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2002 ISHLT J Heart Lung Transplant 2002; 21: 827-840. HEART TRANSPLANTATION Pediatric Recipients.

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Presentation on theme: "2002 ISHLT J Heart Lung Transplant 2002; 21: 827-840. HEART TRANSPLANTATION Pediatric Recipients."— Presentation transcript:

1 2002 ISHLT J Heart Lung Transplant 2002; 21: HEART TRANSPLANTATION Pediatric Recipients

2 2002 ISHLT J Heart Lung Transplant 2002; 21: AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS ( )

3 2002 ISHLT J Heart Lung Transplant 2002; 21: AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS ( )

4 2002 ISHLT J Heart Lung Transplant 2002; 21: AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS By Year of Transplant Number of Transplants * Numbers may be low due to delayed reporting.

5 2002 ISHLT J Heart Lung Transplant 2002; 21: NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS * Numbers may be low due to delayed reporting

6 2002 ISHLT J Heart Lung Transplant 2002; 21: DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year)

7 2002 ISHLT J Heart Lung Transplant 2002; 21: DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 1-10 Years)

8 2002 ISHLT J Heart Lung Transplant 2002; 21: DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: Years)

9 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART TRANSPLANTATION Actuarial Survival ( ) <1 year vs years: p = <1 year vs years: p = 0.001

10 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART TRANSPLANTATION Conditional Actuarial Survival ( ) Both comparisons with years significant at p <

11 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART TRANSPLANTATION Conditional Actuarial Survival for Recent Era ( ) Comparison of <1 vs years significant at p = 0.01

12 2002 ISHLT J Heart Lung Transplant 2002; 21: 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 J Heart Lung Transplant 2002; 21: PEDIATRIC HEART TRANSPLANTATION Actuarial Survival by Age Group For Diagnosis = Cardiomyopathy ( ) Survival (%) No comparisons were statistically significant.

14 2002 ISHLT J Heart Lung Transplant 2002; 21: 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 J Heart Lung Transplant 2002; 21: PEDIATRIC HEART TRANSPLANTS ( ) Risk Factors For 1 Year Mortality In Descending Order of Magnitude N=1,554

16 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART TRANSPLANTS ( ) Risk Factors for 1 Year Mortality Continuous Factors N=1,554

17 2002 ISHLT J Heart Lung Transplant 2002; 21: 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 J Heart Lung Transplant 2002; 21: PEDIATRIC HEART TRANSPLANTS (April December 1996) Risk Factors For 5 Year Mortality In Descending Order of Magnitude N=937

19 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART TRANSPLANTS (April December 1996) Risk Factors For 5 Year Mortality Continuous Factors N=937

20 2002 ISHLT J Heart Lung Transplant 2002; 21: 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 J Heart Lung Transplant 2002; 21: 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 J Heart Lung Transplant 2002; 21: PEDIATRIC HEART RECIPIENTS Functional Status (April 1994-December 2001)

23 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant (April December 2001)

24 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART RECIPIENTS Induction Immunosuppression For follow-ups between October 1999 and December 2001

25 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Any Time During Follow-up Period For follow-ups between October 1999 and December 2001

26 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between October 1999 and December 2001

27 2002 ISHLT J Heart Lung Transplant 2002; 21: 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 J Heart Lung Transplant 2002; 21: PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between October 1999 and December 2001

29 2002 ISHLT J Heart Lung Transplant 2002; 21: POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Incidence for Survivors (April 1994-December 2001)

30 2002 ISHLT J Heart Lung Transplant 2002; 21: Freedom from CAV For Pediatric Heart Recipients (April 1994-December 2000)

31 2002 ISHLT J Heart Lung Transplant 2002; 21: 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 J Heart Lung Transplant 2002; 21: 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 J Heart Lung Transplant 2002; 21: Freedom from Malignancy For Pediatric Heart Recipients (April 1994-December 2000)

34 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART TRANSPLANTATION Actuarial Survival Based on Prednisone Use p = 0.005

35 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART TRANSPLANTATION Actuarial Survival Based on Rejection within 1 st Year P = 0.09

36 2002 ISHLT J Heart Lung Transplant 2002; 21: 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 J Heart Lung Transplant 2002; 21: 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 J Heart Lung Transplant 2002; 21: 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 J Heart Lung Transplant 2002; 21: 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 J Heart Lung Transplant 2002; 21: PEDIATRIC HEART RECIPIENTS Growth Following Transplantation: Height Stratified by Prednisone Use at Discharge and at 1 Year

41 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART RECIPIENTS Growth Following Transplantation: Weight Stratified by Prednisone Use at Discharge and at 1 Year

42 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART RECIPIENTS: Time of Death ( )

43 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death ( ) Timing of Death Cause of Death (%)

44 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART TRANSPLANTS RECIPIENTS: CAUSE OF DEATH BY ERA: Deaths in 0-30 Days

45 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART TRANSPLANTS RECIPIENTS: CAUSE OF DEATH BY ERA: Deaths in 31 Days - 1 Year

46 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART TRANSPLANTS RECIPIENTS: CAUSE OF DEATH BY ERA: Deaths in >1 Year - 3 Years

47 2002 ISHLT J Heart Lung Transplant 2002; 21: PEDIATRIC HEART TRANSPLANTS RECIPIENTS: CAUSE OF DEATH BY ERA: Deaths in >3 Years - 5 Years


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