heart_pediatric heart failure presentation

HEART TRANSPLANTATION
Pediatric Recipients
2011
ISHLT
ISHLT
J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

NUMBER OF CENTERS REPORTING
PEDIATRIC HEART TRANSPLANTS
0
10
20
30
40
50
60
70
80
90
100
110
120
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Number
of
Centers
Reporting
ISHLT 2011
ISHLT

NUMBER OF CENTERS REPORTING
PEDIATRIC HEART TRANSPLANTS
0
10
20
30
40
50
60
70
80
90
100
110
120
1
9
8
2
1
9
8
3
1
9
8
4
1
9
8
5
1
9
8
6
1
9
8
7
1
9
8
8
1
9
8
9
1
9
9
0
1
9
9
1
1
9
9
2
1
9
9
3
1
9
9
4
1
9
9
5
1
9
9
6
1
9
9
7
1
9
9
8
1
9
9
9
2
0
0
0
2
0
0
1
2
0
0
2
2
0
0
3
2
0
0
4
2
0
0
5
2
0
0
6
2
0
0
7
2
0
0
8
2
0
0
9
Other
North America
Europe
Number
of
Centers
Reporting
ISHLT 2011
ISHLT

AVERAGE CENTER VOLUME AND PERCENTAGE
OF TRANSPLANTS BY CENTER VOLUME
Pediatric Heart Transplants: January 1, 1997 - June 30, 2010
132
19
145
16 17
9
0
20
40
60
80
100
120
140
160
1-4/yr 5-9/yr 10-19/yr
Average number of heart transplants per year
0
7
14
21
28
35
42
49
56
Number of centers 1997-2000 Number of centers 2001-June 2010
Percentage of transplants 1997-2000 Percentage of transplants 2001-June 2010
Number
of
centers
Percentage
of
transplants
ISHLT 2011
ISHLT

0%
20%
40%
60%
80%
100%
Europe North America Other
%
of
Transplants
1-4/year 5-9/year 10-19/year
PEDIATRIC HEART TRANSPLANTS:
AVERAGE CENTER VOLUME DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2010
ISHLT 2011
ISHLT

DISTRIBUTION OF TRANSPLANTS
BY CENTER VOLUME
36.3
29.5 29.2
31.5
22.0
46.5
0
10
20
30
40
50
1-4 5-9 10-19
Average number of heart transplants per year
1997-2000 2001-June 2010
%
of
transplants
ISHLT 2011
ISHLT

AGE DISTRIBUTION OF PEDIATRIC HEART
RECIPIENTS (Transplants: January 1996 - June 2010)
0
100
200
300
400
500
600
700
800
900
1000
1100
1200
1300
1400
1500
1600
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Recipient Age (Years)
Number
of
Transplants
ISHLT 2011
ISHLT

AGE DISTRIBUTION OF
PEDIATRIC HEART RECIPIENTS
By Year of Transplant
0
50
100
150
200
250
300
350
400
450
500
550
600
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
11-17 Years
1-10 Years
<1 Year
Number
of
Transplants
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.
ISHLT 2011
ISHLT

0%
20%
40%
60%
80%
100%
%
of
Transplants
<1 years 1-10 years 11-17 years
AGE DISTRIBUTION BY LOCATION
ISHLT 2011
ISHLT

AGE DISTRIBUTION FOR DONORS OF
(Transplants: January 1996 - June 2010)
0
100
200
300
400
500
600
700
800
900
1000
1100
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)
Number
of
Transplants
ISHLT 2011
ISHLT

0%
20%
40%
60%
80%
100%
%
of
Donors
<1 1-10 11-17 18-34 35-49 50-64
DONOR AGE DISTRIBUTION BY LOCATION
ISHLT 2011
ISHLT

DISTRIBUTION OF TRANSPLANTS
by Donor/Recipient Weight Ratio
0
5
10
15
20
25
30
35
40
45
50
<0.75 0.75-<1.0 1.0-<1.5 1.5-<2.0 2.0-<2.5 2.5+
Donor/Recipient Weight Ratio
1995-2002 2003-June 2010
%
of
transplants
ISHLT 2011
ISHLT

DIAGNOSIS IN PEDIATRIC HEART
TRANSPLANT RECIPIENTS (Age: < 1 Year)
0
25
50
75
100
1
9
8
6
1
9
8
7
1
9
8
8
1
9
8
9
1
9
9
0
1
9
9
1
1
9
9
2
1
9
9
3
1
9
9
4
1
9
9
5
1
9
9
6
1
9
9
7
1
9
9
8
1
9
9
9
2
0
0
0
2
0
0
1
2
0
0
2
2
0
0
3
2
0
0
4
2
0
0
5
2
0
0
6
2
0
0
7
2
0
0
8
2
0
0
9
2
0
1
0
Myopathy Congenital
%
of
Cases
35%
62%
2%
1%
1/1996-6/2010
18%
79%
2%
1%
Myopathy
Congenital
Other
ReTX
1988-1995
ISHLT 2011
ISHLT

TRANSPLANT RECIPIENTS (Age: 1-10 Years)
0
25
50
75
100
1
9
8
6
1
9
8
7
1
9
8
8
1
9
8
9
1
9
9
0
1
9
9
1
1
9
9
2
1
9
9
3
1
9
9
4
1
9
9
5
1
9
9
6
1
9
9
7
1
9
9
8
1
9
9
9
2
0
0
0
2
0
0
1
2
0
0
2
2
0
0
3
2
0
0
4
2
0
0
5
2
0
0
6
2
0
0
7
2
0
0
8
2
0
0
9
2
0
1
0
Myopathy Congenital
%
of
Cases
56%
37%
3%
5%
1/1996-6/2010
53%
41%
2%
4%
Myopathy
Congenital
Other
ReTX
1988-1995
ISHLT 2011
ISHLT

TRANSPLANT RECIPIENTS (Age: 11-17 Years)
0
25
50
75
100
1
9
8
6
1
9
8
7
1
9
8
8
1
9
8
9
1
9
9
0
1
9
9
1
1
9
9
2
1
9
9
3
1
9
9
4
1
9
9
5
1
9
9
6
1
9
9
7
1
9
9
8
1
9
9
9
2
0
0
0
2
0
0
1
2
0
0
2
2
0
0
3
2
0
0
4
2
0
0
5
2
0
0
6
2
0
0
7
2
0
0
8
2
0
0
9
2
0
1
0
Myopathy Congenital
%
of
Cases
65%
25%
3%
8%
1/1996-6/2010
67%
27%
3%
3%
Myopathy
Congenital
Other
ReTX
1988-1995
ISHLT 2011
ISHLT

0%
20%
40%
60%
80%
100%
%
of
Transplants
Other
Re-TX/Graft
Failure
Malignancy
Coronary Artery
Disease
Congenital
Cardiomyopathy
DIAGNOSIS DISTRIBUTION BY LOCATION
ISHLT 2011
ISHLT

23.0
9.2
0.4 0.1
4.8
0.1 1.0
7.3
0
10
20
30
Any Device LVAD RVAD TAH LVAD+RVAD Unknown
Type (VAD
or TAH)
VAD+ECMO ECMO
%
of
Patients PEDIATRIC HEART RECIPIENTS
% of Patients Bridged with Mechanical Circulatory
Support* (Transplants: 7/2004 – 6/2010)
* LVAD, RVAD, TAH, ECMO
ISHLT 2011
ISHLT

PEDIATRIC HEART TRANSPLANTATION
Kaplan-Meier Survival (Transplants: 1/1982-6/2009)
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 = 2,226) 1-10 Years (N = 3,247)
11-17 Years (N = 3,357) Overall (N = 8,830)
0-<1 vs. 1-10: p < 0.0007;
0-<1 vs. 11-17: p=0.5977;
1-10 vs. 11-17: p=0.0005.
Half-life <1: 18.4 Years; 1-10: 16.4 Years; 11-17: 12.0 Years
Survival
(%)
ISHLT 2011
ISHLT

Conditional Kaplan-Meier Survival
(Transplants: 1/1982-6/2009)
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 = 1,553) 1-10 Years (N = 2,536)
11-17 Years (N =2,692) Overall (N = 6,781)
0-<1 vs. 1-10: p = 0.0023;
0-<1 vs. 11-17: p < 0.0001;
1-10 vs. 11-17: p < 0.0001.
Half-life: <1: na; 1-10: 19.3 Years; 11-17: 16.0 Years
Survival
(%)
ISHLT 2011
ISHLT

Kaplan-Meier Survival by Era
(Transplants: 1/1982-6/2009)
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=913) 1990-1994 (N=1,902)
1995-1999 (N=1,907) 2000-2004 (N=2,005)
2005-6/2009 (N=2,103)
P-values for era comparisons
All p-values significant at p = 0.001 except comparison of 82-89 vs.
90-94, 95-99 vs. 00-04 and 00-04 vs. 05-6/09
Half-life 1982-1989: 12.0 years; 1990-1994: 12.9 years;
1995-1999: n.c.; 2000-2004: n.c.; 2005-6/2009: n.c.
Survival
(%)
ISHLT 2011
ISHLT

Conditional Kaplan-Meier Survival for Recent Era
(Transplants: 1/1999-6/2009)
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
<1 Year (N = 783) 1-10 Years (N =1,374)
11-17 Years (N = 1,397) Overall (N = 3,554)
0-<1 vs. 1-10: p = 0.1153
0-<1 vs. 11-17: p < 0.0001;
1-10 vs. 11-17: p < 0.0001
Survival
(%)
ISHLT 2011
ISHLT

Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2009)
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 16
Years
1982-1989 (N=189) 1990-1994 (N=590)
1995-1999 (N=479) 2000-2004 (N=456)
2005-6/2009 (N=512)
All p-values significant at p = 0.001 except comparison of 82-89 vs. 90-
94, 95-99 vs. 00-04, 95-99 vs. 05-6/09 and 00-04 vs. 05-6/09
Half-life 1982-1989: 12.2 years; 1990-1994: 11.4 years;
1995-1999: n.c. ; 2000-2004: n.c.; 2005-6/2009: n.c.
Survival
(%)
ISHLT 2011
ISHLT

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 = 286) 1990-1994 (N=670)
1995-1999 (N=738) 2000-2004 (N=752)
2005-6/2009 (N=801)
All p-values significant at p = 0.05 except for 00-05 vs.
05-6/09
Half-life 1982-1989: 11.2; 1990-1994: 14.1; 1995-1999: n.c.; 2000-2004: n.c.;
2005-6/2009: n.c.
Survival
(%)
ISHLT 2011
ISHLT

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=438) 1990-1994 (N=642)
1995-1999 (N=690) 2000-2004 (N=797)
2005-6/2009 (N=790)
No p-values significant at p = 0.05 except 82-89 vs. 05-6/09: p < 0.0001
and 90-94 vs. 05-6/09: p=0.0187
Half-life 1982-1989: 12.0; 1990-1994: 12.9; 1995-1999:
10.3; 2000-2004: n.c.; 2005-6/2009: n.c.
Survival
(%)
ISHLT 2011
ISHLT

Kaplan-Meier Survival by Diagnosis
Age: < 1 Year (Transplants: 1/1996-6/2009)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
Congenital (N=838) Cardiomyopathy (N=447)
p-value < 0.0001
Survival
(%)
ISHLT 2011
ISHLT

Age: 1 - 10 Years (Transplants: 1/1996-6/2009)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
Congenital (N=777) Cardiomyopathy (N=1,164)
Retransplant (N=110)
Congenital vs. Cardiomyopathy: p < 0.0001
Congenital vs. Retransplant: p = 0.0170
Cardiomyopathy vs. Retransplant: p < 0.0001
Survival
(%)
ISHLT 2011
ISHLT

Age: 11 - 17 Years (Transplants: 1/1996-6/2009)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
Congenital (N=527) Cardiomyopathy (N=1,344)
Retransplant (N=164)
No p-values significant at p = 0.05 except
Cardiomyopathy vs. Retransplant: p=0.0007
Survival
(%)
ISHLT 2011
ISHLT

Kaplan-Meier Patient vs. Graft Survival
(Transplants: 1/1999-6/2009)
Average Center Volume: 1-4 Transplants per Year
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
Patient (N=1,460) Graft (N=1,460)
p = 0.2081
Survival
(%)
ISHLT 2011
ISHLT

(Transplants: 1/1999-6/2009)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9
Years
Patient (N=985) Graft (N=985)
p = 0.0839
Survival
(%)
ISHLT 2011
ISHLT

(Transplants: 1/1999-6/2009)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
Patient (N=2,041) Graft (N=2,041)
p = 0.0181
Survival
(%)
ISHLT 2011
ISHLT

PEDIATRIC HEART TRANSPLANTS (1/1997-6/2009)
Risk Factors For 1 Year Mortality
N=3,998
VARIABLE N
Relative
Risk
P-value
95% Confidence
Interval
ECMO, age = 0 131 2.83 <0.0001 2.05 -3.91
On dialysis 109 2.01 0.0002 1.40 -2.89
Congenital diagnosis 1650 1.97 <0.0001 1.56 -2.49
ECMO, age >0 173 1.95 0.0004 1.35 -2.82
Retransplant 244 1.74 0.0057 1.17 -2.57
On ventilator 777 1.50 0.0004 1.20 -1.88
Male donor/female recip vs. male donor/male recip 1022 1.42 0.0045 1.11 -1.80
PRA > 10% 369 1.41 0.0.127 1.08 -1.85
Donor cause of death = cerebrovascular/stroke vs.
head trauma
387 1.41 0.021 1.05 -1.88
Prior sternotomy 991 1.26 0.0442 1.01 -1.59
Infection requiring IV drug therapy (with 2wk/TX) 628 1.25 0.0447 1.00 -1.56
Donor cause of death = anoxia vs. head trauma 968 0.77 0.0266 0.62 -0.97
Reference diagnosis = cardiomyopathy
ISHLT 2011
ISHLT

Borderline Significant Risk Factors For 1 Year Mortality
N=3,998
VARIABLE N
Relative
Risk
P-value
95%
Confidence
Interval
Transplant year 1999/2000 vs. 2003/2004 542 1.34 0.084 0.96 -1.86
ISHLT 2011
ISHLT

Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Creatinine Ischemia time
Pediatric transplant volume (borderline)
N=3,998
ISHLT 2011
ISHLT

Pre-Transplant Creatinine
0
0.5
1
1.5
2
2.5
3
0 0.5 1 1.5
Recipient serum creatinine (mg/dl)
Relative
Risk
of
1
Year
Mortality
p = 0.0007
N=3,998
ISHLT 2011
ISHLT

Ischemia Time
0
0.5
1
1.5
2
2.5
2 3 4 5 6
Ischemia time (hours)
Relative
Risk
of
1
Year
Mortality
p = 0.0146
N=3,998
ISHLT 2011
ISHLT

Center Volume of Pediatric Transplants
0
0.5
1
1.5
2
2.5
0 5 10 15 20
Center volume (cases per year)
Relative
Risk
of
1
Year
Mortality
p = 0.096
N=3,998
ISHLT 2011
ISHLT

Factors Not Significant for 1 Year Mortality
Recipient Factors:
Age, gender, IV inotropes, sternotomy, history of
malignancy, hospitalized, diabetes
Donor Factors:
Age, gender, clinical infection, history of diabetes
Transplant Factors:
CMV mismatch, HLA mismatch
ISHLT 2011
ISHLT

Age = <1 Years
N=1,064
VARIABLE
N
Relative
Risk
P-value 95% Confidence
Interval
ECMO, diagnosis = congenital 84 2.92 <.0001 1.91 -4.46
ECMO, diagnosis other than congenital 47 2.52 0.0091 1.26 -5.05
On dialysis 30 2.28 0.0037 1.31 -3.98
PRA > 10% 80 1.8 0.022 1.09 -2.99
On ventilator 383 1.7 0.0014 1.23 -2.34
Prior sternotomy 196 1.49 0.0443 1.01 -2.19
Diagnosis = cardiomyopathy 334 0.6 0.0496 0.36 -1.00
Reference diagnosis = congenital
without PGE or ECMO
ISHLT 2011
ISHLT

Age = <1 Years
N=1,064
VARIABLE N
Relative
Risk
P-value
95%
Confidence
Interval
Donor cause of death =
cerebrovascular/stroke vs. head trauma
47 1.74 0.0574 0.98 -3.08
Transplant Year: 1997-1998 vs. 2003-2004 170 1.56 0.0806 0.95 -2.57
Infection requiring IV drug therapy (with
2wk/TX) 279 1.32 0.0886 0.96 -1.8
ISHLT 2011
ISHLT

Age = <1 Years
Ischemia time Pediatric transplant volume
Creatinine
N=1,064
ISHLT 2011
ISHLT

Risk Factors for 1 Year Mortality in Age = <1 Years
Ischemia Time
0
0.5
1
1.5
2
2.5
2 3 4 5 6
Relative
Risk
of
1
Year
Mortality
p = 0.0091
N=1,064
ISHLT 2011
ISHLT

0
0.5
1
1.5
2
2.5
3
0 0.2 0.4 0.6 0.8 1
Relative
Risk
of
1
Year
Mortality
p = 0.0025
N=1,064
ISHLT 2011
ISHLT

Center Volume for Pediatric Transplants
0
0.5
1
1.5
2
0 2 4 6 8 10 12 14 16 18 20
Center Volume (cases per year)
Relative
Risk
of
1
Year
Mortality
p = 0.0361
N=1,064
ISHLT 2011
ISHLT

Age = 1-10 Years
N=1,536
VARIABLE N
Relative
Risk
P-value
95% Confidence
Interval
Diagnosis = congenital 601 2.07 <.0001 1.46 -2.92
Transfusions prior to transplant 423 1.72 0.0033 1.2 -2.46
Female recipient 768 1.39 0.0455 1.01 -1.91
ISHLT 2011
ISHLT

Age = 1-10 Years
Creatinine Bilirubin
Donor height
N=1,536
ISHLT 2011
ISHLT

Risk Factors for 1 Year Mortality in Age = 1-10 Years
0
1
2
3
4
0.2 0.4 0.6 0.8 1 1.2 1.4
Relative
Risk
of
1
Year
Mortality
p < 0.0001
N=1,536
ISHLT 2011
ISHLT

Donor Height
0
0.5
1
1.5
2
2.5
3
70 80 90 100 110 120 130 140 150
Height (cm)
Relative
Risk
of
1
Year
Mortality
p < 0.0001
N=1,536
ISHLT 2011
ISHLT

Recipient Bilirubin
0
0.5
1
1.5
2
2.5
0 0.5 1 1.5 2 2.5 3 3.5 4
Bilirubin (mg/dL)
Relative
Risk
of
1
Year
Mortality
p = 0.0166
N=1,536
ISHLT 2011
ISHLT

Age = 11-17 Years
N=1,398
VARIABLE N
Relative
Risk
P-
value
95%
Confidence
Interval
ECMO 49 2.96 0.0006 1.59 -5.53
Diagnosis = other than myopathy,
congenital, or retransplant
41 2.72 0.022 1.16 -6.40
Diagnosis = retransplant 138 2.34 0.0018 1.37 -3.98
Diagnosis = congenital 359 2.09 0.0004 1.40 -3.14
On dialysis prior to transplant 44 2.08 0.0408 1.03 -4.21
ISHLT 2011
ISHLT

Age = 11-17 Years
N=1,398
VARIABLE N
Relative
Risk
P-value
95%
Confidence
Interval
Transplant Year: 2001-2002 vs. 2003-2004 221 1.72 0.0787 0.94 -3.13
PRA > 10% 119 1.58 0.072 0.96 -2.60
Donor cause of death = cerebrovascular/stroke
vs. head trauma
202 1.55 0.053 0.99 -2.42
ISHLT 2011
ISHLT

Age = 11-17 Years
Ischemia time
N=1,398
ISHLT 2011
ISHLT

Ischemia Time
0
0.5
1
1.5
2
2.5
2 3 4 5 6
Relative
Risk
of
1
Year
Mortality
p = 0.0039
N=1,398
ISHLT 2011
ISHLT

N=2,529
VARIABLE N
Relative
Risk
P-value
95% Confidence
Interval
ECMO, age = 0 69 2.78 <.0001 1.92 -4.02
Diagnosis = retransplant 154 2.12 <.0001 1.56 -2.89
On dialysis 64 1.64 0.0146 1.10 -2.43
Diagnosis = congenital 1061 1.53 <.0001 1.26 -1.85
PRA > 10% 258 1.52 0.0003 1.21 -1.91
On ventilator 490 1.30 0.0147 1.05 -1.60
Female recipient 1115 1.26 0.004 1.08 -1.48
ISHLT 2011
ISHLT

N=2,529
VARIABLE N
Relative
Risk
P-value
95%
Confidence
Interval
Donor clinical infection 451 0.82 0.0741 0.66 -1.02
ISHLT 2011
ISHLT

Pediatric transplant volume
(borderline)
Ischemia time (borderline)
N=2,529
ISHLT 2011
ISHLT

0
0.5
1
1.5
2
2.5
0 2 4 6 8 10 12 14 16 18 20
Relative
Risk
of
5
Year
Mortality
p = 0.061
N=2,529
ISHLT 2011
ISHLT

Ischemia Time
0
0.5
1
1.5
2
2.5
2 3 4 5 6
Relative
Risk
of
5
Year
Mortality
p = 0.054
N=2,529
ISHLT 2011
ISHLT

N=933
VARIABLE N
Relative
Risk
P-
value
95% Confidence
Interval
Diagnosis = retransplant 52 2.33 <.0001 1.53 -3.55
Infection requiring IV drug therapy
(within 2 weeks prior to transplant)
117 1.42 0.0253 1.04 -1.92
ISHLT 2011
ISHLT

N=933
VARIABLE N
Relative
Risk
P-value 95% Confidence
Interval
ECMO, age = 0 17 2.01 0.0506 1.00 -4.06
Diagnosis = not myopathy, congenital
or retransplant
33 1.64 0.07 0.96 -2.80
ISHLT 2011
ISHLT

Height ratio Recipient weight (borderline)
Donor BSA (borderline)
N=933
ISHLT 2011
ISHLT

Recipient Weight
0
0.5
1
1.5
2
2.5
3
3.5
0 10 20 30 40 50 60 70 80 90 100
Recipient weight (kg)
Relative
Risk
of
10
Year
Mortality
p = 0.095
N=933
ISHLT 2011
ISHLT

Donor BSA
0
0.5
1
1.5
2
0.4 0.6 0.8 1 1.2 1.4 1.6 1.8
Donor BSA (m2
)
Relative
Risk
of
10
Year
Mortality
p = 0.0841
N=933
ISHLT 2011
ISHLT

Donor Height/Recipient Height Ratio
0
0.5
1
1.5
2
2.5
0.9 1 1.1 1.2 1.3 1.4
Height ratio
Relative
Risk
of
10
Year
Mortality
p = 0.0057
N=933
ISHLT 2011
ISHLT

Recipient Factors:
PRA, diabetes, hospitalized, PGE, VAD, bilirubin,
creatinine
Donor Factors:
Cause of death, age, clinical infection
Transplant Factors:
Ischemia time, CMV mismatch
ISHLT 2011
ISHLT

N=1105
VARIABLE N
Relative
Risk
P-
value
95% Confidence
Interval
Diagnosis = retransplant 35 2.45 0.0062 1.29 -4.67
ISHLT 2011
ISHLT

Continuous Factors (see figure)
Center volume
N=1105
ISHLT 2011
ISHLT

0
0.5
1
1.5
2
0 5 10 15 20
Relative
Risk
of
15
Year
Mortality
p < 0.0001
N=1105
ISHLT 2011
ISHLT

Recipient Factors:
Age, height, weight, gender
Donor Factors:
Cause of death, age, height, weight, gender
Transplant Factors:
Ischemia time, HLA mismatch
ISHLT 2011
ISHLT

Cross-Sectional Analysis
Functional Status of Surviving Recipients
(Follow-ups: April 1994 - June 2010)
0%
20%
40%
60%
80%
100%
1 Year (N = 2,177) 3 Years (N = 1,783) 5 Year (N = 1,432)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT 2011
ISHLT

Age: <1 Year
0%
20%
40%
60%
80%
100%
1 Year (N = 547) 3 Year (N = 526) 5 Year (N = 477)
ISHLT 2011
ISHLT

Age: 1-10 Years
0%
20%
40%
60%
80%
100%
ISHLT 2011
ISHLT

Age: 11-17 Years
0%
20%
40%
60%
80%
100%
ISHLT 2011
ISHLT

(Follow-ups: March 2005 - June 2010)
US Recipients Only
0%
20%
40%
60%
80%
100%
1 Year (N = 1,409) 2 Years (N = 1,242) 3 Years (N = 1,136)
Not Applicable (patient <
1 year old)
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ISHLT 2011
ISHLT

Rehospitalization Post-transplant of Surviving Recipients
0%
20%
40%
60%
80%
100%
1 Year (N = 4,161) 3 Years (N =3,274) 5 Years (N = 2,598)
No Hospitalization Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection Hospitalized, Infection Only
Hospitalized, Rejection + Infection
ISHLT 2011
ISHLT

0
10
20
30
40
50
60
Any Induction (N =
1,738)
Polyclonal ALG/ATG
(N = 1,163)
OKT3 (N = 55) IL-2R Antagonist (N
= 576)
%
of
Patients PEDIATRIC HEART RECIPIENTS
Induction Immunosuppression
Analysis is limited to patients who were alive
at the time of the discharge
ISHLT 2011
ISHLT

0
10
20
30
40
50
60
70
Any Induction Polyclonal ALG/ATG IL-2R Antagonist
%
of
Patients
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Induction Immunosuppression (Transplants: January 2001 - June 2010)
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 discharge
ISHLT 2011
ISHLT

Kaplan-Meier Survival by Induction Group
(Transplants: January 2000 – June 2009) Conditional on Survival to 14 Days
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
No induction (N = 1,377)
Polyclonal induction (N = 1,072)
IL-2R antagonist (N = 449)
No comparisons are statistically significant.
Survival
(%)
ISHLT 2011
ISHLT

Kaplan-Meier Survival by Induction Group and Treated Rejection Between
Transplant Discharge and 1-Year Follow-up
(1-Year Follow-ups: July 2004 - June 2009)
Conditional on Survival to 1 Year
50
60
70
80
90
100
0 1 2 3 4 5
Years
No induction/No rejection (N = 379)
Polyclonal induction/No rejection (N = 356)
IL-2R antagonist/No rejection (N = 162)
No induction/Treated Rejection (N = 129)
Polyclonal induction/Treated Rejection (N = 142)
IL-2R antagonist/Treated Rejection (N = 65)
Survival
(%)
No pair-wise comparisons of survival by induction are statistically
significant within either rejection grouping
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.
ISHLT 2011
ISHLT

Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2009)
Conditional on Survival to 14 Days
Age: < 1 Year
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
No induction (N = 305)
Polyclonal induction (N = 369)
Survival
(%)
ISHLT 2011
ISHLT

Age: 1-10 Years
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
No induction (N = 551)
Survival
(%)
ISHLT 2011
ISHLT

Age: 11-17 Years
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
No induction (N =521)
Survival
(%)
ISHLT 2011
ISHLT

0
20
40
60
80
100
Cyclosporine Tacrolimus Sirolimus MMF Azathioprine Prednisone
Year 1 (N = 2,579) Year 5 (N = 1,644)
Maintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2001 - June 2010)
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
ISHLT 2011
ISHLT

Maintenance Immunosuppression at Time of Follow-up
for Same Patients at Each Time Point
0%
20%
40%
60%
80%
100%
Year 1 (N = 984) Year 5 (N = 984)
None
Other
Tacrolimus
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine
Cyclosporine + MMF
Cyclosporine + AZA
%
of
Patients
ISHLT 2011
ISHLT

Maintenance Immunosuppression Drug Combinations at Time of Follow-up
0%
20%
40%
60%
80%
100%
Year 1 (N = 2,579) Year 5 (N = 1,644)
None
Other
Tacrolimus
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine
Cyclosporine + MMF
Cyclosporine + AZA
%
of
Patients
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2011
ISHLT

Kaplan-Meier Survival Based on Prednisone Use
Conditional on Survival to 1 Year (Transplants: April 1994 - June 2009)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
Prednisone use at discharge and 1 year (N = 2,274)
No Prednisone at discharge or at 1 year (N = 578)
Prednisone at discharge/not at 1 year (N = 534)
p < 0.0001
Survival
(%)
ISHLT 2011
ISHLT

Kaplan-Meier Survival Based on Prednisone Use for a Recent Era
Conditional on Survival to 1 Year (Transplants: January 1998 – June 2009)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
Prednisone use at discharge and 1 year (N = 1,810)
No Prednisone at discharge or at 1 year (N = 460)
Prednisone at discharge/not at 1 year (N = 447)
p = 0.0045
Survival
(%)
ISHLT 2011
ISHLT

Kaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use at Discharge
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
Tacrolimus use at discharge (N = 1,711)
Cyclosporine use at discharge (N = 1,550)
p = 0.3357
Survival
(%)
ISHLT 2011
ISHLT

Kaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use
Conditional on Survival to 1 Year (Transplants: January 1998 - June 2009)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
Cyclosporine use at discharge and 1 year (N = 949)
Tacrolimus use at discharge and 1 year (N = 1,298)
Cyclosporine use at discharge/Tacrolimus at 1 year (N = 285)
Tacrolimus use at discharge/Cyclosporine at 1 year (N = 33)
p = 0.1130
Survival
(%)
ISHLT 2011
ISHLT

Kaplan-Meier Survival Based on Treated Rejection within 1st Year
Conditional on survival to 1 year (1-Year Follow-ups: April 2004 - June 2009)
50
60
70
80
90
100
0 1 2 3 4 5
Years
Free from Rejection during 1 year (N = 725)
Treated Rejection within 1st Year (N = 362)
p = 0.0378
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.
ISHLT 2011
ISHLT

Stratified by Calcineurin Use at Discharge
50
60
70
80
90
100
0 1 2 3 4 5
Years
CyA: Free from Rejection during 1 year (N = 198)
CyA: Treated Rejection within 1st Year (N = 126)
TAC: Free from Rejection during 1 year (N = 485)
TAC: Treated Rejection within 1st Year (N = 200)
Free from Rejection: CyA vs. TAC p = 0.5676
Treated Rejection: CyA vs. TAC p = 0.0758
CyA: Rejection vs. no rejection p = 0.9100
TAC: Rejection vs. no rejection p = 0.0199
Survival
(%)
rejection.
ISHLT 2011
ISHLT

Stratified by Calcineurin Use at Discharge: Age = 0-10 Years
50
60
70
80
90
100
0 1 2 3 4 5
Years
CyA: Free from Rejection during 1 year (N = 138)
CyA: Treated Rejection within 1st Year (N = 83)
TAC: Free from Rejection during 1 year (N = 308)
Rejection: CyA vs. TAC p = 0.2169
Survival
(%)
ISHLT 2011
ISHLT

Stratified by Calcineurin Use at Discharge: Age = 11-17 Years
Conditional on survival to 1 year (1-Year Follow-ups: April 2004 - July 2009)
50
60
70
80
90
100
0 1 2 3 4
Years
CyA: Free from Rejection during 1st Year (N = 60)
CyA: Treated Rejection within 1st Year (N =43)
TAC: Free from Rejection during 1st Year (N = 177)
Rejection: CyA vs. TAC p = 0.2358
Survival
(%)
rejection.
ISHLT 2011
ISHLT

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 2010)
0
10
20
30
40
50
60
70
No induction Used, Treatment No induction Used, No Treatment
Induction Used (no OKT3), Treatment Induction Used (no OKT3), No Treatment
%
experiencing
acute
rejection
within
1
year
Overall < 1 1-10 10-17 Female Male
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.
ISHLT 2011
No comparisons are statistically significant at 0.05.
ISHLT

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 2010)
0
10
20
30
40
50
60
70 No induction, Treatment No induction, No Treatment
Polyclonal, Treatment Polyclonal, No Treatment
IL-2R antagonist, Treatment ILR antagonist, No Treatment
%
experiencing
acute
rejection
within
1
year
No comparisons are statistically significant at 0.05.
Overall < 1 1-10 10-17 Female Male
ISHLT 2011
ISHLT

Stratified by Maintenance Immunosuppression and Induction (Follow-ups: July 2004 - June 2010)
0
10
20
30
40
50
60
70
CyA + No induction, Treatment CyA + No induction, No Treatment
CyA + Induction (no OKT3), Treatment CyA + Induction (no OKT3), No Treatment
TAC + No induction, Treatment TAC + No induction, No Treatment
TAC + Induction (no OKT3), Treatment TAC + Induction (no OKT3), No Treatment
%
experiencing
acute
rejection
within
1
year
No CyA + no induction vs. CyA + induction and TAC + no induction vs. TAC + induction comparisons are
statistically significant at 0.05
All other comparisons are statistically significant at 0.05 except <1: CyA + induction vs. TAC + no
induction vs. and <1: CyA + induction vs. TAC + induction
Overall < 1 1-10 10-17
Analysis is limited to patients who were alive at the time
of the follow-up
ISHLT 2011
ISHLT

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 2010)
0
10
20
30
40
50
60
70
Cyclosporine + MMF, Treatment Cyclosporine + MMF, No Treatment
Cyclosporine + AZA, Treatment Cyclosporine + AZA, No Treatment
Tacrolimus + MMF, Treatment Tacrolimus + MMF, No Treatment
Tacrolimus + AZA, Treatment Tacrolimus + AZA, No Treatment
%
experiencing
acute
rejection
within
1
year
Overall < 1 1-10 10-17
Analysis is limited to patients who were alive at the time
of the follow-up
ISHLT 2011
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 =0.0037).
1-10: CyA + MMF vs. TAC + MMF (p = 0.0017); CyA + AZA vs. TAC + MMF (p=0.0036).
11-17: all comparisons were statistically significant at 0.05 except CyA +MMF vs. CyA +AZA TAC + MMF vs. TAC + AZA.
ISHLT

Stratified by Calcineurin Inhibitor Use at Discharge
(Follow-ups: July 2004 - June 2010)
0
10
20
30
40
50
60
Cyclosporine, Treatment Cyclosporine, No Treatment
Tacrolimus, Treatment Tacrolimus, No Treatment
%
experiencing
acute
rejection
within
1
year
Overall: CyA vs. TAC (p < 0.0001)
<1: CyA vs. TAC (p = 0.0247)
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
ISHLT 2011
ISHLT

FREEDOM FROM CORONARY ARTERY VASCULOPATHY
For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2010)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11
Years
%
Freedom
from
CAV
ISHLT 2011
ISHLT

Stratified by Induction
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
Induction (N = 1,682)
No Induction (N = 1,976)
p = 0.2243
%
Freedom
from
CAV
ISHLT 2011
ISHLT

For Pediatric Heart Recipients (Follow-ups: 1999 - June 2010)
Stratified by Tacrolimus vs. Cyclosporine Use
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
p = 0.7862
%
Freedom
from
CAV
ISHLT 2011
ISHLT

Stratified by Age Group
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Years
<1 Year (N = 968)
1-10 Years (N = 1,377)
11-17 Years (N = 1,329)
p < 0.0001
%
Freedom
from
CAV
ISHLT 2011
ISHLT

For Pediatric Heart Recipients (Follow-ups: 1999-June 2010)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
<1 Year (N = 722)
1-10 Years (N = 1,077)
11-17 Years (N = 1,046)
p < 0.0001
%
Freedom
from
CAV
ISHLT 2011
ISHLT

Stratified by Ischemia Time
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
0-<2 hours (N=376)
2-<4 hours (N=1,878)
4+ hours (N=1,158)
p = 0.0017
%
Freedom
from
CAV
ISHLT 2011
ISHLT

For Pediatric Heart Recipients (Follow-ups: January 1999 - June 2010)
Stratified by Ischemia Time for Recent Era
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
0-<2 hours (N=261)
2-<4 hours (N=1,443)
4+ hours (N=900)
p = 0.0022
%
Freedom
from
CAV
ISHLT 2011
ISHLT

Stratified by Ischemia Time and Recipient Age
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
0-<2 hours/0-10 years (N=217)
2+ hours/0-10 years (N=1,958)
0-<2 hours/11-17 years (N=159)
2+ hours/11-17 years (N=1,078)
0-10 years: p = 0.0093;
11-17 years: p = 0.1662
%
Freedom
from
CAV
ISHLT 2011
ISHLT

GRAFT SURVIVAL FOLLOWING REPORT OF CORONARY
ARTERY VASCULOPATHY
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5
Time since Report of CAV (Years)
<1 Year (N = 98)
1-10 Years (N = 174)
11-17 Years (N = 226)
p = 0.5233
Survival
since
Report
of
CAV
(%)
ISHLT 2011
ISHLT

FREEDOM FROM SEVERE RENAL DYSFUNCTION*
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11
Years
%
Freedom
from
Severe
Renal
Dysfunction
* Severe renal dysfunction = Creatinine > 2.5
mg/dl (221 μmol/L), dialysis or renal transplant
ISHLT 2011
ISHLT

FREEDOM FROM SEVERE RENAL DYSFUNCTION*
For Pediatric Heart Recipients (Follow-ups: 1999 - June 2010)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
p = 0.2590
%
Freedom
from
Severe
Renal
Dysfunction
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221
μmol/L), dialysis or renal transplant
ISHLT 2011
ISHLT

FREEDOM FROM RENAL REPLACEMENT THERAPY*
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11
Years
%
Freedom
from
Renal
Replacemetn
Therapy
* Renal replacement therapy = dialysis or renal transplant
ISHLT 2011
ISHLT

MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICS
Cumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2010)
Malignancy/Type 1-Year
Survivors
5-Year
Survivors
10-Year
Survivors
No Malignancy 4,026 (98.2%) 1,717 (95.1%) 488 (92.2%)
Malignancy (all types combined) 72 (1.8%) 89 (4.9%) 41 (7.8%)
Malignancy
Type
Lymph 67 84 38
Other 4 5 4
Skin 0 1 1
Type Not Reported 1 0 0
NOTE: Multiple types may be reported; sum of types
may be greater than total number with malignancy.
ISHLT 2011
ISHLT

FREEDOM FROM MALIGNANCY
80
85
90
95
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Years
All malignancy Lymph Skin Other
%
Freedom
from
Malignancy
ISHLT 2011
ISHLT

FREEDOM FROM MALIGNANCY
70
75
80
85
90
95
100
0 1 2 3 4 5 6 7 8 9
Years
p = 0.0061
%
Freedom
from
Malignancy
ISHLT 2011
ISHLT

FREEDOM FROM LYMPHOMA
Stratified by Induction
80
85
90
95
100
0 1 2 3 4 5 6 7 8 9 10 11
Years
Induction (N = 1,727)
No Induction (N = 1,885)
p = 0.8355
%
Freedom
from
Lymphoma
ISHLT 2011
ISHLT

Incidence of Hypertension between 1 and 3 Years
(Transplants: April 1993 - June 2007)
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
Azathioprine 20.0 25.3 0.0415
Cyclosporine 22.1 22.0 0.9823
MMF 24.8 22.3 0.3428
Prednisone 29.0 12.8 <0.0001
Rapamycin 38.5 22.1 0.1784
Tacrolimus 24.4 21.2 0.1997
ISHLT 2011
ISHLT

Incidence of Hypertension between 3 and 5 Years
(Transplants: April 1993 - June 2005)
Maintenance
Immunosuppression at
discharge and 1 year
% HTN reported between 3 and
5 years
P-value
For Patients
on drug
For Patients
not on drug
Azathioprine 13.8 20.8 0.0339
Cyclosporine 16.1 19.3 0.3655
MMF 19.9 15.9 0.2579
Prednisone 21.4 7.2 <.0001
Rapamycin 25.0 17.3 0.5340
Tacrolimus 17.9 16.2 0.6212
ISHLT 2011
ISHLT

Relationship of Rejection and Coronary Artery Vasculopathy
(Follow-ups: July 2004 – June 2010)
Rejection
During 1st
Year
Reported CAV between 1st and 3rd years
post-transplant
Yes No All
Yes 13
5.2%
239
94.8%
252
100%
No 17
4.2%
387
95.8%
404
100%
p = 0.5707
ISHLT 2011
ISHLT

40
50
60
70
80
90
100
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
Surrvival
(%)
<1 Year (N=54) 1-<3 Years (N=39) 3-<5 Years (N=50)
5+ Years (N=166) Primary TX (N=6,054)
Comparison of survival for
re-transplant groups: p = 0.0019
Time (years) since most recent transplant
KAPLAN-MEIER SURVIVAL RATES FOR PEDIATRIC HEART
RETRANSPLANTS STRATIFIED 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.
ISHLT 2011
ISHLT

PEDIATRIC HEART RE-TRANSPLANTS
By Transplant Year
Re-transplants: January 1994 – December 2009
0
5
10
15
20
25
30
35
40
1
9
9
4
1
9
9
5
1
9
9
6
1
9
9
7
1
9
9
8
1
9
9
9
2
0
0
0
2
0
0
1
2
0
0
2
2
0
0
3
2
0
0
4
2
0
0
5
2
0
0
6
2
0
0
7
2
0
0
8
2
0
0
9
Number
of
transplants
Year of re-transplant
Only patients who were less than 18 years
old at the time of re-transplant are included.
ISHLT 2011
ISHLT

0
10
20
30
40
50
<1 month 1-<12
months
12-<36
months
36-<60
months
60+ months Not reported
%
of
Re-Transplants
0-10 Years 11-17 Years
Time Between Previous and Current Transplant
PEDIATRIC HEART RE-TRANSPLANTS
By Inter-transplant Interval
Re-transplants: January 1994 - June 2010
Only patients who were less than 18 years old at
the time of re-transplant are included. Analysis is
based on the age at the time of re-transplant
ISHLT 2011
ISHLT

PEDIATRIC HEART TRANSPLANT RECIPIENTS:
Cause of Death (Deaths: January 1992 - June 2010)
CAUSE OF DEATH 0-30 Days
(N = 508)
31 Days - 1
Year (N = 479)
>1 Year - 3
Years (N = 363)
>3 Years - 5
Years (N = 271)
>5 Years - 10
Years (N = 424)
>10 Years
(N = 264)
CORONARY ARTERY
VASCULOPATHY
5 (1.0%) 35 (7.3%) 71 (19.6%) 74 (27.3%) 113 (26.7%) 62 (23.5%)
ACUTE REJECTION 49 (9.6%) 112 (23.4%) 80 (22.0%) 35 (12.9%) 47 (11.1%) 15 (5.7%)
LYMPHOMA 1 (0.2%) 9 (1.9%) 13 (3.6%) 10 (3.7%) 36 (8.5%) 21 (8.0%)
MALIGNANCY, OTHER 4 (0.8%) 4 (1.1%) 4 (1.5%) 12 (2.8%) 19 (7.2%)
CMV 1 (0.2%) 12 (2.5%) 1 (0.3%) 1 (0.4%)
INFECTION, NON-CMV 60 (11.8%) 72 (15.0%) 28 (7.7%) 13 (4.8%) 19 (4.5%) 24 (9.1%)
PRIMARY FAILURE 111 (21.9%) 24 (5.0%) 12 (3.3%) 18 (6.6%) 23 (5.4%) 8 (3.0%)
GRAFT FAILURE 106 (20.9%) 56 (11.7%) 76 (20.9%) 67 (24.7%) 98 (23.1%) 59 (22.3%)
TECHNICAL 29 (5.7%) 4 (0.8%) 4 (1.1%) 3 (1.1%) 5 (1.2%) 6 (2.3%)
OTHER 24 (4.7%) 30 (6.3%) 32 (8.8%) 23 (8.5%) 37 (8.7%) 18 (6.8%)
MULTIPLE ORGAN
FAILURE
51 (10.0%) 62 (12.9%) 12 (3.3%) 8 (3.0%) 14 (3.3%) 16 (6.1%)
RENAL FAILURE 1 (0.2%) 7 (1.5%) 1 (0.3%) 1 (0.4%) 2 (0.5%) 6 (2.3%)
PULMONARY 31 (6.1%) 35 (7.3%) 18 (5.0%) 11 (4.1%) 10 (2.4%) 5 (1.9%)
CEREBROVASCULAR 39 (7.7%) 17 (3.5%) 11 (3.0%) 4 (1.5%) 8 (1.9%) 4 (1.5%)
ISHLT 2011
ISHLT

Cause of Death (Deaths: January 1998 - June 2010)
CAUSE OF DEATH 0-30 Days
(N = 259)
31 Days - 1
Year (N = 299)
>1 Year - 3
Years (N = 239)
>3 Years - 5
Years (N = 197)
>5 Years - 10
Years (N = 358)
>10 Years
(N =257)
CAV 2 (0.8%) 17 (5.7%) 39 (16.3%) 48 (24.4%) 92 (25.7%) 60 (23.3%)
ACUTE REJECTION 26 (10.0%) 56 (18.7%) 44 (18.4%) 27 (13.7%) 38 (10.6%) 15 (5.8%)
LYMPHOMA 6 (2.0%) 8 (3.3%) 8 (4.1%) 30 (8.4%) 21 (8.2%)
MALIGNANCY,
OTHER
1 (0.3%) 3 (1.3%) 2 (1.0%) 10 (2.8%) 18 (7.0%)
CMV 8 (2.7%) 1 (0.4%) 1 (0.4%)
INFECTION, NON-
CMV
32 (12.4%) 39 (13.0%) 19 (7.9%) 8 (4.1%) 15 (4.2%) 22 (8.6%)
PRIMARY FAILURE 54 (20.8%) 10 (3.3%) 6 (2.5%) 9 (4.6%) 15 (4.2%) 8 (3.1%)
GRAFT FAILURE 39 (15.1%) 35 (11.7%) 59 (24.7%) 58 (29.4%) 90 (25.1%) 57 (22.2%)
TECHNICAL 15 (5.8%) 1 (0.3%) 3 (1.3%) 1 (0.5%) 5 (1.4%) 6 (2.3%)
OTHER 19 (7.3%) 25 (8.4%) 27 (11.3%) 16 (8.1%) 33 (9.2%) 18 (7.0%)
MULTIPLE ORGAN
FAILURE
33 (12.7%) 49 (16.4%) 11 (4.6%) 7 (3.6%) 12 (3.4%) 16 (6.2%)
RENAL FAILURE 7 (2.3%) 1 (0.4%) 1 (0.5%) 2 (0.6%) 6 (2.3%)
PULMONARY 13 (5.0%) 32 (10.7%) 13 (5.4%) 9 (4.6%) 9 (2.5%) 5 (1.9%)
CEREBROVASCULAR 26 (10.0%) 13 (4.3%) 5 (2.1%) 3 (1.5%) 7 (2.0%) 4 (1.6%)
ISHLT 2011
ISHLT

Relative Incidence of Leading Causes of Death
(Deaths: January 1998 - June 2010)
0
10
20
30
40
0-30 Days (N
= 259)
31 Days – 1
Year (N =
299)
>1 Year – 3
Years (N =
239)
>3 Years – 5
Years (N =
197)
>5 Years – 10
Years (N =
358 )
>10 Years (N
= 257)
CAV Acute Rejection Infection (non-CMV) Primary Failure Graft Failure
Percentage
of
Deaths
ISHLT 2011
ISHLT

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