heart transplantation
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HEART TRANSPLANTATION
Pediatric Recipients
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
0102030405060708090
100110120
OtherNorth AmericaEurope
Transplant Year
Num
ber o
f Cen
ters
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AVERAGE CENTER VOLUME AND PERCENTAGE OF TRANSPLANTS BY CENTER VOLUMEPediatric Heart Transplants: January 1, 2000 - June 30, 2011
1-4 5-9 10+0
20
40
60
80
100
120
140
160
0
7
14
21
28
35
42
49
56
139
17 14
111
21 21
Number of centers 2000-2005 Number of centers 2006-June 2011Percentage of transplants 2000-2005 Percentage of transplants 2006-June 2011
Average number of heart transplants per year
Num
ber o
f Cen
ters
% o
f Tra
nspl
ants
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS Distribution of Transplants By Location and Average Center
Volume (Transplants: January 2000 – June 2011)
ISHLT 2012
Europe North America Other0%
20%
40%
60%
80%
100%
1-4/year 5-9/year 10+/year
% o
f Tra
nspl
ants
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
DISTRIBUTION OF TRANSPLANTS By Center Volume
Pediatric Heart Transplants: January 1, 2000 - June 30, 2011
1-4 5-9 10+0
10
20
30
40
50
60
33.126
40.9
22.4 22.4
55.3
2000-2005 2006-June 2011
Average number of heart transplants per year
% o
f Tra
nspl
ants
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS(Transplants: January 2000 - June 2011)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170
200
400
600
800
1,000
1,200
1,400
Recipient Age (Years)
Num
ber o
f Tra
nspl
ants
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTSBy Year of Transplant
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
050
100150200250300350400450500550600
11-17 Years1-10 Years<1 Year
Num
ber o
f Tra
nspl
ants
ISHLT 2012
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. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSAge Distribution By Location
(Transplants: January 2000 – June 2011)
ISHLT 2012
Europe North America Other0%
20%
40%
60%
80%
100%
<1 years 1-10 years 11-17 years
% o
f Tra
nspl
ants
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS (Transplants: January 2000 - June 2011)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18-25
26-30
31+0
100
200
300
400
500
600
700
800
900
1,000
Donor Age (Years)
Num
ber o
f Tra
nspl
ants
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSDonor Age Distribution By Location
(Transplants: January 2000 – June 2011)
ISHLT 2012
Europe North America Other0%
20%
40%
60%
80%
100%
<1 1-10 11-17 18-34 35-49 50-64
% o
f Tra
nspl
ants
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
DISTRIBUTION OF TRANSPLANTS by Donor/Recipient Weight Ratio
(Pediatric Heart Transplants: January 1, 2000 - June 30, 2011)
<0.75 0.75-<1.0 1.0-<1.5 1.5-<2.0 2.0-<2.5 2.5+0
5
10
15
20
25
30
35
40
45
50
2000-2005 2006-June 2011
Donor/Recipient Weight Ratio
% o
f Tra
nspl
ants
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year)
ISHLT 2012
21%
76%
2%1%
Myopathy
Congenital
Other
ReTX1988-1999
38%
59%
3%
1%
2000-6/2011
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
0
25
50
75
100Myopathy Congenital
% o
f Cas
es
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 1-10 Years)
ISHLT 2012
54%
39%
2%
5%Myopathy
Congenital
Other
ReTX1988-1999
56%
37%
3%
5%
2000-6/2011
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
0
25
50
75
100Myopathy Congenital
% o
f Cas
es
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 11-17 Years)
ISHLT 2012
66%28%
3%3%
Myopathy
Congenital
Other
ReTX1988-1999
65%
23%
3%
9%
2000-6/2011
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
0
25
50
75
100Myopathy Congenital
% o
f Cas
es
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSDiagnosis Distribution By Location
(Transplants: January 2000 – June 2011)
ISHLT 2012
0%
20%
40%
60%
80%
100%
Europe North America Other
Other
Re-TX/Graft Failure
Malignancy
Coronary Artery Disease
Congenital
Cardiomyopathy
% o
f Tra
nspl
ants
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTS% of Patients Bridged with Mechanical Circulatory Support*
by Year (Transplants: January 2005 – December 2010)
ISHLT 2012
2005 2006 2007 2008 2009 20100
5
10
15
20
25
30
35
40
22.1 21.122.7 22.1 28.3 24.6
AnyECMOVAD + ECMO
% o
f Pat
ient
s
* LVAD, RVAD, TAH, ECMOJ Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTS% of Patients Bridged with Mechanical Circulatory Support*
(Transplants: July 2004 – June 2011)
ISHLT 2012
Any Device (N=578)
LVAD (N=243)
ECMO (N=166)
BIVAD (N=125)
VAD+ECMO (N=28)
RVAD (N=9) Unknown Type
(VAD or TAH) (N=4)
TAH (N=3)0
5
10
15
20
25
30
23.3
9.8
6.75.0
1.1 0.4 0.2 0.1
% o
f Pat
ient
s
* LVAD, RVAD, TAH, ECMOJ Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTS% of Patients Bridged with Mechanical Circulatory Support*
by Age Group (Transplants: July 2004 – June 2011)
ISHLT 2012
<1 1-10 11-170
5
10
15
20
25
30
35
40
21.9 23.524.2
AnyECMOVAD + ECMO
Age Group
% o
f Pat
ient
s
* LVAD, RVAD, TAH, ECMOJ Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTS PRA Distribution by Year (Transplants: 2005 – 2010)
ISHLT 2012
2005 2006 2007 2008 2009 20100%
20%
40%
60%
80%
100%0-9% 10-39% 40-79% 80%+
% o
f Pat
ient
s
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTS PRA Distribution by Age Group (Transplants: July 2004 – June 2011)
ISHLT 2012
<1 1-10 11-170%
20%
40%
60%
80%
100%0-9% 10-39% 40-79% 80%+
Age Group
% o
f Pat
ient
s
p-value = 0.0001
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Survival (Transplants: 1/1982-6/2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 200
20
40
60
80
100<1 Year (N = 2,396)1-10 Years (N = 3,512)11-17 Years (N = 3,695)Overall (N = 9,603)
Years
Surv
ival
(%)
Half-life <1: 19.2 Years; 1-10: 15.6 Years; 11-17: 11.9 Years
ISHLT 2012
0-<1 vs. 1-10: p = 0.0041 0-<1 vs. 11-17: p = 0.9859 1-10 vs. 11-17: p = 0.0003
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSConditional Kaplan-Meier Survival (Transplants: 1/1982-6/2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 200
20
40
60
80
100
<1 Year (N = 1,673) 1-10 Years (N = 2,741)11-17 Years (N =2,934) Overall (N = 7,348)
Years
Surv
ival
(%)
Half-life: <1: n.c.; 1-10: 19.2 Years; 11-17: 15.9 Years
ISHLT 2012
0-<1 vs. 1-10: p = 0.0003 0-<1 vs. 11-17: p < 0.00011-10 vs. 11-17: p < 0.0001
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Survival by Era (Transplants: 1/1982-6/2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 200
20
40
60
80
1001982-1989 (N=925) 1990-1999 (N=3,872)
2000-6/2010 (N=4,806)
Years
Surv
ival
(%)
Half-life 1982-1989: 9.1 years; 1990-1999: 13.9 years; 2000-6/2010: n.c.
ISHLT 2012
All p-values significant at p = 0.001
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSConditional Kaplan-Meier Survival for Recent Era
(Transplants: 1/2000-6/2010)
0 1 2 3 4 5 6 750
60
70
80
90
100
<1 Year (N = 841) 1-10 Years (N = 1,463)11-17 Years (N = 1,502) Overall (N = 3,554)
Years
Surv
ival
(%)
ISHLT 2012
0-<1 vs. 1-10: p = 0.02720-<1 vs. 11-17: p = 0.0008 1-10 vs. 11-17: p < 0.0001
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Survival by Era (Transplants: 1/1982-6/2010)
Age: < 1 Year
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170
20
40
60
80
100
1982-1989 (N=188) 1990-1999 (N=1,077)2000-6/2010 (N=1,131)
Years
Surv
ival
(%)
ISHLT 2012
1982-1989 vs. 1990-1999: p = 0.00571982-1989 vs. 2000-6/2010: p < 0.0001 1990-1999 vs. 2000-6/2010: p < 0.0001Half-life 1982-1989: 10.8 years; 1990-1999: 18.3 years; 2000-6/2010: n.c.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Survival by Era (Transplants: 1/1982-6/2010)
Age: 1-10 Years
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170
20
40
60
80
100 1982-1989 (N = 288) 1990-1999 (N=1,425)2000-6/2010 (N=1,799)
Years
Surv
ival
(%)
ISHLT 2012
All p-values significant at p = 0.0001
Half-life 1982-1989: 8.0; 1990-1999: 14.3; 2000-6/2010: n.c.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Survival by Era (Transplants: 1/1982-6/2010)
Age: 11-17 Years
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 190
20
40
60
80
1001982-1989 (N=449) 1990-1999 (N=1,370)2000-6/2010 (N=1,876)
Years
Surv
ival
(%)
ISHLT 2012
1982-1989 vs. 1990-1999: p = 0.01581982-1989 vs. 2000-6/2010: p < 0.0001 1990-1999 vs. 2000-6/2010: p = 0.0311
Half-life 1982-1989: 9.3; 1990-1999: 11.4; 2000-6/2010: n.c.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Survival by Diagnosis (Transplants: 2000-6/2010)
Age: < 1 Year
0 1 2 3 4 5 6 7 8 9 100
20
40
60
80
100
Congenital (N=662) Cardiomyopathy (N=422)
Years
Surv
ival
(%)
ISHLT 2012
p-value < 0.0001
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Survival by Diagnosis (Transplants: 2000-6/2010)
Age: 1 - 10 Years
0 1 2 3 4 5 6 7 8 9 100
20
40
60
80
100
Congenital (N=652) Cardiomyopathy (N=1,001)Retransplant (N=83)
Years
Surv
ival
(%)
ISHLT 2012
Congenital vs. Cardiomyopathy: p < 0.0001Congenital vs. Retransplant: p = 0.0154Cardiomyopathy vs. Retransplant: p < 0.0001
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Survival by Diagnosis (Transplants: 2000-6/2010)
Age: 11 - 17 Years
0 1 2 3 4 5 6 7 8 9 100
20
40
60
80
100
Congenital (N=423) Cardiomyopathy (N=1,185)Retransplant (N=164)
Years
Surv
ival
(%)
ISHLT 2012
Congenital vs. Cardiomyopathy: p = 0.0526 Congenital vs. Retransplant: p = 0.1841Cardiomyopathy vs. Retransplant: p=0.0024
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Patient vs. Graft Survival (Transplants: 1/2000-6/2010)
Average Center Volume: 1-4 Transplants per Year
0 1 2 3 4 5 6 7 8 90
20
40
60
80
100
Patient (N=1,500) Graft (N=1,500)
Years
Surv
ival
(%)
ISHLT 2012
p = 0.1973
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Patient vs. Graft Survival (Transplants: 1/2000-6/2010)
Average Center Volume: 5-9 Transplants per Year
0 1 2 3 4 5 6 7 8 90
20
40
60
80
100
Patient (N=1,193) Graft (N=1,193)
Years
Surv
ival
(%)
ISHLT 2012
p = 0.0580
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Patient vs. Graft Survival (Transplants: 1/2000-6/2010)
Average Center Volume: 10+ Transplants per Year
0 1 2 3 4 5 6 7 8 90
20
40
60
80
100
Patient (N=2,113) Graft (N=2,113)
Years
Surv
ival
(%)
ISHLT 2012
p = 0.0135
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTS Cross-Sectional Analysis
Functional Status of Surviving Recipients (Follow-ups: January 2000 – June 2011)
ISHLT 2012
1 Year (N = 1,130) 3 Years (N = 944) 5 Year (N = 789)0%
20%
40%
60%
80%
100%
No Activity Limitations Performs with Some AssistanceRequires Total Assistance
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: January 2000 – June 2011)Age: <1 Year
ISHLT 2012
1 Year (N = 246) 3 Year (N = 251) 5 Year (N = 240)0%
20%
40%
60%
80%
100%
No Activity Limitations Performs with Some AssistanceRequires Total Assistance
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: January 2000 – June 2011)Age: 1-10 Years
ISHLT 2012
1 Year (N = 444) 3 Year (N = 350) 5 Year (N = 295)0%
20%
40%
60%
80%
100%
No Activity Limitations Performs with Some AssistanceRequires Total Assistance
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: January 2000 – June 2011)Age: 11-17 Years
ISHLT 2012
1 Year (N = 440) 3 Year (N = 343) 5 Year (N = 254)0%
20%
40%
60%
80%
100%
No Activity Limitations Performs with Some AssistanceRequires Total Assistance
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTSFunctional Status of Surviving Recipients
US Recipients Only(Follow-ups: March 2005 – June 2011)
ISHLT 2012
0%
20%
40%
60%
80%
100%
1 Year (N = 1,712)
2 Years (N = 1,533)
3 Years (N = 1,388)
10% 20%
30% 40%
50% 60%
70% 80%
90% 100%
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTSRehospitalization Post-transplant of Surviving Recipients
(Follow-ups: January 2000 – June 2011)
ISHLT 2012
0%
20%
40%
60%
80%
100%
1 Year (N = 3,361)
3 Years (N =2,675)
5 Years (N = 2,153)
No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Hospitalized, Infection OnlyHospitalized, Rejection + Infection
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTSInduction Immunosuppression
(Transplants: January 2001 – June 2011)
ISHLT 2012
Any Induction (N = 1,982)
Polyclonal ALG/ATG (N =
1,332)
OKT3 (N = 56) IL-2R Antagonist (N = 659)
0
10
20
30
40
50
60
70
% o
f Pat
ient
s
Analysis is limited to patients who were alive at the time of the discharge
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTSInduction Immunosuppression
(Transplants: January 2001 – June 30, 2011)
ISHLT 2012Analysis is limited to patients who were alive at the time of the discharge
20012003
20052007
2009
1/11-6/112001
20032005
20072009
1/11-6/112001
20032005
20072009
1/11-6/110
10
20
30
40
50
60
70
% o
f Pat
ient
s
Any Induction Polyclonal ALG/ATG IL-2R AntagonistTest of increasing trend over time:Any induction p < 0.0001Polyclonal p < 0.0001IL-2R p < 0.0001
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Survival by Induction Group Conditional on
Survival to 14 Days (Transplants: January 2000 – June 2010)
0 1 2 3 4 5 6 7 8 950
60
70
80
90
100
No induction (N = 1,527)
Polyclonal induction (N = 1,237)
IL-2R antagonist (N = 524)
Years
Surv
ival
(%)
No comparisons are statistically significant
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival by Induction Group and Treated Rejection
Between Transplant Discharge and 1-Year Follow-up (1-Year Follow-ups: July 2004 - June 2010)
Conditional on Survival to 1 Year
0 1 2 3 4 550
60
70
80
90
100
No induction/No rejection (N = 462)Polyclonal induction/No rejection (N = 469)IL-2R antagonist/No rejection (N = 207)No induction/Treated Rejection (N = 142)Polyclonal induction/Treated Rejection (N = 169)IL-2R antagonist/Treated Rejection (N = 80)
Years
Surv
ival
(%)
No pair-wise comparisons of survival by induction are statistically significant within either rejection grouping
ISHLT 2012
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.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Survival by Induction Group Conditional on
Survival to 14 Days (Transplants: January 2000 – June 2010)Age: <1 Year
0 1 2 3 4 5 650
60
70
80
90
100
No induction (N = 346)
Polyclonal induction (N = 430)
IL-2R antagonist (N = 81)
Years
Surv
ival
(%)
No comparisons are statistically significant
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Survival by Induction Group Conditional on
Survival to 14 Days (Transplants: January 2000 – June 2010)Age: 1-10 Years
0 1 2 3 4 5 6 750
60
70
80
90
100
No induction (N = 604)
Polyclonal induction (N = 433)
IL-2R antagonist (N = 206)
Years
Surv
ival
(%)
No comparisons are statistically significant
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Survival by Induction Group Conditional on
Survival to 14 Days (Transplants: January 2000 – June 2010)Age: 11-17 Years
0 1 2 3 4 5 650
60
70
80
90
100
No induction (N =577)
Polyclonal induction (N = 374)
IL-2R antagonist (N = 237)
Years
Surv
ival
(%)
No comparisons are statistically significant
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTSMaintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2001 – June 2011)
Cyclosporine Tacrolimus Sirolimus/Everolimus
MMF/MPA Azathioprine Prednisone0
20
40
60
80
100Year 1 (N = 2,904) Year 5 (N = 1,842)
% o
f Pat
ient
s
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2012Analysis is limited to patients who were alive at the time of the follow-up
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
for Same Patients at Each Time Point(Follow-ups: January 2001 – June 2011)
ISHLT 2012
0%
20%
40%
60%
80%
100%
Year 1 (N = 1,180)
Year 5 (N = 1,180)
None
Other
Tacrolimus + MMF/MPA + Sirolimus/Everolimus
Tacrolimus + Sirolimus/Everolimus
Tacrolimus
Tacrolimus + MMF/MPA
Tacrolimus + AZA
Cyclosporine
Cyclosporine + MMF/MPA
Cyclosporine + AZA
Analysis is limited to patients who were alive at the time of the follow-up
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at
Time of Follow-up (Follow-ups: January 2001 – June 2011)
ISHLT 2012
0%
20%
40%
60%
80%
100%
Year 1 (N = 2,904)
Year 5 (N = 1,842)
None
Other
Tacrolimus + MMF/MPA + Sirolimus/Everolimus
Tacrolimus + Sirolimus/Everolimus
Tacrolimus
Tacrolimus + MMF/MPA
Tacrolimus + AZA
Cyclosporine
Cyclosporine + MMF/MPA
Cyclosporine + AZA
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
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Survival Based on Prednisone Use
Conditional on Survival to 1 Year (Transplants: January 2000 - June 2010)
0 1 2 3 4 5 6 7 8 9 1050
60
70
80
90
100
Prednisone use at discharge and 1 year (N = 1,631)
No Prednisone at discharge or at 1 year (N = 484)
Prednisone at discharge/not at 1 year (N = 460)
Years
Surv
ival
(%)
p = 0.0009
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival Stratified by Tacrolimus vs.
Cyclosporine Use at DischargeConditional on Survival to 14 Days (Transplants: January 2000 - June 2010)
0 1 2 3 4 5 6 7 8 9 1050
60
70
80
90
100
Tacrolimus use at discharge (N = 1,902)
Cyclosporine use at discharge (N = 1,243)
Years
Surv
ival
(%)
p = 0.1599
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS Kaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use
Conditional on Survival to 1 Year (Transplants: January 2000 - June 2010)
0 1 2 3 4 5 6 7 8 9 1050
60
70
80
90
100
Cyclosporine use at discharge and 1 year (N = 787)Tacrolimus use at discharge and 1 year (N = 1,458)Cyclosporine use at discharge/Tacrolimus at 1 year (N = 241)Tacrolimus use at discharge/Cyclosporine at 1 year (N = 33)
Years
Surv
ival
(%)
p = 0.0567
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Survival Based on Treated Rejection within 1st Year
Conditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2010)
0 1 2 3 4 5 650
60
70
80
90
100
Free from Rejection during 1 year (N = 942)
Treated Rejection within 1st Year (N = 438)
Years
Surv
ival
(%)
p = 0.0151
ISHLT 2012
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.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Survival Based on Treated Rejection within 1st Year
Stratified by Calcineurin Use at DischargeConditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2010)
0 1 2 3 4 5 650
60
70
80
90
100
CyA: Free from Rejection during 1 year (N = 238)CyA: Treated Rejection within 1st Year (N = 139)TAC: Free from Rejection during 1 year (N = 648)TAC: Treated Rejection within 1st Year (N = 262)
Years
Surv
ival
(%)
Free from Rejection: CyA vs. TAC p = 0.5818Treated Rejection: CyA vs. TAC p = 0.0332 CyA: Rejection vs. no rejection p = 0.9998TAC: Rejection vs. no rejection p = 0.0067
ISHLT 2012
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.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Survival Based on Treated Rejection within 1st Year
Stratified by Calcineurin Use at Discharge: Age = 0-10 YearsConditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2010)
0 1 2 3 4 550
60
70
80
90
100
CyA: Free from Rejection during 1 year (N = 172)CyA: Treated Rejection within 1st Year (N = 91)TAC: Free from Rejection during 1 year (N = 426)TAC: Treated Rejection within 1st Year (N = 146)
Years
Surv
ival
(%)
Free from Rejection: CyA vs. TAC p = 0.6663Rejection: CyA vs. TAC p = 0.2116 CyA: Rejection vs. no rejection p = 0.5128TAC: Rejection vs. no rejection p = 0.0361
ISHLT 2012
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.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTSKaplan-Meier Survival Based on Treated Rejection within 1st Year
Stratified by Calcineurin Use at Discharge: Age = 11-17 Years Conditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2010)
0 1 2 3 450
60
70
80
90
100
CyA: Free from Rejection during 1st Year (N = 66)CyA: Treated Rejection within 1st Year (N =48)TAC: Free from Rejection during 1st Year (N = 222)TAC: Treated Rejection within 1st Year (N = 116)
Years
Surv
ival
(%)
Free from Rejection: CyA vs. TAC p = 0.9896Treated Rejection: CyA vs. TAC p = 0.0944 CyA: Rejection vs. no rejection p = 0.4559TAC: Rejection vs. no rejection p = 0.1451
ISHLT 2012
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.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
Stratified by Era (Follow-ups: July 2004 - June 2011)
0
10
20
30
40
50
7/2004-6/2008, Treatment 7/2004-6/2008, Rejection/Not Treated7/2008-6/2011, Treatment 7/2008-6/2011, Rejection/Not Treated
% e
xper
ienc
ing
reje
ctio
n w
ithin
1 y
ear
All pair-wise comparisons were statistically significant at < 0.02
Overall < 1 1-10 11-17 Female Male
ISHLT 2012 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.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
Stratified by Induction (Follow-ups: July 2004 - June 2011)
0
10
20
30
40
50
No induction, Treatment No induction, Rejection/Not TreatedInduction (no OKT3), Treatment Induction (no OKT3), Rejection/Not Treated
% e
xper
ienc
ing
reje
ctio
n w
ithin
1
year
No comparisons were statistically significant at 0.05
Overall < 1 1-10 11-17 Female Male
ISHLT 2012 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.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
Stratified by Type of Induction (Follow-ups: July 2004 - June 2011)
0
10
20
30
40
50
No induction, Treatment No induction, Rejection/Not TreatedPolyclonal, Treatment Polyclonal, Rejection/Not TreatedIL-2R antagonist, Treatment ILR antagonist, Rejection/Not Treated
% e
xper
ienc
ing
reje
ctio
n w
ithin
1 y
ear
No comparisons were statistically significant at 0.05 except:Overall – No induction vs. IL-2R antagonist (p=0.0371)
Overall < 1 1-10 11-17 Female Male
ISHLT 2012 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.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
Stratified by Maintenance Immunosuppression and Induction(Follow-ups: July 2004 - June 2011)
0
10
20
30
40
50
CyA+No induction, Treatment CyA+No induction, Rejection/Not TreatedCyA+Induction (no OKT3), Treatment CyA+Induction (no OKT3), Rejection/Not TreatedTAC+No induction, Treatment TAC+No induction, Rejection/Not TreatedTAC+Induction (no OKT3), Treatment TAC+Induction (no OKT3), Rejection/Not Treated
% e
xper
ienc
ing
reje
ctio
n w
ithin
1 y
ear
All pair-wise comparisons were significant at 0.05 except: CyA + no induction vs. CyA + induction (overall and all age groups); TAC + no induction vs. TAC + induction (overall and all age groups); CyA + induction vs. TAC + no induction (<1); CyA + induction vs. TAC + induction (<1).
Overall < 1 1-10 11-17
ISHLT 2012
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.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
Stratified by Maintenance Immunosuppression(Follow-ups: July 2004 - June 2011)
0102030405060
Cyclosporine + MMF/MPA, Treatment Cyclosporine + MMF/MPA, Rejection/Not TreatedCyclosporine + AZA, Treatment Cyclosporine + AZA, Rejection/Not TreatedTacrolimus + MMF/MPA, Treatment Tacrolimus + MMF/MPA, Rejection/Not TreatedTacrolimus + AZA, Treatment Tacrolimus + AZA, Rejection/Not Treated
% e
xper
ienc
ing
reje
ctio
n w
ithin
1 y
ear
Overall: all comparisons were statistically significant at 0.05 except CyA+MMF/MPA vs. CyA+AZA and TAC+MMF/MPA vs. TAC+AZA<1: CyA + MMF/MPA vs. TAC + MMF/MPA (p =0.0008)1-10: CyA + MMF/MPA vs. TAC + MMF/MPA (p = 0.0002); CyA + AZA vs. TAC + MMF/MPA (p=0.0011).11-17: all comparisons were statistically significant at 0.05 except CyA +MMF/MPA vs. CyA +AZA and TAC + MMF/MPA vs. TAC + AZA
Overall < 1 1-10 11-17
ISHLT 2012
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.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
Stratified by Stratified by Calcineurin Inhibitor Use at Discharge(Follow-ups: July 2004 - June 2011)
0
10
20
30
40
50
60
70Cyclosporine, Treatment Cyclosporine, Rejection/Not TreatedTacrolimus, Treatment Tacrolimus, Rejection/Not Treated
% e
xper
ienc
ing
reje
ctio
n w
ithin
1 y
ear
Overall: CyA vs. TAC (p < 0.0001)<1: CyA vs. TAC (p = 0.0046) 1-10: CyA vs. TAC (p = 0.0001)11-17: CyA vs. TAC (p < 0.0001)
Overall < 1 1-10 11-17
ISHLT 2012 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.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Coronary Artery VasculopathyFor Pediatric Heart Recipients (Follow-ups: April 1994 – June 2011)
0 1 2 3 4 5 6 7 8 9 10 11 1250
60
70
80
90
100
Years
% F
ree
from
CA
V
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Coronary Artery VasculopathyFor Pediatric Heart Recipients (Follow-ups: April 1994 – June 2011)
Stratified by Induction
0 1 2 3 4 5 6 7 8 9 1050
60
70
80
90
100
Induction (N = 1,894)No Induction (N = 2,071)
Years
% F
ree
from
CA
V
p = 0.2843
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Coronary Artery VasculopathyFor Pediatric Heart Recipients (Follow-ups: 2000 – June 2011)
Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year
0 1 2 3 4 5 6 7 8 950
60
70
80
90
100
Cyclosporine use at discharge and 1 year (N = 841)Tacrolimus use at discharge and 1 year (N = 1,354)Cyclosporine use at discharge/Tacrolimus at 1 year (N = 253)Tacrolimus use at discharge/Cyclosporine at 1 year (N = 35)
Years
% F
ree
from
CA
V
p = 0.7785
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Coronary Artery VasculopathyFor Pediatric Heart Recipients (Follow-ups: 2000 – June 2011)
Stratified by Age Group
0 1 2 3 4 5 6 7 8 950
60
70
80
90
100
<1 Year (N = 759)
1-10 Years (N = 1,113)
11-17 Years (N = 1,091)
Years
% F
ree
from
CA
V
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Coronary Artery VasculopathyFor Pediatric Heart Recipients (Follow-ups: 2000 – June 2011)
Stratified by Ischemia Time
0 1 2 3 4 5 6 7 8 950
60
70
80
90
100
0-<2 hours (N=267)
2-<4 hours (N=1,520)
4+ hours (N=929)
Years
% F
ree
from
CA
V
p = 0.0232
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Coronary Artery VasculopathyFor Pediatric Heart Recipients (Follow-ups: 2000 – June 2011)
Stratified by Ischemia Time and Recipient Age
0 1 2 3 4 5 6 7 8 950
60
70
80
90
100
0-<2 hours/0-10 years (N=157)2+ hours/0-10 years (N=1,555)0-<2 hours/11-17 years (N=110)2+ hours/11-17 years (N=894)
Years
% F
ree
from
CA
V
0-10 years: p = 0.029711-17 years: p = 0.4690
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Graft Survival Following Report of Coronary Artery Vasculopathy
For Pediatric Heart Recipients (Follow-ups: 2000 – June 2011)Stratified by Age Group
0 1 2 3 4 50
10
20
30
40
50
60
70
80
90
100
<1 Year (N = 54)
1-10 Years (N = 123)
11-17 Years (N = 176)
Time since Report of CAV (Years)
Surv
ival
sin
ce R
epor
t of C
AV
(%)
p = 0.7238
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Severe Renal Dysfunction*For Pediatric Heart Recipients (Follow-ups: 2000 – June 2011)
0 1 2 3 4 5 6 7 8 9 10 1150
60
70
80
90
100
Years
% F
ree
from
Sev
ere
Ren
al D
ys-
func
tion * Severe renal dysfunction = Creatinine > 2.5 mg/dl
(221 μmol/L), dialysis or renal transplant
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Severe Renal Dysfunction*For Pediatric Heart Recipients (Follow-ups: 2000 – June 2011)
Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year
ISHLT 2012
0 1 2 3 4 5 6 7 8 9 1050
60
70
80
90
100
Cyclosporine use at discharge and 1 year (N = 870)
Years
% F
ree
from
Sev
ere
Ren
al D
ys-
func
tion * Severe renal dysfunction = Creatinine > 2.5 mg/dl
(221 μmol/L), dialysis or renal transplant
p = 0.3394
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Renal Replacement TherapyFor Pediatric Heart Recipients (Follow-ups: April 1994 – June 2011)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1550
60
70
80
90
100
Years
% F
ree
from
Sev
ere
Ren
al D
ys-
func
tion
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Malignancy Post-Heart Transplant for PediatricsCumulative Morbidity Rates in Survivors
(Follow-ups: April 1994 – June 2011)
Malignancy/Type 1-Year Survivors
5-Year Survivors
10-Year Survivors
No Malignancy 4,358 (98.3%) 1,900 (95.1%) 579 (91.2%)
Malignancy (all types combined) 76 (1.7%) 97 (4.9%) 56 (8.8%)
Malignancy Type*
Lymphoma 70 92 53
Other 5 5 4
Skin 0 1 1
Type Not Reported 1 0 0
*Recipients may have experienced more than one type of malignancy so sum of individual malignancy types may be greater than total number with malignancy.
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM MALIGNANCYFor Pediatric Heart Recipients (Follow-ups: April 1994 – June 2011)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
100
All malignancy Lymphoma Skin Other
Years
% F
ree
from
Mal
igna
ncy
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM MALIGNANCYby Maintenance Immunosuppression Combinations at Discharge
For Pediatric Heart Recipients (Follow-ups: January 2000 - June 2011) Conditional on Survival to 1 year
0 1 2 3 4 5 6 7 850
60
70
80
90
100
Cyclosporine use at discharge and 1 year (N = 772)Tacrolimus use at discharge and 1 year (N = 1,371)Cyclosporine use at discharge and Tacrolimus use at 1 year (N = 245)Tacrolimus use at discharge and Cyclosporine use at 1 year (N = 33)
Years
% F
ree
from
Mal
igna
ncy
ISHLT 2012
p = 0.0385
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
FREEDOM FROM LYMPHOMA BY INDUCTION For Pediatric Heart Recipients (Follow-ups: April 1994 – June 2011)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1550
60
70
80
90
100
Induction (N=1,858)No Induction (N=1,854)
Years
% F
ree
from
Lym
phom
a
ISHLT 2012
p = 0.5803
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 1 and 3 Years
(Transplants: January 2000 - June 2008)
Maintenance Immunosuppression at discharge and 1 year
% HTN reported between 1 and 3 years
P-valueFor Patients on
drugFor Patients not on drug
Azathioprine 20.1 24.9 0.1917
Cyclosporine 24.7 21.6 0.3397
MMF/MPA 23.8 23.9 0.9864
Prednisone 26.9 20.9 0.0987
Sirolimus/Everolimus 35.7 23.3 0.3363
Tacrolimus 23.4 24.3 0.7847
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095ISHLT 2012
PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 3 and 5 Years
(Transplants: January 2000 - June 2006)
Maintenance Immunosuppression at discharge and 1 year
% HTN reported between 3 and 5 years
P-valueFor Patients
on drugFor Patients not on drug
Azathioprine 13.1 17.5 0.3137
Cyclosporine 14.2 17.0 0.5003MMF/MPA 15.3 16.1 0.8745Prednisone 18.8 10.0 0.0607Sirolimus/Everolimus 16.7 16.1 > 0.9999
Tacrolimus 17.7 14.8 0.4838
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RECIPIENTSRelationship of Rejection and Coronary Artery Vasculopathy
(Follow-ups: July 2004 – June 2011)
Rejection During 1st Year
Reported CAV between 1st and 3rd years post-transplant
Yes No All
Yes 175.4%
30094.6%
317100%
No 254.6%
52195.4%
546100%
p = 0.6058
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 540
50
60
70
80
90
100
<1 Year (N=57) 1-<3 Years (N=45) 3-<5 Years (N=52) 5+ Years (N=192)Primary TX (N=6,762)
Surr
viva
l (%
)
Comparison of survival for re-transplant groups: p = 0.0002
Time (years) since most recent transplant
PEDIATRIC HEART RETRANSPLANTS Kaplan-Meier Survival Rates Stratified by Inter-Transplant Interval
(Re-transplants: January 1994 - June 2010)
Only patients who were less than 18 years old at the time of re-transplant are included.
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART RE-TRANSPLANTSBy Transplant Year
(Re-transplants: January 1994 – December 2010)
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
0
5
10
15
20
25
30
35
40
45
Num
ber o
f tra
nspl
ants
Year of re-transplantOnly patients who were less than 18 years old at the time of re-transplant are included.ISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
<1 month 1-<12 months
12-<36 months
36-<60 months
60+ months Not reported0
10
20
30
40
50
0-10 Years 11-17 Years
% o
f Re-
Tran
spla
nts
Time Between Previous and Current Transplant
PEDIATRIC HEART RE-TRANSPLANTSBy Inter-transplant Interval
(Re-transplants: January 1994 - June 2011)
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
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 2000 - June 2011)
CAUSE OF DEATH 0-30 Days (N = 240)
31 Days - 1 Year (N = 282)
>1 Year - 3 Years (N = 240)
>3 Years - 5 Years (N = 191)
>5 Years - 10 Years (N = 335)
>10 Years(N = 262)
CORONARY ARTERY VASCULOPATHY 3 (1.3%) 14 (5.0%) 40 (16.7%) 47 (24.6%) 84 (25.1%) 71 (27.1%)
ACUTE REJECTION 22 (9.2%) 50 (17.7%) 47 (19.6%) 24 (12.6%) 43 (12.8%) 13 (5.0%)
LYMPHOMA 6 (2.1%) 5 (2.1%) 7 (3.7%) 26 (7.8%) 20 (7.6%)
MALIGNANCY, OTHER 1 (0.4%) 3 (1.3%) 1 (0.5%) 5 (1.5%) 10 (3.8%)
CMV 7 (2.5%) 1 (0.4%)
INFECTION, NON-CMV 30 (12.5%) 37 (13.1%) 16 (6.7%) 8 (4.2%) 14 (4.2%) 18 (6.9%)
GRAFT FAILURE 80 (33.3%) 42 (14.9%) 74 (30.8%) 66 (34.6%) 106 (31.6%) 75 (28.6%)
TECHNICAL 20 (8.3%) 2 (0.7%) 1 (0.4%) 1 (0.5%) 4 (1.2%) 6 (2.3%)
OTHER 16 (6.7%) 23 (8.2%) 27 (11.3%) 16 (8.4%) 26 (7.8%) 21 (8.0%)
MULTIPLE ORGAN FAILURE 32 (13.3%) 53 (18.8%) 11 (4.6%) 8 (4.2%) 9 (2.7%) 11 (4.2%)
RENAL FAILURE 7 (2.5%) 1 (0.4%) 1 (0.5%) 1 (0.3%) 7 (2.7%)
PULMONARY 11 (4.6%) 27 (9.6%) 10 (4.2%) 7 (3.7%) 10 (3.0%) 6 (2.3%)
CEREBROVASCULAR 26 (10.8%) 13 (4.6%) 4 (1.7%) 5 (2.6%) 7 (2.1%) 4 (1.5%)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANT RECIPIENTS:Relative Incidence of Leading Causes of Death
(Deaths: January 2000 - June 2011)
0-30 Days(N = 240)
31 Days - 1 Year(N = 282)
>1 Year - 3 Years (N = 240)
>3 Years - 5 Years (N = 191)
>5 Years - 10 Years (N = 335)
>10 Years(N = 262)
0
10
20
30
40
50CAV Acute Rejection Infection (non-CMV) Graft Failure
Perc
enta
ge o
f Dea
ths
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009)Risk Factors For 1 Year Mortality
VARIABLE N Relative Risk
P-value 95% Confidence Interval
ECMO, age = 0 years 129 2.98 <.0001 2.11.-4.21Retransplant 212 1.98 0.0017 1.29-3.05Congenital diagnosis 1376 1.98 <.0001 1.51-2.59ECMO, age = 1-17 years 145 1.91 0.0033 1.24-2.93On dialysis 108 1.68 0.0073 1.15-2.46On ventilator 696 1.57 0.0003 1.23-2.01Prior sternotomy 815 1.55 0.0014 1.19-2.02Donor cause of death = cerebrovascular/stroke vs. head trauma 387 1.45 0.023 1.05-1.99Male donor/female recip vs. male donor/male recip 893 1.39 0.0125 1.07-1.80
Previous transfusions 1155 1.28 0.0416 1.01-1.61Donor cause of death = anoxia vs. head trauma 335 0.68 0.0033 0.53-0.88
N = 3,417Reference group = Cardiomyopathy, no devices
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009)Borderline Significant Risk Factors For 1 Year Mortality
N = 3,417
ISHLT 2012
VARIABLE N Relative Risk P-value 95% Confidence
Interval
Donor with prior clinical infection 912 0.81 0.0816 0.63-1.03
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009)Risk Factors For 1 Year Mortality
Continuous Factors (see figures)
Donor age Ischemia time
Recipient pre-transplant creatinine
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009)Risk Factors For 1 Year Mortality with 95% Confidence Limits
Donor Age
0 5 10 15 20 25 30 35 400.0
0.5
1.0
1.5
2.0
2.5
3.0
Donor Age
Rel
ativ
e R
isk
of 1
Yea
r Mor
talit
y
p = 0.022
ISHLT 2012
(N = 3,417)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009)Risk Factors For 1 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant Creatinine
0.0 0.5 1.0 1.5 2.0 2.50.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Recipient creatinine (mg/dl)
Rel
ativ
e R
isk
of 1
Yea
r Mor
talit
y
p = 0.0381
ISHLT 2012 (N = 3,417)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009)Risk Factors For 1 Year Mortality with 95% Confidence Limits
Ischemia time
1 2 3 4 5 6 7 80.0
0.5
1.0
1.5
2.0
2.5
3.0
Ischemia time (hours)
Rel
ativ
e R
isk
of 1
Yea
r Mor
talit
y
p = 0.0099
ISHLT 2012 (N = 3,417)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009)Age = <1 Year
Risk Factors For 1 Year MortalityVARIABLE N Relative
RiskP-value 95% Confidence
Interval
ECMO, diagnosis = congenital 80 3.09 <.0001 1.94-4.92
PRA > 10% 64 2.65 0.0006 1.52-4.61
ECMO, diagnosis = not congenital 48 2.37 0.0057 1.29-4.38
On dialysis 30 2.35 0.0026 1.35-4.10
Donor cause of death = cerebrovascular/stroke vs. head trauma 33 2.27 0.0141 1.18-4.36
Prior sternotomy 181 2.24 <.0001 1.49-3.36
On ventilator 358 2.15 <.0001 1.50-3.09
N = 902Reference group = Congenital, no devices
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009) Age = <1 Year
Borderline Significant Risk Factors For 1 Year Mortality
N = 902
ISHLT 2012
VARIABLE N Relative Risk P-value 95% Confidence
Interval
Infection requiring IV drug therapy (within 2wk/TX) 257 1.40 0.0579 0.99-1.99
Transplant year: 2002-2003 vs. 2000-2001 161 0.59 0.0747 0.33-1.05
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009) Age = <1 Year
Risk Factors For 1 Year Mortality
Continuous Factors (see figures)
Recipient pre-transplant creatinine Ischemia time
Volume of pediatric transplants
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009)Risk Factors For 1 Year Mortality in Age = <1 Year
Recipient Pre-Transplant Creatinine
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.00.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Recipient creatinine (mg/dl)
Rel
ativ
e R
isk
of 1
Yea
r Mor
talit
y
p = 0.0036
ISHLT 2012 (N = 902)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009)Risk Factors For 1 Year Mortality in Age = <1 Year
Ischemia time
1 2 3 4 5 6 7 80.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Ischemia time (hours)
Rel
ativ
e R
isk
of 1
Yea
r Mor
talit
y
p = 0.0005
ISHLT 2012 (N = 902)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009)Risk Factors For 1 Year Mortality in Age = <1 Year
Center Volume for Pediatric Transplants
0 5 10 15 20 250.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Center volume (cases per year)
Rel
ativ
e R
isk
of 1
Yea
r Mor
talit
y
p = 0.0096
ISHLT 2012 (N = 902)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009)Age = 1-10 Years
Risk Factors For 1 Year Mortality
VARIABLE N Relative Risk
P-value 95% Confidence Interval
ECMO 104 1.96 0.0157 1.14-3.38
Previous transfusion 380 1.92 0.001 1.30-2.83
Diagnosis = congenital 521 1.83 0.0049 1.20-2.78
Donor cause of death = anoxia vs. head trauma 324 0.46 0.0023 0.28-0.76
N = 1,306Reference group = Cardiomyopathy, no devices
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009) Age = 1-10 Year s
Borderline Significant Risk Factors For 1 Year Mortality
N = 1,306
ISHLT 2012
VARIABLE N Relative Risk P-value 95% Confidence
Interval
Female recipient 664 1.45 0.0546 0.99-2.11
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009) Age = 1-10 Year s
Risk Factors For 1 Year Mortality
Continuous Factors (see figures)
Recipient age Recipient pre-transplant creatinine
Recipient height Recipient pre-transplant bilirubin
Donor BSA
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095ISHLT 2012
PEDIATRIC HEART TRANSPLANTS (2000-2009)Risk Factors For 1 Year Mortality in Age = 1-10 Years
Recipient Age
1 2 3 4 5 6 7 8 9 100.0
1.0
2.0
3.0
4.0
5.0
Recipient Age (years)
Rel
ativ
e R
isk
of 1
Yea
r Mor
talit
y p = 0.00143
ISHLT 2012NOTE: Due to the correlation in donor size, recipient size and recipient age, the interpretation of the impact of each factor should be considered in the context of the other factors.
(N = 1,306)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009)Risk Factors For 1 Year Mortality in Age = 1-10 Years
Recipient Height
65 75 85 95 105 115 125 135 145 1550.0
1.0
2.0
3.0
4.0
Recipient Height (cm)
Rel
ativ
e R
isk
of 1
Yea
r Mor
talit
y
p = 0.0055
NOTE: Due to the correlation in donor size, recipient size and recipient age, the interpretation of the impact of each factor should be considered in the context of the other factors.
(N = 1,306)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095ISHLT 2012
PEDIATRIC HEART TRANSPLANTS (2000-2009)Risk Factors For 1 Year Mortality in Age = 1-10 Years
Donor BSA
0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.80.0
1.0
2.0
3.0
Donor BSA (m2)
Rel
ativ
e R
isk
of 1
Yea
r Mor
talit
y
p = 0.042
ISHLT 2012NOTE: Due to the correlation in donor size, recipient size and recipient age, the interpretation of the impact of each factor should be considered in the context of the other factors.
(N = 1,306)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009)Risk Factors For 1 Year Mortality in Age = 1-10 Years
Recipient Pre-Transplant Creatinine
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 1.1 1.2 1.30.0
1.0
2.0
3.0
4.0
5.0
6.0
Recipient creatinine (mg/dl)
Rel
ativ
e R
isk
of 1
Yea
r Mor
talit
y
p = 0.0018
(N = 1,306)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ISHLT 2012
PEDIATRIC HEART TRANSPLANTS (2000-2009)Risk Factors For 1 Year Mortality in Age = 1-10 Years
Recipient Pre-Transplant Bilirubin
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 1.1 1.2 1.30.0
0.5
1.0
1.5
2.0
Recipient bilirubin (mg/dl)
Rel
ativ
e R
isk
of 1
Yea
r Mor
talit
y p = 0.0052
(N = 1,306)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ISHLT 2012
PEDIATRIC HEART TRANSPLANTS (2000-2009)Age = 11-17 Years
Risk Factors For 1 Year Mortality
VARIABLE N Relative Risk
P-value 95% Confidence Interval
Retransplant 132 2.63 0.0006 1.51-4.58
Diagnosis = congenital 296 2.07 0.0017 1.31-3.25
Previous transfusion 284 1.60 0.0292 1.05-2.45
Donor cause of death = anoxia vs. head trauma 162 0.36 0.024 0.15-0.87
N = 1,200Reference group = Cardiomyopathy, no devices
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095ISHLT 2012
PEDIATRIC HEART TRANSPLANTS (2000-2009) Age = 11-17 Year s
Risk Factors For 1 Year Mortality
Continuous Factors (see figures)
Recipient pre-transplant bilirubin Height ratio (borderline)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (2000-2009)Risk Factors For 1 Year Mortality in Age = 11-17 Years
Recipient Pre-Transplant Bilirubin
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.00
1
2
3
4
Recipient bilirubin (mg/dl)
Rel
ativ
e R
isk
of 1
Yea
r Mor
talit
y p = 0.0228
(N = 1,200)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ISHLT 2012
PEDIATRIC HEART TRANSPLANTS (2000-2009)Risk Factors For 1 Year Mortality in Age = 11-17 Years
Donor Height/Recipient Height Ratio
0.9 1.0 1.1 1.20.0
0.5
1.0
1.5
2.0
2.5
Donor height/recipient height
Rel
ativ
e R
isk
of 1
Yea
r Mor
talit
y p = 0.0574
ISHLT 2012 (N = 1,200)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (1996-2005)Risk Factors For 5 Year Mortality
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
ECMO, age = 0 years 78 2.50 <.0001 1.77-3.54
ECMO, age = 11-17 years 42 2.01 0.0086 1.19-3.40
Retransplant 179 1.93 <.0001 1.44-2.59
Diagnosis = congenital 1246 1.62 <.0001 1.36-1.91
On dialysis 77 1.50 0.0285 1.04-2.15
PRA > 10% 297 1.49 0.0002 1.21-1.85
Male donor/female recip vs. male donor/male recip 723 1.37 0.0013 1.13-1.67
On ventilator 554 1.28 0.016 1.05-1.67
N = 2,940Reference group = Cardiomyopathy, no devices
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095ISHLT 2012
PEDIATRIC HEART TRANSPLANTS (1996-2005)Borderline Significant Risk Factors For 5 Year Mortality
VARIABLEN Relative
RiskP-value 95% Confidence
IntervalInfection requiring IV drug therapy (within 2wk/TX) 448 1.20 0.0702 0.99-1.46
N = 2,940Reference group = Cardiomyopathy, no devices
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095ISHLT 2012
PEDIATRIC HEART TRANSPLANTS (1996-2005)Risk Factors For 5 Year Mortality
Continuous Factors (see figures)
Recipient age Estimated GFR (borderline)
Volume of pediatric transplants (borderline)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095ISHLT 2012
PEDIATRIC HEART TRANSPLANTS (1996-2005)Risk Factors For 5 Year Mortality with 95% Confidence Limits
Recipient Age
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170.0
0.5
1.0
1.5
2.0
Recipient Age (years)
Rel
ativ
e R
isk
of 5
Yea
r Mor
talit
y p = 0.0002
(N = 2,904)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ISHLT 2012
PEDIATRIC HEART TRANSPLANTS (1996-2005)Risk Factors For 5 Year Mortality with 95% Confidence Limits
Center Volume for Pediatric Transplants
0 5 10 15 20 250.0
0.5
1.0
1.5
2.0
Center volume (cases per year)
Rel
ativ
e R
isk
of 5
Yea
r Mor
talit
y
p = 0.0728
(N = 2,904)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ISHLT 2012
PEDIATRIC HEART TRANSPLANTS (1996-2005)Risk Factors For 5 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant Estimated GFR
30 40 50 60 70 80 90 100 110 1200.0
0.5
1.0
1.5
2.0
Estimated GFR (mL/min/1.73 m2)
Rel
ativ
e R
isk
of 5
Yea
r Mor
talit
y p = 0.0687
(N = 2,904)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ISHLT 2012
PEDIATRIC HEART TRANSPLANTS (1991-2000)Risk Factors For 10 Year Mortality
VARIABLE N Relative Risk
P-value 95% Confidence Interval
Retransplant 135 2.21 <.0001 1.73-2.84
ECMO, age = 0 years 36 1.8 0.0095 1.15-2.82
On ventilator 492 1.31 0.0009 1.12-1.54
Diagnosis = congenital 1501 1.29 0.0001 1.13-1.46Male donor/female recip vs. male donor/male recip 777 1.27 0.0017 1.09-1.47
Transplant year: 1995/1996 vs. 1991/1992 609 0.82 0.0314 0.68-0.98
0-3 vs. 4-6 total HLA mismatches 297 0.76 0.01 0.62-0.94
Transplant year: 1999/2000 vs. 1991/1992 704 0.73 0.0009 0.61-0.88
Transplant year: 1997/1998 vs. 1991/1992 707 0.66 <.0001 0.55-0.80
N = 3,263Reference group = Cardiomyopathy, no devices
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095ISHLT 2012
PEDIATRIC HEART TRANSPLANTS (1991-2000)Borderline Significant Risk Factors For 10 Year Mortality
VARIABLEN Relative
RiskP-value 95% Confidence
Interval
Balloon pump 35 1.59 0.0517 1.00-2.54
Diagnosis = not myopathy, congenital or retransplant 160 1.28 0.0676 0.98-1.66
Donor cause of death = anoxia vs. head trauma 558 0.85 0.0624 0.72-1.01
N = 3,263Reference group = Cardiomyopathy, no devices
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (1991-2000)Risk Factors For 10 Year Mortality
Continuous Factors (see figures)
Donor age Recipient weight
Volume of pediatric transplants
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095ISHLT 2012
PEDIATRIC HEART TRANSPLANTS (1991-2000)Risk Factors For 10 Year Mortality with 95% Confidence Limits
Donor Age
0 5 10 15 20 25 30 35 400.0
0.5
1.0
1.5
2.0
2.5
Donor Age (years)
Rel
ativ
e R
isk
of 1
0 Ye
ar M
orta
lity p = 0.0074
ISHLT 2012 (N = 3,263)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (1991-2000)Risk Factors For 10 Year Mortality with 95% Confidence Limits
Recipient Weight
0 10 20 30 40 50 60 70 80 900.0
0.5
1.0
1.5
2.0
2.5
3.0
Recipient Weight (kg)
Rel
ativ
e R
isk
of 1
0 Ye
ar M
orta
lity
p = 0.0048
ISHLT 2012 (N = 3,263)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (1991-2000)Risk Factors For 10 Year Mortality with 95% Confidence Limits
Center Volume for Pediatric Transplants
0 5 10 15 20 250.0
0.5
1.0
1.5
2.0
Center volume (cases per year)
Rel
ativ
e R
isk
of 1
0 Ye
ar M
orta
lity
p = 0.0041
ISHLT 2012 (N = 3,263)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (1988-1995)Risk Factors For 15 Year Mortality
VARIABLE N Relative Risk
P-value 95% Confidence Interval
Retransplant 69 1.66 0.0024 1.20-2.30
Balloon pump 31 1.62 0.0368 1.03-2.56
Recipient history of malignancy 45 1.60 0.0116 1.11-2.31
On ventilator 397 1.28 0.0031 1.09-1.51
Diagnosis = congenital 1076 1.16 0.0436 1.00-1.35
N = 2,113Reference group = Cardiomyopathy, no devices
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (1988-1995)Risk Factors For 15 Year Mortality
Continuous Factors (see figures)
Donor age Volume of pediatric transplants
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (1988-1995)Risk Factors For 15 Year Mortality with 95% Confidence Limits
Donor Age
0 5 10 15 20 25 30 35 400.0
0.5
1.0
1.5
2.0
2.5
Donor Age (years)
Rel
ativ
e R
isk
of 1
5 Ye
ar M
orta
lity p = 0.0061
ISHLT 2012 (N = 2,113)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PEDIATRIC HEART TRANSPLANTS (1988-1995)Risk Factors For 15 Year Mortality with 95% Confidence Limits
Center Volume for Pediatric Transplants
0 5 10 15 20 250.0
0.5
1.0
1.5
2.0
Center volume (cases per year)
Rel
ativ
e R
isk
of 1
5 Ye
ar M
orta
lity
p = 0.0004
ISHLT 2012 (N = 2,113)J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
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