Heart Transplantation: Pediatric Recipients

HEART TRANSPLANTATION
Pediatric Recipients
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Table of Contents
 Donor, recipient and center characteristics: slides 3-29

 Post transplant – survival and other outcomes: slides 30-
53
 Induction and maintenance immunosuppression: slides
54-65
 Rejection and post transplant morbidities: slides 66-101
 Retransplantation: slides 102-108
 Multivariable analyses: slides 109-183
 Focus theme: slides 184-199
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Donor, Recipient and Center
Characteristics
2017
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Pediatric Heart Transplants
Number of Centers Reporting Transplants
130
120 Other
110 Europe
100 North America
Number of Centers
90
80
70
60
50
40
30
20
10
0
Transplant Year
2017
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Number of Centers by Center Volume
(Transplants: January 2004 – June 2016)
160
140 2004-2008 2009-June 2016
120
Number of Centers
100
80
150 150
60
40
20
32
16 15 22
0
1-4 5-9 10+
Average number of heart transplants per year
2017
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Distribution of Transplants by Center Volume
60
2004-2008 2009-June 2016
50
% of Transplants
40
30
42.2 47.4
20
35.3
28.1
24.5 22.5
10
0
1-4 5-9 10+
2017
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Recipient Age Distribution by Center Volume
<1 1-5 6-10 11-17
100%
80%
% of Transplants
60%
40%
20%
0%
1-4 5-9 10+
2017
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Distribution of Transplants by Location and Average Center
Volume (Transplants: January 2004 – June 2016)
1-4 5-9 10+
100%
80%
% of Transplants
60%
40%
20%
0%
Europe North America Other
2017
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Recipient Age Distribution (Transplants: January 2004 – June 2016)
1,800
1,600
Number of Transplants
1,400
1,200
1,000
800
600
400
200
0
<1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Recipient Age (Years)
2017
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Recipient Age Distribution by Year of Transplant
700
11-17
600
6-10
500 1-5
<1
400
300
200
100
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
2017 number of hearts transplanted worldwide has increased
and/or decreased in recent years.
JHLT. 2017 Oct; 36(10): 1037-1079
Recipient Age Distribution by Location
<1 1-5 6-10 11-17
100%
80%
% of Transplants
60%
40%
20%
0%
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Donor Age Distribution (Transplants: January 2004 – June 2016)
1,200
1,000
800
600
400
200
0
<1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18- 26- 31+
25 30
Donor Age (Years)
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Donor and Recipient Age
Recipient Age: <1 1-5 6-10 11-17
100%
80%
% of Transplants
60%
40%
20%
0%
<1 1-5 6-10 11-17 18-34 35-49 50-65
Donor Age (Years)
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Donor Age Distribution by Location
<1 1-5 6-10 11-17 18-34 35-49 50-65
100%
80%
% of Transplants
60%
40%
20%
0%
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Distribution of Transplants by Donor/Recipient Weight Ratio
50
45 2004-2008 2009-June 2016
40
% of Transplants
35
30
25
20
15
10
5
0
<0.75 0.75-<1.0 1.0-<1.5 1.5-<2.0 2.0-<2.5 2.5+
Donor/Recipient Weight Ratio
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Recipient Diagnosis (Age: < 1 Year)
59% 55%
73%
CHD
7% DCM
5%
8%
1% Retransplant
1% 0.3%
37%
21% 33% Other
1988-2003 2004-2008 2009-6/2016
100
% of Cases
DCM CHD
75
50
25
0
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Recipient Diagnosis (Age: 1-5 Years)
40% 38% 41%
CHD
12% DCM
10%
14% Retransplant
4% 47% 46% 44%
2% 2.8% Other
1988-2003 2004-2008 2009-6/2016
100
% of Cases
DCM CHD
75
50
25
0
2017
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33% 29% 35%
CHD
DCM
16%
14% 44% 14% 49% 43% Retransplant
9% 7% Other
9%
1988-2003 2004-2008 2009-6/2016
100
% of Cases
DCM CHD
75
50
25
0
2017
JHLT. 2017 Oct; 36(10): 1037-1079
25% 23% CHD

19%
55%
58% 54% DCM
16%
12%
15% Retransplant
5% 8%
11% Other
1988-2003 2004-2008 2009-6/2016
100
% of Cases
DCM CHD
75
50
25
0
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Diagnosis Distribution by Location
100%
80% Other
% of Transplants
60% Retransplant
DCM
40%
CHD
20%
0%
2017
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% of Patients Bridged with Mechanical Circulatory Support*
by Year (Transplants: January 2005 – December 2015)
50
ECMO VAD + ECMO VAD or TAH
40
34.6
32.4
30.9
% of Patients
29.2 28.8
30 27.5
25.4
21.4 22.5 22.2
20.6
20
10
0
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
2017 * LVAD, RVAD, TAH, ECMO

JHLT. 2017 Oct; 36(10): 1037-1079
50
40
% of Patients
29.5
30
20 18.0
10
5.9
3.8
1.2 0.4 0.2 0.1
0
Any Device LVAD BIVAD ECMO VAD+ECMO RVAD (N=12) TAH (N=5) Unknown
(N=912) (N=556) (N=181) (N=118) (N=38) VAD Type
(N=2)

JHLT. 2017 Oct; 36(10): 1037-1079
by Diagnosis (Transplants: January 2009 – June 2016)
50
DCM CHD Retransplant Other
40
% of Patients
30
20
10
0
Any Device LVAD BIVAD ECMO VAD+ECMO RVAD TAH Unknown
VAD Type

JHLT. 2017 Oct; 36(10): 1037-1079
by Age Group (Transplants: January 2009 – June 2016)
50
ECMO VAD + ECMO VAD or TAH
40
34.3
32.1
% of Patients
30.5
30
22.1
20
10
0
<1 1-5 6-10 11-17
Age Group (Years)

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by Age Group and Diagnosis (Transplants: January 2009 – June 2016)
60
ECMO VAD + ECMO VAD or TAH 57.1
51.2 51.2
50
38.4
40
% of Patients
30
20.1
20
14.5 13.6
11.8
10
0
CHD DCM CHD DCM CHD DCM CHD DCM
<1 year 1-5 years 6-10 years 11-17 years
JHLT. 2017 Oct; 36(10): 1037-1079

PRA Distribution by Year
(Transplants: January 2005 – December 2015)
0-9% 10-39% 40-79% 80%+

100%
80%
% of Patients
60%
40%
20%
0%
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
CPRA and PRA values were combined. If Class I and

2017 Class II PRA values were reported separately, the
higher of the two values was used.
JHLT. 2017 Oct; 36(10): 1037-1079
PRA Distribution by Age Group
0-9% 10-39% 40-79% 80%+
100%
80%
% of Patients
60%
40%
20%
0%
<1 1-5 6-10 11-17
Age Group (Years)
p<0.0001
JHLT. 2017 Oct; 36(10): 1037-1079
PRA Distribution by Diagnosis
0-9% 10-39% 40-79% 80%+
100%
80%
% of Patients
60%
40%
20%
0%
CHD DCM Retransplant Other
Diagnosis
p<0.0001
JHLT. 2017 Oct; 36(10): 1037-1079
PRA Distribution by Age Group and Diagnosis
0-9% 10-39% 40-79% 80%+
100%
80%
% of Patients
60%
40%
20%
0%
CHD DCM CHD DCM CHD DCM CHD DCM
<1 Year 1-5 Years 6-10 Years 11-17 Years
JHLT. 2017 Oct; 36(10): 1037-1079
Post Transplant:
Survival and Other Outcomes
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival (Transplants: January 1982 – June 2015)
100
<1 Year (N = 3,108)
1-5 Years (N = 2,934)
6-10 Years (N = 1,888)
75 11-17 Years (N = 5,065)
Overall (N = 12,995)
Survival (%)
50
No pair-wise comparisons were significant at p < 0.05

except 1-5 vs. 11-17 and 6-10 vs. 11-17.
25
Median survival (years): <1=22.3; 1-5=18.4; 6-10=14.4; 11-17=13.1
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival Conditional on Survival to 1 Year
100
Median survival (years): <1=NA; 1-5=21.9;
6-10=16.9; 11-17=15.8
75
Survival (%)
50
All pair-wise comparisons were significant at p < 0.05.

25 <1 Year (N = 2,303) 1-5 Years (N = 2,319)
6-10 Years (N = 1,549) 11-17 Years (N = 4,165)
Overall (N = 10,336)
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival Conditional on Survival to 5 Years
100
75
Survival (%)
50
All pair-wise comparisons were significant
at p < 0.05 except 6-10 vs. 11-17.
25 <1 (N = 1,489) 1-5 (N = 1,485)

6-10 (N = 1,034) 11-17 (N = 2,578)
Overall (N = 6,586)
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival Conditional on Survival to 10 Years
100
75
Survival (%)
All pair-wise comparisons were significant

at p < 0.05 except 1-5 vs. 11-17.
50
<1 (N = 832)
1-5 (N = 787)
25
6-10 (N = 534)
11-17 (N = 1,253)
Overall (N = 3,406)
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival by Era
100
1982-1989 (N=907) 1990-2003 (N=5,668)
2004-2008 (N=2,535) 2009-6/2015 (N=3,885)
75
Survival (%)
50
All p-values were significant at p < 0.05.

25
Median survival (years):1982-1989= 9.8; 1990-2003=14.4;

2004-2008=NA; 2009-6/2015=NA
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Conditional Kaplan-Meier Survival for Recent Era
100
90
Survival (%)
80
All pair-wise comparisons with 11-17 were
significant at p<0.05. No other pair-wise
comparisons were significant at p<0.05.
70
<1 Year (N = 1,168) 1-5 Years (N = 1,228)

60
6-10 Years (N = 791) 11-17 Years (N = 2,074)
Overall (N = 5,261)
50
0 1 2 3 4 5 6 7 8 9 10 11
Years
2017
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Age: < 1 Year (Transplants: January 1982 – June 2015)
100
1982-1989 (N=181) 1990-2003 (N=1,449)
2004-2008 (N=572) 2009-6/2015 (N=906)

75
Survival (%)
50
All pair-wise comparisons were significant at p<0.05.

25
Median survival (years): 1982-1989=10.8; 1990-2003=20.3;

2004-2008=NA; 2009-6/2015=NA
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Age: 1-5 Years (Transplants: January 1982 – June 2015)
100
All p-values significant at p<0.05 except
2004-2008 vs. 2009-6/2015.
75
Survival (%)
50
1982-1989 (N=161) 1990-2003 (N=1,282)

25 2004-2008 (N=582) 2009-6/2015 (N=909)
Median survival (years): 1982-1989= 9.1; 1990-2003=16.9;

2004-2008=NA; 2009-6/2015=NA
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
100
1982-1989 (N=121) 1990-2003 (N=804)
2004-2008 (N=372) 2009-6/2015 (N=591)

75
Survival (%)
50
All p-values significant at < 0.05 except

2004-2008 vs. 2009-6/2015.
25
Median survival (years): 1982-1989= 7.7; 1990-2003=13.3;

2004-2008=NA; 2009-6/2015=NA
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
100
1982-1989 (N=444) 1990-2003 (N=2,133)
2004-2008 (N=1,009) 2009-6/2015 (N=1,479)
75
Median survival (years): 1982-1989= 9.9.; 1990-
2003=12.0; 2004-2008=NA; 2009-6/2015=NA
Survival (%)
50
25
All other pair-wise comparisons were significant at p<0.05

except 1982-1989 vs. 1990-2003 and 2004-2008 vs. 2009-6/2015.
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival by Recipient Gender
100
p = 0.1114
75
Survival (%)
50
25
Male (N = 3,476) Female (N = 2,944)
0
0 1 2 3 4 5 6 7 8 9 10 11
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival by Donor/Recipient Gender
100
75
Survival (%)
No pair-wise comparisons were significant at p<0.05.

50
25
Male/Male (N = 2,072) Male/Female (N = 1,575)
Female/Male (N = 1,401) Female/Female (N = 1,366)

0
0 1 2 3 4 5 6 7 8 9 10
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival by Diagnosis
Age: < 1 Year (Transplants: January 2004 – June 2015)
100
p<0.0001
75
Survival (%)
50
25
CHD (N=828) DCM (N=525)
0
0 1 2 3 4 5 6 7 8 9 10 11
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
100
75
Survival (%)
50
CHD vs. DCM: p=0.0002
CHD vs. Retransplant: p=0.0809
DCM vs. Retransplant: p<0.0001
25
CHD (N=582) DCM (N=665) Retransplant (N=38)
0
0 1 2 3 4 5 6 7 8 9 10 11
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
100
75
Survival (%)
50
DCM vs. Retransplant: p=0.4268
25
CHD (N=305) DCM (N=426) Retransplant (N=68)

0
0 1 2 3 4 5 6 7 8 9 10 11
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
100
75
Survival (%)
50
DCM vs. Retransplant: p<0.0001
25
CHD (N=515) DCM (N=1,307) Retransplant (N=222)
0
0 1 2 3 4 5 6 7 8 9 10 11
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival by PRA
Diagnosis=CHD (Transplants: January 2005 – June 2015)
100
75
Survival (%)
50
0-9% vs. 10-39%: p=0.9998
0-9% vs. 40%+: p=0.1426
10-39% vs. 40%+: p=0.4343
25
0-9% (N=1,026) 10-39% (N=180) 40%+ (N=289)
0
0 1 2 3 4 5 6 7 8 9 10
Years
JHLT. 2017 Oct; 36(10): 1037-1079
Diagnosis=DCM (Transplants: January 2005 – June 2015)
100
75
Survival (%)
50
0-9% vs. 10-39%: p=0.8560
0-9% vs. 40%+: p=0.9588
10-39% vs. 40%+: p=0.9788
25
0-9% (N=1,144) 10-39% (N=159) 40%+ (N=100)
0
0 1 2 3 4 5 6 7 8 9 10
Years
JHLT. 2017 Oct; 36(10): 1037-1079
Diagnosis=Retransplant (Transplants: January 2005 – June 2015)
100
75
Survival (%)
50
0-9% vs. 10-39%: p=0.8560
0-9% vs. 40%+: p=0.9588
10-39% vs. 40%+: p=0.9788
25
0-9% (N=109) 10-39% (N=38) 40%+ (N=78)
0
0 1 2 3 4 5 6 7 8 9
Years
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Patient vs. Graft Survival
100
p = 0.0006
75
Survival (%)
50
25
Patient (N = 6,420) Graft (N = 6,420)
0
0 1 2 3 4 5 6 7 8 9 10 11
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival by Mechanical Circulatory Support
Usage* (Transplants: January 2009 – June 2015)
100
75
Survival (%)
50
ECMO, no VAD or TAH vs. VAD or TAH, no ECMO: p <0.0001
ECMO, no VAD or TAH vs. No ECMO/VAD/TAH: p<0.0001
VAD or TAH, no ECMO vs. No ECMO/VAD/TAH: p=0.9476
25
ECMO, no VAD or TAH (N=118) VAD or TAH, no ECMO (N=756)
No ECMO/VAD/TAH (N=2,179)
0
0 1 2 3 4 5 6
Years
JHLT. 2017 Oct; 36(10): 1037-1079
Functional Status of Surviving Recipients
(Follow-ups: January 2009 – June 2016)
100%
10%
20%
80%
30%
40%
60%
50%
40% 60%
70%
20% 80%
90%
0%
1 Year (N = 2,513) 2 Years (N = 2,292) 3 Years (N = 2,130) 100%
.
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Rehospitalization Post-transplant of Surviving Recipients
100%
80%
60%
40%
20% No Hospitalization Hospitalized, Not Rejection/Not Infectio

Hospitalized, Rejection Hospitalized, Infection Only
Hospitalized, Rejection + Infection
0%
1 Year (N = 2,898) 3 Years (N = 2,429) 5 Years (N = 2,020)
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Induction and Maintenance
Immunosuppression
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Induction Immunosuppression
80
70
60
% of Patients
50
40
30
20
10
0
Any Induction Polyclonal ALG/ATG IL-2R Antagonist OKT3
(N = 3,127) (N = 2,251) (N = 945) (N = 32)
Analysis is limited to patients who were

2017 alive at the time of the discharge.
JHLT. 2017 Oct; 36(10): 1037-1079
Induction Immunosuppression by Era
80
2004-2008 2009-6/2016
70
All pair-wise comparisons between eras were
60 significant at p < 0.05.
% of Patients
50
40
30
20
10
0
Any Induction Polyclonal ALG/ATG IL-2R Antagonist

2017 alive at the time of the discharge.
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival by Induction Group Conditional on
Survival to 14 Days (Transplants: January 2004 – June 2015)
100
75
Survival (%)
50
No induction (N = 1,435)
25
Polyclonal induction (N = 1,934)
IL-2R antagonist (N = 777)

0
0 1 2 3 4 5 6 7 8 9 10 11
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
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 2015)
100
75
Survival (%)
No pair-wise comparisons of survival by

induction were significant at p < 0.05
within either rejection grouping.
50
No induction/No rejection (N=916)

Polyclonal induction/No rejection (N=1097)
25 IL-2R antagonist/No rejection (N=475)
No induction/Treated Rejection (N=205)
Polyclonal induction/Treated Rejection (N=265)
IL-2R antagonist/Treated Rejection (N=151)
0
0 1 2 3 4 5 6 7 8 9 10
Years 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
2017 and (ii) was reported either as not hospitalized for rejection or
did not receive anti-rejection agents.
JHLT. 2017 Oct; 36(10): 1037-1079
Maintenance Immunosuppression at Time of Transplant
Discharge by Era (Transplants: January 2004 – June 2016)
100
2004-2008 (N = 1,619) 2009-6/2016 (N = 3,019)
80
% of Patients
60
40
20
0
Cyclosporine Tacrolimus Sirolimus/ MMF/MPA Azathioprine Prednisone
Everolimus
Analysis is limited to patients who were alive at
2017 the time of the discharge.
JHLT. 2017 Oct; 36(10): 1037-1079
Maintenance Immunosuppression at Time of 1 Year Follow-up
100
N = 3,767
80
% of Patients
60
40
20
0
Cyclosporine Tacrolimus Sirolimus/ MMF/MPA Azathioprine Prednisone
Everolimus
Analysis is limited to patients who were alive at
2017 the time of the follow-up
JHLT. 2017 Oct; 36(10): 1037-1079
Maintenance Immunosuppression Drug Combinations at
Time of 1 Year Follow-up (Follow-ups: January 2004 – June 2016)
100% Other
Tacrolimus + MMF/MPA +
Sirolimus/Everolimus
80%
Tacrolimus + Sirolimus/Everolimus
Tacrolimus
60%
Tacrolimus + MMF/MPA
40% Tacrolimus + AZA
Cyclosporine
20% Cyclosporine + MMF/MPA
Cyclosporine + AZA
0%
Year 1 (N = 3,767)
2017 alive at the time of the follow-up.
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival Based on Prednisone Use
Conditional on Survival to 1 Year (Transplants: January 2004 – June 2015)
100
75
Survival (%)
p < 0.0001
50
25 Prednisone use at discharge and 1 year (N = 2,005)

No Prednisone at discharge or at 1 year (N = 863)
Prednisone at discharge/not at 1 year (N = 562)
0
0 1 2 3 4 5 6 7 8 9 10 11
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival by Calcineurin Inhibitor Use at
Discharge (Transplants: January 2004 – June 2015)
Conditional on Survival to 14 Days
100
75
Survival (%)
p = 0.6350
50
25 Cyclosporine use at discharge (N = 834)

Tacrolimus use at discharge (N = 3,155)
0
0 1 2 3 4 5 6 7 8 9 10 11
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival by Maintenance Immunosuppression
at Discharge (Transplants: January 2004 – June 2015)
Conditional on Survival to 14 Days
100
75
Survival (%)
50
Cyclosporine + AZA (N = 120)
Cyclosporine + MMF/MPA (N = 618)
25 Tacrolimus + AZA (N = 183)
Tacrolimus + MMF/MPA (N = 2,785)
Tacrolimus Alone (N = 162)
0
0 1 2 3 4 5 6 7 8 9 10 11
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival by Calcineurin Inhibitor Use
Conditional on Survival to 1 Year (Transplants: January 2004 – June 2015)
100
75
Survival (%)
50 No pair-wise comparisons were significant at p<0.05 except

Cyclosporine use at discharge and 1 year vs. Cyclosporine
use at discharge/Tacrolimus at 1 year.
25 Cyclosporine use at discharge and 1 year (N=547)

Tacrolimus use at discharge and 1 year (N=2,617)
Cyclosporine use at discharge/Tacrolimus at 1 year (N=191)
0
0 1 2 3 4 5 6 7 8 9 10 11
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Rejection and Post Transplant
Morbidities
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival Based on Treated Rejection within 1st Year
100
p < 0.0001
75
Survival (%)
50
25 Free from Rejection during 1 year (N = 2,290)
Treated Rejection within 1st Year (N = 900)
0
0 1 2 3 4 5 6 7 8 9 10
JHLT. 2017 Oct; 36(10): 1037-1079
Age = < 1 Year
100
75
Survival (%)
p = 0.0001
50
25 Free from Rejection during 1 year (N = 727)
0
0 1 2 3 4 5 6 7 8 9 10
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 1-5 Years
100
75
Survival (%)
p = 0.0058
50
0
0 1 2 3 4 5 6 7 8 9 10
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 6-10 Years
100
75
Survival (%)
p = 0.0752
50
0
0 1 2 3 4 5 6 7 8 9 10
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 11-17 Years
100
75
Survival (%)
p < 0.0001
50
0
0 1 2 3 4 5 6 7 8 9 10
JHLT. 2017 Oct; 36(10): 1037-1079
by Calcineurin Use at Discharge
100
75
Survival (%)
Pair-wise comparisons within each

50 Calcineurin use group were significant
and no pair-wise comparisons within
rejection group were significant at p<0.05.
25 CyA: Free from Rejection during 1 year (N = 461)

CyA: Treated Rejection within 1st Year (N = 240)
TAC: Free from Rejection during 1 year (N = 1,703)
TAC: Treated Rejection within 1st Year (N = 579)
0
0 1 2 3 4 5 6 7 8 9 10
Treated rejection = Recipient was reported to (1) have at least
Years one acute rejection episode that was treated with an anti-
JHLT. 2017 Oct; 36(10): 1037-1079
Percentage Experiencing Treated Rejection between Discharge
and 1-Year Follow-Up by Era (Follow-ups: July 2004 – June 2016)
40
7/2004-2008 2009-6/2016 All pair-wise comparisons

% experiencing treated rejection
were significant at p<0.05.
30
within 1 year
20
10
0
Overall <1 1-5 6-10 11-17 Female Male
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
2017 anti-rejection agent; or (2) have been hospitalized for
rejection.
JHLT. 2017 Oct; 36(10): 1037-1079
and 1-Year Follow-Up by Induction (Follow-ups: July 2004 – June 2016)
40
No pair-wise comparisons
No Induction Induction
30
within 1 year
20
10
0
rejection.
JHLT. 2017 Oct; 36(10): 1037-1079
Percentage Experiencing Treated Rejection between Discharge and
1-Year Follow-Up by Induction Type (Follow-ups: July 2004 – June 2016)
40
No Induction Polyclonal IL-2R antagonist No pair-wise comparisons
30
within 1 year
20
10
0
rejection.
JHLT. 2017 Oct; 36(10): 1037-1079
and 1-Year Follow-Up by Maintenance Immunosuppression and
Induction (Follow-ups: July 2004 – June 2016)
50
CyA+No induction CyA+Induction (no OKT3)
40 TAC+No induction TAC+Induction (no OKT3)

within 1 year
30
20
10
0
Overall <1 1-5 6-10 11-17
CyA + No Induction vs. TAC + No Induction (Overall), CyA +No Induction vs. TAC + 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
Treated rejection = Recipient was reported to (1) have at
of the follow-up.
rejection.
JHLT. 2017 Oct; 36(10): 1037-1079
and 1-Year Follow-Up by Maintenance Immunosuppression
(Follow-ups: July 2004 – June 2016)
60
Cyclosporine + MMF/MPA Cyclosporine + AZA
50 Tacrolimus + MMF/MPA Tacrolimus + AZA
40
within 1 year
30
20
10
0
Overall <1 1-5 6-10 11-17
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
Treated rejection = Recipient was reported to (1) have at
of the follow-up.
rejection.
JHLT. 2017 Oct; 36(10): 1037-1079
and 1-Year Follow-Up by Calcineurin Inhibitor Use at Discharge
(Follow-ups: July 2004 – June 2016)
50
All pair-wise comparisons were significant at p<0.05.
Cyclosporine Tacrolimus
40
within 1 year
30
20
10
0
Overall <1 1-5 6-10 11-17
rejection.
JHLT. 2017 Oct; 36(10): 1037-1079
Freedom from Cardiac Allograft Vasculopathy
100
75
Freedom from CAV (%)
50
25
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Freedom from Cardiac Allograft Vasculopathy by Era
100
75
p = 0.0086
50
25 1994-2003 (N = 2,026)
2004-6/2015 (N = 3,597)
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Freedom from Cardiac Allograft Vasculopathy by Induction
100
75
p = 0.0273
50
25
Induction (N = 3,100)
No Induction (N=2,448)
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Freedom from Cardiac Allograft Vasculopathy by Calcineurin
Inhibitor Use (Transplants: January 2004 – June 2015)
Conditional on Survival to 1 Year
100
75
p = 0.1344
50
25 Cyclosporine use at discharge and 1 year (N = 521)
Tacrolimus use at discharge and 1 year (N = 2,409)
Cyclosporine use at discharge/Tacrolimus at 1 year (N = 180)

0
0 1 2 3 4 5 6 7 8 9 10
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
by Age Group (Transplants: January 2004 – June 2015)
100
75
p <0.0001
50
<1 Year (N = 961)

25 1-5 Years (N = 831)
6-10 Years (N = 513)
11-17 Years (N = 1,292)
0
0 1 2 3 4 5 6 7 8 9 10 11
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
by Ischemic Time (Transplants: January 2004 – June 2015)
100
75
p = 0.4832
50
25 0-<2 hours (N = 265)

2-<4 hours (N = 2,050)
4+ hours (N = 1,141)
0
0 1 2 3 4 5 6 7 8 9 10 11
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Freedom from Cardiac Allograft Vasculopathy by Ischemic
Time and Recipient Age (Transplants: January 2004 – June 2015)
100
75
<1 year: p=0.9841

1-10 years: p=0.9978
11-17 years: p=0.9166
50
0-<2 hours/<1 year (N=75)
2+ hours/<1 year (N=849)
0-<2 hours/1-10 years (N=94)
25
2+ hours/1-10 years (N=1,194)
0-<2 hours/11-17 years (N=96)
2+ hours/11-17 years (N=1,148)
0
0 1 2 3 4 5 6 7 8 9 10
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Graft Survival Following Report of Cardiac Allograft
Vasculopathy by Age Group (Transplants: January 2004 – June 2015)
100
Survival since Report of CAV (%)
75
50
Age at transplant:
<1 Year (N = 83)
p = 0.0458
25 1-5 Years (N = 95)
6-10 Years (N = 74)
11-17 Years (N = 235)
0
0 1 2 3 4 5
Time since Report of CAV (Years)
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Freedom from Severe Renal Dysfunction* by Age Group
100
Freedom from Severe Renal
90
Dysfunction (%)
80
All pair-wise comparisons were significant at
p<0.05 except <1 vs. 1-5 and 6-10 vs. 11-17.
70
<1 Year (N = 895)

60 1-5 Years (N = 750)
6-10 Years (N = 463) * Severe renal dysfunction = Creatinine > 2.5
11-17 Years (N = 1,183) mg/dl (221 μmol/L), dialysis or renal transplant
50
0 1 2 3 4 5 6 7 8 9 10
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Freedom from Severe Renal Dysfunction* by Calcineurin
Inhibitor Use (Transplants: January 2004 – June 2015)
Conditional on Survival to 1 Year
100
90
p = 0.7031
Dysfunction (%)
80
* Severe renal dysfunction = Creatinine > 2.5

70 mg/dl (221 μmol/L), dialysis or renal transplant
Cyclosporine use at discharge and 1 year (N = 518)

60
Tacrolimus use at discharge and 1 year (N = 2,229)
Cyclosporine use at discharge/Tacrolimus at 1 year (N = 167)

50
0 1 2 3 4 5 6 7 8 9 10
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Freedom from Renal Replacement Therapy by Age Group
100
Freedom from Renal Replacement
90
80
Therapy (%)
No pair-wise comparisons were significant at <0.05

except <1 vs. 11-17, 1-5 vs. 6-10 and 1-5 vs. 11-17.
70
60 <1 Year (N=1,486) 1-5 Years (N=1,260)

6-10 Years (N=792) 11-17 Years (N=1,958)
50
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Post Transplant Malignancy
Cumulative Morbidity Rates in Survivors
1-Year 5-Year 10-Year

Malignancy/Type
Survivors Survivors Survivors
No Malignancy 5,851 (98.3%) 3,369 (95.3%) 1,451 (90.2%)
Malignancy (all types combined) 101 (1.7%) 167 (4.7%) 157 (9.8%)
Malignancy Lymphoma 93 159 148

Type* 8 11 13
Other
Skin 0 1 2
*Recipients may have experienced more than one type of malignancy so sum of
individual malignancy types may be greater than total number with malignancy.
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Post Transplant Malignancy
Cumulative Morbidity Rates in Survivors
Recipient Age
Malignancy
<1 1-5 6-10 11-17
1-Year No Malignancy 1,585 (99.2%) 1,347 (98.5%) 848 (96.7%) 2,071 (98.2%)
Survivors
Malignancy* 13 (0.8%) 20 (1.5%) 29 (3.3%) 39 (1.8%)
5-Year No Malignancy 934 (95.5%) 774 (93%) 527 (95.5%) 1,134 (96.6%)
Survivors
Malignancy* 44 (4.5%) 58 (7.0%) 25 (4.5%) 40 (3.4%)
10-Year No Malignancy 462 (90.6%) 351 (86.7%) 225 (91.5%) 413 (92.4%)
Survivors
Malignancy* 48 (9.4%) 54 (13.3%) 21 (8.5%) 34 (7.6%)
2017 * All types combined
JHLT. 2017 Oct; 36(10): 1037-1079

Freedom from Malignancy (Transplants: January 1994 - June 2015)
100
Freedom from Malignancy (%)
90
80
70
60
All malignancy Lymphoma Skin Other
50
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Freedom from Malignancy by Maintenance Immunosuppression
Combinations (Transplants: January 2004 – June 2015)
Conditional on Survival to 1 year
100
Freedom from Malignancy (%)
90
p = 0.0866
80
70
Cyclosporine use at discharge and 1 year (N=546)

60
Tacrolimus use at discharge and 1 year (N=2,626)
Cyclosporine use at discharge/ Tacrolimus use at 1 year (N=193)
50
0 1 2 3 4 5 6 7 8 9 10
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Freedom from Lymphoma by Induction
100
Freedom from Lymphoma (%)
90
p = 0.1699
80
70
60
Induction (N=3,308) No induction (N=2,700)
50
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Relationship of Rejection and Cardiac Allograft Vasculopathy
Reported CAV between 1st and 3rd years

Rejection During post-transplant
1st Year
Yes No All
Yes 49 (6.6%) 689 (93.4%) 738 (100%)
No 64 (4.1%) 1,487 (95.9%) 1,551 (100%)
p = 0.0095
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Cause of Death (Deaths: January 2004 – June 2016)
0-30 Days 31 Days - 1 Year >1 Year - 3 Years >3 Years - 5 >5 Years - 10 >10 Years
CAUSE OF DEATH
(N = 285) (N = 328) (N = 266) Years (N = 226) Years (N = 402) (N = 467)
CARDIAC ALLOGRAFT
4 (1.4%) 9 (2.7%) 38 (14.3%) 38 (16.8%) 82 (20.4%) 112 (24.0%)
VASCULOPATHY
ACUTE REJECTION 17 (6.0%) 51 (15.5%) 45 (16.9%) 33 (14.6%) 42 (10.4%) 23 (4.9%)
LYMPHOMA 0 5 (1.5%) 9 (3.4%) 10 (4.4%) 22 (5.5%) 28 (6.0%)
MALIGNANCY, OTHER 0 3 (0.9%) 4 (1.5%) 1 (0.4%) 8 (2.0%) 18 (3.9%)
CMV 0 6 (1.8%) 0 0 0 0
INFECTION, NON-CMV 18 (6.3%) 40 (12.2%) 15 (5.6%) 13 (5.8%) 21 (5.2%) 29 (6.2%)
GRAFT FAILURE 112 (39.3%) 69 (21.0%) 108 (40.6%) 85 (37.6%) 166 (41.3%) 157 (33.6%)
TECHNICAL 23 (8.1%) 2 (0.6%) 0 1 (0.4%) 4 (1.0%) 5 (1.1%)
OTHER 22 (7.7%) 25 (7.6%) 15 (5.6%) 15 (6.6%) 20 (5.0%) 28 (6.0%)
MULTIPLE ORGAN
35 (12.3%) 68 (20.7%) 13 (4.9%) 10 (4.4%) 15 (3.7%) 27 (5.8%)
FAILURE
RENAL FAILURE 0 6 (1.8%) 1 (0.4%) 4 (1.8%) 2 (0.5%) 15 (3.2%)
PULMONARY 9 (3.2%) 31 (9.5%) 11 (4.1%) 9 (4.0%) 11 (2.7%) 12 (2.6%)
CEREBROVASCULAR 45 (15.8%) 13 (4.0%) 7 (2.6%) 7 (3.1%) 9 (2.2%) 13 (2.8%)
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Cause of Death for Age <1 Year (Deaths: January 2004 – June 2016)
CAUSE OF DEATH
CARDIAC ALLOGRAFT
3 (3.7%) 4 (3.2%) 10 (15.4%) 6 (13.3%) 12 (22.6%) 17 (25.8%)
VASCULOPATHY
ACUTE REJECTION 6 (7.4%) 10 (7.9%) 10 (15.4%) 2 (4.4%) 1 (1.9%) 3 (4.5%)
LYMPHOMA 0 0 3 (4.6%) 3 (6.7%) 9 (17.0%) 9 (13.6%)
MALIGNANCY, OTHER 0 0 2 (3.1%) 1 (2.2%) 2 (3.8%) 2 (3.0%)
CMV 0 2 (1.6%) 0 0 0 0
GRAFT FAILURE 35 (43.2%) 27 (21.4%) 21 (32.3%) 17 (37.8%) 18 (34.0%) 17 (25.8%)
TECHNICAL 6 (7.4%) 0 0 0 1 (1.9%) 1 (1.5%)
OTHER 5 (6.2%) 13 (10.3%) 5 (7.7%) 3 (6.7%) 1 (1.9%) 2 (3.0%)
MULTIPLE ORGAN
12 (14.8%) 30 (23.8%) 4 (6.2%) 3 (6.7%) 1 (1.9%) 6 (9.1%)
FAILURE
RENAL FAILURE 0 6 (4.8%) 1 (1.5%) 1 (2.2%) 0 1 (1.5%)
PULMONARY 3 (3.7%) 18 (14.3%) 5 (7.7%) 3 (6.7%) 3 (5.7%) 0
CEREBROVASCULAR 6 (7.4%) 3 (2.4%) 0 3 (6.7%) 1 (1.9%) 1 (1.5%)
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Cause of Death for Age 1-5 Years (Deaths: January 2004 – June 2016)
CAUSE OF DEATH
CARDIAC ALLOGRAFT
0 1 (1.2%) 9 (15.3%) 9 (19.6%) 11 (19.3%) 26 (22.6%)
VASCULOPATHY
ACUTE REJECTION 6 (11.8%) 26 (31.3%) 10 (16.9%) 7 (15.2%) 4 (7.0%) 7 (6.1%)
LYMPHOMA 0 1 (1.2%) 1 (1.7%) 4 (8.7%) 5 (8.8%) 9 (7.8%)
MALIGNANCY, OTHER 0 1 (1.2%) 1 (1.7%) 0 2 (3.5%) 4 (3.5%)
CMV 0 1 (1.2%) 0 0 0 0
GRAFT FAILURE 26 (51.0%) 19 (22.9%) 25 (42.4%) 13 (28.3%) 21 (36.8%) 36 (31.3%)
TECHNICAL 3 (5.9%) 0 0 0 0 1 (0.9%)
OTHER 1 (2.0%) 2 (2.4%) 1 (1.7%) 5 (10.9%) 1 (1.8%) 7 (6.1%)
MULTIPLE ORGAN
3 (5.9%) 16 (19.3%) 2 (3.4%) 1 (2.2%) 2 (3.5%) 9 (7.8%)
FAILURE
RENAL FAILURE 0 0 0 0 1 (1.8%) 3 (2.6%)
PULMONARY 4 (7.8%) 3 (3.6%) 1 (1.7%) 4 (8.7%) 2 (3.5%) 4 (3.5%)
CEREBROVASCULAR 6 (11.8%) 5 (6.0%) 5 (8.5%) 0 3 (5.3%) 6 (5.2%)
2017
JHLT. 2017 Oct; 36(10): 1037-1079
CAUSE OF DEATH
CARDIAC ALLOGRAFT
1 (1.9%) 0 5 (23.8%) 4 (14.8%) 11 (20.8%) 23 (22.5%)
VASCULOPATHY
ACUTE REJECTION 2 (3.8%) 2 (7.7%) 1 (4.8%) 11 (40.7%) 5 (9.4%) 6 (5.9%)
LYMPHOMA 0 1 (3.8%) 2 (9.5%) 0 5 (9.4%) 5 (4.9%)
MALIGNANCY, OTHER 0 0 0 0 3 (5.7%) 2 (2.0%)
CMV 0 3 (11.5%) 0 0 0 0
GRAFT FAILURE 14 (26.9%) 1 (3.8%) 7 (33.3%) 8 (29.6%) 17 (32.1%) 39 (38.2%)
TECHNICAL 4 (7.7%) 0 0 1 (3.7%) 2 (3.8%) 0
OTHER 7 (13.5%) 3 (11.5%) 2 (9.5%) 0 0 4 (3.9%)
MULTIPLE ORGAN
9 (17.3%) 7 (26.9%) 1 (4.8%) 0 3 (5.7%) 5 (4.9%)
FAILURE
RENAL FAILURE 0 0 0 0 0 5 (4.9%)
PULMONARY 0 2 (7.7%) 1 (4.8%) 1 (3.7%) 2 (3.8%) 3 (2.9%)
CEREBROVASCULAR 14 (26.9%) 3 (11.5%) 0 1 (3.7%) 1 (1.9%) 3 (2.9%)
2017
JHLT. 2017 Oct; 36(10): 1037-1079
CAUSE OF DEATH
CARDIAC ALLOGRAFT
0 4 (4.3%) 14 (11.6%) 19 (17.6%) 48 (20.1%) 46 (25.0%)
VASCULOPATHY
ACUTE REJECTION 3 (3.0%) 13 (14.0%) 24 (19.8%) 13 (12.0%) 32 (13.4%) 7 (3.8%)
LYMPHOMA 0 3 (3.2%) 3 (2.5%) 3 (2.8%) 3 (1.3%) 5 (2.7%)
MALIGNANCY, OTHER 0 2 (2.2%) 1 (0.8%) 0 1 (0.4%) 10 (5.4%)
GRAFT FAILURE 37 (36.6%) 22 (23.7%) 55 (45.5%) 47 (43.5%) 110 (46.0%) 65 (35.3%)
TECHNICAL 10 (9.9%) 2 (2.2%) 0 0 1 (0.4%) 3 (1.6%)
OTHER 9 (8.9%) 7 (7.5%) 7 (5.8%) 7 (6.5%) 18 (7.5%) 15 (8.2%)
MULTIPLE ORGAN
11 (10.9%) 15 (16.1%) 6 (5.0%) 6 (5.6%) 9 (3.8%) 7 (3.8%)
FAILURE
RENAL FAILURE 0 0 0 3 (2.8%) 1 (0.4%) 6 (3.3%)
PULMONARY 2 (2.0%) 8 (8.6%) 4 (3.3%) 1 (0.9%) 4 (1.7%) 5 (2.7%)
CEREBROVASCULAR 19 (18.8%) 2 (2.2%) 2 (1.7%) 3 (2.8%) 4 (1.7%) 3 (1.6%)
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Relative Incidence of Leading Causes of Death
(Deaths: January 2004 – June 2016)
50
CAV Acute Rejection Infection (non-CMV) Graft Failure
Percentage of Deaths
40
30
20
10
0
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Retransplantation
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Pediatric Heart Retransplants
by Year of Retransplant
40 18
35 N % 16
Number of retransplants
14
30
% of transplants
12
25
10
20
8
15
6
10 4
5 2
0 0
Year of retransplant
Only patients who were less than 18 years
2017 old at the time of retransplant are included.
JHLT. 2017 Oct; 36(10): 1037-1079
by Inter-transplant Interval and Recipient Age
(Retransplants: January 1994 – June 2016)
60
<1 Year 1-5 Years 6-10 Years 11-17 Years
50
% of Retransplants
40
30
20
10
0
<1 month 1-<12 months 12-<36 36-<60 >60 months Not reported
months months
Time Between Previous and Current Transplant
Only patients who were less than 18 years old at the
2017 time of retransplant are included. Analysis is based
on the recipient age at the time of retransplant.
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival Rates for Primary and Repeat
Transplants (Transplants: January 1994 – June 2015)
100
p < 0.0001
75
Survival (%)
50
25
Retransplant (N = 543) Primary (N = 9,990)
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Years
Only patients who were less than 18 years old
2017 at the time of retransplant are included.
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival Rates by Inter-transplant Interval
<1 Year (N=74) 1-<3 Years (N=66) 3-<5 Years (N=70)
5+ Years (N=286) Primary TX (N=9,990)
100
75
Survival (%)
50
25
Comparison of survival for
retransplant groups: p < 0.0001
0
0 1 2 3 4 5 6 7 8 9 10
Time (years) since most recent transplant
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival Rates by Retransplant Reason
100
75
Survival (%)
50
25
Coronary Artery Disease (N=273) No pair-wise comparisons were
Primary Failure (N=38) significant at p < 0.05 except Coronary
Artery Disease vs. Primary Failure
Rejection (N=78)
0
0 1 2 3 4 5 6 7 8 9
Years
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival Conditional on Survival to 1 Year for Primary and
Repeat Transplants (Transplants: January 1994 – June 2015)
100
75
Survival (%)
p < 0.0001
50
25
Retransplant (N = 437) Primary (N = 8,171)
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Years
JHLT. 2017 Oct; 36(10): 1037-1079
Multivariable Analyses
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Pediatric Heart Transplants (1/2004-6/2015)
Statistically Significant Risk Factors For 1 Year Mortality with 95%
Confidence Limits
2017 (N = 6,327)
JHLT. 2017 Oct; 36(10): 1037-1079
Statistically Significant Risk Factors For 1 Year Mortality
Continuous Factors (see figures)

Ischemic time Recipient BMI
Donor BSA Height difference
Estimated GFR Center volume: prev ped TXs within 1 yr
Total bilirubin
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Risk Factors For 1 Year Mortality with 95% Confidence Limits
Ischemic time
2.5
Hazard Ratio for 1 Year Mortality
p = 0.0003
2.0
1.5
1.0
0.5
0.0
2 3 4 5 6
Ischemic time (hours)
2017 (N = 6,327)
JHLT. 2017 Oct; 36(10): 1037-1079
Recipient BMI
2.5
p = 0.0072
2.0
1.5
1.0
0.5
0.0
12 14 16 18 20 22 24
Recipient BMI (kg/m2)
2017 (N = 6,327)
JHLT. 2017 Oct; 36(10): 1037-1079
Donor BSA
2.5
p = 0.0038
2.0
1.5
1.0
0.5
0.0
0.3 0.5 0.7 0.9 1.1 1.3 1.5 1.7 1.9
Donor BSA
2017 (N = 6,327)
JHLT. 2017 Oct; 36(10): 1037-1079
Height difference
2.5
p = 0.0119
2.0
1.5
1.0
0.5
0.0
-15 -10 -5 0 5 10 15 20
Height difference (cm)
2017 (N = 6,327)
JHLT. 2017 Oct; 36(10): 1037-1079
Estimated GFR
2.5
p = 0.0117
2.0
1.5
1.0
0.5
0.0
40 50 60 70 80 90 100 110 120
Estimated GFR
2017 (N = 6,327)
JHLT. 2017 Oct; 36(10): 1037-1079
Center volume: prev ped TXs within 1 yr

2.5
p = 0.0004
2.0
1.5
1.0
0.5
0.0
0 5 10 15 20 25
2017 (N = 6,327)
JHLT. 2017 Oct; 36(10): 1037-1079
Total bilirubin
2.5
p = 0.0170
2.0
1.5
1.0
0.5
0.0
0.5 1.0 1.5 2.0 2.5
Total bilirubin (mg/dl)
2017 (N = 6,327)
JHLT. 2017 Oct; 36(10): 1037-1079
Confidence Limits
Age = <1 Year
2017 (N = 1,463)
JHLT. 2017 Oct; 36(10): 1037-1079
Age = <1 Year

Recipient creatinine Ischemic time
Recipient height Recipient BSA
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Age = <1 Year
Recipient creatinine
2.5
p = 0.0009
2.0
1.5
1.0
0.5
0.0
0.2 0.3 0.4 0.5 0.6
Recipient creatinine (mg/dl)
2017 (N = 1,463)
JHLT. 2017 Oct; 36(10): 1037-1079
Age = <1 Year
Ischemic time
2.5
p = 0.0104
2.0
1.5
1.0
0.5
0.0
2 3 4 5 6
2017 (N = 1,463)
JHLT. 2017 Oct; 36(10): 1037-1079
Age = <1 Year
Recipient height
2.5
p = 0.0128
2.0
1.5
1.0
0.5
0.0
50 55 60 65 70
Recipient height (cm)
2017 (N = 1,463)
JHLT. 2017 Oct; 36(10): 1037-1079
Age = <1 Year
Recipient BSA
2.5
p = 0.0235
2.0
1.5
1.0
0.5
0.0
0.20 0.25 0.30 0.35
Recipient BSA
2017 (N = 1,463)
JHLT. 2017 Oct; 36(10): 1037-1079
Confidence Limits
Age = 1-5 Years
2017 (N = 1,460)
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 1-5 Years

Recipient height Height ratio
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 1-5 Years
Recipient height
2.5
p = 0.0165
2.0
1.5
1.0
0.5
0.0
70 75 80 85 90 95 100 105 110
2017 (N = 1,460)
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 1-5 Years
Height ratio
2.5
p = 0.0306
2.0
1.5
1.0
0.5
0.0
0.9 1.0 1.0 1.1 1.1 1.2 1.2
Height ratio
2017 (N = 1,460)
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 1-5 Years
Estimated GFR
2.5
p = 0.0008
2.0
1.5
1.0
0.5
0.0
60 70 80 90 100 110 120
Estimated GFR
2017 (N = 1,460)
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 1-5 Years
2.5
p = 0.0208
2.0
1.5
1.0
0.5
0.0
0 5 10 15 20 25 30
2017 (N = 1,460)
JHLT. 2017 Oct; 36(10): 1037-1079
Confidence Limits
Age = 6-10 Years
2017 (N = 952)
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 6-10 Years

Donor age Recipient height
BSA ratio Height difference
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 6-10 Years
Donor age
2.5
p = 0.0443
2.0
1.5
1.0
0.5
0.0
5 10 15 20 25 30 35
Donor age (years)
2017 (N = 952)
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 6-10 Years
Recipient height
2.5
p = 0.0160
2.0
1.5
1.0
0.5
0.0
105 110 115 120 125 130 135 140 145 150
2017 (N = 952)
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 6-10 Years
BSA ratio
2.5
p = 0.0484
2.0
1.5
1.0
0.5
0.0
0.9 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8
BSA ratio
2017 (N = 952)
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 6-10 Years
Height difference
2.5
p = 0.0083
2.0
1.5
1.0
0.5
0.0
-5 0 5 10 15 20
Height difference (cm)
2017 (N = 952)
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 6-10 Years
Estimated GFR
2.5
p = 0.0152
2.0
1.5
1.0
0.5
0.0
50 60 70 80 90 100 110 120
Estimated GFR
2017 (N = 952)
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 6-10 Years
2.5
p = 0.0397
2.0
1.5
1.0
0.5
0.0
0 5 10 15 20 25 30
2017 (N = 952)
JHLT. 2017 Oct; 36(10): 1037-1079
Confidence Limits
Age = 11-17 Years
2017 (N = 2,452)
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 11-17 Years

PCW Most recent PRA
PA mean
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 11-17 Years
PCW
2.5
p = 0.0004
2.0
1.5
1.0
0.5
0.0
10 15 20 25 30 35
PCW (mm/Hg)
2017 (N = 2,452)
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 11-17 Years
Most recent PRA
2.5
p = 0.0149
2.0
1.5
1.0
0.5
0.0
0 10 20 30 40 50 60 70 80
Most recent PRA (%)
2017 (N = 2,452)
JHLT. 2017 Oct; 36(10): 1037-1079
Age = 11-17 Years
PA mean
2.5
p = 0.0008
2.0
1.5
1.0
0.5
0.0
10 15 20 25 30 35 40 45 50
PA mean (mm/Hg)
2017 (N = 2,452)
JHLT. 2017 Oct; 36(10): 1037-1079
Confidence Limits
2017 (N = 5,651)
JHLT. 2017 Oct; 36(10): 1037-1079

Recipient age Donor age
Ischemic time Recipient weight (kg)
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Recipient age
2.5
p = 0.0002
2.0
1.5
1.0
0.5
0.0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Recipient age (years)
2017 (N = 5,651)
JHLT. 2017 Oct; 36(10): 1037-1079
Donor age
2.5
p = 0.0434
2.0
1.5
1.0
0.5
0.0
0 5 10 15 20 25 30 35 40
Donor age (years)
2017 (N = 5,651)
JHLT. 2017 Oct; 36(10): 1037-1079
Ischemic time
2.5
p = 0.0048
2.0
1.5
1.0
0.5
0.0
2 3 4 5 6
2017 (N = 5,651)
JHLT. 2017 Oct; 36(10): 1037-1079
Recipient weight (kg)

2.5
p = 0.0403
2.0
1.5
1.0
0.5
0.0
5 10 15 20 25 30 35 40 45 50 55 60 65 70
2017 (N = 5,651)
JHLT. 2017 Oct; 36(10): 1037-1079
Estimated GFR
2.5
p = 0.0006
2.0
1.5
1.0
0.5
0.0
35 45 55 65 75 85 95 105 115 125
Estimated GFR
2017 (N = 5,651)
JHLT. 2017 Oct; 36(10): 1037-1079

2.5
p = 0.0026
2.0
1.5
1.0
0.5
0.0
0 5 10 15 20 25 30
2017 (N = 5,651)
JHLT. 2017 Oct; 36(10): 1037-1079
Confidence Limits
2017 (N = 4,878)
JHLT. 2017 Oct; 36(10): 1037-1079

Recipient age Donor age
Recipient height Estimated GFR
Transplant center volume
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Recipient age
2.5
p = 0.0010
2.0
1.5
1.0
0.5
0.0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Recipient age (years)
2017 (N = 4,878)
JHLT. 2017 Oct; 36(10): 1037-1079
Donor age
2.5
p = 0.0006
2.0
1.5
1.0
0.5
0.0
0 5 10 15 20 25 30 35 40
Donor age (years)
2017 (N = 4,878)
JHLT. 2017 Oct; 36(10): 1037-1079
Recipient height
2.5
p = 0.0023
2.0
1.5
1.0
0.5
0.0
50 60 70 80 90 100 110 120 130 140 150 160 170 180
2017 (N = 4,878)
JHLT. 2017 Oct; 36(10): 1037-1079
Estimated GFR
2.5
p = 0.0143
2.0
1.5
1.0
0.5
0.0
35 45 55 65 75 85 95 105 115 125
Estimated GFR
2017 (N = 4,878)
JHLT. 2017 Oct; 36(10): 1037-1079

2.5
p = 0.0084
2.0
1.5
1.0
0.5
0.0
0 10 20 30 40 50 60 70 80 90
2017 (N = 4,878)
JHLT. 2017 Oct; 36(10): 1037-1079
Pediatric Heart Transplants (1990-6/2001)
Confidence Limits
2017 (N = 4,493)
JHLT. 2017 Oct; 36(10): 1037-1079

Donor age Donor weight (kg)
Donor BMI Center volume: prev ped TXs within 1 yr
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Donor age
2.5
p = 0.0137
2.0
1.5
1.0
0.5
0.0
0 5 10 15 20 25 30 35 40
Donor age (years)
2017 (N = 4,493)
JHLT. 2017 Oct; 36(10): 1037-1079
Donor weight (kg)

2.5
p = 0.0016
2.0
1.5
1.0
0.5
0.0
5 10 15 20 25 30 35 40 45 50 55 60 65 70
Donor weight (kg)
2017 (N = 4,493)
JHLT. 2017 Oct; 36(10): 1037-1079
Donor BMI
2.5
p = 0.0038
2.0
1.5
1.0
0.5
0.0
12 14 16 18 20 22 24
Donor BMI (kg/m2)
2017 (N = 4,493)
JHLT. 2017 Oct; 36(10): 1037-1079

2.5
p = 0.0236
2.0
1.5
1.0
0.5
0.0
0 5 10 15 20 25
2017 (N = 4,493)
JHLT. 2017 Oct; 36(10): 1037-1079
Statistically Significant Risk Factors for Developing CAV within 5 Years
with 95% Confidence Limits
Conditional on Survival to Transplant Discharge
2017 (N = 3,044)
JHLT. 2017 Oct; 36(10): 1037-1079

Donor age Transplant center volume
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Risk Factors for Developing CAV within 5 Years with 95% Confidence Limits
Donor age
2.5
Hazard Ratio for CAV within 5 Years
p < 0.0001
2.0
1.5
1.0
0.5
0.0
0 5 10 15 20 25 30
Donor age (years)
2017 (N = 3,044)
JHLT. 2017 Oct; 36(10): 1037-1079
2.5
Hazard Ratio for CAV within 5 Years
p = 0.0312
2.0
1.5
1.0
0.5
0.0
0 10 20 30 40 50 60 70 80 90
2017 (N = 3,044)
JHLT. 2017 Oct; 36(10): 1037-1079
with 95% Confidence Limits
2017 (N = 2,456)
JHLT. 2017 Oct; 36(10): 1037-1079

Donor age BMI ratio
Donor BSA Transplant center volume
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Donor age
2.5
Hazard Ratio for CAV within 10
p = 0.0105
2.0
1.5
Years
1.0
0.5
0.0
0 5 10 15 20 25 30
Donor age (years)
2017 (N = 2,456)
JHLT. 2017 Oct; 36(10): 1037-1079
BMI ratio
2.5
p = 0.0115
2.0
1.5
Years
1.0
0.5
0.0
0.80 0.85 0.90 0.95 1.00 1.05 1.10 1.15 1.20
BMI ratio (kg/m2)
2017 (N = 2,456)
JHLT. 2017 Oct; 36(10): 1037-1079
Donor BSA
2.5
p = 0.0021
2.0
1.5
Years
1.0
0.5
0.0
0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8
Donor BSA
2017 (N = 2,456)
JHLT. 2017 Oct; 36(10): 1037-1079
2.5
p < 0.0001
2.0
1.5
Years
1.0
0.5
0.0
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90
2017 (N = 2,456)
JHLT. 2017 Oct; 36(10): 1037-1079
Statistically Significant Risk Factors for Developing Renal Dysfunction
within 5 Years with 95% Confidence Limits
Limited to Recipients without Severe Renal Dysfunction* Pre-Transplant
2017 (N = 2,983)
JHLT. 2017 Oct; 36(10): 1037-1079
within 5 Years

Donor height Donor BSA
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Risk Factors for Developing Renal Dysfunction within 5 Years with 95% Confidence Limits
Donor height
5.0
Hazard Ratio for renal dysfunction
4.5
p = 0.0306
4.0
3.5
within 5 Years
3.0
2.5
2.0
1.5
1.0
0.5
0.0
80 90 100 110 120 130 140 150 160 170 180
Donor height (cm)
2017 (N = 2,983)
JHLT. 2017 Oct; 36(10): 1037-1079
Donor BSA
5.0
4.5
p = 0.0079
4.0
3.5
within 5 Years
3.0
2.5
2.0
1.5
1.0
0.5
0.0
0.3 0.5 0.7 0.9 1.1 1.3 1.5 1.7
Donor BSA
2017 (N = 2,983)
JHLT. 2017 Oct; 36(10): 1037-1079
within 10 Years with 95% Confidence Limits
2017 (N = 2,427)
JHLT. 2017 Oct; 36(10): 1037-1079
within 10 Years

Recipient weight (kg) Estimated GFR
2017
JHLT. 2017 Oct; 36(10): 1037-1079
2.5
p < 0.0001
2.0
within 10 Years
1.5
1.0
0.5
0.0
5 10 15 20 25 30 35 40 45 50 55 60 65 70
2017 (N = 2,427)
JHLT. 2017 Oct; 36(10): 1037-1079
Estimated GFR
2.5
p = 0.0100
2.0
within 10 Years
1.5
1.0
0.5
0.0
35 45 55 65 75 85 95 105 115 125
Estimated GFR
2017 (N = 2,427)
JHLT. 2017 Oct; 36(10): 1037-1079
2.5
p = 0.0243
2.0
within 10 Years
1.5
1.0
0.5
0.0
0 5 10 15 20 25 30
2017 (N = 2,427)
JHLT. 2017 Oct; 36(10): 1037-1079
Focus Theme
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Ischemic Time Distribution by Diagnosis
0-<2 hours 2-<4 hours 4-<6 hours 6+ hours
100%
80%
% of Transplants
60%
40%
20%
0%
CHD DCM Retransplant Other
2017 p < 0.0001
JHLT. 2017 Oct; 36(10): 1037-1079

Ischemic Time Distribution by Recipient Age
100%
80%
% of Transplants
60%
40%
20%
0%
<1 1-5 6-10 11-17
Recipient Age (Years)
2017 p < 0.0001
JHLT. 2017 Oct; 36(10): 1037-1079

Ischemic Time Distribution by Mechanical Circulatory Support*
100%
80%
% of Transplants
60%
40%
20%
0%
None ECMO VAD/TAH
* LVAD, RVAD, TAH, ECMO
2017 p = 0.0552
JHLT. 2017 Oct; 36(10): 1037-1079
Ischemic Time Distribution by Donor Age
100%
80%
% of Transplants
60%
40%
20%
0%
<1 1-5 6-10 11-17 18-34 35-49 50-65
Donor Age (Years)
2017 p < 0.0001
JHLT. 2017 Oct; 36(10): 1037-1079

Ischemic Time Distribution by Donor Cause of Death
100%
80%
% of Transplants
60%
40%
20%
0%
Anoxia Cerebrovascular/ Head Trauma Other
Stroke
2017 p < 0.0001
JHLT. 2017 Oct; 36(10): 1037-1079

Ischemic Time Distribution by Year of Transplant
0-<2 hours 2-<4 hours 4-<6 hours 6+ hours Median Ischemic Time
100% 4.5
Median ischemic time (hours)

90% 4.0
80% 3.5
% of transplants
70%
3.0
60%
2.5
50%
2.0
40%
1.5
30%
20% 1.0
10% 0.5
0% 0.0
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Ischemic Time Distribution by Location
100%
80%
% of Transplants
60%
40%
20%
0%
Europe North America Others
2017 p < 0.0001
JHLT. 2017 Oct; 36(10): 1037-1079

Ischemic Time Distribution by Center Volume
100%
80%
% of Transplants
60%
40%
20%
0%
1-4 5-9 10+
2017 p < 0.0001
JHLT. 2017 Oct; 36(10): 1037-1079

Kaplan-Meier Survival Within 30 Days by Ischemic Time
100
75
All pair-wise comparisons were significant at

Survival (%)
p < 0.05 except 0-<2 vs. 2-<4 hours

50
25 0-<2 hours (N = 370)

2-<4 hours (N = 2,688)
4+ hours (N = 1,823)
0
0 5 10 15 20 25 30
Days
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival by Ischemic Time
100
75
No pair-wise comparisons were significant at

Survival (%)
p < 0.05 except 2-<4 vs. 4+ hours

50
25 0-<2 hours (N = 370)

2-<4 hours (N = 2,688)
4+ hours (N = 1,823)
0
0 1 2 3 4 5 6 7 8 9 10 11
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Kaplan-Meier Survival by Ischemic Time
Diagnosis = CHD
100
75
Survival (%)
50
No pair-wise comparisons were significant at p < 0.05.
25 0-<2 hours (N = 94)

2-<4 hours (N = 893)
4+ hours (N = 873)
0
0 1 2 3 4 5 6 7 8 9 10 11
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
and 1-Year Follow-Up by Ischemic Time
50

40
within 1 year
30
20
10
0
0-<2 hours 2-<4 hours 4+ hours
rejection.
JHLT. 2017 Oct; 36(10): 1037-1079
by Ischemic Time (Transplants: January 2004 – June 2015)
100
75
50
25 0-<2 hours (N = 265)

2-<4 hours (N = 2,050)
4+ hours (N = 1,141)
0
0 1 2 3 4 5 6 7 8 9 10 11
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Freedom from Severe Renal Dysfunction* by Ischemic Time
100
75
Dysfunction (%)
50
0-<2 hours (N = 261)

25
2-<4 hours (N = 1,871)
* Severe renal dysfunction = Creatinine > 2.5
4+ hours (N = 1,010) mg/dl (221 μmol/L), dialysis or renal transplant
0
0 1 2 3 4 5 6 7 8 9 10
Years
2017
JHLT. 2017 Oct; 36(10): 1037-1079
Length of Stay Distribution by Ischemic Time
0-7 days 8-10 days 11-14 days 15-21 days 22-28 days 29+ days
100%
80%
% of Transplants
60%
40%
20%
0%
0-<2 hours 2-<4 hours 4+ hours
2017
JHLT. 2017 Oct; 36(10): 1037-1079

Heart Transplantation: Pediatric Recipients

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Heart Transplantation: Pediatric Recipients

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HEART TRANSPLANTATION

 Donor, recipient and center characteristics: slides 3-29

140 2004-2008 2009-June 2016

NOTE: This figure includes only the heart transplants

25% 23% CHD

2017 * LVAD, RVAD, TAH, ECMO

2017 * LVAD, RVAD, TAH, ECMO

2017 * LVAD, RVAD, TAH, ECMO

2017 * LVAD, RVAD, TAH, ECMO

JHLT. 2017 Oct; 36(10): 1037-1079

0-9% 10-39% 40-79% 80%+

CPRA and PRA values were combined. If Class I and

No pair-wise comparisons were significant at p < 0.05

Median survival (years): <1=22.3; 1-5=18.4; 6-10=14.4; 11-17=13.1

All pair-wise comparisons were significant at p < 0.05.

25 <1 (N = 1,489) 1-5 (N = 1,485)

All pair-wise comparisons were significant

2004-2008 (N=2,535) 2009-6/2015 (N=3,885)

All p-values were significant at p < 0.05.

Median survival (years):1982-1989= 9.8; 1990-2003=14.4;

<1 Year (N = 1,168) 1-5 Years (N = 1,228)

2004-2008 (N=572) 2009-6/2015 (N=906)

All pair-wise comparisons were significant at p<0.05.

Median survival (years): 1982-1989=10.8; 1990-2003=20.3;

1982-1989 (N=161) 1990-2003 (N=1,282)

Median survival (years): 1982-1989= 9.1; 1990-2003=16.9;

2004-2008 (N=372) 2009-6/2015 (N=591)

All p-values significant at < 0.05 except

Median survival (years): 1982-1989= 7.7; 1990-2003=13.3;

All other pair-wise comparisons were significant at p<0.05

Male (N = 3,476) Female (N = 2,944)

No pair-wise comparisons were significant at p<0.05.

Female/Male (N = 1,401) Female/Female (N = 1,366)

CHD (N=828) DCM (N=525)

CHD (N=582) DCM (N=665) Retransplant (N=38)

CHD (N=305) DCM (N=426) Retransplant (N=68)

CHD (N=515) DCM (N=1,307) Retransplant (N=222)

0-9% (N=1,026) 10-39% (N=180) 40%+ (N=289)

0-9% (N=1,144) 10-39% (N=159) 40%+ (N=100)

0-9% (N=109) 10-39% (N=38) 40%+ (N=78)

Patient (N = 6,420) Graft (N = 6,420)

20% No Hospitalization Hospitalized, Not Rejection/Not Infectio

Analysis is limited to patients who were

Analysis is limited to patients who were

No pair-wise comparisons were significant at p<0.05.

IL-2R antagonist (N = 777)

No pair-wise comparisons of survival by

No induction/No rejection (N=916)

40% Tacrolimus + AZA

20% Cyclosporine + MMF/MPA

25 Prednisone use at discharge and 1 year (N = 2,005)

25 Cyclosporine use at discharge (N = 834)

No pair-wise comparisons were significant at p<0.05.

50 No pair-wise comparisons were significant at p<0.05 except

25 Cyclosporine use at discharge and 1 year (N=547)

25 Free from Rejection during 1 year (N = 2,290)

Treated Rejection within 1st Year (N = 900)

25 Free from Rejection during 1 year (N = 727)

Treated Rejection within 1st Year (N = 147)

25 Free from Rejection during 1 year (N = 516)

Treated Rejection within 1st Year (N = 208)

25 Free from Rejection during 1 year (N = 284)

Treated Rejection within 1st Year (N = 173)