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HEART TRANSPLANTATION Pediatric Recipients ISHLT 2007 J Heart Lung Transplant 2007;26: 796-807.

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Presentation on theme: "HEART TRANSPLANTATION Pediatric Recipients ISHLT 2007 J Heart Lung Transplant 2007;26: 796-807."— Presentation transcript:

1 HEART TRANSPLANTATION Pediatric Recipients ISHLT 2007 J Heart Lung Transplant 2007;26:

2 AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS (Transplants: January June 2006) Number of Transplants ISHLT 2007 J Heart Lung Transplant 2007;26:

3 AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS (Transplants: January June 2006) Number of Transplants ISHLT 2007 J Heart Lung Transplant 2007;26:

4 AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS By Year of Transplant Number of Transplants ISHLT 2007 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. J Heart Lung Transplant 2007;26:

5 NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS Number of Pediatric Cases Reporting ISHLT 2007 J Heart Lung Transplant 2007;26:

6 AVERAGE CENTER VOLUME Pediatric Heart Transplants: January 1, June 30, 2006 ISHLT 2007 J Heart Lung Transplant 2007;26:

7 DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Pediatric Heart Transplants: January 1, June 30, 2006 ISHLT 2007 J Heart Lung Transplant 2007;26:

8 PEDIATRIC HEART RE-TRANSPLANTS By Transplant Year Retransplants: January 1994 – December 2005 Year of transplant ISHLT 2007 J Heart Lung Transplant 2007;26:

9 PEDIATRIC HEART RE-TRANSPLANTS By Intertransplant Interval Retransplants: January June 2005 ISHLT 2007 Time Between Previous and Current Transplant J Heart Lung Transplant 2007;26:

10 KAPLAN-MEIER SURVIVAL RATES FOR PEDIATRIC HEART RETRANSPLANTS STRATIFIED BY INTER-TRANSPLANT INTERVAL Retransplants: January June 2005 ISHLT 2007 Time (years) since most recent transplant J Heart Lung Transplant 2007;26:

11 KAPLAN-MEIER SURVIVAL RATES FOR PEDIATRIC HEART RETRANSPLANTS STRATIFIED BY INTER-TRANSPLANT INTERVAL Retransplants: January June 2005 ISHLT 2007 Time (years) since most recent transplant J Heart Lung Transplant 2007;26:

12 DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year) /1996-6/2006 % of Cases ISHLT 2007 J Heart Lung Transplant 2007;26:

13 DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 1-10 Years) /1996-6/2006 % of Cases ISHLT 2007 J Heart Lung Transplant 2007;26:

14 DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: Years) /1996-6/2006 % of Cases ISHLT 2007 J Heart Lung Transplant 2007;26:

15 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2005) Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

16 PEDIATRIC HEART TRANSPLANTATION Conditional Kaplan-Meier Survival (1/1982-6/2005) Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

17 PEDIATRIC HEART TRANSPLANTATION Conditional 5-year Kaplan-Meier Survival (1/1982-6/2005) Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

18 PEDIATRIC HEART TRANSPLANTATION Conditional Kaplan-Meier Survival for Recent Era (1/1999-6/2005) Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

19 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2005) Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

20 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2005) Age: < 1 Year Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

21 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2005) Age: 1-10 Years Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

22 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2005) Age: Years Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

23 PEDIATRIC HEART TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT 2007 J Heart Lung Transplant 2007;26:

24 PEDIATRIC HEART TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT 2007 J Heart Lung Transplant 2007;26:

25 PEDIATRIC HEART TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT 2007 J Heart Lung Transplant 2007;26:

26 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2005) Risk Factors For 1 Year Mortality N=3,209 ISHLT 2007 Reference diagnosis = cardiomyopathy J Heart Lung Transplant 2007;26:

27 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2005) Borderline Significant Risk Factors For 1 Year Mortality N=3,209 ISHLT 2007 J Heart Lung Transplant 2007;26:

28 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality ISHLT 2007 N=3,209 J Heart Lung Transplant 2007;26:

29 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality Donor Age ISHLT 2007 N=3,209 J Heart Lung Transplant 2007;26:

30 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality Pre-Transplant Bilirubin ISHLT 2007 N=3,209 J Heart Lung Transplant 2007;26:

31 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality Pre-Transplant Creatinine ISHLT 2007 N=3,209 J Heart Lung Transplant 2007;26:

32 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality Weight Ratio ISHLT 2007 N=3,209 J Heart Lung Transplant 2007;26:

33 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality Center Volume for Pediatric Transplants ISHLT 2007 N=3,209 J Heart Lung Transplant 2007;26:

34 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2005) Factors Not Significant for 1 Year Mortality Recipient Factors: IV inotropes, sternotomy, thoracotomy, history of malignancy, height, recent infection, age Donor Factors: Gender, history of hypertension, height, clinical infection, history of diabetes Transplant Factors: CMV mismatch, ABO identical/compatible, ischemia time, HLA mismatch ISHLT 2007 J Heart Lung Transplant 2007;26:

35 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2005) 1-Year Predicted Survival Model ISHLT 2007

36 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2001) Risk Factors For 5 Year Mortality N=1,896 ISHLT 2007 J Heart Lung Transplant 2007;26:

37 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2001) Borderline Significant Risk Factors For 5 Year Mortality ISHLT 2007 N=1,896 J Heart Lung Transplant 2007;26:

38 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality ISHLT 2007 N=1,896 J Heart Lung Transplant 2007;26:

39 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Recipient Age ISHLT 2007 N=1,896 J Heart Lung Transplant 2007;26:

40 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Pre-Transplant Bilirubin ISHLT 2007 N=1,896 J Heart Lung Transplant 2007;26:

41 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Center Volume for Pediatric Transplants ISHLT 2007 N=1,896 J Heart Lung Transplant 2007;26:

42 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2001) Factors Not Significant for 5 Year Mortality Recipient Factors: History of malignancy, PRA, height, weight, creatinine, diabetes, repeat transplant, transfusions ISHLT 2007 J Heart Lung Transplant 2007;26:

43 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Factors Not Significant for 5 Year Mortality Donor Factors: Cause of death, history of hypertension, weight, height, age, clinical infection Transplant Factors: CMV mismatch, ischemia time, HLA mismatch ISHLT 2007 J Heart Lung Transplant 2007;26:

44 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2001) Conditional 5-Year Predicted Survival Model ISHLT 2007

45 PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

46 PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

47 PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Transplants: January June 2006) % of Patients ISHLT 2007 J Heart Lung Transplant 2007;26:

48 PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Transplants: January June 2006) ISHLT 2007 Test of increasing trend over time: Any induction p < Polyclonal p < IL2 p = J Heart Lung Transplant 2007;26:

49 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2005) Conditional on Survival to 14 Days Survival (%) No comparisons were statistically significant. ISHLT 2007 J Heart Lung Transplant 2007;26:

50 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group and Treated for Rejection Between Transplant Discharge and 1-Year Follow-up ( Transplants: January 2000 – June 2004) Conditional on Survival to 1 Year Survival (%) No pair-wise comparisons of survival by induction were statistically significant within either rejection grouping. ISHLT 2007 J Heart Lung Transplant 2007;26:

51 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2005) Conditional on Survival to 14 Days Age: < 1 Year Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

52 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2005) Conditional on Survival to 14 Days Age: 1-10 Years Survival (%) ISHLT 2007 No comparisons were statistically significant. J Heart Lung Transplant 2007;26:

53 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2005) Conditional on Survival to 14 Days Age: Years Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

54 PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January June 2006) NOTE: Different patients are analyzed in Year 1 and Year 5 % of Patients ISHLT 2007 J Heart Lung Transplant 2007;26:

55 PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up for Same Patients at Each Time Point (Follow-ups: January June 2006) % of Patients ISHLT 2007 J Heart Lung Transplant 2007;26:

56 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Prednisone Use Conditional on Survival to 1 Year (Transplants: April June 2005) p = Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

57 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Prednisone Use for a Recent Era Conditional on Survival to 1 Year (Transplants: January 1998 – June 2005) p = Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

58 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use at Discharge (Transplants: January June 2005) Conditional on Survival to 14 Days Survival (%) ISHLT 2007 p = J Heart Lung Transplant 2007;26:

59 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Rejection within 1 st Year (Transplants: April June 2004) p = <.0001 Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

60 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Rejection within 1 st Year for Recent Transplants (Transplants: January 2000 – June 2004) p = Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

61 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Rejection within 1 st Year Stratified by Calcineurin Use at Discharge (Transplants: April June 2005) Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

62 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Rejection within 1 st Year Stratified by Calcineurin Use at Discharge: Age = 0-10 Years (Transplants: April June 2005) Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

63 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Rejection within 1 st Year Stratified by Calcineurin Use at Discharge: Age = Years (Transplants: April June 2005) Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

64 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Rejection within 1 st Year for Recent Transplants Stratified by Calcineurin Use at Discharge (Transplants: January June 2005) Survival (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

65 PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up (Follow-ups: January June 2006) NOTE: Different patients are analyzed in Year 1 and Year 5 % of Patients ISHLT 2007 J Heart Lung Transplant 2007;26:

66 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Induction (Transplants: January June 2005) % treated for rejection within 1year No within age group or gender comparisons were significant except 1-10 years (p=0.005). ISHLT 2007 J Heart Lung Transplant 2007;26:

67 NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Induction (Transplants: January June 2005) Average number of rejection episodes ISHLT 2007 J Heart Lung Transplant 2007;26:

68 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January June 2005) % treated for rejection within 1year Overall: No induction vs. OKT3 (p = ); polyclonal vs. OKT3 (p = 0.024); IL2 vs. OKT3 (p = 0.035). 1-10: No induction vs. polyclonal (p = ); 11-17: No induction vs. OKT3 (p = ); polyclonal vs. OKT3 (p = 0.028); IL2R vs. OKT3 (p = 0.013) Female: No induction vs. OKT3 (p = 0.015); polyclonal vs. OKT3 (p = 0.041) ISHLT 2007 J Heart Lung Transplant 2007;26:

69 NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January June 2005) Average number of rejection episodes ISHLT 2007 J Heart Lung Transplant 2007;26:

70 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression and Induction (Transplants: January June 2005) % treated for rejection within 1year Overall: CyA + induction vs. TAC + no induction: p = <1: CyA + no induction vs. TAC + no induction: p = years: CyA + induction vs. TAC + induction: p = 0.017; CyA + induction vs. TAC + no induction: p = ; CyA + no induction vs. CyA + induction: No other age group differences were significant. ISHLT 2007 J Heart Lung Transplant 2007;26:

71 NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression and Induction (Transplants: January June 2005) Average number of rejection episodes ISHLT 2007 J Heart Lung Transplant 2007;26:

72 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January June 2005) % treated for rejection within 1 year Overall: CyA +MMF vs. TAC + AZA (p = ); CyA + AZA vs. TAC + AZA (p = 0.013). <1: CyA + MMF vs. TAC + MMF ( p = 0.024); CyA + AZA vs. TAC + MMF (p = 0.021). 1-10: CyA + MMF vs. TAC + AZA (p = ); TAC + MMF vs. TAC + AZA (p = 0.011); CyA + AZA vs. TAC + AZA (p = 0.016). ISHLT 2007 J Heart Lung Transplant 2007;26:

73 NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January June 2005) Average number of rejection episodes <1 years: CyA + AZA vs. TAC + MMF (p=0.0027); CyA + AZA vs. TAC + AZA (p=0.45). No other age group comparisons were significant. ISHLT 2007 J Heart Lung Transplant 2007;26:

74 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Calcineurin Inhibitor Use at Discharge (Transplants: January June 2005) % treated for rejection within 1year Overall: CyA vs. TAC (p = ) 1-10: CyA vs. TAC (p = ) ISHLT 2007 J Heart Lung Transplant 2007;26:

75 NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Calcineurin Inhibitor Use at Discharge (Transplants: January June 2005) Average number of rejection episodes ISHLT 2007 J Heart Lung Transplant 2007;26:

76 POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

77 POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 5 Years Post-Transplant (Follow-ups: April June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

78 POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 8 Years Post-Transplant (Follow-ups: April June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

79 POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 10 Years Post-Transplant (Follow-ups: April June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

80 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April June 2006) % Freedom from CAV ISHLT 2007 J Heart Lung Transplant 2007;26:

81 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April June 2006) Stratified by Induction % Freedom from CAV p = ISHLT 2007 J Heart Lung Transplant 2007;26:

82 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April June 2006) Stratified by Age Group % Freedom from CAV ISHLT 2007 J Heart Lung Transplant 2007;26:

83 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: January 1999-June 2006) Stratified by Age Group % Freedom from CAV ISHLT 2007 J Heart Lung Transplant 2007;26:

84 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients ( Follow-ups: April June 2006) Stratified by Ischemia Time % Freedom from CAV ISHLT 2007 J Heart Lung Transplant 2007;26:

85 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients ( Follow-ups: January June 2006) Stratified by Ischemia Time for Recent Era % Freedom from CAV ISHLT 2007 J Heart Lung Transplant 2007;26:

86 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients ( Follow-ups: April June 2006) Stratified by Ischemia Time and Recipient Age % Freedom from CAV ISHLT 2007 J Heart Lung Transplant 2007;26:

87 GRAFT SURVIVAL FOLLOWING REPORT OF CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April June 2006) Stratified by Age Group Survival since Report of CAV (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

88 FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Pediatric Heart Recipients (Follow-ups: April June 2006) * Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant % Freedom from Severe Renal Dysfunction ISHLT 2007 J Heart Lung Transplant 2007;26:

89 MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICS Cumulative Prevalence in Survivors (Follow-ups: April June 2006) Malignancy/Type1-Year Survivors 5-Year Survivors 10-Year Survivors No Malignancy 2771 (98.1%)1010 (95%)186 (93%) Malignancy (all types combined) 55 (1.9%)53 (5%)14 (7%) Malignancy Type Lymph Other36 Skin1 Type Not Reported11 ISHLT 2007 NOTE: Multiple types may be reported; sum of types may be greater than total number with malignancy. J Heart Lung Transplant 2007;26:

90 FREEDOM FROM MALIGNANCY For Pediatric Heart Recipients (Follow-ups: April June 2006) % Freedom from Malignancy ISHLT 2007 J Heart Lung Transplant 2007;26:

91 PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 1 and 3 Years (Transplants: April June 2003) 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 2007 J Heart Lung Transplant 2007;26:

92 PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 3 and 8 Years (Transplants: April June 1998) 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 Rapamycin Tacrolimus ISHLT 2007 N=204 J Heart Lung Transplant 2007;26:

93 PEDIATRIC HEART RECIPIENTS Relationship of Rejection and Coronary Artery Vasculopathy (Follow-ups: April 1994 – June 2006) Rejection During 1 st Year Reported CAV between 1 st and 3 rd years post-transplant Reported CAV between 3 rd and 5 th years post-transplant YesNoAllYesNoAll Yes44 7.7% % % % % % No18 3.0% % % % % % p = p = NOTE: Only those recipients without CAV prior to 3 years were included in the last set of columns ISHLT 2007 J Heart Lung Transplant 2007;26:

94 PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January June 2006) CAUSE OF DEATH 0-30 Days (N = 387) 31 Days - 1 Year (N = 332) >1 Year - 3 Years (N = 249) >3 Years - 5 Years (N = 169) >5 Years - 10 Years (N = 237) >10 Years (N = 103) CORONARY ARTERY VASCULOPATHY 4 (1.0%)27 (8.1%)50 (20.1%)60 (35.5%)72 (30.4%)32 (31.1%) ACUTE REJECTION 40 (10.3%)83 (25.0%)65 (26.1%)23 (13.6%)36 (15.2%)7 (6.8%) LYMPHOMA 7 (2.1%)11 (4.4%)3 (1.8%)23 (9.7%)6 (5.8%) MALIGNANCY, OTHER 4 (1.2%)2 (0.8%)1 (0.6%)3 (1.3%)7 (6.8%) CMV 1 (0.3%)7 (2.1%)1 (0.4%) INFECTION, NON- CMV 53 (13.7%)55 (16.6%)17 (6.8%)7 (4.1%)14 (5.9%)10 (9.7%) PRIMARY FAILURE 73 (18.9%)17 (5.1%)8 (3.2%)10 (5.9%)11 (4.6%)2 (1.9%) GRAFT FAILURE 90 (23.3%)35 (10.5%)45 (18.1%)38 (22.5%)47 (19.8%)25 (24.3%) TECHNICAL 21 (5.4%)2 (0.6%)2 (0.8%)1 (0.6%)2 (0.8%) OTHER 19 (4.9%)15 (4.5%)19 (7.6%)14 (8.3%)17 (7.2%)2 (1.9%) MULTIPLE ORGAN FAILURE 38 (9.8%)45 (13.6%)7 (2.8%)3 (1.8%)4 (1.7%)6 (5.8%) RENAL FAILURE 1 (0.3%)5 (1.5%)1 (0.4%)1 (1.0%) PULMONARY 24 (6.2%)20 (6.0%)13 (5.2%)8 (4.7%)4 (1.7%)5 (4.9%) CEREBROVASCULAR 23 (5.9%)10 (3.0%)8 (3.2%)1 (0.6%)4 (1.7%) ISHLT 2007 J Heart Lung Transplant 2007;26:

95 PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January June 2006) CAUSE OF DEATH 0-30 Days (N = 164) 31 Days - 1 Year (N = 159) >1 Year - 3 Years (N = 144) >3 Years - 5 Years (N = 104) >5 Years - 10 Years (N = 184) >10 Years (N = 96) CAV 1 (0.6%)11 (6.9%)25 (17.4%)36 (34.6%)56 (30.4%)30 (31.3%) ACUTE REJECTION 19 (11.6%)30 (18.9%)32 (22.2%)14 (13.5%)27 (14.7%)7 (7.3%) LYMPHOMA 3 (1.9%)6 (4.2%)2 (1.9%)19 (10.3%)6 (6.3%) MALIGNANCY, OTHER 1 (0.6%)1 (0.7%)2 (1.1%)6 (6.3%) CMV 3 (1.9%)1 (0.7%) INFECTION, NON- CMV 24 (14.6%)22 (13.8%)8 (5.6%)2 (1.9%)12 (6.5%)8 (8.3%) PRIMARY FAILURE 30 (18.3%)5 (3.1%)4 (2.8%)3 (2.9%)5 (2.7%)2 (2.1%) GRAFT FAILURE 29 (17.7%)15 (9.4%)30 (20.8%)30 (28.8%)38 (20.7%)23 (24.0%) TECHNICAL 8 (4.9%). (.%)2 (1.4%)2 (1.1%) OTHER 14 (8.5%)10 (6.3%)16 (11.1%)9 (8.7%)14 (7.6%)2 (2.1%) MULTIPLE ORGAN FAILURE 20 (12.2%)31 (19.5%)6 (4.2%)2 (1.9%)3 (1.6%)6 (6.3%) RENAL FAILURE 5 (3.1%)1 (0.7%)1 (1.0%) PULMONARY 8 (4.9%)17 (10.7%)8 (5.6%)6 (5.8%)3 (1.6%)5 (5.2%) CEREBROVASCULAR 11 (6.7%)6 (3.8%)4 (2.8%)3 (1.6%) ISHLT 2007 J Heart Lung Transplant 2007;26:


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