2004 ishlt j heart lung transplant 2004; 23: 933-947 heart transplantation pediatric recipients

2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947

HEART TRANSPLANTATION

Pediatric Recipients


AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS (Transplants: January 1996 - June 2003)

0

100

200

300

400

500

600

700

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Recipient Age (Years)

Nu

mb

er o

f T

ran

spla

nts


AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS (Transplants: January 1996 - June 2003)

0

100

200

300

400

500

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18-25

26-30

31+

Donor Age (Years)

Nu

mb

er o

f T

ran

spla

nts


AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS

By Year of Transplant

0

100

200

300

40011-17 Years1-10 Years

<1 Year

11 941

75110

130

194

254

325369367

388370383

359386

368359365

347359

Nu

mb

er o

f T

ran

spla

nts


NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS

0

20

40

60

80

100

120

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

Nu

mb

er o

f P

edia

tric

Cen

ters

Rep

ort

ing


DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year)

0

25

50

75

100

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

% o

f Cas

es

MyopathyCongenital

30%

66%

3%

1%

15%

81%2%

2%

Myopathy

Congenital

Other

ReTX

1988-1995 1/1996-6/2003


DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 1-10 Years)

0

25

50

75

100

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

% o

f Cas

es

Myopathy Congenital

52%

37%

4%7%51%

40%

5%

4%Myopathy

Congenital

Other

ReTX

1988-1995 1/1996-6/2003


DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 11-17 Years)

0

25

50

75

100

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

% o

f Cas

es

Myopathy Congenital

62%

28%

4%

6%

67%

24%

6%

3%

Myopathy

Congenital

Other

ReTX

1988-1995 1/1996-6/2003l


PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival (1/1982-6/2002)

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Years

Su

rviv

al (

%)

<1 Year (N=1,286) 1-10 Years (N=1,962)11-17 Years (N=2,048) Overall (N=5,296)

<1 year vs. 1-10 years: p = 0.0015<1 year vs. 11-17 years: p = 0.02

HALF-LIFE <1: 13.3 years; 1-10: 12.9 years; 11-17: 11.3 years


PEDIATRIC HEART TRANSPLANTATIONConditional Kaplan-Meier Survival (1/1982-6/2002)

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Years

Su

rviv

al (

%)

<1 Year (N=849) 1-10 Years (N=1,437)11-17 Years (N=1,506) Overall (N=3,792)

Both comparisons with 11-17 years significant at p < 0.0001

HALF-LIFE <1: not computable; 1-10: 17.5 years; 11-17: 13.7 years


PEDIATRIC HEART TRANSPLANTATIONConditional Kaplan-Meier Survival for Recent Era (1/1998-6/2002)

50

60

70

80

90

100

0 1 2 3 4

Years

Su

rviv

al (

%)

<1 Year (N=264) 1-10 Years (N=469)11-17 Years (N=445) Overall (N=1,178)

No comparisons were statistically significant


PEDIATRIC HEART TRANSPLANTATION

Kaplan-Meier Survival by Era (1/1982-6/2002)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Years

1982-1988 (N=570) 1989-1993 (N=1,703)

1994-1998 (N=1,866) 1/1999-6/2002 (N = 1,247)

All comparisons with 1999-2002 are significant at p < 0.0001Comparison of 1982-1988 vs. 1994-1998 is significant at p < 0.0001Comparison of 1989-1993 vs. 1994-1998 is significant at p < 0.0001

HALF-LIFE 1982-1988: 9.7 years; 1989-1993: 11.3 yearsSu

rviv

al (

%)


PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2002)

Age: < 1 Year

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Years

1982-1988 (N=52) 1989-1993 (N=516)

1994-1998 (N=462) 1/1999-6/2002 (N = 281)

P-values for era comparisons1982-88 vs. 1999-2002: p = 0.01; 1989-93 vs. 1994-1998: p = 0.00031989-93 vs. 1999-2002: p < 0.0001; 1994-98 vs. 1999-2002: p = 0.0002


rviv

al (

%)



Age: 1-10 Years

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Years

1982-1988 (N=182) 1989-1993 (N=598)

1994-1998 (N=740) 1/1999-6/2002 (N = 475)

P-values for era comparisons1982-88 vs. 1994-98: p < 0.0001; 1982-88 vs. 1999-2002: p < 0.0001; 1989-93 vs. 1994-1998: p = 0.0008; 1989-93 vs. 1999-2002: p < 0.0001


rviv

al (

%)



Age: 11-17 Years

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Years

1982-1988 (N=336) 1989-1993 (N=589)

1994-1998 (N=664) 1/1999-6/2002 (N = 491)

P-values for era comparisons1982-88 vs. 1994-98: p = 0.002; 1982-88 vs. 1999-2002: p < 0.0001;


rviv

al (

%)


PEDIATRIC HEART TRANSPLANTS (1/1995-6/2002)

Risk Factors For 1 Year Mortality

N=2,290

VARIABLE

Odds Ratio

P-value 95%

Confidence Interval

Congenital heart disease 2.88 <.0001 2.08 -4.00

Other diagnosis (excluding cardiomyopathy)

2.35 0.0074 1.26 -4.39

Retransplant 2.26 0.0209 1.13 -4.53

On ventilator 1.81 0.0005 1.30 -2.52

Hospitalized (including ICU) 1.60 0.003 1.17 -2.18


PEDIATRIC HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality

Continuous Factors (see figures)

Donor Age PCW

PA systolic



Donor Age

0

0.5

1

1.5

2

0 10 20 30 40

Donor Age (Years)

Od

ds

of

1 Y

ear

Mo

rtal

ity

p = 0.033



Recipient Pulmonary Capillary Wedge Pressure (PCW)

0

0.5

1

1.5

2

5 10 15 20 25 30 35

Recipient PCW (mm Hg)

Od

ds

of

1 Y

ear

Mo

rtal

ity

p = 0.049



Recipient PA systolic

0

0.5

1

1.5

2

10 20 30 40 50 60 70

Recipient PA Systolic (mm Hg)

Od

ds

of

1 Y

ear

Mo

rtal

ity

p = 0.02


PEDIATRIC HEART TRANSPLANTS (1/1995-6/2002) Factors Not Significant for 1 Year Mortality

Recipient Factors:IV inotropes, PGE, ECMO, sternotomy, history of malignancy, weight, height, dialysis, recent infection, gender, age



Donor Factors:Gender, clinical infection, history of diabetes, height, COD

Transplant Factors:Donor/recipient weight ratio, CMV mismatch, ABO identical/compatible, year of transplant, ischemia time, HLA mismatch, transplant center volume



Risk Factors For 5 Year Mortality

N=1,234

VARIABLE

Odds Ratio

P-value 95%

Confidence Interval

Dialysis 4.44 0.03 1.19 -16.55

Other diagnosis (excluding cardiomyopathy and retransplant)

2.4 0.03 1.07 -5.39

Congenital diagnosis 1.49 0.03 1.05 -2.11

Female donor 1.44 0.01 1.08 -1.91



Continuous Factors (see figures) Recipient age

Recipient BMI Donor BMI



Recipient Age

0

1

2

3

0 3 6 9 12 15 18

Recipient Age (Years)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.03



Recipient Factors:IV inotropes, PGE, ECMO, history of malignancy, recent infection, gender, hospitalized at time of transplant, bilirubin



Donor Factors:Gender, clinical infection, history of diabetes, 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



Risk Factors For 5 Year Mortality Conditional on 1 Year Survival

N=968

VARIABLE

Odds Ratio

P-value 95%

Confidence Interval

ECMO 3.38 0.04 1.05 -10.86

Prior sternotomy 2.21 0.006 1.25 -3.92

Congenital heart disease (>0 years) 0.5 0.03 0.27 -0.92

0 year old/congenital/no PGE 0.23 0.04 0.06 -0.95


PEDIATRIC HEART RECIPIENTS Functional Status (Follow-ups: April 1994-June 2003)

0%

20%

40%

60%

80%

100%

1 Year (N =1,724)

3 Years (N =1,429)

5 Years (N =1,147)

7 Years (N =792)

No Activity Limitations Performs with Some Assistance Requires Total Assistance


PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant (Follow-ups: April 1994 - June 2003)

0%

20%

40%

60%

80%

100%

Up to 1 Year (N =1,973)

Between 2 and 3Years (N = 1,539)

Between 4 and 5Years (N = 1,204)

Between 6 and 7Years (N = 856)

No Hospitalization Hospitalized, Not Rejection/Not Infection

Hospitalized, Rejection Hospitalized, Infection Only

Hospitalized, Rejection + Infection


0

10

20

30

40

50

Any Induction (N = 312) Polyclonal ALG/ATG (N= 198)

OKT3 (N = 27) IL2R-antagonist (N =104)

% o

f p

ati

en

ts

PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Follow-ups: January 2001 - June 2003)


0

10

20

30

40

50

60

Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist

% o

f p

ati

en

ts

2001 2002 1/2003-6/2003

PEDIATRIC HEART RECIPIENTSInduction Immunosuppression (Follow-ups: January 2001 - June 2003)


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

ati

en

ts

Year 1 (N = 579) Year 5 (N = 384)

PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up

For follow-ups between January 2000 through June 2003

NOTE: Different patients are analyzed in Year 1 and Year 5


0%

20%

40%

60%

80%

100%

Year 1 (N = 594) Year 5 (N = 402)

% o

f P

ati

en

ts

Other

Tacrolimus + MMF

Tacrolimus + AZA

Cyclosporine + MMF

Cyclosporine + AZA

PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up

For follow-ups between January 2001 through June 2003

NOTE: Different patients are analyzed in Year 1 and Year 5


POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 1 Year Post-Transplant

(Follow-ups: April 1994 - June 2003)

Outcome Within 1

Year Total number with known response

Hypertension 45.6% (N = 1,932)

Renal Dysfunction 5.4% (N = 1,929)

Abnormal Creatinine < 2.5 mg/dl 3.5% Creatinine > 2.5 mg/dl 1.3% Chronic Dialysis 0.6% Renal Transplant 0.1%

Hyperlipidemia 9.9% (N = 2,021)

Diabetes 3.2% (N = 1,935)

CAV 2.5% (N = 1,754)


POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 5 Years Post-Transplant


Outcome Within 5

Years Total number with known response

Hypertension 60.4% (N = 553)

Renal Dysfunction 8.4% (N = 571)


Hyperlipidemia 20.2% (N = 593)

Diabetes 4.5% (N = 552)

CAV 11.4% (N = 369)


POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 7 Years Post-Transplant


Outcome Within 7

Years Total number with known response

Hypertension 64.7% (N = 249)

Renal Dysfunction 10.0% (N = 260)


Hyperlipidemia 23.3% (N = 266)

Diabetes 4.4% (N = 250)

CAV 14.3% (N = 147)


FREEDOM FROM CAV For Pediatric Heart Recipients (Follow-ups: April 1994-June 2003)

0

20

40

60

80

100

0 1 2 3 4 5 6 7

Years

% F

reed

om

fro

m C

AV


FREEDOM FROM CAV For Pediatric Heart Recipients (Follow-ups: April 1994-June 2003)

Stratified by Age Group

0

20

40

60

80

100

0 1 2 3 4 5 6 7

Years

% F

ree

do

m f

rom

CA

V

<1 Year (N = 487)1-10 Years (N = 724)11-17 Years (N = 671)

p = 0.005


SURVIVAL FOLLOWING REPORT OF CAV For Pediatric Heart Recipients (Follow-ups: April 1994-June 2003)

Stratified by Age Group

0

20

40

60

80

100

0 0.5 1 1.5 2 2.5

Time since Report of CAV (Years)

Su

rviv

al s

ince

Rep

ort

of

CA

V (

%)

<1 Year (N = 33)

1-10 Years (N = 54)

11-17 Years (N = 70)

p = 0.4


FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Pediatric Heart Recipients (Follow-ups: April 1994-June

2003)

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

% F

reed

om fr

om S

ever

e R

enal

Dys

func

tion

* Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant


MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICSCumulative Prevalence in Survivors (Follow-ups: April 1994-June 2003)

Malignancy/Type 1-Year Survivors

5-Year Survivors

7-Year Survivors

No Malignancy 1974 (98.2%) 568 (95.6%) 251 (94%)

Malignancy (all types combined)

37 (1.8%) 26 (4.4%) 16 (6%)

Malignancy Type

Lymph 33 23 16

Other 3 3

Type Not Reported

1


FREEDOM FROM MALIGNANCYFor Pediatric Heart Recipients (Follow-ups: April 1994-June

2003)

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Months

% F

reed

om fr

om M

alig

nanc

y

All malignancy Lymph Skin Other


PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Prednisone Use

(Transplants: April 1994 - June 2002)

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9

Years

Su

rviv

al (

%)

Prednisone use at discharge and 1 year (N=1032)

No Prednisone at discharge or at 1 year (N=195)

Prednisone at discharge/not at 1 year (N = 191)

p = 0.02


PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Rejection within 1st Year


50

60

70

80

90

100

0 1 2 3 4 5 6 7 8

Years

Su

rviv

al (

%)

Free from Rejection during 1st Year (N = 712)Rejection within 1st Year (N = 862)

P = 0.016


PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 1 and 3 Years


Maintenance Immunosuppression at discharge and 1 year

% HTN reported between 1 and 3 years

P-valueFor Patients on drug

For Patients not on drug

Azathioprine 22.0% 19.3% 0.5

Cyclosporine 19.7% 19.5% 0.9

MMF 18.3% 21.2% 0.6

Prednisone 28.8% 6.5% <.0001

Rapamycin . 19.9%

Tacrolimus 22.1% 19.2% 0.6


PEDIATRIC HEART RECIPIENTSRelationship of Rejection and CAV

(Follow-ups: April 1994 – June 2003)

Rejection During 1st

Year

Reported CAV between 1st and 2nd years post-

transplant

Reported CAV between 1st and 3rd years post-

transplant

Yes No Yes No

Yes 27

5.0%

515

95.0%

33

8.2%

367

91.8%

No 8

1.6%

502

98.4%

11

3.0%

351

97.0%p = 0.002 p = 0.002


PEDIATRIC HEART RECIPIENTS Growth Following Transplantation: Height

Stratified by Prednisone Use at Discharge and at 1 Year

-1.25

-1

-0.75

-0.5

-0.25

0

Immediately Pre-Transplant

1 Year Follow-up 2 Year Follow-up 3 Year Follow-up

Time of Measurement

Z-S

core

1-5 Years/No Prednisone 1-5 Years/Prednisone

11-17/No Prednisone 11-17/Prednisone


PEDIATRIC HEART RECIPIENTS Growth Following Transplantation: Weight

Stratified by Prednisone Use at Discharge and at 1 Year

-1.5

-1.25

-1

-0.75

-0.5

-0.25

0

0.25

0.5

Immediately Pre-Transplant

1 Year Follow-up 2 Year Follow-up 3 Year Follow-up

Time of Measurement

Z-S

core

1-5 Years/No Prednisone 1-5 Years/Prednisone

11-17/No Prednisone 11-17/Prednisone


PERCENTAGE OF PEDIATRIC HEART TRANSPLANT

RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2002)

0

10

20

30

40

50

60

70

80

90

Overall <1 1-10 11-17 F M

% t

reat

ed f

or

reje

ctio

n w

ith

in 1

yea

r No induction PolyclonalIL2R-antagonist OKT3

1-10: No induction vs. polyclonal (p = 0.015); 11-17: No induction vs. OKT3 (p = 0.006); polyclonal vs. OKT3 (p = 0.02); IL2R vs. OKT3 (p = 0.03)Female: No induction vs. OKT3 (p = 0.003); polyclonal vs. OKT3 (p = 0.014); IL2R vs. OTK3 (p = 0.03)


NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR

Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2002)

0

0.5

1

1.5

2

2.5

Overall <1 1-10 11-17 F M

Ave

rag

e n

um

ber

of

reje

ctio

n e

pis

od

es No induction Polyclonal IL2R-antagonist OKT3

No within-age group or within-gender comparisons were statistically significant.


PERCENTAGE OF PEDIATRIC HEART TRANSPLANT

RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2002)

0

10

20

30

40

50

60

70

Overall <1 1-10 11-17 F M

% t

reat

ed f

or

reje

ctio

n w

ith

in 1

yea

r

Cyclosporin + MMF Cyclosporin + AZATacrolimus + MMF Tacrolimus + AZA

1-10: Cya + MMF vs. TAC + AZA (p = 0.007); CyA + AZA vs. TAC + AZA (p = 0.003)11-17: CyA + AZA vs. TAC + MMF (p = 0.01)Female: CyA + MMF vs. TAC + AZA (p = 0.008); CyA + AZA vs. TAC + MMF (p = 0.01); CyA + AZA vs. TAC + AZA (p = 0.0006)


NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2002)

0

0.5

1

1.5

2

2.5

3

Overall <1 1-10 11-17 F M

Av

era

ge

nu

mb

er

of

reje

cti

on

ep

iso

de

s

Cyclosporin + MMF Cyclosporin + AZATacrolimus + MMF Tacrolimus + AZA

No within-age group or within-gender comparisons were statistically significant.


PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2002)

Conditional on Survival to 14 Days

50

60

70

80

90

100

0 1 2 3

Years

Su

rviv

al (

%)

No induction (N= 465)

Polyclonal induction (N= 201)

IL2R-antagonist (N= 66)

OKT3 (N = 31)

No comparisons were statistically significant.



Conditional on Survival to 14 DaysAge: < 1 Year

50

60

70

80

90

100

0 1 2 3

Years

Su

rviv

al (

%)

No induction (N=90)

Polyclonal induction (N= 72)

p = 0.7



Conditional on Survival to 14 DaysAge: 1-10 Years

50

60

70

80

90

100

0 1 2 3

Years

Su

rviv

al (

%)

No induction (N=183)Polyclonal induction (N= 65)IL2R-antagonist (N = 25)

None of the comparisons were statistically significant.



Conditional on Survival to 14 DaysAge: 11-17 Years

50

60

70

80

90

100

0 1 2 3

Years

Su

rviv

al (

%)

No induction (N=170)Polyclonal induction (N= 55)IL2R-antagonist (N = 29)OKT3 (N = 19)

None of the comparisons were statistically significant.


PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2003)

CAUSE OF DEATH 0-30 Days (N = 310)

31 Days - 1 Year (N = 258)

>1 Year - 3 Years (N = 166)

>3 Years - 5 Years (N = 106)

>5 Years (N = 199)

CAV 3 (1.0%) 25 (9.7%) 35 (21.1%) 42 (39.6%) 64 (32.2%)

ACUTE REJECTION 26 (8.4%) 72 (27.9%) 45 (27.1%) 16 (15.1%) 24 (12.1%)

LYMPHOMA 5 (1.9%) 8 (4.8%) 2 (1.9%) 17 (8.5%)

MALIGNANCY, OTHER 4 (1.6%) 1 (0.6%) 1 (0.9%) 8 (4.0%)

CMV 1 (0.3%) 7 (2.7%) 1 (0.6%)

INFECTION, NON-CMV 40 (12.9%) 43 (16.7%) 12 (7.2%) 5 (4.7%) 12 (6.0%)

PRIMARY FAILURE 55 (17.7%) 12 (4.7%) 5 (3.0%) 7 (6.6%) 11 (5.5%)

GRAFT FAILURE 78 (25.2%) 31 (12.0%) 31 (18.7%) 21 (19.8%) 40 (20.1%)

TECHNICAL 21 (6.8%) 3 (1.2%) 2 (1.2%) 1 (0.9%) 1 (0.5%)

OTHER 8 (2.6%) 8 (3.1%) 9 (5.4%) 4 (3.8%) 10 (5.0%)

MULTIPLE ORGAN FAILURE

34 (11.0%) 26 (10.1%) 3 (1.8%) 1 (0.9%) 3 (1.5%)

RENAL FAILURE 1 (0.3%) 1 (0.4%)

PULMONARY 24 (7.7%) 14 (5.4%) 8 (4.8%) 5 (4.7%) 7 (3.5%)

CEREBROVASCULAR 19 (6.1%) 7 (2.7%) 6 (3.6%) 1 (0.9%) 2 (1.0%)

2004 ishlt j heart lung transplant 2004; 23: 933-947 heart transplantation pediatric recipients

Documents

ishlt j heart lung transplant

pediatric heart transplants

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year mortality slide

transplant center volume

year mortality donor

bilirubin slide