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HEART TRANSPLANTATION Pediatric Recipients 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141.

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Presentation on theme: "HEART TRANSPLANTATION Pediatric Recipients 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141."— Presentation transcript:

1 HEART TRANSPLANTATION Pediatric Recipients 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

2 AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS (Transplants: January 1996 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

3 AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS (Transplants: January 1996 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

4 AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS By Year of Transplant 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

5 NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

6 NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

7 AVERAGE CENTER VOLUME AND PERCENTAGE OF TRANSPLANTS BY CENTER VOLUME Pediatric Heart Transplants: January 1, 1997 - June 30, 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

8 DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Pediatric Heart Transplants: January 1, 1997 - June 30, 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

9 PEDIATRIC HEART RE-TRANSPLANTS By Transplant Year Re-transplants: January 1994 – December 2008 Only patients who were less than 18 years old at the time of re-transplant are included. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

10 PEDIATRIC HEART RE-TRANSPLANTS By Inter-transplant Interval Re-transplants: January 1994 - June 2009 Only patients who were less than 18 years old at the time of re-transplant are included. Analysis is based on the age at the time of re-transplant 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

11 KAPLAN-MEIER SURVIVAL RATES FOR PEDIATRIC HEART RETRANSPLANTS STRATIFIED BY INTER-TRANSPLANT INTERVAL Re-transplants: January 1994 - June 2008 Only patients who were less than 18 years old at the time of re-transplant are included. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

12 DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

13 DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS ( Age: 1-10 Years ) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

14 DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS ( Age: 11-17 Years ) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

15 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival (Transplants: 1/1982-6/2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

16 PEDIATRIC HEART TRANSPLANTATION Conditional Kaplan-Meier Survival (Transplants: 1/1982-6/2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

17 PEDIATRIC HEART TRANSPLANTATION Conditional Kaplan-Meier Survival for Recent Era (Transplants: 1/1999-6/2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

18 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

19 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2008) Age: < 1 Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

20 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2008) Age: 1-10 Years 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

21 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2008) Age: 11-17 Years 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

22 PEDIATRIC HEART TRANSPLANTS: AVERAGE CENTER VOLUME DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

23 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Patient vs. Graft Survival (Transplants: 1/1999-6/2008) Average Center Volume: 1-4 Transplants per Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

24 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Patient vs. Graft Survival (Transplants: 1/1999-6/2008) Average Center Volume: 5-9 Transplants per Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

25 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Patient vs. Graft Survival (Transplants: 1/1999-6/2008) Average Center Volume: 10-19 Transplants per Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

26 PEDIATRIC HEART TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

27 PEDIATRIC HEART TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

28 PEDIATRIC HEART TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

29 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors For 1 Year Mortality N=3,838 Reference diagnosis = cardiomyopathy 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

30 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Borderline Significant Risk Factors For 1 Year Mortality N=3,838 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

31 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality N=3,838 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

32 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Recipient Age N=3,838 NOTE: The impact of age should be considered in the context of height and diagnosis+age. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

33 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Recipient Height N=3,838 NOTE: The impact of height should be considered in the context of age and diagnosis+age. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

34 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Donor Age N=3,838 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

35 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Pre-Transplant Creatinine N=3,838 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

36 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Ischemia Time N=3,838 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

37 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) 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, center volume 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

38 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = <1 Years Risk Factors For 1 Year Mortality N=1,009 Reference diagnosis = congenital without PGE or ECMO 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

39 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = <1 Years Borderline Significant Risk Factors For 1 Year Mortality N=1,009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

40 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = <1 Years Risk Factors for 1 Year Mortality N=1,009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

41 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = <1 Years Ischemia Time N=1,009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

42 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = <1 Years Pre-Transplant Creatinine N=1,009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

43 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = <1 Years Center Volume for Pediatric Transplants N=1,009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

44 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = <1 Years Recipient Height N=1,009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

45 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = 1-10 Years Risk Factors For 1 Year Mortality N=1,448 Reference diagnosis = cardiomyopathy 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

46 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = 1-10 Years Borderline Significant Risk Factors For 1 Year Mortality N=1,448 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

47 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = 1-10 Years Risk Factors for 1 Year Mortality N=1,448 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

48 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = 1-10 Years Pre-Transplant Creatinine N=1,448 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

49 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = 1-10 Years Recipient Height N=1,448 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

50 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = 1-10 Years Recipient Bilirubin N=1,448 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

51 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = 11-17 Years Risk Factors For 1 Year Mortality N=1,381 Reference diagnosis = cardiomyopathy 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

52 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = 11-17 Years Borderline Significant Risk Factors For 1 Year Mortality N=1,381 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

53 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = 11-17 Years Risk Factors for 1 Year Mortality N=1,381 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

54 PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = 11-17 Years Ischemia Time N=1,381 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

55 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors For 5 Year Mortality N=2,420 Reference diagnosis = cardiomyopathy 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

56 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Borderline Significant Risk Factors For 5 Year Mortality N=2,420 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

57 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality N=2,420 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

58 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Recipient Age N=2,420 NOTE: The impact of age should be considered in the context of height and diagnosis+age. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

59 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Recipient Height N=2,420 NOTE: The impact of height should be considered in the context of age and diagnosis+age. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

60 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Donor Age N=2,420 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

61 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Center Volume for Pediatric Transplants N=2,420 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

62 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Ischemia Time N=2,420 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

63 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality BSA Ratio N=2,420 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

64 PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Risk Factors For 10 Year Mortality N=910 Reference diagnosis = cardiomyopathy * Impact should be considered in context of donor age and recipient BSA shown in subsequent figures. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

65 PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Borderline Significant Risk Factors For 10 Year Mortality N=910 Reference diagnosis = cardiomyopathy 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

66 PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 10 Year Mortality N=910 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

67 PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality Donor Age N=910 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

68 PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality Recipient BSA N=910 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

69 PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality Pre-Transplant Creatinine N=910 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

70 PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality Center Volume for Pediatric Transplants N=910 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

71 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Factors Not Significant for 10 Year Mortality Recipient Factors: PRA, diabetes, repeat transplant, transfusions, hospitalized, PGE, VAD, bilirubin Donor Factors: Cause of death, weight, height, age, clinical infection Transplant Factors: Ischemia time, CMV mismatch 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

72 PEDIATRIC HEART TRANSPLANTS (7/1997-6/2004) Risk Factors for the Development of CAV within 5 Years N=1,470 Reference diagnosis = cardiomyopathy 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

73 PEDIATRIC HEART TRANSPLANTS (7/1997-6/2004) Borderline Significant Risk Factors for the Development of CAV within 5 Years N=1,470 Reference diagnosis = cardiomyopathy 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

74 PEDIATRIC HEART TRANSPLANTS (7/1997-6/2004) Risk Factors for the Development of CAV within 5 Years N=1,470 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

75 PEDIATRIC HEART TRANSPLANTS (7/1997-6/2004) Risk Factors for the Development of CAV within 5 Years Donor Height N=1,470 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

76 PEDIATRIC HEART TRANSPLANTS (7/1997-6/2004) Risk Factors for the Development of CAV within 5 Years Center Volume of All Age Transplants N=1,470 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

77 PEDIATRIC HEART RECIPIENTS Cross-Sectional Analysis Functional Status of Surviving Recipients (Follow-ups: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

78 PEDIATRIC HEART RECIPIENTS Longitudinal Analysis Functional Status of Surviving Recipients (Follow-ups: April 1994 - June 2009) For the Same Patients 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

79 PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994 - June 2009) Age: <1 Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

80 PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994 - June 2009) Age: 1-10 Years 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

81 PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994 - June 2009) Age: 11-17 Years 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

82 PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: March 2005 - June 2009) US Recipients Only 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

83 PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

84 PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Transplants: January 2001 - June 2009) Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

85 PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Transplants: January 2001 - June 2009) Test of increasing trend over time: Any induction p < 0.0001 Polyclonal p < 0.0001 IL2 p < 0.0001 Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

86 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2008) Conditional on Survival to 14 Days 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

87 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 2004 - June 2008) Conditional on Survival to 1 Year 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

88 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2008) Conditional on Survival to 14 Days Age: < 1 Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

89 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2008) Conditional on Survival to 14 Days Age: 1-10 Years 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

90 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2008) Conditional on Survival to 14 Days Age: 11-17 Years 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

91 PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January 2001 - June 2009) NOTE: Different patients are analyzed in Year 1 and Year 5 % of Patients Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

92 PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up for Same Patients at Each Time Point (Follow-ups: January 2001 - June 2009) Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

93 PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up (Follow-ups: January 2001 - June 2009) Analysis is limited to patients who were alive at the time of the follow-up NOTE: Different patients are analyzed in Year 1 and Year 5 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

94 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Prednisone Use Conditional on Survival to 1 Year (Transplants: 1998 - June 2008) Survival (%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

95 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Prednisone Use for a Recent Era Conditional on Survival to 1 Year (Transplants: January 1998 – June 2008) Survival (%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

96 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use at Discharge (Transplants: January 1998 - June 2008) Conditional on Survival to 14 Days Survival (%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

97 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year (Transplants: January 1998 - June 2008) Survival (%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

98 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 2004 - June 2008) Survival (%) 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

99 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 2004 - June 2008) Survival (%) 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

100 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 2004 - June 2008) Survival (%) 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

101 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Treated Rejection within 1 st Year Stratified by Calcineurin Use at Discharge: Age = 11-17 Years Conditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2008) Survival (%) 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

102 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION BETWEEN TRANSPLANT DISCHARGE AND 1-YEAR FOLLOW-UP Stratified by Induction (Follow-ups: July 2004 - June 2009) % experiencing acute rejection within 1 year Overall: p = 0.6601 Overall< 11-1010-17FemaleMale 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

103 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 2004 - June 2009) % experiencing acute rejection within 1 year No comparisons were statistically significant at 0.05. Overall< 1 1-10 10-17FemaleMale 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

104 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 2004 - June 2009) % 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=0.0268); 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 11-17 years: CyA + no induction vs. TAC + no induction (p = 0.0005); CyA + induction vs. TAC + no induction (p < 0.0001); CyA + induction vs. TAC + induction ( p =0.0025) Overall< 11-1010-17 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

105 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION BETWEEN TRANSPLANT DISCHARGE AND 1-YEAR FOLLOW-UP Stratified by Maintenance Immunosuppression ( Follow-ups: July 2004 - June 2009 ) % 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 =0.0076). 1-10: CyA + MMF vs. TAC + MMF (p = 0.0008); CyA + AZA vs. TAC + MMF (p=0.0007). 11-17: all comparisons were statistically significant at 0.05 except CyA +MMF vs. CyA +AZA TAC + MMF vs. TAC + AZA. Overall< 11-1010-17 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

106 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 2004 - June 2009) % experiencing acute rejection within 1 year Overall: CyA vs. TAC (p < 0.0001) <1: CyA vs. TAC (p=0.0356) 1-10: CyA vs. TAC (p < 0.0001) 11-17: CyA vs. TAC (p < 0.0001) Overall< 1 1-10 10-17 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

107 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

108 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) Stratified by Induction 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

109 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: 1999 - June 2009) Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

110 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) Stratified by Age Group 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

111 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: January 1999-June 2009) Stratified by Age Group 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

112 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients ( Follow-ups: April 1994 - June 2009) Stratified by Ischemia Time 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

113 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients ( Follow-ups: January 1999 - June 2009) Stratified by Ischemia Time for Recent Era 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

114 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients ( Follow-ups: April 1994 - June 2009) Stratified by Ischemia Time and Recipient Age 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

115 GRAFT SURVIVAL FOLLOWING REPORT OF CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) Stratified by Age Group 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

116 FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

117 FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Pediatric Heart Recipients (Follow-ups: 1999 - June 2009) Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

118 FREEDOM FROM RENAL REPLACEMENT THERAPY* For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

119 MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICS Cumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2009) Malignancy/Type1-Year Survivors 5-Year Survivors 10-Year Survivors No Malignancy 3,684 (98.2%)1,521 (94.9%)411 (92.6%) Malignancy (all types combined) 69 (1.8%)82 (5.1%)33 (7.4%) Malignancy Type Lymph 647731 Other 463 Skin 11 Type Not Reported 1 NOTE: Multiple types may be reported; sum of types may be greater than total number with malignancy. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

120 FREEDOM FROM MALIGNANCY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

121 FREEDOM FROM MALIGNANCY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

122 FREEDOM FROM LYMPHOMA For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) Stratified by Induction 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

123 PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 1 and 3 Years (Transplants: April 1993 - June 2006) 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 Azathioprine20.125.10.0639 Cyclosporine21.322.60.6409 MMF24.022.30.5552 Prednisone28.911.9<.0001 Rapamycin36.422.0- Tacrolimus26.020.40.0408 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

124 PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 3 and 8 Years (Transplants: April 1993 - June 2001) 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 Azathioprine35.154.30.0339 Cyclosporine36.046.70.2637 MMF41.437.80.7112 Prednisone47.120.2<.0001 Rapamycin-37.5- Tacrolimus40.734.80.541 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

125 PEDIATRIC HEART RECIPIENTS Relationship of Rejection and Coronary Artery Vasculopathy (Follow-ups: July 2004 – June 2009) Rejection During 1 st Year Reported CAV between 1 st and 3 rd years post-transplant YesNoAll Yes9 5.1% 168 94.9% 177 100% No9 3.4% 255 96.6% 264 100% p = 0.3834 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

126 PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2009) CAUSE OF DEATH 0-30 Days (N = 475) 31 Days - 1 Year (N = 443) >1 Year - 3 Years (N = 318) >3 Years - 5 Years (N = 246) >5 Years - 10 Years (N = 371) >10 Years (N = 197) CORONARY ARTERY VASCULOPATHY 5 (1.1%)30 (6.8%)62 (19.5%)72 (29.3%)105 (28.3%)54 (27.4%) ACUTE REJECTION 45 (9.5%)108 (24.4%)75 (23.6%)35 (14.2%)46 (12.4%)12 (6.1%) LYMPHOMA 1 (0.2%)9 (2.0%)12 (3.8%)8 (3.3%)35 (9.4%)15 (7.6%) MALIGNANCY, OTHER 4 (0.9%)2 (0.6%)2 (0.8%)5 (1.3%)10 (5.1%) CMV 1 (0.2%)12 (2.7%)1 (0.3%) INFECTION, NON-CMV 55 (11.6%)68 (15.3%)21 (6.6%)8 (3.3%)18 (4.9%)18 (9.1%) PRIMARY FAILURE 108 (22.7%)24 (5.4%)10 (3.1%)16 (6.5%)21 (5.7%)7 (3.6%) GRAFT FAILURE 101 (21.3%)51 (11.5%)64 (20.1%)60 (24.4%)76 (20.5%)49 (24.9%) TECHNICAL 27 (5.7%)3 (0.7%)2 (0.6%)3 (1.2%)4 (1.1%)2 (1.0%) OTHER 23 (4.8%)26 (5.9%)32 (10.1%)24 (9.8%)34 (9.2%)10 (5.1%) MULTIPLE ORGAN FAILURE 48 (10.1%)56 (12.6%)10 (3.1%)7 (2.8%)10 (2.7%)10 (5.1%) RENAL FAILURE 1 (0.2%)5 (1.1%)1 (0.3%)1 (0.4%)1 (0.3%)3 (1.5%) PULMONARY 29 (6.1%)31 (7.0%)16 (5.0%)8 (3.3%)9 (2.4%)5 (2.5%) CEREBROVASCULAR 31 (6.5%)16 (3.6%)10 (3.1%)2 (0.8%)7 (1.9%)2 (1.0%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

127 PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1998 - June 2009) CAUSE OF DEATH 0-30 Days (N = 226) 31 Days - 1 Year (N = 266) >1 Year - 3 Years (N = 202) >3 Years - 5 Years (N = 173) >5 Years - 10 Years (N = 306) >10 Years (N =190) CAV 2 (0.9%)14 (5.3%)33 (16.3%)46 (26.6%)84 (27.5%)52 (27.4%) ACUTE REJECTION 23 (10.2%)53 (19.9%)40 (19.8%)27 (15.6%)37 (12.1%)12 (6.3%) LYMPHOMA 6 (2.3%)7 (3.5%)6 (3.5%)29 (9.5%)15 (7.9%) MALIGNANCY, OTHER 1 (0.4%)1 (0.5%)1 (0.6%)4 (1.3%)9 (4.7%) CMV 8 (3.0%)1 (0.5%) INFECTION, NON- CMV 27 (11.9%)34 (12.8%)12 (5.9%)3 (1.7%)14 (4.6%)16 (8.4%) PRIMARY FAILURE 50 (22.1%)10 (3.8%)4 (2.0%)7 (4.0%)13 (4.2%)7 (3.7%) GRAFT FAILURE 35 (15.5%)31 (11.7%)50 (24.8%)51 (29.5%)68 (22.2%)47 (24.7%) TECHNICAL 14 (6.2%)2 (1.0%)1 (0.6%)4 (1.3%)2 (1.1%) OTHER 17 (7.5%)21 (7.9%)27 (13.4%)17 (9.8%)30 (9.8%)10 (5.3%) MULTIPLE ORGAN FAILURE 29 (12.8%)43 (16.2%)9 (4.5%)6 (3.5%)8 (2.6%)10 (5.3%) RENAL FAILURE 5 (1.9%)1 (0.5%)1 (0.6%)1 (0.3%)3 (1.6%) PULMONARY 11 (4.9%)28 (10.5%)11 (5.4%)6 (3.5%)8 (2.6%)5 (2.6%) CEREBROVASCULAR 18 (8.0%)12 (4.5%)4 (2.0%)1 (0.6%)6 (2.0%)2 (1.1%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

128 PEDIATRIC HEART TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death (Deaths: January 1998 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141


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