, cytomegalovirus; EBV, Epstein-Barr virus.
Donor Recipient CMV EBV
D- R- 33.8% 17.1%
D- R+ 14.9% 14.7%
D- R unk 1.1% 1.4%
D+ R- 28.1% 28.7%
D+ R+ 20.4% 36.2%
D+ R unk 0.7% 1.6%
D unk R- 0.7% 0.0%
D unk R+ 0.3% 0.3%
D unk R unk 0.0% 0.0%