HEART TRANSPLANTATION
Pediatric Recipients
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS (Transplants: January 1996 - June 2004)
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)
Nu
mb
er o
f T
ran
spla
nts
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS
(Transplants: January 1996 - June 2004)
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)
Nu
mb
er o
f T
ran
spla
nts
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS
By Year of Transplant
0
100
200
300
40011-17 Years
1-10 Years
<1 Year
11 942
75109
130
194
254
325370367
388370385
359390
369360365
353365
Nu
mb
er o
f T
ran
spla
nts
355
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS
0
20
40
60
80
100
120
Nu
mb
er o
f P
edia
tric
Cas
es R
epo
rtin
g
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
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 2003
MyopathyCongenital
29%
65%
5%
1%
15%
81%2%
2%
Myopathy
Congenital
Other
ReTX
1988-1995 1/1996-6/2004
% o
f C
ases
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
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 2003
Myopathy Congenital
52%
37%
5%6%52%
39%
5%
4%Myopathy
Congenital
Other
ReTX
1988-1995 1/1996-6/2004
% o
f C
ases
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
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 2003
Myopathy Congenital
62%
27%
5%
6%
65%
25%
7%
3%
Myopathy
Congenital
Other
ReTX
1988-1995 1/1996-6/2004
% o
f C
ases
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival (1/1982-6/2003)
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Years
<1 Year (N = 1,375) 1-10 Years (N = 2,106)11-17 Years (N = 2,196) Overall (N = 5,677)
<1 year vs. 1-10 years: p = 0.0082
HALF-LIFE 1-10: 13.1 years; 11-17: 11.3 years
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTATIONConditional Kaplan-Meier Survival (1/1982-6/2003)
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Years
<1 Year (N = 924) 1-10 Years (N = 1,559)11-17 Years (N = 1,644) Overall (N = 4,127)
0-1 vs. 1-10: p=0.0181Both comparisons with 11-17 years significant at p < 0.0001
HALF-LIFE 1-10: 17.5 years; 11-17: 13.7 years
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTATIONConditional 5-year Kaplan-Meier Survival (1/1982-6/2003)
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Years
<1 Year (N = 521) 1-10 Years (N = 854)11-17 Years (N = 856) Overall (N = 2,231)
0-1 vs. 1-10: p=0.00070-1 vs. 11-17: p<0.00011-10 vs. 11-17: p=0.0025
HALF-LIFE not computable for any age group
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTATIONConditional Kaplan-Meier Survival for Recent Era
(1/1999-6/2003)
50
60
70
80
90
100
0 1 2 3 4 5
Years
<1 Year (N = 270) 1-10 Years (N = 464)11-17 Years (N = 464) Overall (N = 1,198)
No comparisons were statistically significant.Half-life for each age group not computable.
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2003)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Years
1982-1988 (N = 570) 1989-1993 (N = 1,704)
1994-1998 (N = 1,873) 1999-6/2003 (N = 1,620)
All p-values significant at < 0.05 except comparison of 1994-1998 vs. 1999-2003
HALF-LIFE 1982-1988: 9.7 years; 1989-1993: 11.5 years;
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2003)
Age: < 1 Year
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Years
1982-1988 (N = 52) 1989-1993 (N = 516)
1994-1998 (N = 462) 2000-6/2003 (N = 370)
P-values for era comparisons1982-88 vs. 1999-03: p = 0.0052; 1989-93 vs. 1994-98: p = 0.00041989-93 vs. 1999-03: p < 0.0001; 1994-98 vs. 1999-03: p = 0.0071
HALF-LIFE 1982-1988: 12.0 years; 1989-1993: 11.4 yearsSu
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2003)
Age: 1-10 Years
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Years
1982-1988 (N = 182) 1989-1993 (N = 599)
1994-1998 (N = 742) 1999-6/2003 (N = 616)
P-values for era comparisons1982-88 vs. 1989-93: p < 0.05; 1982-88 vs. 1994-98: p < 0.0001; 1982-88 vs. 1999-03: p < 0.0001; 1989-93 vs. 1994-1998: p = 0.0008; 1989-94 vs. 1999-03: p < 0.0001
HALF-LIFE 1982-1988: 12.0 years; 1989-1993: 12.3 years
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (1/1982-6/2003)
Age: 11-17 Years
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Years
1982-1988 (N = 336) 1989-1993 (N = 589)
1994-1998 (N = 669) 1999-6/2003 (N = 634)
P-values for era comparisons1982-89 vs. 1995-99: p = 0.0328; 1982-89 vs. 2000-2003: p < 0.0001;
HALF-LIFE 1982-1988: 8.3 years; 1989-1993: 11.1 years;
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Rejection within 1st Year
(Transplants: April 1994 - June 2002)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
Free from Rejection during 1st Year (N = 762)Rejection within 1st Year (N = 899)
p = 0.0002
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Rejection within 1st Year
(Transplants: January 1998 – June 2002)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
Free from Rejection during 1st Year (N = 454)Rejection within 1st Year (N = 526)
p = 0.0001
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003)
Risk Factors For 1 Year Mortality
N=3,014
VARIABLE N
Relative Risk
P-value 95% Confidence
Interval
Congenital diagnosis, on ECMO 69 4.16 <0.0001 2.66 -6.51
Congenital diagnosis, no ECMO 974 2.19 <0.0001 1.74 -2.77
ECMO, diagnosis other than congenital 68 1.9 0.0211 1.10 -3.28
Year of Transplant: 1995 vs. 1998 362 1.9 0.001 1.30 -2.77
Year of Transplant: 1996 vs. 1998 342 1.62 0.018 1.09 -2.42
Hospitalized (including ICU) 2132 1.55 0.0007 1.20 -2.00
Year of Transplant: 1997 vs. 1998 366 1.5 0.0477 1.00 -2.23
On ventilator 448 1.35 0.0239 1.04 -1.76
Female recipient 1300 1.22 0.0409 1.01 -1.48
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003)
Borderline Significant Risk Factors For 1 Year Mortality
N=3,014
VARIABLE N
Relative Risk
P-value 95% Confidence
Interval Other diagnosis (not congenital, retransplant or cardiomyopathy)
106 1.64 0.0634 0.97 -2.75
Recipient on dialysis 48 1.57 0.0884 0.93 -2.63
Re-transplant 142 1.5 0.0903 0.94 -2.39
Year of transplant: 1999 vs. 1998 353 1.47 0.0587 0.99 -2.20
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality
Continuous Factors (see figures) Donor Age
Bilirubin
Creatinine
Weight ratio
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality
Donor Age
0
0.5
1
1.5
2
0 10 20 30 40
Donor Age (Years)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.0014
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality
Pre-Transplant Bilirubin
0
0.5
1
1.5
2
0 1 2 3 4 5 6 7 8 9 10
Recipient Bilirubin (mg/dl)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.006
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality
Pre-Transplant Creatinine
0
0.5
1
1.5
2
0 0.5 1 1.5 2 2.5
Recipient serum creatinine (mg/dl)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p < 0.0001
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality
Weight Ratio
0
0.5
1
1.5
2
0.5 1 1.5 2 2.5 3 3.5
Weight ratio (donor weight/recipient weight)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.024
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Factors Not Significant for 1 Year Mortality
Recipient Factors:IV inotropes, sternotomy, thoracotomy, history of malignancy, height, recent infection, age, PA pressure, cardiac output, pulmonary vascular resistance, PRA
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) Factors Not Significant for 1 Year Mortality
Donor Factors:Gender, history of hypertension, height, clinical infection, cause of death, history of diabetes
Transplant Factors:CMV mismatch, ABO identical/compatible, ischemia time, HLA mismatch, transplant center volume
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) 1-Year Predicted Survival – Hypothetical Cases #1 and #2
50%
60%
70%
80%
90%
100%
0 30 60 90 120 150 180 210 240 270 300 330 360
Time (days)
Pre
dic
ted
Su
rviv
al .
CASE #1: Recipient: male with congenital diagnosis, 3 months old, 3 kg, creatinine=0.6, not hospitalized; Donor: male, 6 months old, 5 kg
CASE #2: Recipient : male with congenital diagnosis, 3 months old, 3.5 kg, creatinine=1.5, ECMO, PGE, ventilator; Donor: male, 18 months old, 10 kg
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) 1-Year Predicted Survival – Hypothetical Case #3
50%
60%
70%
80%
90%
100%
0 30 60 90 120 150 180 210 240 270 300 330 360
Time (days)
Pre
dic
ted
Su
rviv
all
CASE #3: Recipient: female with congenital diagnosis, 6 years old, 12 kg, creatinine=1.0, not hospitalized; Donor: female, 9 years old, 18 kg
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2003) 1-Year Predicted Survival – Hypothetical Cases #4 and #5
50%
60%
70%
80%
90%
100%
0 30 60 90 120 150 180 210 240 270 300 330 360
Time (days)
Pre
dic
ted
Su
rviv
all
CASE #4: Recipient: male with cardiomyopathy, 14 years old, 30 kg, creatinine=1.0, hospitalized; Donor: male, 16 years old, 40 kg
CASE #5: Recipient: male with congenital diagnosis, 14 years old, 40 kg, creatinine=1.8, hospitalized; Donor: male, 22 years old, 65 kg
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999)
Risk Factors For 5 Year Mortality
N=1,598
VARIABLE N Relative
Risk P-value
95% Confidence Interval
Recipient on dialysis 17 2.64 .0038 1.37 -5.09
Congenital diagnosis, on ECMO 24 2.53 .0039 1.35 -4.77
Re-transplant 63 1.81 .0110 1.15 -2.86
Congenital diagnosis, age=0, PGE 124 1.72 .0095 1.14 -2.59
Congenital diagnosis, no ECMO 522 1.69 <0.0001 1.34 -2.13
Female donor 667 1.28 .0158 1.05 -1.55
IV inotropes 633 1.26 .0366 1.01 -1.57
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality
Continuous Factors (see figures)
Recipient weight Creatinine (borderline)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality Pre-Transplant Recipient Weight
0
1
2
3
0 15 30 45 60 75
Recipient Weight (kg)
Rela
tive R
isk o
f 5 Y
ear
Mo
rtality
.
p = 0.0067
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality
Pre-Transplant Creatinine
0
0.5
1
1.5
2
0 0.5 1 1.5 2 2.5
Recipient serum creatinine (mg/dl)
Rela
tive R
isk o
f 5 Y
ear
Mo
rtality
.
p = 0.071
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999) Factors Not Significant for 5 Year Mortality
Recipient Factors:History of malignancy, recent infection, bilirubin, age, hospitalized at time of transplant, PRA, pulmonary vascular resistance, gender, PA pressures, cardiac output, sternotomy, height
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999) Factors Not Significant for 5 Year Mortality
Donor Factors:Cause of death, history of hypertension, weight, height, age
Transplant Factors:Donor/recipient weight ratio, year of transplant, CMV mismatch, ischemia time, HLA mismatch, transplant center volume
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999) 5-Year Predicted Survival – Hypothetical Cases #1,2 and 3
50%
60%
70%
80%
90%
100%
0 1 2 3 4 5
Time (years)
Pre
dic
ted
Su
rviv
all
CASE #1: Recipient: male with congenital diagnosis, 3 months old, 3 kg, creatinine=0.6, not hospitalized; Donor: male, 6 months old, 5 kg
CASE #2: Recipient: female with congenital diagnosis, 6 years old, 12 kg, creatinine=1.0, not hospitalized; Donor: female, 9 years old, 18 kg
CASE #3: Recipient: male with congenital diagnosis, 14 years old, 40 kg, creatinine=1.8, hospitalized, on inotropes; Donor: male, 22 years old, 65 kg
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999) 5-Year Predicted Survival – Hypothetical Cases #4 and 5
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0 1 2 3 4 5
Time (years)
Pre
dic
ted
Su
rviv
all
CASE #4: Recipient: male with congenital diagnosis, 3 months old, 3.5 kg, creatinine=1.5, ECMO, PGE, ventilator; Donor: male, 18 months old, 10 kg
CASE #5: Recipient: male with cardiomyopathy, 14 years old, 30 kg, creatinine=1.0, hospitalized, on inotropes; Donor: male, 16 years old, 40 kg
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999)Risk Factors For 5 Year Mortality Conditional on 1 Year Survival
N=1,276
VARIABLE N Relative
Risk P-value
95% Confidence Interval
ECMO, diagnosis other than congenital
22 2.94 0.0126 1.26 -6.86
Re-transplant 50 2.41 0.004 1.32 -4.37
Congenital diagnosis, age=0, PGE 93 2.28 0.0198 1.14 -4.55
Treated for rejection (after transplant hospitalization)
328 2.19 <0.0001 1.57 -3.03
Female recipient 536 1.45 0.0282 1.04 -2.01
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999) Risk Factors For 5 Year Mortality Conditional on 1 Year Survival
Continuous Factors (see figures)
Recipient weight Ischemia time
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999) Risk Factors For 5 Year Mortality Conditional on 1 Year Survival
Recipient Weight
0
0.5
1
1.5
2
0 15 30 45 60 75
Recipient Weight (kg)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity p = 0.002
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999) Risk Factors For 5 Year Mortality Conditional on 1 Year Survival
Ischemia Time
0
0.5
1
1.5
2
1 2 3 4 5 6 7
Ischemia time (hours)
Rela
tive R
isk o
f 5 Y
ear
Mo
rtality
.
p = 0.002
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999) Factors Not Significant for Conditional 5 Year Mortality
Recipient Factors:History of malignancy, recent infection, hospitalized at time of transplant, bilirubin, creatinine, cardiac output, pulmonary vascular resistance, PRA, sternotomy, ventilator, VAD, age, PA pressures
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999) Factors Not Significant for Conditional 5 Year Mortality
Donor Factors:Cause of death, history of hypertension, weight, height, age, gender, clinical infection at donation
Transplant Factors:Donor/recipient weight ratio, year of transplant, CMV mismatch, transplant center volume, induction use, treated for infection prior to discharge, dialysis prior to discharge
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999) 5-Year Predicted Survival Conditional on Survival to 1 Year –
Hypothetical Case #1
50%
60%
70%
80%
90%
100%
1 2 3 4 5
Time (years)
Pre
dic
ted
Su
rviv
all
Not treated for rejection
Treated for rejection
Recipient: male with congenital diagnosis, 3 months old, 3 kg, creatinine=0.6, not hospitalized;
Donor: male, 6 months old, 5 kg
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999) 5-Year Predicted Survival Conditional on Survival to 1 Year –
Hypothetical Case #2
50%
60%
70%
80%
90%
100%
1 2 3 4 5
Time (years)
Pre
dic
ted
Su
rviv
all
Not treated for rejection
Treated for rejection
Recipient: male with congenital diagnosis, 3 months old, 3.5 kg, creatinine=1.5, ECMO, PGE, ventilator;
Donor: male, 18 months old, 10 kg
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999) 5-Year Predicted Survival Conditional on Survival to 1 Year –
Hypothetical Case #3
50%
60%
70%
80%
90%
100%
1 2 3 4 5
Time (years)
Pre
dic
ted
Su
rviv
all
Not treated for rejection
Treated for rejection
Recipient: female with congenital diagnosis, 6 years old, 12 kg, creatinine=1.0, not hospitalized;
Donor: female, 9 years old, 18 kg
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999) 5-Year Predicted Survival Conditional on Survival to 1 Year –
Hypothetical Case #4
50%
60%
70%
80%
90%
100%
1 2 3 4 5
Time (years)
Pre
dic
ted
Su
rviv
all
Not treated for rejection
Treated for rejection
Recipient: male with cardiomyopathy, 14 years old, 30 kg, creatinine=1.0, hospitalized, on inotropes;
Donor: male, 16 years old, 40 kg
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1999) 5-Year Predicted Survival Conditional on Survival to 1 Year –
Hypothetical Case #5
50%
60%
70%
80%
90%
100%
1 2 3 4 5
Time (years)
Pre
dic
ted
Su
rviv
all
Not treated for rejection
Treated for rejection
Recipient: male with congenital diagnosis, 14 years old, 40 kg, creatinine=1.8, hospitalized, on inotropes;
Donor: male, 22 years old, 65 kg
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: April 1994 - June 2004)
0%
20%
40%
60%
80%
100%
1 Year (N = 1,947) 3 Years (N = 1,621) 5 Years (N = 1,305) 7 Years (N = 924)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2004)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N = 2,236)
Between 2 and 3Years (N = 1,762)
Between 4 and 5Years (N = 1,387)
Between 6 and 7Years (N = 1,017)
No Hospitalization Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection Hospitalized, Infection Only
Hospitalized, Rejection + Infection
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0
10
20
30
40
50
Any Induction (N = 472) Polyclonal ALG/ATG (N = 295)
OKT3 (N = 29) IL2R-antagonist (N = 167)
PEDIATRIC HEART RECIPIENTS Induction Immunosuppression (Follow-ups: January 2001 - June 2004)
% o
f P
atie
nts
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0
10
20
30
40
50
60
Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist
% o
f P
atien
ts
2001 2002
2003 1/2004-6/2004
PEDIATRIC HEART RECIPIENTSInduction Immunosuppression (Follow-ups: January 2001 - June 2004)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
Year 1 (N = 822) Year 5 (N = 558)
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2001 - June 2004)
NOTE: Different patients are analyzed in Year 1 and Year 5
% o
f P
atie
nts
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0%
20%
40%
60%
80%
100%
Year 1 (N = 815) Year 5 (N = 571)
Other
Tacrolimus
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine
Cyclosporine + MMF
Cyclosporine + AZA
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
(Follow-ups: January 2001 - June 2004)
NOTE: Different patients are analyzed in Year 1 and Year 5
% o
f P
atie
nts
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEARStratified by Induction (Transplants: January 2000 - June 2003)
0
10
20
30
40
50
60
Overall <1 1-10 11-17 F M
No induction Used Induction Used (no OKT3)
Age group Gender
% t
reat
ed f
or
reje
ctio
n w
ith
in 1
yea
r
No within age group or gender comparisons were significant.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Induction (Transplants: January 2000 - June 2003)
0
0.5
1
1.5
2
2.5
Overall <1 1-10 11-17 F M
No induction Used Induction Used (no OKT3)
No within age group or gender comparisons were significant.
Age group Gender
Ave
rag
e n
um
ber
of
reje
ctio
n e
pis
od
es
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Type of Induction (Transplants: January 2000 - June 2003)
0
10
20
30
40
50
60
70
80
90
Overall <1 1-10 11-17 F M
No induction PolyclonalIL2R-antagonist OKT3
% t
reat
ed f
or
reje
ctio
n w
ith
in 1
yea
r
Overall: No induction vs. OKT3 (p = 0.0003); polyclonal vs. OKT3 (p = 0.0017); IL2 vs. OKT3 (p = 0.0010). 1-10: No induction vs. polyclonal (p = 0.04); 11-17: No induction vs. OKT3 (p = 0.003); polyclonal vs. OKT3 (p = 0.007); IL2R vs. OKT3 (p = 0.002)Female: No induction vs. OKT3 (p = 0.003); polyclonal vs. OKT3 (p = 0.01); IL2R vs. OTK3 (p = 0.03)Male: No induction vs. OKT3 (p=0.03); polyclonal vs. OKT3 (p < 0.05); IL2R vs. OKT3 (p = 0.01)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Type of Induction (Transplants: January 2000 - June 2003)
0
0.5
1
1.5
2
2.5
Overall <1 1-10 11-17 F M
No induction Polyclonal IL2R-antagonist OKT3
11-17 years: No induction vs. OKT3 (p = 0.04). No other comparisons were significant.
Ave
rag
e n
um
ber
of
reje
ctio
n e
pis
od
es
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression and Induction (Transplants: January 2000 - June 2003)
0
10
20
30
40
50
60
Overall <1 1-10 11-17 F M
CyA + No induction Used CyA + Induction Used (no OKT3)TAC + No induction Used TAC + Induction Used (no OKT3)
Age group Gender% t
reat
ed f
or
reje
ctio
n w
ith
in 1
yea
r
Overall: CyA + no induction vs. TAC + no induction: p = 0.0045; CyA + induction vs. TAC + induction: p = 0.0188; CyA + induction vs. TAC + no induction: p = 0.0204; CyA + no induction vs. TAC +induction: p = 0.0071; 1-10 years: CyA + no induction vs. TAC + no induction: p = 0.0313; CyA + induction vs. TAC + induction: p = 0.0144; CyA + induction vs. TAC + no induction: p = 0.0011.Female: CyA + no induction vs. TAC + no induction: p=0.008; CyA + induction vs. TAC + induction: p = 0.0163; CyA + induction vs. TAC + no induction: p = 0.0166; CyA + no induction vs. TAC + induction: p = 0.0097.No other age group or gender differences were significant.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression and Induction (Transplants: January 2000 - June 2003)
0
0.5
1
1.5
2
2.5
Overall <1 1-10 11-17 F M
CyA + No induction Used CyA + Induction Used (no OKT3)TAC + No induction Used TAC + Induction Used (no OKT3)
<1 years: CyA + no induction vs. TAC + no induction: p = 0.0477.No other age group or gender comparisons were significant.
Age group Gender
Ave
rag
e n
um
ber
of
reje
ctio
n e
pis
od
es
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression (Transplants: January 2000 - June 2003)
0
10
20
30
40
50
60
70
Overall <1 1-10 11-17 F M
Cyclosporin + MMF Cyclosporin + AZATacrolimus + MMF Tacrolimus + AZA
% t
reat
ed f
or
reje
ctio
n w
ith
in 1
yea
r
Overall: CyA+MMF vs. TAC+MMF (p = 0.0071); CyA +MMF vs. TAC + AZA (p = 0.0018); CyA + AZA vs. TAC + MMF (p = 0.0026); CyA + AZA vs. TAC + AZA (p = 0.0009).<1: CyA + MMF vs. TAC + MMF ( p = 0.03); CyA + AZA vs. TAC + MMF (p = 0.005). 1-10: Cya + MMF vs. TAC + AZA (p = 0.005); CyA + AZA vs. TAC + AZA (p = 0.004).11-17: CyA + AZA vs. TAC + MMF (p = 0.01). Female: CyA + MMF vs. TAC + AZA (p = 0.002); CyA + AZA vs. TAC + MMF (p = 0.01); CyA + AZA vs. TAC + AZA (p=0.0006); TAC + MMF vs. TAC + AZA (p = 0.03). Male: CyA + MMF vs. TAC + MMF (p < 0.05)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 2000 - June 2003)
0
0.5
1
1.5
2
2.5
3
Overall <1 1-10 11-17 F M
Cyclosporin + MMF Cyclosporin + AZATacrolimus + MMF Tacrolimus + AZA
Ave
rag
e n
um
ber
of
reje
ctio
n e
pis
od
es
<1 years: CyA + AZA vs. TAC + MMF (p=0.004). No other age group or gender comparisons were significant.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Tacrolimus vs. Cyclosporine Use at Discharge Conditional on Survival to 14 Days
(Transplants: January 2000 - June 2003)
0
10
20
30
40
50
60
Overall <1 1-10 11-17 F M
Cyclosporine Tacrolimus
Age group Gender
% t
reat
ed f
or
reje
ctio
n w
ith
in 1
yea
r
<1: CyA vs. TAC (p = 0.0156)1-10: CyA vs. TAC (p = 0.0013)Females: CyA vs. TAC (p = 0.0001)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
NUMBER OF REJECTION EPISODES FOR PEDIATRIC HEART TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Tacrolimus vs. Cyclosporine Use at Discharge
Conditional on Survival to 14 Days (Transplants: January 2000 - June 2003)
0
0.5
1
1.5
2
2.5
Overall <1 1-10 11-17 F M
Cyclosporine Tacrolimus
No within age group or gender comparisons were significant.
Age group Gender
Ave
rag
e n
um
ber
of
reje
ctio
n e
pis
od
es
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994 - June 2004)
Outcome Within 1
Year Total number with known response
Hypertension 46.7% (N = 2,184)
Renal Dysfunction 5.8% (N = 2,183)
Abnormal Creatinine < 2.5 mg/dl 3.8% Creatinine > 2.5 mg/dl 1.3% Chronic Dialysis 0.6% Renal Transplant 0.0%
Hyperlipidemia 10.1% (N = 2,285)
Diabetes 3.2% (N = 2,188)
Coronary Artery Vasculopathy 2.5% (N = 1,996)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 5 Years Post-Transplant
(Follow-ups: April 1994 - June 2004)
Outcome Within 5
Years Total number with known response
Hypertension 61.4% (N = 696)
Renal Dysfunction 9.4% (N = 715)
Abnormal Creatinine < 2.5 mg/dl 8.0% Creatinine > 2.5 mg/dl 0.8% Chronic Dialysis 0.4% Renal Transplant 0.1%
Hyperlipidemia 21.4% (N = 746)
Diabetes 4.6% (N = 694)
Coronary Artery Vasculopathy 11.0% (N = 480)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
POST-HEART TRANSPLANT MORBIDITY FOR PEDIATRICS Cumulative Prevalence in Survivors within 7 Years Post-Transplant
(Follow-ups: April 1994 - June 2004)
Outcome Within 7
Years Total number with known response
Hypertension 65.8% (N = 357)
Renal Dysfunction 11.4% (N = 370) Abnormal Creatinine < 2.5 mg/dl 7.8% Creatinine > 2.5 mg/dl 2.2% Chronic Dialysis 0.5% Renal Transplant 0.8%
Hyperlipidemia 26.3% (N = 388)
Diabetes 3.9% (N = 358)
Coronary Artery Vasculopathy 15.2% (N = 217)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2004)
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
% F
reed
om
fro
m C
AV
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2004)
Stratified by Induction
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
Induction (N =806)
No Induction (N = 1,362)% F
ree
do
m f
rom
CA
V
p = 0.43
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2004)
Stratified by Age Group
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
<1 Year (N =574)
1-10 Years (N = 862)
11-17 Years (N = 838)
p = 0.0001
% F
ree
do
m f
rom
CA
V
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
GRAFT SURVIVAL FOLLOWING REPORT OF CORONARY ARTERY VASCULOPATHY
For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2004)Stratified by Age Group
0
10
20
30
40
50
60
70
80
90
100
0 0.5 1 1.5 2 2.5
Time since Report of CAV (Years)
<1 Year (N = 35)
1-10 Years (N = 69)
11-17 Years (N = 88)
p = 0.1108
Su
rviv
al s
ince
Rep
ort
of
CA
V (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2004)
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
* Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant
% F
reed
om
fro
m S
ever
e
Ren
al D
ysfu
nct
ion
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2004)
Malignancy/Type 1-Year Survivors
5-Year Survivors
7-Year Survivors
No Malignancy2230 (98.0%) 716 (95.9%) 365 (93.8%)
Malignancy (all types combined) 45 (2.0%) 31 (4.1%) 24 (6.2%)
Malignancy Type
Lymph 41 27 22
Other 3 3
Type Not Reported 1
Other types: Ewings, Large cell lymphoma
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
FREEDOM FROM MALIGNANCYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2004)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
All malignancy Lymph Skin Other
% F
reed
om
fro
m M
alig
nan
cy
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Prednisone Use
(Transplants: April 1994 - June 2003)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
Prednisone use at discharge and 1 year (N = 1,256)
No Prednisone at discharge or at 1 year (N = 215)
Prednisone at discharge/not at 1 year (N = 249)
p = 0.0006
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Prednisone Use
(Transplants: January 1998 – June 2003)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
Prednisone use at discharge and 1 year (N = 924)
No Prednisone at discharge or at 1 year (N = 139)
Prednisone at discharge/not at 1 year (N = 187)
p = 0.009
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group
(Transplants: January 2000 – June 2003) Conditional on Survival to 14 Days
50
60
70
80
90
100
0 1 2 3
Years
No induction (N = 604)
Polyclonal induction (N = 290)
IL2R-antagonist (N = 104)
OKT3 (N = 40)
Su
rviv
al (
%)
No comparisons were statistically significant.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2003)
Conditional on Survival to 14 DaysAge: < 1 Year
50
60
70
80
90
100
0 1 2 3
Years
No induction (N = 123)Polyclonal induction (N = 109)IL2R-antagonist (N = 16)
No comparisons were statistically significant.
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2003)
Conditional on Survival to 14 DaysAge: 1-10 Years
50
60
70
80
90
100
0 1 2 3
Years
No induction (N = 252)Polyclonal induction (N = 102)IL2R-antagonist (N = 35)
No induction vs. polyclonal: p = 0.00182
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2003)
Conditional on Survival to 14 DaysAge: 11-17 Years
50
60
70
80
90
100
0 1 2 3 4
Years
No induction (N = 229)Polyclonal induction (N =79)IL2R-antagonist (N = 53)OKT3 (N = 24)
No comparisons were statistically significant.
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use at Discharge
(Transplants: January 1998 - June 2003) Conditional on Survival to 14 Days
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
Tacrolimus use at discharge (N = 449)
Cyclosporine use at discharge (N = 1,029)
Su
rviv
al (
%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 1 and 3 Years
(Transplants: April 1993 - June 2001)
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 21.6% 22.1% 0.9
Cyclosporine 20.5% 21.4% 0.8
MMF 19.9% 21.0% 0.8
Prednisone 28.9% 6.6% <0.0001
Rapamycin . 20.6%
Tacrolimus 24.8% 19.5% 0.2
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART RECIPIENTSRelationship of Rejection and Coronary Artery Vasculopathy
(Follow-ups: April 1994 – June 2004)
Rejection During 1st
Year
Reported CAV between 1st and 3rd years
post-transplant
Reported CAV between 3rd
and 5th years
post-transplant
Yes No All Yes No All
Yes 36
8.1%
408
91.9%
444
100%
12
6.5%
174
93.5%
186
100%
No 13
3.0%
420
97.0%
433
100%
9
4.6%
188
95.4%
197
100%
p = 0.001 p = 0.4185NOTE: Only those recipients without CAV prior to 3 years were included in the last set of columnsISHLT 2005
J Heart Lung Transplant 2005;24: 945-982
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
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
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
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2004)
CAUSE OF DEATH 0-30 Days (N = 335)
31 Days - 1 Year (N = 281)
>1 Year - 3 Years (N = 198)
>3 Years - 5 Years (N = 139)
>5 Years (N = 252)
CORONARY ARTERY VASCULOPATHY
3 (0.9%) 26 (9.3%) 36 (18.2%) 52 (37.4%) 72 (28.6%)
ACUTE REJECTION 27 (8.1%) 76 (27.0%) 54 (27.3%) 18 (12.9%) 32 (12.7%)
LYMPHOMA 6 (2.1%) 10 (5.1%) 3 (2.2%) 21 (8.3%)
MALIGNANCY, OTHER 4 (1.4%) 2 (1.0%) 1 (0.7%) 9 (3.6%)
CMV 1 (0.3%) 7 (2.5%) 1 (0.5%)
INFECTION, NON-CMV 47 (14.0%) 46 (16.4%) 17 (8.6%) 6 (4.3%) 16 (6.3%)
PRIMARY FAILURE 58 (17.3%) 11 (3.9%) 6 (3.0%) 8 (5.8%) 12 (4.8%)
GRAFT FAILURE 79 (23.6%) 31 (11.0%) 35 (17.7%) 27 (19.4%) 49 (19.4%)
TECHNICAL 21 (6.3%) 2 (0.7%) 2 (1.0%) 1 (0.7%) 1 (0.4%)
OTHER 15 (4.5%) 16 (5.7%) 16 (8.1%) 14 (10.1%) 24 (9.5%)
MULTIPLE ORGAN FAILURE
36 (10.7%) 29 (10.3%) 3 (1.5%) 2 (1.4%) 6 (2.4%)
RENAL FAILURE 1 (0.3%) 4 (1.4%) 1 (0.5%)
PULMONARY 24 (7.2%) 16 (5.7%) 9 (4.5%) 6 (4.3%) 7 (2.8%)
CEREBROVASCULAR 23 (6.9%) 7 (2.5%) 6 (3.0%) 1 (0.7%) 3 (1.2%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
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