2004 ishlt j heart lung transplant 2004; 23: 804-15 lung transplantation overall

2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15

LUNG TRANSPLANTATION

Overall


NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE

0

200

400

600

800

1000

1200

1400

1600

1800

Nu

mb

er

of

Tra

ns

pla

nts

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

Bilateral/Double LungSingle Lung

13 15 46 83188

418

706

922

1086

1229

1365 1370

1443143614121497

15631655


AVERAGE CENTER VOLUMELung Transplants: January 1, 1998 - June 30, 2003

53

30 2818

83 20

10

20

30

40

50

60

1-4 5-9 10-19 20-29 30-39 40-49 50+

Average number of lung transplants per year

Nu

mb

er o

f ce

nte

rs


DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME

Lung Transplants: January 1, 1998 - June 30, 2003

0

5

10

15

20

25

30

35

1-4 5-9 10-19 20-29 30-39 40-49 50+

Average number of lung transplants per year

Per

cen

tag

e o

f tr

ansp

lan

ts


LUNG TRANSPLANTS: Donor Age by Year of Transplant

0%

20%

40%

60%

80%

100%

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

Year of Transplant

% o

f T

ran

sp

lan

ts

0-10 11-17 18-34 35-49 50-59 60+

0

5

10

15

20

25

30

35

40

Me

an

do

no

r a

ge

(y

ea

rs)

Mean Age


AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2003)

0

10

20

30

40

50

% o

f tr

ansp

lan

ts

<1 1-5 6-10 11-17 18-34 35-49 50-64 65+

Recipient Age


AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA

0

10

20

30

40

50

<1 1-5 6-10 11-17 18-34 35-49 50-64 65+

% o

f tr

an

sp

lan

ts

1985-1996 (N = 7,374)

1997-6/2003 (N = 9,665)

p < 0.0001


LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1990 - June 2002)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12

Years

Su

rviv

al (

%)

Bilateral/Double Lung (N=6,686)

Single Lung (N=8,581)

All Lungs (N=15,267)

Double lung: 1/2-life = 5.3 Years; Conditional 1/2-life = 8.3 YearsSingle lung: 1/2-life = 3.9 Years; Conditional 1/2-life = 6.2 YearsAll lungs: 1/2-life = 4.4 Years; Conditional 1/2-life = 6.9 Years

p < 0.0001


LUNG TRANSPLANTATION

Adult Recipients


ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2003)

DIAGNOSIS SLT (N = 5,793) BLT (N = 5,166) TOTAL (N = 10,959)

COPD/Emphysema 3,091 ( 53% ) 1,201 ( 23% ) 4,292 ( 39% )

IPF 1,369 ( 24% ) 503 ( 9.7% ) 1,872 ( 17% )

CF 131 ( 2.3% ) 1,615 ( 31% ) 1,746 ( 16% )

Alpha-1 493 ( 8.5% ) 491 ( 9.5% ) 984 ( 9.0% )

PPH 66 ( 1.1% ) 391 ( 7.6% ) 457 ( 4.2% )

Sarcoidosis 143 ( 2.5% ) 144 ( 2.8% ) 287 ( 2.6% )

Bronchiectasis 21 ( 0.4% ) 254 ( 4.9% ) 275 ( 2.5% )

LAM 50 ( 0.9% ) 72 ( 1.4% ) 122 ( 1.1% )

Congenital Heart Disease 13 ( 0.2% ) 107 ( 2.1% ) 120 ( 1.1% )

Re-TX: OB 67 ( 1.2% ) 48 ( 0.9% ) 115 ( 1.0% )

OB (Non-ReTX) 33 ( 0.6% ) 65 ( 1.3% ) 98 ( 0.9% )

Re-TX: Non-OB 49 ( 0.8% ) 42 ( 0.8% ) 91 ( 0.8% )

Connective Tissue Disease 29 ( 0.5% ) 27 ( 0.5% ) 56 ( 0.5% )

Histiocytosis X 18 ( 0.3% ) 17 ( 0.3% ) 35 ( 0.3% )

Cancer 5 ( 0.1% ) 11 ( 0.2% ) 16 ( 0.1% )

Other 215 ( 3.7% ) 178 ( 3.4% ) 393 ( 3.6% )


ADULT LUNG TRANSPLANTATION: Indications (Transplants: January 1995 - June 2003)

0%

53%2%

24%

1% 5%

2%

0%

9%2%

1%

1%5%

30%

10%

1%

1%

10%

2%

2%3%8%

23%

5%

Alpha-1 Bronchiectasis Congenital Heart DiseaseCOPD CF IPFLAM OB (Non-ReTX) OtherPPH Re-TX Sarcoidosis

Single Lung Transplants

Bilateral/Double Lung Transplants


ADULT LUNG TRANSPLANTATIONIndications By Year (%)

0

20

40

60

80

100

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Transplant Year

% o

f T

ran

sp

lan

ts

Cystic Fibrosis IPF Emphysema A1A PPH


ADULT LUNG TRANSPLANTATIONIndications By Year (Number)

0

250

500

750

1000

1250

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Transplant Year

Nu

mb

er o

f T

ran

spla

nts

Cystic Fibrosis IPF Emphysema A1A PPH


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Era (Transplants: January 1988 – June 2002)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

1988-1992 (N=2,166)1993-1997 (N=6,140)1/1998-6/2002 (N=6,417)

1988-1992: 1/2-life = 3.5 Years; Conditional 1/2-life = 6.8 Years1993-1997: 1/2-life = 4.4 Years; Conditional 1/2-life = 7.0 Years1998-6/2002: 1/2-life = 4.7 Years; Conditional 1/2-life = n.c.

Survival comparisons by era1988-92 vs. 1993-97: p = 0.00041988-92 vs. 1998-2002: p < 0.00011993-97 vs. 1998-2002: p = 0.0001


ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: January 1990 – June 2002)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

18-34 (N= 2,591)35-49 (N= 4,370)50-64 (N= 6,952)65+ (N= 389)

Survival comparisons18-34 vs. 50-64: p < 0.000118-34 vs. 65+: p < 0.000135-49 vs. 50-64: p < 0.000135-49 vs. 65+: p < 0.000150-64 vs. 65+: p = 0.006

HALF-LIFE 18-34: 5.0 Years; 35-49: 5.3 Years; 50-64 4.0 Years; 65+: 3.3 Years


ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: January 1990 – June 2002)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

Male (N= 7,283)

Female (N= 6,949)

HALF-LIFE Male: 4.2 years; Female 4.8 Years

p = 0.001


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2002)

YearALPHA-1 (N=1,356)

CF

(N= 1,923)

COPD

(N= 4,955)

IPF

(N= 2,119)

PPH

(N= 737)

SARCOIDOSIS

(N = 317)

1 74.7 78.6 79.9 67.5 64.8 66.7

3 60.0 63.0 62.4 51.6 54.4 52.8

5 50.2 52.9 46.8 40.0 45.2 44.9

7 40.2 44.9 33.7 28.3 37.3 40.4

10 26.0 34.1 18.2 17.5 20.3 29.8

Survival comparisonsAlpha-1 vs. IPF: p < 0.0001 Alpha-1 vs. PPH: p = 0.0009CF vs. COPD: p = 0.0001 CF vs. IPF: p < 0.0001CF vs. PPH: p < 0.0001 CF vs. Sarcoidosis: p = 0.0014


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 3

Months (Transplants: January 1990 – June 2002)

YearALPHA-1 (N=1,075)

CF

(N= 1,541)COPD

(N= 4,152)IPF

(N= 1,618)PPH

(N= 503)SARCOIDOSIS

(N = 222)

1 87.5 90.0 89.5 83.9 88.9 82.8

3 70.3 72.2 69.9 64.1 74.7 65.5

5 58.8 60.7 52.4 49.6 62.1 55.7

7 47.0 51.5 37.8 35.2 51.2 50.1

10 30.4 39.0 20.4 21.8 27.8 36.9

Survival comparisonsAlpha-1 vs. IPF: p < 0.0001 Alpha-1 vs. COPD: p = 0.002CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001PPH vs. COPD: p < 0.0001 PPH vs. IPF: p < 0.0001COPD vs. IPF: p = 0.002


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year

(Transplants: January 1990 – June 2002)

YearALPHA-1 (N=898)

CF

(N= 1,298)COPD

(N=3,508)IPF

(N= 1,279)PPH

(N= 429)SARCOIDOSIS

(N = 176)

1 100.0 100.0 100.0 100.0 100.0 100.0

3 80.3 80.1 78.1 76.4 84.0 79.1

5 67.2 67.3 58.6 59.2 69.9 67.2

7 53.8 57.1 42.2 41.9 57.6 60.5

10 34.7 43.3 22.8 25.9 31.3 44.6

Survival comparisonsAlpha-1 vs. IPF: p = 0.0002 Alpha-1 vs. COPD: p < 0.0001CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001PPH vs. COPD: p < 0.0001 PPH vs. IPF: p < 0.0001


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2002)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10Years

Su

rviv

al (

%)

ALPHA-1 (N=1,356) CF (N= 1,923)COPD (N= 4,955) IPF (N= 2,119)PPH (N= 737) SARCOIDOSIS (N = 317)

HALF-LIFE Alpha-1: 5.1 Years; CF: 5.6 Years; COPD: 4.6 Years; IPF: 3.4 Years; PPH: 4.0 Years; Sarcoidosis: 3.8 Years

Survival comparisonsAlpha-1 vs. IPF: p < 0.0001Alpha-1 vs. PPH: p = 0.0009CF vs. COPD: p = 0.0001CF vs. IPF: p < 0.0001CF vs. PPH: p < 0.0001CF vs. Sarcoidosis: p = 0.0014


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 3 Months


0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10Years

Su

rviv

al (

%)

ALPHA-1 (N=1,075) CF (N= 1,541)COPD (N= 4,152) IPF (N= 1,618)PPH (N= 503) SARCOIDOSIS (N = 222)


Survival comparisonsAlpha-1 vs. IPF: p < 0.0001Alpha-1 vs. COPD: p = 0.002CF vs. COPD: p < 0.0001CF vs. IPF: p < 0.0001PPH vs. COPD: p < 0.0001PPH vs. IPF: p < 0.0001COPD vs. IPF: p = 0.002


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year


0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10Years

Su

rviv

al (

%)

ALPHA-1 (N=898) CF (N= 1,298)COPD (N=3,508) IPF (N= 1,279)PPH (N= 429) SARCOIDOSIS (N = 176)


Survival comparisonsAlpha-1 vs. IPF: p = 0.0002Alpha-1 vs. COPD: p < 0.0001CF vs. COPD: p < 0.0001CF vs. IPF: p < 0.0001PPH vs. COPD: p < 0.0001PPH vs. IPF: p < 0.0001


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival for Eisenmenger’s Syndrome


0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10Years

Su

rviv

al (

%)

ASD (N= 114) VSD (N= 58) PDA (N= 22)

HALF-LIFE ASD: 2.9 Years; VSD: 1.0 Years; PDA 0.4 Years


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Procedure Type (Transplants: January 1990 – June 2002)

Diagnosis: Alpha-1 Antitrypsin Deficiency

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

Single Lung (N = 799)

Double Lung (N=557)N=34

N=15

P = 0.02


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2002)

Diagnosis: Emphysema/COPD

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

Single Lung (N = 3,737)

Double Lung (N=1,218)N=43

N=14

P < 0.0001



Diagnosis: IPF

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

Single Lung (N =1,645)

Double Lung (N=474)

N=22

N=18

P = 0.5



Diagnosis: PPH

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

Single Lung (N =247)

Double Lung (N=444) N=18

N=13

P = 0.3


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era


Diagnosis: Emphysema/COPD, Single Lung

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

1990-1994 (N = 1,009)

1995-1997 (N = 1,007)

1998-6/2002 (N = 1,721)

Survival comparisons1990-1994 vs. 1995-1997: p = 0.9 1990-1994 vs. 1998-6/2002: p = 0.0081995-1997 vs. 1998-6/2002: p = 0.06




Diagnosis: Emphysema/COPD, Double/Bilateral Lung

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

1990-1994 (N = 199)

1995-1997 (N = 308)

1998-6/2002 (N = 711)





Diagnosis: IPF, Single Lung

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

1990-1994 (N =451)

1995-1997 (N = 443)

1998-6/2002 (N = 751)





Diagnosis: IPF, Double/Bilateral Lung

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

1990-1994 (N = 65)

1995-1997 (N = 146)

1998-6/2002 (N = 263)



ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Donor CMV status/Recipient CMV status

(Transplants: October 1999 – June 2002)

50

60

70

80

90

100

0 1 2 3

Years

Su

rviv

al (

%)

D(-)/R(-) (N=430)D(-)/R(+) (N=605)D(+)/R(-) (N=492)D(+)/R(+) (N=799)

Survival comparisonsD(-)/R(-) vs. D(-)/R(+): p = 0.04D(-)/R(-) vs. D(+)/R(-): p = 0.8D(-)/R(-) vs. D(+)/R(+): p = 0.7D(-)/R(+) vs. D(+)/R(-): p = 0.01D(-)/R(+) vs. D(+)/R(+): p = 0.003D(+)/R(-) vs. D(+)/R(+): p = 0.9


ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 1 Year Mortality

VARIABLE Odds Ratio P-value

95% Confidence

Interval

Repeat transplant 2.42 <.0001 1.79 -3.27

Sarcoidosis 2.29 <.0001 1.63 -3.22

IV inotropes 2.26 0.0067 1.25 -4.08

PPH 2.24 <.0001 1.54 -3.27

Ventilator 2.21 0.0003 1.44 -3.37

(N=8,043)




95% Confidence

Interval

Donor history of diabetes 1.95 0.0006 1.33 -2.86

Alpha-1 antitrypsin deficiency 1.67 <.0001 1.37 -2.04

Recipient history of malignancy 1.61 0.0123 1.11 -2.33

IPF 1.60 <.0001 0.90 -2.84

PRA > 10% 1.46 0.0176 1.07 -2.00

(N=8,043)




95% Confidence

Interval

Other diagnosis (excluding COPD) 1.45 <.0001 1.22 -1.73

Hospitalized immediately prior to transplant

1.37 0.0081 1.08 -1.72

Recipient history of diabetes 1.34 0.0242 1.04 -1.73

Donor CMV+/Recipient CMV - 1.32 <.0001 1.18 -1.48

Donor female/recipient female 0.84 0.007 0.74 -0.94

Donor cause of death: anoxia 0.73 0.0486 0.53 -1.00

(N=8,043)


ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality

Continuous Factors (see figures)

Recipient age

Transplant center volume

Recipient Bilirubin

Recipient FEV1 % predicted

Pulmonary vascular resistance (PVR)



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

1 Y

ear

Mo

rtal

ity

p < 0.0001



Center volume

0

0.5

1

1.5

2

0 10 20 30 40 50

Center Volume (cases per year)

Od

ds

of

1 Y

ea

r M

ort

alit

y

p < 0.0001



Recipient Pulmonary Vascular Resistance (PVR)

0

0.5

1

1.5

2

0 1 2 3 4 5 6 7 8

Recipient PVR

Od

ds

of

1 Y

ear

Mo

rtal

ity

p = 0.01



FEV1 (% predicted) in Recipients with IPF

0

0.5

1

1.5

2

20 30 40 50 60 70Recipient FEV1 (% predicted)

Od

ds

of

1 Y

ear

Mo

rtal

ity

p = 0.03



Recipient Bilirubin

0

0.5

1

1.5

0 1 2 3 4 5 6 7 8

Recipient Bilirubin (mg/dl)

Od

ds

of

1 Y

ear

Mo

rtal

ity

p = 0.02


ADULT LUNG TRANSPLANTS (1995-6/2002) Factors Not Significant for 1 Year Mortality

Recipient factors:pCO2, chronic steroid use, transfusions, recent infection requiring IV drug therapy

Donor factors:Clinical infection, history of hypertension, history of cancer

Transplant factors:Procedure type, ABO compatibility, HLA mismatch, year of transplant, height ratio




95% Confidence

Interval

Ventilator 2.24 0.0074 1.24 -4.04

Previous transplant 1.98 0.0011 1.31 -2.98

Infection requiring IV drug therapy within 2 weeks of transplant

1.36 0.05 1.00 -1.86

Diagnosis: IPF 1.30 0.011 1.06 -1.59

Total HLA mismatches (per mismatch) 1.07 0.0498 1.00 -1.15

Prior thoracotomy 0.66 0.025 0.45 -0.95

Donor COD: anoxia 0.58 0.006 0.39 -0.86

(N=4,178)



Continuous Factors (see figures)

Recipient age

Donor age

Donor weight

Recipient PVR



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

5 Y

ear

Mo

rtal

ity

p < 0.0001



Donor Age

0

0.5

1

1.5

2

15 25 35 45 55Donor Age

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.001



Donor weight

0

0.5

1

1.5

2

50 60 70 80 90 100

Donor weight (kg)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.02



Recipient Pulmonary Vascular Resistance (PVR)

0

0.5

1

1.5

2

0 1 2 3 4 5 6 7 8 9 10

Recipent PVR

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.002


ADULT LUNG TRANSPLANTS (1995-6/1998) Factors Not Significant for 5 Year Mortality

Recipient factors:Hospitalized, chronic steroid use, transfusions, history of malignancy, PRA, gender, FVC, FEV1, height, weight

Donor factors:Gender, clinical infection, history of hypertension, history of cancer, history of diabetes, height

Transplant factors:Procedure type, ABO compatibility


ADULT LUNG TRANSPLANTS (1995-6/1998) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year


95% Confidence

Interval

Bronchiolitis obliterans within 1st year 2.61 <.0001 1.84 -3.72

Treated for rejection within 1st year 1.51 <.0001 1.24 -1.85

Other surgical procedures prior to transplant hospitalization discharge

1.45 0.008 1.11 -1.99

Double lung transplant 0.80 0.04 0.65 -0.99

Donor COD: anoxia 0.57 0.027 0.34 -0.94

(N=2,982)


ADULT LUNG TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year

Continuous Factors (see figure)

Recipient age


ADULT LUNG TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Condtional on Survival to 1 Year

Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

5 Y

ear

Mo

rtal

ity

p < 0.0001


ADULT LUNG TRANSPLANTS (1995-6/1997) Factors Not Significant for Conditional 5 Year Mortality

Recipient factors:Diagnosis, ventilator, inotropes, hospitalized at transplant, pCO2, gender, chronic steroid use, transfusions, history of

malignancy, PRA, repeat transplant, FeV1, FVC, height, weight

Donor factors:Gender, clinical infection, history of hypertension, history of cancer, history of diabetes, COD, age, height, weight

Transplant factors:ABO compatibility, HLA mismatch, CMV mismatch


ADULT LUNG TRANSPLANTS (1995-6/1997) Factors Not Significant for Conditional 5 Year Mortality

Post-transplant factors:Hospitalized for infection, stroke, dialysis, prolonged graft dysfunction


ADULT LUNG RECIPIENTSFunctional Status (Follow-ups: April 1994 – June 2003)

0%

20%

40%

60%

80%

100%

1 Year (N = 5,283) 3 Years (N =3,293) 5 Years (N = 1,891) 7 Years (N = 888)

No Activity Limitations Performs with Some Assistance Requires Total Assistance


ADULT LUNG RECIPIENTSEmployment Status (Follow-ups: April 1994 – June 2003)

0%

20%

40%

60%

80%

100%

1 Year (N =4,978)

3 Years (N =2,945)

5 Years (N =1,686)

7 Years (N =794)

Retired

Not Working

Working Part Time

Working Full Time


ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant (Follow-ups: April 1994 - June 2003)

0%

20%

40%

60%

80%

100%

Up to 1 Year (N =6,111)

Between 2 and 3Years (N = 3,654)

Between 4 and 5Years (N = 2,099)

Between 6 and 7Years (N = 991)

No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Only Hospitalized, Infection OnlyHospitalized, Rejection and Infection


0

5

10

15

20

25

30

35

40

45

Any Induction (N =1,199)

PolyclonalALG/ATG (N = 449)

OKT3 (N = 22) IL2R-antagonist (N =737)

% o

f p

ati

en

tsADULT LUNG RECIPIENTS

Induction Immunosuppression (Follow-ups: January 2001 - June 2003)


0

10

20

30

40

50

Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist

% o

f p

ati

en

ts

2000 2001 2002

ADULT LUNG RECIPIENTSInduction Immunosuppression (Follow-ups: January 2000 - December 2002)


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

ati

en

ts

Year 1 (N = 1,753) Year 5 (N = 814)

ADULT LUNG RECIPIENTSMaintenance Immunosuppression At Time of Follow-up

For follow-ups between January 2000 through June 2003

NOTE: Different patients are analyzed in Year 1 and Year 5


0

20

40

60

80

100

CalcineurinInhibitor

CellCycle Prednisone CalcineurinInhibitor

CellCycle Prednisone

% o

f P

ati

en

ts

CyA

Tac Tac

CyA

AZA AZA

MMF MMF

ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up


1 Year Follow-up (N = 1,753) 5 Year Follow-up (N = 814)NOTE: Different patients are analyzed in Year 1 and Year 5


0%

20%

40%

60%

80%

100%

Year 1 (N = 1,753) Year 5 (N = 814)

% o

f P

atie

nts

Other

Tacrolimus + MMF

Tacrolimus + AZA

Cyclosporine + MMF

Cyclosporine + AZA

ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up


NOTE: Different patients are analyzed in Year 1 and Year 5


POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant

(Follow-ups: April 1994 - June 2003)

Outcome Within 1

Year Total number with known response

Hypertension 50.4% (N = 6,031)

Renal Dysfunction 25.8% (N = 6,005)

Abnormal Creatinine < 2.5 mg/dl 15.7% Creatinine > 2.5 mg/dl 8.1% Chronic Dialysis 1.9% Renal Transplant 0.0%

Hyperlipidemia 16.3% (N = 6,316)

Diabetes 20.1% (N = 5,997)

Bronchiolitis Obliterans 9.4% (N = 5,632)


POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant


Outcome Within 5

Years Total number with known response

Hypertension 86.4% (N = 1,196)

Renal Dysfunction 38.4% (N = 1,275)


Hyperlipidemia 45.4% (N = 1,315)

Diabetes 29.4% (N = 1,172)

Bronchiolitis Obliterans 34.4% (N = 921)


POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 7 Years Post-Transplant


Outcome Within 7

Years Total number with known response

Hypertension 92.0% (N = 424)

Renal Dysfunction 42.0% (N = 462)


Hyperlipidemia 52.9% (N = 476)

Diabetes 26.9% (N = 412)

Bronchiolitis Obliterans 42.9% (N = 294)


Freedom from Bronchiolitis Obliterans For Adult Lung Recipients (Follow-ups: April 1994-June 2003)

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20

40

60

80

100

0 1 2 3 4 5Years

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B


Freedom from Severe Renal Dysfunction*For Adult Lung Recipients (Follow-ups: April 1994-June 2003)

0

20

40

60

80

100

0 1 2 3 4 5

Years

% F

ree

do

m f

rom

Se

ve

re R

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nc

tio

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* Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant


MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2003)

Malignancy/Type 1-Year Survivors 5-Year Survivors 7-Year Survivors

No Malignancy 6006 (96.2%) 1137 (87%) 386 (81.4%)

Malignancy (all types combined) 237 (3.8%) 170 (13%) 88 (18.6%)

Malignancy Type*

Skin 44 86 55

Lymph 122 37 18

Other 48 41 25

Type Not Reported

19 10 1

* Recipients may have experienced more than one type of malignancy so sum of individual malignancy types may be greater than total number with malignancy.

Other malignancies reported include: adenocarcinoma (2; 2; 1), bladder (2; 1; 0), lung (2; 4; 2), breast (1; 5; 4); prostate (0; 5; 3), cervical (1; 1; 1). Numbers in parentheses represent the number of reported cases within each time period.


Freedom from MalignancyFor Adult Lung Recipients (Follow-ups: April 1994-June 2003)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7Years

% F

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fro

m M

alig

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All malignancy Lymph Skin Other


ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January 1992- June 2003)

CAUSE OF DEATH0-30 Days

(N = 937)

31 Days - 1 Year

(N = 1,345)

>1 Year - 3 Years

(N = 1,096)

>3 Years - 5 Years

(N = 572)

>5 Years

(N = 456)

BRONCHIOLITIS 5 (0.5%) 74 (5.5%) 313 (28.6%) 185 (32.3%) 142 (31.1%)

ACUTE REJECTION 46 (4.9%) 27 (2.0%) 21 (1.9%) 4 (0.7%) 2 (0.4%)

LYMPHOMA 1 (0.1%) 44 (3.3%) 23 (2.1%) 9 (1.6%) 18 (3.9%)

MALIGNANCY, OTHER 27 (2.0%) 52 (4.7%) 43 (7.5%) 40 (8.8%)

CMV 1 (0.1%) 56 (4.2%) 17 (1.6%) 4 (0.7%) 2 (0.4%)

INFECTION, NON-CMV 220 (23.5%) 521 (38.7%) 284 (25.9%) 113 (19.8%) 79 (17.3%)

GRAFT FAILURE 286 (30.5%) 236 (17.5%) 175 (16.0%) 99 (17.3%) 58 (12.7%)

CARDIOVASCULAR 108 (11.5%) 58 (4.3%) 36 (3.3%) 24 (4.2%) 21 (4.6%)

TECHNICAL 78 (8.3%) 37 (2.8%) 12 (1.1%) 1 (0.2%) 2 (0.4%)

OTHER 192 (20.5%) 265 (19.7%) 163 (14.9%) 90 (15.7%) 92 (20.2%)

2004 ishlt j heart lung transplant 2004; 23: 804-15 lung transplantation overall

Documents

ishlt j heart lung transplant

number of lung transplants

year of transplant slide

copd n

year transplants

era slide

sarcoidosis n

diagnosis transplants