heart transplantation

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


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


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


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


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.


PEDIATRIC HEART TRANSPLANTSAge Distribution By Location

(Transplants: January 2000 – June 2011)

ISHLT 2012


20%

40%

60%

80%

100%

<1 years 1-10 years 11-17 years

% o

f Tra

nspl

ants


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


PEDIATRIC HEART TRANSPLANTSDonor Age Distribution By Location


ISHLT 2012


20%

40%

60%

80%

100%

<1 1-10 11-17 18-34 35-49 50-64

% o

f Tra

nspl

ants


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


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


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


% o

f Cas

es


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


% o

f Cas

es


PEDIATRIC HEART TRANSPLANTSDiagnosis Distribution By Location


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


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


(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



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


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


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


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


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


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


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



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.



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.



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.


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



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



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


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



Average Center Volume: 5-9 Transplants per Year

0 1 2 3 4 5 6 7 8 90

20

40

60

80

100


Years

Surv

ival

(%)

ISHLT 2012

p = 0.0580



Average Center Volume: 10+ Transplants per Year

0 1 2 3 4 5 6 7 8 90

20

40

60

80

100


Years

Surv

ival

(%)

ISHLT 2012

p = 0.0135


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


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%




(Follow-ups: January 2000 – June 2011)Age: 1-10 Years

ISHLT 2012


20%

40%

60%

80%

100%




(Follow-ups: January 2000 – June 2011)Age: 11-17 Years

ISHLT 2012


20%

40%

60%

80%

100%



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%


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


PEDIATRIC HEART RECIPIENTSInduction Immunosuppression


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


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


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


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.



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)


Years

Surv

ival

(%)




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)



Years

Surv

ival

(%)




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)



Years

Surv

ival

(%)



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


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


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


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


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


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


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


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




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




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




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



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




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






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)






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





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





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




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


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


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



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



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



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


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


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


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


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


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.


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


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


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


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


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


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.


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


<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


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%)


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


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


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



Continuous Factors (see figures)

Donor age Ischemia time

Recipient pre-transplant creatinine


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)



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


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


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


PEDIATRIC HEART TRANSPLANTS (2000-2009) Age = <1 Year

Borderline Significant Risk Factors For 1 Year Mortality

N = 902

ISHLT 2012


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


PEDIATRIC HEART TRANSPLANTS (2000-2009) Age = <1 Year

Risk Factors For 1 Year Mortality


Recipient pre-transplant creatinine Ischemia time

Volume of pediatric transplants


PEDIATRIC HEART TRANSPLANTS (2000-2009)Risk Factors For 1 Year Mortality in Age = <1 Year


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


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


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



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


PEDIATRIC HEART TRANSPLANTS (2000-2009)Age = 1-10 Years




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



PEDIATRIC HEART TRANSPLANTS (2000-2009) Age = 1-10 Year s

Borderline Significant Risk Factors For 1 Year Mortality

N = 1,306

ISHLT 2012


Interval

Female recipient 664 1.45 0.0546 0.99-2.11





Recipient age Recipient pre-transplant creatinine

Recipient height Recipient pre-transplant bilirubin

Donor BSA


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)



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)



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)




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


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


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


ISHLT 2012

PEDIATRIC HEART TRANSPLANTS (2000-2009)Age = 11-17 Years




Retransplant 132 2.63 0.0006 1.51-4.58


Previous transfusion 284 1.60 0.0292 1.05-2.45







Recipient pre-transplant bilirubin Height ratio (borderline)



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


ISHLT 2012


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



VARIABLEN Relative


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




VARIABLEN Relative


IntervalInfection requiring IV drug therapy (within 2wk/TX) 448 1.20 0.0702 0.99-1.46





Recipient age Estimated GFR (borderline)

Volume of pediatric transplants (borderline)



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


ISHLT 2012



0 5 10 15 20 250.0

0.5

1.0

1.5

2.0


Rel

ativ

e R

isk

of 5

Yea

r Mor

talit

y

p = 0.0728


ISHLT 2012


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


ISHLT 2012




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




VARIABLEN Relative


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 age Recipient weight

Volume of pediatric transplants



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



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




0 5 10 15 20 250.0

0.5

1.0

1.5

2.0


Rel

ativ

e R

isk

of 1

0 Ye

ar M

orta

lity

p = 0.0041





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






Donor age Volume of pediatric transplants



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




0 5 10 15 20 250.0

0.5

1.0

1.5

2.0


Rel

ativ

e R

isk

of 1

5 Ye

ar M

orta

lity

p = 0.0004


heart transplantation

Documents

ecmoj heart lung transplant

location transplants

year transplants

percentage of transplants

ishlt transplant registry

unknown diagnoses

recent years

number of centers