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J Heart Lung Transplant 2009;28: 989-1049 HEART TRANSPLANTATION Pediatric Recipients ISHLT 2009.

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Presentation on theme: "J Heart Lung Transplant 2009;28: 989-1049 HEART TRANSPLANTATION Pediatric Recipients ISHLT 2009."— Presentation transcript:

1 J Heart Lung Transplant 2009;28: HEART TRANSPLANTATION Pediatric Recipients ISHLT 2009

2 J Heart Lung Transplant 2009;28: AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS (Transplants: January June 2008) ISHLT 2009

3 J Heart Lung Transplant 2009;28: AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS (Transplants: January June 2008) ISHLT 2009

4 J Heart Lung Transplant 2009;28: AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS By Year of Transplant ISHLT 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. 2009

5 J Heart Lung Transplant 2009;28: NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS ISHLT 2009

6 J Heart Lung Transplant 2009;28: NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS ISHLT 2009

7 J Heart Lung Transplant 2009;28: AVERAGE CENTER VOLUME Pediatric Heart Transplants: January 1, June 30, 2008 ISHLT 2009

8 J Heart Lung Transplant 2009;28: DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Pediatric Heart Transplants: January 1, June 30, 2008 ISHLT 2009

9 J Heart Lung Transplant 2009;28: PEDIATRIC HEART RE-TRANSPLANTS By Transplant Year Retransplants: January 1994 – December 2007 ISHLT 2009 Analysis is based on the age at the time of retransplant

10 J Heart Lung Transplant 2009;28: PEDIATRIC HEART RE-TRANSPLANTS By Intertransplant Interval Retransplants: January June 2008 ISHLT 2009 Analysis is based on the age at the time of retransplant

11 J Heart Lung Transplant 2009;28: KAPLAN-MEIER SURVIVAL RATES FOR PEDIATRIC HEART RETRANSPLANTS STRATIFIED BY INTER-TRANSPLANT INTERVAL Retransplants: January June 2007 ISHLT 2009 Analysis is based on the age at the time of retransplant

12 J Heart Lung Transplant 2009;28: DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year) ISHLT 2009

13 J Heart Lung Transplant 2009;28: DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS ( Age: 1-10 Years ) ISHLT 2009

14 J Heart Lung Transplant 2009;28: DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS ( Age: Years ) ISHLT 2009

15 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival (Transplants: 1/1982-6/2007) ISHLT 2009

16 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION Conditional Kaplan-Meier Survival (Transplants: 1/1982-6/2007) ISHLT 2009

17 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION Conditional Kaplan-Meier Survival for Recent Era (Transplants: 1/1999-6/2007) ISHLT 2009

18 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2007) ISHLT 2009

19 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2007) Age: < 1 Year ISHLT 2009

20 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2007) Age: 1-10 Years ISHLT 2009

21 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2007) Age: Years ISHLT 2009

22 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS: AVERAGE CENTER VOLUME DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2008 ISHLT 2009

23 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2008 ISHLT 2009

24 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2008 ISHLT 2009

25 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2008 ISHLT 2009

26 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors For 1 Year Mortality N=3,756 ISHLT Reference diagnosis = cardiomyopathy 2009

27 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Borderline Significant Risk Factors For 1 Year Mortality N=3,756 ISHLT 2009

28 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality ISHLT N=3,

29 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality Recipient Age ISHLT N=3,

30 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality Donor Age ISHLT N=3,

31 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality Pre-Transplant Creatinine ISHLT N=3,

32 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality Center Volume for Pediatric Transplants ISHLT N=3,

33 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality Recipient Height ISHLT N=3, NOTE: The impact of height should be considered in the context of age and diagnosis+age.

34 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality Donor Height ISHLT N=3, NOTE: The impact of height should be considered in the context of age.

35 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality Ischemia Time ISHLT N=3,

36 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) 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 ISHLT 2009

37 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Age = <1 Years Risk Factors For 1 Year Mortality N=1,014 ISHLT Reference diagnosis = congenital without PGE or ECMO 2009

38 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Age = <1 Years Borderline Significant Risk Factors For 1 Year Mortality N=1,014 ISHLT 2009

39 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Age = <1 Years Risk Factors for 1 Year Mortality ISHLT N=1,

40 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality in Age = <1 Years Pre-Transplant Creatinine ISHLT N=1,

41 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality in Age = <1 Years Center Volume for Pediatric Transplants ISHLT N=1,

42 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality in Age = <1 Years Recipient Height ISHLT N=1,

43 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Age = 1-10 Years Risk Factors For 1 Year Mortality N=1,412 ISHLT Reference diagnosis = cardiomyopathy 2009

44 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Age = 1-10 Years Borderline Significant Risk Factors For 1 Year Mortality N=1,412 ISHLT 2009

45 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Age = 1-10 Years Risk Factors for 1 Year Mortality ISHLT N=1,

46 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality in Age = 1-10 Years Pre-Transplant Creatinine ISHLT N=1,

47 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality in Age = 1-10 Years BSA Ratio ISHLT N=1,

48 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality in Age = 1-10 Years Donor Height ISHLT N=1,

49 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality in Age = 1-10 Years Recipient Bilirubin ISHLT N=1,

50 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Age = Years Risk Factors For 1 Year Mortality N=1,330 ISHLT Reference diagnosis = cardiomyopathy 2009

51 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Age = Years Borderline Significant Risk Factors For 1 Year Mortality N=1,330 ISHLT 2009

52 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Age = Years Risk Factors for 1 Year Mortality ISHLT N=1,

53 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality in Age = Years Donor Age ISHLT N=1,

54 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors For 5 Year Mortality N=2,364 ISHLT Reference diagnosis = cardiomyopathy 2009

55 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Borderline Significant Risk Factors For 5 Year Mortality N=2,364 ISHLT 2009

56 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality ISHLT N=2,

57 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Recipient Age ISHLT N=2,

58 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Donor Age ISHLT N=2,

59 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Pre-Transplant Bilirubin ISHLT N=2,

60 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Center Volume for Pediatric Transplants ISHLT N=2,

61 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Recipient Height ISHLT N=2, NOTE: The impact of height should be considered in the context of age and diagnosis+age.

62 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Risk Factors For 10 Year Mortality N=915 ISHLT Reference diagnosis = cardiomyopathy 2009

63 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Borderline Significant Risk Factors For 10 Year Mortality N=915 ISHLT Reference diagnosis = cardiomyopathy 2009

64 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 10 Year Mortality ISHLT N=

65 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality Recipient Age ISHLT N=

66 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality Recipient Weight ISHLT N=

67 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality Center Volume for Pediatric Transplants ISHLT N=

68 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality Pre-Transplant Creatinine ISHLT N=

69 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Factors Not Significant for 10 Year Mortality Recipient Factors: PRA, diabetes, repeat transplant, transfusions, hospitalized, gender, PGE, VAD, bilirubin Donor Factors: Cause of death, weight, height, age, clinical infection Transplant Factors: Ischemia time, HLA mismatch, CMV mismatch ISHLT 2009

70 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (7/1996-6/2003) Risk Factors for the Development of CAV within 5 Years N=1,391 ISHLT Reference diagnosis = cardiomyopathy 2009

71 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (7/1996-6/2003) Borderline Significant Risk Factors for the Development of CAV within 5 Years N=1,391 ISHLT Reference diagnosis = cardiomyopathy 2009

72 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (7/1996-6/2003) Risk Factors for the Development of CAV within 5 Years ISHLT N=1,

73 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (7/1996-6/2003) Risk Factors for the Development of CAV within 5 Years Donor Age ISHLT N=

74 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (7/1996-6/2003) Risk Factors for the Development of CAV within 5 Years Center Volume of All Age Transplants ISHLT N=1,

75 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTS (7/1996-6/2003) Risk Factors for the Development of CAV within 5 Years Pre-Transplant Bilirubin ISHLT N=1,

76 J Heart Lung Transplant 2009;28: PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April June 2008) ISHLT 2009

77 J Heart Lung Transplant 2009;28: PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April June 2008) For the Same Patients ISHLT 2009

78 J Heart Lung Transplant 2009;28: PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April June 2008) Age: <1 Year ISHLT 2009

79 J Heart Lung Transplant 2009;28: PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April June 2008) Age: 1-10 Years ISHLT 2009

80 J Heart Lung Transplant 2009;28: PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April June 2008) Age: Years ISHLT 2009

81 J Heart Lung Transplant 2009;28: PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April June 2008) ISHLT 2009

82 J Heart Lung Transplant 2009;28: PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Transplants: January June 2008) % of Patients ISHLT Analysis is limited to patients who were alive at the time of the follow-up 2009

83 J Heart Lung Transplant 2009;28: PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Transplants: January June 2008) ISHLT Test of increasing trend over time: Any induction p < Polyclonal p < IL2 p < Analysis is limited to patients who were alive at the time of the follow-up 2009

84 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2007) Conditional on Survival to 14 Days ISHLT 2009

85 J Heart Lung Transplant 2009;28: 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 June 2007) Conditional on Survival to 1 Year ISHLT 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. 2009

86 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2007) Conditional on Survival to 14 Days Age: < 1 Year ISHLT 2009

87 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2007) Conditional on Survival to 14 Days Age: 1-10 Years ISHLT 2009

88 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2007) Conditional on Survival to 14 Days Age: Years ISHLT 2009

89 J Heart Lung Transplant 2009;28: PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January June 2008) NOTE: Different patients are analyzed in Year 1 and Year 5 % of Patients ISHLT Analysis is limited to patients who were alive at the time of the follow-up 2009

90 J Heart Lung Transplant 2009;28: PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up for Same Patients at Each Time Point (Follow-ups: January June 2008) % of Patients ISHLT Analysis is limited to patients who were alive at the time of the follow-up 2009

91 PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up (Follow-ups: January June 2008) NOTE: Different patients are analyzed in Year 1 and Year 5 % of Patients ISHLT Analysis is limited to patients who were alive at the time of the follow-up 2009 J Heart Lung Transplant 2009;28:

92 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Prednisone Use Conditional on Survival to 1 Year (Transplants: April June 2007) Survival (%) ISHLT 2009

93 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Prednisone Use for a Recent Era Conditional on Survival to 1 Year (Transplants: January 1998 – June 2007) Survival (%) ISHLT 2009

94 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use at Discharge (Transplants: January June 2007) Conditional on Survival to 14 Days Survival (%) ISHLT 2009

95 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year (Transplants: January June 2007) Survival (%) ISHLT 2009

96 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Treated Rejection within 1 st Year Conditional on survival to 1 year (1-Year Follow-ups: July June 2007) Survival (%) ISHLT 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. 2009

97 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION 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 June 2007) Survival (%) ISHLT 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. 2009

98 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION 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 June 2007) Survival (%) ISHLT 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. 2009

99 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Treated Rejection within 1 st Year Stratified by Calcineurin Use at Discharge: Age = Years Conditional on survival to 1 year (1-Year Follow-ups: July June 2007) Survival (%) ISHLT 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. 2009

100 J Heart Lung Transplant 2009;28: PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION BETWEEN TRANSPLANT DISCHARGE AND 1-YEAR FOLLOW-UP Stratified by Induction (Follow-ups: July June 2008) % experiencing acute rejection within 1 year Overall: p = ISHLT Overall< FemaleMale 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. 2009

101 J Heart Lung Transplant 2009;28: 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 June 2008) % experiencing acute rejection within 1 year Overall: No induct vs. IL2R (p=0.024); 11-17: No induction vs. IL2R (p=0.021) ISHLT Overall< FemaleMale 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. 2009

102 J Heart Lung Transplant 2009;28: 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 June 2008) % experiencing acute rejection within 1 year 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=0.016); 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 years: CyA + no induction vs. TAC + no induction (p = 0.004); CyA + induction vs. TAC + no induction (p < 0.001); CyA + induction vs. TAC + induction ( p =0.001) ISHLT Overall< 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. 2009

103 J Heart Lung Transplant 2009;28: PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION BETWEEN TRANSPLANT DISCHARGE AND 1-YEAR FOLLOW-UP Stratified by Maintenance Immunosuppression ( Follow-ups: July June 2008 ) % experiencing acute rejection within 1 year 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 =0.017). 1-10: CyA + MMF vs. TAC + MMF (p = 0.001); CyA + AZA vs. TAC + MMF (p=0.004) : CyA + MMF vs. TAC + MMF (p =0.001); CyA + MMF vs. TAC + AZA (p=0.033). ISHLT Overall< 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. 2009

104 J Heart Lung Transplant 2009;28: 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 June 2008) % experiencing acute rejection within 1 year Overall: CyA vs. TAC (p < ) <1: CyA vs. TAC (p=0.031) 1-10: CyA vs. TAC (p < ) 11-17: CyA vs. TAC (p < ) ISHLT Overall< 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. 2009

105 J Heart Lung Transplant 2009;28: FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April June 2008) ISHLT 2009

106 J Heart Lung Transplant 2009;28: FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April June 2008) Stratified by Induction ISHLT 2009

107 J Heart Lung Transplant 2009;28: FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: June 2008) Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year ISHLT 2009

108 J Heart Lung Transplant 2009;28: FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April June 2008) Stratified by Age Group ISHLT 2009

109 J Heart Lung Transplant 2009;28: FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: January 1999-June 2008) Stratified by Age Group ISHLT 2009

110 J Heart Lung Transplant 2009;28: FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients ( Follow-ups: April June 2008) Stratified by Ischemia Time ISHLT 2009

111 J Heart Lung Transplant 2009;28: FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients ( Follow-ups: January June 2008) Stratified by Ischemia Time for Recent Era ISHLT 2009

112 J Heart Lung Transplant 2009;28: FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients ( Follow-ups: April June 2008) Stratified by Ischemia Time and Recipient Age ISHLT 2009

113 J Heart Lung Transplant 2009;28: GRAFT SURVIVAL FOLLOWING REPORT OF CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April June 2008) Stratified by Age Group ISHLT 2009

114 J Heart Lung Transplant 2009;28: FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Pediatric Heart Recipients (Follow-ups: April June 2008) ISHLT 2009

115 J Heart Lung Transplant 2009;28: FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Pediatric Heart Recipients (Follow-ups: June 2008) Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year ISHLT 2009

116 J Heart Lung Transplant 2009;28: MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICS Cumulative Prevalence in Survivors (Follow-ups: April June 2008) Malignancy/Type1-Year Survivors 5-Year Survivors 10-Year Survivors No Malignancy 3,361 (98.1%)1,343 (95.2%)332 (92.2%) Malignancy (all types combined) 64 (1.9%)68 (4.8%)28 (7.8%) Malignancy Type Lymph Other 452 Skin 1 Type Not Reported 1 ISHLT NOTE: Multiple types may be reported; sum of types may be greater than total number with malignancy. 2009

117 J Heart Lung Transplant 2009;28: FREEDOM FROM MALIGNANCY For Pediatric Heart Recipients (Follow-ups: April June 2008) ISHLT 2009

118 J Heart Lung Transplant 2009;28: FREEDOM FROM MALIGNANCY For Pediatric Heart Recipients (Follow-ups: April June 2008) Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year ISHLT 2009

119 J Heart Lung Transplant 2009;28: FREEDOM FROM LYMPHOMA For Pediatric Heart Recipients (Follow-ups: April June 2008) Stratified by Induction ISHLT 2009

120 J Heart Lung Transplant 2009;28: PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 1 and 3 Years (Transplants: April June 2005) 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 Azathioprine Cyclosporine MMF Prednisone <.0001 Rapamycin Tacrolimus ISHLT 2009

121 J Heart Lung Transplant 2009;28: PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 3 and 8 Years (Transplants: April June 2000) Maintenance Immunosuppression at discharge and 1 year % HTN reported between 3 and 8 years P-value For Patients on drug For Patients not on drug Azathioprine Cyclosporine MMF Prednisone <.0001 Rapamycin Tacrolimus ISHLT 2009

122 J Heart Lung Transplant 2009;28: FREEDOM FROM CMV For Pediatric Heart Recipients (Follow-ups: April June 2008) Stratified by Induction ISHLT 2009

123 J Heart Lung Transplant 2009;28: FREEDOM FROM CMV For Pediatric Heart Recipients (Follow-ups: April June 2008) Stratified by Induction and Donor CMV Status ISHLT 2009 Analysis is limited to patients who were CMV negative at transplant.

124 J Heart Lung Transplant 2009;28: FREEDOM FROM CMV For Pediatric Heart Recipients (Follow-ups: April June 2008) Stratified by Donor CMV Status/ Recipient CMV status Induction ISHLT 2009

125 J Heart Lung Transplant 2009;28: FREEDOM FROM CMV For Pediatric Heart Recipients (Follow-ups: April June 2008) Stratified by Donor CMV Status/ Recipient CMV status No Induction ISHLT 2009

126 J Heart Lung Transplant 2009;28: PEDIATRIC HEART RECIPIENTS Relationship of Rejection and Coronary Artery Vasculopathy (Follow-ups: July 2004 – June 2008) Rejection During 1 st Year Reported CAV between 1 st and 3 rd years post-transplant YesNoAll Yes5 5.9% % % No6 4.1% % % p = ISHLT 2009

127 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January June 2008) CAUSE OF DEATH 0-30 Days (N = 461) 31 Days - 1 Year (N = 421) >1 Year - 3 Years (N = 307) >3 Years - 5 Years (N = 226) >5 Years - 10 Years (N = 350) >10 Years (N = 172) CORONARY ARTERY VASCULOPATHY 5 (1.1%)30 (7.1%)62 (20.2%)69 (30.5%)98 (28.0%)49 (28.5%) ACUTE REJECTION 44 (9.5%)100 (23.8%)71 (23.1%)31 (13.7%)45 (12.9%)10 (5.8%) LYMPHOMA 10 (2.4%)12 (3.9%)6 (2.7%)33 (9.4%)11 (6.4%) MALIGNANCY, OTHER 4 (1.0%)2 (0.7%)1 (0.4%)5 (1.4%)11 (6.4%) CMV 1 (0.2%)11 (2.6%)1 (0.3%) INFECTION, NON-CMV 54 (11.7%)65 (15.4%)20 (6.5%)8 (3.5%)17 (4.9%)13 (7.6%) PRIMARY FAILURE 102 (22.1%)23 (5.5%)10 (3.3%)15 (6.6%)18 (5.1%)5 (2.9%) GRAFT FAILURE 97 (21.0%)45 (10.7%)62 (20.2%)53 (23.5%)74 (21.1%)44 (25.6%) TECHNICAL 27 (5.9%)3 (0.7%)2 (0.7%)2 (0.9%)4 (1.1%)1 (0.6%) OTHER 25 (5.4%)26 (6.2%)29 (9.4%)24 (10.6%)30 (8.6%)10 (5.8%) MULTIPLE ORGAN FAILURE 46 (10.0%)54 (12.8%)11 (3.6%)6 (2.7%)10 (2.9%)8 (4.7%) RENAL FAILURE 1 (0.2%)4 (1.0%)1 (0.3%)1 (0.4%)1 (0.3%)3 (1.7%) PULMONARY 29 (6.3%)30 (7.1%)15 (4.9%)8 (3.5%)8 (2.3%)5 (2.9%) CEREBROVASCULAR 30 (6.5%)16 (3.8%)9 (2.9%)2 (0.9%)7 (2.0%)2 (1.2%) ISHLT 2009

128 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January June 2008) CAUSE OF DEATH 0-30 Days (N = 213) 31 Days - 1 Year (N = 241) >1 Year - 3 Years (N = 192) >3 Years - 5 Years (N = 153) >5 Years - 10 Years (N = 286) >10 Years (N =165) CAV 2 (0.9%)14 (5.8%)33 (17.2%)43 (28.1%)77 (26.9%)47 (28.5%) ACUTE REJECTION 22 (10.3%)45 (18.7%)36 (18.8%)23 (15.0%)36 (12.6%)10 (6.1%) LYMPHOMA 6 (2.5%)7 (3.6%)4 (2.6%)28 (9.8%)11 (6.7%) MALIGNANCY, OTHER 1 (0.4%)1 (0.5%)4 (1.4%)10 (6.1%) CMV 7 (2.9%)1 (0.5%) INFECTION, NON- CMV 26 (12.2%)31 (12.9%)11 (5.7%)3 (2.0%)13 (4.5%)11 (6.7%) PRIMARY FAILURE 44 (20.7%)9 (3.7%)4 (2.1%)6 (3.9%)10 (3.5%)5 (3.0%) GRAFT FAILURE 31 (14.6%)25 (10.4%)48 (25.0%)44 (28.8%)66 (23.1%)42 (25.5%) TECHNICAL 14 (6.6%)2 (1.0%)4 (1.4%)1 (0.6%) OTHER 19 (8.9%)20 (8.3%)24 (12.5%)17 (11.1%)26 (9.1%)10 (6.1%) MULTIPLE ORGAN FAILURE 27 (12.7%)40 (16.6%)10 (5.2%)5 (3.3%)8 (2.8%)8 (4.8%) RENAL FAILURE 4 (1.7%)1 (0.5%)1 (0.7%)1 (0.3%)3 (1.8%) PULMONARY 11 (5.2%)27 (11.2%)10 (5.2%)6 (3.9%)7 (2.4%)5 (3.0%) CEREBROVASCULAR 17 (8.0%)12 (5.0%)4 (2.1%)1 (0.7%)6 (2.1%)2 (1.2%) ISHLT 2009

129 J Heart Lung Transplant 2009;28: PEDIATRIC HEART TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death (Deaths: January June 2008) ISHLT 2009


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