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HEART TRANSPLANTATION Pediatric Recipients ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983.

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Presentation on theme: "HEART TRANSPLANTATION Pediatric Recipients ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983."— Presentation transcript:

1 HEART TRANSPLANTATION Pediatric Recipients ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

2 AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS (Transplants: January 1996 - June 2007) Number of Transplants ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

3 AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS (Transplants: January 1996 - June 2007) Number of Transplants ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

4 AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS By Year of Transplant Number of Transplants ISHLT 2008 NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of hearts transplanted worldwide has increased and/or decreased in recent years. J Heart Lung Transplant 2008;27: 937-983

5 NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS Number of Pediatric Cases Reporting ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

6 AVERAGE CENTER VOLUME Pediatric Heart Transplants: January 1, 1997 - June 30, 2007 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

7 DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Pediatric Heart Transplants: January 1, 1997 - June 30, 2007 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

8 PEDIATRIC HEART RE-TRANSPLANTS By Transplant Year Retransplants: January 1994 – December 2006 Year of transplant ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

9 PEDIATRIC HEART RE-TRANSPLANTS By Intertransplant Interval Retransplants: January 1994 - June 2007 ISHLT 2008 Time Between Previous and Current Transplant J Heart Lung Transplant 2008;27: 937-983

10 KAPLAN-MEIER SURVIVAL RATES FOR PEDIATRIC HEART RETRANSPLANTS STRATIFIED BY INTER-TRANSPLANT INTERVAL Retransplants: January 1994 - June 2006 ISHLT 2008 Time (years) since most recent transplant J Heart Lung Transplant 2008;27: 937-983

11 DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year) 1988-19951/1996-6/2007 % of Cases ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

12 DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 1-10 Years) 1988-19951/1996-6/2007 % of Cases ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

13 DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 11-17 Years) 1988-19951/1996-6/2007 % of Cases ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

14 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival (Transplants: 1/1982-6/2006) Survival (%) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

15 PEDIATRIC HEART TRANSPLANTATION Conditional Kaplan-Meier Survival (Transplants: 1/1982-6/2006) Survival (%) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

16 PEDIATRIC HEART TRANSPLANTATION Conditional Kaplan-Meier Survival for Recent Era (Transplants: 1/1999-6/2006) Survival (%) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

17 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2006) Survival (%) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

18 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2005) Age: < 1 Year Survival (%) ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983

19 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2005) Age: 1-10 Years Survival (%) ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983

20 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2005) Age: 11-17 Years Survival (%) ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983

21 PEDIATRIC HEART TRANSPLANTS: AVERAGE CENTER VOLUME DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2007 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

22 PEDIATRIC HEART TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2007 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

23 PEDIATRIC HEART TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2007 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

24 PEDIATRIC HEART TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2007 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

25 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2006) Risk Factors For 1 Year Mortality N=3,395 ISHLT 2008 Reference diagnosis = cardiomyopathy J Heart Lung Transplant 2008;27: 937-983

26 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2005) Borderline Significant Risk Factors For 1 Year Mortality N=3,395 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

27 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality ISHLT 2008 N=3,395 J Heart Lung Transplant 2008;27: 937-983

28 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality Recipient Age ISHLT 2008 N=3,395 J Heart Lung Transplant 2008;27: 937-983

29 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality Donor Age ISHLT 2008 N=3,395 J Heart Lung Transplant 2008;27: 937-983

30 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality Pre-Transplant Creatinine ISHLT 2008 N=3,395 J Heart Lung Transplant 2008;27: 937-983

31 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality Center Volume for Pediatric Transplants ISHLT 2008 N=3,395 J Heart Lung Transplant 2008;27: 937-983

32 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality Donor BSA ISHLT 2008 N=3,395 J Heart Lung Transplant 2008;27: 937-983

33 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2006) 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, ischemia time, HLA mismatch ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

34 PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors For 10 Year Mortality N=697 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

35 PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality ISHLT 2008 N=697 J Heart Lung Transplant 2008;27: 937-983

36 PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality Pre-Transplant Creatinine ISHLT 2008 N=697 J Heart Lung Transplant 2008;27: 937-983

37 PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality Donor Weight ISHLT 2008 N=697 J Heart Lung Transplant 2008;27: 937-983

38 PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality Center Volume for Pediatric Transplants ISHLT 2008 N=697 J Heart Lung Transplant 2008;27: 937-983

39 PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality BSA Ratio (Donor BSA/Recipient BSA) ISHLT 2008 N=697 J Heart Lung Transplant 2008;27: 937-983

40 PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Factors Not Significant for 10 Year Mortality Recipient Factors: PRA, diabetes, repeat transplant, transfusions, hospitalized, gender, PGE, VAD, bilirubin Donor Factors: Cause of death, age, clinical infection Transplant Factors: Ischemia time, HLA mismatch, CMV mismatch ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

41 PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994 - June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

42 PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April 1994 - June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

43 PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Transplants: January 2001 - June 2007) % of Patients ISHLT 2008 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

44 PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Transplants: January 2001 - June 2007) ISHLT 2008 Test of increasing trend over time: Any induction p < 0.0001 Polyclonal p < 0.0001 IL2 p = 0.0029 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

45 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2005) Conditional on Survival to 14 Days Survival (%) No comparisons were statistically significant. ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983

46 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group and Rejection Between Transplant Discharge and 1-Year Follow-up (1-Year Follow-ups: July 2004 - June 2006) Conditional on Survival to 1 Year Survival (%) No pair-wise comparisons of survival by induction were statistically significant within either rejection grouping except No induction/Rejection vs. Polyclonal/Rejection (p=0.0329). ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

47 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2005) Conditional on Survival to 14 Days Age: < 1 Year Survival (%) ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983

48 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2005) Conditional on Survival to 14 Days Age: 1-10 Years Survival (%) ISHLT 2008 No comparisons were statistically significant. Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983

49 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2005) Conditional on Survival to 14 Days Age: 11-17 Years Survival (%) ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983

50 PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January 2001 - June 2007) NOTE: Different patients are analyzed in Year 1 and Year 5 % of Patients ISHLT 2008 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

51 PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up for Same Patients at Each Time Point (Follow-ups: January 2001 - June 2007) % of Patients ISHLT 2008 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

52 PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up (Follow-ups: January 2001 - June 2007) NOTE: Different patients are analyzed in Year 1 and Year 5 % of Patients ISHLT 2008 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

53 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Prednisone Use Conditional on Survival to 1 Year (Transplants: April 1994 - June 2006) p < 0.0001 Survival (%) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

54 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Prednisone Use for a Recent Era Conditional on Survival to 1 Year (Transplants: January 1998 – June 2006) p = 0.0050 Survival (%) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

55 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use at Discharge (Transplants: January 1998 - June 2006) Conditional on Survival to 14 Days Survival (%) ISHLT 2008 p = 0.1706 J Heart Lung Transplant 2008;27: 937-983

56 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Rejection within 1 st Year (1-Year Follow-ups: July 2004 - June 2006) p = 0.0346 Survival (%) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

57 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Rejection within 1 st Year Stratified by Calcineurin Use at Discharge (1-Year Follow-ups: July 2004 - June 2006) Survival (%) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

58 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Rejection within 1 st Year Stratified by Calcineurin Use at Discharge: Age = 0-10 Years (1-Year Follow-ups: July 2004 - June 2006) Survival (%) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

59 PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival Based on Rejection within 1 st Year Stratified by Calcineurin Use at Discharge: Age = 11-17 Years (1-Year Follow-ups: July 2004 - June 2006) Survival (%) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

60 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION IN 1ST YEAR Stratified by Induction (Follow-ups: July 2004 - June 2007) % experiencing acute rejection within 1 year Overall: p = 0.042 ISHLT 2008 Overall< 11-1010-17FemaleMale Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

61 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION IN 1ST YEAR Stratified by Type of Induction (Follow-ups: July 2004 - June 2007) % experiencing acute rejection within 1 year Overall: No induct vs. IL2R (p=0.001); Polyclonal vs. IL2R (p = 0.006) 1-10: No induct vs. IL2R (p=0.019) 11-17: No induction vs. IL2R (p=0.037) Female: No induction vs. IL2R (p = 0.006); Polyclonal vs. IL2R (p =0.026) Male: No induction vs. IL2R (p = 0.034) ISHLT 2008 Overall< 11-1010-17 Female Male Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

62 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression and Induction (Follow-ups: July 2004 - June 2007) % 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=0.001; CyA + no induction vs. TAC + induction: p=0.001; CyA + induction vs. TAC + no induction: p=0.032; CyA + induction vs. TAC + induction: p= 0.026 1-10 years: CyA + induction vs. TAC + induction: p =0.006; CyA + induction vs. TAC + no induction: p = 0.0001 11-17 years: CyA + no induction vs. TAC + no induction: p = 0.001; CyA + induction vs. TAC + no induction: p < 0.0001; CyA + induction vs. TAC + induction: p =0.008 ISHLT 2008 Overall< 11-10 10-17 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

63 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression ( Follow-ups: July 2004 - June 2007 ) % experiencing acute rejection within 1 year Overall: CyA +MMF vs. TAC + MMF (p < 0.0001); CyA + MMF vs. TAC + AZA (p =0.001); <1: CyA + MMF vs. TAC + MMF (p =0.0004); CyA + MMF vs. TAC + AZA )p=0.016). 1-10: CyA + MMF vs. TAC + MMF (p = 0.010). 11-17: CyA + MMF vs. TAC + MMF (p =0.0002). ISHLT 2008 Overall< 11-1010-17 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

64 PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION IN 1ST YEAR Stratified by Calcineurin Inhibitor Use at Discharge ( Follow-ups: July 2004 - June 2007) % experiencing acute rejection within 1 year Overall: CyA vs. TAC (p < 0.0001) <1: CyA vs. TAC (p=0.0005) 1-10: CyA vs. TAC (p < 0.0008) 11-17: CyA vs. TAC (p < 0.0001) ISHLT 2008 Overall< 1 1-10 10-17 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

65 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2007) % Freedom from CAV ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

66 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2007) Stratified by Induction % Freedom from CAV p = 0.7992 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

67 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2007) Stratified by Age Group % Freedom from CAV ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

68 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: January 1999-June 2007) Stratified by Age Group % Freedom from CAV ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

69 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients ( Follow-ups: April 1994 - June 2007) Stratified by Ischemia Time % Freedom from CAV ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

70 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients ( Follow-ups: January 1999 - June 2007) Stratified by Ischemia Time for Recent Era % Freedom from CAV ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

71 FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients ( Follow-ups: April 1994 - June 2007) Stratified by Ischemia Time and Recipient Age % Freedom from CAV ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

72 GRAFT SURVIVAL FOLLOWING REPORT OF CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2007) Stratified by Age Group Survival since Report of CAV (%) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

73 FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2007) * Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant % Freedom from Severe Renal Dysfunction ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

74 MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICS Cumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2007) Malignancy/Type1-Year Survivors 5-Year Survivors 10-Year Survivors No Malignancy 3,065 (98.1%)1,177 (95%)253 (91.7%) Malignancy (all types combined) 58 (1.9%)62 (5%)23 (8.3%) Malignancy Type Lymph545722 Other36 Skin1 Type Not Reported11 ISHLT 2008 NOTE: Multiple types may be reported; sum of types may be greater than total number with malignancy. J Heart Lung Transplant 2008;27: 937-983

75 FREEDOM FROM MALIGNANCY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2007) % Freedom from Malignancy ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

76 PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 1 and 3 Years (Transplants: April 1993 - June 2004) 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 Azathioprine22.225.70.2649 Cyclosporine20.827.10.0569 MMF22.122.80.8454 Prednisone29.78.4<.0001 Rapamycin50.022.1- Tacrolimus30.819.60.0007 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

77 PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 3 and 8 Years (Transplants: April 1993 - June 1999) 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 Azathioprine37.544.70.4159 Cyclosporine36.742.90.5334 MMF38.137.60.9627 Prednisone47.721.50.0003 Rapamycin.37.3- Tacrolimus40.934.50.5515 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

78 PEDIATRIC HEART RECIPIENTS Relationship of Rejection and Coronary Artery Vasculopathy (Follow-ups: July 2004 – June 2007) Rejection During 1 st Year Reported CAV between 1 st and 3 rd years post-transplant YesNoAll Yes1 5.5% 17 94.4% 18 100% No1 3.4% 28 96.6% 29 100% p = 0.7279 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

79 PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2007) CAUSE OF DEATH 0-30 Days (N = 444) 31 Days - 1 Year (N = 392) >1 Year - 3 Years (N = 294) >3 Years - 5 Years (N = 216) >5 Years - 10 Years (N = 323) >10 Years (N = 144) CORONARY ARTERY VASCULOPATHY 5 (1.1%)31 (7.9%)59 (20.1%)65 (30.1%)92 (28.5%)44 (30.6%) ACUTE REJECTION 42 (9.5%)94 (24.0%)69 (23.5%)29 (13.4%)36 (11.1%)8 (5.6%) LYMPHOMA 10 (2.6%)11 (3.7%)5 (2.3%)32 (9.9%)9 (6.3%) MALIGNANCY, OTHER 4 (1.0%)2 (0.7%)1 (0.5%)4 (1.2%)10 (6.9%) CMV 1 (0.2%)8 (2.0%)1 (0.3%) INFECTION, NON-CMV 53 (11.9%)64 (16.3%)20 (6.8%)8 (3.7%)14 (4.3%)10 (6.9%) PRIMARY FAILURE 101 (22.7%) 21 (5.4%)10 (3.4%)15 (6.9%)17 (5.3%)4 (2.8%) GRAFT FAILURE 95 (21.4%)41 (10.5%)53 (18.0%)49 (22.7%)68 (21.1%)32 (22.2%) TECHNICAL 24 (5.4%)3 (0.8%)2 (0.7%)2 (0.9%)4 (1.2%) OTHER 26 (5.9%)30 (7.7%)33 (11.2%)25 (11.6%)35 (10.8%)12 (8.3%) MULTIPLE ORGAN FAILURE 41 (9.2%)47 (12.0%)10 (3.4%)6 (2.8%)9 (2.8%)7 (4.9%) RENAL FAILURE 1 (0.2%)3 (0.8%)1 (0.5%)2 (1.4%) PULMONARY 29 (6.5%)23 (5.9%)15 (5.1%)8 (3.7%)6 (1.9%)5 (3.5%) CEREBROVASCULAR 26 (5.9%)13 (3.3%)9 (3.1%)2 (0.9%)6 (1.9%)1 (0.7%) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

80 PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1998 - June 2007) CAUSE OF DEATH 0-30 Days (N = 189) 31 Days - 1 Year (N = 208) >1 Year - 3 Years (N = 179) >3 Years - 5 Years (N = 142) >5 Years - 10 Years (N = 257) >10 Years (N =137) CAV 2 (1.1%)13 (6.3%)30 (16.8%)39 (27.5%)71 (27.6%)42 (30.7%) ACUTE REJECTION 20 (10.6%)39 (18.8%)34 (19.0%)20 (14.1%)27 (10.5%)8 (5.8%) LYMPHOMA 6 (2.9%)6 (3.4%)3 (2.1%)27 (10.5%)9 (6.6%) MALIGNANCY, OTHER 1 (0.5%)1 (0.6%)3 (1.2%)9 (6.6%) CMV 4 (1.9%)1 (0.6%) INFECTION, NON- CMV 23 (12.2%)30 (14.4%)11 (6.1%)3 (2.1%)10 (3.9%)8 (5.8%) PRIMARY FAILURE 39 (20.6%)7 (3.4%)4 (2.2%)6 (4.2%)9 (3.5%)4 (2.9%) GRAFT FAILURE 29 (15.3%)21 (10.1%)39 (21.8%)40 (28.2%)59 (23.0%)30 (21.9%) TECHNICAL 11 (5.8%)2 (1.1%)4 (1.6%) OTHER 19 (10.1%)22 (10.6%)28 (15.6%)18 (12.7%)30 (11.7%)12 (8.8%) MULTIPLE ORGAN FAILURE 22 (11.6%)33 (15.9%)9 (5.0%)5 (3.5%)7 (2.7%)7 (5.1%) RENAL FAILURE 3 (1.4%)1 (0.7%) 2 (1.5%) PULMONARY 11 (5.8%)20 (9.6%)10 (5.6%)6 (4.2%)5 (1.9%)5 (3.6%) CEREBROVASCULAR 13 (6.9%)9 (4.3%)4 (2.2%)1 (0.7%)5 (1.9%)1 (0.7%) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983


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