HEART TRANSPLANTATION Pediatric Recipients ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983.
Post on 27-Mar-2015
216 Views
Preview:
Transcript
HEART TRANSPLANTATION
Pediatric Recipients
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS (Transplants: January 1996 - June 2007)
0100200
300400500600
700800900
10001100
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 2008 J Heart Lung Transplant 2008;27: 937-983
AGE DISTRIBUTION FOR DONORS OF PEDIATRIC HEART RECIPIENTS
(Transplants: January 1996 - June 2007)
Nu
mb
er o
f T
ran
spla
nts
ISHLT 2008
0
100
200
300
400
500
600
700
800
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)
J Heart Lung Transplant 2008;27: 937-983
AGE DISTRIBUTION OF PEDIATRIC HEART RECIPIENTS
By Year of Transplant
0
50
100
150
200
250
300
350
400
450
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
11-17 Years
1-10 Years
<1 Year
Nu
mb
er o
f T
ran
spla
nts
ISHLT 2008
NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as evidence that the number of hearts transplanted worldwide has increased and/or decreased in recent years.
J Heart Lung Transplant 2008;27: 937-983
NUMBER OF CENTERS REPORTING PEDIATRIC HEART TRANSPLANTS
0102030405060708090
100110
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006N
um
ber
of
Ped
iatr
ic C
ases
Rep
ort
ing
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
AVERAGE CENTER VOLUMEPediatric Heart Transplants: January 1, 1997 - June 30, 2007
125
17
110
17 1590102030405060708090
100110120130
1-4/yr 5-9/yr 10-19/yr
Average number of heart transplants per year
Nu
mb
er
of
ce
nte
rs
.
1997-2000
2001-June 2007
ISHLT 2008J Heart Lung Transplant 2008;27: 937-983
DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME
Pediatric Heart Transplants: January 1, 1997 - June 30, 2007
35.728.4 30.627.7 24.5
47.8
0
10
20
30
40
50
1-4 5-9 10-19
Average number of heart transplants per year
% o
f tr
ansp
lan
ts .
1997-2000 2001-June 2007
ISHLT 2008J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART RE-TRANSPLANTSBy Transplant Year
Retransplants: January 1994 – December 2006
0
5
10
15
20
25
30
35
40
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Nu
mb
er
of
tra
ns
pla
nts
Year of transplantISHLT 2008J Heart Lung Transplant 2008;27: 937-983
0
10
20
30
40
50
<1 month 1-<12 months 12-<36 months 36-<60 months 60+ months Not reported
% o
f R
e-T
ran
spla
nts
PEDIATRIC HEART RE-TRANSPLANTSBy Intertransplant Interval
Retransplants: January 1994 - June 2007
ISHLT 2008
Time Between Previous and Current Transplant
J Heart Lung Transplant 2008;27: 937-983
40
50
60
70
80
90
100
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
Su
rrv
iva
l (%
)
<1 Year (N=40) 1-<3 Years (N=30) 3-<5 Years (N=38)
5+ Years (N=114) Primary TX (N=4,593)
Comparison of survival for re-transplant groups: p = 0.0053
KAPLAN-MEIER SURVIVAL RATES FOR PEDIATRIC HEART RETRANSPLANTS STRATIFIED BY INTER-TRANSPLANT INTERVAL
Retransplants: January 1994 - June 2006
ISHLT 2008
Time (years) since most recent transplant
J Heart Lung Transplant 2008;27: 937-983
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: < 1 Year)
02550
75100
Myopathy Congenital
30%
63%
6%
1%
17%
78%4%
1%
Myopathy
Congenital
Other
ReTX
1988-1995 1/1996-6/2007
% o
f C
ases
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 1-10 Years)
025
5075
100Myopathy Congenital
52%
37%
6%
5%52%
40%
4%
4%Myopathy
Congenital
Other
ReTX
1988-1995 1/1996-6/2007
% o
f C
ases
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
DIAGNOSIS IN PEDIATRIC HEART TRANSPLANT RECIPIENTS (Age: 11-17 Years)
025
5075
100Myopathy Congenital
61%
7%
25%
7%67%
3%
26%
4%
Myopathy
Congenital
Other
ReTX1988-1995 1/1996-6/2007
% o
f C
ases
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival (Transplants: 1/1982-6/2006)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years
<1 Year (N = 1,862) 1-10 Years (N = 2,598)11-17 Years (N = 2,742) Overall (N = 7,202)
0-<1 vs. 1-10: p = 0.0005; 0-<1 vs. 11-17: p=0.1835; 1-10 vs. 11-17: p=0.0099.
Half-life <1: 15.8 Years; 1-10: 15.0 Years; 11-17: 11.3 Years
Su
rviv
al (
%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATIONConditional Kaplan-Meier Survival
(Transplants: 1/1982-6/2006)
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years
<1 Year (N = 1,267) 1-10 Years (N = 1,985)11-17 Years (N = 2,130) Overall (N = 5,382)
0-<1 vs. 1-10: p = 0.0096; 0-<1 vs. 11-17: p < 0.0001;1-10 vs. 11-17: p < 0.0001.
Half-life: <1: n.c.; 1-10: 18.7 Years; 11-17: 15.2 Years
Su
rviv
al (
%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATIONConditional Kaplan-Meier Survival for Recent Era
(Transplants: 1/1999-6/2006)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
<1 Year (N = 519) 1-10 Years (N = 873)11-17 Years (N = 910) Overall (N = 2,302)
0-<1 vs. 1-10: p = 0.3648;0-<1 vs. 11-17: p = 0.0032; 1-10 vs. 11-17: p < 0.0001
Su
rviv
al (
%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Era
(Transplants: 1/1982-6/2006)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years
1982-1989 (N=869) 1990-1994 (N=1,863)
1995-1999 (N=1,902) 2000-6/2006 (N=2,568)
All p-values significant at p< 0.0001 except comparison of 1995-1999 vs. 2000-6/2006
Half-life 1982-1989: 9.9 years; 1990-1994: 12.4 years; 1995-1999: n.c.; 2000-6/2006: n.c.
Su
rviv
al (
%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: 1/1982-6/2005)
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 16Years
1982-1989 (N=167) 1990-1994 (N=562)
1995-1999 (N=480) 2000-6/2005 (N =473)
P-values for era comparisons82-89 vs. 90-94: 0.3879; 82-89 vs. 95-99: <.0001; 82_90 vs. 00-6/05: <.000190-94 vs. 95-99: <.0001; 90-94 vs. 00-6/05: <.0001; 95-99 vs. 00-6/05: 0.7892
Half-life 1982-1989: 10.8 years; 1990-1994: 10.6 years; 1995-1999: n.c. ; 2000-6/2005: n.c.S
urv
ival
(%
)
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Era (Transplants: 1/1982-6/2005)
Age: 1-10 Years
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Years
1982-1989 (N = 266) 1990-1994 (N=652)
1995-1999 (N=724) 2000-6/2005 (N=790)
P-values for era comparisons82-89 vs. 90-94: 0.0270; 82-89 vs. 95-99: <.0001; 82-89 vs. 00-6/05: <.0001 90-94 vs. 95-99: 0.0021;89-94 vs. 00-6/05: <.0001; 95-99 vs. 00-6/05: 0.2005
Half-life 1982-1989: 10.9; 1990-1994: 12.5; 1995-1999: . ; 2000-6/2005: n.a.
Su
rviv
al (
%)
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Era (Transplants: 1/1982-6/2005)
Age: 11-17 Years
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Years
1982-1989 (N=427) 1990-1994 (N=628)
1995-1999 (N=673) 2000-6/2005 (N=833)
P-values for era comparisons82-89 vs. 90-94: 0.0465; 82-89 vs. 95-99: 0.0860; 82_90 vs. 88-6/05: <.0001; 90-94 vs. 95-99: 0.6394; 90-94 vs. 00-6/05: 0.0577; 95-99 vs. 00-6/05: 0.2086
Half-life 1982-1989: 9.9; 1990-1994: 11.5; 1995-1999: 10.1; 2000-6/2005: n.a.
Su
rviv
al (
%)
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f T
ran
spla
nts
1-4/yr 5-9/yr 10-19/yr
PEDIATRIC HEART TRANSPLANTS: AVERAGE CENTER VOLUME DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2007
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f T
ran
spla
nts
<1 years 1-10 years 11-17 years
PEDIATRIC HEART TRANSPLANTS:AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2007
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f T
ran
sp
lan
ts
Other
Re-TX/GraftFailure
Malignancy
Coronary ArteryDisease
Congenital
Cardiomyopathy
PEDIATRIC HEART TRANSPLANTS:DIAGNOSIS DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2007
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f D
ono
rs
<1 1-10 11-17 18-34 35-49 50-64
PEDIATRIC HEART TRANSPLANTS:DONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2007
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2006)
Risk Factors For 1 Year Mortality
N=3,395
VARIABLE N
Relative Risk
P-value 95% Confidence Interval
Congenital diagnosis, age > 0, on ECMO 56 4.80 <0.0001 2.94 -7.83
Congenital diagnosis, age = 0, on ECMO 63 4.74 <0.0001 2.99 -7.53
Congenital diagnosis, age > 0, no ECMO 735 2.32 <0.0001 1.76 -3.06
Retransplant 201 2.26 0.0001 1.52 -3.36
Congenital diagnosis, age=0, on PGE 209 1.93 0.0021 1.27 -2.93
Congenital diagnosis, age = 0, no PGE or ECMO 352 1.7 0.0039 1.19 -2.45
Year of Transplant: 1995-96 vs. 1999-2000 505 1.54 0.0057 1.13 -2.08
On ventilator 636 1.51 0.0008 1.19 -1.92
Female recipient 1488 1.23 0.0321 1.02 -1.48
Not ABO identical 759 0.77 0.0231 0.61 -0.96
ISHLT 2008
Reference diagnosis = cardiomyopathyJ Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2005)
Borderline Significant Risk Factors For 1 Year Mortality
N=3,395
VARIABLE N Relative
Risk P-value
95% Confidence Interval
VAD (diagnosis other than congenital) 217 1.44 0.0769 0.96 -2.14
Infection requiring IV drug therapy (with 2wk/TX)
511 1.23 0.0952 0.96 -1.56
Donor cause of death = anoxia 764 0.82 0.0893 0.66 -1.03
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Recipient Age (borderline) Creatinine
Donor Age Donor BSA (borderline)
Pediatric transplant volume
ISHLT 2008
N=3,395
J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality
Recipient Age
0
0.5
1
1.5
2
2.5
0 3 6 9 12 15 18
Recipient Age (Years)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.081
ISHLT 2008 N=3,395J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality
Donor Age
0
0.5
1
1.5
2
0 10 20 30 40
Donor Age (Years)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.006
ISHLT 2008 N=3,395J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2006) 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)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2008 N=3,395J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality
Center Volume for Pediatric Transplants
0
0.5
1
1.5
2
2.5
0 2 4 6 8 10 12 14 16 18 20
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.012
ISHLT 2008 N=3,395J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality
Donor BSA
0
0.5
1
1.5
2
0 0.5 1 1.5 2
Donor body surface area (m2)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.074
ISHLT 2008 N=3,395J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2006) Factors Not Significant for 1 Year Mortality
Recipient Factors:IV inotropes, sternotomy, history of malignancy, hospitalized, diabetes
Donor Factors:Gender, clinical infection, history of diabetes
Transplant Factors:CMV mismatch, ischemia time, HLA mismatch
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997)
Risk Factors For 10 Year Mortality
N=697
VARIABLE N Relative
Risk P-
value 95% Confidence
Interval
Congenital diagnosis, ECMO 15 3.31 .0078 1.37 -7.99
Ventilator 107 1.60 .0339 1.04 -2.48
Female donor 299 1.56 .0141 1.09 -2.24
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality
Continuous Factors (see figures)
Creatinine BSA ratio (borderline)
Pediatric transplant volume Donor weight
ISHLT 2008
N=697J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality
Pre-Transplant Creatinine
0
0.5
1
1.5
2
2.5
0 0.5 1 1.5 2
Creatinine (mg/dl)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
p = 0.0029
ISHLT 2008
N=697J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality
Donor Weight
0
0.5
1
1.5
2
2.5
0 10 20 30 40 50 60 70 80
Donor weight (kg)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
p = 0.0008
ISHLT 2008 N=697J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality
Center Volume for Pediatric Transplants
0
0.5
1
1.5
2
0 2 4 6 8 10 12 14 16 18 20
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
p = 0.0017
ISHLT 2008
N=697J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 10 Year Mortality
BSA Ratio (Donor BSA/Recipient BSA)
0
0.5
1
1.5
2
2.5
0.8 1 1.2 1.4 1.6 1.8 2
BSA ratio
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
ali
ty
p = 0.052
ISHLT 2008
N=697J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTS (1/1995-6/2000) Factors Not Significant for 10 Year Mortality
Recipient Factors:PRA, diabetes, repeat transplant, transfusions, hospitalized, gender, PGE, VAD, bilirubin
Donor Factors:Cause of death, age, clinical infection
Transplant Factors:Ischemia time, HLA mismatch, CMV mismatch
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART RECIPIENTS Functional Status of Surviving Recipients
(Follow-ups: April 1994 - June 2007)
0%
20%
40%
60%
80%
100%
1 Year (N = 2,134) 5 Year (N = 1,415) 10 Year (N = 554)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2007)
0%
20%
40%
60%
80%
100%
1 Year (N = 3,110) 5 Years (N = 1,965) 10 Years (N = 883)
No Hospitalization Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection Hospitalized, Infection Only
Hospitalized, Rejection + Infection
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
0
10
20
30
40
50
Any Induction (N =1,033)
Polyclonal ALG/ATG (N= 685)
OKT3 (N = 44) IL2R-antagonist (N =332)
PEDIATRIC HEART RECIPIENTS Induction Immunosuppression
(Transplants: January 2001 - June 2007)
% o
f P
atie
nts
ISHLT 2008
Analysis is limited to patients who were alive at the time of the follow-up
J Heart Lung Transplant 2008;27: 937-983
0
10
20
30
40
50
60
70
Any Induction Polyclonal ALG/ATG IL2R-antagonist
% o
f P
ati
en
ts
2001200220032004200520062007
PEDIATRIC HEART RECIPIENTSInduction Immunosuppression (Transplants: January 2001 - June 2007)
ISHLT 2008
Test of increasing trend over time:Any induction p < 0.0001Polyclonal p < 0.0001IL2 p = 0.0029Analysis is limited to patients who were alive at the time of the follow-upJ Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group
(Transplants: January 2000 – June 2005) Conditional on Survival to 14 Days
50
60
70
80
90
100
0 1 2 3 4
Years
No induction (N =891)
Polyclonal induction (N = 509)
IL2R-antagonist (N =185)
Su
rviv
al (
%)
No comparisons were statistically significant.
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group and Rejection Between Transplant
Discharge and 1-Year Follow-up (1-Year Follow-ups: July 2004 - June 2006) Conditional on Survival to 1 Year
50
60
70
80
90
100
0 1 2
Years
No induction/No rejection (N = 180)
Polyclonal induction/No rejection (N = 95)
IL2R-antagonist/No rejection (N = 33)
No induction/Rejection (N = 68)
Polyclonal induction/Rejection (N = 61)
IL2R-antagonist/Rejection (N = 41)
Su
rviv
al (
%)
No pair-wise comparisons of survival by induction were statistically significant within either rejection grouping except No induction/Rejection vs. Polyclonal/Rejection (p=0.0329).
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2005)
Conditional on Survival to 14 DaysAge: < 1 Year
50
60
70
80
90
100
0 1 2 3 4
Years
No induction (N = 185)Polyclonal induction (N = 191)IL2R-antagonist (N = 23)
No comparisons were statistically significant.
Su
rviv
al (
%)
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2005)
Conditional on Survival to 14 DaysAge: 1-10 Years
50
60
70
80
90
100
0 1 2 3 4
Years
No induction (N = 358)Polyclonal induction (N = 177)IL2R-antagonist (N = 66)
Su
rviv
al (
%)
ISHLT 2008
No comparisons were statistically significant.
Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATION Kaplan-Meier Survival by Induction Group (Transplants: January 2000 – June 2005)
Conditional on Survival to 14 DaysAge: 11-17 Years
50
60
70
80
90
100
0 1 2 3 4
Years
No induction (N = 348)
Polyclonal induction (N = 141)
IL2R-antagonist (N = 96)
No comparisons were statistically significant.
Su
rviv
al (
%)
ISHLT 2008 Last updated based on data as of December 2006 J Heart Lung Transplant 2008;27: 937-983
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
Year 1 (N = 1,647) Year 5 (N = 1,114)
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
(Follow-ups: January 2001 - June 2007)
NOTE: Different patients are analyzed in Year 1 and Year 5
% o
f P
atie
nts
ISHLT 2008
Analysis is limited to patients who were alive at the time of the follow-up
J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
for Same Patients at Each Time Point(Follow-ups: January 2001 - June 2007)
% o
f P
atie
nts
ISHLT 2008
0%
20%
40%
60%
80%
100%
Year 1 (N = 432) Year 5 (N = 432)
None
Other
Tacrolimus
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine
Cyclosporine + MMF
Cyclosporine + AZA
Analysis is limited to patients who were alive at the time of the follow-up
J Heart Lung Transplant 2008;27: 937-983
0%
20%
40%
60%
80%
100%
Year 1 (N = 1,647) Year 5 (N = 1,114)
None
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 2007)
NOTE: Different patients are analyzed in Year 1 and Year 5
% o
f P
atie
nts
ISHLT 2008
Analysis is limited to patients who were alive at the time of the follow-up
J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Prednisone Use
Conditional on Survival to 1 Year (Transplants: April 1994 - June 2006)
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 = 1,684)
No Prednisone at discharge or at 1 year (N = 344)
Prednisone at discharge/not at 1 year (N = 319)
p < 0.0001
Su
rviv
al (
%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Prednisone Use for a Recent Era
Conditional on Survival to 1 Year (Transplants: January 1998 – June 2006)
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
Prednisone use at discharge and 1 year (N = 1,352)
No Prednisone at discharge or at 1 year (N = 254)
Prednisone at discharge/not at 1 year (N = 259)
p = 0.0050
Su
rviv
al (
%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Stratified by Tacrolimus vs. Cyclosporine Use at Discharge
(Transplants: January 1998 - June 2006) Conditional on Survival to 14 Days
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
Tacrolimus use at discharge (N = 987)
Cyclosporine use at discharge (N = 1,330)
Su
rviv
al (
%)
ISHLT 2008
p = 0.1706
J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Rejection within 1st Year
(1-Year Follow-ups: July 2004 - June 2006)
50
60
70
80
90
100
0 1 2
Years
Free from Rejection during 1 year (N = 191)Rejection within 1st Year (N = 130)
p = 0.0346
Su
rviv
al (
%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Rejection within 1st Year
Stratified by Calcineurin Use at Discharge (1-Year Follow-ups: July 2004 - June 2006)
50
60
70
80
90
100
0 1 2
Years
CyA: Free from Rejection during 1 year (N = 68)
CyA: Rejection within 1st Year (N = 58)
TAC: Free from Rejection during 1 year (N = 106)
TAC: Rejection within 1st Year (N = 58)
Free from Rejection: CyA vs. TAC p = 0.9104Rejection: CyA vs. TAC p = 0.8471 CyA: Rejection vs. no rejection p = 0.3447TAC: Rejection vs. no rejection p = 0.1567
Su
rviv
al (
%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Rejection within 1st Year
Stratified by Calcineurin Use at Discharge: Age = 0-10 Years (1-Year Follow-ups: July 2004 - June 2006)
50
60
70
80
90
100
0 1 2
Years
CyA: Free from Rejection during 1 year (N = 50)
CyA: Rejection within 1st Year (N = 44)
TAC: Free from Rejection during 1 year (N = 66)
TAC: Rejection within 1st Year (N = 30)
Free from Rejection: CyA vs. TAC p = 0.1832Rejection: CyA vs. TAC p = 0.5836 CyA: Rejection vs. no rejection p = 0.3782TAC: Rejection vs. no rejection p = 0.1706
Su
rviv
al (
%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANTATIONKaplan-Meier Survival Based on Rejection within 1st Year
Stratified by Calcineurin Use at Discharge: Age = 11-17 Years (1-Year Follow-ups: July 2004 - June 2006)
50
60
70
80
90
100
0 1 2
Years
CyA: Free from Rejection during 1 year (N = 18)
CyA: Rejection within 1st Year (N =14)
TAC: Free from Rejection during 1 year (N = 40)
TAC: Rejection within 1st Year (N = 28)
Free from Rejection: CyA vs. TAC p = 0.1772Rejection: CyA vs. TAC p = 0.2053 CyA: Rejection vs. no rejection naTAC: Rejection vs. no rejection p = 0.5540
Su
rviv
al (
%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION IN 1ST YEAR
Stratified by Induction (Follow-ups: July 2004 - June 2007)
0
10
20
30
40
50
60
70No induction Used, Treatment No induction Used, No Treatment
Induction Used (no OKT3), Treatment Induction Used (no OKT3), No Treatment
% e
xper
ien
cin
g a
cute
rej
ecti
on
wit
hin
1 y
ear
Overall: p = 0.042
ISHLT 2008
Overall < 1 1-10 10-17 Female Male
Analysis is limited to patients who were alive at the time of the follow-up
J Heart Lung Transplant 2008;27: 937-983
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION IN 1ST YEAR
Stratified by Type of Induction (Follow-ups: July 2004 - June 2007)
0
10
20
30
40
50
60
70 No induction, Treatment No induction, No TreatmentPolyclonal, Treatment Polyclonal, No TreatmentIL2R-antagonist, Treatment IL2R-antagonist, No Treatment
% e
xper
ien
cin
g a
cute
rej
ecti
on
wit
hin
1 y
ear
Overall: No induct vs. IL2R (p=0.001); Polyclonal vs. IL2R (p = 0.006) 1-10: No induct vs. IL2R (p=0.019) 11-17: No induction vs. IL2R (p=0.037)Female: No induction vs. IL2R (p = 0.006); Polyclonal vs. IL2R (p =0.026)Male: No induction vs. IL2R (p = 0.034)
ISHLT 2008
Overall < 1 1-10 10-17 Female Male
Analysis is limited to patients who were alive at the time of the follow-up
J Heart Lung Transplant 2008;27: 937-983
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression and Induction (Follow-ups: July 2004 - June 2007)
0
10
20
30
40
50
60
70CyA + No induction, Treatment CyA + No induction, No TreatmentCyA + Induction (no OKT3), Treatment CyA + Induction (no OKT3), No TreatmentTAC + No induction, Treatment TAC + No induction, No TreatmentTAC + Induction (no OKT3), Treatment TAC + Induction (no OKT3), No Treatment
% e
xper
ien
cin
g a
cute
rej
ecti
on
wit
hin
1 y
ear
Overall: all comparisons were statistically significant at 0.05 except CyA + no induction vs. CyA + induction and TAC + no induction vs. TAC + induction<1 year: CyA + no induction vs. TAC + no induction: p=0.001; CyA + no induction vs. TAC + induction: p=0.001; CyA + induction vs. TAC + no induction: p=0.032; CyA + induction vs. TAC + induction: p= 0.026
1-10 years: CyA + induction vs. TAC + induction: p =0.006; CyA + induction vs. TAC + no induction: p = 0.0001
11-17 years: CyA + no induction vs. TAC + no induction: p = 0.001; CyA + induction vs. TAC + no induction: p < 0.0001; CyA + induction vs. TAC + induction: p =0.008
ISHLT 2008
Overall < 1 1-10 10-17
Analysis is limited to patients who were alive at the time of the follow-up
J Heart Lung Transplant 2008;27: 937-983
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression (Follow-ups: July 2004 - June 2007)
0
10
20
30
40
50
60
70
Cyclosporine + MMF, Treatment Cyclosporine + MMF, No TreatmentCyclosporine + AZA, Treatment Cyclosporine + AZA, No TreatmentTacrolimus + MMF, Treatment Tacrolimus + MMF, No TreatmentTacrolimus + AZA, Treatment Tacrolimus + AZA, No Treatment
% e
xper
ien
cin
g a
cute
rej
ecti
on
wit
hin
1 y
ear
Overall: CyA +MMF vs. TAC + MMF (p < 0.0001); CyA + MMF vs. TAC + AZA (p =0.001); <1: CyA + MMF vs. TAC + MMF (p =0.0004); CyA + MMF vs. TAC + AZA )p=0.016).1-10: CyA + MMF vs. TAC + MMF (p = 0.010).11-17: CyA + MMF vs. TAC + MMF (p =0.0002).
ISHLT 2008
Overall < 1 1-10 10-17
Analysis is limited to patients who were alive at the time of the follow-up
J Heart Lung Transplant 2008;27: 937-983
PERCENTAGE OF PEDIATRIC HEART TRANSPLANT RECIPIENTS EXPERIENCING ACUTE REJECTION IN 1ST YEAR
Stratified by Calcineurin Inhibitor Use at Discharge (Follow-ups: July 2004 - June 2007)
0
10
20
30
40
50
60Cyclosporine, Treatment Cyclosporine, No TreatmentTacrolimus, Treatment Tacrolimus, No Treatment
% e
xper
ien
cin
g a
cute
rej
ect
ion
wit
hin
1 y
ear
Overall: CyA vs. TAC (p < 0.0001)<1: CyA vs. TAC (p=0.0005) 1-10: CyA vs. TAC (p < 0.0008)11-17: CyA vs. TAC (p < 0.0001)
ISHLT 2008
Overall < 1 1-10 10-17
Analysis is limited to patients who were alive at the time of the follow-up
J Heart Lung Transplant 2008;27: 937-983
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2007)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
% F
reed
om
fro
m C
AV
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
FREEDOM FROM CORONARY ARTERY VASCULOPATHY For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2007)
Stratified by Induction
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
Induction (N = 1,084)
No Induction (N = 1,673)% F
ree
do
m f
rom
CA
V
p = 0.7992
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
FREEDOM FROM CORONARY ARTERY VASCULOPATHYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2007)
Stratified by Age Group
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8
Years
<1 Year (N =732)
1-10 Years (N = 1,024)
11-17 Years (N = 1,013)
p < 0.0001
% F
ree
do
m f
rom
CA
V
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
FREEDOM FROM CORONARY ARTERY VASCULOPATHYFor Pediatric Heart Recipients (Follow-ups: January 1999-June 2007)
Stratified by Age Group
50
60
70
80
90
100
0 1 2 3 4 5 6
Years
<1 Year (N = 484)
1-10 Years (N = 724)
11-17 Years (N = 732)
p < 0.0001
% F
ree
do
m f
rom
CA
V
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
FREEDOM FROM CORONARY ARTERY VASCULOPATHYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2007)
Stratified by Ischemia Time
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
0-<2 hours (N=296)
2-<4 hours (N=1,407)
4+ hours (N=874)
p = 0.0204
% F
ree
do
m f
rom
CA
V
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
FREEDOM FROM CORONARY ARTERY VASCULOPATHYFor Pediatric Heart Recipients (Follow-ups: January 1999 - June 2007)
Stratified by Ischemia Time for Recent Era
50
60
70
80
90
100
0 1 2 3 4 5 6 7
Years
0-<2 hours (N=183)
2-<4 hours (N=972)
4+ hours (N=614)
p = 0.0476
% F
ree
do
m f
rom
CA
V
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
FREEDOM FROM CORONARY ARTERY VASCULOPATHYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2007)
Stratified by Ischemia Time and Recipient Age
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
0-<2 hours/0-10 years (N=165)
2+ hours/0-10 years (N=1,469)
0-<2 hours/11-17 years (N=115)
2+ hours/11-17 years (N=718)
0-10 years: p = 0.0106;11-17 years: p = 0.4709
% F
ree
do
m f
rom
CA
V
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
GRAFT SURVIVAL FOLLOWING REPORT OF CORONARY ARTERY VASCULOPATHY
For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2007)Stratified by Age Group
0
10
20
30
40
50
60
70
80
90
100
0 0.5 1 1.5 2 2.5 3 3.5
Time since Report of CAV (Years)
<1 Year (N = 70)
1-10 Years (N = 117)
11-17 Years (N = 162)
p = 0.2006
Su
rviv
al s
ince
Rep
ort
of
CA
V (
%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Pediatric Heart Recipients (Follow-ups: April 1994 - June 2007)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9
Years
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
% F
reed
om
fro
m S
ever
e
Ren
al D
ysfu
nct
ion
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
MALIGNANCY POST-HEART TRANSPLANTATION FOR PEDIATRICSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2007)
Malignancy/Type 1-Year Survivors
5-Year Survivors
10-Year Survivors
No Malignancy 3,065 (98.1%) 1,177 (95%) 253 (91.7%)
Malignancy (all types combined) 58 (1.9%) 62 (5%) 23 (8.3%)
Malignancy Type
Lymph 54 57 22
Other 3 6
Skin 1
Type Not Reported 1 1
ISHLT 2008
NOTE: Multiple types may be reported; sum of types may be greater than total number with malignancy.
J Heart Lung Transplant 2008;27: 937-983
FREEDOM FROM MALIGNANCYFor Pediatric Heart Recipients (Follow-ups: April 1994 - June 2007)
80
85
90
95
100
0 1 2 3 4 5 6 7 8 9 10
Years
All malignancy Lymph Skin Other
% F
reed
om
fro
m M
alig
nan
cy
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 1 and 3 Years
(Transplants: April 1993 - June 2004)
Maintenance Immunosuppression at discharge and 1 year
% HTN reported between 1 and 3 years
P-valueFor Patients
on drugFor Patients not on drug
Azathioprine 22.2 25.7 0.2649
Cyclosporine 20.8 27.1 0.0569
MMF 22.1 22.8 0.8454
Prednisone 29.7 8.4 <.0001
Rapamycin 50.0 22.1 -
Tacrolimus 30.8 19.6 0.0007
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART RECIPIENTS Incidence of Hypertension between 3 and 8 Years
(Transplants: April 1993 - June 1999)
Maintenance Immunosuppression at discharge and 1 year
% HTN reported between 3 and 8 years
P-valueFor Patients
on drugFor Patients not on drug
Azathioprine 37.5 44.7 0.4159
Cyclosporine 36.7 42.9 0.5334
MMF 38.1 37.6 0.9627
Prednisone 47.7 21.5 0.0003
Rapamycin . 37.3 -
Tacrolimus 40.9 34.5 0.5515
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART RECIPIENTSRelationship of Rejection and Coronary Artery Vasculopathy
(Follow-ups: July 2004 – June 2007)
Rejection During 1st
Year
Reported CAV between 1st and 3rd years
post-transplant
Yes No All
Yes 1
5.5%
17
94.4%
18
100%
No 1
3.4%
28
96.6%
29
100%p = 0.7279
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2007)
CAUSE OF DEATH 0-30 Days (N = 444)
31 Days - 1 Year (N = 392)
>1 Year - 3 Years (N = 294)
>3 Years - 5 Years (N = 216)
>5 Years - 10 Years (N = 323)
>10 Years (N = 144)
CORONARY ARTERY VASCULOPATHY
5 (1.1%) 31 (7.9%) 59 (20.1%) 65 (30.1%) 92 (28.5%) 44 (30.6%)
ACUTE REJECTION 42 (9.5%) 94 (24.0%) 69 (23.5%) 29 (13.4%) 36 (11.1%) 8 (5.6%)
LYMPHOMA 10 (2.6%) 11 (3.7%) 5 (2.3%) 32 (9.9%) 9 (6.3%)
MALIGNANCY, OTHER 4 (1.0%) 2 (0.7%) 1 (0.5%) 4 (1.2%) 10 (6.9%)
CMV 1 (0.2%) 8 (2.0%) 1 (0.3%)
INFECTION, NON-CMV 53 (11.9%) 64 (16.3%) 20 (6.8%) 8 (3.7%) 14 (4.3%) 10 (6.9%)
PRIMARY FAILURE 101 (22.7%)
21 (5.4%) 10 (3.4%) 15 (6.9%) 17 (5.3%) 4 (2.8%)
GRAFT FAILURE 95 (21.4%) 41 (10.5%) 53 (18.0%) 49 (22.7%) 68 (21.1%) 32 (22.2%)
TECHNICAL 24 (5.4%) 3 (0.8%) 2 (0.7%) 2 (0.9%) 4 (1.2%)
OTHER 26 (5.9%) 30 (7.7%) 33 (11.2%) 25 (11.6%) 35 (10.8%) 12 (8.3%)
MULTIPLE ORGAN FAILURE
41 (9.2%) 47 (12.0%) 10 (3.4%) 6 (2.8%) 9 (2.8%) 7 (4.9%)
RENAL FAILURE 1 (0.2%) 3 (0.8%) 1 (0.5%) 2 (1.4%)
PULMONARY 29 (6.5%) 23 (5.9%) 15 (5.1%) 8 (3.7%) 6 (1.9%) 5 (3.5%)
CEREBROVASCULAR 26 (5.9%) 13 (3.3%) 9 (3.1%) 2 (0.9%) 6 (1.9%) 1 (0.7%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
PEDIATRIC HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1998 - June 2007)
CAUSE OF DEATH 0-30 Days (N = 189)
31 Days - 1 Year (N = 208)
>1 Year - 3 Years (N = 179)
>3 Years - 5 Years (N = 142)
>5 Years - 10 Years (N = 257)
>10 Years (N =137)
CAV 2 (1.1%) 13 (6.3%) 30 (16.8%) 39 (27.5%) 71 (27.6%) 42 (30.7%)
ACUTE REJECTION 20 (10.6%) 39 (18.8%) 34 (19.0%) 20 (14.1%) 27 (10.5%) 8 (5.8%)
LYMPHOMA 6 (2.9%) 6 (3.4%) 3 (2.1%) 27 (10.5%) 9 (6.6%)
MALIGNANCY, OTHER
1 (0.5%) 1 (0.6%) 3 (1.2%) 9 (6.6%)
CMV 4 (1.9%) 1 (0.6%)
INFECTION, NON-CMV
23 (12.2%) 30 (14.4%) 11 (6.1%) 3 (2.1%) 10 (3.9%) 8 (5.8%)
PRIMARY FAILURE 39 (20.6%) 7 (3.4%) 4 (2.2%) 6 (4.2%) 9 (3.5%) 4 (2.9%)
GRAFT FAILURE 29 (15.3%) 21 (10.1%) 39 (21.8%) 40 (28.2%) 59 (23.0%) 30 (21.9%)
TECHNICAL 11 (5.8%) 2 (1.1%) 4 (1.6%)
OTHER 19 (10.1%) 22 (10.6%) 28 (15.6%) 18 (12.7%) 30 (11.7%) 12 (8.8%)
MULTIPLE ORGAN FAILURE
22 (11.6%) 33 (15.9%) 9 (5.0%) 5 (3.5%) 7 (2.7%) 7 (5.1%)
RENAL FAILURE 3 (1.4%) 1 (0.7%) 1 (0.7%) 2 (1.5%)
PULMONARY 11 (5.8%) 20 (9.6%) 10 (5.6%) 6 (4.2%) 5 (1.9%) 5 (3.6%)
CEREBROVASCULAR 13 (6.9%) 9 (4.3%) 4 (2.2%) 1 (0.7%) 5 (1.9%) 1 (0.7%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
top related