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Pediatric Transplantation                                   Page 6 of 11



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   3           James was not the first – that falls to the second transplant in 1968 who lived for six years. That
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   5           many of these early transplants were undertaken and the patients survived as long as they did
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   7           must however be considered a success.
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   10          Limitations:
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   13          The ISHLT thoracic registry data was entered retrospectively by the clinicians around the time of
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   15          the institution of the registry. We recognize the high likelihood of ascertainment bias and that it
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   17          is uncertain how many failed transplant were not reported, so these results may be not be an
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   19          accurate representation of results from the early era. Follow-up data is incomplete and may be
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   21          subject to inaccuracies. The cause of death, post-transplant morbidities and ischemic time were
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   24          recorded too infrequently for analysis and they are thus lost in the mists of time.
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   26          Conclusion:
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   29          This report demonstrates that the first successful transplant reported to the ISHLT registry was
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   31          in 1968 and that a number of hitherto unreported patients were transplanted prior to 1982.
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   33          Whilst transplant survival for these early patients (and especially grafts) was considerably less
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   35          than the subsequent eras, the experience managing these children laid the foundation for the
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   38          future and the recipient and donor families and pioneering teams are to be respected and
                                        For Peer Review
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   40          honored for their courage and skill.
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   42          Acknowledgements:
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   45          This research was not funded and none of the authors have any relevant disclosures.
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   60                          The official publication of the International Pediatric Transplant Association
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