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HEART TRANSPLANTATION
Pediatric Recipients
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
AGE DISTRIBUTION OF PEDIATRIC HEART
RECIPIENTS (Transplants: January 1996 - June 2009)
1400
1300
1200
1100
Number of Transplants
1000
900
800
700
600
500
400
300
200
100
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Recipient Age (Years)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
AGE DISTRIBUTION FOR DONORS OF
PEDIATRIC HEART RECIPIENTS
(Transplants: January 1996 - June 2009)
1000
900
800
Number of Transplants
700
600
500
400
300
200
100
0
0 2 4 6 8 10 12 14 16 18- 31+
25
Donor Age (Years)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
AGE DISTRIBUTION OF
PEDIATRIC HEART RECIPIENTS
By Year of Transplant
500
450 11-17 Years
Number of Transplants
400 1-10 Years
350 <1 Year
300
250
200
150
100
50
0
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
00
01
02
03
04
05
06
07
08
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
20
20
20
20
20
20
20
20
20
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.
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Number of Centers Reporting
10
20
30
40
50
60
70
80
90
100
110
0
19
8
19 2
8
19 3
8
19 4
8
19 5
8
ISHLT
19 6
8
19 7
8
19 8
8
19 9
9
19 0
9
19 1
9
19 2
9
19 3
9
19 4
2010
9
19 5
9
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
19 6
9
19 7
9
19 8
9
20 9
0
20 0
0
20 1
0
20 2
0
20 3
0
20 4
0
20 5
PEDIATRIC HEART TRANSPLANTS
0
NUMBER OF CENTERS REPORTING
20 6
0
20 7
08
NUMBER OF CENTERS REPORTING
PEDIATRIC HEART TRANSPLANTS
110
Number of Centers Reporting
100 Other
90 North America
80 Europe
70
60
50
40
30
20
10
0
19 2
19 3
19 4
19 5
19 6
19 7
19 8
19 9
19 0
19 1
19 2
19 3
19 4
19 5
19 6
19 7
19 8
20 9
20 0
20 1
20 2
20 3
20 4
20 5
20 6
20 7
08
8
8
8
8
8
8
8
8
9
9
9
9
9
9
9
9
9
9
0
0
0
0
0
0
0
0
19
ISHLT 2010
J 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
140 49
Percentage of transplants
120 42
Number of centers
100 35
80 28
60 123 126 21
40 14
20 7
18 16 16
0 9 0
1-4/yr 5-9/yr 10-19/yr
Average number of heart transplants per year
Number of centers 1997-2000 Number of centers 2001-June 2009
Percentage of transplants 1997-2000 Percentage of transplants 2001-June 2009
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
DISTRIBUTION OF TRANSPLANTS
BY CENTER VOLUME
Pediatric Heart Transplants: January 1, 1997 - June 30, 2009
50
1997-2000 2001-June 2009
40
% of transplants
30
46.3
20
34.8
29.3 29.5 30.4
24.4
10
0
1-4 5-9 10-19
Average number of heart transplants per year
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RE-TRANSPLANTS
By Transplant Year
Re-transplants: January 1994 – December 2008
40
35
Number of transplants
30
25
20
15
10
5
0
94
95
96
97
98
99
00
01
02
03
04
05
06
07
08
19
19
19
19
19
19
20
20
20
20
20
20
20
20
20
Year of re-transplant
ISHLT 2010 Only patients who were less than 18 years
old at the time of re-transplant are included.
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RE-TRANSPLANTS
By Inter-transplant Interval
Re-transplants: January 1994 - June 2009
50
0-10 Years 11-17 Years
% of Re-Transplants
40
30
20
10
0
<1 month 1-<12 12-<36 36-<60 60+ months Not reported
months months months
Time Between Previous and Current Transplant
ISHLT 2010 Only patients who were less than 18 years old at
the time of re-transplant are included. Analysis is
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 based on the age at the time of re-transplant
KAPLAN-MEIER SURVIVAL RATES FOR PEDIATRIC HEART
RETRANSPLANTS STRATIFIED BY INTER-TRANSPLANT INTERVAL
Re-transplants: January 1994 - June 2008
<1 Year (N=48) 1-<3 Years (N=34) 3-<5 Years (N=48)
5+ Years (N=145) Primary TX (N=5,417)
100
Comparison of survival for
re-transplant groups: p = 0.0019
90
Surrvival (%)
80
70
60
50
40
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
Time (years) since most recent transplant
ISHLT 2010
Only patients who were less than 18 years
old at the time of re-transplant are included.
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
DIAGNOSIS IN PEDIATRIC HEART
TRANSPLANT RECIPIENTS (Age: < 1 Year)
33%
Myopathy
17%
Congenital
1% 0%
Other 3%
2% 80%
ReTX 63%
1988-1995 1/1996-6/2009
100
% of Cases
75
50 Myopathy Congenital
25
0
86
87
88
89
90
91
92
93
94
95
96
97
98
99
00
01
02
03
04
05
06
07
08
09
19
19
19
19
19
19
19
19
19
19
19
19
19
19
20
20
20
20
20
20
20
20
20
20
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
DIAGNOSIS IN PEDIATRIC HEART
TRANSPLANT RECIPIENTS (Age: 1-10 Years)
4% 5%
53% Myopathy
2% 55%
3%
Congenital
Other
41% ReTX 37%
1988-1995 1/1996-6/2009
100
% of Cases
Myopathy Congenital
75
50
25
0
86
87
88
89
90
91
92
93
94
95
96
97
98
99
00
01
02
03
04
05
06
07
08
09
19
19
19
19
19
19
19
19
19
19
19
19
19
19
20
20
20
20
20
20
20
20
20
20
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
DIAGNOSIS IN PEDIATRIC HEART
TRANSPLANT RECIPIENTS (Age: 11-17 Years)
Myopathy
25%
27%
Congenital
68% Other 65% 3%
3%
8%
2% ReTX
1988-1995 1/1996-6/2009
100
% of Cases
Myopathy Congenital
75
50
25
0
86
87
88
89
90
91
92
93
94
95
96
97
98
99
00
01
02
03
04
05
06
07
08
09
19
19
19
19
19
19
19
19
19
19
19
19
19
19
20
20
20
20
20
20
20
20
20
20
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION
Kaplan-Meier Survival (Transplants: 1/1982-6/2008)
100
<1 Year (N = 2,049) 1-10 Years (N = 2,929)
90 11-17 Years (N = 3,027) Overall (N = 8,005)
80
70
Survival (%)
60
0-<1 vs. 1-10: p < 0.0001;
50 0-<1 vs. 11-17: p=0.3284;
1-10 vs. 11-17: p=0.0003.
40
30
20
10 Half-life <1: 18.3 Years; 1-10: 15.5 Years; 11-17: 11.3 Years
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION
Conditional Kaplan-Meier Survival
(Transplants: 1/1982-6/2008)
100
Half-life: <1: 21.4; 1-10: 19.3 Years; 11-17: 15.2 Years
90
80
Survival (%)
70
0-<1 vs. 1-10: p = 0.0138;
60 0-<1 vs. 11-17: p < 0.0001;
1-10 vs. 11-17: p < 0.0001.
50
40 <1 Year (N = 1,422) 1-10 Years (N = 2,272)
11-17 Years (N =2,399) Overall (N = 6,093)
30
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION
Conditional Kaplan-Meier Survival for Recent Era
(Transplants: 1/1999-6/2008)
100
90
Survival (%)
80 0-<1 vs. 1-10: p = 0.0251
0-<1 vs. 11-17: p = 0.0010;
1-10 vs. 11-17: p < 0.0001
70
60
<1 Year (N = 683) 1-10 Years (N =1,184)
11-17 Years (N = 1,201) Overall (N = 3,068)
50
0 1 2 3 4 5 6 7
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION
Kaplan-Meier Survival by Era
(Transplants: 1/1982-6/2008)
100
1982-1989 (N=846) 1990-1994 (N=1,803)
1995-1999 (N=1,846) 2000-6/2008 (N=3,510)
80 Half-life 1982-1989: 9.5 years; 1990-1994: 11.7 years; 1995-
1999: 14.3; 2000-6/2008: n.c.
Survival (%)
60
40
20
All p-values significant at p = 0.01
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years
ISHLT 2010
J 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
100
1982-1989 (N=176) 1990-1994 (N=571)
1995-1999 (N=479) 2000-6/2008 (N =823)
80
Survival (%)
60
Half-life 1982-1989: 10.8 years; 1990-1994: 9.7 years; 1995-
40
1999: n.c. ; 2000-6/2008: n.c.
P-values for era comparisons
20 All p-values significant at p < 0.0001 except comparison of 82-89 vs. 90-94 and
95-99 vs. 00-6/08
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION
Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2008)
Age: 1-10 Years
100
1982-1989 (N = 263) 1990-1994 (N=633)
1995-1999 (N=708) 2000-6/2008 (N=1,325)
80
Survival (%)
60
40
P-values for era comparisons
All p-values significant at p = 0.01 except
for 82-89 vs. 90-94
20
Half-life 1982-1989: 9.1; 1990-1994: 12.4; 1995-1999: 13.6 ; 2000-6/2008: n.a.
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION
Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2008)
Age: 11-17 Years
100
1982-1989 (N=407) 1990-1994 (N=599)
1995-1999 (N=659) 2000-6/2008 (N=1,362)
80
Survival (%)
60
40
Half-life 1982-1989: 9.3; 1990-1994: 11.8; 1995-1999: 10.3;
2000-6/2008: n.a.
20
P-values for era comparisons
No 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;
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS:
AVERAGE CENTER VOLUME DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2009
1-4/year 5-9/year 10-19/year
100%
% of Transplants
80%
60%
40%
20%
0%
Europe North America Other
ISHLT 2010
J 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
100
80
Survival (%)
60
40
p = 0.2878
20
Patient (N=1,172) Graft (N=1,172)
0
0 1 2 3 4 5 6 7 8 9
Years
ISHLT 2010
J 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
100
80
Survival (%)
60
40
p = 0.1670
20
Patient (N=900) Graft (N=900)
0
0 1 2 3 4 5 6 7 8 9
Years
ISHLT 2010
J 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
100
80
Survival (%)
60
40
p = 0.0201
20
Patient (N=1,801) Graft (N=1,801)
0
0 1 2 3 4 5 6 7 8 9
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS:
AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2009
<1 years 1-10 years 11-17 years
100%
% of Transplants
80%
60%
40%
20%
0%
Europe North America Other
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS:
DIAGNOSIS DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2009
100%
Other
80%
% of Transplants
Re-TX/Graft
Failure
60% Malignancy
Coronary Artery
40% Disease
Congenital
20% Cardiomyopathy
0%
Europe North America Other
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS:
DONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2009
<1 1-10 11-17 18-34 35-49 50-64
100%
80%
% of Donors
60%
40%
20%
0%
Europe North America Other
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Risk Factors For 1 Year Mortality
Relative 95% Confidence
VARIABLE N P-value
Risk 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.
387 1.35 0.0401 1.01 -1.81
head trauma
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
N=3,838
ISHLT 2010 Reference diagnosis = cardiomyopathy
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Borderline Significant Risk Factors For 1 Year Mortality
95%
Relative
VARIABLE N P-value Confidence
Risk
Interval
Infection requiring IV drug therapy (with
584 1.24 0.0735 0.98 -1.56
2wk/TX)
Transfusions prior to transplant 1159 1.23 0.0525 1.00 -1.52
Donor cause of death = anoxia vs head
898 0.81 0.065 0.65 -1.01
trauma
N=3,838
ISHLT 2010
J 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
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Risk Factors for 1 Year Mortality
Recipient Age
4
Relative Risk of 1 Year Mortality
p = 0.0024
3.5
3
2.5
2
1.5
1
0.5
0
0 3 6 9 12 15 18
NOTE: The impact of age
Recipient Age (Years) should be considered in the
context of height and
ISHLT 2010 diagnosis+age.
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=3,838
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Risk Factors for 1 Year Mortality
Recipient Height
4
Relative Risk of 1 Year Mortality
p < 0.0001
3.5
3
2.5
2
1.5
1
0.5
0
55 65 75 85 95 105 115 125 135 145 155 165 175
Height (cm) NOTE: The impact of height should
be considered in the context of age
and diagnosis+age.
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=3,838
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Risk Factors for 1 Year Mortality
Donor Age
3
Relative Risk of 1 Year Mortality
p = 0.027
2.5
2
1.5
1
0.5
0
0 5 10 15 20 25 30 35
Donor Age (Years)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=3,838
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Risk Factors for 1 Year Mortality
Pre-Transplant Creatinine
3
Relative Risk of 1 Year Mortality
2.5
2
1.5
1
0.5
p = 0.004
0
0 0.5 1 1.5 2
Recipient serum creatinine (mg/dl)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=3,838
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Risk Factors for 1 Year Mortality
Ischemia Time
2.5
Relative Risk of 1 Year Mortality
2
1.5
1
0.5
p = 0.0075
0
2 3 4 5 6
Ischemia time (hours)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=3,838
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
ISHLT 2010
J 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
Relative
VARIABLE P-value 95% Confidence
N Risk 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
48 1.79 0.0359 1.04 -3.10
vs. head trauma
On ventilator 354 1.72 0.001 1.24 -2.37
Infection requiring IV drug therapy (within 2
259 1.52 0.0099 1.11 -2.08
weeks prior to transplant)
Diagnosis = cardiomyopathy 296 0.48 0.004 0.29 -0.79
N=1,009
ISHLT 2010 Reference diagnosis = congenital
without PGE or ECMO
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Age = <1 Years
Borderline Significant Risk Factors For 1 Year Mortality
95%
Relative
VARIABLE N P-value Confidence
Risk
Interval
Transplant Year: 1998-1999 vs. 2002-
134 1.72 0.0691 0.96 -3.10
2003
PRA > 10% 76 1.60 0.0849 0.94 -2.73
Donor clinical infection 182 0.71 0.081 0.48 -1.04
N=1,009
ISHLT 2010
J 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)
Pediatric transplant volume
Creatinine (borderline)
(borderline)
N=1,009
ISHLT 2010
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
Ischemia Time
2.5
Relative Risk of 1 Year Mortality
2
1.5
1
0.5
p = 0.038
0
2 3 4 5 6
Ischemia time (hours)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=1,009
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Risk Factors for 1 Year Mortality in Age = <1 Years
Pre-Transplant Creatinine
2.5
Relative Risk of 1 Year Mortality
2
1.5
1
0.5
p = 0.051
0
0 0.2 0.4 0.6 0.8 1
Recipient serum creatinine (mg/dl)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=1,009
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Risk Factors for 1 Year Mortality in Age = <1 Years
Center Volume for Pediatric Transplants
2
Relative Risk of 1 Year Mortality
1.5
1
0.5
p = 0.062
0
0 2 4 6 8 10 12 14 16 18 20
Center Volume (cases per year)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=1,009
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Risk Factors for 1 Year Mortality in Age = <1 Years
Recipient Height
3
Relative Risk of 1 Year Mortality
p = 0.089
2.5
2
1.5
1
0.5
0
45 50 55 60 65 70 75
Height (cm)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=1,009
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Age = 1-10 Years
Risk Factors For 1 Year Mortality
Relative 95% Confidence
VARIABLE N P-value
Risk 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
N=1,448
ISHLT 2010 Reference diagnosis = cardiomyopathy
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Age = 1-10 Years
Borderline Significant Risk Factors For 1 Year Mortality
Relative 95% Confidence
VARIABLE N P-value
Risk 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
N=1,448
ISHLT 2010
J 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
ISHLT 2010
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
Pre-Transplant Creatinine
3.5
Relative Risk of 1 Year Mortality
3
2.5
2
1.5
1
0.5
p = 0.0002
0
0.2 0.4 0.6 0.8 1 1.2 1.4
Recipient serum creatinine (mg/dl)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=1,448
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Risk Factors for 1 Year Mortality in Age = 1-10 Years
Recipient Height
2
Relative Risk of 1 Year Mortality
p = 0.0045
1.5
1
0.5
0
70 80 90 100 110 120 130 140 150
Height (cm)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=1,448
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Risk Factors for 1 Year Mortality in Age = 1-10 Years
Recipient Bilirubin
2.5
Relative Risk of 1 Year Mortality
p = 0.022
2
1.5
1
0.5
0
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5
Bilirubin (mg/dL)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=1,448
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Age = 11-17 Years
Risk Factors For 1 Year Mortality
95%
Relative P-
VARIABLE N Confidence
Risk value
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
0 DR MM: N = 48
HLA mismatches at DR locus (per increasing
mismatch, compared to 0 mismatches)
1 DR MM: N = 552 0.72 0.03 0.54 -0.97
2 DR MM: N = 781
N=1,381
ISHLT 2010 Reference diagnosis = cardiomyopathy
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008)
Age = 11-17 Years
Borderline Significant Risk Factors For 1 Year Mortality
95%
Relative
VARIABLE N P-value Confidence
Risk
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
175 0.57 0.0944 0.30 -1.10
trauma
N=1,381
ISHLT 2010
J 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
ISHLT 2010
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 = 11-17 Years
Ischemia Time
2.5
Relative Risk of 1 Year Mortality
2
1.5
1
0.5
p = 0.094
0
2 3 4 5 6
Ischemia time (hours)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=1,381
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003)
Risk Factors For 5 Year Mortality
Relative 95% Confidence
VARIABLE N P-value
Risk 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
N=2,420
ISHLT 2010 Reference diagnosis = cardiomyopathy
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003)
Borderline Significant Risk Factors For 5 Year Mortality
95%
Relative
VARIABLE N P-value Confidence
Risk
Interval
Infection requiring IV drug therapy (within
348 1.20 0.0957 0.97 -1.50
2 weeks prior to transplant)
Donor cause of death = anoxia vs. head
515 0.82 0.0587 0.67 -1.01
trauma
N=2,420
ISHLT 2010
J 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
BSA ratio (borderline)
(borderline)
N=2,420
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003)
Risk Factors for 5 Year Mortality
Recipient Age
3.5
Relative Risk of 5 Year Mortality
p < 0.0001
3
2.5
2
1.5
1
0.5
0
0 3 6 9 12 15 18
NOTE: The impact of age should be
Recipient Age (Years) considered in the context of height
and diagnosis+age.
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=2,420
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003)
Risk Factors for 5 Year Mortality
Recipient Height
3
Relative Risk of 5 Year Mortality
p = 0.013
2.5
2
1.5
1
0.5
0
55 65 75 85 95 105 115 125 135 145 155 165 175
Height (cm) NOTE: The impact of height should
be considered in the context of age
and diagnosis+age.
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=2,420
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003)
Risk Factors for 5 Year Mortality
Donor Age
3
Relative Risk of 5 Year Mortality
p = 0.026
2.5
2
1.5
1
0.5
0
0 5 10 15 20 25 30 35 40
Donor Age (Years)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=2,420
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003)
Risk Factors for 5 Year Mortality
Center Volume for Pediatric Transplants
2.5
Relative Risk of 5 Year Mortality
2
1.5
1
0.5
p = 0.064
0
0 2 4 6 8 10 12 14 16 18 20
Center Volume (cases per year)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=2,420
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003)
Risk Factors for 5 Year Mortality
Ischemia Time
2.5
Relative Risk of 5 Year Mortality
2
1.5
1
0.5
p = 0.063
0
2 3 4 5 6
Ischemia time (hours)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=2,420
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003)
Risk Factors for 5 Year Mortality
BSA Ratio
2.5
Relative Risk of 5 Year Mortality
2
1.5
1
0.5
p = 0.063
0
0.8 1 1.2 1.4 1.6 1.8 2
Donor BSA/Recipient BSA
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=2,420
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998)
Risk Factors For 10 Year Mortality
Relative P- 95% Confidence
VARIABLE N
Risk value 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 0 DR MM: N = 57
mismatch compared to 0 mismatches
1 DR MM: N = 306 1.25 0.0198 1.04 -1.51
2 DR MM: N = 547
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
* Impact should be considered in context of donor age and recipient BSA shown in subsequent figures.
Reference diagnosis = cardiomyopathy
ISHLT 2010 N=910
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998)
Borderline Significant Risk Factors For 10 Year Mortality
Relative 95% Confidence
VARIABLE N P-value
Risk Interval
Infection requiring IV drug therapy
103 1.33 0.087 0.96 -1.83
(within 2 weeks prior to transplant)
Reference diagnosis = cardiomyopathy
ISHLT 2010 N=910
J 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 Recipient BSA
(borderline)
ISHLT 2010 N=910
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997)
Risk Factors for 10 Year Mortality
Donor Age
3.5
Relative Risk of 10 Year Mortality
3
2.5
2
1.5
1
p < 0.0001
0.5
0
0 5 10 15 20 25 30 35
Donor Age (Years)
ISHLT 2010 N=910
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997)
Risk Factors for 10 Year Mortality
Recipient BSA
2
Relative Risk of 10 Year Mortality
p = 0.0045
1.5
1
0.5
0
0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2
Recipient BSA (m2)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 N=910
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997)
Risk Factors for 10 Year Mortality
Pre-Transplant Creatinine
2.5
Relative Risk of 10 Year Mortality
p = 0.011
2
1.5
1
0.5
0
0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2
Creatinine (mg/dl)
ISHLT 2010 N=910
J 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
2
Relative Risk of 10 Year Mortality
1.5
1
0.5
p = 0.084
0
0 2 4 6 8 10 12 14 16 18 20
Center Volume (cases per year)
ISHLT 2010 N=910
J 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
ISHLT 2010
J 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
Relative P- 95% Confidence
VARIABLE N
Risk value Interval
Diagnosis = retransplant 96 2.13 0.0033 1.29 -3.53
Reference diagnosis = cardiomyopathy
ISHLT 2010 N=1,470
J 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
Relative 95% Confidence
VARIABLE N P-value
Risk 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
233 0.61 0.0716 0.35 -1.04
maintenance immunosuppression
Reference diagnosis = cardiomyopathy
ISHLT 2010 N=1,470
J 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
ISHLT 2010 N=1,470
J 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
2
Relative Risk of CAV within 5 Years
1.5
1
0.5
p < 0.0001
0
50 60 70 80 90 100 110 120 130 140 150 160 170 180
Donor Height (cm)
ISHLT 2010 N=1,470
J 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
Relative Risk of CAV within 5 Years
2
1.5
1
0.5
p = 0.0026
0
0 5 10 15 20 25 30 35 40
Center Volume (cases per year)
ISHLT 2010 N=1,470
J 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)
100%
80%
60%
40%
20%
No Activity Limitations Performs with Some Assistance Requires Total Assistance
0%
1 Year (N = 2,171) 5 Year (N = 1,428) 10 Year (N = 561)
ISHLT 2010
J 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
100%
80%
60%
40%
20%
No Activity Limitations Performs with Some Assistance Requires Total Assistance
0%
1 Year (N = 792) 3 Year (N = 792) 5 Year (N = 792)
ISHLT 2010
J 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
100%
80%
60%
40%
20%
No Activity Limitations Performs with Some Assistance Requires Total Assistance
0%
1 Year (N = 547) 3 Year (N = 477) 5 Year (N = 215)
ISHLT 2010
J 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
100%
80%
60%
40%
20%
No Activity Limitations Performs with Some Assistance Requires Total Assistance
0%
1 Year (N = 831) 3 Year (N = 522) 5 Year (N = 179)
ISHLT 2010
J 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
100%
80%
60%
40%
20%
No Activity Limitations Performs with Some Assistance Requires Total Assistance
0%
1 Year (N = 793) 3 Year (N = 429) 5 Year (N = 167)
ISHLT 2010
J 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
100%
Not Applicable (patient <
1 year old)
10%
80% 20%
30%
60% 40%
50%
60%
40%
70%
80%
20%
90%
100%
0%
1 Year (N = 1,103) 2 Years (N = 972) 3 Years (N = 897)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RECIPIENTS
Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2009)
100%
80%
60%
40%
No Hospitalization Hospitalized, Not Rejection/Not Infection
20% Hospitalized, Rejection Hospitalized, Infection Only
Hospitalized, Rejection + Infection
0%
1 Year (N = 3,783) 5 Years (N =2,366) 10 Years (N = 958)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RECIPIENTS
Induction Immunosuppression
(Transplants: January 2001 - June 2009)
60
50
40
% of Patients
30
20
10
0
Any Induction (N = Polyclonal ALG/ATG OKT3 (N = 48) IL2R-antagonist (N
1,489) (N = 997) = 485)
ISHLT 2010 Analysis is limited to patients who
were alive at the time of the follow-up
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RECIPIENTS
Induction Immunosuppression (Transplants: January 2001 - June 2009)
70
2001
2002
60 2003
2004
2005
50 2006
% of Patients
2007
2008
40 2009
30
20
10
0
Any Induction Polyclonal ALG/ATG IL2R-antagonist
Test of increasing trend over time:
Any induction p < 0.0001
Polyclonal p < 0.0001
ISHLT 2010 IL2 p < 0.0001
Analysis is limited to patients who
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 were alive at the time of the follow-up
PEDIATRIC HEART TRANSPLANTATION
Kaplan-Meier Survival by Induction Group
(Transplants: January 2000 – June 2008) Conditional on Survival to 14 Days
100
No comparisons were statistically significant.
90
Survival (%)
80
70
No induction (N = 1,261)
Polyclonal induction (N = 888)
60
IL2R-antagonist (N = 378)
50
0 1 2 3 4 5 6 7
Years
ISHLT 2010
J 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
100
90
Survival (%)
80
No pair-wise comparisons of survival by induction were statistically
significant within either rejection grouping
70 No induction/No rejection (N = 303)
Polyclonal induction/No rejection (N = 266)
IL2R-antagonist/No rejection (N = 114)
60 No induction/Treated Rejection (N = 108)
Polyclonal induction/Treated Rejection (N = 116)
IL2R-antagonist/Treated Rejection (N = 53)
50
0 1 2 3 4
Years Treated rejection = Recipient was reported to (1) have at least
one acute rejection episode that was treated with an anti-
ISHLT 2010
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
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 did not receive anti-rejection agents.
PEDIATRIC HEART TRANSPLANTATION
Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2008)
Conditional on Survival to 14 Days
Age: < 1 Year
100
90
Survival (%)
80
No comparisons were statistically significant.
70
No induction (N = 267)
60 Polyclonal induction (N = 300)
IL2R-antagonist (N = 52)
50
0 1 2 3 4 5 6
Years
ISHLT 2010
J 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
Age: 1-10 Years
100
90
Survival (%)
80
No comparisons were statistically significant.
70
60 No induction (N = 506)
Polyclonal induction (N = 309)
IL2R-antagonist (N = 148)
50
0 1 2 3 4 5 6
Years
ISHLT 2010
J 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
Age: 11-17 Years
100
90
Survival (%)
80
No comparisons were statistically significant.
70
No induction (N = 488)
60
Polyclonal induction (N = 279)
IL2R-antagonist (N = 178)
50
0 1 2 3 4 5 6
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RECIPIENTS
Maintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2001 - June 2009)
100
Year 1 (N = 2,235) Year 5 (N = 1,441)
80
% of Patients
60
40
20
0
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2010 Analysis is limited to patients who
were alive at the time of the follow-up
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)
100%
None
80%
Other
% of Patients
Tacrolimus
60%
Tacrolimus + MMF
Tacrolimus + AZA
40%
Cyclosporine
Cyclosporine + MMF
20%
Cyclosporine + AZA
0%
Year 1 (N = 789) Year 5 (N = 789)
ISHLT 2010 Analysis is limited to patients who
were alive at the time of the follow-up
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)
100%
None
80%
Other
Tacrolimus
% of Patients
60%
Tacrolimus + MMF
Tacrolimus + AZA
40%
Cyclosporine
Cyclosporine + MMF
20%
Cyclosporine + AZA
0%
Year 1 (N = 2,235) Year 5 (N = 1,441)
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2010 Analysis is limited to patients who
were alive at the time of the follow-up
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION
Kaplan-Meier Survival Based on Prednisone Use
Conditional on Survival to 1 Year (Transplants: 1998 - June 2008)
100
90
Survival (%)
80
p = 0.0147
70
Prednisone use at discharge and 1 year (N = 1,644)
60 No Prednisone at discharge or at 1 year (N = 384)
Prednisone at discharge/not at 1 year (N = 371)
50
0 1 2 3 4 5 6 7 8 9 10
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION
Kaplan-Meier Survival Based on Prednisone Use for a Recent Era
Conditional on Survival to 1 Year (Transplants: January 1998 – June 2008)
100
90
Survival (%)
80
70
Prednisone use at discharge and 1 year (N = 1,644) p = 0.0147
60 No Prednisone at discharge or at 1 year (N = 384)
Prednisone at discharge/not at 1 year (N = 371)
50
0 1 2 3 4 5 6 7 8 9
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION
Kaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use at Discharge
(Transplants: January 1998 - June 2008)
Conditional on Survival to 14 Days
100
p = 0.2594
90
Survival (%)
80
70
Tacrolimus use at discharge (N = 1,423)
60
Cyclosporine use at discharge (N = 1,482)
50
0 1 2 3 4 5 6 7 8 9
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION
Kaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use
Conditional on Survival to 1 Year (Transplants: January 1998 - June 2008)
100
p = 0.0333
90
Survival (%)
80
70
Cyclosporine use at discharge and 1 year (N = 902)
60 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)
50
0 1 2 3 4 5 6 7 8 9
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION
Kaplan-Meier Survival Based on Treated Rejection within 1st Year
Conditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2008)
100
90
Survival (%)
80
p = 0.1693
70
60
Free from Rejection during 1 year (N = 526)
Treated Rejection within 1st Year (N = 283)
50
0 1 2 3 4
Treated rejection = Recipient was reported to (1) have at
Years least one acute rejection episode that was treated with an
anti-rejection agent; or (2) have been hospitalized for
rejection.
ISHLT 2010 No rejection = Recipient had (i) no acute rejection
episodes and (ii) was reported either as not hospitalized
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 for rejection or did not receive anti-rejection agents.
PEDIATRIC HEART TRANSPLANTATION
Kaplan-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)
100
90
Survival (%)
Free from Rejection: CyA vs. TAC p = 0.2682
80
Treated Rejection: CyA vs. TAC p = 0.1586
CyA: Rejection vs. no rejection p = 0.6131
TAC: Rejection vs. no rejection p = 0.1430
70
CyA: Free from Rejection during 1 year (N = 144)
CyA: Treated Rejection within 1st Year (N = 101)
60
TAC: Free from Rejection during 1 year (N = 347)
TAC: Treated Rejection within 1st Year (N = 150)
50
0 1 2 3 4
Treated rejection = Recipient was reported to (1) have at
Years least one acute rejection episode that was treated with an
anti-rejection agent; or (2) have been hospitalized for
rejection.
ISHLT 2010 No rejection = Recipient had (i) no acute rejection
episodes and (ii) was reported either as not hospitalized
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 for rejection or did not receive anti-rejection agents.
PEDIATRIC HEART TRANSPLANTATION
Kaplan-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)
100
90
Survival (%)
80 Free from Rejection: CyA vs. TAC p = 0.8741
Rejection: CyA vs. TAC p = 0.7176
CyA: Rejection vs. no rejection p = 0.8305
TAC: Rejection vs. no rejection p = 0.3347
70
CyA: Free from Rejection during 1 year (N = 103)
CyA: Treated Rejection within 1st Year (N = 69)
60
TAC: Free from Rejection during 1 year (N = 221)
TAC: Treated Rejection within 1st Year (N = 83)
50
0 1 2 3 4
Years 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.
ISHLT 2010 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.
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART TRANSPLANTATION
Kaplan-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)
100
90
Survival (%)
Free from Rejection: CyA vs. TAC p = 0.0338
80
Rejection: CyA vs. TAC p = 0.1014
CyA: Rejection vs. no rejection p = 0.1693
TAC: Rejection vs. no rejection p = 0.3492
70
CyA: Free from Rejection during 1st Year (N = 41)
CyA: Treated Rejection within 1st Year (N =32)
60
TAC: Free from Rejection during 1st Year (N = 126)
TAC: Treated Rejection within 1st Year (N = 67)
50
0 1 2 3 4
Treated rejection = Recipient was reported to (1) have at
Years least one acute rejection episode that was treated with an
anti-rejection agent; or (2) have been hospitalized for
rejection.
ISHLT 2010 No rejection = Recipient had (i) no acute rejection
episodes and (ii) was reported either as not hospitalized
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 for rejection or did not receive anti-rejection agents.
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)
% experiencing acute rejection within 1 year
70 No induction Used, Treatment No induction Used, No Treatment
60 Induction Used (no OKT3), Treatment Induction Used (no OKT3), No Treatment
50
40
30
20
10
0
Overall <1 1-10 10-17 Female Male
Treated rejection = Recipient was reported to (1) have at least
Overall: p = 0.6601 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
ISHLT 2010 receive anti-rejection agents.
Analysis is limited to patients who
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 were alive at the time of the follow-up
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)
70 No induction, Treatment No induction, No Treatment
% experiencing acute rejection within 1 year
Polyclonal, Treatment Polyclonal, No Treatment
IL2R-antagonist, Treatment IL2R-antagonist, No Treatment
60
50
40
30
20
10
0 Overall <1 1-10 10-17 Female Male
Treated rejection = Recipient was reported to (1) have at least
No comparisons were statistically significant at 0.05. 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
ISHLT 2010
did not receive anti-rejection agents.
Analysis is limited to patients who
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 were alive at the time of the follow-up
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)
CyA + No induction, Treatment CyA + No induction, No Treatment
% experiencing acute rejection within
70 CyA + Induction (no OKT3), Treatment CyA + Induction (no OKT3), No Treatment
TAC + No induction, Treatment TAC + No induction, No Treatment
TAC + Induction (no OKT3), Treatment TAC + Induction (no OKT3), No Treatment
60
50
1 year
40
30
20
10
0
Overall <1 1-10 10-17
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) 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
ISHLT 2010
reported either as not hospitalized for rejection or did not receive anti-
rejection agents.
Analysis is limited to patients who were alive at the time
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 of the follow-up
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)
Cyclosporine + MMF, Treatment Cyclosporine + MMF, No Treatment
% experiencing acute rejection within
Cyclosporine + AZA, Treatment Cyclosporine + AZA, No Treatment
70 Tacrolimus + MMF, Treatment Tacrolimus + MMF, No Treatment
Tacrolimus + AZA, Treatment Tacrolimus + AZA, No Treatment
60
50
1 year
40
30
20
10
0
Overall <1 1-10 10-17
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.
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
ISHLT 2010
reported either as not hospitalized for rejection or did not receive anti-
rejection agents.
Analysis is limited to patients who were alive at the time
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 of the follow-up
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)
% experiencing acute rejection within 1 year
Cyclosporine, Treatment Cyclosporine, No Treatment
60 Tacrolimus, Treatment Tacrolimus, No Treatment
50
40
30
20
10
0
Overall <1 1-10 10-17
Overall: CyA vs. TAC (p < 0.0001) Treated rejection = Recipient was reported to (1) have at least
<1: CyA vs. TAC (p=0.0356) one acute rejection episode that was treated with an anti-
1-10: CyA vs. TAC (p < 0.0001) rejection agent; or (2) have been hospitalized for rejection.
11-17: CyA vs. TAC (p < 0.0001) No rejection = Recipient had (i) no acute rejection episodes
ISHLT 2010
and (ii) was reported either as not hospitalized for rejection or
did not receive anti-rejection agents.
Analysis is limited to patients who were alive at the
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 time of the follow-up
FREEDOM FROM CORONARY ARTERY VASCULOPATHY
For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009)
100
90
% Freedom from CAV
80
70
60
50
0 1 2 3 4 5 6 7 8 9 10
Years
ISHLT 2010
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)
Stratified by Induction
100
90
% Freedom from CAV
80
p = 0.5133
70
60 Induction (N = 1,455)
No Induction (N = 1,880)
50
0 1 2 3 4 5 6 7 8 9
Years
ISHLT 2010
J 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
100
% Freedom from CAV
90
80
p = 0.6217
70
Cyclosporine use at discharge and 1 year (N = 850)
Tacrolimus use at discharge and 1 year (N = 960)
60
Cyclosporine use at discharge/Tacrolimus at 1 year (N = 252)
Tacrolimus use at discharge/Cyclosporine at 1 year (N = 29)
50
0 1 2 3 4 5 6 7 8
Years
ISHLT 2010
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)
Stratified by Age Group
100
% Freedom from CAV
90
80
p < 0.0001
70
<1 Year (N = 869)
60 1-10 Years (N = 1,251)
11-17 Years (N = 1,230)
50
0 1 2 3 4 5 6 7 8 9 10
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM CORONARY ARTERY VASCULOPATHY
For Pediatric Heart Recipients (Follow-ups: January 1999-June 2009)
Stratified by Age Group
100
90
% Freedom from CAV
80
p < 0.0001
70
<1 Year (N = 623)
1-10 Years (N = 950)
60
11-17 Years (N = 948)
50
0 1 2 3 4 5 6 7 8
Years
ISHLT 2010
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)
Stratified by Ischemia Time
100
90
% Freedom from CAV
80
p = 0.0080
70
0-<2 hours (N=349)
60
2-<4 hours (N=1,705)
4+ hours (N=1,067)
50
0 1 2 3 4 5 6 7 8 9
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM CORONARY ARTERY VASCULOPATHY
For Pediatric Heart Recipients (Follow-ups: January 1999 - June 2009)
Stratified by Ischemia Time for Recent Era
100
90
% Freedom from CAV
80
p = 0.0105
70
0-<2 hours (N=234)
60
2-<4 hours (N=1,271)
4+ hours (N=808)
50
0 1 2 3 4 5 6 7
Years
ISHLT 2010
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)
Stratified by Ischemia Time and Recipient Age
100
90
% Freedom from CAV
80
0-10 years: p = 0.0049;
11-17 years: p = 0.3641
70
0-<2 hours/0-10 years (N=197)
2+ hours/0-10 years (N=1,776)
60
0-<2 hours/11-17 years (N=152)
2+ hours/11-17 years (N=996)
50
0 1 2 3 4 5 6 7 8 9
Years
ISHLT 2010
J 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)
100
Stratified by Age Group
Survival since Report of CAV (%)
<1 Year (N = 86)
90
1-10 Years (N = 150)
80
11-17 Years (N = 198)
70
60
50
40
30
20
p = 0.6115
10
0
0 0.5 1 1.5 2 2.5 3 3.5 4
Time since Report of CAV (Years)
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM SEVERE RENAL DYSFUNCTION*
For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009)
100
% Freedom from Severe
90
Renal Dysfunction
80
* Severe renal dysfunction = Creatinine > 2.5 mg/dl
(221 μmol/L), dialysis or renal transplant
70
60
50
0 1 2 3 4 5 6 7 8 9 10
Years
ISHLT 2010
J 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
100
% Freedom from Severe
90
Renal Dysfunction
p = 0.1311
80
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis
or renal transplant
70
Cyclosporine use at discharge and 1 year (N = 887)
Tacrolimus use at discharge and 1 year (N = 1,054)
60
Cyclosporine use at discharge/Tacrolimus at 1 year (N = 258)
Tacrolimus use at discharge/Cyclosporine at 1 year (N = 30)
50
0 1 2 3 4 5 6 7 8
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM RENAL REPLACEMENT THERAPY*
For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009)
100
% Freedom from Renal
90
Replacemetn Therapy
80
* Renal replacement therapy = dialysis or renal
transplant
70
60
50
0 1 2 3 4 5 6 7 8 9 10
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICS
Cumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2009)
Malignancy/Type 1-Year 5-Year 10-Year
Survivors Survivors 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 Lymph 64 77 31
Type 4 6 3
Other
Skin 1 1
Type Not Reported 1
NOTE: Multiple types may be reported; sum of types
may be greater than total number with malignancy.
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM MALIGNANCY
For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009)
100
% Freedom from Malignancy
95
90
85
All malignancy Lymph Skin Other
80
0 1 2 3 4 5 6 7 8 9 10 11 12
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM MALIGNANCY
For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009)
Stratified by Tacrolimus vs. Cyclosporine Use
Conditional on Survival to 1 Year
100
% Freedom from Malignancy
p = 0.0214
95
90
Cyclosporine use at discharge and 1 year (N = 900)
85 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)
80
0 1 2 3 4 5 6 7 8 9
Years
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
FREEDOM FROM LYMPHOMA
For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009)
Stratified by Induction
100
% Freedom from Lymphoma
95
p = 0.7922
90
85
Induction No Induction
80
0 1 2 3 4 5 6 7 8 9 10
Years
ISHLT 2010
J 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 % HTN reported between 1 and
Immunosuppression at 3 years
discharge and 1 year P-value
For Patients For Patients
on drug 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
ISHLT 2010
J 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 % HTN reported between 3 and
Immunosuppression at 8 years
discharge and 1 year P-value
For Patients For Patients
on drug 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
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
PEDIATRIC HEART RECIPIENTS
Relationship of Rejection and Coronary Artery Vasculopathy
(Follow-ups: July 2004 – June 2009)
Rejection Reported CAV between 1st and 3rd years
During 1st post-transplant
Year
Yes No All
Yes 9 168 177
5.1% 94.9% 100%
No 9 255 264
3.4% 96.6% 100%
p = 0.3834
ISHLT 2010
J 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 31 Days - 1 >1 Year - 3 >3 Years - 5 >5 Years - 10 >10 Years
(N = 475) Year (N = Years (N = 318) Years (N = 246) Years (N = 371) (N = 197)
443)
CORONARY ARTERY
5 (1.1%) 30 (6.8%) 62 (19.5%) 72 (29.3%) 105 (28.3%) 54 (27.4%)
VASCULOPATHY
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
48 (10.1%) 56 (12.6%) 10 (3.1%) 7 (2.8%) 10 (2.7%) 10 (5.1%)
FAILURE
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%)
ISHLT 2010
J 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 31 Days - 1 >1 Year - 3 >3 Years - 5 >5 Years - 10 >10 Years
(N = 226) Year (N = 266) Years (N = 202) Years (N = 173) Years (N = 306) (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,
1 (0.4%) 1 (0.5%) 1 (0.6%) 4 (1.3%) 9 (4.7%)
OTHER
CMV 8 (3.0%) 1 (0.5%)
INFECTION, NON-
27 (11.9%) 34 (12.8%) 12 (5.9%) 3 (1.7%) 14 (4.6%) 16 (8.4%)
CMV
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
29 (12.8%) 43 (16.2%) 9 (4.5%) 6 (3.5%) 8 (2.6%) 10 (5.3%)
FAILURE
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%)
ISHLT 2010
J 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)
40 CAV Acute Rejection Infection (non-CMV)
Primary Failure Graft Failure
Percentage of Deaths
30
20
10
0
0-30 Days (N 31 Days – 1 >1 Year – 3 >3 Years – 5 >5 Years – 10 >10 Years (N
= 226) Year (N = Years (N = Years (N = Years (N = = 190)
266) 173) 173) 306 )
ISHLT 2010
J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
