heart transplantation pediatric recipients 2014 jhlt. 2014 oct; 33(10): 985-995
TRANSCRIPT
HEART TRANSPLANTATION
Pediatric Recipients
2014JHLT. 2014 Oct; 33(10): 985-995
Table of Contents
Donor, recipient and center characteristics: slides 3-25
Post transplant – survival and other outcomes: slides 26-
46
Induction and maintenance immunosuppression: slides
47-61
Rejection and post transplant morbidities: slides 62-98
Multivariable analyses: slides 99-163 and 177-181
Retransplantation: slides 164-181
2014JHLT. 2014 Oct; 33(10): 985-995
Donor, Recipient and Center Characteristics
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsNumber of Centers Reporting Transplants
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
0
10
20
30
40
50
60
70
80
90
100
110
120Other
North America
Europe
Transplant Year
Nu
mb
er
of
Ce
nte
rs
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsNumber of Centers by Center Volume
(Transplants: January 2000 – June 2013)
1-4 5-9 10+0
20
40
60
80
100
120
140
160
150
17 14
137
23 21
2000-2005 2006-June 2013
Average number of heart transplants per year
Nu
mb
er
of
Ce
nte
rs
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsDistribution of Transplants by Center Volume
(Transplants: January 2000 – June 2013)
1-4 5-9 10+0
10
20
30
40
50
60
34.625.4
40
25.4 23.9
50.7
2000-2005 2006-June 2013
Average number of heart transplants per year
% o
f T
ran
sp
lan
ts
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsRecipient Age Distribution by Center Volume
(Transplants: January 2000 – June 2013)
1-4 5-9 10+0%
20%
40%
60%
80%
100%<1 1-5 6-10 11-17
Average number of heart transplants per year
% o
f T
ran
sp
lan
ts
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants Distribution of Transplants by Location and Average Center
Volume (Transplants: January 2000 – June 2013)
Europe North America Other0%
20%
40%
60%
80%
100%
1-4/year 5-9/year 10+/year
% o
f T
ran
sp
lan
ts
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsRecipient Age Distribution (Transplants: January 2000 – June 2013)
<1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170
200
400
600
800
1,000
1,200
1,400
1,600
1,800
Recipient Age (Years)
Nu
mb
er
of
Tra
ns
pla
nts
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsRecipient Age Distribution by Year of Transplant
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
0
50
100
150
200
250
300
350
400
450
500
550
600
650
11-17 Years
6-10 Years
1-5 Years
<1 Year
Nu
mb
er
of
Tra
ns
pla
nts
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.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsRecipient Age Distribution by Location
(Transplants: January 2000 – June 2013)
Europe North America Other0%
20%
40%
60%
80%
100%
<1 years 1-5 years 6-10 years 11-17 years
% o
f T
ran
sp
lan
ts
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsDonor Age Distribution (Transplants: January 2000 – June 2013)
<1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18-25
26-30
31+0
200
400
600
800
1,000
1,200
Donor Age (Years)
Nu
mb
er
of
Tra
ns
pla
nts
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsDonor and Recipient Age
(Transplants: January 2000 – June 2013)
<1 1-10 11-17 18-34 35-49 50-650%
20%
40%
60%
80%
100%
<1 1-5 6-10 11-17
Donor Age
% o
f T
ran
sp
lan
ts
Recipient Age:
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsDonor Age Distribution by Location
(Transplants: January 2000 – June 2013)
Europe North America Other0%
20%
40%
60%
80%
100%
<1 1-10 11-17 18-34 35-49 50-65
% o
f T
ran
sp
lan
ts
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsDistribution of Transplants by Donor/Recipient Weight Ratio
(Transplants: January 2000 – June 2013)
<0.75 0.75-<1.0 1.0-<1.5 1.5-<2.0 2.0-<2.5 2.5+0
5
10
15
20
25
30
35
40
45
50
2000-2005 2006-June 2013
Donor/Recipient Weight Ratio
% o
f T
ran
sp
lan
ts
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsRecipient Diagnosis (Age: < 1 Year)
41%
55%
3%
0.3%Myopathy
Congenital
Other
ReTX2006-6/2013
21%
76%
2%1%
1988-1999
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
25
50
75
100Myopathy Congenital
% o
f C
as
es
35%
62%
2%1%
2000-2005
2014 For some retransplants diagnosis other than retransplant is reported, so the total percentage of retransplants may be greater.JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsRecipient Diagnosis (Age: 1-5 Years)
54%
40%
2%
3%Myopathy
Congenital
Other
ReTX2006-6/2013
53%
42%
2%
3%
1988-1999
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
25
50
75
100Myopathy Congenital
% o
f C
as
es
56%
40%
1%
3%
2000-2005
2014 For some retransplants diagnosis other than retransplant is reported, so the total percentage of retransplants may be greater.JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsRecipient Diagnosis (Age: 6-10 Years)
59%
32%2%
7%
Myopathy
Congenital
Other
ReTX2006-6/2013
56%
35%2%
8%
1988-1999
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
25
50
75
100Myopathy Congenital
% o
f C
as
es
54%
34%3%
8%
2000-2005
2014 For some retransplants diagnosis other than retransplant is reported, so the total percentage of retransplants may be greater.JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsRecipient Diagnosis (Age: 11-17 Years)
66%
23%2%
9%
Myopathy
Congenital
Other
ReTX2006-6/2013
67%
28%
2%
3%
1988-1999
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
25
50
75
100Myopathy Congenital
% o
f C
as
es
66%
24%2%
8%
2000-2005
2014 For some retransplants diagnosis other than retransplant is reported, so the total percentage of retransplants may be greater.JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsDiagnosis Distribution by Location (Transplants: January 2000 – June 2013)
0%
20%
40%
60%
80%
100%
Europe North America Other
Other
Re-TX/Graft Failure
Malignancy
Coronary Artery Disease
Congenital
Cardiomyopathy
% o
f T
ran
sp
lan
ts
2014 For some retransplants diagnosis other than retransplant is reported, so the total percentage of retransplants may be greater.JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants% of Patients Bridged with Mechanical Circulatory Support*
by Year (Transplants: January 2005 – December 2012)
2005 2006 2007 2008 2009 2010 2011 20120
5
10
15
20
25
30
35
22.121.1
22.7 22.0
29.1
25.2 25.7
28.8
Any
ECMO
VAD + ECMO
% o
f P
ati
en
ts
* LVAD, RVAD, TAH, ECMO2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants% of Patients Bridged with Mechanical Circulatory Support*
(Transplants: July 2004 – June 2013)
Any Device (N=826)
LVAD (N=384)
ECMO (N=204)
BIVAD (N=174)
VAD+ECMO (N=42)
RVAD (N=11)
TAH (N=6) Unknown Type
(VAD or TAH) (N=4)
ECMO + TAH (N=1)
0
5
10
15
20
25
30
35
25.3
11.8
6.2 5.3
1.3 0.3 0.2 0.1 0.0
% o
f P
ati
en
ts
* LVAD, RVAD, TAH, ECMO2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants% of Patients Bridged with Mechanical Circulatory Support*
by Age Group (Transplants: July 2004 – June 2013)
<1 1-5 6-10 11-170
5
10
15
20
25
30
35
21.7 27.1
26.9 26.3
Any ECMO VAD + ECMO
Age Group
% o
f P
ati
en
ts
* LVAD, RVAD, TAH, ECMO2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants PRA Distribution by Year
(Transplants: January 2005 – December 2012)
2005 2006 2007 2008 2009 2010 2011 20120%
20%
40%
60%
80%
100%
0-9% 10-39% 40-79% 80%+
% o
f P
ati
en
ts
If Class I and Class II values were reported separately, the higher of the two values was used.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants PRA Distribution by Age Group (Transplants: July 2004 – June 2013)
<1 1-5 6-10 11-170%
20%
40%
60%
80%
100%
0-9% 10-39% 40-79% 80%+
Age Group
% o
f P
ati
en
ts
p<0.0001
If Class I and Class II values were reported separately, the higher of the two values was used.
2014JHLT. 2014 Oct; 33(10): 985-995
Post Transplant:Survival and Other Outcomes
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival (Transplants: January 1982 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 220
20
40
60
80
100<1 Year (N = 2,702)1-5 Years (N = 2,419)6-10 Years (N = 1,552)11-17 Years (N = 4,219)Overall (N = 10,892)
Years
Su
rviv
al (
%)
Median survival (years): <1=20.6; 1-5=17.3; 6-10=14.6; 11-17=12.9
1-5 vs. 11-17: p = 0.01336-10 vs. 11-17: p = 0.0298No other pair-wise comparisons were significant at p < 0.05.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival Conditional on Survival to 1 Year
(Transplants: January 1982 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 220
20
40
60
80
100
<1 Year (N = 1,932) 1-5 Years (N = 1,876)
6-10 Years (N = 1,270) 11-17 Years (N = 3,401)
Overall (N = 8,479)
Years
Su
rviv
al (
%)
Median survival (years): <1 = NA; 1-5 = 21.5; 6-10 = 16.7; 11-17 = 16.1
All pair-wise comparisons were significant at p < 0.05 except <1 vs. 1-5.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival Conditional on Survival to 5 Years
(Transplants: January 1982 – June 2008)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 220
20
40
60
80
100
<1 Year (N = 1,151) 1-5 Years (N = 1,167)
6-10 Years (N = 790) 11-17 Years (N = 1,989)
Overall (N = 5,097)
Years
Su
rviv
al (
%)
All pair-wise comparisons were significant at p < 0.05 except 6-10 vs. 11-17.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival Conditional on Survival to 10 Years
(Transplants: January 1982 – June 2003)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 220
20
40
60
80
100
<1 Year (N = 648) 1-5 Years (N = 587)
6-10 Years (N = 375) 11-17 Years (N = 927)
Overall (N = 2,537)
Years
Su
rviv
al (
%) All pair-wise comparisons with <1 were
significant at p<0.0001. 1-5 vs. 6-10 was significant at p<0.05 (p=0.0199). No other pair-wise comparisons were significant at p<0.05.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival by Era
(Transplants: January 1982 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 220
20
40
60
80
100
1982-1989 (N=926) 1990-1999 (N=3,933)
2000-2004 (N=2,130) 2005-6/2012 (N=3,903)
Years
Su
rviv
al (
%)
Median survival (years): 1982-1989=9.9; 1990-1999=14.1; 2000-2004=NA; 2005-6/2012=NA
All p-values significant at p < 0.0001 except 2000-2004 vs. 2005-6/2012 (p = 0.0587).
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsConditional Kaplan-Meier Survival for Recent Era
(Transplants: January 2000 – June 2012)
0 1 2 3 4 5 6 7 8 9 1050
60
70
80
90
100
<1 Year (N = 1,095) 1-5 Years (N = 1,113)
6-10 Years (N = 742) 11-17 Years (N = 1,932)
Overall (N = 4,882)
Years
Su
rviv
al (
%)
All pair-wise comparisons with 11-17 were significant at p<0.05. No other pair-wise comparisons were significant at p<0.05.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival by Era
Age: < 1 Year (Transplants: January 1982 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 190
20
40
60
80
100
1982-1989 (N=188) 1990-1999 (N=1,088)
2000-2004 (N=471) 2005-6/2012 (N=955)
Years
Su
rviv
al (
%)
All pair-wise comparisons were significant at p<0.05 except 1982-1989 vs. 1990-1999 and 2000-2004 vs. 2005-6/2012.
Median survival (years): 1982-1989=10.8; 1990-1999=19.3; 2000-2004=NA; 2005-6/2012=NA
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival by Era
Age: 1-5 Years (Transplants: January 1982 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 190
20
40
60
80
100
1982-1989 (N=163) 1990-1999 (N=896)
2000-2004 (N=475) 2005-6/2012 (N=885)
Years
Su
rviv
al (
%)
All p-values significant at p<0.05 except 2000-2004 vs. 2005-6/2012 (p=0.5431).
Median survival (years): 1982-1989=9.1; 1990-1999=15.4; 2000-2004=NA; 2005-6/2012=NA
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival by Era
Age: 6-10 Years (Transplants: January 1982 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 190
20
40
60
80
100
1982-1989 (N=125) 1990-1999 (N=545)
2000-2004 (N=315) 2005-6/2012 (N=567)
Years
Su
rviv
al (
%)
All p-values significant at < 0.05 except 1982-1989 vs. 1990-1999 and 2000-2004 vs. 2005-6/2012.
Median survival (years): 1982-1989 = 9.4; 1990-1999 = 12.9; 2000-2004 = NA; 2005-6/2012 = NA
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival by Era
Age: 11-17 Years (Transplants: January 1982 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 210
20
40
60
80
100
1982-1989 (N=450) 1990-1999 (N=1,404)
2000-2004 (N=869) 2005-6/2012 (N=1,496)
Years
Su
rviv
al (
%)
1982-1989 vs. 2000-2004: p=0.03641982-1989 vs. 2005-6/2012: p<0.00011990-1999 vs. 2005-6/2012: p=0.0003No other pair-wise comparisons were significant at p<0.05.
Median survival (years): 1982-1989=9.9; 1990-1999=12.1; 2000-2004=11.8; 2005-6/2012=NA
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival by Recipient Gender
(Transplants: January 2000 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 11 1250
60
70
80
90
100
Male (N = 3,255) Female (N = 2,778)
Years
Su
rviv
al (
%)
p = 0.1667
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival by Donor/Recipient Gender
(Transplants: January 2000 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 11 1250
60
70
80
90
100
Male/Male (N = 1,901) Male/Female (N = 1,510)
Female/Male (N = 1,352) Female/Female (N = 1,266)
Years
Su
rviv
al (
%)
No pair-wise comparisons were significant at p<0.05.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival by Diagnosis
Age: < 1 Year (Transplants: January 2000 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 11 120
20
40
60
80
100
Congenital (N=811) Cardiomyopathy (N=551)
Years
Su
rviv
al (
%)
p<0.0001
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival by Diagnosis
Age: 1-5 Years (Transplants: January 2000 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 11 120
20
40
60
80
100
Congenital (N=528) Cardiomyopathy (N=763) Retransplant (N=37)
Years
Su
rviv
al (
%)
Congenital vs. Cardiomyopathy: p < 0.0001Congenital vs. Retransplant: p = 0.5814Cardiomyopathy vs. Retransplant: p = 0.0057
2014 For some retransplants diagnosis other than retransplant is reported, so the total number of retransplants may be greater.JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival by Diagnosis
Age: 6-10 Years (Transplants: January 2000 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 110
20
40
60
80
100
Congenital (N=282) Cardiomyopathy (N=497) Retransplant (N=65)
Years
Su
rviv
al (
%)
Congenital vs. Cardiomyopathy: p = 0.0772Congenital vs. Retransplant: p = 0.6779Cardiomyopathy vs. Retransplant: p = 0.0369
2014 For some retransplants diagnosis other than retransplant is reported, so the total number of retransplants may be greater.JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival by Diagnosis
Age: 11-17 Years (Transplants: January 2000 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 11 120
20
40
60
80
100
Congenital (N=543) Cardiomyopathy (N=1,501) Retransplant (N=196)
Years
Su
rviv
al (
%)
Congenital vs. Cardiomyopathy: p = 0.0017 Congenital vs. Retransplant: p = 0.1382Cardiomyopathy vs. Retransplant: p<0.0001
2014 For some retransplants diagnosis other than retransplant is reported, so the total number of retransplants may be greater.JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Patient vs. Graft Survival
(Transplants: January 2000 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 11 120
20
40
60
80
100
Patient (N=6,033) Graft (N=6,033)
Years
Su
rviv
al (
%)
p<0.0001
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival by Mechanical Circulatory Support
Usage* (Transplants: January 2005 – June 2012)
0 1 2 3 4 5 60
20
40
60
80
100
ECMO, no VAD or TAH (N=190) VAD or TAH, no ECMO (N=566)
No ECMO/VAD/TAH (N=2,311)
Years
Su
rviv
al (
%)
All pair-wise comparisons were significant at p < 0.0001 except No ECMO/VAD/TAH vs. VAD or TAH, no ECMO.
* LVAD, RVAD, TAH, ECMO2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsFunctional Status of Surviving Recipients
(Follow-ups: March 2005 – June 2013)
0%
20%
40%
60%
80%
100%
1 Year (N = 2,342)
2 Years (N = 2,134)
3 Years (N = 1,971)
10% 20%
30% 40%
50% 60%
70% 80%
90% 100%
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsRehospitalization Post-transplant of Surviving Recipients
(Follow-ups: January 2000 – June 2013)
0%
20%
40%
60%
80%
100%
1 Year (N = 4,097)
3 Years (N = 3,323)
5 Years (N = 2,657)
No Hospitalization Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection Hospitalized, Infection Only
Hospitalized, Rejection + Infection
2014JHLT. 2014 Oct; 33(10): 985-995
Induction and Maintenance Immunosuppression
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsInduction Immunosuppression
(Transplants: January 2001 – June 2013)
Any Induction(N = 2,558)
Polyclonal ALG/ATG
(N = 1,729)
IL-2R Antagonist(N = 869)
OKT3 (N = 58)0
10
20
30
40
50
60
% o
f P
ati
en
ts
Analysis is limited to patients who were alive at the time of the discharge.2014
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsInduction Immunosuppression by Era
(Transplants: January 2000 – June 2013)
Any Induction Polyclonal ALG/ATG IL-2R Antagonist0
10
20
30
40
50
60
70
80
2000-2005 2006-6/2013
% o
f P
ati
en
ts
All pair-wise comparisons between eras were significant at p < 0.0001.
Analysis is limited to patients who were alive at the time of the discharge.2014
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsInduction Immunosuppression by Year
(Transplants: January 2001 – June 2013)
Analysis is limited to patients who were alive at the time of the discharge.
20012003
20052007
20092011
1/13-6/13
20012003
20052007
20092011
1/13-6/13
20012003
20052007
20092011
1/13-6/13
0
10
20
30
40
50
60
70
80
% o
f P
ati
en
ts
Any Induction Polyclonal ALG/ATG IL-2R AntagonistTest of increasing trend over time:Any induction p < 0.0001Polyclonal p < 0.0001IL-2R p < 0.00012014
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival by Induction Group Conditional on
Survival to 14 Days (Transplants: January 2000 – June 2012)
0 1 2 3 4 5 6 7 8 9 1050
60
70
80
90
100
No induction (N = 1,806)
Polyclonal induction (N = 1,621)
IL-2R antagonist (N = 688)
Years
Su
rviv
al (
%)
Polyclonal vs. IL-2R: p=0.0407No other pair-wise comparisons were significant at p<0.05.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants Kaplan-Meier Survival by Induction and Treated Rejection Between
Transplant Discharge and 1-Year Follow-up Conditional on Survival to 1 Year (1-Year Follow-ups: July 2004 – June 2012)
0 1 2 3 4 5 650
60
70
80
90
100
No induction/No rejection (N = 633)
Polyclonal induction/No rejection (N = 692)
IL-2R antagonist/No rejection (N = 311)
No induction/Treated Rejection (N = 171)
Polyclonal induction/Treated Rejection (N = 199)
IL-2R antagonist/Treated Rejection (N = 107)
Years
Su
rviv
al (
%) No pair-wise comparisons
of survival by induction were significant at p < 0.05 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.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsMaintenance Immunosuppression at Time of Transplant
Discharge by Era (Transplants: January 2001 – June 2013)
Cyclosporine Tacrolimus Sirolimus/Everolimus
MMF/MPA Azathioprine Prednisone0
20
40
60
80
1002001-2006 (N = 1,860) 2007-6/2013 (N = 2,449)
% o
f P
ati
en
ts
Analysis is limited to patients who were alive at the time of the discharge.2014
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsMaintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2001 – June 2013)
Cyclosporine Tacrolimus Sirolimus/Everolimus
MMF/MPA Azathioprine Prednisone0
20
40
60
80
100
Year 1 (N = 3,597) Year 5 (N = 2,304)
% o
f P
ati
en
ts
NOTE: Different patients are analyzed in Year 1 and Year 5.
Analysis is limited to patients who were alive at the time of the follow-up2014
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants Maintenance Immunosuppression at Time of Follow-up
for Same Patients at Each Time Point (Follow-ups: January 2001 – June 2013)
0%
20%
40%
60%
80%
100%
Year 1 (N = 1,629)
Year 5 (N = 1,629)
None
Other
Tacrolimus + MMF/MPA + Sirolimus/Everolimus
Tacrolimus + Sirolimus/Everolimus
Tacrolimus
Tacrolimus + MMF/MPA
Tacrolimus + AZA
Cyclosporine
Cyclosporine + MMF/MPA
Cyclosporine + AZA
Analysis is limited to patients who were alive at the time of the follow-up.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants Maintenance Immunosuppression Drug Combinations at
Time of Follow-up (Follow-ups: January 2001 – June 2013)
0%
20%
40%
60%
80%
100%
Year 1 (N = 3,597)
Year 5 (N = 2,304)
None
Other
Tacrolimus + MMF/MPA + Sirolimus/Everolimus
Tacrolimus + Sirolimus/Everolimus
Tacrolimus
Tacrolimus + MMF/MPA
Tacrolimus + AZA
Cyclosporine
Cyclosporine + MMF/MPA
Cyclosporine + AZA
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.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival Based on Prednisone Use
Conditional on Survival to 1 Year (Transplants: January 2000 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 1150
60
70
80
90
100
Prednisone use at discharge and 1 year (N = 2,013)
No Prednisone at discharge or at 1 year (N = 675)
Prednisone at discharge/not at 1 year (N = 570)
Years
Su
rviv
al (
%)
p < 0.0001
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants Kaplan-Meier Survival by Calcineurin Inhibitor Use at
Discharge (Transplants: January 2000 – June 2012) Conditional on Survival to 14 Days
0 1 2 3 4 5 6 7 8 9 10 11 1250
60
70
80
90
100
Cyclosporine use at discharge (N = 1,360)
Tacrolimus use at discharge (N = 2,532)
Years
Su
rviv
al (
%)
p=0.2974
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants Kaplan-Meier Survival by Maintenance Immunosuppression
at Discharge (Transplants: January 2000 – June 2012) Conditional on Survival to 14 Days
0 1 2 3 4 5 6 7 8 9 10 11 1250
60
70
80
90
100
Cyclosporine + AZA (N = 362)
Cyclosporine + MMF/MPA (N = 769)
Tacrolimus + AZA (N = 247)
Tacrolimus + MMF/MPA (N = 1,983)
TAC Alone (N = 255)
Years
Su
rviv
al (
%)
No pair-wise comparisons were significant at p<0.05.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants Kaplan-Meier Survival by Calcineurin Inhibitor Use
Conditional on Survival to 1 Year (Transplants: January 2000 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 1150
60
70
80
90
100
Cyclosporine use at discharge and 1 year (N = 880)
Tacrolimus use at discharge and 1 year (N = 2,008)
Cyclosporine use at discharge/Tacrolimus at 1 year (N = 270)
Years
Su
rviv
al (
%)
p = 0.1634
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants Kaplan-Meier Survival by Calcineurin Inhibitor Use
(Transplants: January 2000 – June 2007) Conditional on Survival to 5 Years
0 1 2 3 4 5 6 7 8 9 10 11 1250
60
70
80
90
100
Cyclosporine use at discharge and 5 years (N = 334)
Tacrolimus use at discharge and 5 years (N = 563)
Cyclosporine use at discharge/Tacrolimus at 5 years (N = 270)
Years
Su
rviv
al (
%)
Cyclosporine at discharge and 5 years vs. Cyclosporine at discharge/TAC at 5 years p=0.0036.No other pair-wise comparisons were significant at p<0.05.
2014JHLT. 2014 Oct; 33(10): 985-995
Rejection and Post Transplant Morbidities
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival Based on Treated Rejection within 1st Year
Conditional on survival to 1 year (1-Year Follow-ups: July 2004 – June 2012)
0 1 2 3 4 5 6 7 850
60
70
80
90
100
Free from Rejection during 1 year (N = 1,384)
Treated Rejection within 1st Year (N = 577)
Years
Su
rviv
al (
%)
p<0.0001
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.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival Based on Treated Rejection within 1st Year
Conditional on survival to 1 year (1-Year Follow-ups: July 2004 – June 2012)Age = < 1 Year
0 1 2 3 4 5 6 750
60
70
80
90
100
Free from Rejection during 1 year (N = 436)
Treated Rejection within 1st Year (N = 105)
Years
Su
rviv
al (
%)
p = 0.0095
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.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival Based on Treated Rejection within 1st Year
Conditional on survival to 1 year (1-Year Follow-ups: July 2004 – June 2012)Age = 1-5 Years
0 1 2 3 4 5 6 750
60
70
80
90
100
Free from Rejection during 1 year (N = 310)
Treated Rejection within 1st Year (N = 138)
Years
Su
rviv
al (
%)
p = 0.0107
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.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival Based on Treated Rejection within 1st Year
Conditional on survival to 1 year (1-Year Follow-ups: July 2004 – June 2012)Age = 6-10 Years
0 1 2 3 4 5 650
60
70
80
90
100
Free from Rejection during 1 year (N = 173)
Treated Rejection within 1st Year (N = 109)
Years
Su
rviv
al (
%)
p = 0.3500
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.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival Based on Treated Rejection within 1st Year
Conditional on survival to 1 year (1-Year Follow-ups: July 2004 – June 2012)Age = 11-17 Years
0 1 2 3 4 5 6 750
60
70
80
90
100
Free from Rejection during 1 year (N = 465)
Treated Rejection within 1st Year (N = 225)
Years
Su
rviv
al (
%)
p = 0.0163
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.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsKaplan-Meier Survival Based on Treated Rejection within 1st Year
by Calcineurin Use at DischargeConditional on survival to 1 year (1-Year Follow-ups: July 2004 – June 2012)
0 1 2 3 4 5 6 7 850
60
70
80
90
100
CyA: Free from Rejection during 1 year (N = 313)CyA: Treated Rejection within 1st Year (N = 162)TAC: Free from Rejection during 1 year (N = 1,005)TAC: Treated Rejection within 1st Year (N = 373)
Years
Su
rviv
al (
%)
TAC: Rejection vs. no rejection p<0.0001No other pair-wise comparisons within rejection or Calcineurin group were significant at p<0.05.
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.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsPercentage Experiencing Treated Rejection between Discharge and
1-Year Follow-Up by Era (Follow-ups: July 2004 – June 2013)
Overall <1 1-5 6-10 11-17 Female Male0
10
20
30
40
50
7/2004-6/2008 7/2008-6/2013
% e
xper
ien
cin
g tr
eate
d r
ejec
tion
wit
hin
1
year
All pair-wise comparisons were significant at p<0.05 except comparisons for 6-10 age group.
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.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsPercentage Experiencing Treated Rejection between Discharge and
1-Year Follow-Up by Induction (Follow-ups: July 2004 – June 2013)
Overall <1 1-5 6-10 11-17 Female Male0
10
20
30
40
50
No Induction Induction
% e
xper
ien
cin
g tr
eate
d r
ejec
tion
wit
hin
1
year
No pair-wise comparisons were significant at p < 0.05.
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.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsPercentage Experiencing Treated Rejection between Discharge and 1-
Year Follow-Up by Induction Type (Follow-ups: July 2004 – June 2013)
Overall <1 1-5 6-10 11-17 Female Male0
10
20
30
40
50
No Induction Polyclonal IL-2R antagonist
% e
xper
ien
cin
g tr
eate
d r
ejec
tion
wit
hin
1
year
No pair-wise comparisons were significant at p < 0.05.
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.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsPercentage Experiencing Treated Rejection between Discharge and
1-Year Follow-Up by Maintenance Immunosuppression and Induction (Follow-ups: July 2004 – June 2013)
Overall <1 1-5 6-10 11-170
10
20
30
40
50
60
CyA+No induction CyA+Induction (no OKT3)TAC+No induction TAC+Induction (no OKT3)
% e
xper
ien
cin
g tr
eate
d r
ejec
tion
w
ith
in 1
yea
r
CyA + No Induction vs. TAC + No Induction (Overall), CyA + Induction vs. TAC + No Induction (Overall and 11-17 years) and CyA + Induction vs. TAC + Induction (Overall and 11-17 years) were significant at p < 0.05. No other pair-wise comparisons were significant at p < 0.05.
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.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsPercentage Experiencing Treated Rejection between Discharge and
1-Year Follow-Up by Maintenance Immunosuppression(Follow-ups: July 2004 – June 2013)
Overall <1 1-5 6-10 11-170
10
20
30
40
50
60
70
Cyclosporine + MMF/MPA Cyclosporine + AZATacrolimus + MMF/MPA Tacrolimus + AZA
% e
xper
ien
cin
g tr
eate
d r
ejec
tion
w
ith
in 1
yea
r
CyA + MMF/MPA vs. TAC + MMF/MPA for Overall, <1 and 11-17 years were significant at p < 0.05. No other pair-wise comparisons were significant at p < 0.05.
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.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsPercentage Experiencing Treated Rejection between Discharge and
1-Year Follow-Up by Calcineurin Inhibitor Use at Discharge(Follow-ups: July 2004 – June 2013)
Overall <1 1-5 6-10 11-170
10
20
30
40
50
60
Cyclosporine Tacrolimus
% e
xper
ien
cin
g tr
eate
d r
ejec
tion
w
ith
in 1
yea
r
Pair-wise comparisons between Calcineurin Inhibitor groups were significant at p<0.05 for Overall, 6-10 and 11-17 age groups. No other pair-wise comparisons were significant at p<0.05.
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.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsFreedom from Coronary Artery Vasculopathy
(Follow-ups: April 1994 – June 2013)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1540
50
60
70
80
90
100
Years
% F
ree
fro
m C
AV
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsFreedom from Coronary Artery Vasculopathy by Induction
(Follow-ups: April 1994 – June 2013)
0 1 2 3 4 5 6 7 8 9 10 11 1240
50
60
70
80
90
100
Induction (N = 2,335)
No Induction (N = 2,256)
Years
% F
ree
fro
m C
AV
p = 0.2598
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsFreedom from Coronary Artery Vasculopathy by Calcineurin
Inhibitor Use (Follow-ups: 2000 – June 2013) Conditional on Survival to 1 Year
0 1 2 3 4 5 6 7 8 9 1040
50
60
70
80
90
100
Cyclosporine use at discharge and 1 year (N = 920)
Tacrolimus use at discharge and 1 year (N = 1,864)
Cyclosporine use at discharge/Tacrolimus at 1 year (N = 276)
Years
% F
ree
fro
m C
AV
p = 0.1613
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsFreedom from Coronary Artery Vasculopathy
by Age Group (Follow-ups: 2000 – June 2013)
0 1 2 3 4 5 6 7 8 9 10 1140
50
60
70
80
90
100
<1 Year (N = 937)1-5 Years (N = 836)6-10 Years (N = 513)11-17 Years (N=1,311)
Years
% F
ree
fro
m C
AV
p < 0.0001
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsFreedom from Coronary Artery Vasculopathy by Ischemia Time (Follow-ups: 2000 – June 2013)
0 1 2 3 4 5 6 7 8 9 1040
50
60
70
80
90
100
0-<2 hours (N=306)
2-<4 hours (N=1,911)
4+ hours (N=1,125)
Years
% F
ree
fro
m C
AV
p = 0.0633
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsFreedom from Coronary Artery Vasculopathy
by Ischemia Time and Recipient Age (Follow-ups: 2000 – June 2013)
0 1 2 3 4 5 6 7 8 9 1040
50
60
70
80
90
100
0-<2 hours/<1 year (N=75)
2+ hours/<1 year (N=794)
0-<2 hours/1-10 years (N=108)
2+ hours/1-10 years (N=1,141)
0-<2 hours/11-17 years (N=123)
2+ hours/11-17 years (N=1,101)
Years
% F
ree
fro
m C
AV
<1 year: p = 0.64251-10 years: p = 0.422211-17 years: p = 0.9212
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsGraft Survival Following Report of Coronary Artery
Vasculopathy by Age Group (Follow-ups: 2000 – June 2013)
0 1 2 3 4 5 60
20
40
60
80
100
<1 Year (N = 86)1-5 Years (N = 104)6-10 Years (N = 73)11-17 Years (N = 213)
Time since Report of CAV (Years)
Su
rviv
al s
inc
e R
ep
ort
of
CA
V (
%)
p=0.5035
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsFreedom from Severe Renal Dysfunction* by Age Group
(Follow-ups: 2000 – June 2013)
0 1 2 3 4 5 6 7 8 9 10 11 1250
60
70
80
90
100
<1 Year (N = 1,019)
1-5 Years (N = 895)
6-10 Years (N = 542)
11-17 Years (N = 1,373)
Years
% F
ree
fro
m S
ev
ere
Re
na
l Dy
sfu
nc
-ti
on
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
No pair-wise comparisons were significant at p<0.05 except <1 vs. 11-17 (p=0.0003) and 1-5 vs. 11-17 (p=0.0001).
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsFreedom from Severe Renal Dysfunction* by Calcineurin
Inhibitor Use (Follow-ups: 2000 – June 2013) Conditional on Survival to 1 Year
0 1 2 3 4 5 6 7 8 9 10 1150
60
70
80
90
100
Cyclosporine use at discharge and 1 year (N = 961)
Tacrolimus use at discharge and 1 year (N = 2,016)
Cyclosporine use at discharge/Tacrolimus at 1 year (N = 284)
Years
% F
ree
fro
m S
ev
ere
Re
na
l Dy
s-
fun
cti
on * Severe renal dysfunction = Creatinine > 2.5 mg/dl
(221 μmol/L), dialysis or renal transplant
p = 0.9049
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsFreedom from Renal Replacement Therapy by Age Group
(Follow-ups: April 1994 – June 2013)
0 1 2 3 4 5 6 7 8 9 10 11 12 1350
60
70
80
90
100
<1 Year (N = 1,355) 1-5 Years (N = 1,138)
6-10 Years (N = 712) 11-17 Years (N = 1,766)
Years
% F
ree
fro
m R
en
al R
ep
lac
em
en
t T
he
rap
y
<1 vs. 11-17: p=0.0381-5 vs. 6-10: p=0.04711-5 vs. 11-17: p=0.0033No other pair-wise comparisons were significant at <0.05.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsPost Transplant Malignancy (Follow-ups: April 1994 – June 2013)
Cumulative Morbidity Rates in Survivors
Malignancy/Type 1-Year Survivors
5-Year Survivors
10-Year Survivors
No Malignancy 5,013 (98.4%) 2,317 (95.2%) 763 (90.7%)
Malignancy (all types combined) 82 (1.6%) 117 (4.8%) 78 (9.3%)
Malignancy Type*
Lymphoma 76 111 75
Other 5 7 5
Skin 0 1 1
Type Not Reported 1 0 0
*Recipients may have experienced more than one type of malignancy so sum of individual malignancy types may be greater than total number with malignancy.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsPost Transplant Malignancy (Follow-ups: April 1994 – June 2013)
Cumulative Morbidity Rates in Survivors
Malignancy/Type
Recipient Age
<1 1-5 6-10 11-17
1-Year Survivors
No Malignancy 1,367 (99.0%) 1,152 (98.7%) 713 (97.3%) 1,781 (98.2%)
Malignancy* 14 (1.0%) 15 (1.3%) 20 (2.7%) 33 (1.8%)
5-Year Survivors
No Malignancy 631 (95.3%) 542 (93.0%) 372 (95.1%) 772 (96.7%)
Malignancy* 31 (4.7%) 41 (7.0%) 19 (4.9%) 26 (3.3%)
10-Year Survivors
No Malignancy 261 (90.9%) 189 (88.7%) 108 (93.1%) 205 (91.1%)
Malignancy* 26 (9.1%) 24 (11.3%) 8 (6.9%) 20 (8.9%)
* All types combined2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsFreedom from Malignancy (Follow-ups: April 1994 – June 2013)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1550
60
70
80
90
100
All malignancy Lymphoma Skin Other
Years
% F
ree
fro
m M
alig
na
nc
y
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsFreedom from Malignancy by Maintenance Immunosuppression
Combinations (Follow-ups: January 2000 – June 2013) Conditional on Survival to 1 year
0 1 2 3 4 5 6 7 8 9 1050
60
70
80
90
100
Cyclosporine use at discharge and 1 year (N = 841)
Tacrolimus use at discharge and 1 year (N = 1,856)
Cyclosporine use at discharge/ Tacrolimus use at 1 year (N = 265)
Years
% F
ree
fro
m M
alig
na
nc
y
p = 0.3064
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsFreedom from Lymphoma by Induction
(Follow-ups: April 1994 – June 2013)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1550
60
70
80
90
100
Induction (N = 2,277) No Induction (N = 1,990)
Years
% F
ree
fro
m L
ym
ph
om
a
p = 0.5283
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants Incidence of Hypertension between 1 and 3 Years
(Transplants: January 2000 – June 2010)
Maintenance Immunosuppression at discharge and 1 year
% HTN reported between 1 and 3 years
P-valueFor Patients on
drugFor Patients not on drug
Azathioprine 18.8 25.2 0.0522
Cyclosporine 22.8 23.0 0.9513
MMF/MPA 23.9 22.9 0.7729
Prednisone 27.2 19.5 0.0123
Sirolimus/Everolimus 40.0 23.3 0.1070
Tacrolimus 24.0 22.9 0.6979
Only patients without hypertension reported by 1 year were analyzed.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsIncidence of Hypertension between 3 and 5 Years
(Transplants: January 2000 – June 2008)
Maintenance Immunosuppression at discharge and 1 year
% HTN reported between 3 and 5 years
P-valueFor Patients
on drugFor Patients not on drug
Azathioprine 11.5 19.1 0.0566
Cyclosporine 11.5 19.6 0.0209
MMF/MPA 16.7 14.2 0.5398
Prednisone 20.0 9.8 0.0082
Sirolimus/Everolimus 14.3 15.6 0.9999
Tacrolimus 20.7 12.1 0.0152
Only patients without hypertension reported by 3 years were analyzed.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsRelationship of Rejection and Coronary Artery Vasculopathy
(Follow-ups: July 2004 – June 2013)
Rejection During 1st Year
Reported CAV between 1st and 3rd years post-transplant
Yes No All
Yes 316.7%
43493.3%
465100%
No 394.3%
87695.7%
915100%
p = 0.0544
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsCause of Death (Deaths: January 2000 – June 2013)
CAUSE OF DEATH 0-30 Days
(N = 312)31 Days - 1
Year (N = 338)>1 Year - 3 Years
(N = 284)>3 Years - 5
Years (N = 235) >5 Years - 10 Years (N = 416)
>10 Years(N = 366)
CORONARY ARTERY VASCULOPATHY 4 (1.3%) 17 (5.0%) 45 (15.8%) 55 (23.4%) 95 (22.8%) 94 (25.7%)
ACUTE REJECTION 24 (7.7%) 54 (16.0%) 55 (19.4%) 32 (13.6%) 53 (12.7%) 16 (4.4%)
LYMPHOMA 6 (1.8%) 9 (3.2%) 7 (3.0%) 26 (6.3%) 20 (5.5%)
MALIGNANCY, OTHER 4 (1.2%) 3 (1.1%) 2 (0.9%) 8 (1.9%) 12 (3.3%)
CMV 8 (2.4%) 1 (0.4%)
INFECTION, NON-CMV 36 (11.5%) 40 (11.8%) 17 (6.0%) 11 (4.7%) 19 (4.6%) 24 (6.6%)
GRAFT FAILURE 111 (35.6%) 62 (18.3%) 96 (33.8%) 84 (35.7%) 145 (34.9%) 119 (32.5%)
TECHNICAL 24 (7.7%) 3 (0.9%) 1 (0.4%) 1 (0.4%) 4 (1.0%) 6 (1.6%)
OTHER 23 (7.4%) 26 (7.7%) 23 (8.1%) 16 (6.8%) 30 (7.2%) 23 (6.3%)
MULTIPLE ORGAN FAILURE 41 (13.1%) 62 (18.3%) 14 (4.9%) 9 (3.8%) 14 (3.4%) 22 (6.0%)
RENAL FAILURE 7 (2.1%) 2 (0.7%) 1 (0.4%) 1 (0.2%) 11 (3.0%)
PULMONARY 14 (4.5%) 33 (9.8%) 12 (4.2%) 9 (3.8%) 12 (2.9%) 9 (2.5%)
CEREBROVASCULAR 35 (11.2%) 16 (4.7%) 6 (2.1%) 8 (3.4%) 9 (2.2%) 10 (2.7%)
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsCause of Death for Age = <1 Year (Deaths: January 2000 - June 2013)
CAUSE OF DEATH 0-30 Days
(N = 98)31 Days - 1
Year (N = 121)>1 Year - 3 Years
(N = 65)>3 Years - 5
Years (N = 43) >5 Years - 10 Years (N = 55)
>10 Years(N = 54)
CORONARY ARTERY VASCULOPATHY 3 (3.1%) 4 (3.3%) 8 (12.3%) 7 (16.3%) 14 (25.5%) 18 (33.3%)
ACUTE REJECTION 9 (9.2%) 12 (9.9%) 11 (16.9%) 3 (7.0%) 3 (5.5%) 2 (3.7%)
LYMPHOMA 4 (6.2%) 2 (4.7%) 8 (14.5%) 6 (11.1%)
MALIGNANCY, OTHER 1 (1.5%) 1 (2.3%) 1 (1.8%)
CMV 3 (2.5%)
INFECTION, NON-CMV 13 (13.3%) 11 (9.1%) 5 (7.7%) 3 (7.0%) 6 (10.9%) 5 (9.3%)
GRAFT FAILURE 39 (39.8%) 25 (20.7%) 16 (24.6%) 13 (30.2%) 17 (30.9%) 13 (24.1%)
TECHNICAL 6 (6.1%) 1 (1.5%) 1 (1.8%) 1 (1.9%)
OTHER 5 (5.1%) 13 (10.7%) 9 (13.8%) 4 (9.3%) 1 (1.9%)
MULTIPLE ORGAN FAILURE 11 (11.2%) 25 (20.7%) 4 (6.2%) 4 (9.3%) 2 (3.6%) 6 (11.1%)
RENAL FAILURE 5 (4.1%) 1 (1.5%) 1 (1.9%)
PULMONARY 5 (5.1%) 19 (15.7%) 5 (7.7%) 2 (4.7%) 3 (5.5%)
CEREBROVASCULAR 7 (7.1%) 4 (3.3%) 4 (9.3%) 1 (1.9%)
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsCause of Death for Age = 1-5 Years (Deaths: January 2000 – June 2013)
CAUSE OF DEATH 0-30 Days
(N = 55)31 Days - 1
Year (N = 83)>1 Year - 3 Years
(N = 67)>3 Years - 5
Years (N = 48) >5 Years - 10 Years (N = 62)
>10 Years(N = 84)
CORONARY ARTERY VASCULOPATHY 4 (4.8%) 15 (22.4%) 9 (18.8%) 14 (22.6%) 17 (20.2%)
ACUTE REJECTION 9 (16.4%) 23 (27.7%) 13 (19.4%) 8 (16.7%) 8 (12.9%) 6 (7.1%)
LYMPHOMA 2 (3.0%) 3 (6.3%) 5 (8.1%) 6 (7.1%)
MALIGNANCY, OTHER 1 (1.2%) 1 (1.5%) 1 (1.6%) 2 (2.4%)
CMV 1 (1.2%)
INFECTION, NON-CMV 5 (9.1%) 10 (12.0%) 6 (9.0%) 1 (2.1%) 3 (4.8%) 3 (3.6%)
GRAFT FAILURE 23 (41.8%) 17 (20.5%) 21 (31.3%) 16 (33.3%) 21 (33.9%) 26 (31.0%)
TECHNICAL 4 (7.3%) 1 (1.2%)
OTHER 3 (3.6%) 2 (3.0%) 5 (10.4%) 3 (4.8%) 7 (8.3%)
MULTIPLE ORGAN FAILURE 6 (10.9%) 16 (19.3%) 2 (3.0%) 1 (2.1%) 2 (3.2%) 8 (9.5%)
RENAL FAILURE 1 (1.2%) 1 (1.2%)
PULMONARY 3 (5.5%) 3 (3.6%) 1 (1.5%) 5 (10.4%) 2 (3.2%) 2 (2.4%)
CEREBROVASCULAR 5 (9.1%) 4 (4.8%) 4 (6.0%) 3 (4.8%) 5 (6.0%)
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsCause of Death for Age = 6-10 Years (Deaths: January 2000 – June 2013)
CAUSE OF DEATH 0-30 Days
(N = 49)31 Days - 1
Year (N = 24)>1 Year - 3 Years
(N = 25)>3 Years - 5
Years (N = 38) >5 Years - 10 Years (N = 65)
>10 Years(N = 78)
CORONARY ARTERY VASCULOPATHY 1 (2.0%) 6 (24.0%) 9 (23.7%) 17 (26.2%) 16 (20.5%)
ACUTE REJECTION 1 (2.0%) 3 (12.5%) 3 (12.0%) 10 (26.3%) 8 (12.3%) 2 (2.6%)
LYMPHOMA 1 (4.2%) 2 (8.0%) 1 (2.6%) 7 (10.8%) 4 (5.1%)
MALIGNANCY, OTHER 3 (4.6%) 2 (2.6%)
CMV 3 (12.5%)
INFECTION, NON-CMV 4 (8.2%) 5 (20.8%) 2 (8.0%) 2 (5.3%) 4 (6.2%) 4 (5.1%)
GRAFT FAILURE 12 (24.5%) 1 (4.2%) 8 (32.0%) 12 (31.6%) 17 (26.2%) 31 (39.7%)
TECHNICAL 3 (6.1%) 1 (2.6%) 1 (1.5%)
OTHER 8 (16.3%) 1 (4.2%) 1 (4.0%) 2 (3.1%) 3 (3.8%)
MULTIPLE ORGAN FAILURE 10 (20.4%) 5 (20.8%) 1 (4.0%) 3 (4.6%) 4 (5.1%)
RENAL FAILURE 1 (4.0%) 6 (7.7%)
PULMONARY 1 (4.2%) 1 (4.0%) 2 (5.3%) 1 (1.5%) 4 (5.1%)
CEREBROVASCULAR 10 (20.4%) 4 (16.7%) 1 (2.6%) 2 (3.1%) 2 (2.6%)
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsCause of Death for Age = 11-17 Years (Deaths: January 2000 – June 2013)
CAUSE OF DEATH 0-30 Days
(N = 110)31 Days - 1
Year (N = 110)>1 Year - 3 Years
(N = 127)>3 Years - 5
Years (N = 106) >5 Years - 10 Years (N = 234)
>10 Years(N = 150)
CORONARY ARTERY VASCULOPATHY 9 (8.2%) 16 (12.6%) 30 (28.3%) 50 (21.4%) 43 (28.7%)
ACUTE REJECTION 5 (4.5%) 16 (14.5%) 28 (22.0%) 11 (10.4%) 34 (14.5%) 6 (4.0%)
LYMPHOMA 5 (4.5%) 1 (0.8%) 1 (0.9%) 6 (2.6%) 4 (2.7%)
MALIGNANCY, OTHER 3 (2.7%) 1 (0.8%) 1 (0.9%) 3 (1.3%) 8 (5.3%)
CMV 1 (0.9%) 1 (0.8%)
INFECTION, NON-CMV 14 (12.7%) 14 (12.7%) 4 (3.1%) 5 (4.7%) 6 (2.6%) 12 (8.0%)
GRAFT FAILURE 37 (33.6%) 19 (17.3%) 51 (40.2%) 43 (40.6%) 90 (38.5%) 49 (32.7%)
TECHNICAL 11 (10.0%) 3 (2.7%) 2 (0.9%) 4 (2.7%)
OTHER 10 (9.1%) 9 (8.2%) 11 (8.7%) 7 (6.6%) 25 (10.7%) 12 (8.0%)
MULTIPLE ORGAN FAILURE 14 (12.7%) 16 (14.5%) 7 (5.5%) 4 (3.8%) 7 (3.0%) 4 (2.7%)
RENAL FAILURE 1 (0.9%) 1 (0.9%) 1 (0.4%) 3 (2.0%)
PULMONARY 6 (5.5%) 10 (9.1%) 5 (3.9%) 6 (2.6%) 3 (2.0%)
CEREBROVASCULAR 13 (11.8%) 4 (3.6%) 2 (1.6%) 3 (2.8%) 4 (1.7%) 2 (1.3%)
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart TransplantsRelative Incidence of Leading Causes of Death
(Deaths: January 2000 – June 2013)
0-30 Days(N = 312)
31 Days - 1 Year(N = 338)
>1 Year - 3 Years (N = 284)
>3 Years - 5 Years (N = 235)
>5 Years - 10 Years (N = 416)
>10 Years(N = 366)
0
10
20
30
40
50
CAV Acute Rejection Infection (non-CMV) Graft Failure
Pe
rce
nta
ge
of
De
ath
s
2014JHLT. 2014 Oct; 33(10): 985-995
Multivariable Analyses
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Risk Factors For 1 Year Mortality
N = 3,649Reference group = Cardiomyopathy, no devices
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Risk Factors For 1 Year Mortality
Continuous Factors (see figures)
Recipient height Recipient pre-transplant creatinine
Ischemia time
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Height
50 60 70 80 90 100 110 120 130 140 150 160 170 1800.0
0.5
1.0
1.5
2.0
2.5
3.0
Recipient height (cm)
Ha
zard
Ra
tio
of
1 Y
ea
r M
ort
alit
y
p = 0.0027
(N = 3,649)
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Ischemia time
2 3 4 5 60.0
0.5
1.0
1.5
2.0
2.5
3.0
Ischemia time (hours)
Ha
zard
Ra
tio
of
1 Y
ea
r M
ort
alit
y
p = 0.0002
(N = 3,649)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Creatinine
0.0 0.5 1.0 1.5 2.0 2.50.0
1.0
2.0
3.0
4.0
5.0
Recipient creatinine (mg/dl)
Ha
zard
Ra
tio
of
1 Y
ea
r M
ort
alit
y
p = 0.0025
(N = 3,649)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Age = <1 YearRisk Factors For 1 Year Mortality
N = 990Reference group = Congenital, no devices
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011) Age = <1 Year
Risk Factors For 1 Year Mortality
Continuous Factors (see figures)
Recipient age Ischemia time
Recipient pre-transplant creatinine Donor height
Donor/recipient height ratio
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Risk Factors For 1 Year Mortality in Age = <1 YearRecipient Age
0.0 0.2 0.4 0.6 0.8 1.00.0
1.0
2.0
3.0
4.0
Recipient age (years)
Ha
zard
Ra
tio
of
1 Y
ea
r M
ort
alit
y p = 0.0076
(N = 990)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Risk Factors For 1 Year Mortality in Age = <1 YearDonor height
50 60 70 80 90 1000.0
1.0
2.0
3.0
4.0
Donor height (cm)
Ha
zard
Ra
tio
of
1 Y
ea
r M
ort
alit
y
p = 0.0006
(N = 990)2014
The impact of donor height must be considered in the context of height ratio.
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Risk Factors For 1 Year Mortality in Age = <1 YearDonor/recipient height ratio
0.9 1.0 1.1 1.2 1.3 1.4 1.50.0
1.0
2.0
3.0
4.0
Donor height/recipient height
Ha
zard
Ra
tio
of
1 Y
ea
r M
ort
alit
y
p = 0.0038
(N = 990)2014
The impact of height ratio must be considered in the context of donor height.
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Risk Factors For 1 Year Mortality in Age = <1 YearRecipient Pre-Transplant Creatinine
0.1 0.2 0.3 0.4 0.5 0.6 0.70.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Recipient creatinine (mg/dl)
Ha
zard
Ra
tio
of
1 Y
ea
r M
ort
alit
y
p = 0.0007
(N = 990)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Risk Factors For 1 Year Mortality in Age = <1 YearIschemia time
1 2 3 4 5 6 7 80.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Ischemia time (hours)
Ha
zard
Ra
tio
of
1 Y
ea
r M
ort
alit
y
p = 0.0028
(N = 990)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Age = 1-5 YearsRisk Factors For 1 Year Mortality
N = 852Reference group = Cardiomyopathy, no devices
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011) Age = 1-5 Years
Risk Factors For 1 Year Mortality
Continuous Factors (see figures)
Recipient age Donor/recipient BSA ratio
Recipient pre-transplant creatinine Volume of pediatric transplants
Recipient heightRatio of pediatric transplant volume to total transplant volume
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Risk Factors For 1 Year Mortality in Age = 1-5 YearsRecipient Age
1 2 3 4 50.0
1.0
2.0
3.0
4.0
Recipient age (years)
Ha
zard
Ra
tio
of
1 Y
ea
r M
ort
alit
y p = 0.0434
(N = 852)2014
The impact of recipient age must be considered in the context of recipient height.
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Risk Factors For 1 Year Mortality in Age = 1-5 YearRecipient Pre-Transplant Creatinine
0.1 0.2 0.3 0.4 0.5 0.6 0.70.0
0.5
1.0
1.5
2.0
2.5
3.0
Recipient creatinine (mg/dl)
Ha
zard
Ra
tio
of
1 Y
ea
r M
ort
alit
y p = 0.0097
(N = 852)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Risk Factors For 1 Year Mortality in Age = 1-5 YearsRecipient Height
70 80 90 100 110 1200.0
1.0
2.0
3.0
4.0
Recipient Height (cm)
Ha
zard
Ra
tio
of
1 Y
ea
r M
ort
alit
y
p = 0.0049
(N = 852)
2014The impact of recipient height must be considered in the context of recipient age.JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Risk Factors For 1 Year Mortality in Age = 1-5 YearsDonor/Recipient BSA Ratio
0.8 1.0 1.2 1.4 1.6 1.80.0
1.0
2.0
3.0
4.0
Donor BSA/recipient BSA
Ha
zard
Ra
tio
of
1 Y
ea
r M
ort
alit
y
p = 0.0357
(N = 852)2014
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Risk Factors For 1 Year Mortality in Age = 1-5 YearsCenter Volume for Pediatric Transplants
0 5 10 15 200.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Center pediatric volume (cases per year)
Ha
zard
Ra
tio
of
1 Y
ea
r M
ort
alit
y
p = 0.0091
(N = 852)2014
The impact of pediatric volume must be considered in the context of percentage of total volume.JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Risk Factors For 1 Year Mortality in Age = 1-5 YearsRatio of Pediatric Transplant Volume to Total Transplant Volume
0% 20% 40% 60% 80% 100%0.0
1.0
2.0
3.0
4.0
% of Total Transplant Volume Represented by Pediatric Transplants
Ha
zard
Ra
tio
of
1 Y
ea
r M
ort
alit
y p = 0.0118
(N = 852)2014The impact of percentage volume must be considered in the context of pediatric volume.JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Age = 6-10 YearsRisk Factors For 1 Year Mortality
N = 523Reference group = Cardiomyopathy, no devices
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011) Age = 6-10 Years
Risk Factors For 1 Year Mortality
Continuous Factors (see figures)
Recipient pre-transplant bilirubin
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Risk Factors For 1 Year Mortality in Age = 6-10 YearsRecipient Pre-Transplant Bilirubin
0.0 0.5 1.0 1.5 2.0 2.5 3.00.0
1.0
2.0
3.0
4.0
Recipient bilirubin (mg/dl)
Ha
zard
Ra
tio
of
1 Y
ea
r M
ort
alit
y
p = 0.0137
(N = 523)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011)
Age = 11-17 YearsRisk Factors For 1 Year Mortality
N = 1,275
Reference group = Cardiomyopathy, no devices
* Other = Not head trauma, cerebrovascular/stroke, anoxia, or CNS tumor2014
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 2002 – December 2011) Age = 11-17 Years
Risk Factors For 1 Year Mortality
Continuous Factors
No statistically significant continuous risk factors were identified
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1998 – December 2007)
Risk Factors For 5 Year Mortality
N = 3,143
Reference group = Cardiomyopathy, no devices
2014 * Other = Not head trauma, cerebrovascular/stroke, anoxia, or CNS tumor
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1998 – December 2007)
Risk Factors For 5 Year Mortality
Continuous Factors (see figures)
Recipient ageRatio of pediatric transplant volume to total transplant volume
Ischemia time
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1998 – December 2007)
Risk Factors For 5 Year Mortality with 95% Confidence LimitsRecipient Age
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170.0
0.5
1.0
1.5
2.0
Recipient Age (years)
Ha
zard
Ra
tio
of
5 Y
ea
r M
ort
alit
y p < 0.0001
(N = 3,143)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1998 – December 2007)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Ischemia time
2 3 4 5 6 7 80.0
0.5
1.0
1.5
2.0
Ischemia time (hours)
Ha
zard
Ra
tio
of
5 Y
ea
r M
ort
alit
y
p = 0.0232
(N = 3,143)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1998 – December 2007)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Ratio of Pediatric Transplant Volume to Total Transplant Volume
0% 20% 40% 60% 80% 100%0.0
0.5
1.0
1.5
2.0
% of Total Transplant Volume Represented by Pediatric Transplants
Ha
zard
Ra
tio
of
5 Y
ea
r M
ort
alit
y p = 0.0368
(N = 3,143)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1993 – December 2002)
Risk Factors For 10 Year Mortality
N = 3,400Reference group = Cardiomyopathy, no devices2014
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1993 – December 2002)
Risk Factors For 10 Year Mortality
Continuous Factors (see figures)
Difference in ageRatio of pediatric transplant volume to total transplant volume
Recipient BMI Recipient pre-transplant serum creatinine
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1993 – December 2002)
Risk Factors For 10 Year Mortality with 95% Confidence LimitsDifference in Age
-5 0 5 10 15 20 25 300.0
0.5
1.0
1.5
2.0
2.5
Donor Age – Recipient Age (years)
Ha
zard
Ra
tio
of
10
Ye
ar
Mo
rta
lity
p = 0.0034
(N = 3,400)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1993 – December 2002)
Risk Factors For 10 Year Mortality with 95% Confidence Limits Recipient BMI
12 14 16 18 20 22 240.0
0.5
1.0
1.5
2.0
Recipient BMI (kg/m2)
Ha
zard
Ra
tio
of
10
Ye
ar
Mo
rta
lity
p = 0.0056
(N = 3,400)
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1993 – December 2002)
Risk Factors For 10 Year Mortality with 95% Confidence Limits Ratio of Pediatric Transplant Volume to Total Transplant Volume
0% 20% 40% 60% 80% 100%0.0
0.5
1.0
1.5
2.0
% of Total Transplant Volume Represented by Pediatric Transplants
Ha
zard
Ra
tio
of
10
Ye
ar
Mo
rta
lity
p = 0.0043
(N = 3,400)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1993 – December 2002)
Risk Factors For 10 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Creatinine
0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.00.0
0.5
1.0
1.5
2.0
Recipient creatinine (mg/dl)
Ha
zard
Ra
tio
of
10
Ye
ar
Mo
rta
lity
p = 0.0197
(N = 3,400)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1988 – December 1997)
Risk Factors For 15 Year Mortality
N = 2,755Reference group = Cardiomyopathy, no devices
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1988 – December 1997)
Risk Factors For 15 Year Mortality
Continuous Factors (see figures)
Donor age Volume of pediatric transplants
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1988 – December 1997)
Risk Factors For 15 Year Mortality with 95% Confidence LimitsDonor Age
0 5 10 15 20 25 30 35 400.0
0.5
1.0
1.5
2.0
2.5
Donor Age (years)
Ha
zard
Ra
tio
of
15
Ye
ar
Mo
rta
lity
p = 0.0119
(N = 2,755)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1988 – December 1997)
Risk Factors For 15 Year Mortality with 95% Confidence Limits Center Volume for Pediatric Transplants
0 5 10 15 20 250.0
0.5
1.0
1.5
2.0
Center pediatric volume (cases per year)
Ha
zard
Ra
tio
of
15
Ye
ar
Mo
rta
lity
p = 0.0002
(N = 2,755)2014JHLT. 2014 Oct; 33(10): 985-995
PEDIATRIC HEART TRANSPLANTS (1998-2007)Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
N = 2,260*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
2014JHLT. 2014 Oct; 33(10): 985-995
PEDIATRIC HEART TRANSPLANTS (1998-2007)Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
Continuous Factors (see figures)
Recipient BSA Ischemia time
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis2014
JHLT. 2014 Oct; 33(10): 985-995
PEDIATRIC HEART TRANSPLANTS (1998-2007)Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
Recipient BSA
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.80.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Recipient BSA (m2)
Ha
zard
Ra
tio
of
Re
na
l Dy
sfu
nc
tio
n
wit
hin
5 Y
ea
rs
p < 0.0001
(N = 2,260)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
2014JHLT. 2014 Oct; 33(10): 985-995
PEDIATRIC HEART TRANSPLANTS (1998-2007)Risk Factors for Developing Severe Renal Dysfunction within 5 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
Ischemia time
1 2 3 4 5 60.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
Ischemia time
Ha
zard
Ra
tio
of
Re
na
l Dy
sfu
nc
tio
n
wit
hin
5 Y
ea
rs
p = 0.0367
(N = 2,260)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
2014JHLT. 2014 Oct; 33(10): 985-995
PEDIATRIC HEART TRANSPLANTS (1995-2002)Risk Factors for Developing Severe Renal Dysfunction within 10 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
N = 1,564*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
2014JHLT. 2014 Oct; 33(10): 985-995
PEDIATRIC HEART TRANSPLANTS (1995-2002)Risk Factors for Developing Severe Renal Dysfunction within 10 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
Continuous Factors (see figures)
Recipient height
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis2014
JHLT. 2014 Oct; 33(10): 985-995
PEDIATRIC HEART TRANSPLANTS (1995-2002)Risk Factors for Developing Severe Renal Dysfunction within 10 Years
Limited to Recipients without Severe Renal Dysfunction* Pre-TransplantConditional on Survival to Transplant Discharge
Recipient Height
50 60 70 80 90 100 110 120 130 140 150 160 1700.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
Recipient height (cm)
Ha
zard
Ra
tio
of
Re
na
l Dy
sfu
nc
tio
n
wit
hin
5 Y
ea
rs
p < 0.0001
(N = 1,564)
*Severe renal dysfunction = creatinine > 2.5 mg/dl or dialysis
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1998 – December 2007)Risk Factors for Developing CAV within 5 YearsConditional on Survival to Transplant Discharge
N = 2,2512014
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1998 – December 2007)Risk Factors for Developing CAV within 5 Years Conditional on Survival to Transplant Discharge
Continuous Factors (see figures)
Difference in age Transplant center volume
Recipient weight
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1998 – December 2007)Risk Factors for Developing CAV within 5 Years Conditional on Survival to Transplant Discharge
Difference in Age
-5 0 5 10 150.0
0.5
1.0
1.5
2.0
2.5
3.0
Donor age – recipient age (years)
Ha
zard
Ra
tio
of
CA
V w
ith
in 1
0 Y
ea
rs
p = 0.001
(N = 2,251)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1998 – December 2007)Risk Factors for Developing CAV within 5 Years Conditional on Survival to Transplant Discharge
Recipient Weight
5 10 15 20 25 30 35 40 45 50 55 60 65 700.0
0.5
1.0
1.5
2.0
2.5
3.0
Recipient weight (kg)
Ha
zard
Ra
tio
of
CA
V w
ith
in 1
0 Y
ea
rs
p < 0.0001
(N = 2,251)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1998 – December 2007)Risk Factors for Developing CAV within 5 Years Conditional on Survival to Transplant Discharge
Total Program Volume (Pediatric and Adult)
0 10 20 30 40 500.0
0.5
1.0
1.5
2.0
Total program volume for pediatric and adult (cases per year)
Ha
zard
Ra
tio
of
CA
V w
ith
in 1
0 Y
ea
rs
p = 0.0289
(N = 2,251)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1995 – December 2002)Risk Factors for Developing CAV within 10 YearsConditional on Survival to Transplant Discharge
N = 1,4942014
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1995 – December 2002)Risk Factors for Developing CAV within 10 Years Conditional on Survival to Transplant Discharge
Continuous Factors (see figures)
Recipient weight Transplant center volume
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1995 – December 2002)Risk Factors for Developing CAV within 10 Years Conditional on Survival to Transplant Discharge
Recipient Weight
5 10 15 20 25 30 35 40 45 50 55 60 65 700.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
Recipient weight (kg)
Ha
zard
Ra
tio
of
CA
V w
ith
in 1
0 Y
ea
rs
p < 0.0001
(N = 1,494)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (January 1995 – December 2002)Risk Factors for Developing CAV within 10 Years Conditional on Survival to Transplant Discharge
Total Program Volume (Pediatric and Adult)
0 10 20 30 40 500.0
0.5
1.0
1.5
2.0
Total program volume for pediatric and adult (cases per year)
Ha
zard
Ra
tio
of
CA
V w
ith
in 1
0 Y
ea
rs
p = 0.0216
(N = 1,494)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (2002 – 2011)
Risk Factors For 1 Year Mortality: Diagnosis = Cardiomyopathy*
N = 2,701* Please refer to notes section for important supplemental information
2014JHLT. 2014 Oct; 33(10): 985-995
0 3 6 9 12 15 180.0
0.5
1.0
1.5
2.0
Recipient age (years)
Ha
zard
Ra
tio
fo
r 1
Ye
ar
Mo
rta
lity p = 0.0118
Pediatric Heart Transplants (2002 – 2011)
Risk Factors For 1 Year Mortality: Diagnosis = Cardiomyopathy* Recipient Age
* Please refer to notes section for important supplemental information
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (1995 – 2004)
Risk Factors For 8 Year Mortality: Diagnosis = Cardiomyopathy*
N = 2,072* Please refer to notes section for important supplemental information
2014* *The hazard ratio and p-value for the main effect for Europe and for age can not be interpreted in isolation; they must be interpreted in combination with the interaction between recipient age and Europe. JHLT. 2014 Oct; 33(10): 985-995
0 3 6 9 12 15 180.0
0.5
1.0
1.5
2.0
2.5
3.0
North America
Europe
Other locations
Recipient age (years)
Ha
zard
Ra
tio
fo
r 8
Ye
ar
Mo
rta
lity
Pediatric Heart Transplants (1995-2004)
Risk Factors For 8 Year Mortality: Diagnosis = Cardiomyopathy* Combined effect of age, geography, and age*geography interaction
* Please refer to notes section for important supplemental information
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (2002 – 2011)
Risk Factors For 1 Year Mortality: Diagnosis = Congenital*
N = 1,711* Please refer to notes section for important supplemental information
2014* *The hazard ratio and p-value for the main effect for Europe and for age can not be interpreted in isolation; they must be interpreted in combination with the interaction between recipient age and Europe. JHLT. 2014 Oct; 33(10): 985-995
0 3 6 9 12 15 180.0
1.0
2.0
3.0
4.0
North America
Europe
Other locations
Recipient age (years)
Ha
zard
Ra
tio
fo
r 1
Ye
ar
Mo
rta
lity
Pediatric Heart Transplants (1995-2004)
Risk Factors For 1 Year Mortality: Diagnosis = Congenital* Combined effect of age, geography, and age*geography interaction
* Please refer to notes section for important supplemental information
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants (1995-2004)Risk Factors For 8 Year Mortality: Diagnosis = Congenital*
N = 1,568 * Please refer to notes section for important supplemental information
2014JHLT. 2014 Oct; 33(10): 985-995
0 3 6 9 12 15 180.0
0.5
1.0
1.5
2.0
Recipient age (years)
Ha
zard
Ra
tio
fo
r 8
Ye
ar
Mo
rta
lity p = 0.0597
Pediatric Heart Transplants (1995-2004)
Risk Factors For 8 Year Mortality: Diagnosis = Congenital* Recipient Age
* Please refer to notes section for important supplemental information
2014JHLT. 2014 Oct; 33(10): 985-995
Retransplantation
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Retransplantsby Year of Retransplant
Only patients who were less than 18 years old at the time of retransplant are included.2014
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
5
10
15
20
25
30
35
40
45
0
2
4
6
8
10
12
14
16
18
N %
Year of retransplant
Nu
mb
er o
f re
tran
spla
nts
% o
f re
tran
spla
nts
JHLT. 2014 Oct; 33(10): 985-995
<1 month 1-<12 months
12-<36 months
36-<60 months
60+ months Not reported0
10
20
30
40
50
60<1 Year 1-5 years 6-10 Years 11-17 Years
% o
f R
etra
nsp
lan
ts
Time Between Previous and Current Transplant
Pediatric Heart Retransplantsby Inter-transplant Interval and Recipient Age
(Retransplants: January 1994 – June 2013)
Only patients who were less than 18 years old at the time of retransplant are included. Analysis is based on the recipient age at the time of retransplant.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Retransplants Kaplan-Meier Survival Rates for Primary and Repeat
Transplants (Transplants: January 1994 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
100
Retransplant (N = 452) Primary (N=7,938)
Years
Su
rviv
al (
%)
p < 0.0001
Only patients who were less than 18 years old at the time of retransplant are included.2014
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Retransplants Kaplan-Meier Survival Rates by Inter-transplant Interval
(Transplants: January 1994 – June 2012)
Only patients who were less than 18 years old at the time of retransplant are included.2014
0 1 2 3 4 5 60
10
20
30
40
50
60
70
80
90
100
<1 Year (N=70) 1-<3 Years (N=48) 3-<5 Years (N=57)5+ Years (N=239) Primary TX (N=7,938)
Time (years) since most recent transplant
Su
rviv
al
(%)
Comparison of survival for retransplant groups: p<0.0001.
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Retransplants Kaplan-Meier Survival Rates by Retransplant Reason
(Retransplants: January 1994 – June 2012)
0 1 2 3 4 5 60
20
40
60
80
100
Coronary Artery Disease (N=225)
Primary Failure (N=31)
Rejection (N=59)
Years
Su
rviv
al (
%)
No pair-wise comparisons were significant at p < 0.05 except coronary artery disease vs. primary failure.
Only patients who were less than 18 years old at the time of retransplant are included.2014
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Transplants Kaplan-Meier Survival Conditional on Survival to 1 Year for Primary and
Repeat Transplants (Transplants: January 1994 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
100
Retransplant (N = 361) Primary (N=6,377)
Years
Su
rviv
al (
%)
p < 0.0001
Only patients who were less than 18 years old at the time of retransplant are included.2014
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart RetransplantsPercentage Experiencing Treated Rejection between Discharge and 1-Year Follow-Up by Age and Gender (Follow-ups: July 2004 – June 2013)
Overall <1 1-5 6-10 11-17 Female Male0
10
20
30
40
50
% e
xper
ien
cin
g tr
eate
d r
ejec
tion
wit
hin
1 y
ear
No pair-wise comparisons between different age groups or between genders were significant at p<0.05.
Analysis is limited to patients who were alive at the time of the follow-up. Number of <1 retransplant recipients with known rejection status is <10.
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.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart RetransplantsPercentage Experiencing Treated Rejection between Discharge and
1-Year Follow-Up by Era (Follow-ups: July 2004 – June 2013)
Overall Female Male0
10
20
30
40
50
7/2004-6/2008 7/2008-6/2013
% e
xper
ien
cin
g tr
eate
d r
ejec
tion
wit
hin
1
year
No pair-wise comparisons were significant at p<0.05.
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.
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart RetransplantsFreedom from Coronary Artery Vasculopathy
(Retransplants: April 1994 – June 2012)
0 1 2 3 4 5 6 7 8 90
20
40
60
80
100
Years
% F
ree
fro
m C
AV
Only patients who were less than 18 years old at the time of retransplant are included.2014
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart RetransplantsFreedom from Severe Renal Dysfunction*
(Retransplants: April 1994 – June 2012)
0 1 2 3 4 5 6 7 8 9 100
20
40
60
80
100
Years
% F
ree
from
Sev
ere
Ren
al D
ysfu
nc-
tion
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
Only patients who were less than 18 years old at the time of retransplant are included.2014
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart RetransplantsFreedom from Malignancy (Retransplants: April 1994 – June 2012)
0 1 2 3 4 5 6 7 8 9 10 110
20
40
60
80
100
All malignancy Lymphoma Skin Other
Years
% F
ree
fro
m M
alig
na
nc
y
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart RetransplantsCause of Death (Deaths: January 2000 – June 2013)
CAUSE OF DEATH 0-30 Days
(N = 20)31 Days - 1
Year (N = 29)>1 Year - 3 Years
(N = 21)>3 Years - 5
Years (N = 28) >5 Years - 10 Years (N = 26)
>10 Years(N = 10)
CORONARY ARTERY VASCULOPATHY 3 (10.3%) 1 (4.8%) 10 (35.7%) 9 (34.6%) 1 (10.0%)
ACUTE REJECTION 2 (6.9%) 6 (28.6%) 5 (17.9%) 1 (3.8%)
LYMPHOMA 1 (3.4%) 1 (4.8%)
MALIGNANCY, OTHER 1 (3.8%) 1 (10.0%)
INFECTION, NON-CMV 5 (25.0%) 6 (20.7%) 4 (14.3%) 2 (7.7%) 1 (10.0%)
GRAFT FAILURE 5 (25.0%) 6 (20.7%) 7 (33.3%) 5 (17.9%) 10 (38.5%) 5 (50.0%)
TECHNICAL 3 (15.0%)
OTHER 1 (3.4%) 1 (4.8%) 2 (7.1%) 1 (10.0%)
MULTIPLE ORGAN FAILURE 2 (10.0%) 6 (20.7%) 3 (14.3%) 1 (3.6%) 1 (3.8%)
RENAL FAILURE 1 (4.8%) 1 (10.0%)
PULMONARY 3 (15.0%) 2 (6.9%) 1 (4.8%) 1 (3.6%) 1 (3.8%)
CEREBROVASCULAR 2 (10.0%) 2 (6.9%) 1 (3.8%)
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Retransplants (January 1998 – December 2007)
Risk Factors For 5 Year Mortality after Retransplant
N = 255
Reference group = Cardiomyopathy, no devices2014
JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Retransplants (January 1998 – December 2007)
Risk Factors For 5 Year Mortality After Retransplant
Continuous Factors (see figures)
Recipient BSA Days between primary and retransplant
Donor height/recipient height ratio
2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Retransplants (January 1998 – December 2007)
Risk Factors For 5 Year Mortality with 95% Confidence LimitsRecipient BSA
0.7 0.9 1.1 1.3 1.5 1.70.0
0.5
1.0
1.5
2.0
2.5
3.0
Recipient BSA (m2)
Ha
zard
Ra
tio
of
5 Y
ea
r M
ort
alit
y p = 0.0434
(N = 255)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Retransplants (January 1998 – December 2007)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Donor/Recipient Height Ratio
0.9 1.0 1.1 1.2 1.30.0
0.5
1.0
1.5
2.0
2.5
3.0
Donor height/recipient height
Ha
zard
Ra
tio
of
5 Y
ea
r M
ort
alit
y p = 0.0232
(N = 255)2014JHLT. 2014 Oct; 33(10): 985-995
Pediatric Heart Retransplants (January 1998 – December 2007)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Days between Primary Transplant and Retransplant
0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,0000.0
1.0
2.0
3.0
4.0
Days between primary transplant and retransplant
Ha
zard
Ra
tio
of
5 Y
ea
r M
ort
alit
y p = 0.0064
(N = 255)2014JHLT. 2014 Oct; 33(10): 985-995