Download presentation
Presentation is loading. Please wait.
Published byNoah Stewart Modified over 11 years ago
1
HEART TRANSPLANTATION Pediatric Recipients 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
2
AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS (Transplants: January 1996 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
3
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS (Transplants: January 1996 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
4
AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS By Year of Transplant 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
5
NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
6
NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
7
AVERAGE CENTER VOLUME AND PERCENTAGE OF TRANSPLANTS BY CENTER VOLUME Pediatric Heart Transplants: January 1, 1997 - June 30, 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
8
DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Pediatric Heart Transplants: January 1, 1997 - June 30, 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
9
PEDIATRIC HEART RE-TRANSPLANTS By Transplant Year Re-transplants: January 1994 – December 2008 Only patients who were less than 18 years old at the time of re-transplant are included. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
10
PEDIATRIC HEART RE-TRANSPLANTS By Inter-transplant Interval Re-transplants: January 1994 - June 2009 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 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
11
KAPLAN-MEIER SURVIVAL RATES FOR PEDIATRIC HEART RETRANSPLANTS STRATIFIED BY INTER-TRANSPLANT INTERVAL Re-transplants: January 1994 - June 2008 Only patients who were less than 18 years old at the time of re-transplant are included. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
12
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
13
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS ( Age: 1-10 Years ) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
14
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS ( Age: 11-17 Years ) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
15
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival (Transplants: 1/1982-6/2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
16
PEDIATRIC HEART TRANSPLANTATION Conditional Kaplan-Meier Survival (Transplants: 1/1982-6/2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
17
PEDIATRIC HEART TRANSPLANTATION Conditional Kaplan-Meier Survival for Recent Era (Transplants: 1/1999-6/2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
18
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
19
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2008) Age: < 1 Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
20
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2008) Age: 1-10 Years 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
21
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2008) Age: 11-17 Years 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
22
PEDIATRIC HEART TRANSPLANTS: AVERAGE CENTER VOLUME DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
23
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Patient vs. Graft Survival (Transplants: 1/1999-6/2008) Average Center Volume: 1-4 Transplants per Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
24
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Patient vs. Graft Survival (Transplants: 1/1999-6/2008) Average Center Volume: 5-9 Transplants per Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
25
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Patient vs. Graft Survival (Transplants: 1/1999-6/2008) Average Center Volume: 10-19 Transplants per Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
26
PEDIATRIC HEART TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
27
PEDIATRIC HEART TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
28
PEDIATRIC HEART TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
29
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors For 1 Year Mortality N=3,838 Reference diagnosis = cardiomyopathy 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
30
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Borderline Significant Risk Factors For 1 Year Mortality N=3,838 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
31
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality N=3,838 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
32
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Recipient Age N=3,838 NOTE: The impact of age should be considered in the context of height and diagnosis+age. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
33
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Recipient Height N=3,838 NOTE: The impact of height should be considered in the context of age and diagnosis+age. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
34
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Donor Age N=3,838 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
35
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Pre-Transplant Creatinine N=3,838 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
36
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Ischemia Time N=3,838 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
37
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Factors Not Significant for 1 Year Mortality Recipient Factors: IV inotropes, sternotomy, history of malignancy, hospitalized, diabetes Donor Factors: Gender, clinical infection, history of diabetes Transplant Factors: CMV mismatch, HLA mismatch, center volume 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
38
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = <1 Years Risk Factors For 1 Year Mortality N=1,009 Reference diagnosis = congenital without PGE or ECMO 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
39
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = <1 Years Borderline Significant Risk Factors For 1 Year Mortality N=1,009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
40
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = <1 Years Risk Factors for 1 Year Mortality N=1,009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
41
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = <1 Years Ischemia Time N=1,009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
42
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = <1 Years Pre-Transplant Creatinine N=1,009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
43
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = <1 Years Center Volume for Pediatric Transplants N=1,009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
44
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = <1 Years Recipient Height N=1,009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
45
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = 1-10 Years Risk Factors For 1 Year Mortality N=1,448 Reference diagnosis = cardiomyopathy 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
46
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = 1-10 Years Borderline Significant Risk Factors For 1 Year Mortality N=1,448 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
47
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = 1-10 Years Risk Factors for 1 Year Mortality N=1,448 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
48
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = 1-10 Years Pre-Transplant Creatinine N=1,448 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
49
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = 1-10 Years Recipient Height N=1,448 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
50
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = 1-10 Years Recipient Bilirubin N=1,448 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
51
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = 11-17 Years Risk Factors For 1 Year Mortality N=1,381 Reference diagnosis = cardiomyopathy 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
52
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = 11-17 Years Borderline Significant Risk Factors For 1 Year Mortality N=1,381 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
53
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Age = 11-17 Years Risk Factors for 1 Year Mortality N=1,381 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
54
PEDIATRIC HEART TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality in Age = 11-17 Years Ischemia Time N=1,381 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
55
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors For 5 Year Mortality N=2,420 Reference diagnosis = cardiomyopathy 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
56
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Borderline Significant Risk Factors For 5 Year Mortality N=2,420 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
57
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality N=2,420 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
58
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Recipient Age N=2,420 NOTE: The impact of age should be considered in the context of height and diagnosis+age. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
59
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Recipient Height N=2,420 NOTE: The impact of height should be considered in the context of age and diagnosis+age. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
60
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Donor Age N=2,420 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
61
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Center Volume for Pediatric Transplants N=2,420 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
62
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Ischemia Time N=2,420 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
63
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality BSA Ratio N=2,420 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
64
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Risk Factors For 10 Year Mortality N=910 Reference diagnosis = cardiomyopathy * Impact should be considered in context of donor age and recipient BSA shown in subsequent figures. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
65
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Borderline Significant Risk Factors For 10 Year Mortality N=910 Reference diagnosis = cardiomyopathy 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
66
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 10 Year Mortality N=910 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
67
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality Donor Age N=910 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
68
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality Recipient BSA N=910 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
69
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality Pre-Transplant Creatinine N=910 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
70
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality Center Volume for Pediatric Transplants N=910 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
71
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Factors Not Significant for 10 Year Mortality Recipient Factors: PRA, diabetes, repeat transplant, transfusions, hospitalized, PGE, VAD, bilirubin Donor Factors: Cause of death, weight, height, age, clinical infection Transplant Factors: Ischemia time, CMV mismatch 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
72
PEDIATRIC HEART TRANSPLANTS (7/1997-6/2004) Risk Factors for the Development of CAV within 5 Years N=1,470 Reference diagnosis = cardiomyopathy 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
73
PEDIATRIC HEART TRANSPLANTS (7/1997-6/2004) Borderline Significant Risk Factors for the Development of CAV within 5 Years N=1,470 Reference diagnosis = cardiomyopathy 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
74
PEDIATRIC HEART TRANSPLANTS (7/1997-6/2004) Risk Factors for the Development of CAV within 5 Years N=1,470 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
75
PEDIATRIC HEART TRANSPLANTS (7/1997-6/2004) Risk Factors for the Development of CAV within 5 Years Donor Height N=1,470 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
76
PEDIATRIC HEART TRANSPLANTS (7/1997-6/2004) Risk Factors for the Development of CAV within 5 Years Center Volume of All Age Transplants N=1,470 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
77
PEDIATRIC HEART RECIPIENTS Cross-Sectional Analysis Functional Status of Surviving Recipients (Follow-ups: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
78
PEDIATRIC HEART RECIPIENTS Longitudinal Analysis Functional Status of Surviving Recipients (Follow-ups: April 1994 - June 2009) For the Same Patients 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
79
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994 - June 2009) Age: <1 Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
80
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994 - June 2009) Age: 1-10 Years 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
81
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994 - June 2009) Age: 11-17 Years 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
82
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: March 2005 - June 2009) US Recipients Only 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
83
PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
84
PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Transplants: January 2001 - June 2009) Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
85
PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Transplants: January 2001 - June 2009) Test of increasing trend over time: Any induction p < 0.0001 Polyclonal p < 0.0001 IL2 p < 0.0001 Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
86
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2008) Conditional on Survival to 14 Days 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
87
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group and Treated Rejection Between Transplant Discharge and 1-Year Follow-up (1-Year Follow-ups: July 2004 - June 2008) Conditional on Survival to 1 Year 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
88
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2008) Conditional on Survival to 14 Days Age: < 1 Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
89
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2008) Conditional on Survival to 14 Days Age: 1-10 Years 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
90
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2008) Conditional on Survival to 14 Days Age: 11-17 Years 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
91
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January 2001 - June 2009) NOTE: Different patients are analyzed in Year 1 and Year 5 % of Patients Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
92
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up for Same Patients at Each Time Point (Follow-ups: January 2001 - June 2009) Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
93
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up (Follow-ups: January 2001 - June 2009) 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 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
94
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Prednisone Use Conditional on Survival to 1 Year (Transplants: 1998 - June 2008) Survival (%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
95
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Prednisone Use for a Recent Era Conditional on Survival to 1 Year (Transplants: January 1998 – June 2008) Survival (%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
96
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use at Discharge (Transplants: January 1998 - June 2008) Conditional on Survival to 14 Days Survival (%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
97
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year (Transplants: January 1998 - June 2008) Survival (%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
98
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Treated Rejection within 1 st Year Conditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2008) Survival (%) 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
99
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Treated Rejection within 1 st Year Stratified by Calcineurin Use at Discharge Conditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2008) Survival (%) 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
100
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Treated Rejection within 1 st Year Stratified by Calcineurin Use at Discharge: Age = 0-10 Years Conditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2008) Survival (%) 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
101
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Treated Rejection within 1 st Year Stratified by Calcineurin Use at Discharge: Age = 11-17 Years Conditional on survival to 1 year (1-Year Follow-ups: July 2004 - June 2008) Survival (%) 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
102
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION BETWEEN TRANSPLANT DISCHARGE AND 1-YEAR FOLLOW-UP Stratified by Induction (Follow-ups: July 2004 - June 2009) % experiencing acute rejection within 1 year Overall: p = 0.6601 Overall< 11-1010-17FemaleMale 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
103
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION BETWEEN TRANSPLANT DISCHARGE AND 1-YEAR FOLLOW-UP Stratified by Type of Induction (Follow-ups: July 2004 - June 2009) % experiencing acute rejection within 1 year No comparisons were statistically significant at 0.05. Overall< 1 1-10 10-17FemaleMale 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
104
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION BETWEEN TRANSPLANT DISCHARGE AND 1-YEAR FOLLOW-UP Stratified by Maintenance Immunosuppression and Induction (Follow-ups: July 2004 - June 2009) % experiencing acute rejection within 1 year Overall: all comparisons were statistically significant at 0.05 except CyA + no induction vs. CyA + induction and TAC + no induction vs. TAC + induction <1 year: CyA + no induction vs. TAC + no induction ( p=0.0268); 1-10 years: all comparisons were statistically significant at 0.05 except CyA + no induction vs. CyA + induction and TAC + no induction vs. TAC + induction 11-17 years: CyA + no induction vs. TAC + no induction (p = 0.0005); CyA + induction vs. TAC + no induction (p < 0.0001); CyA + induction vs. TAC + induction ( p =0.0025) Overall< 11-1010-17 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
105
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION BETWEEN TRANSPLANT DISCHARGE AND 1-YEAR FOLLOW-UP Stratified by Maintenance Immunosuppression ( Follow-ups: July 2004 - June 2009 ) % experiencing acute rejection within 1 year Overall: all comparisons were statistically significant at 0.05 except CyA +MMF vs. CyA +AZA and TAC + MMF vs. TAC + AZA. <1: CyA + MMF vs. TAC + MMF (p =0.0076). 1-10: CyA + MMF vs. TAC + MMF (p = 0.0008); CyA + AZA vs. TAC + MMF (p=0.0007). 11-17: all comparisons were statistically significant at 0.05 except CyA +MMF vs. CyA +AZA TAC + MMF vs. TAC + AZA. Overall< 11-1010-17 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
106
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION BETWEEN TRANSPLANT DISCHARGE AND 1-YEAR FOLLOW-UP Stratified by Calcineurin Inhibitor Use at Discharge ( Follow-ups: July 2004 - June 2009) % experiencing acute rejection within 1 year Overall: CyA vs. TAC (p < 0.0001) <1: CyA vs. TAC (p=0.0356) 1-10: CyA vs. TAC (p < 0.0001) 11-17: CyA vs. TAC (p < 0.0001) Overall< 1 1-10 10-17 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
107
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
108
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) Stratified by Induction 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
109
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: 1999 - June 2009) Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
110
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) Stratified by Age Group 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
111
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: January 1999-June 2009) Stratified by Age Group 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
112
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients ( Follow-ups: April 1994 - June 2009) Stratified by Ischemia Time 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
113
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients ( Follow-ups: January 1999 - June 2009) Stratified by Ischemia Time for Recent Era 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
114
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients ( Follow-ups: April 1994 - June 2009) Stratified by Ischemia Time and Recipient Age 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
115
GRAFT SURVIVAL FOLLOWING REPORT OF CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) Stratified by Age Group 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
116
FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
117
FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Pediatric Heart Recipients (Follow-ups: 1999 - June 2009) Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
118
FREEDOM FROM RENAL REPLACEMENT THERAPY* For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
119
MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICS Cumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2009) Malignancy/Type1-Year Survivors 5-Year Survivors 10-Year Survivors No Malignancy 3,684 (98.2%)1,521 (94.9%)411 (92.6%) Malignancy (all types combined) 69 (1.8%)82 (5.1%)33 (7.4%) Malignancy Type Lymph 647731 Other 463 Skin 11 Type Not Reported 1 NOTE: Multiple types may be reported; sum of types may be greater than total number with malignancy. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
120
FREEDOM FROM MALIGNANCY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
121
FREEDOM FROM MALIGNANCY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) Stratified by Tacrolimus vs. Cyclosporine Use Conditional on Survival to 1 Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
122
FREEDOM FROM LYMPHOMA For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2009) Stratified by Induction 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
123
PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 1 and 3 Years (Transplants: April 1993 - June 2006) Maintenance Immunosuppression at discharge and 1 year % HTN reported between 1 and 3 years P-value For Patients on drug For Patients not on drug Azathioprine20.125.10.0639 Cyclosporine21.322.60.6409 MMF24.022.30.5552 Prednisone28.911.9<.0001 Rapamycin36.422.0- Tacrolimus26.020.40.0408 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
124
PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 3 and 8 Years (Transplants: April 1993 - June 2001) Maintenance Immunosuppression at discharge and 1 year % HTN reported between 3 and 8 years P-value For Patients on drug For Patients not on drug Azathioprine35.154.30.0339 Cyclosporine36.046.70.2637 MMF41.437.80.7112 Prednisone47.120.2<.0001 Rapamycin-37.5- Tacrolimus40.734.80.541 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
125
PEDIATRIC HEART RECIPIENTS Relationship of Rejection and Coronary Artery Vasculopathy (Follow-ups: July 2004 – June 2009) Rejection During 1 st Year Reported CAV between 1 st and 3 rd years post-transplant YesNoAll Yes9 5.1% 168 94.9% 177 100% No9 3.4% 255 96.6% 264 100% p = 0.3834 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
126
PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2009) CAUSE OF DEATH 0-30 Days (N = 475) 31 Days - 1 Year (N = 443) >1 Year - 3 Years (N = 318) >3 Years - 5 Years (N = 246) >5 Years - 10 Years (N = 371) >10 Years (N = 197) CORONARY ARTERY VASCULOPATHY 5 (1.1%)30 (6.8%)62 (19.5%)72 (29.3%)105 (28.3%)54 (27.4%) ACUTE REJECTION 45 (9.5%)108 (24.4%)75 (23.6%)35 (14.2%)46 (12.4%)12 (6.1%) LYMPHOMA 1 (0.2%)9 (2.0%)12 (3.8%)8 (3.3%)35 (9.4%)15 (7.6%) MALIGNANCY, OTHER 4 (0.9%)2 (0.6%)2 (0.8%)5 (1.3%)10 (5.1%) CMV 1 (0.2%)12 (2.7%)1 (0.3%) INFECTION, NON-CMV 55 (11.6%)68 (15.3%)21 (6.6%)8 (3.3%)18 (4.9%)18 (9.1%) PRIMARY FAILURE 108 (22.7%)24 (5.4%)10 (3.1%)16 (6.5%)21 (5.7%)7 (3.6%) GRAFT FAILURE 101 (21.3%)51 (11.5%)64 (20.1%)60 (24.4%)76 (20.5%)49 (24.9%) TECHNICAL 27 (5.7%)3 (0.7%)2 (0.6%)3 (1.2%)4 (1.1%)2 (1.0%) OTHER 23 (4.8%)26 (5.9%)32 (10.1%)24 (9.8%)34 (9.2%)10 (5.1%) MULTIPLE ORGAN FAILURE 48 (10.1%)56 (12.6%)10 (3.1%)7 (2.8%)10 (2.7%)10 (5.1%) RENAL FAILURE 1 (0.2%)5 (1.1%)1 (0.3%)1 (0.4%)1 (0.3%)3 (1.5%) PULMONARY 29 (6.1%)31 (7.0%)16 (5.0%)8 (3.3%)9 (2.4%)5 (2.5%) CEREBROVASCULAR 31 (6.5%)16 (3.6%)10 (3.1%)2 (0.8%)7 (1.9%)2 (1.0%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
127
PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1998 - June 2009) CAUSE OF DEATH 0-30 Days (N = 226) 31 Days - 1 Year (N = 266) >1 Year - 3 Years (N = 202) >3 Years - 5 Years (N = 173) >5 Years - 10 Years (N = 306) >10 Years (N =190) CAV 2 (0.9%)14 (5.3%)33 (16.3%)46 (26.6%)84 (27.5%)52 (27.4%) ACUTE REJECTION 23 (10.2%)53 (19.9%)40 (19.8%)27 (15.6%)37 (12.1%)12 (6.3%) LYMPHOMA 6 (2.3%)7 (3.5%)6 (3.5%)29 (9.5%)15 (7.9%) MALIGNANCY, OTHER 1 (0.4%)1 (0.5%)1 (0.6%)4 (1.3%)9 (4.7%) CMV 8 (3.0%)1 (0.5%) INFECTION, NON- CMV 27 (11.9%)34 (12.8%)12 (5.9%)3 (1.7%)14 (4.6%)16 (8.4%) PRIMARY FAILURE 50 (22.1%)10 (3.8%)4 (2.0%)7 (4.0%)13 (4.2%)7 (3.7%) GRAFT FAILURE 35 (15.5%)31 (11.7%)50 (24.8%)51 (29.5%)68 (22.2%)47 (24.7%) TECHNICAL 14 (6.2%)2 (1.0%)1 (0.6%)4 (1.3%)2 (1.1%) OTHER 17 (7.5%)21 (7.9%)27 (13.4%)17 (9.8%)30 (9.8%)10 (5.3%) MULTIPLE ORGAN FAILURE 29 (12.8%)43 (16.2%)9 (4.5%)6 (3.5%)8 (2.6%)10 (5.3%) RENAL FAILURE 5 (1.9%)1 (0.5%)1 (0.6%)1 (0.3%)3 (1.6%) PULMONARY 11 (4.9%)28 (10.5%)11 (5.4%)6 (3.5%)8 (2.6%)5 (2.6%) CEREBROVASCULAR 18 (8.0%)12 (4.5%)4 (2.0%)1 (0.6%)6 (2.0%)2 (1.1%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
128
PEDIATRIC HEART TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death (Deaths: January 1998 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.