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HEART TRANSPLANTATION Pediatric Recipients ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095.

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Presentation on theme: "HEART TRANSPLANTATION Pediatric Recipients ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095."— Presentation transcript:

1 HEART TRANSPLANTATION Pediatric Recipients ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

2 NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

3 AVERAGE CENTER VOLUME AND PERCENTAGE OF TRANSPLANTS BY CENTER VOLUME Pediatric Heart Transplants: January 1, 2000 - June 30, 2011 ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

4 PEDIATRIC HEART TRANSPLANTS Distribution of Transplants By Location and Average Center Volume (Transplants: January 2000 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

5 DISTRIBUTION OF TRANSPLANTS By Center Volume Pediatric Heart Transplants: January 1, 2000 - June 30, 2011 ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

6 AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS (Transplants: January 2000 - June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

7 AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS By Year of Transplant ISHLT 2012 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. J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

8 PEDIATRIC HEART TRANSPLANTS Age Distribution By Location (Transplants: January 2000 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

9 AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS (Transplants: January 2000 - June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

10 PEDIATRIC HEART TRANSPLANTS Donor Age Distribution By Location (Transplants: January 2000 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

11 DISTRIBUTION OF TRANSPLANTS by Donor/Recipient Weight Ratio (Pediatric Heart Transplants: January 1, 2000 - June 30, 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

12 DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

13 DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 1-10 Years) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

14 DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 11-17 Years) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

15 PEDIATRIC HEART TRANSPLANTS Diagnosis Distribution By Location (Transplants: January 2000 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

16 PEDIATRIC HEART RECIPIENTS % of Patients Bridged with Mechanical Circulatory Support* by Year (Transplants: January 2005 – December 2010) ISHLT 2012 * LVAD, RVAD, TAH, ECMO J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

17 PEDIATRIC HEART RECIPIENTS % of Patients Bridged with Mechanical Circulatory Support* (Transplants: July 2004 – June 2011) ISHLT 2012 * LVAD, RVAD, TAH, ECMO J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

18 PEDIATRIC HEART RECIPIENTS % of Patients Bridged with Mechanical Circulatory Support* by Age Group (Transplants: July 2004 – June 2011) ISHLT 2012 * LVAD, RVAD, TAH, ECMO J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

19 PEDIATRIC HEART RECIPIENTS PRA Distribution by Year (Transplants: 2005 – 2010) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

20 PEDIATRIC HEART RECIPIENTS PRA Distribution by Age Group (Transplants: July 2004 – June 2011) ISHLT 2012 p-value = 0.0001 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

21 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival (Transplants: 1/1982-6/2010) ISHLT 2012 0-<1 vs. 1-10: p = 0.0041 0-<1 vs. 11-17: p = 0.9859 1-10 vs. 11-17: p = 0.0003 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

22 PEDIATRIC HEART TRANSPLANTS Conditional Kaplan-Meier Survival (Transplants: 1/1982-6/2010) ISHLT 2012 0-<1 vs. 1-10: p = 0.0003 0-<1 vs. 11-17: p < 0.0001 1-10 vs. 11-17: p < 0.0001 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

23 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2010) ISHLT 2012 All p-values significant at p = 0.001 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

24 PEDIATRIC HEART TRANSPLANTS Conditional Kaplan-Meier Survival for Recent Era (Transplants: 1/2000-6/2010) ISHLT 2012 0-<1 vs. 1-10: p = 0.0272 0-<1 vs. 11-17: p = 0.0008 1-10 vs. 11-17: p < 0.0001 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

25 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2010) Age: < 1 Year ISHLT 2012 1982-1989 vs. 1990-1999: p = 0.0057 1982-1989 vs. 2000-6/2010: p < 0.0001 1990-1999 vs. 2000-6/2010: p < 0.0001 Half-life 1982-1989: 10.8 years; 1990-1999: 18.3 years; 2000-6/2010: n.c. J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

26 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2010) Age: 1-10 Years ISHLT 2012 All p-values significant at p = 0.0001 Half-life 1982-1989: 8.0; 1990-1999: 14.3; 2000-6/2010: n.c. J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

27 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2010) Age: 11-17 Years ISHLT 2012 1982-1989 vs. 1990-1999: p = 0.0158 1982-1989 vs. 2000-6/2010: p < 0.0001 1990-1999 vs. 2000-6/2010: p = 0.0311 Half-life 1982-1989: 9.3; 1990-1999: 11.4; 2000-6/2010: n.c. J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

28 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival by Diagnosis (Transplants: 2000-6/2010) Age: < 1 Year ISHLT 2012 p-value < 0.0001 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

29 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival by Diagnosis (Transplants: 2000-6/2010) Age: 1 - 10 Years ISHLT 2012 Congenital vs. Cardiomyopathy: p < 0.0001 Congenital vs. Retransplant: p = 0.0154 Cardiomyopathy vs. Retransplant: p < 0.0001 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

30 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival by Diagnosis (Transplants: 2000-6/2010) Age: 11 - 17 Years ISHLT 2012 Congenital vs. Cardiomyopathy: p = 0.0526 Congenital vs. Retransplant: p = 0.1841 Cardiomyopathy vs. Retransplant: p=0.0024 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

31 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Patient vs. Graft Survival (Transplants: 1/2000-6/2010) Average Center Volume: 1-4 Transplants per Year ISHLT 2012 p = 0.1973 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

32 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Patient vs. Graft Survival (Transplants: 1/2000-6/2010) Average Center Volume: 5-9 Transplants per Year ISHLT 2012 p = 0.0580 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

33 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Patient vs. Graft Survival (Transplants: 1/2000-6/2010) Average Center Volume: 10+ Transplants per Year ISHLT 2012 p = 0.0135 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

34 PEDIATRIC HEART RECIPIENTS Cross-Sectional Analysis Functional Status of Surviving Recipients (Follow-ups: January 2000 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

35 PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: January 2000 – June 2011) Age: <1 Year ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

36 PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: January 2000 – June 2011) Age: 1-10 Years ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

37 PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: January 2000 – June 2011) Age: 11-17 Years ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

38 PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients US Recipients Only (Follow-ups: March 2005 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

39 PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: January 2000 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

40 PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (T ransplants: January 2001 – June 2011) ISHLT 2012 Analysis is limited to patients who were alive at the time of the discharge J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

41 PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Transplants: January 2001 – June 30, 2011) ISHLT 2012 Analysis is limited to patients who were alive at the time of the discharge Test of increasing trend over time: Any induction p < 0.0001 Polyclonal p < 0.0001 IL-2R p < 0.0001 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

42 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival by Induction Group Conditional on Survival to 14 Days (Transplants: January 2000 – June 2010) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

43 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival by Induction Group and Treated Rejection Between Transplant Discharge and 1-Year Follow-up (1-Year Follow-ups: July 2004 - June 2010) Conditional on Survival to 1 Year ISHLT 2012 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. J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

44 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival by Induction Group Conditional on Survival to 14 Days (Transplants: January 2000 – June 2010) Age: <1 Year ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

45 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival by Induction Group Conditional on Survival to 14 Days (Transplants: January 2000 – June 2010) Age: 1-10 Years ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

46 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival by Induction Group Conditional on Survival to 14 Days (Transplants: January 2000 – June 2010) Age: 11-17 Years ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

47 PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January 2001 – June 2011) ISHLT 2012 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

48 PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up for Same Patients at Each Time Point (Follow-ups: January 2001 – June 2011) ISHLT 2012 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

49 PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up (Follow-ups: January 2001 – June 2011) ISHLT 2012 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 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

50 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival Based on Prednisone Use Conditional on Survival to 1 Year (Transplants: January 2000 - June 2010) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

51 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use at Discharge Conditional on Survival to 14 Days (Transplants: January 2000 - June 2010) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

52 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year (Transplants: January 2000 - June 2010) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

53 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival Based on Treated Rejection within 1 st Year Conditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2010) ISHLT 2012 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. J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

54 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival Based on Treated Rejection within 1 st Year Stratified by Calcineurin Use at Discharge Conditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2010) ISHLT 2012 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. J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

55 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival Based on Treated Rejection within 1 st Year Stratified by Calcineurin Use at Discharge: Age = 0-10 Years Conditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2010) ISHLT 2012 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. J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

56 PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival Based on Treated Rejection within 1 st Year Stratified by Calcineurin Use at Discharge: Age = 11-17 Years Conditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2010) ISHLT 2012 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. J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

57 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up Stratified by Era (Follow-ups: July 2004 - June 2011) ISHLT 2012 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. J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

58 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up Stratified by Induction (Follow-ups: July 2004 - June 2011) ISHLT 2012 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. J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

59 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up Stratified by Type of Induction (Follow-ups: July 2004 - June 2011) ISHLT 2012 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. J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

60 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up Stratified by Maintenance Immunosuppression and Induction (Follow-ups: July 2004 - June 2011) ISHLT 2012 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. J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

61 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up Stratified by Maintenance Immunosuppression (Follow-ups: July 2004 - June 2011) ISHLT 2012 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. J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

62 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up Stratified by Stratified by Calcineurin Inhibitor Use at Discharge (Follow-ups: July 2004 - June 2011) ISHLT 2012 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. J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

63 Freedom from Coronary Artery Vasculopathy For Pediatric Heart Recipients (Follow-ups: April 1994 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

64 Freedom from Coronary Artery Vasculopathy For Pediatric Heart Recipients (Follow-ups: April 1994 – June 2011) Stratified by Induction ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

65 Freedom from Coronary Artery Vasculopathy For Pediatric Heart Recipients (Follow-ups: 2000 – June 2011) Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

66 Freedom from Coronary Artery Vasculopathy For Pediatric Heart Recipients (Follow-ups: 2000 – June 2011) Stratified by Age Group ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

67 Freedom from Coronary Artery Vasculopathy For Pediatric Heart Recipients (Follow-ups: 2000 – June 2011) Stratified by Ischemia Time ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

68 Freedom from Coronary Artery Vasculopathy For Pediatric Heart Recipients (Follow-ups: 2000 – June 2011) Stratified by Ischemia Time and Recipient Age ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

69 Graft Survival Following Report of Coronary Artery Vasculopathy For Pediatric Heart Recipients (Follow-ups: 2000 – June 2011) Stratified by Age Group ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

70 Freedom from Severe Renal Dysfunction* For Pediatric Heart Recipients (Follow-ups: 2000 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

71 Freedom from Severe Renal Dysfunction* For Pediatric Heart Recipients (Follow-ups: 2000 – June 2011) Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

72 Freedom from Renal Replacement Therapy For Pediatric Heart Recipients (Follow-ups: April 1994 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

73 Malignancy Post-Heart Transplant for Pediatrics Cumulative Morbidity Rates in Survivors (Follow-ups: April 1994 – June 2011) Malignancy/Type 1-Year Survivors 5-Year Survivors 10-Year Survivors No Malignancy 4,358 (98.3%)1,900 (95.1%)579 (91.2%) Malignancy (all types combined) 76 (1.7%)97 (4.9%)56 (8.8%) Malignancy Type* Lymphoma 709253 Other 554 Skin 011 Type Not Reported 100 *Recipients may have experienced more than one type of malignancy so sum of individual malignancy types may be greater than total number with malignancy. ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

74 FREEDOM FROM MALIGNANCY For Pediatric Heart Recipients (Follow-ups: April 1994 – June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

75 FREEDOM FROM MALIGNANCY by Maintenance Immunosuppression Combinations at Discharge For Pediatric Heart Recipients (Follow-ups: January 2000 - June 2011) Conditional on Survival to 1 year ISHLT 2012 p = 0.0385 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

76 FREEDOM FROM LYMPHOMA BY INDUCTION For Pediatric Heart Recipients (Follow-ups: April 1994 – June 2011) ISHLT 2012 p = 0.5803 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

77 PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 1 and 3 Years (Transplants: January 2000 - June 2008) Maintenance Immunosuppression at discharge and 1 year % HTN reported between 1 and 3 years P-value For Patients on drug For Patients not on drug Azathioprine20.124.90.1917 Cyclosporine24.721.60.3397 MMF/MPA23.823.90.9864 Prednisone26.920.90.0987 Sirolimus/Everolimus35.723.30.3363 Tacrolimus23.424.30.7847 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 ISHLT 2012

78 PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 3 and 5 Years (Transplants: January 2000 - June 2006) Maintenance Immunosuppression at discharge and 1 year % HTN reported between 3 and 5 years P-value For Patients on drug For Patients not on drug Azathioprine13.117.50.3137 Cyclosporine14.217.00.5003 MMF/MPA15.316.10.8745 Prednisone18.810.00.0607 Sirolimus/Everolimus16.716.1> 0.9999 Tacrolimus17.714.80.4838 ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

79 PEDIATRIC HEART RECIPIENTS Relationship of Rejection and Coronary Artery Vasculopathy (Follow-ups: July 2004 – June 2011) Rejection During 1 st Year Reported CAV between 1 st and 3 rd years post-transplant YesNo All Yes17 5.4% 300 94.6% 317 100% No25 4.6% 521 95.4% 546 100% p = 0.6058 ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

80 PEDIATRIC HEART RETRANSPLANTS Kaplan-Meier Survival Rates Stratified by Inter-Transplant Interval (Re-transplants: January 1994 - June 2010) Only patients who were less than 18 years old at the time of re-transplant are included. ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

81 PEDIATRIC HEART RE-TRANSPLANTS By Transplant Year (Re-transplants: January 1994 – December 2010) Only patients who were less than 18 years old at the time of re-transplant are included. ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

82 PEDIATRIC HEART RE-TRANSPLANTS By Inter-transplant Interval (Re-transplants: January 1994 - June 2011) 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 ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

83 PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 2000 - June 2011) CAUSE OF DEATH 0-30 Days (N = 240) 31 Days - 1 Year (N = 282) >1 Year - 3 Years (N = 240) >3 Years - 5 Years (N = 191) >5 Years - 10 Years (N = 335) >10 Years (N = 262) CORONARY ARTERY VASCULOPATHY 3 (1.3%)14 (5.0%)40 (16.7%)47 (24.6%)84 (25.1%)71 (27.1%) ACUTE REJECTION22 (9.2%)50 (17.7%)47 (19.6%)24 (12.6%)43 (12.8%)13 (5.0%) LYMPHOMA 6 (2.1%)5 (2.1%)7 (3.7%)26 (7.8%)20 (7.6%) MALIGNANCY, OTHER 1 (0.4%)3 (1.3%)1 (0.5%)5 (1.5%)10 (3.8%) CMV 7 (2.5%)1 (0.4%) INFECTION, NON-CMV30 (12.5%)37 (13.1%)16 (6.7%)8 (4.2%)14 (4.2%)18 (6.9%) GRAFT FAILURE80 (33.3%)42 (14.9%)74 (30.8%)66 (34.6%)106 (31.6%)75 (28.6%) TECHNICAL20 (8.3%)2 (0.7%)1 (0.4%)1 (0.5%)4 (1.2%)6 (2.3%) OTHER16 (6.7%)23 (8.2%)27 (11.3%)16 (8.4%)26 (7.8%)21 (8.0%) MULTIPLE ORGAN FAILURE 32 (13.3%)53 (18.8%)11 (4.6%)8 (4.2%)9 (2.7%)11 (4.2%) RENAL FAILURE 7 (2.5%)1 (0.4%)1 (0.5%)1 (0.3%)7 (2.7%) PULMONARY11 (4.6%)27 (9.6%)10 (4.2%)7 (3.7%)10 (3.0%)6 (2.3%) CEREBROVASCULAR26 (10.8%)13 (4.6%)4 (1.7%)5 (2.6%)7 (2.1%)4 (1.5%) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

84 PEDIATRIC HEART TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death (Deaths: January 2000 - June 2011) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

85 PEDIATRIC HEART TRANSPLANTS (2000-2009) Risk Factors For 1 Year Mortality VARIABLE NRelative Risk P-value95% Confidence Interval ECMO, age = 0 years1292.98<.00012.11.-4.21 Retransplant2121.980.00171.29-3.05 Congenital diagnosis13761.98<.00011.51-2.59 ECMO, age = 1-17 years1451.910.00331.24-2.93 On dialysis1081.680.00731.15-2.46 On ventilator6961.570.00031.23-2.01 Prior sternotomy8151.550.00141.19-2.02 Donor cause of death = cerebrovascular/stroke vs. head trauma 3871.450.0231.05-1.99 Male donor/female recip vs. male donor/male recip 8931.390.01251.07-1.80 Previous transfusions11551.280.04161.01-1.61 Donor cause of death = anoxia vs. head trauma3350.680.00330.53-0.88 N = 3,417 Reference group = Cardiomyopathy, no devices ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

86 PEDIATRIC HEART TRANSPLANTS (2000-2009) Borderline Significant Risk Factors For 1 Year Mortality N = 3,417 ISHLT 2012 VARIABLEN Relative Risk P-value 95% Confidence Interval Donor with prior clinical infection9120.810.08160.63-1.03 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

87 PEDIATRIC HEART TRANSPLANTS (2000-2009) Risk Factors For 1 Year Mortality Continuous Factors (see figures) Donor ageIschemia time Recipient pre-transplant creatinine ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

88 PEDIATRIC HEART TRANSPLANTS (2000-2009) Risk Factors For 1 Year Mortality with 95% Confidence Limits Donor Age p = 0.022 ISHLT 2012 (N = 3,417) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

89 PEDIATRIC HEART TRANSPLANTS (2000-2009) Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Creatinine p = 0.0381 ISHLT 2012 (N = 3,417) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

90 PEDIATRIC HEART TRANSPLANTS (2000-2009) Risk Factors For 1 Year Mortality with 95% Confidence Limits Ischemia time p = 0.0099 ISHLT 2012 (N = 3,417) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

91 PEDIATRIC HEART TRANSPLANTS (2000-2009) Age = <1 Year Risk Factors For 1 Year Mortality VARIABLE NRelative Risk P-value95% Confidence Interval ECMO, diagnosis = congenital803.09<.00011.94-4.92 PRA > 10%642.650.00061.52-4.61 ECMO, diagnosis = not congenital482.370.00571.29-4.38 On dialysis302.350.00261.35-4.10 Donor cause of death = cerebrovascular/stroke vs. head trauma 332.270.01411.18-4.36 Prior sternotomy1812.24<.00011.49-3.36 On ventilator3582.15<.00011.50-3.09 N = 902 Reference group = Congenital, no devices ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

92 PEDIATRIC HEART TRANSPLANTS (2000-2009) Age = <1 Year Borderline Significant Risk Factors For 1 Year Mortality N = 902 ISHLT 2012 VARIABLEN Relative Risk P-value 95% Confidence Interval Infection requiring IV drug therapy (within 2wk/TX)2571.400.05790.99-1.99 Transplant year: 2002-2003 vs. 2000-20011610.590.07470.33-1.05 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

93 PEDIATRIC HEART TRANSPLANTS (2000-2009) Age = <1 Year Risk Factors For 1 Year Mortality Continuous Factors (see figures) Recipient pre-transplant creatinineIschemia time Volume of pediatric transplants ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

94 PEDIATRIC HEART TRANSPLANTS (2000-2009) Risk Factors For 1 Year Mortality in Age = <1 Year Recipient Pre-Transplant Creatinine p = 0.0036 ISHLT 2012 (N = 902) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

95 PEDIATRIC HEART TRANSPLANTS (2000-2009) Risk Factors For 1 Year Mortality in Age = <1 Year Ischemia time p = 0.0005 ISHLT 2012 (N = 902) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

96 PEDIATRIC HEART TRANSPLANTS (2000-2009) Risk Factors For 1 Year Mortality in Age = <1 Year Center Volume for Pediatric Transplants p = 0.0096 ISHLT 2012 (N = 902) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

97 PEDIATRIC HEART TRANSPLANTS (2000-2009) Age = 1-10 Years Risk Factors For 1 Year Mortality VARIABLE NRelative Risk P-value95% Confidence Interval ECMO1041.960.01571.14-3.38 Previous transfusion3801.920.0011.30-2.83 Diagnosis = congenital5211.830.00491.20-2.78 Donor cause of death = anoxia vs. head trauma 3240.460.00230.28-0.76 N = 1,306 Reference group = Cardiomyopathy, no devices ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

98 PEDIATRIC HEART TRANSPLANTS (2000-2009) Age = 1-10 Year s Borderline Significant Risk Factors For 1 Year Mortality N = 1,306 ISHLT 2012 VARIABLEN Relative Risk P-value 95% Confidence Interval Female recipient6641.450.05460.99-2.11 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

99 PEDIATRIC HEART TRANSPLANTS (2000-2009) Age = 1-10 Year s Risk Factors For 1 Year Mortality Continuous Factors (see figures) Recipient ageRecipient pre-transplant creatinine Recipient heightRecipient pre-transplant bilirubin Donor BSA J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 ISHLT 2012

100 PEDIATRIC HEART TRANSPLANTS (2000-2009) Risk Factors For 1 Year Mortality in Age = 1-10 Years Recipient Age p = 0.00143 ISHLT 2012 NOTE: Due to the correlation in donor size, recipient size and recipient age, the interpretation of the impact of each factor should be considered in the context of the other factors. (N = 1,306) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

101 PEDIATRIC HEART TRANSPLANTS (2000-2009) Risk Factors For 1 Year Mortality in Age = 1-10 Years Recipient Height p = 0.0055 NOTE: Due to the correlation in donor size, recipient size and recipient age, the interpretation of the impact of each factor should be considered in the context of the other factors. (N = 1,306) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 ISHLT 2012

102 PEDIATRIC HEART TRANSPLANTS (2000-2009) Risk Factors For 1 Year Mortality in Age = 1-10 Years Donor BSA p = 0.042 ISHLT 2012 NOTE: Due to the correlation in donor size, recipient size and recipient age, the interpretation of the impact of each factor should be considered in the context of the other factors. (N = 1,306) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

103 PEDIATRIC HEART TRANSPLANTS (2000-2009) Risk Factors For 1 Year Mortality in Age = 1-10 Years Recipient Pre-Transplant Creatinine p = 0.0018 (N = 1,306) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 ISHLT 2012

104 PEDIATRIC HEART TRANSPLANTS (2000-2009) Risk Factors For 1 Year Mortality in Age = 1-10 Years Recipient Pre-Transplant Bilirubin p = 0.0052 (N = 1,306) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 ISHLT 2012

105 PEDIATRIC HEART TRANSPLANTS (2000-2009) Age = 11-17 Years Risk Factors For 1 Year Mortality VARIABLE NRelative Risk P-value95% Confidence Interval Retransplant132 2.630.00061.51-4.58 Diagnosis = congenital296 2.070.00171.31-3.25 Previous transfusion284 1.600.02921.05-2.45 Donor cause of death = anoxia vs. head trauma 162 0.360.0240.15-0.87 N = 1,200 Reference group = Cardiomyopathy, no devices J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 ISHLT 2012

106 PEDIATRIC HEART TRANSPLANTS (2000-2009) Age = 11-17 Year s Risk Factors For 1 Year Mortality Continuous Factors (see figures) Recipient pre-transplant bilirubinHeight ratio (borderline) ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

107 PEDIATRIC HEART TRANSPLANTS (2000-2009) Risk Factors For 1 Year Mortality in Age = 11-17 Years Recipient Pre-Transplant Bilirubin p = 0.0228 (N = 1,200) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 ISHLT 2012

108 PEDIATRIC HEART TRANSPLANTS (2000-2009) Risk Factors For 1 Year Mortality in Age = 11-17 Years Donor Height/Recipient Height Ratio p = 0.0574 ISHLT 2012 (N = 1,200) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

109 PEDIATRIC HEART TRANSPLANTS (1996-2005) Risk Factors For 5 Year Mortality VARIABLE NRelative Risk P-value95% Confidence Interval ECMO, age = 0 years782.50<.00011.77-3.54 ECMO, age = 11-17 years422.010.00861.19-3.40 Retransplant1791.93<.00011.44-2.59 Diagnosis = congenital12461.62<.00011.36-1.91 On dialysis771.500.02851.04-2.15 PRA > 10%2971.490.00021.21-1.85 Male donor/female recip vs. male donor/male recip 7231.370.00131.13-1.67 On ventilator5541.280.0161.05-1.67 N = 2,940 Reference group = Cardiomyopathy, no devices J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 ISHLT 2012

110 PEDIATRIC HEART TRANSPLANTS (1996-2005) Borderline Significant Risk Factors For 5 Year Mortality VARIABLE NRelative Risk P-value95% Confidence Interval Infection requiring IV drug therapy (within 2wk/TX) 4481.200.07020.99-1.46 N = 2,940 Reference group = Cardiomyopathy, no devices J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 ISHLT 2012

111 PEDIATRIC HEART TRANSPLANTS (1996-2005) Risk Factors For 5 Year Mortality Continuous Factors (see figures) Recipient ageEstimated GFR (borderline) Volume of pediatric transplants (borderline) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 ISHLT 2012

112 PEDIATRIC HEART TRANSPLANTS (1996-2005) Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient Age p = 0.0002 (N = 2,904) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 ISHLT 2012

113 PEDIATRIC HEART TRANSPLANTS (1996-2005) Risk Factors For 5 Year Mortality with 95% Confidence Limits Center Volume for Pediatric Transplants p = 0.0728 (N = 2,904) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 ISHLT 2012

114 PEDIATRIC HEART TRANSPLANTS (1996-2005) Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Estimated GFR p = 0.0687 (N = 2,904) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 ISHLT 2012

115 PEDIATRIC HEART TRANSPLANTS (1991-2000) Risk Factors For 10 Year Mortality VARIABLE NRelative Risk P-value95% Confidence Interval Retransplant1352.21<.00011.73-2.84 ECMO, age = 0 years361.80.00951.15-2.82 On ventilator4921.310.00091.12-1.54 Diagnosis = congenital15011.290.00011.13-1.46 Male donor/female recip vs. male donor/male recip 7771.270.00171.09-1.47 Transplant year: 1995/1996 vs. 1991/19926090.820.03140.68-0.98 0-3 vs. 4-6 total HLA mismatches2970.760.010.62-0.94 Transplant year: 1999/2000 vs. 1991/19927040.730.00090.61-0.88 Transplant year: 1997/1998 vs. 1991/19927070.66<.00010.55-0.80 N = 3,263 Reference group = Cardiomyopathy, no devices J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 ISHLT 2012

116 PEDIATRIC HEART TRANSPLANTS (1991-2000) Borderline Significant Risk Factors For 10 Year Mortality VARIABLE NRelative Risk P-value95% Confidence Interval Balloon pump351.590.05171.00-2.54 Diagnosis = not myopathy, congenital or retransplant 1601.280.06760.98-1.66 Donor cause of death = anoxia vs. head trauma5580.850.06240.72-1.01 N = 3,263 Reference group = Cardiomyopathy, no devices ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

117 PEDIATRIC HEART TRANSPLANTS (1991-2000) Risk Factors For 10 Year Mortality Continuous Factors (see figures) Donor ageRecipient weight Volume of pediatric transplants J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095 ISHLT 2012

118 PEDIATRIC HEART TRANSPLANTS (1991-2000) Risk Factors For 10 Year Mortality with 95% Confidence Limits Donor Age p = 0.0074 ISHLT 2012 (N = 3,263) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

119 PEDIATRIC HEART TRANSPLANTS (1991-2000) Risk Factors For 10 Year Mortality with 95% Confidence Limits Recipient Weight p = 0.0048 ISHLT 2012 (N = 3,263) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

120 PEDIATRIC HEART TRANSPLANTS (1991-2000) Risk Factors For 10 Year Mortality with 95% Confidence Limits Center Volume for Pediatric Transplants p = 0.0041 ISHLT 2012 (N = 3,263) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

121 PEDIATRIC HEART TRANSPLANTS (1988-1995) Risk Factors For 15 Year Mortality VARIABLE NRelative Risk P-value95% Confidence Interval Retransplant691.660.00241.20-2.30 Balloon pump311.620.03681.03-2.56 Recipient history of malignancy451.600.01161.11-2.31 On ventilator3971.280.00311.09-1.51 Diagnosis = congenital10761.160.04361.00-1.35 N = 2,113 Reference group = Cardiomyopathy, no devices ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

122 PEDIATRIC HEART TRANSPLANTS (1988-1995) Risk Factors For 15 Year Mortality Continuous Factors (see figures) Donor ageVolume of pediatric transplants ISHLT 2012 J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

123 PEDIATRIC HEART TRANSPLANTS (1988-1995) Risk Factors For 15 Year Mortality with 95% Confidence Limits Donor Age p = 0.0061 ISHLT 2012 (N = 2,113) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

124 PEDIATRIC HEART TRANSPLANTS (1988-1995) Risk Factors For 15 Year Mortality with 95% Confidence Limits Center Volume for Pediatric Transplants p = 0.0004 ISHLT 2012 (N = 2,113) J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095


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