Kidney Kidney-Pancreas Pancreas Liver Heart Lung Intestine 521 173 118 236 206 99 16 28,953 1,014 477 10,306 3,069 2,152 78 843,318 24,175 8,083 186,642

Kidney

Kidney-Pancreas

Pancreas

Liver

Heart

Lung

Intestine

521

173

118

236

206

99

16

28,953

1,014

477

10,306

3,069

2,152

78

843,318

24,175

8,083

186,642

90,976

28,421

878

Organ Centers 2008 Total

Worldwide Transplant Directory

Clinical Transplants 2008

KIDNEY

Related donor

Deceased donor

Unrelated live donor

LIVER

HEART

PANCREAS-KIDNEY

PANCREAS

LUNG

BONE MARROW

46

41

37

39

30

27

26

22

41

University of Colorado

Royal North Shore Hosp

Univ de Sao Paulo

University of Colorado

Stanford UniversityUniv of Cincinnati College

Thomas E Starzl Inst

The Toronto Hospital

Univ Hosp, Leiden

Survyrs Hospital

Longest Surviving Transplants-2008

Clinical Transplants 2008

1991-19951996-20002001-2005

N37,32738,37742,070

T1/2

89

10

P<0.001

Deceased donor Kidney Graft Survival by Era

63

44

25

Cecka, Clinical Transplants 2008, p. 2


Age demographics of DD recipients with time

19-50

51-65

>65

<19

1991-19951996-20002001-2005

N13,99221,63130,231

T1/2

12.414.717.5


Living donor Kidney Graft Survival by Era

81

59

39


SiblingOffspring

ParentSpouse

Unrelated

Living Donor Relationships

HLA-ID1-haplo2-haplo

N4,665

25,75616,656

T1/2

26.714.815.1


HLA compatibility effect on Living donor GS

74

5857

0MM1-4MM5-6MM

N11,83241,32723,609

T1/2

11.69.68.6

HLA-ABDR

P<0.001


51

4439

Living donorDeceased donor

N2,375

71,686

Number of Liver Transplants in Adult donor

Goh, Clinical Transplants 2008, p. 20

Number of Liver Transplants in Pediatric donor


Living donorDeceased donor

N1,1458,844

Liver graft survival by MELD/PELD scores


76%

84%

70%

59%

0

25

50

75

100

Pe

rce

nt

Gra

ft S

urv

iva

l

0 2 4 6 8 10 12

Months after Transplant

1-year

0 1 2 3 4 5

Years after Transplant

5-year

p < 0.001

84

76

70

59p < 0.001

Graft survival in recipientswith Hepatocellular Carcinoma


Years after Transplantation

49%

54%

0

25

50

75

100

Per

cen

t G

raft

Su

rviv

al

0 1 2 3 4 5 0 1 2 3 4 5

HCC T2 (n = 3,457)M/P score 22-30 (n = 11,294)

HCC (n = 4,817)Other cancers (n = 1,048)

p < 0.001

62

70

p < 0.001 49

54

p<0.000110

20

30

40

50

60

70

80

90

100P

erce

nt

All

og

raft

Su

rviv

al

0 1 2 3 4 5 6 7


2000 -20081995-19991988-1994

N17,41411,73214,760

Everly, Clinical Transplants 2008, p. 38

Heart Allograft survival by transplant Era

Infant, 0-1 yr (n=1,636)

Pediatric, 1-18 yr (n=3,959)

Elderly, 65+ yr (n=3,100)

Adult, 18-65 yr (n=35,211)

10

20

30

40

50

60

70

80

90

100P

erce

nt A

llogr

aft

Sur

viva

l

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20



Heart Allograft survival by Recip AGE group


PRA<50% (n=8,273)

PRA>50% (n=9,141)

Log-rank p=NS10

20

30

40

50

60

70

80

90

100P

erce

nt

All

og

raft

Su

rviv

al

0 1 2 3 4 5Years after Transplantation

Heart Allograft survival by PRA

Patient survival for primary deceased donor PAK2004-2008

LivingDeceased

N795327

1 yr (%)97.294.3

Gruessner & Sutherland, Clinical Transplants 2008, p.52

SPKPAKPTA

N42001136

491

1 yr (%)84.978.678.9

Pancreas graft function primary deceased donor2004-2008

Gruessner & Sutherland, Clinical Transplants 2008, p.52

Number of Repeat Transplants, by Organ

1990–2007*

Source: SRTR analysis, Jan 2009

*Includes living and deceased donors

Kidney

Liver

Heart

Lung

Rao & Ojo, Clinical Transplants 2008, p.60

Unadjusted Living and Deceased Donor Graft Survival

for First and Second Kidney Transplants, 2002–2007



Unadjusted Deceased Donor Graft Survivalfor First and Second Liver Transplants,

2002–2007



Unadjusted Deceased Donor Graft Survival

for First and Second Heart Transplants, 2002–2007

Source: SRTR analysis, Jan 2009Rao & Ojo, Clinical Transplants 2008, p.65

Unadjusted Deceased Donor Graft Survivalfor First and Second Lung Transplants, 2002–

2007



Survival (95% CI) N %Live 89.3 (88.1 – 90.4) 4502

DBD 82.1 (81.3 – 82.9) 11539DCD 81.5 (78.1 – 84.4) 1281

Graft survival for kidney only transplants in the UK,

1998 to 2007

P<0.001

% G

raft

Su

rviv

al

40

50

60

70

80

90

100

Years Posttransplant0 1 2 3 4 5

Johnson, et al. Clinical Transplants 2008, p.85

Pregnancies in female transplant recipients reported to the NTPR

Organ Recipients Pregnancies Outcomes*

Kidney 834 1301 1339

Liver 143 247 251

Liver-Kidney 4 6 7

Pancreas-Kidney 43 76 78

Pancreas alone 1 4 5

Heart 48 82 83

Heart-Lung 4 4 4

Lung 17 23 25

Totals 1094 1743 1792* Includes twins and tripletsAs of January 2009 Coscia, Armenti, et al. Clinical Transplants 2008, p.89

Pregnancies fathered by male transplant recipients reported to the NTPR

Organ Recipients Fathered Pregnancies

Outcomes*

Kidney 571 850 864

Liver 60 89 94

Liver-Kidney 2 4 4

Pancreas-Kidney 33 39 40

Heart 102 139 142

Heart-Lung 1 2 2

Heart-Lung-Kidney 1 2 2

Lung 3 3 3

Totals 773 1128 1151* Includes twins and tripletsAs of Jan 2009 Coscia, Armenti, et al. Clinical Transplants 2008, p.90

DQ2

SCr

Zhu, Terasaki, et al. Clinical Transplants 2008, p.175

Ascending strength of antibodies in graft-failure patients

DQ7

DQ2

B8

DR7SCr

Donor : A11,-, B8,49, DR7,17, DQ2,7Recipient: 2,A11,B38,60, DR4,14,DQ5,8DSA: B8, DR7, DQ2, DQ7


Combined strength of antibodies in graft-failure patients


Time to de novo antibody among all patients

A B C DRB1 DRB345 DQ

PT 2 24 56 40 1 7 10 15 51 - 1 -

DN 24 33 18 40 1 12 10 15 51 - 1 -

CD52, 27/M, Tx: 5/12/08

Kaneku, Terasaki, et al. Clinical Transplants 2008, p.193

Clonal deletion with no post-tx maintenance

for 2 months

A B C DRB1 DRB345 DQ

PT 24 68 7 35 4 12 14 15 51 52 1 -

DN 24 1 51 7 12 16 13 15 51 52 1 4

CD15, 35/M, Tx: 4/16/08

Kaneku, Terasaki, et al. Clinical Transplants 2008, p.194

Clonal deletion with no post-tx maintenance

For 3.5 months

50

100

150

200

250

300

350

A3101 A3303 A3301 B5801

Rea

ctio

n st

reng

th

Single Antigen Beads Specificities

Intact antigens Dissociated antigens

73I

Heavy chainHeavy chain

β2

Pep

tide

Intactclass I antigen

Dissociatedclass I antigen

HundredsSerum 316

71 73 74A*01011 S T DA*31012 S I DA*3301 S I DA*3303 S I DB*5801 A T Y

aa & position

El-Awar, Terasaki, et al. Clinical Transplants 2008, p.206

Reactivity of anti HLA A-locus alloantibody with intact and dissociated antigens on the SA beads

20

40

60

80

100

120

140

160

180

200

B5501 B8101 B8201 B4201 B0702 B6701 B5601 B5401 B0801

Rea

ctio

n st

reng

th

Hundreds


Serum 96Intact antigens Dissociated antigens

70Q

66I

Pep

tide



Heavy chainβ

2 Heavy chain

66 70B*07021 I QB*07021 I QB*4201 I QB*5401 I QB*5502 I QB*5501 I QB*5601 I QB*67011 I QB*8101 I QB*8201 I QB*0801 I N

aa & position


Reactivity of anti HLA B-locus alloantibody with intact and dissociated antigens on the SA beads

10

20

30

40

50

CW*1701 CW*0602 CW*0403 CW*1802 CW*0702

Hundreds

Intact antigens Dissociated antigens




77N

73AP

epti

de

Heavy chain

β2

Heavy chain

Rea

ctio

n st

reng

thMI-CB 32

73 77Cw*010201 T SCw*040101 A NCw*060201 A NCw*1701 A NCw*1802 A NCw*070201 A S

aa & position


Reactivity of anti HLA C-locus alloantibody with intact and dissociated antigens on the SA beads

B*5401 Epitopes (detected number)

Distance （angstrom ）

Amino acid position Amino Acid# of aa

min max

0204PA 2 13 13 43 69 　　 PA

0205PAE 3 11 19 43 69 76 　 PAE

0302QIA 3 4 7 65 66 69 　 QIA

0303QIAQ(3) 4 4 7 65 66 69 70 QIAQ

Immunogen

Number of mismatched

pairsNumber of allo-sera

Antibody production rate (%)

Total number of epitopes

Kind of epitopes

B*5401 6 4 66.7% 6 4

Immunogenic amino acids positions for B*54 antibody production

43 65 66 69 70 76

P Q I A Q E

B*54 Immunogenic aa position for Ab.

production

Amino acid position of HLA-B*54 putative

epitopes

Putative epitopes of anti sera produced by HLA-B54 mismatched mothers

Immunogenic aa position for HLA-B*54 mismatched pair

Maruya, Terasaki, et al. Clinical Transplants 2008, p.221

Immunogen

Number of mismatched

pairsNumber of allo-sera

Antibody production

rate

Total number of epitopes

Kind of epitopes

A*2601 14 4 28.6% 11 9

A*2601 Immunogenic aa position for Ab.

production

aa position of HLA-A*2601 putative

epitopes

Putative epitopes of anti sera produced by HLA-A*2601, A*2602 mismatched mothers

Immunogenic aa position for HLA-A*2601, A*2602 mismatched pair

Immunogenic amino acids positions for A*2601 antibody production

43 62 65 66 70 73 76 77 80 90 144 145 149 163 166 167 184 207

Q R R N H T A N T D Q R T R E W A S

Maruya, Terasaki, et al. Clinical Transplants 2008, p.221

A*2601 Epitopes (detected number)

Distance （ angstrom ）

Amino acid positionAmino Acids# of

aamin max

0603QRT (3) 3 4 9 144 145 149 QRT

0607REW 3 4 6 163 166 167 REW

0202QR 2 13 13 43 62 　 QR

0304RNH 3 4 4 65 66 70 RNH

0309TAN 3 4 6 73 76 77 TAN

0310ANT 3 4 6 76 77 80 ANT

0102D 1 　　 90 　　 D

0801AS 2 7 7 184 207 　 AS

0606R 1 　　 163 　　 R

Patient 1

25/M Tx: 3/7/08

Idica, Terasaki, et al. Clinical Transplants 2008, p.231

PT 3 26 8 35 4 7 17 8 3 - 52 - 6 -DN 1 3 57 35 12 15 7 8 3 - - - 4 6

A B C DRB1 DQ DRB345 Bw

Effective removal of donor-specific HLA antibody with Bortezomib

Patient 8

30/M Tx: 6/20/08

Idica, Terasaki, et al. Clinical Transplants 2008, p.234

PT 24(9) 10 40 44(12) 7 15 4 11 1 - 52 - 4 6

DN 2 32 51(5) 40 2 7 10 12 1 3 52 - 4 6

BwA B C DRB1 DQ DRB345

Effective removal of donor-specific HLA antibody with Bortezomib

Gra

ft S

urv

iva

l (%

)Deceased Donor Transplants

0%

20%

40%

60%

80%

100%

0 2 4 6 8 10 12 14Years after Transplant

Lentine, et al. Clinical Transplants 2008, p.262

T-neg, B-neg (reference)B-pos, T-negB-not measurable, T-negT-pos, B-positiveT-positive, B-not measurableUndifferentiated-negativeUndifferentiated-positive

Living Donor Transplants

0%

20%

40%

60%

80%

100%

0 2 4 6 8 10 12 14Years after Transplant

T-neg, B-neg (reference)B-pos, T-negB-not measurable, T-negT-pos, B-positiveT-positive, B-not measurableUndifferentiated-negativeUndifferentiated-positive

Lentine, et al. Clinical Transplants 2008, p.262

Gra

ft S

urv

iva

l (%

)

5 pioneers in History of Transplantation

David H. SachsRobert A. Good Ben Cosimi

Jean-Michel Dubernard

Herman Waldmann

Documents

Kidney Kidney-Pancreas Pancreas Liver Heart Lung Intestine 521 173 118 236 206 99 16 28,953 1,014 477 10,306 3,069 2,152 78 843,318 24,175 8,083 186,642