heart transplantation pediatric recipients ishlt 2006 j heart lung transplant 2006;25:893-903
TRANSCRIPT
HEART TRANSPLANTATION
Pediatric Recipients
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS (Transplants: January 1996 - June 2005)
0
100
200
300
400
500
600
700
800
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Recipient Age (Years)
Nu
mb
er o
f T
ran
spla
nts
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS
(Transplants: January 1996 - June 2005)
Nu
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er o
f T
ran
spla
nts
ISHLT 2006
0
100
200
300
400
500
600
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18-25
26-30
31+
Donor Age (Years)
J Heart Lung Transplant 2006;25:893-903
AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS
By Year of Transplant
0
100
200
300
400 11-17 Years
1-10 Years
<1 Year
11 945
77122
142
195
257
326
368366
384370
381355
386374
358362
346360
354 343
Nu
mb
er o
f T
ran
spla
nts
ISHLT 2006
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 declined in recent years.
J Heart Lung Transplant 2006;25:893-903
NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS
0
20
40
60
80
100
Nu
mb
er o
f P
edia
tric
Cas
es R
epo
rtin
g
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
AVERAGE CENTER VOLUMEPediatric Heart Transplants: January 1, 1997 - June 30, 2005
114
19 1
96
22 1180
10
20
30
40
50
60
70
80
90
100
110
120
1-4 5-9 10-19 20-29
Average number of heart transplants per year
Nu
mb
er
of
cen
ters
. 1997-2000
2001-6/2005
ISHLT 2006J Heart Lung Transplant 2006;25:893-903
DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME
Pediatric Heart Transplants: January 1, 1997 - June 30, 2005
33.3 32.928.4
5.4
25.9
35.139.0
0
5
10
15
20
25
30
35
40
1-4 5-9 10-19 20-29
Average number of heart transplants per year
% o
f tr
ansp
lan
ts .
1997-2000
2001-6/2005
ISHLT 2006J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART RE-TRANSPLANTSBy Transplant Year
Retransplants: January 1990 – December 2003
0
5
10
15
20
25
30
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Nu
mb
er
of
tra
ns
pla
nts
Year of transplant
J Heart Lung Transplant 2006;25:893-903
ISHLT
0
10
20
30
40
50
60
70
80
90
100
<1 month 1-<12 months 12-<36 months 36-<60 months 60+ months Not reported
Nu
mb
er
of
Re
-Tra
ns
pla
nts
PEDIATRIC HEART RE-TRANSPLANTSBy Intertransplant Interval
Retransplants: January 1994 - June 2005
ISHLT 2006
Time Between Previous and Current Transplant
J Heart Lung Transplant 2006;25:893-903
50
60
70
80
90
100
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
Su
rrviv
al (
%)
<1 month (N=21) 1-<12 months (N=13) 12-<36 months (N=26)
36+ months (N=104) Primary TX (N=3560)
KAPLAN-MEIER SURVIVAL RATES FOR PEDIATRIC HEART RETRANSPLANTS STRATIFIED BY INTER-TRANSPLANT INTERVAL
Retransplants: January 1994 - June 2004
ISHLT 2006
Time (years) since most recent transplant
J Heart Lung Transplant 2006;25:893-903
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year)
025
5075
100
MyopathyCongenital
31%
66%
2%
1%
16%
81%1%
2%
Myopathy
Congenital
Other
ReTX
1988-1995 1/1996-6/2005
% o
f C
ases
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 1-10 Years)
025
5075
100Myopathy Congenital
53%
1%
0%
37%
2%
7%53%
1%
0%
40%
2%
4% Myopathy
CoronaryArtery DiseaseMalignancy
CongenitalHeart DiseaseOther
ReTX
1988-1995 1/1996-6/2005
% o
f C
ases
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 11-17 Years)
025
5075
100Myopathy Congenital
63%
27%
2%
7%
1% 0%
67%
26%
2%
3%
2%0%
Myopathy
Coronary ArteryDiseaseMalignancy
Congenital
Other
ReTX
1
1988-1995 1/1996-6/2005
% o
f C
ases
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival (1/1982-6/2004)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years
<1 Year (N = 1,503) 1-10 Years (N = 2,213)11-17 Years (N = 2,308) Overall (N = 6,024)
<1 year vs. 1-10 years: p = 0.0027
HALF-LIFE <1: 14.9 years; 1-10: 13.4 years; 11-17: 11.5 years
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATIONConditional Kaplan-Meier Survival (1/1982-6/2004)
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years
<1 Year (N = 1,014) 1-10 Years (N = 1,666)11-17 Years (N = 1,780) Overall (N = 4,460)
0-1 vs. 1-10: p=0.0092Both comparisons with 11-17 years significant at p < 0.0001
HALF-LIFE <1: 18.4 years;1-10: 17.5 years; 11-17: 15.2 years
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATIONConditional 5-year Kaplan-Meier Survival (1/1982-6/2004)
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years
<1 Year (N = 598) 1-10 Years (N = 936)11-17 Years (N = 945) Overall (N = 2,479)
0-1 vs. 1-10: p=0.00030-1 vs. 11-17: p<0.00011-10 vs. 11-17: p=0.0025
HALF-LIFE 1-10: 19.8 years
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATIONConditional Kaplan-Meier Survival for Recent Era
(1/1999-6/2004)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
<1 Year (N = 333) 1-10 Years (N = 582)11-17 Years (N = 585) Overall (N = 1,500)
0-1 vs. 11-17: p<0.039
Half-life not computable for any age group.
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2004)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years
1982-1989 (N = 850) 1990-1994 (N=1,775)
1995-1999 (N=1,820) 2000-6/2004 (N=1,579)
All p-values significant at p< 0.0001 except comparison of 1995-1999 vs. 2000-6/2004
HALF-LIFE 1982-1989: 10.0 years; 1990-1994: 11.9 years; 1995-1999: n.c.; 2000-6/2004: n.c.
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2004)
Age: < 1 Year
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16Years
1982-1989 (N=164) 1990-1994 (N=521)
1995-1999 (N=451) 2000-6/2004 (N =367)
P-values for era comparisons1982-89 vs. 1990-94: p=0.39; 1982-89 vs. 1995-1999: p < 0.0001;1982-89 vs. 2000-6/04: p < 0.0001; 1990-94 vs. 1995-99: p < 0.0001;1990-94 vs. 2000-6/04: p < 0.0001; 1995-99 vs. 2000-6/04: p = 0.41
HALF-LIFE 1982-1989: 10.8 years; 1990-1994: 10.6 years;1995-1999: n.c.; 2000-6/2004: n.c.S
urv
ival
(%
)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2004)
Age: 1-10 Years
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Years
1982-1989 (N = 264) 1990-1994 (N=641)
1995-1999 (N=709) 2000-6/2004 (N=599)
P-values for era comparisons1982-89 vs. 1990-94: p = 0.028; 1982-89 vs. 1995-99: p < 0.0001; 1982-89 vs. 2000-6/04: p < 0.0001; 1990-94 vs. 1995-99: p = 0.0009; 1989-94 vs. 2000-6/04: p < 0.0001; 1995-99 vs. 2000-6/04: p = 0.71
HALF-LIFE 1982-1989: 10.9 years; 1990-1994: 12.6 years; 1995-1999: n.c.; 2000-6/2004: n.c.
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2004)
Age: 11-17 Years
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years
1982-1989 (N=422) 1990-1994 (N=613)
1995-1999 (N=660) 2000-6/2004 (N=613)
P-values for era comparisons1982-89 vs. 1990-94: p=0.08; 1982-89 vs. 1995-99: p = 0.0101; 1982-89 vs. 2000-6/04: p < 0.0001; 1990-94 vs. 1995-99: p = 0.77; 1990-94 vs. 2000-6/04: p = 0.75; 1995-99 vs. 2000-6/04: p = 0.31
HALF-LIFE 1982-1989: 9.9 years; 1990-1994: 11.3 years; 1995-1999: 10.1 years; 2000-6/2004: n.c.
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004)
Risk Factors For 1 Year Mortality
N=3,341
VARIABLE N
Relative Risk
P-value 95% Confidence
Interval
Congenital diagnosis, on ECMO 81 4.57 <0.0001 3.03 -6.89
Congenital diagnosis, no ECMO 1025 2.11 <0.0001 1.68 -2.65
Other diagnosis (not congenital, cardiomyopathy or retransplant)
122 1.92 0.0072 1.19 -3.10
Retransplant 160 1.85 0.0043 1.21 -2.83
Year of Transplant: 1995 vs. 1998 361 1.84 0.0016 1.26 -2.68
Congenital diagnosis, age=0, on PGE 189 1.73 0.0074 1.16 -2.58
Year of Transplant: 1996 vs. 1998 341 1.6 0.0204 1.08 -2.39
Hospitalized (including ICU) 2384 1.38 0.0097 1.08 -1.75
On ventilator 513 1.37 0.0132 1.07 -1.75
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004)
Borderline Significant Risk Factors For 1 Year Mortality
N=3,341
VARIABLE N Relative
Risk P-value
95% Confidence Interval
ECMO, diagnosis other than congenital 80 1.66 0.0649 0.97 -2.83
VAD 165 1.47 0.0535 0.99 -2.17
Year of Transplant: 1997 vs. 1998 363 1.42 0.0845 0.95 -2.12
Female recipient 1451 1.2 0.0554 1 -1.44
Donor cause of death: anoxia 607 0.82 0.0977 0.64 1.04
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality
Continuous Factors (see figures) Donor Age
Bilirubin
Creatinine
Weight ratio
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality
Donor Age
0
0.5
1
1.5
2
0 10 20 30 40
Donor Age (Years)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0005
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality
Pre-Transplant Bilirubin
0
0.5
1
1.5
2
0 1 2 3 4 5 6 7 8 9 10
Recipient Bilirubin (mg/dl)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.03
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality
Pre-Transplant Creatinine
0
0.5
1
1.5
2
0 0.5 1 1.5 2 2.5
Recipient serum creatinine (mg/dl)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.001
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality
Weight Ratio
0
0.5
1
1.5
2
2.5
0.5 1 1.5 2 2.5 3 3.5
Weight ratio (donor weight/recipient weight)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.004
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) Factors Not Significant for 1 Year Mortality
Recipient Factors:IV inotropes, sternotomy, thoracotomy, history of malignancy, height, recent infection, age, PA pressure, cardiac output, pulmonary vascular resistance, PRA
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) Factors Not Significant for 1 Year Mortality
Donor Factors:Gender, history of hypertension, height, clinical infection, history of diabetes
Transplant Factors:CMV mismatch, ABO identical/compatible, ischemia time, HLA mismatch, transplant center volume
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2004) 1-Year Predicted Survival
50%
60%
70%
80%
90%
100%
0 0.2 0.4 0.6 0.8 1
Time (years)
Pre
dic
ted
Su
rviv
all
Recipient: 12 year old female, 30 kg, creatinine=1.4;
Donor: 16 year old female, COD = MVA, 45 kg, ischemia time = 3 hours.
Retransplant, on home milrinone
Primary transplant, ECMO, ventilator
ISHLT 2006J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000)
Risk Factors For 5 Year Mortality
N=1,953
VARIABLE N Relative
Risk P-
value 95% Confidence
Interval
Re-transplant 79 2.22 .0000 1.51 -3.25
Recipient on dialysis 21 2.02 .0292 1.07 -3.79
ECMO 63 1.88 .0040 1.22 -2.90
Congenital diagnosis, no ECMO 595 1.55 .0001 1.25 -1.93
Congenital diagnosis, age=0, PGE 144 1.53 .0294 1.04 -2.24
Year of Transplant: 1995 vs. 1998 361 1.40 .0277 1.04 -1.89
Year of Transplant: 1996 vs. 1998 341 1.36 .0463 1.01 -1.85
Hospitalized (including ICU) 1388 1.26 .0400 1.01 -1.56
Female donor 836 1.25 .0142 1.05 -1.49
A locus HLA mismatches (0,1 or 2 – RR per mismatch)
1 MM – 752 2 MM - 1096 1.21 .0157 1.04 -1.42
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000)
Borderline Significant Risk Factors For 5 Year Mortality
N=1,953
VARIABLE N Relative
Risk P-
value 95% Confidence
Interval Other diagnosis (not congenital, cardiomyopathy or retransplant)
66 1.53 .0828 0.95 -2.49
Female recipient 817 1.19 .0575 0.99 -1.43
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality
Continuous Factors (see figure)
Recipient weight
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality Pre-Transplant Recipient Weight
0
1
2
3
0 15 30 45 60 75
Recipient Weight (kg)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.004
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Factors Not Significant for 5 Year Mortality
Recipient Factors:History of malignancy, recent infection, bilirubin, age, PRA, pulmonary vascular resistance, PA pressures, cardiac output, sternotomy, height
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Factors Not Significant for 5 Year Mortality
Donor Factors:Cause of death, history of hypertension, weight, height, age
Transplant Factors:Donor/recipient weight ratio, CMV mismatch, ischemia time, HLA mismatch, transplant center volume
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000)Risk Factors For 5 Year Mortality Conditional on 1 Year Survival
N=1,571
VARIABLE N Relative Risk
P-value 95% Confidence Interval
ECMO, diagnosis other than congenital
23 2.71 0.018 1.19 -6.2
Re-transplant 61 2.51 0.0004 1.51 -4.17
Treated for rejection (after transplant hospitalization)
424 1.96 <.0001 1.47 -2.62
Female recipient 654 1.39 0.0261 1.04 -1.85
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000)Borderline Significant Risk Factors
For 5 Year Mortality Conditional on 1 Year Survival
N=1,571
VARIABLE N Relative Risk
P-value 95% Confidence Interval
Congenital diagnosis, age=0, PGE 106 1.78 0.0728 0.95 3.35
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Risk Factors For 5 Year Mortality Conditional on 1 Year Survival
Continuous Factors (see figures)
Recipient weight
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Risk Factors For 5 Year Mortality Conditional on 1 Year Survival
Recipient Weight
0
0.5
1
1.5
2
0 15 30 45 60 75
Recipient Weight (kg)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity p = 0.0034
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Factors Not Significant for Conditional 5 Year Mortality
Recipient Factors:History of malignancy, recent infection, hospitalized at time of transplant, bilirubin, creatinine, cardiac output, pulmonary vascular resistance, PRA, sternotomy, ventilator, VAD, age, PA pressures
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Factors Not Significant for Conditional 5 Year Mortality
Donor Factors:Cause of death, history of hypertension, weight, height, age, gender, clinical infection at donation
Transplant Factors:Donor/recipient weight ratio, year of transplant, CMV mismatch, transplant center volume, induction use, treated for infection prior to discharge, dialysis prior to discharge
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) 5-Year Predicted Survival Conditional on Survival to 1 Year
50%
60%
70%
80%
90%
100%
1 2 3 4 5
Time (years)
Pre
dic
ted
Su
rviv
all
Treated for rejection
Not treated for rejection
Recipient: male with dilated cardiomyopathy, 1 year old, 8 kg, creatinine=0.8, not hospitalized at time of transplant;
Donor: male, 2 years old, 13 kg, COD = asphyxia, ischemia time = 3 hours.
ISHLT 2006J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: April 1994 - June 2005)
0%
20%
40%
60%
80%
100%
1 Year (N = 2,072) 3 Years (N = 1,715) 5 Years (N = 1,386) 8 Years (N = 861)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2005)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N = 2,503)
Between 2 and 3Years (N = 1,975)
Between 4 and 5Years (N = 1,562)
Between 7 and 8Years (N = 1,001)
No Hospitalization Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection Hospitalized, Infection Only
Hospitalized, Rejection + Infection
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
0
10
20
30
40
50
Any Induction (N = 626) Polyclonal ALG/ATG (N= 413)
OKT3 (N = 34) IL2R-antagonist (N =208)
PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Transplants: January 2001 - June 2005)
% o
f P
atie
nts
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
0
10
20
30
40
50
60
Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist
% o
f P
atien
ts
2001
2002
2003
2004
1/2005-6/2005
PEDIATRIC HEART RECIPIENTSInduction Immunosuppression (Transplants: January 2001 - June 2005)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group
(Transplants: January 2000 – June 2004) Conditional on Survival to 14 Days
50
60
70
80
90
100
0 1 2 3
Years
No induction (N = 704)
Polyclonal induction (N = 386)
IL2R-antagonist (N = 148)
Su
rviv
al (
%)
No comparisons were statistically significant.
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2004)
Conditional on Survival to 14 DaysAge: < 1 Year
50
60
70
80
90
100
0 1 2 3
Years
No induction (N = 149)Polyclonal induction (N = 148)IL2R-antagonist (N = 18)
No comparisons were statistically significant.
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2004)
Conditional on Survival to 14 DaysAge: 1-10 Years
50
60
70
80
90
100
0 1 2 3
Years
No induction (N = 287)Polyclonal induction (N = 139)IL2R-antagonist (N = 49)
Su
rviv
al (
%)
ISHLT 2006
No comparisons were statistically significant.
J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2004)
Conditional on Survival to 14 DaysAge: 11-17 Years
50
60
70
80
90
100
0 1 2 3
Years
No induction (N = 268)
Polyclonal induction (N = 99)
IL2R-antagonist (N = 81)
No comparisons were statistically significant.
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
Year 1 (N = 1,105) Year 5 (N = 756)
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2001 - June 2005)
NOTE: Different patients are analyzed in Year 1 and Year 5
% o
f P
atie
nts
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Prednisone Use
Conditional on Survival to 1 Year (Transplants: April 1994 - June 2004)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
Prednisone use at discharge and 1 year (N = 1,349)
No Prednisone at discharge or at 1 year (N = 241)
Prednisone at discharge/not at 1 year (N = 270)
p = 0.0017
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Prednisone Use for a Recent Era
Conditional on Survival to 1 Year (Transplants: January 1998 – June 2004)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
Prednisone use at discharge and 1 year (N = 1,017)
No Prednisone at discharge or at 1 year (N = 160)
Prednisone at discharge/not at 1 year (N = 207)
p = 0.023
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use at Discharge
(Transplants: January 1998 - June 2004) Conditional on Survival to 14 Days
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
Tacrolimus use at discharge (N = 600)
Cyclosporine use at discharge (N = 1,128)
Su
rviv
al (
%)
ISHLT 2006
p = 0.56
J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Rejection within 1st Year
(Transplants: April 1994 - June 2003)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
Free from Rejection during 1 year (N = 888)Rejection within 1st Year (N =1,000)
p = 0.0005
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Rejection within 1st Year
for Recent Transplants
(Transplants: January 2000 – June 2003)
50
60
70
80
90
100
0 1 2 3 4 5
Years
Free from Rejection during 1st Year (N = 405)Rejection within 1st Year (N = 319)
p = 0.038
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Rejection within 1st Year
Stratified by Calcineurin Use at Discharge (Transplants: April 1994 - June 2003)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
CyA: Free from Rejection during 1 year (N = 633)
CyA: Rejection within 1st Year (N = 728)
TAC: Free from Rejection during 1 year (N = 224)
TAC: Rejection within 1st Year (N = 232)
Free from Rejection: CyA vs. TAC p = 0.7508Rejection: CyA vs. TAC p = 0.2764 CyA: Rejection vs. no rejection p = 0.0014TAC: Rejection vs. no rejection p = 0.3098
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Rejection within 1st Year
for Recent TransplantsStratified by Calcineurin Use at Discharge (Transplants: January 2000 - June 2003)
50
60
70
80
90
100
0 1 2 3 4 5
Years
CyA: Free from Rejection during 1 year (N = 237)
CyA: Rejection within 1st Year (N = 254)
TAC: Free from Rejection during 1 year (N =162)
TAC: Rejection within 1st Year (N = 128)
Free from Rejection: CyA vs. TAC p = 0.8565Rejection: CyA vs. TAC p = 0.1541 CyA: Rejection vs. no rejection p = 0.0593TAC: Rejection vs. no rejection p = 0.4562
Su
rviv
al (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
0%
20%
40%
60%
80%
100%
Year 1 (N = 1,105) Year 5 (N = 756)
None
Other
Tacrolimus
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine
Cyclosporine + MMF
Cyclosporine + AZA
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
(Follow-ups: January 2001 - June 2005)
NOTE: Different patients are analyzed in Year 1 and Year 5
% o
f P
atie
nts
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEARStratified by Induction (Transplants: January 2000 - June 2004)
0
10
20
30
40
50
60
70
Overall <1 1-10 11-17 F M
No induction Used Induction Used (no OKT3)
Age group Gender
% t
reat
ed f
or
reje
ctio
n w
ith
in 1
yea
r
No within age group or gender comparisons were significant except 1-10 years (p=0.005).
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Induction (Transplants: January 2000 - June 2004)
0
0.5
1
1.5
2
2.5
Overall <1 1-10 11-17 F M
No induction Used Induction Used (no OKT3)
No within age group or gender comparisons were significant.
Age group Gender
Ave
rag
e n
um
ber
of
reje
ctio
n e
pis
od
es
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Type of Induction (Transplants: January 2000 - June 2004)
0
10
20
30
40
50
60
70
80
90
Overall <1 1-10 11-17 F M
No induction PolyclonalIL2R-antagonist OKT3
% t
reat
ed f
or
reje
ctio
n w
ith
in 1
yea
r
Overall: No induction vs. OKT3 (p = 0.0007); polyclonal vs. OKT3 (p = 0.009); IL2 vs. OKT3 (p = 0.009). 1-10: No induction vs. polyclonal (p = 0.022); 11-17: No induction vs. OKT3 (p = 0.004); polyclonal vs. OKT3 (p = 0.019); IL2R vs. OKT3 (p = 0.005)Female: No induction vs. OKT3 (p = 0.007); polyclonal vs. OKT3 (p = 0.021)Male: No induction vs. OKT3 (p=0.034); IL2R vs. OKT3 (p = 0.035)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Type of Induction (Transplants: January 2000 - June 2004)
0
0.5
1
1.5
2
2.5
Overall <1 1-10 11-17 F M
No induction Polyclonal IL2R-antagonist OKT3
11-17 years: No induction vs. OKT3 (p = 0.04). No other comparisons were significant.
Ave
rag
e n
um
ber
of
reje
ctio
n e
pis
od
es
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression and Induction (Transplants: January 2000 - June 2004)
0
10
20
30
40
50
60
70
Overall <1 1-10 11-17 F M
CyA + No induction Used CyA + Induction Used (no OKT3)TAC + No induction Used TAC + Induction Used (no OKT3)
Age group Gender% t
reat
ed f
or
reje
ctio
n w
ith
in 1
yea
r
Overall: CyA + no induction vs. TAC + no induction: p = 0.0076; CyA + induction vs. TAC + induction: p = 0.012; CyA + induction vs. TAC + no induction: p = 0.0025; CyA + no induction vs. TAC + induction: p = 0.024; <1: CyA + no induction vs. TAC + no induction: p = 0.0471-10 years: CyA + no induction vs. TAC + no induction: p = 0.047; CyA + induction vs. TAC + induction: p = 0.036; CyA + induction vs. TAC + no induction: p < 0.0001; CyA + no induction vs. CyA + induction: 0.0143.Female: CyA + no induction vs. TAC + no induction: p=0.028; CyA + induction vs. TAC + induction: p = 0.0049; CyA + induction vs. TAC + no induction: p = 0.0097; CyA + no induction vs. TAC + induction: p = 0.011.No other age group or gender differences were significant.
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression and Induction (Transplants: January 2000 - June 2004)
0
0.5
1
1.5
2
2.5
Overall <1 1-10 11-17 F M
CyA + No induction Used CyA + Induction Used (no OKT3)TAC + No induction Used TAC + Induction Used (no OKT3)
<1 years: CyA + no induction vs. TAC + no induction: p = 0.048.No other age group or gender comparisons were significant.
Age group Gender
Ave
rag
e n
um
ber
of
reje
ctio
n e
pis
od
es
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression (Transplants: January 2000 - June 2004)
0
10
20
30
40
50
60
70
Overall <1 1-10 11-17 F M
Cyclosporine + MMF Cyclosporine + AZATacrolimus + MMF Tacrolimus + AZA
% t
reat
ed f
or
reje
ctio
n w
ith
in 1
yea
r
Overall: CyA+MMF vs. TAC+MMF (p = 0.0011); CyA +MMF vs. TAC + AZA (p = 0.0011); CyA + AZA vs. TAC + MMF (p = 0.009); CyA + AZA vs. TAC + AZA (p = 0.009).<1: CyA + MMF vs. TAC + MMF ( p = 0.004); CyA + AZA vs. TAC + MMF (p = 0.01). 1-10: CyA + MMF vs. TAC + MMF (p = 0.4); Cya + MMF vs. TAC + AZA (p = 0.004); CyA + AZA vs. TAC + AZA (p = 0.019).11-17: CyA + AZA vs. TAC + MMF (p = 0.012). Female: CyA + MMF vs. TAC + AZA (p = 0.002); CyA + AZA vs. TAC + MMF (p = 0.045); CyA + AZA vs. TAC + AZA (p=0.001); TAC + MMF vs. TAC + AZA (p = 0.038). Male: CyA + MMF vs. TAC + MMF (p = 0.007)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 2000 - June 2004)
0
0.5
1
1.5
2
2.5
3
Overall <1 1-10 11-17 F M
Cyclosporine + MMF Cyclosporine + AZATacrolimus + MMF Tacrolimus + AZA
Ave
rag
e n
um
ber
of
reje
ctio
n e
pis
od
es
<1 years: CyA + AZA vs. TAC + MMF (p=0.004). No other age group or gender comparisons were significant.
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Calcineurin Inhibitor Use at Discharge (Transplants: January 2000 - June 2004)
0
10
20
30
40
50
60
Overall <1 1-10 11-17 F M
Cyclosporine Tacrolimus
Age group Gender
% t
reat
ed f
or
reje
ctio
n w
ith
in 1
yea
r
Overall: CyA vs. TAC (p < 0.0001) <1: CyA vs. TAC (p = 0.032) 1-10: CyA vs. TAC (p = 0.0004)Females: CyA vs. TAC (p = 0.0002) Male: CyA vs. TAC (p = 0.
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Calcineurin Inhibitor Use at Discharge (Transplants: January 2000 - June 2004)
0
0.5
1
1.5
2
2.5
Overall <1 1-10 11-17 F M
Cyclosporine Tacrolimus
No within age group or gender comparisons were significant other than <1 (p = 0.035).
Age group Gender
Ave
rag
e n
um
ber
of
reje
ctio
n e
pis
od
es
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS
Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April 1994 - June 2005)
Outcome Within 1
Year Total number with known response
Hypertension 47.2% (N = 2,428)
Renal Dysfunction 5.8% (N = 2,431)
Abnormal Creatinine < 2.5 mg/dl 3.9% Creatinine > 2.5 mg/dl 1.2% Chronic Dialysis 0.7% Renal Transplant 0.0%
Hyperlipidemia 10.8% (N = 2,555)
Diabetes 3.4% (N = 2,436)
Coronary Artery Vasculopathy 2.6% (N = 2,235)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 5 Years Post-Transplant
(Follow-ups: April 1994 - June 2005)
Outcome Within 5 Years
Total number with known response
Hypertension 62.7% (N = 836)
Renal Dysfunction 9.9% (N = 862)
Abnormal Creatinine < 2.5 mg/dl 8.2% Creatinine > 2.5 mg/dl 0.8% Chronic Dialysis 0.6% Renal Transplant 0.2%
Hyperlipidemia 25.1% (N = 902)
Diabetes 5.2% (N = 833)
Coronary Artery Vasculopathy 10.9% (N = 605)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 8 Years Post-Transplant
(Follow-ups: April 1994 - June 2005)
Outcome Within 8 Years
Total number with known response
Hypertension 68.3% (N = 325)
Renal Dysfunction 10.3% (N = 339) Abnormal Creatinine < 2.5 mg/dl 7.7% Creatinine > 2.5 mg/dl 0.6% Chronic Dialysis 1.5% Renal Transplant 0.6%
Hyperlipidemia 28.1% (N = 356)
Diabetes 4.0% (N = 323)
Coronary Artery Vasculopathy 12.8% (N = 188)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2005)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
% F
reed
om
fro
m C
AV
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2005)
Stratified by Induction
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
Induction (N =859)
No Induction (N = 1,440)% F
ree
do
m f
rom
CA
V
p = 0.78
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2005)
Stratified by Age Group
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
<1 Year (N =618)
1-10 Years (N = 952)
11-17 Years (N = 923)
p < 0.0001
% F
ree
do
m f
rom
CA
V
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: January 1999-June 2005)
Stratified by Age Group
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
<1 Year (N = 401)
1-10 Years (N = 649)
11-17 Years (N = 670)
p = 0.0005
% F
ree
do
m f
rom
CA
V
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
FREEDOM FROM CORONARY ARTERY VASCULOPATHYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2005)
Stratified by Ischemia Time
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
0-<2 hours (N=254)
2-<4 hours (N=1,174)
4+ hours (N=741)
p = 0.0109
% F
ree
do
m f
rom
CA
V
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
FREEDOM FROM CORONARY ARTERY VASCULOPATHYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2005)
Stratified by Ischemia Time and Recipient Age
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
0-<2 hours/0-10 years (N=136)2-<4 hours/0-10 years (N=699)4+ hours/0-10 years (N=741)0-<2 hours/11-17 years (N=102)2-<4 hours/11-17 years (N=424)4+ hours/11-17 years (N=159)
0-10 years: p = 0.1483;11-17 years: p = 0.2163
% F
ree
do
m f
rom
CA
V
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
GRAFT SURVIVAL FOLLOWING REPORT OF CORONARY ARTERY VASCULOPATHY
For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2005)Stratified by Age Group
0
10
20
30
40
50
60
70
80
90
100
0 0.5 1 1.5 2 2.5 3 3.5
Time since Report of CAV (Years)
<1 Year (N = 44)
1-10 Years (N = 86)
11-17 Years (N = 110)
p = 0.014
Su
rviv
al s
ince
Rep
ort
of
CA
V (
%)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2005)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
* Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant
% F
reed
om
fro
m S
ever
e
Ren
al D
ysfu
nct
ion
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2005)
Malignancy/Type 1-Year Survivors
5-Year Survivors
8-Year Survivors
No Malignancy 2493 (98.0%) 864 (95.7%) 330 (92.4%)
Malignancy (all types combined) 52 (2.0%) 39 (4.3%) 27 (7.6%)
Malignancy Type
Lymph 48 35 27
Other 3 5 1
Skin 1
Type Not Reported 1
ISHLT 2006
NOTE: Multiple types may be reported; sum of types may be greater than total number with malignancy.
J Heart Lung Transplant 2006;25:893-903
FREEDOM FROM MALIGNANCYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2005)
80
85
90
95
100
0 1 2 3 4 5 6 7 8
Years
All malignancy Lymph Skin Other
% F
reed
om
fro
m M
alig
nan
cy
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 1 and 3 Years
(Transplants: April 1993 - June 2002)
Maintenance Immunosuppression at discharge and 1 year
% HTN reported between 1 and 3 years
P-valueFor Patients
on drugFor Patients not on drug
Azathioprine 22.3% 23.2% 0.8
Cyclosporine 20.6% 24.3% 0.34
MMF 20.8% 21.9% 0.8
Prednisone 29.2% 7.2% <0.0001
Rapamycin . 21.0%
Tacrolimus 28.1% 19.2% 0.022
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART RECIPIENTSRelationship of Rejection and Coronary Artery Vasculopathy
(Follow-ups: April 1994 – June 2005)
Rejection During 1st Year
Reported CAV between 1st and 3rd years
post-transplant
Reported CAV between 3rd
and 5th years
post-transplant
Yes No All Yes No All
Yes 40
7.8%
473
92.2%
513
100%
19
7.5%
235
92.5%
254
100%
No 15
2.9%
504
97.1%
519
100%
10
4.1%
234
95.9%
244
100%p = 0.0004 p = 0.1072
NOTE: Only those recipients without CAV prior to 3 years were included in the last set of columnsISHLT 2006
J Heart Lung Transplant 2006;25:893-903
PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2005)
CAUSE OF DEATH 0-30 Days (N = 358)
31 Days - 1 Year (N = 303)
>1 Year - 3 Years (N = 220)
>3 Years - 5 Years (N = 150)
>5 Years (N = 281)
CORONARY ARTERY VASCULOPATHY
4 (1.1%) 26 (8.6%) 42 (19.1%) 55 (36.7%) 79 (28.1%)
ACUTE REJECTION 33 (9.2%) 80 (26.4%) 59 (26.8%) 19 (12.7%) 37 (13.2%)
LYMPHOMA 6 (2.0%) 10 (4.5%) 3 (2.0%) 24 (8.5%)
MALIGNANCY, OTHER 4 (1.3%) 2 (0.9%) 1 (0.7%) 10 (3.6%)
CMV 1 (0.3%) 7 (2.3%) 1 (0.5%)
INFECTION, NON-CMV 49 (13.7%) 49 (16.2%) 17 (7.7%) 7 (4.7%) 21 (7.5%)
PRIMARY FAILURE 62 (17.3%) 12 (4.0%) 7 (3.2%) 8 (5.3%) 12 (4.3%)
GRAFT FAILURE 85 (23.7%) 35 (11.6%) 40 (18.2%) 34 (22.7%) 55 (19.6%)
TECHNICAL 22 (6.1%) 2 (0.7%) 2 (0.9%) 1 (0.7%) 1 (0.4%)
OTHER 18 (5.0%) 17 (5.6%) 18 (8.2%) 12 (8.0%) 19 (6.8%)
MULTIPLE ORGAN FAILURE
35 (9.8%) 36 (11.9%) 4 (1.8%) 3 (2.0%) 10 (3.6%)
RENAL FAILURE 1 (0.3%) 4 (1.3%) 1 (0.5%)
PULMONARY 24 (6.7%) 18 (5.9%) 10 (4.5%) 6 (4.0%) 9 (3.2%)
CEREBROVASCULAR 24 (6.7%) 7 (2.3%) 7 (3.2%) 1 (0.7%) 4 (1.4%)
ISHLT 2006 J Heart Lung Transplant 2006;25:893-903