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HEART TRANSPLANTATION Pediatric Recipients ISHLT 2006 J Heart Lung Transplant 2006;25:893-903.

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Presentation on theme: "HEART TRANSPLANTATION Pediatric Recipients ISHLT 2006 J Heart Lung Transplant 2006;25:893-903."— Presentation transcript:

1 HEART TRANSPLANTATION Pediatric Recipients ISHLT 2006 J Heart Lung Transplant 2006;25:

2 AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS (Transplants: January June 2005) Number of Transplants ISHLT 2006 J Heart Lung Transplant 2006;25:

3 AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS (Transplants: January June 2005) Number of Transplants ISHLT 2006 J Heart Lung Transplant 2006;25:

4 AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS By Year of Transplant Number of Transplants ISHLT 2006 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 declined in recent years. J Heart Lung Transplant 2006;25:

5 NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS Number of Pediatric Cases Reporting ISHLT 2006 J Heart Lung Transplant 2006;25:

6 AVERAGE CENTER VOLUME Pediatric Heart Transplants: January 1, June 30, 2005 ISHLT 2006 J Heart Lung Transplant 2006;25:

7 DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Pediatric Heart Transplants: January 1, June 30, 2005 ISHLT 2006 J Heart Lung Transplant 2006;25:

8 PEDIATRIC HEART RE-TRANSPLANTS By Transplant Year Retransplants: January 1990 – December 2003 Year of transplant J Heart Lung Transplant 2006;25: ISHLT

9 PEDIATRIC HEART RE-TRANSPLANTS By Intertransplant Interval Retransplants: January June 2005 ISHLT 2006 Time Between Previous and Current Transplant J Heart Lung Transplant 2006;25:

10 KAPLAN-MEIER SURVIVAL RATES FOR PEDIATRIC HEART RETRANSPLANTS STRATIFIED BY INTER-TRANSPLANT INTERVAL Retransplants: January June 2004 ISHLT 2006 Time (years) since most recent transplant J Heart Lung Transplant 2006;25:

11 DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year) /1996-6/2005 % of Cases ISHLT 2006 J Heart Lung Transplant 2006;25:

12 DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 1-10 Years) /1996-6/2005 % of Cases ISHLT 2006 J Heart Lung Transplant 2006;25:

13 DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: Years) /1996-6/2005 % of Cases ISHLT 2006 J Heart Lung Transplant 2006;25:

14 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2004) Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

15 PEDIATRIC HEART TRANSPLANTATION Conditional Kaplan-Meier Survival (1/1982-6/2004) Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

16 PEDIATRIC HEART TRANSPLANTATION Conditional 5-year Kaplan-Meier Survival (1/1982-6/2004) Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

17 PEDIATRIC HEART TRANSPLANTATION Conditional Kaplan-Meier Survival for Recent Era (1/1999-6/2004) Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

18 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2004) Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

19 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2004) Age: < 1 Year Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

20 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2004) Age: 1-10 Years Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

21 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2004) Age: Years Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

22 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) Risk Factors For 1 Year Mortality N=3,341 ISHLT 2006 J Heart Lung Transplant 2006;25:

23 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) Borderline Significant Risk Factors For 1 Year Mortality N=3,341 ISHLT 2006 J Heart Lung Transplant 2006;25:

24 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality ISHLT 2006 J Heart Lung Transplant 2006;25:

25 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality Donor Age ISHLT 2006 J Heart Lung Transplant 2006;25:

26 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality Pre-Transplant Bilirubin ISHLT 2006 J Heart Lung Transplant 2006;25:

27 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality Pre-Transplant Creatinine ISHLT 2006 J Heart Lung Transplant 2006;25:

28 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality Weight Ratio ISHLT 2006 J Heart Lung Transplant 2006;25:

29 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) Factors Not Significant for 1 Year Mortality Recipient Factors: IV inotropes, sternotomy, thoracotomy, history of malignancy, height, recent infection, age, PA pressure, cardiac output, pulmonary vascular resistance, PRA ISHLT 2006 J Heart Lung Transplant 2006;25:

30 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) Factors Not Significant for 1 Year Mortality Donor Factors: Gender, history of hypertension, height, clinical infection, history of diabetes Transplant Factors: CMV mismatch, ABO identical/compatible, ischemia time, HLA mismatch, transplant center volume ISHLT 2006 J Heart Lung Transplant 2006;25:

31 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) 1-Year Predicted Survival ISHLT 2006 J Heart Lung Transplant 2006;25:

32 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Risk Factors For 5 Year Mortality N=1,953 ISHLT 2006 J Heart Lung Transplant 2006;25:

33 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Borderline Significant Risk Factors For 5 Year Mortality N=1,953 ISHLT 2006 J Heart Lung Transplant 2006;25:

34 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality ISHLT 2006 J Heart Lung Transplant 2006;25:

35 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality Pre-Transplant Recipient Weight ISHLT 2006 J Heart Lung Transplant 2006;25:

36 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Factors Not Significant for 5 Year Mortality Recipient Factors: History of malignancy, recent infection, bilirubin, age, PRA, pulmonary vascular resistance, PA pressures, cardiac output, sternotomy, height ISHLT 2006 J Heart Lung Transplant 2006;25:

37 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Factors Not Significant for 5 Year Mortality Donor Factors: Cause of death, history of hypertension, weight, height, age Transplant Factors: Donor/recipient weight ratio, CMV mismatch, ischemia time, HLA mismatch, transplant center volume ISHLT 2006 J Heart Lung Transplant 2006;25:

38 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Risk Factors For 5 Year Mortality Conditional on 1 Year Survival N=1,571 ISHLT 2006 J Heart Lung Transplant 2006;25:

39 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Borderline Significant Risk Factors For 5 Year Mortality Conditional on 1 Year Survival N=1,571 ISHLT 2006 J Heart Lung Transplant 2006;25:

40 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Risk Factors For 5 Year Mortality Conditional on 1 Year Survival ISHLT 2006 J Heart Lung Transplant 2006;25:

41 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Risk Factors For 5 Year Mortality Conditional on 1 Year Survival Recipient Weight ISHLT 2006 J Heart Lung Transplant 2006;25:

42 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Factors Not Significant for Conditional 5 Year Mortality Recipient Factors: History of malignancy, recent infection, hospitalized at time of transplant, bilirubin, creatinine, cardiac output, pulmonary vascular resistance, PRA, sternotomy, ventilator, VAD, age, PA pressures ISHLT 2006 J Heart Lung Transplant 2006;25:

43 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Factors Not Significant for Conditional 5 Year Mortality Donor Factors: Cause of death, history of hypertension, weight, height, age, gender, clinical infection at donation Transplant Factors: Donor/recipient weight ratio, year of transplant, CMV mismatch, transplant center volume, induction use, treated for infection prior to discharge, dialysis prior to discharge ISHLT 2006 J Heart Lung Transplant 2006;25:

44 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) 5-Year Predicted Survival Conditional on Survival to 1 Year ISHLT 2006 J Heart Lung Transplant 2006;25:

45 PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

46 PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

47 PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Transplants: January June 2005) % of Patients ISHLT 2006 J Heart Lung Transplant 2006;25:

48 PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Transplants: January June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

49 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2004) Conditional on Survival to 14 Days Survival (%) No comparisons were statistically significant. ISHLT 2006 J Heart Lung Transplant 2006;25:

50 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2004) Conditional on Survival to 14 Days Age: < 1 Year Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

51 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2004) Conditional on Survival to 14 Days Age: 1-10 Years Survival (%) ISHLT 2006 No comparisons were statistically significant. J Heart Lung Transplant 2006;25:

52 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2004) Conditional on Survival to 14 Days Age: Years Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

53 PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January June 2005) NOTE: Different patients are analyzed in Year 1 and Year 5 % of Patients ISHLT 2006 J Heart Lung Transplant 2006;25:

54 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Prednisone Use Conditional on Survival to 1 Year (Transplants: April June 2004) p = Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

55 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Prednisone Use for a Recent Era Conditional on Survival to 1 Year (Transplants: January 1998 – June 2004) p = Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

56 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use at Discharge (Transplants: January June 2004) Conditional on Survival to 14 Days Survival (%) ISHLT 2006 p = 0.56 J Heart Lung Transplant 2006;25:

57 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Rejection within 1 st Year (Transplants: April June 2003) p = Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

58 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Rejection within 1 st Year for Recent Transplants (Transplants: January 2000 – June 2003) p = Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

59 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Rejection within 1 st Year Stratified by Calcineurin Use at Discharge (Transplants: April June 2003) Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

60 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Rejection within 1 st Year for Recent Transplants Stratified by Calcineurin Use at Discharge (Transplants: January June 2003) Survival (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

61 PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up (Follow-ups: January June 2005) NOTE: Different patients are analyzed in Year 1 and Year 5 % of Patients ISHLT 2006 J Heart Lung Transplant 2006;25:

62 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Induction (Transplants: January June 2004) % treated for rejection within 1year No within age group or gender comparisons were significant except 1-10 years (p=0.005). ISHLT 2006 J Heart Lung Transplant 2006;25:

63 NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Induction (Transplants: January June 2004) Average number of rejection episodes ISHLT 2006 J Heart Lung Transplant 2006;25:

64 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January June 2004) % treated for rejection within 1year Overall: No induction vs. OKT3 (p = ); polyclonal vs. OKT3 (p = 0.009); IL2 vs. OKT3 (p = 0.009). 1-10: No induction vs. polyclonal (p = 0.022); 11-17: No induction vs. OKT3 (p = 0.004); polyclonal vs. OKT3 (p = 0.019); IL2R vs. OKT3 (p = 0.005) Female: No induction vs. OKT3 (p = 0.007); polyclonal vs. OKT3 (p = 0.021) Male: No induction vs. OKT3 (p=0.034); IL2R vs. OKT3 (p = 0.035) ISHLT 2006 J Heart Lung Transplant 2006;25:

65 NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January June 2004) Average number of rejection episodes ISHLT 2006 J Heart Lung Transplant 2006;25:

66 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression and Induction (Transplants: January June 2004) % treated for rejection within 1year Overall: CyA + no induction vs. TAC + no induction: p = ; CyA + induction vs. TAC + induction: p = 0.012; CyA + induction vs. TAC + no induction: p = ; CyA + no induction vs. TAC + induction: p = 0.024; <1: CyA + no induction vs. TAC + no induction: p = years: CyA + no induction vs. TAC + no induction: p = 0.047; CyA + induction vs. TAC + induction: p = 0.036; CyA + induction vs. TAC + no induction: p < ; CyA + no induction vs. CyA + induction: Female: CyA + no induction vs. TAC + no induction: p=0.028; CyA + induction vs. TAC + induction: p = ; CyA + induction vs. TAC + no induction: p = ; CyA + no induction vs. TAC + induction: p = No other age group or gender differences were significant. ISHLT 2006 J Heart Lung Transplant 2006;25:

67 NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression and Induction (Transplants: January June 2004) Average number of rejection episodes ISHLT 2006 J Heart Lung Transplant 2006;25:

68 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January June 2004) % treated for rejection within 1 year Overall: CyA+MMF vs. TAC+MMF (p = ); CyA +MMF vs. TAC + AZA (p = ); CyA + AZA vs. TAC + MMF (p = 0.009); CyA + AZA vs. TAC + AZA (p = 0.009). <1: CyA + MMF vs. TAC + MMF ( p = 0.004); CyA + AZA vs. TAC + MMF (p = 0.01). 1-10: CyA + MMF vs. TAC + MMF (p = 0.4); Cya + MMF vs. TAC + AZA (p = 0.004); CyA + AZA vs. TAC + AZA (p = 0.019) : CyA + AZA vs. TAC + MMF (p = 0.012). Female: CyA + MMF vs. TAC + AZA (p = 0.002); CyA + AZA vs. TAC + MMF (p = 0.045); CyA + AZA vs. TAC + AZA (p=0.001); TAC + MMF vs. TAC + AZA (p = 0.038). Male: CyA + MMF vs. TAC + MMF (p = 0.007) ISHLT 2006 J Heart Lung Transplant 2006;25:

69 NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January June 2004) Average number of rejection episodes <1 years: CyA + AZA vs. TAC + MMF (p=0.004). No other age group or gender comparisons were significant. ISHLT 2006 J Heart Lung Transplant 2006;25:

70 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Calcineurin Inhibitor Use at Discharge (Transplants: January June 2004) % treated for rejection within 1year Overall: CyA vs. TAC (p < ) <1: CyA vs. TAC (p = 0.032) 1-10: CyA vs. TAC (p = ) Females: CyA vs. TAC (p = ) Male: CyA vs. TAC (p = 0. ISHLT 2006 J Heart Lung Transplant 2006;25:

71 NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Calcineurin Inhibitor Use at Discharge (Transplants: January June 2004) Average number of rejection episodes ISHLT 2006 J Heart Lung Transplant 2006;25:

72 POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

73 POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 5 Years Post-Transplant (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

74 POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 8 Years Post-Transplant (Follow-ups: April June 2005) ISHLT 2006 J Heart Lung Transplant 2006;25:

75 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April June 2005) % Freedom from CAV ISHLT 2006 J Heart Lung Transplant 2006;25:

76 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April June 2005) Stratified by Induction % Freedom from CAV p = 0.78 ISHLT 2006 J Heart Lung Transplant 2006;25:

77 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April June 2005) Stratified by Age Group % Freedom from CAV ISHLT 2006 J Heart Lung Transplant 2006;25:

78 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: January 1999-June 2005) Stratified by Age Group % Freedom from CAV ISHLT 2006 J Heart Lung Transplant 2006;25:

79 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients ( Follow-ups: April June 2005) Stratified by Ischemia Time % Freedom from CAV ISHLT 2006 J Heart Lung Transplant 2006;25:

80 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients ( Follow-ups: April June 2005) Stratified by Ischemia Time and Recipient Age % Freedom from CAV ISHLT 2006 J Heart Lung Transplant 2006;25:

81 GRAFT SURVIVAL FOLLOWING REPORT OF CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April June 2005) Stratified by Age Group Survival since Report of CAV (%) ISHLT 2006 J Heart Lung Transplant 2006;25:

82 FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Pediatric Heart Recipients (Follow-ups: April June 2005) * Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant % Freedom from Severe Renal Dysfunction ISHLT 2006 J Heart Lung Transplant 2006;25:

83 MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICS Cumulative Prevalence in Survivors (Follow-ups: April June 2005) Malignancy/Type1-Year Survivors 5-Year Survivors 8-Year Survivors No Malignancy 2493 (98.0%)864 (95.7%)330 (92.4%) Malignancy (all types combined) 52 (2.0%)39 (4.3%)27 (7.6%) Malignancy Type Lymph Other351 Skin1 Type Not Reported1 ISHLT 2006 NOTE: Multiple types may be reported; sum of types may be greater than total number with malignancy. J Heart Lung Transplant 2006;25:

84 FREEDOM FROM MALIGNANCY For Pediatric Heart Recipients (Follow-ups: April June 2005) % Freedom from Malignancy ISHLT 2006 J Heart Lung Transplant 2006;25:

85 PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 1 and 3 Years (Transplants: April June 2002) 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 Azathioprine22.3%23.2%0.8 Cyclosporine20.6%24.3%0.34 MMF20.8%21.9%0.8 Prednisone29.2%7.2%< Rapamycin.21.0% Tacrolimus28.1%19.2%0.022 ISHLT 2006 J Heart Lung Transplant 2006;25:

86 PEDIATRIC HEART RECIPIENTS Relationship of Rejection and Coronary Artery Vasculopathy (Follow-ups: April 1994 – June 2005) Rejection During 1 st Year Reported CAV between 1 st and 3 rd years post-transplant Reported CAV between 3 rd and 5 th years post-transplant YesNoAllYesNoAll Yes40 7.8% % % % % % No15 2.9% % % % % % p = p = NOTE: Only those recipients without CAV prior to 3 years were included in the last set of columns ISHLT 2006 J Heart Lung Transplant 2006;25:

87 PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January June 2005) CAUSE OF DEATH 0-30 Days (N = 358) 31 Days - 1 Year (N = 303) >1 Year - 3 Years (N = 220) >3 Years - 5 Years (N = 150) >5 Years (N = 281) CORONARY ARTERY VASCULOPATHY 4 (1.1%)26 (8.6%)42 (19.1%)55 (36.7%)79 (28.1%) ACUTE REJECTION 33 (9.2%)80 (26.4%)59 (26.8%)19 (12.7%)37 (13.2%) LYMPHOMA 6 (2.0%)10 (4.5%)3 (2.0%)24 (8.5%) MALIGNANCY, OTHER 4 (1.3%)2 (0.9%)1 (0.7%)10 (3.6%) CMV 1 (0.3%)7 (2.3%)1 (0.5%) INFECTION, NON-CMV 49 (13.7%)49 (16.2%)17 (7.7%)7 (4.7%)21 (7.5%) PRIMARY FAILURE 62 (17.3%)12 (4.0%)7 (3.2%)8 (5.3%)12 (4.3%) GRAFT FAILURE 85 (23.7%)35 (11.6%)40 (18.2%)34 (22.7%)55 (19.6%) TECHNICAL 22 (6.1%)2 (0.7%)2 (0.9%)1 (0.7%)1 (0.4%) OTHER 18 (5.0%)17 (5.6%)18 (8.2%)12 (8.0%)19 (6.8%) MULTIPLE ORGAN FAILURE 35 (9.8%)36 (11.9%)4 (1.8%)3 (2.0%)10 (3.6%) RENAL FAILURE 1 (0.3%)4 (1.3%)1 (0.5%) PULMONARY 24 (6.7%)18 (5.9%)10 (4.5%)6 (4.0%)9 (3.2%) CEREBROVASCULAR 24 (6.7%)7 (2.3%)7 (3.2%)1 (0.7%)4 (1.4%) ISHLT 2006 J Heart Lung Transplant 2006;25:


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