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2004 ISHLT J Heart Lung Transplant 2004; 23: 933-947 HEART TRANSPLANTATION Pediatric Recipients.

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Presentation on theme: "2004 ISHLT J Heart Lung Transplant 2004; 23: 933-947 HEART TRANSPLANTATION Pediatric Recipients."— Presentation transcript:

1 2004 ISHLT J Heart Lung Transplant 2004; 23: HEART TRANSPLANTATION Pediatric Recipients

2 2004 ISHLT J Heart Lung Transplant 2004; 23: AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS (Transplants: January June 2003)

3 2004 ISHLT J Heart Lung Transplant 2004; 23: AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS (Transplants: January June 2003)

4 2004 ISHLT J Heart Lung Transplant 2004; 23: AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS By Year of Transplant Number of Transplants

5 2004 ISHLT J Heart Lung Transplant 2004; 23: NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS

6 2004 ISHLT J Heart Lung Transplant 2004; 23: DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year) /1996-6/2003

7 2004 ISHLT J Heart Lung Transplant 2004; 23: DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 1-10 Years) /1996-6/2003

8 2004 ISHLT J Heart Lung Transplant 2004; 23: DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: Years) /1996-6/2003l

9 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2002)

10 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTATION Conditional Kaplan-Meier Survival (1/1982-6/2002)

11 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTATION Conditional Kaplan-Meier Survival for Recent Era (1/1998-6/2002)

12 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2002) Survival (%)

13 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2002) Age: < 1 Year Survival (%)

14 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2002) Age: 1-10 Years Survival (%)

15 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2002) Age: Years Survival (%)

16 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2002) Risk Factors For 1 Year Mortality N=2,290

17 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality

18 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality Donor Age

19 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality Recipient Pulmonary Capillary Wedge Pressure (PCW)

20 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality Recipient PA systolic

21 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2002) Factors Not Significant for 1 Year Mortality Recipient Factors: IV inotropes, PGE, ECMO, sternotomy, history of malignancy, weight, height, dialysis, recent infection, gender, age

22 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2002) Factors Not Significant for 1 Year Mortality Donor Factors: Gender, clinical infection, history of diabetes, height, COD Transplant Factors: Donor/recipient weight ratio, CMV mismatch, ABO identical/compatible, year of transplant, ischemia time, HLA mismatch, transplant center volume

23 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Risk Factors For 5 Year Mortality N=1,234

24 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality

25 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Recipient Age

26 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Factors Not Significant for 5 Year Mortality Recipient Factors: IV inotropes, PGE, ECMO, history of malignancy, recent infection, gender, hospitalized at time of transplant, bilirubin

27 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Factors Not Significant for 5 Year Mortality Donor Factors: Gender, clinical infection, history of diabetes, age, COD Transplant Factors: Donor/recipient weight ratio, CMV mismatch, ABO identical/compatible, year of transplant, repeat transplant, ischemia time, HLA mismatch, transplant center volume

28 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Risk Factors For 5 Year Mortality Conditional on 1 Year Survival N=968

29 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART RECIPIENTS Functional Status (Follow-ups: April 1994-June 2003)

30 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant (Follow-ups: April June 2003)

31 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Follow-ups: January June 2003)

32 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Follow-ups: January June 2003)

33 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2000 through June 2003 NOTE: Different patients are analyzed in Year 1 and Year 5

34 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2001 through June 2003 NOTE: Different patients are analyzed in Year 1 and Year 5

35 2004 ISHLT J Heart Lung Transplant 2004; 23: POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April June 2003)

36 2004 ISHLT J Heart Lung Transplant 2004; 23: POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 5 Years Post-Transplant (Follow-ups: April June 2003)

37 2004 ISHLT J Heart Lung Transplant 2004; 23: POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 7 Years Post-Transplant (Follow-ups: April June 2003)

38 2004 ISHLT J Heart Lung Transplant 2004; 23: FREEDOM FROM CAV For Pediatric Heart Recipients (Follow-ups: April 1994-June 2003)

39 2004 ISHLT J Heart Lung Transplant 2004; 23: FREEDOM FROM CAV For Pediatric Heart Recipients (Follow-ups: April 1994-June 2003) Stratified by Age Group

40 2004 ISHLT J Heart Lung Transplant 2004; 23: SURVIVAL FOLLOWING REPORT OF CAV For Pediatric Heart Recipients (Follow-ups: April 1994-June 2003) Stratified by Age Group

41 2004 ISHLT J Heart Lung Transplant 2004; 23: FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Pediatric Heart Recipients (Follow-ups: April 1994-June 2003) * Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant

42 2004 ISHLT J Heart Lung Transplant 2004; 23: MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICS Cumulative Prevalence in Survivors (Follow-ups: April 1994-June 2003) Malignancy/Type1-Year Survivors 5-Year Survivors 7-Year Survivors No Malignancy 1974 (98.2%)568 (95.6%)251 (94%) Malignancy (all types combined) 37 (1.8%)26 (4.4%)16 (6%) Malignancy Type Lymph Other33 Type Not Reported 1

43 2004 ISHLT J Heart Lung Transplant 2004; 23: FREEDOM FROM MALIGNANCY For Pediatric Heart Recipients (Follow-ups: April 1994-June 2003)

44 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Prednisone Use (Transplants: April June 2002) p = 0.02

45 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Rejection within 1 st Year (Transplants: April June 2001) P = 0.016

46 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 1 and 3 Years (Transplants: April June 2000) 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 Azathioprine22.0%19.3%0.5 Cyclosporine19.7%19.5%0.9 MMF18.3%21.2%0.6 Prednisone28.8%6.5%<.0001 Rapamycin.19.9% Tacrolimus22.1%19.2%0.6

47 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART RECIPIENTS Relationship of Rejection and CAV (Follow-ups: April 1994 – June 2003) Rejection During 1 st Year Reported CAV between 1 st and 2 nd years post- transplant Reported CAV between 1 st and 3 rd years post- transplant YesNoYesNo Yes27 5.0% % % % No8 1.6% % % % p = 0.002

48 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART RECIPIENTS Growth Following Transplantation: Height Stratified by Prednisone Use at Discharge and at 1 Year

49 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART RECIPIENTS Growth Following Transplantation: Weight Stratified by Prednisone Use at Discharge and at 1 Year

50 2004 ISHLT J Heart Lung Transplant 2004; 23: PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January 1, June 30, 2002)

51 2004 ISHLT J Heart Lung Transplant 2004; 23: NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January 1, June 30, 2002)

52 2004 ISHLT J Heart Lung Transplant 2004; 23: PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, June 30, 2002)

53 2004 ISHLT J Heart Lung Transplant 2004; 23: NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, June 30, 2002)

54 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2002) Conditional on Survival to 14 Days

55 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2002) Conditional on Survival to 14 Days Age: < 1 Year

56 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2002) Conditional on Survival to 14 Days Age: 1-10 Years

57 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2002) Conditional on Survival to 14 Days Age: Years

58 2004 ISHLT J Heart Lung Transplant 2004; 23: PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January June 2003) CAUSE OF DEATH 0-30 Days (N = 310) 31 Days - 1 Year (N = 258) >1 Year - 3 Years (N = 166) >3 Years - 5 Years (N = 106) >5 Years (N = 199) CAV 3 (1.0%)25 (9.7%)35 (21.1%)42 (39.6%)64 (32.2%) ACUTE REJECTION 26 (8.4%)72 (27.9%)45 (27.1%)16 (15.1%)24 (12.1%) LYMPHOMA 5 (1.9%)8 (4.8%)2 (1.9%)17 (8.5%) MALIGNANCY, OTHER 4 (1.6%)1 (0.6%)1 (0.9%)8 (4.0%) CMV 1 (0.3%)7 (2.7%)1 (0.6%) INFECTION, NON-CMV 40 (12.9%)43 (16.7%)12 (7.2%)5 (4.7%)12 (6.0%) PRIMARY FAILURE 55 (17.7%)12 (4.7%)5 (3.0%)7 (6.6%)11 (5.5%) GRAFT FAILURE 78 (25.2%)31 (12.0%)31 (18.7%)21 (19.8%)40 (20.1%) TECHNICAL 21 (6.8%)3 (1.2%)2 (1.2%)1 (0.9%)1 (0.5%) OTHER 8 (2.6%)8 (3.1%)9 (5.4%)4 (3.8%)10 (5.0%) MULTIPLE ORGAN FAILURE 34 (11.0%)26 (10.1%)3 (1.8%)1 (0.9%)3 (1.5%) RENAL FAILURE 1 (0.3%)1 (0.4%) PULMONARY 24 (7.7%)14 (5.4%)8 (4.8%)5 (4.7%)7 (3.5%) CEREBROVASCULAR 19 (6.1%)7 (2.7%)6 (3.6%)1 (0.9%)2 (1.0%)


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