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2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. HEART TRANSPLANTATION Pediatric Recipients.

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Presentation on theme: "2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. HEART TRANSPLANTATION Pediatric Recipients."— Presentation transcript:

1 2003 ISHLT J Heart Lung Transplant 2003; 22: HEART TRANSPLANTATION Pediatric Recipients

2 2003 ISHLT J Heart Lung Transplant 2003; 22: AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS (Transplants: January June 2002)

3 2003 ISHLT J Heart Lung Transplant 2003; 22: AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS (Transplants: January June 2002)

4 2003 ISHLT J Heart Lung Transplant 2003; 22: AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS By Year of Transplant Number of Transplants

5 2003 ISHLT J Heart Lung Transplant 2003; 22: NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS

6 2003 ISHLT J Heart Lung Transplant 2003; 22: DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year)

7 2003 ISHLT J Heart Lung Transplant 2003; 22: DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 1-10 Years)

8 2003 ISHLT J Heart Lung Transplant 2003; 22: DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: Years)

9 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTATION Actuarial Survival (1/1982-6/2001)

10 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTATION Conditional Actuarial Survival (1/1982-6/2001)

11 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTATION Conditional Actuarial Survival for Recent Era (1/1998-6/2001)

12 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTATION Actuarial Survival by Era (1/1982-6/2001) Survival (%)

13 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTATION Actuarial Survival by Age Group For Diagnosis = Cardiomyopathy (Transplants: January June 2001) Survival (%)

14 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTATION Actuarial Survival By Age Group For Diagnosis = Congenital Disease (Transplants: January June 2001) Survival (%)

15 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2001) Risk Factors For 1 Year Mortality N=2,055

16 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality

17 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Recipient Age

18 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Donor Weight

19 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Bilirubin

20 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Recipient creatinine

21 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2001) Factors Not Significant for 1 Year Mortality Recipient Factors: IV inotropes, PGE, ECMO, sternotomy, history of malignancy, weight, height, dialysis, recent infection, gender

22 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTS (1/1995-6/2001) Factors Not Significant for 1 Year Mortality Donor Factors: Gender, clinical infection, history of diabetes, height, 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

23 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors For 5 Year Mortality N=828

24 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality

25 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Recipient Age

26 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Recipient creatinine

27 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Factors Not Significant for 5 Year Mortality Recipient Factors: IV inotropes, PGE, ECMO, history of malignancy, weight, height, dialysis, recent infection, gender, diagnosis, hospitalized at time of transplant, bilirubin

28 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Factors Not Significant for 5 Year Mortality Donor Factors: Gender, clinical infection, history of diabetes, height, weight, 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

29 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors For 5 Year Mortality Conditional on 1 Year Survival N=630

30 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART RECIPIENTS Functional Status (Follow-ups: April 1994-June 2002)

31 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant (Follow-ups: April June 2002)

32 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Follow-ups: January June 2002)

33 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Follow-ups: January June 2002)

34 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Any Time During Follow-up Period For follow-ups between January 2000 through June 2002 NOTE: Different patients are analyzed in Year 1 and Year 5

35 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2000 through June 2002 NOTE: Different patients are analyzed in Year 1 and Year 5

36 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2000 through June 2002 NOTE: Different patients are analyzed in Year 1 and Year 5

37 2003 ISHLT J Heart Lung Transplant 2003; 22: POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April 1994-June 2002)

38 2003 ISHLT J Heart Lung Transplant 2003; 22: POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 5 Years Post-Transplant (Follow-ups: April 1994-June 2002)

39 2003 ISHLT J Heart Lung Transplant 2003; 22: Freedom from CAV For Pediatric Heart Recipients (Follow-ups: April 1994-June 2002)

40 2003 ISHLT J Heart Lung Transplant 2003; 22: Freedom from CAV For Pediatric Heart Recipients (Follow-ups: April 1994-June 2002) Stratified by Age Group

41 2003 ISHLT J Heart Lung Transplant 2003; 22: SURVIVAL FOLLOWING REPORT OF CAV For Pediatric Heart Recipients (Follow-ups: April 1994-June 2002) Stratified by Age Group

42 2003 ISHLT J Heart Lung Transplant 2003; 22: Freedom from Severe Renal Dysfunction* For Pediatric Heart Recipients (Follow-ups: April 1994-June 2002) * Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant

43 2003 ISHLT J Heart Lung Transplant 2003; 22: MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICS Cumulative Prevalence in Survivors (Follow-ups: April 1994-June 2002) Malignancy/Type1-Year Survivors5-Year Survivors No Malignancy 1674 (98.1%) 434 (95.4%) Malignancy (all types combined) 32 (1.9%) 21 (4.6%) Malignancy Type Lymph2819 Other32 Type Not Reported1

44 2003 ISHLT J Heart Lung Transplant 2003; 22: Freedom from Malignancy For Pediatric Heart Recipients (Follow-ups: April 1994-June 2002)

45 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTATION Actuarial Survival Based on Prednisone Use (Transplants: April June 2001) p = 0.002

46 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTATION Actuarial Survival Based on Rejection within 1 st Year (Transplants: April June 2001) P = 0.01

47 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART RECIPIENTS Relationship of Prednisone Use and CAV (Follow-ups: April 1994 – June 2002) Prednisone Use at Discharge and at 1 Year Reported CAV between 1 st and 2 nd years post- transplant Reported CAV between 1 st and 3 rd years post- transplant YesNoYesNo Yes34 5.2% % % % No4 2.5% % 3 2.7% % p = 0.15 p = 0.08

48 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART RECIPIENTS Relationship of Rejection and CAV (Follow-ups: April 1994 – June 2002) 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 Yes24 5.8% % % % No6 1.6% % 8 3.2% % p = p = 0.06

49 2003 ISHLT J Heart Lung Transplant 2003; 22: 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 Cyclosporine19.4%14.0%0.3 Tacrolimus17.3%18.6%0.8 Azathioprine22.2%14.1%0.1 MMF15.9%20.9%0.4 Rapamycin-19.4%- Prednisone28.5%6.4%<0.0001

50 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART RECIPIENTS Growth Following Transplantation: Height Stratified by Prednisone Use at Discharge and at 1 Year

51 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART RECIPIENTS Growth Following Transplantation: Weight Stratified by Prednisone Use at Discharge and at 1 Year

52 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors For Developing CAV between 1 and 5 Years N=363

53 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for Developing CAV between 1 and 5 Years Recipient Age

54 2003 ISHLT J Heart Lung Transplant 2003; 22: PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January June 2002) CAUSE OF DEATH 0-30 Days (N = 276) 31 Days - 1 Year (N = 231) >1 Year - 3 Years (N = 147) >3 Years - 5 Years (N = 93) >5 Years (N = 156) CAV2 (0.7%)21 (9.1%)32 (21.8%)35 (37.6%)54 (34.6%) ACUTE REJECTION25 (9.1%)66 (28.6%)39 (26.5%)15 (16.1%)20 (12.8%) LYMPHOMA5 (2.2%)8 (5.4%)2 (2.2%)14 (9.0%) MALIGNANCY, OTHER4 (1.7%)1 (0.7%)1 (1.1%)6 (3.8%) CMV1 (0.4%)5 (2.2%) INFECTION, NON-CMV38 (13.8%)37 (16.0%)11 (7.5%)5 (5.4%)5 (3.2%) PRIMARY FAILURE44 (15.9%)12 (5.2%)5 (3.4%)6 (6.5%)10 (6.4%) GRAFT FAILURE76 (27.5%)28 (12.1%)25 (17.0%)17 (18.3%)30 (19.2%) TECHNICAL17 (6.2%)3 (1.3%)2 (1.4%)1 (1.1%)2 (1.3%) OTHER7 (2.5%)7 (3.0%)8 (5.4%)4 (4.3%)8 (5.1%) MULTIPLE ORGAN FAILURE 24 (8.7%)23 (10.0%)3 (2.0%)1 (1.1%)1 (0.6%) RENAL FAILURE1 (0.4%) PULMONARY22 (8.0%)12 (5.2%)7 (4.8%)5 (5.4%)4 (2.6%) CEREBROVASCULAR19 (6.9%)7 (3.0%)6 (4.1%)1 (1.1%)2 (1.3%)


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