Page 6 - First Child
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Page 5 of 11                                     Pediatric Transplantation



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   3           Discussion:
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   6           The ISHLT Registry was formed in 1983 however the registry data analysis is from January
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   8           1982 . It is thought that, whilst data was collected prospectively from 1983, a number of
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   10          transplants performed prior to then, mainly from the larger centers, were entered retrospectively
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   12          (personal communication Dr Hosenpud – the second registry director).
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   15          There is a large difference between patient and graft survival which is explained by the high
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   17          retransplant rate – 27% of these patients underwent retransplantation which is a much higher
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   19          percentage than occurs in the modern era . Whilst the cause of graft failure was not recorded
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   21          frequently enough for assessment, it is likely that the grafts failed due to rejection as anti-
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   24          rejection treatment was a regime based on steroids and azathioprine which is less effective than
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   26          the calcineurin inhibitor and mycophenolate mofetil strategy in use today .
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   28          Another notable, but not surprising difference in survival between these thirty patients and the
   29                                   For Peer Review
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   31          later eras, is the high attrition in the period soon after transplant. The Kaplan-Meier survival
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   33          curves (Figure 3) have shown a consistent improvement in early patient survival due to
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   35          improved peri-transplant management over the years.
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   38          The definition of a successful transplant is clearly debatable. Barnard claimed success, and was
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   40          lauded throughout the world, for his transplant in 1967 even though the patient died 18 days
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   42          later and there was significant professional criticism . Kantrowitz could also claim a success
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   44          (although he did not) as he demonstrated transplantation was technically possible surgically,
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   46          even in infancy. We can all agree that a truly successful transplant would enable a recipient to
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   48          live a normal lifespan however that remains unattainable to this day . James Lovett, the boy
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   50          reported to be the first in 1984 was undoubtedly a success - he lived for 21 years after his
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   52          transplant, studied bioethics, was accepted for medical school and led a full life as chronicled by
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   54          Barron Lerner . Success may be defined by survival to at least one year and by that criteria
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   60                          The official publication of the International Pediatric Transplant Association
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