2004 ishlt j heart lung transplant 2004; 23: 933-947 heart transplantation pediatric recipients
TRANSCRIPT
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
HEART TRANSPLANTATION
Pediatric Recipients
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS (Transplants: January 1996 - June 2003)
0
100
200
300
400
500
600
700
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Recipient Age (Years)
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2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS (Transplants: January 1996 - June 2003)
0
100
200
300
400
500
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)
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2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS
By Year of Transplant
0
100
200
300
40011-17 Years1-10 Years
<1 Year
11 941
75110
130
194
254
325369367
388370383
359386
368359365
347359
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2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS
0
20
40
60
80
100
120
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
Nu
mb
er o
f P
edia
tric
Cen
ters
Rep
ort
ing
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year)
0
25
50
75
100
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
% o
f Cas
es
MyopathyCongenital
30%
66%
3%
1%
15%
81%2%
2%
Myopathy
Congenital
Other
ReTX
1988-1995 1/1996-6/2003
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 1-10 Years)
0
25
50
75
100
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
% o
f Cas
es
Myopathy Congenital
52%
37%
4%7%51%
40%
5%
4%Myopathy
Congenital
Other
ReTX
1988-1995 1/1996-6/2003
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 11-17 Years)
0
25
50
75
100
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
% o
f Cas
es
Myopathy Congenital
62%
28%
4%
6%
67%
24%
6%
3%
Myopathy
Congenital
Other
ReTX
1988-1995 1/1996-6/2003l
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival (1/1982-6/2002)
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Years
Su
rviv
al (
%)
<1 Year (N=1,286) 1-10 Years (N=1,962)11-17 Years (N=2,048) Overall (N=5,296)
<1 year vs. 1-10 years: p = 0.0015<1 year vs. 11-17 years: p = 0.02
HALF-LIFE <1: 13.3 years; 1-10: 12.9 years; 11-17: 11.3 years
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTATIONConditional Kaplan-Meier Survival (1/1982-6/2002)
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Years
Su
rviv
al (
%)
<1 Year (N=849) 1-10 Years (N=1,437)11-17 Years (N=1,506) Overall (N=3,792)
Both comparisons with 11-17 years significant at p < 0.0001
HALF-LIFE <1: not computable; 1-10: 17.5 years; 11-17: 13.7 years
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTATIONConditional Kaplan-Meier Survival for Recent Era (1/1998-6/2002)
50
60
70
80
90
100
0 1 2 3 4
Years
Su
rviv
al (
%)
<1 Year (N=264) 1-10 Years (N=469)11-17 Years (N=445) Overall (N=1,178)
No comparisons were statistically significant
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTATION
Kaplan-Meier Survival by Era (1/1982-6/2002)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Years
1982-1988 (N=570) 1989-1993 (N=1,703)
1994-1998 (N=1,866) 1/1999-6/2002 (N = 1,247)
All comparisons with 1999-2002 are significant at p < 0.0001Comparison of 1982-1988 vs. 1994-1998 is significant at p < 0.0001Comparison of 1989-1993 vs. 1994-1998 is significant at p < 0.0001
HALF-LIFE 1982-1988: 9.7 years; 1989-1993: 11.3 yearsSu
rviv
al (
%)
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2002)
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
Years
1982-1988 (N=52) 1989-1993 (N=516)
1994-1998 (N=462) 1/1999-6/2002 (N = 281)
P-values for era comparisons1982-88 vs. 1999-2002: p = 0.01; 1989-93 vs. 1994-1998: p = 0.00031989-93 vs. 1999-2002: p < 0.0001; 1994-98 vs. 1999-2002: p = 0.0002
HALF-LIFE 1982-1988: 12.0 years; 1989-1993: 11.4 yearsSu
rviv
al (
%)
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2002)
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
Years
1982-1988 (N=182) 1989-1993 (N=598)
1994-1998 (N=740) 1/1999-6/2002 (N = 475)
P-values for era comparisons1982-88 vs. 1994-98: p < 0.0001; 1982-88 vs. 1999-2002: p < 0.0001; 1989-93 vs. 1994-1998: p = 0.0008; 1989-93 vs. 1999-2002: p < 0.0001
HALF-LIFE 1982-1988: 12.0 years; 1989-1993: 12.0 yearsSu
rviv
al (
%)
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2002)
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
Years
1982-1988 (N=336) 1989-1993 (N=589)
1994-1998 (N=664) 1/1999-6/2002 (N = 491)
P-values for era comparisons1982-88 vs. 1994-98: p = 0.002; 1982-88 vs. 1999-2002: p < 0.0001;
HALF-LIFE 1982-1988: 8.3 years; 1989-1993: 11.0 yearsSu
rviv
al (
%)
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2002)
Risk Factors For 1 Year Mortality
N=2,290
VARIABLE
Odds Ratio
P-value 95%
Confidence Interval
Congenital heart disease 2.88 <.0001 2.08 -4.00
Other diagnosis (excluding cardiomyopathy)
2.35 0.0074 1.26 -4.39
Retransplant 2.26 0.0209 1.13 -4.53
On ventilator 1.81 0.0005 1.30 -2.52
Hospitalized (including ICU) 1.60 0.003 1.17 -2.18
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Donor Age PCW
PA systolic
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
Donor Age
0
0.5
1
1.5
2
0 10 20 30 40
Donor Age (Years)
Od
ds
of
1 Y
ear
Mo
rtal
ity
p = 0.033
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
Recipient Pulmonary Capillary Wedge Pressure (PCW)
0
0.5
1
1.5
2
5 10 15 20 25 30 35
Recipient PCW (mm Hg)
Od
ds
of
1 Y
ear
Mo
rtal
ity
p = 0.049
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
Recipient PA systolic
0
0.5
1
1.5
2
10 20 30 40 50 60 70
Recipient PA Systolic (mm Hg)
Od
ds
of
1 Y
ear
Mo
rtal
ity
p = 0.02
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2002) Factors Not Significant for 1 Year Mortality
Recipient Factors:IV inotropes, PGE, ECMO, sternotomy, history of malignancy, weight, height, dialysis, recent infection, gender, age
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2002) Factors Not Significant for 1 Year Mortality
Donor Factors:Gender, clinical infection, history of diabetes, height, COD
Transplant Factors:Donor/recipient weight ratio, CMV mismatch, ABO identical/compatible, year of transplant, ischemia time, HLA mismatch, transplant center volume
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998)
Risk Factors For 5 Year Mortality
N=1,234
VARIABLE
Odds Ratio
P-value 95%
Confidence Interval
Dialysis 4.44 0.03 1.19 -16.55
Other diagnosis (excluding cardiomyopathy and retransplant)
2.4 0.03 1.07 -5.39
Congenital diagnosis 1.49 0.03 1.05 -2.11
Female donor 1.44 0.01 1.08 -1.91
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality
Continuous Factors (see figures) Recipient age
Recipient BMI Donor BMI
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality
Recipient Age
0
1
2
3
0 3 6 9 12 15 18
Recipient Age (Years)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p = 0.03
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Factors Not Significant for 5 Year Mortality
Recipient Factors:IV inotropes, PGE, ECMO, history of malignancy, recent infection, gender, hospitalized at time of transplant, bilirubin
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998) Factors Not Significant for 5 Year Mortality
Donor Factors:Gender, clinical infection, history of diabetes, age, COD
Transplant Factors:Donor/recipient weight ratio, CMV mismatch, ABO identical/compatible, year of transplant, repeat transplant, ischemia time, HLA mismatch, transplant center volume
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1998)
Risk Factors For 5 Year Mortality Conditional on 1 Year Survival
N=968
VARIABLE
Odds Ratio
P-value 95%
Confidence Interval
ECMO 3.38 0.04 1.05 -10.86
Prior sternotomy 2.21 0.006 1.25 -3.92
Congenital heart disease (>0 years) 0.5 0.03 0.27 -0.92
0 year old/congenital/no PGE 0.23 0.04 0.06 -0.95
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART RECIPIENTS Functional Status (Follow-ups: April 1994-June 2003)
0%
20%
40%
60%
80%
100%
1 Year (N =1,724)
3 Years (N =1,429)
5 Years (N =1,147)
7 Years (N =792)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant (Follow-ups: April 1994 - June 2003)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N =1,973)
Between 2 and 3Years (N = 1,539)
Between 4 and 5Years (N = 1,204)
Between 6 and 7Years (N = 856)
No Hospitalization Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection Hospitalized, Infection Only
Hospitalized, Rejection + Infection
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
0
10
20
30
40
50
Any Induction (N = 312) Polyclonal ALG/ATG (N= 198)
OKT3 (N = 27) IL2R-antagonist (N =104)
% o
f p
ati
en
ts
PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Follow-ups: January 2001 - June 2003)
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
0
10
20
30
40
50
60
Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist
% o
f p
ati
en
ts
2001 2002 1/2003-6/2003
PEDIATRIC HEART RECIPIENTSInduction Immunosuppression (Follow-ups: January 2001 - June 2003)
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
ati
en
ts
Year 1 (N = 579) Year 5 (N = 384)
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2000 through June 2003
NOTE: Different patients are analyzed in Year 1 and Year 5
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
0%
20%
40%
60%
80%
100%
Year 1 (N = 594) Year 5 (N = 402)
% o
f P
ati
en
ts
Other
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine + MMF
Cyclosporine + AZA
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
For follow-ups between January 2001 through June 2003
NOTE: Different patients are analyzed in Year 1 and Year 5
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994 - June 2003)
Outcome Within 1
Year Total number with known response
Hypertension 45.6% (N = 1,932)
Renal Dysfunction 5.4% (N = 1,929)
Abnormal Creatinine < 2.5 mg/dl 3.5% Creatinine > 2.5 mg/dl 1.3% Chronic Dialysis 0.6% Renal Transplant 0.1%
Hyperlipidemia 9.9% (N = 2,021)
Diabetes 3.2% (N = 1,935)
CAV 2.5% (N = 1,754)
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 5 Years Post-Transplant
(Follow-ups: April 1994 - June 2003)
Outcome Within 5
Years Total number with known response
Hypertension 60.4% (N = 553)
Renal Dysfunction 8.4% (N = 571)
Abnormal Creatinine < 2.5 mg/dl 7.0% Creatinine > 2.5 mg/dl 0.7% Chronic Dialysis 0.5% Renal Transplant 0.2%
Hyperlipidemia 20.2% (N = 593)
Diabetes 4.5% (N = 552)
CAV 11.4% (N = 369)
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 7 Years Post-Transplant
(Follow-ups: April 1994 - June 2003)
Outcome Within 7
Years Total number with known response
Hypertension 64.7% (N = 249)
Renal Dysfunction 10.0% (N = 260)
Abnormal Creatinine < 2.5 mg/dl 5.4% Creatinine > 2.5 mg/dl 3.1% Chronic Dialysis 0.4% Renal Transplant 1.2%
Hyperlipidemia 23.3% (N = 266)
Diabetes 4.4% (N = 250)
CAV 14.3% (N = 147)
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
FREEDOM FROM CAV For Pediatric Heart Recipients (Follow-ups: April 1994-June 2003)
0
20
40
60
80
100
0 1 2 3 4 5 6 7
Years
% F
reed
om
fro
m C
AV
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
FREEDOM FROM CAV For Pediatric Heart Recipients (Follow-ups: April 1994-June 2003)
Stratified by Age Group
0
20
40
60
80
100
0 1 2 3 4 5 6 7
Years
% F
ree
do
m f
rom
CA
V
<1 Year (N = 487)1-10 Years (N = 724)11-17 Years (N = 671)
p = 0.005
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
SURVIVAL FOLLOWING REPORT OF CAV For Pediatric Heart Recipients (Follow-ups: April 1994-June 2003)
Stratified by Age Group
0
20
40
60
80
100
0 0.5 1 1.5 2 2.5
Time since Report of CAV (Years)
Su
rviv
al s
ince
Rep
ort
of
CA
V (
%)
<1 Year (N = 33)
1-10 Years (N = 54)
11-17 Years (N = 70)
p = 0.4
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Pediatric Heart Recipients (Follow-ups: April 1994-June
2003)
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
% F
reed
om fr
om S
ever
e R
enal
Dys
func
tion
* Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICSCumulative Prevalence in Survivors (Follow-ups: April 1994-June 2003)
Malignancy/Type 1-Year Survivors
5-Year Survivors
7-Year Survivors
No Malignancy 1974 (98.2%) 568 (95.6%) 251 (94%)
Malignancy (all types combined)
37 (1.8%) 26 (4.4%) 16 (6%)
Malignancy Type
Lymph 33 23 16
Other 3 3
Type Not Reported
1
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
FREEDOM FROM MALIGNANCYFor Pediatric Heart Recipients (Follow-ups: April 1994-June
2003)
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Months
% F
reed
om fr
om M
alig
nanc
y
All malignancy Lymph Skin Other
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Prednisone Use
(Transplants: April 1994 - June 2002)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
Su
rviv
al (
%)
Prednisone use at discharge and 1 year (N=1032)
No Prednisone at discharge or at 1 year (N=195)
Prednisone at discharge/not at 1 year (N = 191)
p = 0.02
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Rejection within 1st Year
(Transplants: April 1994 - June 2001)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
Su
rviv
al (
%)
Free from Rejection during 1st Year (N = 712)Rejection within 1st Year (N = 862)
P = 0.016
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 1 and 3 Years
(Transplants: April 1993 - June 2000)
Maintenance Immunosuppression at discharge and 1 year
% HTN reported between 1 and 3 years
P-valueFor Patients on drug
For Patients not on drug
Azathioprine 22.0% 19.3% 0.5
Cyclosporine 19.7% 19.5% 0.9
MMF 18.3% 21.2% 0.6
Prednisone 28.8% 6.5% <.0001
Rapamycin . 19.9%
Tacrolimus 22.1% 19.2% 0.6
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART RECIPIENTSRelationship of Rejection and CAV
(Follow-ups: April 1994 – June 2003)
Rejection During 1st
Year
Reported CAV between 1st and 2nd years post-
transplant
Reported CAV between 1st and 3rd years post-
transplant
Yes No Yes No
Yes 27
5.0%
515
95.0%
33
8.2%
367
91.8%
No 8
1.6%
502
98.4%
11
3.0%
351
97.0%p = 0.002 p = 0.002
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART RECIPIENTS Growth Following Transplantation: Height
Stratified by Prednisone Use at Discharge and at 1 Year
-1.25
-1
-0.75
-0.5
-0.25
0
Immediately Pre-Transplant
1 Year Follow-up 2 Year Follow-up 3 Year Follow-up
Time of Measurement
Z-S
core
1-5 Years/No Prednisone 1-5 Years/Prednisone
11-17/No Prednisone 11-17/Prednisone
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART RECIPIENTS Growth Following Transplantation: Weight
Stratified by Prednisone Use at Discharge and at 1 Year
-1.5
-1.25
-1
-0.75
-0.5
-0.25
0
0.25
0.5
Immediately Pre-Transplant
1 Year Follow-up 2 Year Follow-up 3 Year Follow-up
Time of Measurement
Z-S
core
1-5 Years/No Prednisone 1-5 Years/Prednisone
11-17/No Prednisone 11-17/Prednisone
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT
RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2002)
0
10
20
30
40
50
60
70
80
90
Overall <1 1-10 11-17 F M
% t
reat
ed f
or
reje
ctio
n w
ith
in 1
yea
r No induction PolyclonalIL2R-antagonist OKT3
1-10: No induction vs. polyclonal (p = 0.015); 11-17: No induction vs. OKT3 (p = 0.006); polyclonal vs. OKT3 (p = 0.02); IL2R vs. OKT3 (p = 0.03)Female: No induction vs. OKT3 (p = 0.003); polyclonal vs. OKT3 (p = 0.014); IL2R vs. OTK3 (p = 0.03)
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2002)
0
0.5
1
1.5
2
2.5
Overall <1 1-10 11-17 F M
Ave
rag
e n
um
ber
of
reje
ctio
n e
pis
od
es No induction Polyclonal IL2R-antagonist OKT3
No within-age group or within-gender comparisons were statistically significant.
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT
RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2002)
0
10
20
30
40
50
60
70
Overall <1 1-10 11-17 F M
% t
reat
ed f
or
reje
ctio
n w
ith
in 1
yea
r
Cyclosporin + MMF Cyclosporin + AZATacrolimus + MMF Tacrolimus + AZA
1-10: Cya + MMF vs. TAC + AZA (p = 0.007); CyA + AZA vs. TAC + AZA (p = 0.003)11-17: CyA + AZA vs. TAC + MMF (p = 0.01)Female: CyA + MMF vs. TAC + AZA (p = 0.008); CyA + AZA vs. TAC + MMF (p = 0.01); CyA + AZA vs. TAC + AZA (p = 0.0006)
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2002)
0
0.5
1
1.5
2
2.5
3
Overall <1 1-10 11-17 F M
Av
era
ge
nu
mb
er
of
reje
cti
on
ep
iso
de
s
Cyclosporin + MMF Cyclosporin + AZATacrolimus + MMF Tacrolimus + AZA
No within-age group or within-gender comparisons were statistically significant.
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2002)
Conditional on Survival to 14 Days
50
60
70
80
90
100
0 1 2 3
Years
Su
rviv
al (
%)
No induction (N= 465)
Polyclonal induction (N= 201)
IL2R-antagonist (N= 66)
OKT3 (N = 31)
No comparisons were statistically significant.
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2002)
Conditional on Survival to 14 DaysAge: < 1 Year
50
60
70
80
90
100
0 1 2 3
Years
Su
rviv
al (
%)
No induction (N=90)
Polyclonal induction (N= 72)
p = 0.7
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2002)
Conditional on Survival to 14 DaysAge: 1-10 Years
50
60
70
80
90
100
0 1 2 3
Years
Su
rviv
al (
%)
No induction (N=183)Polyclonal induction (N= 65)IL2R-antagonist (N = 25)
None of the comparisons were statistically significant.
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2002)
Conditional on Survival to 14 DaysAge: 11-17 Years
50
60
70
80
90
100
0 1 2 3
Years
Su
rviv
al (
%)
No induction (N=170)Polyclonal induction (N= 55)IL2R-antagonist (N = 29)OKT3 (N = 19)
None of the comparisons were statistically significant.
2004ISHLTJ Heart Lung Transplant 2004; 23: 933-947
PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2003)
CAUSE OF DEATH 0-30 Days (N = 310)
31 Days - 1 Year (N = 258)
>1 Year - 3 Years (N = 166)
>3 Years - 5 Years (N = 106)
>5 Years (N = 199)
CAV 3 (1.0%) 25 (9.7%) 35 (21.1%) 42 (39.6%) 64 (32.2%)
ACUTE REJECTION 26 (8.4%) 72 (27.9%) 45 (27.1%) 16 (15.1%) 24 (12.1%)
LYMPHOMA 5 (1.9%) 8 (4.8%) 2 (1.9%) 17 (8.5%)
MALIGNANCY, OTHER 4 (1.6%) 1 (0.6%) 1 (0.9%) 8 (4.0%)
CMV 1 (0.3%) 7 (2.7%) 1 (0.6%)
INFECTION, NON-CMV 40 (12.9%) 43 (16.7%) 12 (7.2%) 5 (4.7%) 12 (6.0%)
PRIMARY FAILURE 55 (17.7%) 12 (4.7%) 5 (3.0%) 7 (6.6%) 11 (5.5%)
GRAFT FAILURE 78 (25.2%) 31 (12.0%) 31 (18.7%) 21 (19.8%) 40 (20.1%)
TECHNICAL 21 (6.8%) 3 (1.2%) 2 (1.2%) 1 (0.9%) 1 (0.5%)
OTHER 8 (2.6%) 8 (3.1%) 9 (5.4%) 4 (3.8%) 10 (5.0%)
MULTIPLE ORGAN FAILURE
34 (11.0%) 26 (10.1%) 3 (1.8%) 1 (0.9%) 3 (1.5%)
RENAL FAILURE 1 (0.3%) 1 (0.4%)
PULMONARY 24 (7.7%) 14 (5.4%) 8 (4.8%) 5 (4.7%) 7 (3.5%)
CEREBROVASCULAR 19 (6.1%) 7 (2.7%) 6 (3.6%) 1 (0.9%) 2 (1.0%)