HEART TRANSPLANTATION
Pediatric Recipients
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS (Transplants: January 1996 - June 2009)
0
100
200
300
400
500
600
700
800
900
1000
1100
1200
1300
1400
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
f T
ran
spla
nts
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS
(Transplants: January 1996 - June 2009)
0
100
200
300
400
500
600
700
800
900
1000
0 2 4 6 8 10 12 14 16 18-25
31+
Donor Age (Years)
Nu
mb
er
of
Tra
ns
pla
nts
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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
2008
11-17 Years
1-10 Years
<1 Year
Nu
mb
er
of
Tra
ns
pla
nts
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.
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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
2008
Nu
mb
er
of
Ce
nte
rs R
ep
ort
ing
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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
2008
Other
North America
Europe
Nu
mb
er
of
Ce
nte
rs R
ep
ort
ing
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
AVERAGE CENTER VOLUME AND PERCENTAGE OF TRANSPLANTS BY CENTER VOLUME
Pediatric Heart Transplants: January 1, 1997 - June 30, 2009
123
18
126
16 1690
20
40
60
80
100
120
140
1-4/yr 5-9/yr 10-19/yr
Average number of heart transplants per year
0
7
14
21
28
35
42
49
Number of centers 1997-2000 Number of centers 2001-June 2009
Percentage of transplants 1997-2000 Percentage of transplants 2001-June 2009
Nu
mb
er
of
ce
nte
rs
Pe
rce
nta
ge
of
tra
ns
pla
nts
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME
Pediatric Heart Transplants: January 1, 1997 - June 30, 2009
34.829.5 30.429.3
24.4
46.3
0
10
20
30
40
50
1-4 5-9 10-19
Average number of heart transplants per year
1997-2000 2001-June 2009
% o
f tr
an
sp
lan
ts
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RE-TRANSPLANTSBy Transplant Year
Re-transplants: January 1994 – December 2008
0
5
10
15
20
25
30
35
40
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Nu
mb
er o
f tr
ansp
lan
ts
Year of re-transplant
Only patients who were less than 18 years old at the time of re-transplant are included.
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
0
10
20
30
40
50
<1 month 1-<12months
12-<36months
36-<60months
60+ months Not reported
% o
f R
e-T
ran
spla
nts
0-10 Years 11-17 Years
Time Between Previous and Current Transplant
PEDIATRIC HEART RE-TRANSPLANTSBy Inter-transplant Interval
Re-transplants: January 1994 - June 2009
Only patients who were less than 18 years old at the time of re-transplant are included. Analysis is based on the age at the time of re-transplant
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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=48) 1-<3 Years (N=34) 3-<5 Years (N=48)5+ Years (N=145) Primary TX (N=5,417)
Comparison of survival for re-transplant groups: p = 0.0019
Time (years) since most recent transplant
KAPLAN-MEIER SURVIVAL RATES FOR PEDIATRIC HEART RETRANSPLANTS STRATIFIED BY INTER-TRANSPLANT INTERVAL
Re-transplants: January 1994 - June 2008
Only patients who were less than 18 years old at the time of re-transplant are included.
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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
2009
Myopathy Congenital
% o
f C
as
es
33%
63%
3%
0%
1/1996-6/2009
17%
80%2%
1%
Myopathy
Congenital
Other
ReTX
1988-1995
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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
2009
Myopathy Congenital
% o
f C
as
es
55%
37%
3%
5%
1/1996-6/2009
53%
41%
2%
4%Myopathy
Congenital
Other
ReTX
1988-1995
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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
2009
Myopathy Congenital
% o
f C
as
es
65%
25%
3%
8%
1/1996-6/2009
68%
27%
3%
2%
Myopathy
Congenital
Other
ReTX
1988-1995
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival (Transplants: 1/1982-6/2008)
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 = 2,049) 1-10 Years (N = 2,929)
11-17 Years (N = 3,027) Overall (N = 8,005)
0-<1 vs. 1-10: p < 0.0001; 0-<1 vs. 11-17: p=0.3284; 1-10 vs. 11-17: p=0.0003.
Half-life <1: 18.3 Years; 1-10: 15.5 Years; 11-17: 11.3 Years
Su
rviv
al (
%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATIONConditional Kaplan-Meier Survival
(Transplants: 1/1982-6/2008)
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 = 1,422) 1-10 Years (N = 2,272)11-17 Years (N =2,399) Overall (N = 6,093)
0-<1 vs. 1-10: p = 0.0138; 0-<1 vs. 11-17: p < 0.0001;1-10 vs. 11-17: p < 0.0001.
Half-life: <1: 21.4; 1-10: 19.3 Years; 11-17: 15.2 Years
Su
rviv
al (
%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATIONConditional Kaplan-Meier Survival for Recent Era
(Transplants: 1/1999-6/2008)
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
<1 Year (N = 683) 1-10 Years (N =1,184)
11-17 Years (N = 1,201) Overall (N = 3,068)
0-<1 vs. 1-10: p = 0.02510-<1 vs. 11-17: p = 0.0010; 1-10 vs. 11-17: p < 0.0001
Su
rviv
al (
%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Era
(Transplants: 1/1982-6/2008)
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=846) 1990-1994 (N=1,803)
1995-1999 (N=1,846) 2000-6/2008 (N=3,510)
All p-values significant at p = 0.01
Half-life 1982-1989: 9.5 years; 1990-1994: 11.7 years; 1995-1999: 14.3; 2000-6/2008: n.c.
Su
rviv
al (
%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2008)
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=176) 1990-1994 (N=571)
1995-1999 (N=479) 2000-6/2008 (N =823)
P-values for era comparisonsAll p-values significant at p < 0.0001 except comparison of 82-89 vs. 90-94 and 95-99 vs. 00-6/08
Half-life 1982-1989: 10.8 years; 1990-1994: 9.7 years; 1995-1999: n.c. ; 2000-6/2008: n.c.S
urv
iva
l (%
)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Era (Transplants: 1/1982-6/2008)
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 = 263) 1990-1994 (N=633)
1995-1999 (N=708) 2000-6/2008 (N=1,325)
P-values for era comparisonsAll p-values significant at p = 0.01 except for 82-89 vs. 90-94
Half-life 1982-1989: 9.1; 1990-1994: 12.4; 1995-1999: 13.6 ; 2000-6/2008: n.a.
Su
rviv
al (
%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Era (Transplants: 1/1982-6/2008)
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=407) 1990-1994 (N=599)
1995-1999 (N=659) 2000-6/2008 (N=1,362)
P-values for era comparisonsNo p-values significant at p = 0.05 except 82-89 vs. 90-94: p = 0.0341; 82-89 vs. 00-6/08: p < 0.0001;
Half-life 1982-1989: 9.3; 1990-1994: 11.8; 1995-1999: 10.3; 2000-6/2008: n.a.
Su
rviv
al (
%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f T
ran
sp
lan
ts
1-4/year 5-9/year 10-19/year
PEDIATRIC HEART TRANSPLANTS: AVERAGE CENTER VOLUME DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2009
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Patient vs. Graft Survival
(Transplants: 1/1999-6/2008)
Average Center Volume: 1-4 Transplants per Year
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9
Years
Patient (N=1,172) Graft (N=1,172)
p = 0.2878Su
rviv
al (
%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Patient vs. Graft Survival
(Transplants: 1/1999-6/2008)
Average Center Volume: 5-9 Transplants per Year
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9
Years
Patient (N=900) Graft (N=900)
p = 0.1670Su
rviv
al (
%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Patient vs. Graft Survival
(Transplants: 1/1999-6/2008)
Average Center Volume: 10-19 Transplants per Year
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9
Years
Patient (N=1,801) Graft (N=1,801)
p = 0.0201Su
rviv
al (
%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f T
ran
sp
lan
ts
<1 years 1-10 years 11-17 years
PEDIATRIC HEART TRANSPLANTS:AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2009
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2009
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2009
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Risk Factors For 1 Year Mortality
N=3,838
VARIABLE N Relative
Risk P-value
95% Confidence Interval
Congenital diagnosis, age = 0, on ECMO 81 2.86 <0.0001 1.99 -4.09
Congenital diagnosis, age > 0 921 2.02 <0.0001 1.60 -2.56
Retransplant 230 1.96 0.0007 1.33 -2.89
Year of Transplant: 1996-1997 vs. 2002-2003 523 1.68 0.0013 1.22 -2.32
On dialysis 83 1.66 0.0217 1.08 -2.55
On ventilator 717 1.54 0.0002 1.23 -1.94
Year of Transplant: 1998-1999 vs. 2002-2003 509 1.49 0.0166 1.08 -2.07
PRA > 10% 349 1.36 0.0263 1.04 -1.79
Donor cause of death = cerebrovascular/stroke vs. head trauma
387 1.35 0.0401 1.01 -1.81
Male donor/female recip vs. male donor/male recip 971 1.24 0.0404 1.01 -1.51
Diagnosis other than congenital, no ECMO, age = 0 290 0.47 0.0005 0.31 -0.72
Reference diagnosis = cardiomyopathy
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Borderline Significant Risk Factors For 1 Year Mortality
N=3,838
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Infection requiring IV drug therapy (with 2wk/TX)
584 1.24 0.0735 0.98 -1.56
Transfusions prior to transplant 1159 1.23 0.0525 1.00 -1.52
Donor cause of death = anoxia vs head trauma
898 0.81 0.065 0.65 -1.01
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Recipient age Recipient height
Donor age Ischemia time
Creatinine
N=3,838
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality
Recipient Age
0
0.5
1
1.5
2
2.5
3
3.5
4
0 3 6 9 12 15 18
Recipient Age (Years)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0024
N=3,838
NOTE: The impact of age should be considered in the context of height and diagnosis+age.2010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) 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 < 0.0001
N=3,838
NOTE: The impact of height should be considered in the context of age and diagnosis+age.
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) 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
Donor Age (Years)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.027
N=3,8382010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) 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
Recipient serum creatinine (mg/dl)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.004
N=3,8382010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) 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 = 0.0075
N=3,8382010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) 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, center volume
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Age = <1 YearsRisk Factors For 1 Year Mortality
N=1,009
VARIABLE N
Relative Risk
P-value 95% Confidence Interval
ECMO (diagnosis = congenital) 81 3.25 <0.0001 2.14 -4.95
ECMO, diagnosis other than congenital 42 2.59 0.0147 1.21 -5.57
Year of Transplant: 1996-1997 vs. 2002-2003 162 2.33 0.0029 1.34 -4.07
On dialysis 21 2.22 0.0173 1.15 -4.29
Year of Transplant: 2006-2008 vs. 2002-2003 231 1.8 0.0266 1.07 -3.03
Donor cause of death = cerebrovascular/stroke vs. head trauma
48 1.79 0.0359 1.04 -3.10
On ventilator 354 1.72 0.001 1.24 -2.37
Infection requiring IV drug therapy (within 2 weeks prior to transplant)
259 1.52 0.0099 1.11 -2.08
Diagnosis = cardiomyopathy 296 0.48 0.004 0.29 -0.79
Reference diagnosis = congenital without PGE or ECMO2010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Age = <1 YearsBorderline Significant Risk Factors For 1 Year Mortality
N=1,009
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Transplant Year: 1998-1999 vs. 2002-2003
134 1.72 0.0691 0.96 -3.10
PRA > 10% 76 1.60 0.0849 0.94 -2.73
Donor clinical infection 182 0.71 0.081 0.48 -1.04
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Age = <1 Years Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Ischemia time Recipient height (borderline)
Creatinine (borderline) Pediatric transplant volume (borderline)
N=1,009
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = <1 Years
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 = 0.038
N=1,0092010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) 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 = 0.051
N=1,0092010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) 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 = 0.062
N=1,0092010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) 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 = 0.089
N=1,0092010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Age = 1-10 YearsRisk Factors For 1 Year Mortality
N=1,448
VARIABLE N Relative
Risk P-value
95% Confidence Interval
Diagnosis = congenital 563 2.30 <0.0001 1.62 -3.25
Transfusions prior to transplant 349 1.82 0.0009 1.28 -2.59
Female recipient 713 1.48 0.0144 1.08 -2.04
Donor cause of death = anoxia vs. head trauma 337 0.59 0.0131 0.39 -0.90
Reference diagnosis = cardiomyopathy
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Age = 1-10 YearsBorderline Significant Risk Factors For 1 Year Mortality
N=1,448
VARIABLE N Relative
Risk P-value
95% Confidence Interval
Diagnosis = re-transplant 99 1.86 0.0639 0.96 -3.60
Not ABO identical 288 0.68 0.0768 0.44 -1.04
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Age = 1-10 Years Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Creatinine Bilirubin
Recipient height
N=1,448
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = 1-10 Years
Pre-Transplant Creatinine
0
0.5
1
1.5
2
2.5
3
3.5
0.2 0.4 0.6 0.8 1 1.2 1.4
Recipient serum creatinine (mg/dl)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0002
N=1,4482010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = 1-10 Years
Recipient Height
0
0.5
1
1.5
2
70 80 90 100 110 120 130 140 150
Height (cm)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0045
N=1,4482010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = 1-10 Years
Recipient Bilirubin
0
0.5
1
1.5
2
2.5
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5
Bilirubin (mg/dL)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.022
N=1,4482010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Age = 11-17 YearsRisk Factors For 1 Year Mortality
N=1,381
VARIABLE N Relative
Risk P-
value
95% Confidence
Interval
ECMO 48 3.03 0.0015 1.53 -6.01
Diagnosis = retransplant 125 2.4 0.0008 1.44 -4.01
Diagnosis = congenital 358 1.86 0.0024 1.25 -2.79
HLA mismatches at DR locus (per increasing mismatch, compared to 0 mismatches)
0 DR MM: N = 48 1 DR MM: N = 552 2 DR MM: N = 781
0.72 0.03 0.54 -0.97
Reference diagnosis = cardiomyopathy
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Age = 11-17 YearsBorderline Significant Risk Factors For 1 Year Mortality
N=1,381
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
On dialysis 39 1.88 0.0961 0.89 -3.95
PRA > 10% 118 1.59 0.0614 0.98 -2.58
Donor cause of death = anoxia vs. head trauma
175 0.57 0.0944 0.30 -1.10
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Age = 11-17 Years Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Ischemia time (borderline)
N=1,381
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Risk Factors for 1 Year Mortality in Age = 11-17 YearsIschemia 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 = 0.094
N=1,3812010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003)
Risk Factors For 5 Year Mortality
N=2,420
VARIABLE N Relative
Risk P-value
95% Confidence Interval
Congenital diagnosis, age = 0, on ECMO 43 1.71 0.025 1.07 -2.74
On dialysis 49 1.69 0.0174 1.10 -2.62
Retransplant 140 1.48 0.0166 1.07 -2.04
PRA > 10% 259 1.48 0.0009 1.17 -1.86
On ventilator 459 1.29 0.0177 1.05 -1.59
Prior sternotomy 885 1.24 0.0346 1.02 -1.52
Female recipient 1041 1.22 0.0143 1.04 -1.44
Diagnosis other than congenital, no ECMO, age = 0 183 0.47 0.0006 0.31 -0.72
Reference diagnosis = cardiomyopathy
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003)
Borderline Significant Risk Factors For 5 Year Mortality
N=2,420
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Infection requiring IV drug therapy (within 2 weeks prior to transplant)
348 1.20 0.0957 0.97 -1.50
Donor cause of death = anoxia vs. head trauma
515 0.82 0.0587 0.67 -1.01
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality
Continuous Factors (see figures)
Recipient age Recipient height
Donor age Ischemia time (borderline)
Pediatric transplant volume (borderline)
BSA ratio (borderline)
N=2,420
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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
3.5
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
N=2,420
NOTE: The impact of age should be considered in the context of height and diagnosis+age.
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 = 0.013
N=2,420
NOTE: The impact of height should be considered in the context of age and diagnosis+age.
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 = 0.026
N=2,4202010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 = 0.064
N=2,4202010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003)
Risk Factors for 5 Year MortalityIschemia 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 5
Ye
ar
Mo
rta
lity
p = 0.063
N=2,4202010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003)
Risk Factors for 5 Year MortalityBSA Ratio
0
0.5
1
1.5
2
2.5
0.8 1 1.2 1.4 1.6 1.8 2
Donor BSA/Recipient BSA
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.063
N=2,4202010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998)
Risk Factors For 10 Year Mortality
N=910
VARIABLE N Relative
Risk P-
value 95% Confidence
Interval
Female recipient/male donor vs. male recipient/male donor 372 1.41 0.0239 1.05 -1.90
Female donor/male recipient vs. male recipient/male donor 386 1.40 0.0201 1.05 -1.86
HLA mismatches at A locus (per increasing mismatch compared to 0 mismatches
0 DR MM: N = 57 1 DR MM: N = 306 2 DR MM: N = 547
1.25 0.0198 1.04 -1.51
Female recipient/female donor vs. male recipient/male donor 154 0.62 0.0378 0.40 -0.97
Diagnosis = cardiomyopathy, age = 0 years* 58 0.44 0.0141 0.23 -0.85
Reference diagnosis = cardiomyopathy
* Impact should be considered in context of donor age and recipient BSA shown in subsequent figures.
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998)
Borderline Significant Risk Factors For 10 Year Mortality
N=910
VARIABLE N Relative
Risk P-value 95% Confidence
Interval
Infection requiring IV drug therapy (within 2 weeks prior to transplant)
103 1.33 0.087 0.96 -1.83
Reference diagnosis = cardiomyopathy
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 10 Year Mortality
Continuous Factors (see figures)
Creatinine Donor age
Pediatric transplant volume (borderline)
Recipient BSA
N=9102010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality
Donor Age
0
0.5
1
1.5
2
2.5
3
3.5
0 5 10 15 20 25 30 35
Donor Age (Years)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
p < 0.0001
N=9102010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality
Recipient BSA
0
0.5
1
1.5
2
0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2
Recipient BSA (m2)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
p = 0.0045
N=9102010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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
0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2
Creatinine (mg/dl)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
p = 0.011
N=9102010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 = 0.084
N=9102010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Factors Not Significant for 10 Year Mortality
Recipient Factors:PRA, diabetes, repeat transplant, transfusions, hospitalized, PGE, VAD, bilirubin
Donor Factors:Cause of death, weight, height, age, clinical infection
Transplant Factors:Ischemia time, CMV mismatch
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (7/1997-6/2004)
Risk Factors for the Development of CAV within 5 Years
N=1,470
VARIABLE N Relative
Risk P-
value 95% Confidence
Interval
Diagnosis = retransplant 96 2.13 0.0033 1.29 -3.53
Reference diagnosis = cardiomyopathy
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (7/1997-6/2004)
Borderline Significant Risk Factors for the Development of CAV within 5 Years
N=1,470
VARIABLE N Relative
Risk P-value 95% Confidence
Interval
Diagnosis = other 24 2.03 0.0999 0.87 -4.72
PRA > 10% 171 1.45 0.0807 0.96 -2.21
Diagnosis = congenital 595 1.36 0.0797 0.96 -1.91
No steroids reported for discharge maintenance immunosuppression
233 0.61 0.0716 0.35 -1.04
Reference diagnosis = cardiomyopathy
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (7/1997-6/2004) Risk Factors for the Development of CAV within 5 Years
Continuous Factors (see figures)
Donor height
Total transplant volume
N=1,4702010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (7/1997-6/2004) Risk Factors for the Development of CAV within 5 Years
Donor Height
0
0.5
1
1.5
2
50 60 70 80 90 100 110 120 130 140 150 160 170 180
Donor Height (cm)
Re
lati
ve
Ris
k o
f C
AV
wit
hin
5 Y
ea
rs
p < 0.0001
N=1,4702010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (7/1997-6/2004) 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 = 0.0026
N=1,4702010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RECIPIENTS Cross-Sectional Analysis
Functional Status of Surviving Recipients(Follow-ups: April 1994 - June 2009)
0%
20%
40%
60%
80%
100%
1 Year (N = 2,171) 5 Year (N = 1,428) 10 Year (N = 561)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RECIPIENTS Longitudinal Analysis
Functional Status of Surviving Recipients(Follow-ups: April 1994 - June 2009)
For the Same Patients
0%
20%
40%
60%
80%
100%
1 Year (N = 792) 3 Year (N = 792) 5 Year (N = 792)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: April 1994 - June 2009)Age: <1 Year
0%
20%
40%
60%
80%
100%
1 Year (N = 547) 3 Year (N = 477) 5 Year (N = 215)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: April 1994 - June 2009)Age: 1-10 Years
0%
20%
40%
60%
80%
100%
1 Year (N = 831) 3 Year (N = 522) 5 Year (N = 179)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: April 1994 - June 2009)Age: 11-17 Years
0%
20%
40%
60%
80%
100%
1 Year (N = 793) 3 Year (N = 429) 5 Year (N = 167)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: March 2005 - June 2009)US Recipients Only
0%
20%
40%
60%
80%
100%
1 Year (N = 1,103) 2 Years (N = 972) 3 Years (N = 897)
Not Applicable (patient <1 year old)10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2009)
0%
20%
40%
60%
80%
100%
1 Year (N = 3,783) 5 Years (N =2,366) 10 Years (N = 958)
No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Hospitalized, Infection OnlyHospitalized, Rejection + Infection
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
0
10
20
30
40
50
60
Any Induction (N =1,489)
Polyclonal ALG/ATG(N = 997)
OKT3 (N = 48) IL2R-antagonist (N= 485)
% o
f P
ati
en
tsPEDIATRIC HEART RECIPIENTS
Induction Immunosuppression(Transplants: January 2001 - June 2009)
Analysis is limited to patients who were alive at the time of the follow-up2010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
0
10
20
30
40
50
60
70
Any Induction Polyclonal ALG/ATG IL2R-antagonist
% o
f P
ati
en
ts
200120022003200420052006200720082009
PEDIATRIC HEART RECIPIENTSInduction Immunosuppression (Transplants: January 2001 - June 2009)
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
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group
(Transplants: January 2000 – June 2008) Conditional on Survival to 14 Days
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
No induction (N = 1,261)
Polyclonal induction (N = 888)
IL2R-antagonist (N = 378)
No comparisons were statistically significant.
Su
rviv
al
(%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2008)
Conditional on Survival to 1 Year
50
60
70
80
90
100
0 1 2 3 4
Years
No induction/No rejection (N = 303)
Polyclonal induction/No rejection (N = 266)
IL2R-antagonist/No rejection (N = 114)
No induction/Treated Rejection (N = 108)
Polyclonal induction/Treated Rejection (N = 116)
IL2R-antagonist/Treated Rejection (N = 53)
Su
rviv
al (
%)
No pair-wise comparisons of survival by induction were statistically significant within either rejection grouping
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.
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2008)
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 = 267)Polyclonal induction (N = 300)IL2R-antagonist (N = 52)
No comparisons were statistically significant.
Su
rviv
al (
%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2008)
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 = 506)Polyclonal induction (N = 309)IL2R-antagonist (N = 148)
No comparisons were statistically significant.
Su
rviv
al (
%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2008)
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 = 488)
Polyclonal induction (N = 279)
IL2R-antagonist (N = 178)
No comparisons were statistically significant.
Su
rviv
al (
%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
Year 1 (N = 2,235) Year 5 (N = 1,441)
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2001 - June 2009)
NOTE: Different patients are analyzed in Year 1 and Year 5
% o
f P
atie
nts
Analysis is limited to patients who were alive at the time of the follow-up2010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
for Same Patients at Each Time Point(Follow-ups: January 2001 - June 2009)
0%
20%
40%
60%
80%
100%
Year 1 (N = 789) Year 5 (N = 789)
None
Other
Tacrolimus
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine
Cyclosporine + MMF
Cyclosporine + AZA
% o
f P
ati
en
ts
Analysis is limited to patients who were alive at the time of the follow-up2010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
(Follow-ups: January 2001 - June 2009)
0%
20%
40%
60%
80%
100%
Year 1 (N = 2,235) Year 5 (N = 1,441)
None
Other
Tacrolimus
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine
Cyclosporine + MMF
Cyclosporine + AZA
% o
f P
ati
en
ts
Analysis is limited to patients who were alive at the time of the follow-up
NOTE: Different patients are analyzed in Year 1 and Year 5
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Prednisone Use
Conditional on Survival to 1 Year (Transplants: 1998 - June 2008)
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 = 1,644)
No Prednisone at discharge or at 1 year (N = 384)
Prednisone at discharge/not at 1 year (N = 371)
p = 0.0147
Su
rviv
al (
%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Prednisone Use for a Recent Era
Conditional on Survival to 1 Year (Transplants: January 1998 – June 2008)
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 = 1,644)
No Prednisone at discharge or at 1 year (N = 384)
Prednisone at discharge/not at 1 year (N = 371)
p = 0.0147
Su
rviv
al (
%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use at Discharge
(Transplants: January 1998 - June 2008) 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 = 1,423)
Cyclosporine use at discharge (N = 1,482)
p = 0.2594
Su
rviv
al (
%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use
Conditional on Survival to 1 Year (Transplants: January 1998 - June 2008)
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 = 902)
Tacrolimus use at discharge and 1 year (N = 1,070)
Cyclosporine use at discharge/Tacrolimus at 1 year (N = 267)
Tacrolimus use at discharge/Cyclosporine at 1 year (N = 30)
p = 0.0333
Su
rviv
al (
%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2008)
50
60
70
80
90
100
0 1 2 3 4
Years
Free from Rejection during 1 year (N = 526)Treated Rejection within 1st Year (N = 283)
p = 0.1693
Su
rviv
al (
%)
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.
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2008)
50
60
70
80
90
100
0 1 2 3 4
Years
CyA: Free from Rejection during 1 year (N = 144)
CyA: Treated Rejection within 1st Year (N = 101)
TAC: Free from Rejection during 1 year (N = 347)
TAC: Treated Rejection within 1st Year (N = 150)
Free from Rejection: CyA vs. TAC p = 0.2682Treated Rejection: CyA vs. TAC p = 0.1586 CyA: Rejection vs. no rejection p = 0.6131TAC: Rejection vs. no rejection p = 0.1430
Su
rviv
al (
%)
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.
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2008)
50
60
70
80
90
100
0 1 2 3 4
Years
CyA: Free from Rejection during 1 year (N = 103)
CyA: Treated Rejection within 1st Year (N = 69)
TAC: Free from Rejection during 1 year (N = 221)
TAC: Treated Rejection within 1st Year (N = 83)
Free from Rejection: CyA vs. TAC p = 0.8741Rejection: CyA vs. TAC p = 0.7176 CyA: Rejection vs. no rejection p = 0.8305TAC: Rejection vs. no rejection p = 0.3347
Su
rviv
al (
%)
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.
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2008)
50
60
70
80
90
100
0 1 2 3 4
Years
CyA: Free from Rejection during 1st Year (N = 41)
CyA: Treated Rejection within 1st Year (N =32)
TAC: Free from Rejection during 1st Year (N = 126)
TAC: Treated Rejection within 1st Year (N = 67)
Free from Rejection: CyA vs. TAC p = 0.0338Rejection: CyA vs. TAC p = 0.1014 CyA: Rejection vs. no rejection p = 0.1693TAC: Rejection vs. no rejection p = 0.3492
Su
rviv
al (
%)
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.
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2009)
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 = 0.6601
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.2010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2009)
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
No comparisons were statistically significant at 0.05.
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.
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2009)
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
year
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=0.0268); 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 = 0.0005); CyA + induction vs. TAC + no induction (p < 0.0001); CyA + induction vs. TAC + induction ( p =0.0025)
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.2010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2009)
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
year
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 =0.0076).1-10: CyA + MMF vs. TAC + MMF (p = 0.0008); CyA + AZA vs. TAC + MMF (p=0.0007).
11-17: all comparisons were statistically significant at 0.05 except CyA +MMF vs. CyA +AZA TAC + MMF vs. TAC + AZA.
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.2010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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 2009)
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=0.0356) 1-10: CyA vs. TAC (p < 0.0001)11-17: CyA vs. TAC (p < 0.0001)
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.2010ISHLT
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009)
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
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009)
Stratified by Induction
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
Induction (N = 1,455)
No Induction (N = 1,880)
p = 0.5133
% F
ree
do
m f
rom
CA
V
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: 1999 - June 2009)
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 = 850)
Tacrolimus use at discharge and 1 year (N = 960)
Cyclosporine use at discharge/Tacrolimus at 1 year (N = 252)
Tacrolimus use at discharge/Cyclosporine at 1 year (N = 29)
p = 0.6217
% F
ree
do
m f
rom
CA
V
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM CORONARY ARTERY VASCULOPATHYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009)
Stratified by Age Group
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
<1 Year (N = 869)
1-10 Years (N = 1,251)
11-17 Years (N = 1,230)
p < 0.0001
% F
ree
do
m f
rom
CA
V
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM CORONARY ARTERY VASCULOPATHYFor Pediatric Heart Recipients (Follow-ups: January 1999-June 2009)
Stratified by Age Group
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
<1 Year (N = 623)
1-10 Years (N = 950)
11-17 Years (N = 948)
p < 0.0001
% F
ree
do
m f
rom
CA
V
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM CORONARY ARTERY VASCULOPATHYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009)
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=349)
2-<4 hours (N=1,705)
4+ hours (N=1,067)
p = 0.0080
% F
ree
do
m f
rom
CA
V
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM CORONARY ARTERY VASCULOPATHYFor Pediatric Heart Recipients (Follow-ups: January 1999 - June 2009)
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=234)
2-<4 hours (N=1,271)
4+ hours (N=808)
p = 0.0105
% F
ree
do
m f
rom
CA
V
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM CORONARY ARTERY VASCULOPATHYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009)
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=197)
2+ hours/0-10 years (N=1,776)
0-<2 hours/11-17 years (N=152)
2+ hours/11-17 years (N=996)
0-10 years: p = 0.0049;11-17 years: p = 0.3641
% F
ree
do
m f
rom
CA
V
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
GRAFT SURVIVAL FOLLOWING REPORT OF CORONARY ARTERY VASCULOPATHY
For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009)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 = 86)
1-10 Years (N = 150)
11-17 Years (N = 198)
p = 0.6115
Su
rviv
al s
ince
Rep
ort
of
CA
V (
%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009)
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
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Pediatric Heart Recipients (Follow-ups: 1999 - June 2009)
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 = 887)
Tacrolimus use at discharge and 1 year (N = 1,054)
Cyclosporine use at discharge/Tacrolimus at 1 year (N = 258)
Tacrolimus use at discharge/Cyclosporine at 1 year (N = 30)
p = 0.1311
% 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
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM RENAL REPLACEMENT THERAPY*For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
% F
ree
do
m f
rom
R
en
al
Re
pla
ce
me
tn T
he
rap
y
* Renal replacement therapy = dialysis or renal transplant
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2009)
Malignancy/Type 1-Year Survivors
5-Year Survivors
10-Year Survivors
No Malignancy 3,684 (98.2%) 1,521 (94.9%) 411 (92.6%)
Malignancy (all types combined) 69 (1.8%) 82 (5.1%) 33 (7.4%)
Malignancy Type
Lymph 64 77 31
Other 4 6 3
Skin 1 1
Type Not Reported 1
NOTE: Multiple types may be reported; sum of types may be greater than total number with malignancy.
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM MALIGNANCYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009)
80
85
90
95
100
0 1 2 3 4 5 6 7 8 9 10 11 12
Years
All malignancy Lymph Skin Other% F
ree
do
m f
rom
Ma
lign
an
cy
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM MALIGNANCYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009)
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 = 900)
Tacrolimus use at discharge and 1 year (N = 997)
Cyclosporine use at discharge/Tacrolimus at 1 year (N = 257)
Tacrolimus use at discharge/Cyclosporine at 1 year (N = 31)
p = 0.0214
% F
ree
do
m f
rom
Ma
lig
na
nc
y
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM LYMPHOMAFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009)
Stratified by Induction
80
85
90
95
100
0 1 2 3 4 5 6 7 8 9 10
Years
Induction No Induction
p = 0.7922
% F
ree
do
m f
rom
Ly
mp
ho
ma
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 1 and 3 Years
(Transplants: April 1993 - June 2006)
Maintenance Immunosuppression at discharge and 1 year
% HTN reported between 1 and 3 years
P-valueFor Patients
on drugFor Patients not on drug
Azathioprine 20.1 25.1 0.0639
Cyclosporine 21.3 22.6 0.6409
MMF 24.0 22.3 0.5552
Prednisone 28.9 11.9 <.0001
Rapamycin 36.4 22.0 -
Tacrolimus 26.0 20.4 0.0408
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 3 and 8 Years
(Transplants: April 1993 - June 2001)
Maintenance Immunosuppression at discharge and 1 year
% HTN reported between 3 and 8 years
P-valueFor Patients
on drugFor Patients not on drug
Azathioprine 35.1 54.3 0.0339
Cyclosporine 36.0 46.7 0.2637
MMF 41.4 37.8 0.7112
Prednisone 47.1 20.2 <.0001
Rapamycin - 37.5 -
Tacrolimus 40.7 34.8 0.541
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RECIPIENTSRelationship of Rejection and Coronary Artery Vasculopathy
(Follow-ups: July 2004 – June 2009)
Rejection During 1st
Year
Reported CAV between 1st and 3rd years
post-transplant
Yes No All
Yes 9
5.1%
168
94.9%
177
100%
No 9
3.4%
255
96.6%
264
100%
p = 0.3834
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2009)
CAUSE OF DEATH 0-30 Days (N = 475)
31 Days - 1 Year (N =
443)
>1 Year - 3 Years (N = 318)
>3 Years - 5 Years (N = 246)
>5 Years - 10 Years (N = 371)
>10 Years (N = 197)
CORONARY ARTERY VASCULOPATHY
5 (1.1%) 30 (6.8%) 62 (19.5%) 72 (29.3%) 105 (28.3%) 54 (27.4%)
ACUTE REJECTION 45 (9.5%) 108 (24.4%) 75 (23.6%) 35 (14.2%) 46 (12.4%) 12 (6.1%)
LYMPHOMA 1 (0.2%) 9 (2.0%) 12 (3.8%) 8 (3.3%) 35 (9.4%) 15 (7.6%)
MALIGNANCY, OTHER 4 (0.9%) 2 (0.6%) 2 (0.8%) 5 (1.3%) 10 (5.1%)
CMV 1 (0.2%) 12 (2.7%) 1 (0.3%)
INFECTION, NON-CMV 55 (11.6%) 68 (15.3%) 21 (6.6%) 8 (3.3%) 18 (4.9%) 18 (9.1%)
PRIMARY FAILURE 108 (22.7%) 24 (5.4%) 10 (3.1%) 16 (6.5%) 21 (5.7%) 7 (3.6%)
GRAFT FAILURE 101 (21.3%) 51 (11.5%) 64 (20.1%) 60 (24.4%) 76 (20.5%) 49 (24.9%)
TECHNICAL 27 (5.7%) 3 (0.7%) 2 (0.6%) 3 (1.2%) 4 (1.1%) 2 (1.0%)
OTHER 23 (4.8%) 26 (5.9%) 32 (10.1%) 24 (9.8%) 34 (9.2%) 10 (5.1%)
MULTIPLE ORGAN FAILURE
48 (10.1%) 56 (12.6%) 10 (3.1%) 7 (2.8%) 10 (2.7%) 10 (5.1%)
RENAL FAILURE 1 (0.2%) 5 (1.1%) 1 (0.3%) 1 (0.4%) 1 (0.3%) 3 (1.5%)
PULMONARY 29 (6.1%) 31 (7.0%) 16 (5.0%) 8 (3.3%) 9 (2.4%) 5 (2.5%)
CEREBROVASCULAR 31 (6.5%) 16 (3.6%) 10 (3.1%) 2 (0.8%) 7 (1.9%) 2 (1.0%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1998 - June 2009)
CAUSE OF DEATH 0-30 Days (N = 226)
31 Days - 1 Year (N = 266)
>1 Year - 3 Years (N = 202)
>3 Years - 5 Years (N = 173)
>5 Years - 10 Years (N = 306)
>10 Years (N =190)
CAV 2 (0.9%) 14 (5.3%) 33 (16.3%) 46 (26.6%) 84 (27.5%) 52 (27.4%)
ACUTE REJECTION 23 (10.2%) 53 (19.9%) 40 (19.8%) 27 (15.6%) 37 (12.1%) 12 (6.3%)
LYMPHOMA 6 (2.3%) 7 (3.5%) 6 (3.5%) 29 (9.5%) 15 (7.9%)
MALIGNANCY, OTHER
1 (0.4%) 1 (0.5%) 1 (0.6%) 4 (1.3%) 9 (4.7%)
CMV 8 (3.0%) 1 (0.5%)
INFECTION, NON-CMV
27 (11.9%) 34 (12.8%) 12 (5.9%) 3 (1.7%) 14 (4.6%) 16 (8.4%)
PRIMARY FAILURE 50 (22.1%) 10 (3.8%) 4 (2.0%) 7 (4.0%) 13 (4.2%) 7 (3.7%)
GRAFT FAILURE 35 (15.5%) 31 (11.7%) 50 (24.8%) 51 (29.5%) 68 (22.2%) 47 (24.7%)
TECHNICAL 14 (6.2%) 2 (1.0%) 1 (0.6%) 4 (1.3%) 2 (1.1%)
OTHER 17 (7.5%) 21 (7.9%) 27 (13.4%) 17 (9.8%) 30 (9.8%) 10 (5.3%)
MULTIPLE ORGAN FAILURE
29 (12.8%) 43 (16.2%) 9 (4.5%) 6 (3.5%) 8 (2.6%) 10 (5.3%)
RENAL FAILURE 5 (1.9%) 1 (0.5%) 1 (0.6%) 1 (0.3%) 3 (1.6%)
PULMONARY 11 (4.9%) 28 (10.5%) 11 (5.4%) 6 (3.5%) 8 (2.6%) 5 (2.6%)
CEREBROVASCULAR 18 (8.0%) 12 (4.5%) 4 (2.0%) 1 (0.6%) 6 (2.0%) 2 (1.1%)
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death
(Deaths: January 1998 - June 2009)
0
10
20
30
40
0-30 Days (N= 226)
31 Days – 1Year (N =
266)
>1 Year – 3Years (N =
173)
>3 Years – 5Years (N =
173)
>5 Years – 10Years (N =
306 )
>10 Years (N= 190)
CAV Acute Rejection Infection (non-CMV)
Primary Failure Graft Failure
Pe
rce
nta
ge
of
De
ath
s
2010ISHLTJ Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
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