2004 ISHLT J Heart Lung Transplant 2004; 23: 796-803 HEART TRANSPLANTATION Overall.
J Heart Lung Transplant 2009;28: 989-1049 HEART TRANSPLANTATION Pediatric Recipients ISHLT 2009.
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Transcript of J Heart Lung Transplant 2009;28: 989-1049 HEART TRANSPLANTATION Pediatric Recipients ISHLT 2009.
J Heart Lung Transplant 2009;28: 989-1049
HEART TRANSPLANTATION
Pediatric Recipients
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS (Transplants: January 1996 - June 2008)
0
100
200
300
400
500
600
700
800
900
1000
1100
1200
1300
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Recipient Age (Years)
Nu
mb
er o
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ran
spla
nts
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS
(Transplants: January 1996 - June 2008)
ISHLT
0
100
200
300
400
500
600
700
800
900
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18-25
26-30
31+
Donor Age (Years)
Nu
mb
er
of
Tra
ns
pla
nts
2009
J Heart Lung Transplant 2009;28: 989-1049
AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS
By Year of Transplant
0
50
100
150
200
250
300
350
400
450
500
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
11-17 Years
1-10 Years
<1 Year
Nu
mb
er
of
Tra
ns
pla
nts
ISHLT
NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of hearts transplanted worldwide has increased and/or decreased in recent years.
2009
J Heart Lung Transplant 2009;28: 989-1049
NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS
0
10
20
30
40
50
60
70
80
90
100
110
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Nu
mb
er
of
Ce
nte
rs R
ep
ort
ing
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS
0
10
20
30
40
50
60
70
80
90
100
110
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Other
Europe
North America
Nu
mb
er
of
Ce
nte
rs R
ep
ort
ing
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
AVERAGE CENTER VOLUMEPediatric Heart Transplants: January 1, 1997 - June 30, 2008
120
18
120
18 1490
20
40
60
80
100
120
140
1-4/yr 5-9/yr 10-19/yr
Average number of heart transplants per year
0
5
10
15
20
25
30
35
40
45
50
Number of centers 1997-2000 Number of centers 2001-June 2008
Percentage of transplants 1997-2000 Percentage of transplants 2001-June 2008
Nu
mb
er
of
ce
nte
rs
Pe
rce
nta
ge
of
tra
ns
pla
nts
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME
Pediatric Heart Transplants: January 1, 1997 - June 30, 2008
34.429.7 30.628.5 27.6
43.9
0
10
20
30
40
50
1-4 5-9 10-19
Average number of heart transplants per year
1997-2000 2001-June 2008
% o
f tr
an
sp
lan
ts
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART RE-TRANSPLANTSBy Transplant Year
Retransplants: January 1994 – December 2007
0
5
10
15
20
25
30
35
40
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Nu
mb
er o
f tr
ansp
lan
ts
Year of transplant
ISHLT 2009 Analysis is based on the age at the time of retransplant
J Heart Lung Transplant 2009;28: 989-1049
0
10
20
30
40
50
<1 month 1-<12 months 12-<36 months 36-<60 months 60+ months Not reported
% o
f R
e-T
ran
spla
nts
Time Between Previous and Current Transplant
PEDIATRIC HEART RE-TRANSPLANTSBy Intertransplant Interval
Retransplants: January 1994 - June 2008
ISHLT 2009 Analysis is based on the age at the time of retransplant
J Heart Lung Transplant 2009;28: 989-1049
40
50
60
70
80
90
100
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
Su
rrv
iva
l (%
)
<1 Year (N=41) 1-<3 Years (N=32) 3-<5 Years (N=45)5+ Years (N=126) Primary TX (N=5,019)
Comparison of survival for re-transplant groups: p = 0.0115
Time (years) since most recent transplant
KAPLAN-MEIER SURVIVAL RATES FOR PEDIATRIC HEART RETRANSPLANTS STRATIFIED BY INTER-TRANSPLANT INTERVAL
Retransplants: January 1994 - June 2007
ISHLT 2009 Analysis is based on the age at the time of retransplant
J Heart Lung Transplant 2009;28: 989-1049
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year)
0
25
50
75
100
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Myopathy Congenital
% o
f C
as
es
31%
63%
5%
1%
1/1996-6/2008
16%
79%4%
1%
Myopathy
Congenital
Other
ReTX
1988-1995
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 1-10 Years)
0
25
50
75
100
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Myopathy Congenital
% o
f C
as
es
55%
36%
3%
6%
1/1996-6/2008
52%
40%
4%
4% Myopathy
Congenital
Other
ReTX
1988-1995
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 11-17 Years)
0
25
50
75
100
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Myopathy Congenital
% o
f C
as
es
64%
24%
4%
7%
1/1996-6/2008
66%
26%
5%
3%
Myopathy
Congenital
Other
ReTX
1988-1995
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival (Transplants: 1/1982-6/2007)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years
<1 Year (N = 1,976) 1-10 Years (N = 2,788)
11-17 Years (N = 2,869) Overall (N = 7,633)
0-<1 vs. 1-10: p = 0.0007; 0-<1 vs. 11-17: p=0.4922; 1-10 vs. 11-17: p=0.0011.
Half-life <1: 18.4 Years; 1-10: 14.7 Years; 11-17: 11.1 Years
Su
rviv
al (
%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATIONConditional Kaplan-Meier Survival
(Transplants: 1/1982-6/2007)
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years
<1 Year (N = 1,373) 1-10 Years (N = 2,163)11-17 Years (N =2,289) Overall (N = 5,825)
0-<1 vs. 1-10: p = 0.0044; 0-<1 vs. 11-17: p < 0.0001;1-10 vs. 11-17: p < 0.0001.
Half-life: <1: n.c.; 1-10: 18.5 Years; 11-17: 14.7 Years
Su
rviv
al (
%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATIONConditional Kaplan-Meier Survival for Recent Era
(Transplants: 1/1999-6/2007)
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
<1 Year (N = 606) 1-10 Years (N =1,033)
11-17 Years (N = 1,062) Overall (N = 2,701)
0-<1 vs. 1-10: p = 0.1610;0-<1 vs. 11-17: p = 0.0014; 1-10 vs. 11-17: p < 0.0001
Su
rviv
al (
%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Era
(Transplants: 1/1982-6/2007)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years
1982-1989 (N=855) 1990-1994 (N=1,861)
1995-1999 (N=1,877) 2000-6/2007 (N=3,040)
All p-values significant at p = 0.01 except comparison of 1995-1999 vs. 2000-6/2007
Half-life 1982-1989: 10.0 years; 1990-1994: 12.4 years; 1995-1999: n.c.; 2000-6/2007: n.c.
Su
rviv
al (
%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2007)
Age: < 1 Year
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Years
1982-1989 (N=177) 1990-1994 (N=584)
1995-1999 (N=494) 2000-6/2007 (N =721)
P-values for era comparisonsAll p-values significant at p < 0.0001 except comparison of 82-89 vs. 90-94 and 95-99 vs. 00-6/07
Half-life 1982-1989: 12.0 years; 1990-1994: 11.4 years; 1995-1999: n.c. ; 2000-6/2007: n.c.S
urv
iva
l (%
)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Era (Transplants: 1/1982-6/2007)
Age: 1-10 Years
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Years
1982-1989 (N = 266) 1990-1994 (N=657)
1995-1999 (N=720) 2000-6/2007 (N=1,145)
P-values for era comparisonsAll p-values significant at p = 0.01
Half-life 1982-1989: 10.8; 1990-1994: 13.3; 1995-1999: . ; 2000-6/2007: n.a.
Su
rviv
al (
%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Era (Transplants: 1/1982-6/2007)
Age: 11-17 Years
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years
1982-1989 (N=412) 1990-1994 (N=620)
1995-1999 (N=663) 2000-6/2007 (N=1,174)
P-values for era comparisonsNo p-values significant at p = 0.05 except 82-89 vs. 90-94: p = 0.0250; 82-89 vs. 88-6/07: p < 0.0001;
Half-life 1982-1989: 9.9; 1990-1994: 12.1; 1995-1999: 10.1; 2000-6/2007: n.a.
Su
rviv
al (
%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f T
ran
spla
nts
1-4/year 5-9/year 10-19/year
PEDIATRIC HEART TRANSPLANTS: AVERAGE CENTER VOLUME DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2008
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f T
ran
spla
nts
<1 years 1-10 years 11-17 years
PEDIATRIC HEART TRANSPLANTS:AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2008
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f T
ran
sp
lan
ts
Other
Re-TX/GraftFailure
Malignancy
Coronary ArteryDisease
Congenital
Cardiomyopathy
PEDIATRIC HEART TRANSPLANTS:DIAGNOSIS DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2008
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f D
on
ors
<1 1-10 11-17 18-34 35-49 50-64
PEDIATRIC HEART TRANSPLANTS:DONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2008
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007)
Risk Factors For 1 Year Mortality
N=3,756
VARIABLE N Relative
Risk P-value
95% Confidence Interval
Congenital diagnosis, age = 0, on ECMO 74 2.70 0.0003 1.57 -4.63
Congenital diagnosis, age > 0 893 2.17 <0.0001 1.67 -2.83
Retransplant 225 2.09 0.0002 1.42 -3.07
On ventilator 706 1.80 <0.0001 1.45 -2.23
On dialysis 91 1.62 0.021 1.08 -2.43
Year of Transplant: 1995-96 vs. 2001-2002 506 1.55 0.0049 1.14 -2.09
PRA > 10% 344 1.37 0.0228 1.04 -1.79
Infection requiring IV drug therapy (with 2wk/TX) 565 1.29 0.0267 1.03 -1.62
Donor cause of death = anoxia vs. head trauma 863 0.80 0.0468 0.64 -1.00
Not ABO identical 843 0.79 0.0384 0.63 -0.99
Diagnosis other than congenital, no ECMO, age = 0 295 0.46 0.0042 0.27 -0.78
ISHLT
Reference diagnosis = cardiomyopathy2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007)
Borderline Significant Risk Factors For 1 Year Mortality
N=3,756
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Donor cause of death = cerebrovascular/ stroke vs head trauma
383 1.29 0.0779 0.97 -1.72
Female recipient 1657 1.19 0.0602 0.99 -1.42
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Recipient age Recipient height
Donor age Donor height
Creatinine Ischemia time (borderline)
Pediatric transplant volume
ISHLT
N=3,756
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality
Recipient Age
0
0.5
1
1.5
2
2.5
3
0 3 6 9 12 15 18
Recipient Age (Years)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.023
ISHLT N=3,756
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality
Donor Age
0
0.5
1
1.5
2
2.5
3
0 5 10 15 20 25 30 35 40
Donor Age (Years)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.015
ISHLT N=3,756
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality
Pre-Transplant Creatinine
0
0.5
1
1.5
2
2.5
3
0 0.5 1 1.5 2 2.5
Recipient serum creatinine (mg/dl)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.023
ISHLT N=3,756
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality
Center Volume for Pediatric Transplants
0
0.5
1
1.5
2
2.5
0 2 4 6 8 10 12 14 16 18 20
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.042
ISHLT N=3,756
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality
Recipient Height
0
0.5
1
1.5
2
2.5
3
3.5
4
55 65 75 85 95 105 115 125 135 145 155 165 175
Height (cm)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.00013
ISHLT N=3,756
2009
NOTE: The impact of height should be considered in the context of age and diagnosis+age.
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality
Donor Height
0
0.5
1
1.5
2
2.5
3
55 65 75 85 95 105 115 125 135 145 155 165 175
Height (cm)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.047
ISHLT N=3,756
2009
NOTE: The impact of height should be considered in the context of age.
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality
Ischemia Time
0
0.5
1
1.5
2
2.5
2 3 4 5 6
Ischemia time (hours)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.080
ISHLT N=3,756
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Factors Not Significant for 1 Year Mortality
Recipient Factors:IV inotropes, sternotomy, history of malignancy, hospitalized, diabetes
Donor Factors:Gender, clinical infection, history of diabetes
Transplant Factors:CMV mismatch, HLA mismatch
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007)
Age = <1 YearsRisk Factors For 1 Year Mortality
N=1,014
VARIABLE N
Relative Risk
P-value 95% Confidence Interval
ECMO (diagnosis = congenital) 74 3.31 <0.0001 2.13 -5.15
On dialysis 23 2.24 0.01 1.21 -4.14
Year of Transplant: 1997-98 vs. 2001-2002 170 2.16 0.0072 1.23 -3.79
Year of Transplant: 1995-96 vs. 2001-2002 115 2.15 0.0105 1.20 -3.85
On ventilator 343 1.72 0.0011 1.24 -2.38
Donor cause of death = cerebrovascular/stroke vs. head trauma
54 1.71 0.0399 1.03 -2.86
Infection requiring IV drug therapy (with 2wk/TX) 260 1.40 0.0377 1.02 -1.93
Donor clinical infection 163 0.63 0.0378 0.41 -0.97
Diagnosis = cardiomyopathy 285 0.53 0.0109 0.33 -0.86
ISHLT
Reference diagnosis = congenital without PGE or ECMO2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007)
Age = <1 YearsBorderline Significant Risk Factors For 1 Year Mortality
N=1,014
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Ventricular assist device (excluding patients on ECMO)
23 2.23 0.0858 0.89 -5.55
PRA > 10% 76 1.62 0.0738 0.95 -2.76
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007)
Age = <1 Years Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Creatinine Recipient height
Pediatric transplant volume
ISHLT
N=1,014
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality in Age = <1 Years
Pre-Transplant Creatinine
0
0.5
1
1.5
2
2.5
0 0.2 0.4 0.6 0.8 1
Recipient serum creatinine (mg/dl)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.019
ISHLT N=1,014
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality in Age = <1 Years
Center Volume for Pediatric Transplants
0
0.5
1
1.5
2
0 2 4 6 8 10 12 14 16 18 20
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0097
ISHLT N=1,014
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality in Age = <1 Years
Recipient Height
0
0.5
1
1.5
2
2.5
3
45 50 55 60 65 70 75
Height (cm)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.019
ISHLT N=1,014
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007)
Age = 1-10 YearsRisk Factors For 1 Year Mortality
N=1,412
VARIABLE N Relative
Risk P-value
95% Confidence Interval
Diagnosis = congenital 546 2.13 <0.0001 1.51 -3.01
Diagnosis = retransplant 101 2.02 0.0334 1.06 -3.86
Transfusions prior to transplant 349 1.65 0.0057 1.16 -2.36
Not ABO identical 299 0.62 0.0253 0.40 -0.94
Donor cause of death = anoxia vs. head trauma 318 0.61 0.0213 0.41 -0.93
ISHLT
Reference diagnosis = cardiomyopathy2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007)
Age = 1-10 YearsBorderline Significant Risk Factors For 1 Year Mortality
N=1,412
VARIABLE N Relative
Risk P-value
95% Confidence Interval
Female recipient 717 1.35 0.0626 0.98 -1.84
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007)
Age = 1-10 Years Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Creatinine Donor height
BSA ratio Bilirubin (borderline)
ISHLT
N=1,412
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality in Age = 1-10 Years
Pre-Transplant Creatinine
0
0.5
1
1.5
2
2.5
0 0.2 0.4 0.6 0.8 1 1.2
Recipient serum creatinine (mg/dl)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.032
ISHLT N=1,412
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality in Age = 1-10 Years
BSA Ratio
0
0.5
1
1.5
2
2.5
3
0.8 1 1.2 1.4 1.6 1.8
Donor BSA/Recipient BSA
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0014
ISHLT N=1,412
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality in Age = 1-10 Years
Donor Height
0
0.5
1
1.5
2
70 80 90 100 110 120 130 140 150 160
Height (cm)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT N=1,412
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality in Age = 1-10 Years
Recipient Bilirubin
0
0.5
1
1.5
2
0 0.5 1 1.5 2 2.5 3 3.5
Bilirubin (mg/dL)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.076
ISHLT N=1,412
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007)
Age = 11-17 YearsRisk Factors For 1 Year Mortality
N=1,330
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Diagnosis = retransplant 116 2.37 0.001 1.42 -3.96
Diagnosis = congenital 347 2.32 <0.0001 1.61 -3.35
ECMO 45 2.28 0.0159 1.17 -4.45
On ventilator 123 2.04 0.0051 1.24 -3.37
ISHLT
Reference diagnosis = cardiomyopathy2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007)
Age = 11-17 YearsBorderline Significant Risk Factors For 1 Year Mortality
N=1,330
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
On dialysis 42 1.83 0.0884 0.91 -3.66
PRA > 10% 115 1.50 0.0932 0.93 -2.42
HLA mismatches at DR locus (per increasing mismatch, compared to 0 mismatches)
0 MM: N = 45 1 MM: N = 530 2 MM: N = 755
0.76 0.0542 0.57 -1.01
Transplant Year: 2003-04 vs. 2001-02 239 0.59 0.0822 0.33 -1.07
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007)
Age = 11-17 Years Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Donor Age
ISHLT
N=1,330
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality in Age = 11-17 Years
Donor Age
0
0.5
1
1.5
2
2.5
10 15 20 25 30 35 40
Donor age (years)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.011
ISHLT N=1,330
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003)
Risk Factors For 5 Year Mortality
N=2,364
VARIABLE N Relative
Risk P-value
95% Confidence Interval
Congenital diagnosis, age = 0, on ECMO 36 2.12 0.0072 1.23 -3.67
Retransplant, age > 0 131 1.86 0.0002 1.34 -2.59
On dialysis 49 1.59 0.0337 1.04 -2.43
PRA > 10% 240 1.45 0.0019 1.15 -1.83
Congenital diagnosis, age > 0 586 1.38 0.0039 1.11 -1.71
On ventilator 445 1.30 0.0169 1.05 -1.61
Female recipient 1006 1.25 0.0081 1.06 -1.47
Diagnosis other than congenital, no ECMO, age = 0 185 0.53 0.005 0.34 -0.83
ISHLT
Reference diagnosis = cardiomyopathy2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003)
Borderline Significant Risk Factors For 5 Year Mortality
N=2,364
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Cerebrovascular event prior to transplant 67 1.44 0.0698 0.97 -2.14
Not ABO identical 526 0.84 0.0757 0.69 -1.02
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality
Continuous Factors (see figures)
Recipient age Recipient height (borderline)
Donor age Bilirubin (borderline)
Pediatric transplant volume
ISHLT
N=2,364
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality
Recipient Age
0
0.5
1
1.5
2
2.5
3
0 3 6 9 12 15 18
Recipient Age (Years)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT N=2,364
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality
Donor Age
0
0.5
1
1.5
2
2.5
3
0 5 10 15 20 25 30 35 40
Donor Age (Years)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.023
ISHLT N=2,364
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality
Pre-Transplant Bilirubin
0
0.5
1
1.5
2
2.5
3
0 0.5 1 1.5 2 2.5 3 3.5
Recipient bilirubin (mg/dl)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.085
ISHLT N=2,364
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality
Center Volume for Pediatric Transplants
0
0.5
1
1.5
2
2.5
0 2 4 6 8 10 12 14 16 18 20
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0078
ISHLT N=2,364
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality
Recipient Height
0
0.5
1
1.5
2
2.5
3
55 65 75 85 95 105 115 125 135 145 155 165 175
Height (cm)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.054
ISHLT N=2,364
2009
NOTE: The impact of height should be considered in the context of age and diagnosis+age.
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998)
Risk Factors For 10 Year Mortality
N=915
VARIABLE N Relative
Risk P-
value 95% Confidence
Interval
Diagnosis = congenital 447 2.24 0.0001 1.49 -3.37
On ventilator 144 1.78 0.0068 1.17 -2.71
Female donor 394 1.54 0.009 1.11 -2.14
Transplant year: 1997-98 vs 1995-96 409 0.71 0.0449 0.50 -0.99
ISHLT
Reference diagnosis = cardiomyopathy
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998)
Borderline Significant Risk Factors For 10 Year Mortality
N=915
VARIABLE N Relative
Risk P-value 95% Confidence
Interval
Diagnosis = retransplant 45 2.12 0.0708 0.94 -4.80
Age = 0 years* 289 0.61 0.0794 0.35 -1.06
* Effect should be considered in the context of continuous recipient age and height (see subsequent slides)
ISHLT
Reference diagnosis = cardiomyopathy
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 10 Year Mortality
Continuous Factors (see figures)
Creatinine (borderline) Recipient age
Pediatric transplant volume (borderline)
Recipient weight
ISHLT
N=9152009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality
Recipient Age
0
0.5
1
1.5
2
2.5
3
3.5
0 2 4 6 8 10 12 14 16 18
Age (Years)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
p = 0.011
ISHLT
N=6972009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality
Recipient Weight
0
0.5
1
1.5
2
2.5
3
3.5
4
0 10 20 30 40 50 60 70 80
Recipient weight (kg)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
p < 0.0001
ISHLT N=915
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality
Center Volume for Pediatric Transplants
0
0.5
1
1.5
2
0 2 4 6 8 10 12 14 16 18 20
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
p = 0.071
ISHLT
N=9152009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality
Pre-Transplant Creatinine
0
0.5
1
1.5
2
2.5
0 0.5 1 1.5 2
Creatinine (mg/dl)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
p = 0.085
ISHLT
N=9152009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Factors Not Significant for 10 Year Mortality
Recipient Factors:PRA, diabetes, repeat transplant, transfusions, hospitalized, gender, PGE, VAD, bilirubin
Donor Factors:Cause of death, weight, height, age, clinical infection
Transplant Factors:Ischemia time, HLA mismatch, CMV mismatch
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (7/1996-6/2003)
Risk Factors for the Development of CAV within 5 Years
N=1,391
VARIABLE N Relative
Risk P-
value 95% Confidence
Interval
Diagnosis = retransplant 90 2.26 0.003 1.32 -3.89
Number of mismatches at the A locus 0 A MM (N=72) 1 A MM (N=572) 2 A MM (N=747)
1.32 0.0422 1.01 -1.72
ISHLT
Reference diagnosis = cardiomyopathy
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (7/1996-6/2003)
Borderline Significant Risk Factors for the Development of CAV within 5 Years
N=1,391
VARIABLE N Relative
Risk P-value 95% Confidence
Interval
Induction with IL2R-antagonist 91 1.69 0.0582 0.98 -2.91
Diagnosis = congenital 580 1.37 0.0855 0.96 -1.95
Female donor 561 0.74 0.0649 0.53 -1.02
On ventilator 234 0.60 0.0531 0.36 -1.01
Neither AZA or MMF for discharge maintenance immunosuppression
188 0.55 0.0535 0.30 -1.01
ISHLT
Reference diagnosis = cardiomyopathy
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (7/1996-6/2003) Risk Factors for the Development of CAV within 5 Years
Continuous Factors (see figures)
Donor age Bilirubin
Total transplant volume
ISHLT
N=1,3912009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (7/1996-6/2003) Risk Factors for the Development of CAV within 5 Years
Donor Age
0
1
2
3
4
5
0 5 10 15 20 25 30 35 40
Donor Age (Years)
Re
lati
ve
Ris
k o
f C
AV
wit
hin
5 Y
ea
rs
p < 0.0001
ISHLT
N=6972009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (7/1996-6/2003) Risk Factors for the Development of CAV within 5 Years
Center Volume of All Age Transplants
0
0.5
1
1.5
2
0 5 10 15 20 25 30 35 40
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f C
AV
wit
hin
5 Y
ea
rs
p = 0.018
ISHLT
N=1,3912009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTS (7/1996-6/2003) Risk Factors for the Development of CAV within 5 Years
Pre-Transplant Bilirubin
0
0.5
1
1.5
2
2.5
0 0.5 1 1.5 2
Bilirubin (mg/dl)
Re
lati
ve
Ris
k o
f C
AV
wit
hin
5 Y
ea
rs
p = 0.034
ISHLT
N=1,3912009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: April 1994 - June 2008)
0%
20%
40%
60%
80%
100%
1 Year (N = 2,146) 5 Year (N = 1,418) 10 Year (N = 557)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: April 1994 - June 2008)For the Same Patients
0%
20%
40%
60%
80%
100%
1 Year (N = 758) 3 Year (N = 758) 5 Year (N = 758)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: April 1994 - June 2008)Age: <1 Year
0%
20%
40%
60%
80%
100%
1 Year (N = 546) 3 Year (N = 474) 5 Year (N = 211)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: April 1994 - June 2008)Age: 1-10 Years
0%
20%
40%
60%
80%
100%
1 Year (N = 820) 3 Year (N = 517) 5 Year (N = 178)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: April 1994 - June 2008)Age: 11-17 Years
0%
20%
40%
60%
80%
100%
1 Year (N = 780) 3 Year (N = 427) 5 Year (N = 168)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2008)
0%
20%
40%
60%
80%
100%
1 Year (N = 3,431) 5 Years (N =2,143) 10 Years (N = 944)
No Hospitalization Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection Hospitalized, Infection Only
Hospitalized, Rejection + Infection
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
0
10
20
30
40
50
Any Induction (N =1,237)
Polyclonal ALG/ATG (N = 818)
OKT3 (N = 48) IL2R-antagonist (N =407)
PEDIATRIC HEART RECIPIENTS Induction Immunosuppression
(Transplants: January 2001 - June 2008)
% o
f P
atie
nts
ISHLT
Analysis is limited to patients who were alive at the time of the follow-up2009
J Heart Lung Transplant 2009;28: 989-1049
0
10
20
30
40
50
60
70
Any Induction Polyclonal ALG/ATG IL2R-antagonist
% o
f P
ati
en
ts
20012002200320042005200620072008
PEDIATRIC HEART RECIPIENTSInduction Immunosuppression (Transplants: January 2001 - June 2008)
ISHLT
Test of increasing trend over time:Any induction p < 0.0001Polyclonal p < 0.0001IL2 p < 0.0001Analysis is limited to patients who were alive at the time of the follow-up
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group
(Transplants: January 2000 – June 2007) Conditional on Survival to 14 Days
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
No induction (N = 1,150)
Polyclonal induction (N = 763)
IL2R-antagonist (N = 313)
No comparisons were statistically significant.
Su
rviv
al
(%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group and Treated Rejection Between
Transplant Discharge and 1-Year Follow-up (1-Year Follow-ups: July 2004 - June 2007)
Conditional on Survival to 1 Year
50
60
70
80
90
100
0 1 2 3
Years
No induction/No rejection (N = 242)
Polyclonal induction/No rejection (N = 183)
IL2R-antagonist/No rejection (N = 66)
No induction/Treated Rejection (N = 86)
Polyclonal induction/Treated Rejection (N = 77)
IL2R-antagonist/Treated Rejection (N = 38)
Su
rviv
al (
%)
No pair-wise comparisons of survival by induction were statistically significant within either rejection grouping
ISHLT
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.
No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2007)
Conditional on Survival to 14 DaysAge: < 1 Year
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
No induction (N = 237)Polyclonal induction (N = 271)IL2R-antagonist (N = 41)
No comparisons were statistically significant.
Su
rviv
al (
%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2007)
Conditional on Survival to 14 DaysAge: 1-10 Years
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
No induction (N = 465)Polyclonal induction (N = 260)IL2R-antagonist (N = 122)
No comparisons were statistically significant.
Su
rviv
al (
%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2007)
Conditional on Survival to 14 DaysAge: 11-17 Years
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
No induction (N = 448)
Polyclonal induction (N = 232)
IL2R-antagonist (N = 150)
No comparisons were statistically significant.
Su
rviv
al (
%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
Year 1 (N = 1,946) Year 5 (N = 1,293)
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2001 - June 2008)
NOTE: Different patients are analyzed in Year 1 and Year 5
% o
f P
atie
nts
ISHLT
Analysis is limited to patients who were alive at the time of the follow-up2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
for Same Patients at Each Time Point(Follow-ups: January 2001 - June 2008)
% o
f P
atie
nts
ISHLT
0%
20%
40%
60%
80%
100%
Year 1 (N = 631) Year 5 (N = 631)
None
Other
Tacrolimus
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine
Cyclosporine + MMF
Cyclosporine + AZA
Analysis is limited to patients who were alive at the time of the follow-up2009
0%
20%
40%
60%
80%
100%
Year 1 (N = 1,946) Year 5 (N = 1,293)
None
Other
Tacrolimus
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine
Cyclosporine + MMF
Cyclosporine + AZA
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
(Follow-ups: January 2001 - June 2008)
NOTE: Different patients are analyzed in Year 1 and Year 5
% o
f P
atie
nts
ISHLT
Analysis is limited to patients who were alive at the time of the follow-up
2009J Heart Lung Transplant 2009;28: 989-1049
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Prednisone Use
Conditional on Survival to 1 Year (Transplants: April 1994 - June 2007)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
Prednisone use at discharge and 1 year (N = 1,970)
No Prednisone at discharge or at 1 year (N = 435)
Prednisone at discharge/not at 1 year (N = 388)
p < 0.0001
Su
rviv
al (
%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Prednisone Use for a Recent Era
Conditional on Survival to 1 Year (Transplants: January 1998 – June 2007)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
Prednisone use at discharge and 1 year (N = 1,506)
No Prednisone at discharge or at 1 year (N = 315)
Prednisone at discharge/not at 1 year (N = 304)
p = 0.0289
Su
rviv
al (
%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use at Discharge
(Transplants: January 1998 - June 2007) Conditional on Survival to 14 Days
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
Tacrolimus use at discharge (N = 1,218)
Cyclosporine use at discharge (N = 1,428)
p = 0.0454
Su
rviv
al (
%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use
Conditional on Survival to 1 Year (Transplants: January 1998 - June 2007)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
Cyclosporine use at discharge and 1 year (N = 845)
Tacrolimus use at discharge and 1 year (N = 891)
Cyclosporine use at discharge/Tacrolimus at 1 year (N = 109)
Tacrolimus use at discharge/Cyclosporine at 1 year (N = 20)
p = 0.0015
Su
rviv
al (
%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Treated Rejection within 1st Year
Conditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2007)
50
60
70
80
90
100
0 1 2 3
Years
Free from Rejection during 1 year (N = 347)Treated Rejection within 1st Year (N = 190)
p = 0.2875
Su
rviv
al (
%)
ISHLT
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.
No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Treated Rejection within 1st Year
Stratified by Calcineurin Use at Discharge Conditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2007)
50
60
70
80
90
100
0 1 2 3
Years
CyA: Free from Rejection during 1 year (N = 103)
CyA: Treated Rejection within 1st Year (N = 73)
TAC: Free from Rejection during 1 year (N = 218)
TAC: Treated Rejection within 1st Year (N = 95)
Free from Rejection: CyA vs. TAC p = 0.1253Treated Rejection: CyA vs. TAC p = 0..4397 CyA: Rejection vs. no rejection p = 0.3024TAC: Rejection vs. no rejection p = 0.4076
Su
rviv
al (
%)
ISHLT
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.
No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Treated Rejection within 1st Year
Stratified by Calcineurin Use at Discharge: Age = 0-10 Years Conditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2007)
50
60
70
80
90
100
0 1 2 3
Years
CyA: Free from Rejection during 1 year (N = 72)
CyA: Treated Rejection within 1st Year (N = 53)
TAC: Free from Rejection during 1 year (N = 131)
TAC: Treated Rejection within 1st Year (N = 52)
Free from Rejection: CyA vs. TAC p = 0.5082Rejection: CyA vs. TAC p = 0.8950 CyA: Rejection vs. no rejection p = 0.5133TAC: Rejection vs. no rejection p = 0.5413
Su
rviv
al (
%)
ISHLT
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.
No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Treated Rejection within 1st Year
Stratified by Calcineurin Use at Discharge: Age = 11-17 Years Conditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2007)
50
60
70
80
90
100
0 1 2 3
Years
CyA: Free from Rejection during 1st Year (N = 31)
CyA: Treated Rejection within 1st Year (N =20)
TAC: Free from Rejection during 1st Year (N = 87)
TAC: Treated Rejection within 1st Year (N = 43)
Free from Rejection: CyA vs. TAC p = 0.0746Rejection: CyA vs. TAC p = 0.3449 CyA: Rejection vs. no rejection p = 0.2482TAC: Rejection vs. no rejection p = 0.5380
Su
rviv
al (
%)
ISHLT
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.
No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
2009
J Heart Lung Transplant 2009;28: 989-1049
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION BETWEEN TRANSPLANT
DISCHARGE AND 1-YEAR FOLLOW-UP Stratified by Induction (Follow-ups: July 2004 - June 2008)
0
10
20
30
40
50
60
70No induction Used, Treatment No induction Used, No Treatment
Induction Used (no OKT3), Treatment Induction Used (no OKT3), No Treatment
% e
xper
ien
cin
g a
cute
rej
ecti
on
wit
hin
1 y
ear
Overall: p = 0.042
ISHLT
Overall < 1 1-10 10-17 Female Male
Analysis is limited to patients who were alive at the time of the follow-up
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.
No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
2009
J Heart Lung Transplant 2009;28: 989-1049
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION BETWEEN TRANSPLANT DISCHARGE
AND 1-YEAR FOLLOW-UP Stratified by Type of Induction (Follow-ups: July 2004 - June 2008)
0
10
20
30
40
50
60
70 No induction, Treatment No induction, No TreatmentPolyclonal, Treatment Polyclonal, No TreatmentIL2R-antagonist, Treatment IL2R-antagonist, No Treatment
% e
xper
ien
cin
g a
cute
rej
ecti
on
wit
hin
1 y
ear
Overall: No induct vs. IL2R (p=0.024); 11-17: No induction vs. IL2R (p=0.021)
ISHLT
Overall < 1 1-10 10-17 Female Male
Analysis is limited to patients who were alive at the time of the follow-up
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.
No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
2009
J Heart Lung Transplant 2009;28: 989-1049
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION BETWEEN TRANSPLANT DISCHARGE
AND 1-YEAR FOLLOW-UP Stratified by Maintenance Immunosuppression and Induction (Follow-ups: July 2004 - June 2008)
0
10
20
30
40
50
60
70CyA + No induction, Treatment CyA + No induction, No TreatmentCyA + Induction (no OKT3), Treatment CyA + Induction (no OKT3), No TreatmentTAC + No induction, Treatment TAC + No induction, No TreatmentTAC + Induction (no OKT3), Treatment TAC + Induction (no OKT3), No Treatment
% e
xper
ien
cin
g a
cute
rej
ecti
on
wit
hin
1 y
ear
Overall: all comparisons were statistically significant at 0.05 except CyA + no induction vs. CyA + induction and TAC + no induction vs. TAC + induction<1 year: CyA + no induction vs. TAC + no induction ( p=0.016); 1-10 years: all comparisons were statistically significant at 0.05 except CyA + no induction vs. CyA + induction and TAC + no induction vs. TAC + induction
11-17 years: CyA + no induction vs. TAC + no induction (p = 0.004); CyA + induction vs. TAC + no induction (p < 0.001); CyA + induction vs. TAC + induction ( p =0.001)
ISHLT
Overall < 1 1-10 10-17
Analysis is limited to patients who were alive at the time of the follow-up
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.
No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
2009
J Heart Lung Transplant 2009;28: 989-1049
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION BETWEEN TRANSPLANT
DISCHARGE AND 1-YEAR FOLLOW-UP Stratified by Maintenance Immunosuppression (Follow-ups: July 2004 - June 2008)
0
10
20
30
40
50
60
70
Cyclosporine + MMF, Treatment Cyclosporine + MMF, No TreatmentCyclosporine + AZA, Treatment Cyclosporine + AZA, No TreatmentTacrolimus + MMF, Treatment Tacrolimus + MMF, No TreatmentTacrolimus + AZA, Treatment Tacrolimus + AZA, No Treatment
% e
xper
ien
cin
g a
cute
rej
ecti
on
wit
hin
1 y
ear
Overall: all comparisons were statistically significant at 0.05 except CyA +MMF vs. CyA +AZA and TAC + MMF vs. TAC + AZA. <1: CyA + MMF vs. TAC + MMF (p =0.017).1-10: CyA + MMF vs. TAC + MMF (p = 0.001); CyA + AZA vs. TAC + MMF (p=0.004).11-17: CyA + MMF vs. TAC + MMF (p =0.001); CyA + MMF vs. TAC + AZA (p=0.033).
ISHLT
Overall < 1 1-10 10-17
Analysis is limited to patients who were alive at the time of the follow-up
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.
No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
2009
J Heart Lung Transplant 2009;28: 989-1049
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION BETWEEN TRANSPLANT DISCHARGE
AND 1-YEAR FOLLOW-UP Stratified by Calcineurin Inhibitor Use at Discharge
(Follow-ups: July 2004 - June 2008)
0
10
20
30
40
50
60Cyclosporine, Treatment Cyclosporine, No TreatmentTacrolimus, Treatment Tacrolimus, No Treatment
% e
xper
ien
cin
g a
cute
rej
ect
ion
wit
hin
1 y
ear
Overall: CyA vs. TAC (p < 0.0001)<1: CyA vs. TAC (p=0.031) 1-10: CyA vs. TAC (p < 0.0001)11-17: CyA vs. TAC (p < 0.0001)
ISHLT
Overall < 1 1-10 10-17
Analysis is limited to patients who were alive at the time of the follow-up
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.
No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.2009
J Heart Lung Transplant 2009;28: 989-1049
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2008)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
% F
ree
do
m f
rom
CA
V
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2008)
Stratified by Induction
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
Induction (N = 1,267)
No Induction (N = 1,769)
p = 0.4696
% F
ree
do
m f
rom
CA
V
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: 1999 - June 2008)
Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
Cyclosporine use at discharge and 1 year (N = 790)
Tacrolimus use at discharge and 1 year (N = 799)
Cyclosporine use at discharge/Tacrolimus at 1 year (N = 96)
Tacrolimus use at discharge/Cyclosporine at 1 year (N = 17)
p = 0.2242
% F
ree
do
m f
rom
CA
V
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
FREEDOM FROM CORONARY ARTERY VASCULOPATHYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2008)
Stratified by Age Group
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
<1 Year (N = 801)
1-10 Years (N = 1,134)
11-17 Years (N = 1,113)
p < 0.0001
% F
ree
do
m f
rom
CA
V
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
FREEDOM FROM CORONARY ARTERY VASCULOPATHYFor Pediatric Heart Recipients (Follow-ups: January 1999-June 2008)
Stratified by Age Group
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
<1 Year (N = 553)
1-10 Years (N = 833)
11-17 Years (N = 833)
p < 0.0001
% F
ree
do
m f
rom
CA
V
ISHLT 2009
J Heart Lung Transplant 2009;28: 989-1049
FREEDOM FROM CORONARY ARTERY VASCULOPATHYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2008)
Stratified by Ischemia Time
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
0-<2 hours (N=321)
2-<4 hours (N=1,559)
4+ hours (N=969)
p = 0.0090
% F
ree
do
m f
rom
CA
V
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
FREEDOM FROM CORONARY ARTERY VASCULOPATHYFor Pediatric Heart Recipients (Follow-ups: January 1999 - June 2008)
Stratified by Ischemia Time for Recent Era
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
0-<2 hours (N=208)
2-<4 hours (N=1,125)
4+ hours (N=708)
p = 0.0144
% F
ree
do
m f
rom
CA
V
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
FREEDOM FROM CORONARY ARTERY VASCULOPATHYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2008)
Stratified by Ischemia Time and Recipient Age
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
0-<2 hours/0-10 years (N=182)
2+ hours/0-10 years (N=1,625)
0-<2 hours/11-17 years (N=139)
2+ hours/11-17 years (N=903)
0-10 years: p = 0.0051;11-17 years: p = 0.2992
% F
ree
do
m f
rom
CA
V
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
GRAFT SURVIVAL FOLLOWING REPORT OF CORONARY ARTERY VASCULOPATHY
For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2008)Stratified by Age Group
0
10
20
30
40
50
60
70
80
90
100
0 0.5 1 1.5 2 2.5 3 3.5 4
Time since Report of CAV (Years)
<1 Year (N = 80)
1-10 Years (N = 135)
11-17 Years (N = 176)
p = 0.8363
Su
rviv
al s
ince
Rep
ort
of
CA
V (
%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2008)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
% F
ree
do
m f
rom
Se
ve
re
Re
na
l Dy
sfu
nc
tio
n
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Pediatric Heart Recipients (Follow-ups: 1999 - June 2008)
Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
Cyclosporine use at discharge and 1 year (N = 825)
Tacrolimus use at discharge and 1 year (N = 880)
Cyclosporine use at discharge/Tacrolimus at 1 year (N = 100)
Tacrolimus use at discharge/Cyclosporine at 1 year (N = 18)
p = 0.1663
% F
ree
do
m f
rom
Se
ve
re
Re
na
l Dy
sfu
nc
tio
n
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2008)
Malignancy/Type 1-Year Survivors
5-Year Survivors
10-Year Survivors
No Malignancy 3,361 (98.1%) 1,343 (95.2%) 332 (92.2%)
Malignancy (all types combined) 64 (1.9%) 68 (4.8%) 28 (7.8%)
Malignancy Type
Lymph 59 64 26
Other 4 5 2
Skin 1
Type Not Reported 1
ISHLT
NOTE: Multiple types may be reported; sum of types may be greater than total number with malignancy.
2009
J Heart Lung Transplant 2009;28: 989-1049
FREEDOM FROM MALIGNANCYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2008)
80
85
90
95
100
0 1 2 3 4 5 6 7 8 9 10
Years
All malignancy Lymph Skin Other% F
ree
do
m f
rom
Ma
lign
an
cy
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
FREEDOM FROM MALIGNANCYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2008)
Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year
80
85
90
95
100
0 1 2 3 4 5 6 7 8 9
Years
Cyclosporine use at discharge and 1 year (N = 861)
Tacrolimus use at discharge and 1 year (N = 844)
Cyclosporine use at discharge/Tacrolimus at 1 year (N = 113)
Tacrolimus use at discharge/Cyclosporine at 1 year (N = 19)
p = 0.0042
% F
ree
do
m f
rom
Ma
lig
na
nc
y
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
FREEDOM FROM LYMPHOMAFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2008)
Stratified by Induction
80
85
90
95
100
0 1 2 3 4 5 6 7 8 9 10
Years
Induction No Induction
p = 0.9366
% F
ree
do
m f
rom
Ly
mp
ho
ma
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 1 and 3 Years
(Transplants: April 1993 - June 2005)
Maintenance Immunosuppression at discharge and 1 year
% HTN reported between 1 and 3 years
P-valueFor Patients
on drugFor Patients not on drug
Azathioprine 22.0 26.0 0.1643
Cyclosporine 21.4 26.2 0.1083
MMF 23.4 22.7 0.8049
Prednisone 29.6 10.7 <.0001
Rapamycin 37.5 22.5 -
Tacrolimus 28.8 20.3 0.0039
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 3 and 8 Years
(Transplants: April 1993 - June 2000)
Maintenance Immunosuppression at discharge and 1 year
% HTN reported between 3 and 8 years
P-valueFor Patients
on drugFor Patients not on drug
Azathioprine 37.5 48.9 0.1623
Cyclosporine 36.5 43.8 0.4302
MMF 41.4 37.6 0.6949
Prednisone 47.1 20.2 <.0001
Rapamycin . 37.6 -
Tacrolimus 42.3 34.8 0.4484
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
FREEDOM FROM CMVFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2008)
Stratified by Induction
40
50
60
70
80
90
100
0 1 2 3 4Years
Induction (N = 299) No Induction (N = 420)
p = 0.3026
% F
ree
do
m f
rom
CM
V
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
FREEDOM FROM CMVFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2008)
Stratified by Induction and Donor CMV Status
30
40
50
60
70
80
90
100
0 1 2 3 4Years
Induction/CMV(-) Donor (N = 134)
No Induction/CMV(-) Donor (N = 192)
Induction/CMV(+) Donor (N = 160)
No Induction/CMV(+) Donor (N = 219)
p < 0.0001
% F
ree
do
m f
rom
CM
V
ISHLT
2009 Analysis is limited to patients who were CMV negative at transplant.
J Heart Lung Transplant 2009;28: 989-1049
FREEDOM FROM CMVFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2008)
Stratified by Donor CMV Status/ Recipient CMV status Induction
0
20
40
60
80
100
0 1 2 3Years
D(-)/R(-) (N=134) D(-)/R(+) (N=65)
D(+)/R(-) (N=160) D(+)/R(+) (N=98)
p < 0.0001
% F
ree
do
m f
rom
CM
V
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
FREEDOM FROM CMVFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2008)
Stratified by Donor CMV Status/ Recipient CMV statusNo Induction
0
20
40
60
80
100
0 1 2 3 4Years
D(-)/R(-) (N=192) D(-)/R(+) (N=128)
D(+)/R(-) (N=219) D(+)/R(+) (N=121)
p < 0.0001
% F
ree
do
m f
rom
CM
V
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART RECIPIENTSRelationship of Rejection and Coronary Artery Vasculopathy
(Follow-ups: July 2004 – June 2008)
Rejection During 1st
Year
Reported CAV between 1st and 3rd years
post-transplant
Yes No All
Yes 5
5.9%
80
94.1%
85
100%
No 6
4.1%
142
95.9%
148
100%p = 0.5265
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2008)
CAUSE OF DEATH 0-30 Days (N = 461)
31 Days - 1 Year (N =
421)
>1 Year - 3 Years (N = 307)
>3 Years - 5 Years (N = 226)
>5 Years - 10 Years (N = 350)
>10 Years (N = 172)
CORONARY ARTERY VASCULOPATHY
5 (1.1%) 30 (7.1%) 62 (20.2%) 69 (30.5%) 98 (28.0%) 49 (28.5%)
ACUTE REJECTION 44 (9.5%) 100 (23.8%) 71 (23.1%) 31 (13.7%) 45 (12.9%) 10 (5.8%)
LYMPHOMA 10 (2.4%) 12 (3.9%) 6 (2.7%) 33 (9.4%) 11 (6.4%)
MALIGNANCY, OTHER 4 (1.0%) 2 (0.7%) 1 (0.4%) 5 (1.4%) 11 (6.4%)
CMV 1 (0.2%) 11 (2.6%) 1 (0.3%)
INFECTION, NON-CMV 54 (11.7%) 65 (15.4%) 20 (6.5%) 8 (3.5%) 17 (4.9%) 13 (7.6%)
PRIMARY FAILURE 102 (22.1%) 23 (5.5%) 10 (3.3%) 15 (6.6%) 18 (5.1%) 5 (2.9%)
GRAFT FAILURE 97 (21.0%) 45 (10.7%) 62 (20.2%) 53 (23.5%) 74 (21.1%) 44 (25.6%)
TECHNICAL 27 (5.9%) 3 (0.7%) 2 (0.7%) 2 (0.9%) 4 (1.1%) 1 (0.6%)
OTHER 25 (5.4%) 26 (6.2%) 29 (9.4%) 24 (10.6%) 30 (8.6%) 10 (5.8%)
MULTIPLE ORGAN FAILURE
46 (10.0%) 54 (12.8%) 11 (3.6%) 6 (2.7%) 10 (2.9%) 8 (4.7%)
RENAL FAILURE 1 (0.2%) 4 (1.0%) 1 (0.3%) 1 (0.4%) 1 (0.3%) 3 (1.7%)
PULMONARY 29 (6.3%) 30 (7.1%) 15 (4.9%) 8 (3.5%) 8 (2.3%) 5 (2.9%)
CEREBROVASCULAR 30 (6.5%) 16 (3.8%) 9 (2.9%) 2 (0.9%) 7 (2.0%) 2 (1.2%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1998 - June 2008)
CAUSE OF DEATH 0-30 Days (N = 213)
31 Days - 1 Year (N = 241)
>1 Year - 3 Years (N = 192)
>3 Years - 5 Years (N = 153)
>5 Years - 10 Years (N = 286)
>10 Years (N =165)
CAV 2 (0.9%) 14 (5.8%) 33 (17.2%) 43 (28.1%) 77 (26.9%) 47 (28.5%)
ACUTE REJECTION 22 (10.3%) 45 (18.7%) 36 (18.8%) 23 (15.0%) 36 (12.6%) 10 (6.1%)
LYMPHOMA 6 (2.5%) 7 (3.6%) 4 (2.6%) 28 (9.8%) 11 (6.7%)
MALIGNANCY, OTHER
1 (0.4%) 1 (0.5%) 4 (1.4%) 10 (6.1%)
CMV 7 (2.9%) 1 (0.5%)
INFECTION, NON-CMV
26 (12.2%) 31 (12.9%) 11 (5.7%) 3 (2.0%) 13 (4.5%) 11 (6.7%)
PRIMARY FAILURE 44 (20.7%) 9 (3.7%) 4 (2.1%) 6 (3.9%) 10 (3.5%) 5 (3.0%)
GRAFT FAILURE 31 (14.6%) 25 (10.4%) 48 (25.0%) 44 (28.8%) 66 (23.1%) 42 (25.5%)
TECHNICAL 14 (6.6%) 2 (1.0%) 4 (1.4%) 1 (0.6%)
OTHER 19 (8.9%) 20 (8.3%) 24 (12.5%) 17 (11.1%) 26 (9.1%) 10 (6.1%)
MULTIPLE ORGAN FAILURE
27 (12.7%) 40 (16.6%) 10 (5.2%) 5 (3.3%) 8 (2.8%) 8 (4.8%)
RENAL FAILURE 4 (1.7%) 1 (0.5%) 1 (0.7%) 1 (0.3%) 3 (1.8%)
PULMONARY 11 (5.2%) 27 (11.2%) 10 (5.2%) 6 (3.9%) 7 (2.4%) 5 (3.0%)
CEREBROVASCULAR 17 (8.0%) 12 (5.0%) 4 (2.1%) 1 (0.7%) 6 (2.1%) 2 (1.2%)
ISHLT
2009
J Heart Lung Transplant 2009;28: 989-1049
PEDIATRIC HEART TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death
(Deaths: January 1998 - June 2008)
0
10
20
30
40
0-30 Days (N= 213)
31 Days – 1Year (N =
241)
>1 Year – 3Years (N =
192)
>3 Years – 5Years (N =
153)
>5 Years – 10Years (N =
286 )
>10 Years (N= 165)
CAV Acute Rejection Infection (non-CMV)
Primary Failure Graft Failure
Pe
rce
nta
ge
of
De
ath
s
ISHLT
2009