Allograft Survival

1
Allograft Survival
Grafts Surviving Post-Transplant
Transplant Patient Data Source. (2000 February
16.) Richmond, VA United Network for Organ
Sharing.
2
Adult Heart Transplantation Actuarial Survival
(1982-1999)
A.
B.
1
9
8
0
-
1
9
8
6

(
n

3
,
6
8
0
)
Half-life 9.8 yearsConditional Half-life
12.1 years
1
9
8
7
-
1
9
9
1

(
n

1
4
,
9
5
1
)
1
0
0
1
9
9
2
-
1
9
9
5

(
n

1
4
,
8
0
1
)
1
9
9
6
-
1
9
9
9

(
n

1
1
,
8
4
4
)
N50,578 adults
9
0
8
0
Survival
7
0
6
0
5
0
0
6
1
2
2
4
3
6
Years Post-Transplant
Months Post-Transplant
Note Y-axes differ for visual clarity.
Annual ISHLT Heart and Lung Registry. Addison,
TX International Society for Heart Lung
Transplantation.
3
Lung Transplantation Actuarial Survival
(1982-1999)
A.
B.
1988-1991 (n1,163 Adults)
100
1992-1995 (n4,096 Adults)
1996-1999 (n4,168 Adults)
90
80
70
Survival
60
50
40
0
6
12
18
24
30
36
Years Post-Transplant
Months Post-Transplant
Note Y-axes differ for visual clarity.
Annual ISHLT Heart and Lung Registry. Addison,
TX International Society for Heart Lung
Transplantation.
4
Pathogenesis of Allograft Arteriopathy
Nonimmunologic Factors CMV infection Diabetes
Other infections Donor factors Hyperlipidemia Is
chemic injury
Immunologic Factors T-cell med iated
cytotoxicity T-cell med iated cytokine
release B-cell antibody production
Endothelial Activation Injury to endothelial
cellsInjury to allograft myocytes
Chronic Response to Injury Allograft arteriopathy
Ischemia Myocardial dysfunction
5
(No Transcript)
6
Pathogenesis of Bronchiolitis Obliterans
Nonimmunologic Factors Infection CMV
pneumonitis Ischemic injury Donor age
Immunologic Factors Humoral immunity Cell-mediat
ed immunity
Airway Ulceration Injury to bronchiolar
epithelial cells
Chronic Response to Injury Fibrosis Bronchioliti
s obliterans
Allograft Dysfunction Rapid development of COPD
7
Renal Allograft and Patient Survival in Pediatric
Recipients
A. Graft
B. Patient
LRD Graft
L
R
D

P
a
t
i
e
n
t
CAD Graft
C
A
D

P
a
t
i
e
n
t
100
100
80
98
96
60
Survival
94
40
92
20
90
0
0
1
2
3
5
7
0
1
2
3
7
5
Years Post-Transplant
Years Post-Transplant
Note Y-axes differ for visual clarity.
Stablein DM. Pediatr Transplant. 20004S105.
8
Improving One-Year Renal Allograft Survival in
Pediatric Recipients
Survival
Stablein DM. Pediatr Transplant. 20004S105.
9
Causes of Renal Allograft Failurein Pediatric
Recipients
Stablein DM. Pediatr Transplant. 20004S105.
10
Renal Allograft and Patient Survival in Adult
Recipients
CAD Graft
LRD Graft
CAD Patient
LRD Patient
100
80
60
Survival
40
20
0
0
1
3
5
Years Post-Transplant
Transplant Patient Data Source. (2000 February
16.) Richmond, VA United Network for Organ
Sharing.
11
One-Year Renal Allograft Survival in Adult
Recipients
Survival
Year of Transplant
Transplant Patient Data Source. (2000 February
16.) Richmond, VA United Network for Organ
Sharing.
12
Factors Contributing to Chronic Failure of Renal
Allografts
13
(No Transcript)
14
Patient and Graft Survival Following Primary
Liver Transplant in Pediatric and Adult
Recipients
Pediatric Patient (n4,555)
Pediatric Graft (n4,555)
Adult Patient
(n26,549)
Adult Graft
(n26,549)
100
90
80
Survival
70
60
50
40
0
1
3
7
Years Post-Transplant
Adapted from Cecka JM, Terasaki PI (eds.)
Clinical Transplants 1998. UCLA Tissue Typing
Laboratory, Los Angeles, CA.
15
(No Transcript)
16
Pediatric Patient Survival By AgeFollowing Liver
Transplant
Survival
UNOS Annual Report, 1999.
17
One-Year Liver Allograft Survival in Adult
Recipients
Survival
Years Post-Transplant
Transplant Patient Data Source. (2000 February
16.) Richmond, VA United Network for Organ
Sharing.
18
Patient Survival by Underlying Liver Disease
Following Liver Transplant
A. Pediatric
B. Adult
PBC (n2,317)
Biliary atresia (n2,019)
PSC (n2,178)
Acute fulminant hepatitis (n456)
Hepatitis C (n5,155)
?
-antitrypsin deficiency (n255)
100
Alcohol (n4,258)
100
Other metabolic (n274)
Hepatitis B (n1,368)
95
90
90
80
Survival
85
70
80
60
75
70
50
0
.5
1
4
7
10
0
.5
1
4
7
10
Years
Years
Note Y-axes differ for visual clarity.
UNOS Annual Report, 1999.
19
Cause of Late Graft Loss in Liver Transplant
Recipients
Abbasoglu O et al. Transplantation.
1997641801-7.