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2002 ISHLT HEART TRANSPLANTATION Pediatric Recipients.

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Presentation on theme: "2002 ISHLT HEART TRANSPLANTATION Pediatric Recipients."— Presentation transcript:

1 2002 ISHLT HEART TRANSPLANTATION Pediatric Recipients

2 2002 ISHLT AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS ( )

3 2002 ISHLT AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS ( )

4 2002 ISHLT AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS By Year of Transplant Number of Transplants * Numbers may be low due to delayed reporting.

5 2002 ISHLT NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS * Numbers may be low due to delayed reporting

6 2002 ISHLT DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year)

7 2002 ISHLT DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 1-10 Years)

8 2002 ISHLT DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: Years)

9 2002 ISHLT PEDIATRIC HEART TRANSPLANTATION Actuarial Survival ( ) <1 year vs years: p = <1 year vs years: p = 0.001

10 2002 ISHLT PEDIATRIC HEART TRANSPLANTATION Conditional Actuarial Survival ( ) Both comparisons with years significant at p <

11 2002 ISHLT PEDIATRIC HEART TRANSPLANTATION Conditional Actuarial Survival for Recent Era ( ) Comparison of <1 vs years significant at p = 0.01

12 2002 ISHLT PEDIATRIC HEART TRANSPLANTATION Actuarial Survival by Era ( ) All comparisons with are significant at p < Comparison of vs was significant at p = Comparison of vs was significant at p < Survival (%)

13 2002 ISHLT PEDIATRIC HEART TRANSPLANTATION Actuarial Survival by Age Group For Diagnosis = Cardiomyopathy ( ) Survival (%) No comparisons were statistically significant.

14 2002 ISHLT PEDIATRIC HEART TRANSPLANTATION Actuarial Survival By Age Group For Diagnosis = Congenital Disease ( ) Comparison of <1 vs was significant at p = 0.01 Survival (%)

15 2002 ISHLT PEDIATRIC HEART TRANSPLANTS ( ) Risk Factors For 1 Year Mortality In Descending Order of Magnitude N=1,554

16 2002 ISHLT PEDIATRIC HEART TRANSPLANTS ( ) Risk Factors for 1 Year Mortality Continuous Factors N=1,554

17 2002 ISHLT PEDIATRIC HEART TRANSPLANTS ( ) Factors Not Significant for 1 Year Mortality Previous Transplant Donor history of hypertension Height (recipient/donor) Weight (recipient/donor) Gender (recipient/donor) Age (donor) Year of transplant In ICU or hospital Donor clinical infection ICD Ischemia time Center volume PRA Total bilirubin

18 2002 ISHLT PEDIATRIC HEART TRANSPLANTS (April December 1996) Risk Factors For 5 Year Mortality In Descending Order of Magnitude N=937

19 2002 ISHLT PEDIATRIC HEART TRANSPLANTS (April December 1996) Risk Factors For 5 Year Mortality Continuous Factors N=937

20 2002 ISHLT PEDIATRIC HEART TRANSPLANTS (April December 1996) Factors Not Significant for 5 Year Mortality Donor history of hypertension Height (recipient/donor) Weight (donor) Gender (donor) Age (donor) Donor cause of death In ICU or hospital Donor clinical infection ICD Ischemia time Center volume PRA Total bilirubin

21 2002 ISHLT PEDIATRIC HEART TRANSPLANTS (April December 1996) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year In Descending Order of Magnitude N=728

22 2002 ISHLT PEDIATRIC HEART RECIPIENTS Functional Status (April 1994-December 2001)

23 2002 ISHLT PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant (April December 2001)

24 2002 ISHLT PEDIATRIC HEART RECIPIENTS Induction Immunosuppression For follow-ups between October 1999 and December 2001

25 2002 ISHLT PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Any Time During Follow-up Period For follow-ups between October 1999 and December 2001

26 2002 ISHLT PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between October 1999 and December 2001

27 2002 ISHLT PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between October 1999 and December Year Follow-up (N=429)5 Year Follow-up (N = 303)

28 2002 ISHLT PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between October 1999 and December 2001

29 2002 ISHLT POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Incidence for Survivors (April 1994-December 2001)

30 2002 ISHLT Freedom from CAV For Pediatric Heart Recipients (April 1994-December 2000)

31 2002 ISHLT Freedom from Renal Dysfunction* For Pediatric Heart Recipients (April 1994-December 2000) * Renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant

32 2002 ISHLT MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICS Cumulative Incidence for Survivors (April 1994-December 2001) Malignancy/Type1-Year Survivors5-Year Survivors No Malignancy1,547 (98.2%)378 (95.2%) Malignancy (all types combined)29 (1.8%)19 (4.8%) Malignancy Type Lymph2518 Other31 Type Not Reported1

33 2002 ISHLT Freedom from Malignancy For Pediatric Heart Recipients (April 1994-December 2000)

34 2002 ISHLT PEDIATRIC HEART TRANSPLANTATION Actuarial Survival Based on Prednisone Use p = 0.005

35 2002 ISHLT PEDIATRIC HEART TRANSPLANTATION Actuarial Survival Based on Rejection within 1 st Year P = 0.09

36 2002 ISHLT PEDIATRIC HEART RECIPIENTS Relationship of Prednisone Use and CAD Transplants: April 1994 – December 1999 Prednisone Use at Discharge and at 1 Year Reported CAD between 1 st and 2 nd years post- transplant Reported CAD between 1 st and 3 rd years post- transplant YesNoYesNo Yes28 4.8% % % % No4 2.8% % 2 2.0% % p = 0.4 p = 0.06

37 2002 ISHLT PEDIATRIC HEART RECIPIENTS Relationship of Rejection and CAD Transplants: April 1994 – December 1999 Rejection During 1 st Year Reported CAD between 1 st and 2 nd years post- transplant Reported CAD between 1 st and 3 rd years post- transplant YesNoYesNo Yes19 5.3% % % % No6 1.8% % 7 3.2% % p = 0.02 p = 0.09

38 2002 ISHLT PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 1 and 3 Years Maintenance Immunosuppression at discharge and 1 year On immuno: % HTN reported between 1 and 3 years Not on immuno: % HTN reported between 1 and 3 years P-value Cyclosporine20.3%15.7%0.6 Tacrolimus20.5%19.4%0.8 Azathioprine22.3%15.3%0.3 Prednisone29.9%6.4%<0.0001

39 2002 ISHLT PEDIATRIC HEART RECIPIENTS Incidence of Hypertension by 3 Years Maintenance Immunosuppression at discharge and 1 year On immuno: % HTN reported by 3 years Not on immuno: % HTN reported by 3 years P-value Cyclosporine48.8%40.6%0.2 Tacrolimus44.2%46.2%0.8 Azathioprine51.1%42.4%0.1 Prednisone59.5%12.1%<0.0001

40 2002 ISHLT PEDIATRIC HEART RECIPIENTS Growth Following Transplantation: Height Stratified by Prednisone Use at Discharge and at 1 Year

41 2002 ISHLT PEDIATRIC HEART RECIPIENTS Growth Following Transplantation: Weight Stratified by Prednisone Use at Discharge and at 1 Year

42 2002 ISHLT PEDIATRIC HEART RECIPIENTS: Time of Death ( )

43 2002 ISHLT PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death ( ) Timing of Death Cause of Death (%)

44 2002 ISHLT PEDIATRIC HEART TRANSPLANTS RECIPIENTS: CAUSE OF DEATH BY ERA: Deaths in 0-30 Days

45 2002 ISHLT PEDIATRIC HEART TRANSPLANTS RECIPIENTS: CAUSE OF DEATH BY ERA: Deaths in 31 Days - 1 Year

46 2002 ISHLT PEDIATRIC HEART TRANSPLANTS RECIPIENTS: CAUSE OF DEATH BY ERA: Deaths in >1 Year - 3 Years

47 2002 ISHLT PEDIATRIC HEART TRANSPLANTS RECIPIENTS: CAUSE OF DEATH BY ERA: Deaths in >3 Years - 5 Years


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