Post on 27-Mar-2015
LUNG TRANSPLANTATION
Overall
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE
0
200
400
600
800
1000
1200
1400
1600
1800
2000
2200
Nu
mb
er o
f T
ran
spla
nts
Bilateral/Double LungSingle Lung
ISHLT 2008
NOTE: This figure includes only the lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as representing changes in the number of lung transplants performed worldwide.
14 15 45 83189
418
707
923
1087
122913661375
146114571481
15741615
1788
21962168
1789
1924
J Heart Lung Transplant 2008;27: 937-983
AVERAGE CENTER VOLUMELung Transplants: January 1, 2000 - June 30, 2007
50
28 2818 16
610
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
of
ce
nte
rs
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME
Lung Transplants: January 1, 2000 - June 30, 2007
3.27.9
18.821.5
27.5
19
2.10
5
10
15
20
25
30
35
1-4/yr 5-9/yr 10-19/yr 20-29/yr 30-39/yr 40-49/yr 50+/yr
Average number of lung transplants per year
Pe
rce
nta
ge
of
tra
ns
pla
nts
.
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
LUNG TRANSPLANTS: Transplant Recipient 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
2003
2004
2005
2006
2007
Year of Transplant
% o
f T
ran
sp
lan
ts
0-11 12-17 18-34 35-49 50-59 60+
0
10
20
30
40
50
60
Me
an
do
no
r a
ge
(y
ea
rs)
Mean Age
ISHLT 2008
Transplants between January 1987 and June 2007
J Heart Lung Transplant 2008;27: 937-983
AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2007)
0
5
10
15
20
25
30
35
0-11 12-17 18-29 30-39 40-49 50-59 60-65 66+
Recipient Age
% o
f tr
an
sp
lan
ts
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA
0
5
10
15
20
25
30
35
40
0-11 12-17 18-29 30-39 40-49 50-59 60-65 66+
% o
f tr
ansp
lan
ts
1985-1994 (N = 4,659)
1995-1999 (N = 7,126)
2000-6/2007 (N = 14,096)
p < 0.0001
ISHLT 2008
Transplants with unknown recipient age were excluded from this tabulation.
J Heart Lung Transplant 2008;27: 937-983
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
2003
2004
2005
2006
2007
Year of Transplant
% o
f T
ran
sp
lan
ts
0-11 12-17 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
ISHLT 2008
Transplants between January 1987 and June 2007
J Heart Lung Transplant 2008;27: 937-983
DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS (1/1985-6/2007)
0
5
10
15
20
25
30
35
0-11 12-17 18-29 30-39 40-49 50-59 60-65 66+
Donor Age
% o
f tr
an
sp
lan
ts
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS BY ERA
0
5
10
15
20
25
30
35
40
0-11 12-17 18-29 30-39 40-49 50-59 60-65 66+
% o
f tr
ansp
lan
ts
1985-1994 (N = 4,565)
1995-1999 (N = 6,989)
2000-6/2007 (N = 14,002)
p < 0.0001
ISHLT 2008
Transplants with unknown donor age were excluded from this tabulation.
J Heart Lung Transplant 2008;27: 937-983
LUNG TRANSPLANTATION
Adult Recipients
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS (1/1985-6/2007)
0
5
10
15
20
25
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 66+
Recipient Age
% o
f tr
an
sp
lan
ts
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA
0
5
10
15
20
25
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 66+
% o
f tr
ansp
lan
ts
.
1985-1995 (N = 5,716)
1996-6/2007 (N = 19,010 )
p < 0.0001
ISHLT 2008
Mean age by era1985-1995 = 45.0 years1996-6/2006 = 49.1 years
J Heart Lung Transplant 2008;27: 937-983
AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA
0
5
10
15
20
25
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 66+
% o
f tr
ansp
lan
ts
.
1985-1994 (N=4,434)1995-1999 (N=6,728)2000-6/2007 (N=13,564)
p < 0.0001
ISHLT 2008
Mean age by era1985-1994 = 44.7 years1995-1999 = 47.3 years2000-6/2007 = 49.8 years
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1994 - June 2006)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al
(%)
.
Bilateral/Double Lung (N=10,064)
Single Lung (N=9,384)
All Lungs (N=19,448)
Double lung: 1/2-life = 6.2 Years; Conditional 1/2-life = 8.8 YearsSingle lung: 1/2-life = 4.5 Years; Conditional 1/2-life = 6.4 YearsAll lungs: 1/2-life = 5.2 Years; Conditional 1/2-life = 7.3 Years
P < 0.0001
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2007)
DIAGNOSIS SLT (N = 9,017) BLT (N = 10,775) TOTAL (N = 19,792)
COPD/Emphysema 4,549 ( 50% ) 2,637 ( 24% ) 7,186 ( 36% )
Idiopathic Pulmonary Fibrosis 2,497 ( 28% ) 1,472 ( 14% ) 3,969 ( 20% )
Cystic Fibrosis 169 ( 1.9% ) 3,049 ( 28% ) 3,218 ( 16% )
Alpha-1 644 ( 7.1% ) 865 ( 8.0% ) 1,509 ( 7.6% )
Primary Pulmonary Hypertension 67 ( 0.7% ) 622 ( 5.8% ) 689 ( 3.5% )
Sarcoidosis 191 ( 2.1% ) 324 ( 3.0% ) 515 ( 2.6% )
Bronchiectasis 35 ( 0.4% ) 519 ( 4.8% ) 554 ( 2.8% )
LAM 64 ( 0.7% ) 130 ( 1.2% ) 194 ( 1.0% )
Congenital Heart Disease 17 ( 0.2% ) 138 ( 1.3% ) 155 ( 0.8% )
Re-Transplant: Obliterative Bronchiolitis
124 ( 1.4% ) 109 ( 1.0% ) 233 ( 1.2% )
Obliterative Bronchiolitis
(Not Re-Transplant)
48 ( 0.5% ) 114 ( 1.1% ) 162 ( 0.8% )
Re-Transplant: Not Obliterative Bronchiolitis
93 ( 1.0% ) 81 ( 0.8% ) 174 ( 0.9% )
Connective Tissue Disease 61 ( 0.7% ) 92 ( 0.9% ) 153 ( 0.8% )
Interstitial Pneumonitis 29 ( 0.3% ) 16 ( 0.1% ) 45 ( 0.2% )
Cancer 6 ( 0.1% ) 13 ( 0.1% ) 19 ( 0.1% )
Other 423 ( 4.7% ) 594 ( 5.5% ) 1,017 ( 5.1% )
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATION: Distribution of Procedure Type for Major Indications (1992-2006)
ISHLT 2008
Year of TX
Alpha-1 COPD Cystic Fibrosis IPF PPH
Double Single Double Single Double Single Double Single Double Single
1992 27.0 73.0 15.7 84.3 97.0 3.0 10.3 89.7 26.3 73.7
1993 38.1 61.9 15.5 84.5 94.8 5.2 16.5 83.5 53.8 46.2
1994 41.7 58.3 17.9 82.1 85.8 14.2 14.0 86.0 64.6 35.4
1995 43.7 56.3 20.9 79.1 89.5 10.5 27.9 72.1 90.5 9.5
1996 44.3 55.7 26.6 73.4 87.0 13.0 26.6 73.4 82.0 18.0
1997 45.7 54.3 26.7 73.3 92.8 7.2 22.2 77.8 90.0 10.0
1998 47.3 52.7 28.9 71.1 92.5 7.5 20.1 79.9 86.8 13.2
1999 47.3 52.7 27.1 72.9 90.5 9.5 23.1 76.9 86.0 14.0
2000 57.1 42.9 28.4 71.6 95.0 5.0 32.6 67.4 92.0 8.0
2001 58.9 41.1 27.6 72.4 94.5 5.5 28.7 71.3 90.7 9.3
2002 53.5 46.5 37.2 62.8 96.4 3.6 35.1 64.9 88.3 11.7
2003 65.1 34.9 39.9 60.1 96.1 3.9 40.9 59.1 94.5 5.5
2004 72.1 27.9 43.5 56.5 96.2 3.8 43.4 56.6 93.9 6.1
2005 75.5 24.5 48.0 52.0 97.8 2.2 45.6 54.4 88.1 11.9
2006 76.4 23.6 57.4 42.6 99.1 0.9 49.2 50.8 100.0 0.0
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONProcedure Type within Indication, by Year
0
10
20
30
40
50
60
70
80
90
100
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
% o
f tr
ansp
lan
ts
Bilateral/Double Lung Transplant Single Lung Transplant
AT Def COPD IPF PPH
2008
ISHLTJ Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATION: Indications for Single Lung Transplants (Transplants: January 1995 - June 2007)
50%
28%
2%1%
2%
7%
10%
Alpha-1 COPD CF IPF PPH Re-TX Other*
ISHLT 2008
*Other includes:
Sarcoidosis: 2.1%
Bronchiectasis: 0.4%
Congenital Heart Disease: 0.2%
LAM: 0.7%
OB (non-ReTx): 0.5%
Miscellaneous: 5.8%
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATION: Indications for Bilateral/Double Lung Transplants (Transplants: January 1995 - June 2007)
24%
14%
18%
8%
28%
6% 2%
Alpha-1 COPD CF IPF PPH Re-Tx Other*
ISHLT 2008
*Other includes:
Sarcoidosis: 3.0%
Bronchiectasis: 4.8%
Congenital Heart Disease: 1.3%
LAM: 1.2%
OB (non-ReTx): 1.1%
Miscellaneous: 6.6%
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONIndications By Year (%)
0
20
40
60
80
100
Transplant Year
% o
f T
ran
spla
nts
CF IPF COPD Alpha-1 PPH
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONIndications By Year (Number)
0
250
500
750
1000
1250
1500
1750
Transplant Year
Nu
mb
er o
f T
ran
spla
nts
CF IPF COPD Alpha-1 PPH
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
18-34 years 35-49 years 50-59 years 60-65 years 66+ years
ADULT LUNG 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
Nu
mb
er
of
Tra
ns
pla
nts
-
Sarcoidosis
Re-TX
PPH
Other
IPF
CF
COPD
Bronchiectasis
Alpha-1
ADULT LUNG 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 Don
ors
1-5 6-10 11-17 18-34 35-49 50-59 60-65 66+
ADULT LUNG TRANSPLANTS:DONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2007
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Era (Transplants: January 1988 – June 2006)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
1988-1994 (N=4,390)1995-1999 (N=6,728)2000-6/2006 (N=11,537)
1988-1994: 1/2-life = 3.9 Years; Conditional 1/2-life = 6.9 Years1995-1999: 1/2-life = 4.5 Years; Conditional 1/2-life = 7.2 Years2000-6/2006: 1/2-life = 5.5 Years; Conditional 1/2-life = 7.1 Years
N at risk = 159
N at risk = 523
N at risk = 762
Survival comparisons by era1988-94 vs. 1995-99: p = 0.00091988-94: vs. 2000-6/06: p <0.0001 1995-99 vs. 2000-6/06: p <0.0001
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: January 1990 – June 2006)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al
(%)
.
18-34 (N= 4,033)35-49 (N= 6,051)50-59 (N= 8,209)60-65 (N= 3,579)66+ (N= 527)
Survival comparisons18-34 vs. 35-49: p=0.4384; 18-34 vs. 50-59, 60-65 and 66+ : p < 0.000135-49 vs. 50-59, 60-65 and 66+: p < 0.000150-59 vs. 60-65 and vs. 66+: p < 0.000160-65 vs. 66+: p =0.0011
HALF-LIFE 18-34: 5.5 Years; 35-49: 6.0 Years; 50-59: 4.9 Years; 60-65: 4.1 Years; 66+: 3.0 Years
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: January 1990 – June 2006)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al
(%)
Male (N=11,671)
Female (N=10,724)
HALF-LIFE Male: 4.8 years; Female: 5.2 Years
p = 0.0013
N at risk at 5 years=3,053
N at risk =633
N at risk at 5 years=2,867
N at risk =622
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2006)
YearALPHA-1 (N=1,925)
CF
(N=3,275)COPD
(N=7,760)IPF
(N=3,931)PPH
(N=970)SARCOIDOSIS
(N=506)
1 77.9 81.8 82.1 72.5 67.2 69.9
3 63.9 66.2 65 57.1 57 56.5
5 54.1 56 50 44.6 48.5 50.8
7 44 48.3 37.4 33.8 41.5 42.7
10 31.2 38.6 21.8 21.1 30 31
Survival comparisonsAlpha-1 vs. CF: p = 0.0003 CF vs. COPD: p < 0.0001Alpha-1 vs. COPD: p = 0.0009 CF vs. IPF: p < 0.0001Alpha-1 vs. IPF: p < 0.0001 CF vs. PPH: p < 0.0001Alpha-1 vs. PPH: p = 0.0027 CF vs. Sarcoidosis: p < 0.0001Alpha-1 vs. Sarcoidosis p = 0.0263 COPD vs. IPF: p <0.0001
Note: Other comparisons are not statistically different. ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on
Survival to 3 Months (Transplants: January 1990 – June 2006)
YearALPHA-1 (N=1,655)
CF
(N=2,851)COPD
(N=6,892)IPF
(N=3,197)PPH
(N=697)SARCOIDOSIS
(N=410)
1 89.3 91.1 90.2 86.4 90.8 84.2
3 73.2 73.8 71.4 68 76.9 68
5 62 62.4 54.9 53.2 65.4 61.1
7 50.5 53.8 41.1 40.3 56.1 51.4
10 35.8 43 23.9 25.1 40.5 37.3
Survival comparisonsAlpha-1 vs. CF: p = 0.0081 CF vs. Sarcoidosis : p = 0.0137 Alpha-1 vs. COPD: p < 0.0001 PPH vs. COPD: p < 0.0001Alpha-1 vs. IPF: p < 0.0001 PPH vs. IPF: p < 0.0001Alpha-1 vs. PPH: p = 0.0094 PPH vs. Sarcoidosis: p = 0.0105CF vs. COPD: p < 0.0001 COPD vs. IPF: p = 0.0319CF vs. IPF: p < 0.0001 IPF vs. Sarcoidosis: p = 0.0252
Note: Other comparisons are not statistically different.ISHLT 2008
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2006)
YearALPHA-1 (N=1,442)
CF
(N=2,475)COPD
(N=5,983)IPF
(N=2,595)PPH
(N=616)SARCOIDOSIS
(N=319)
1 100 99.8 100 99.9 99.8 100
3 82 80.9 79.1 78.6 84.6 80.8
5 69.4 68.4 60.8 61.5 72 72.6
7 56.5 58.9 45.5 46.6 61.7 61.1
10 40.1 47.2 26.5 29 44.6 44.3
Survival comparisonsAlpha-1 vs. IPF: p < 0.0001 Alpha-1 vs. COPD: p < 0.0001Alpha-1 vs. PPH: p = 0.0200 CF vs. COPD: p < 0.0001CF vs. IPF: p < 0.0001 PPH vs. COPD: p < 0.0001PPH vs. IPF: p < 0.0001 COPD vs. Sarcoidosis: p = 0.0001IPF vs. Sarcoidosis: p = 0.0006
Note: Other comparisons are not statistically different.
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2006)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al (
%)
Alpha-1 (N=1,925) CF (N=3,275) COPD (N=7,760)
IPF (N=3,931) PPH (N=970) Sarcoidosis (N=506)
HALF-LIFE Alpha-1: 5.9 Years; CF: 6.4 Years; COPD: 5.0 Years; IPF: 4.1 Years; PPH: 4.6 Years; Sarcoidosis: 5.1 Years
ISHLT 2008
Survival comparisonsAlpha-1 vs. CF: p = 0.0003Alpha-1 vs. COPD p = 0.0009Alpha-1 vs. IPF p < 0.0001Alpha-1 vs. PPH: p = 0.0027Alpha-1 vs. Sarcoidosis: p = 0.0263CF vs. COPD: p < 0.0001CF vs. IPF: p < 0.0001CF vs. PPH: p < 0.0001CF vs. Sarcoidosis: p < 0.0001COPD vs. IPF: p <0.0001
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on
Survival to 3 Months (Transplants: January 1990 – June 2006)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al
(%)
Alpha-1 (N=1,655) CF (N= 2,851)COPD (N=6,892) IPF (N=3,197)PPH (N=697) Sarcoidosis (N=410)
HALF-LIFE Alpha-1: 7.1 Years; CF: 7.9 Years; COPD: 5.6 Years; IPF: 5.4 Years; PPH: 8.3 Years; Sarcoidosis: 7.0 Years
ISHLT 2008
Survival comparisonsAlpha-1 vs. CF: p = 0.0081Alpha-1 vs. IPF: p < 0.0001 Alpha-1 vs. COPD: p < 0.0001Alpha-1 vs. PPH: p = 0.0094CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001CF vs. Sarcoidosis: p = 0.0137PPH vs. COPD: p < 0.0001 PPH vs. IPF: p < 0.0001PPH vs. Sarcoidosis: p = 0.0105COPD vs. IPF: p = 0.0319IPF vs. Sarcoidosis: p = 0.0252
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year
(Transplants: January 1990 – June 2006)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al
(%)
Alpha-1 (N=1,442) CF (N=2,475)COPD (N=5,983) IPF (N=2,595)PPH (N=616) Sarcoidosis (N=319)
HALF-LIFE Alpha-1: 8.0 Years; CF: 9.0 Years; COPD: 6.3 Years; IPF: 6.7 Years; PPH: 9.0 Years; Sarcoidosis: 8.7 Years
ISHLT 2008
Survival comparisonsAlpha-1 vs. IPF: p < 0.0001 Alpha-1 vs. COPD: p < 0.0001Alpha-1 vs. PPH: p=0.0200CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001PPH vs. COPD: p < 0.0001 PPH vs. IPF: p < 0.0001COPD vs. Sarcoidosis: p = 0.0001IPF vs. Sarcoidosis: p = 0.0006
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival for Eisenmenger’s Syndrome
(Transplants: January 1990 – June 2006)
0
25
50
75
100
0 1 2 3 4 5Years
Su
rviv
al
(%)
ASD (N=100) VSD (N= 56)
HALF-LIFE ASD: 3.9 Years; VSD: 1.1 Years
ISHLT 2008
p = 0.0860
N at risk= 35
N at risk = 14
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Procedure Type
(Transplants: January 1990 – June 2006) 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
(%)
Alpha-1/Single lung (N=969)
Alpha-1/Double lung (N=956)P = 0.0012
ISHLT 2008
N at risk = 80
N at risk = 106
N at risk at 5 years = 354
N at risk at 5 years = 303
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Procedure Type and Age
(Transplants: January 1990 – June 2006) 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, < 50 (N = 443) Double Lung, <50 (N = 529)
Single Lung, 50+ (N = 526) Double Lung, 50+ (N = 427)
ISHLT 2008
N at risk at 10 years:
Single Lung, <50 = 67; Double Lung, <50 = 65; Single Lung, 50+ = 39; Double Lung, 50+ = 15
p = 0.0654
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2006)
Diagnosis: Emphysema/COPD
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
COPD/Single lung (N=5,316)
COPD/Double lung (N=2,444)N=231
N=90
P < 0.0001
ISHLT 2008
N at risk at 5 years = 580
N at risk at 5 years = 1,571
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Age
(Transplants: January 1990 – June 2006)
Diagnosis: Emphysema/COPD
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
<50/Single lung (N=689) <50/Double lung (N=631)
50+/Single lung (N=4,627) 50+/Double lung (N=1,813)N=60N=171
N=38N=52
P < 0.0001
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type
(Transplants: January 1990 – June 2006)
Diagnosis: Idiopathic Pulmonary Fibrosis
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
IPF/Single lung (N=2,641)
IPF/Double lung (N=1,290) N=87
N=27
P = 0.0133
ISHLT 2008
N at risk at 5 years = 196
N at risk at 5 years = 566
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type
(Transplants: January 1990 – June 2006)Diagnosis: Primary Pulmonary Hypertension
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
PPH/Single lung (N=260)
PPH/Double lung (N=710)N=35
N=56N at risk at 5 years = 80
N at risk at 5 years = 215
P = 0.0051
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2006)
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
(%)
COPD/Single lung/1990-1994 (N=1,002)
COPD/Single lung/1995-1999 (N=1,764)
COPD/Single lung/2000-6/2006 (N=2,550)
Survival comparisons1990-1994 vs. 1995-1999: p = 0.28291990-1994 vs. 2000-6/2006: p = 0.00021995-1999 vs. 2000-6/2006: p = 0.0203
N=43
N=87
N=144
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2006)
Diagnosis: Emphysema/COPD, Double Lung
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
COPD/Double lung/1990-1994 (N=197)
COPD/Double lung/1995-1999 (N=628)
COPD/Double lung/2000-6/2006 (N=1,619)
Survival comparisons1990-1994 vs. 1995-1999: p = 0.30311990-1994 vs. 2000-6/2006: p = 0.17781995-1999 vs. 2000-6/2006: p = 0.0034
N=20
N=48
N=42
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2006)
Diagnosis: Idiopathic Pulmonary Fibrosis, Single Lung
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al
(%)
IPF/Single lung/1990-1994 (N=456)
IPF/Single lung/1995-1999 (N=810)
IPF/Single lung/2000-6/2006 (N=1,375)
Survival comparisons1990-1994 vs. 1995-1999: p = 0.71241990-1994 vs. 2000-6/2006: p = 0.00061995-1999 vs. 2000-6/2006: p = 0.0004
N=16
N=37
N=50
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2006)
Diagnosis: Idiopathic Pulmonary Fibrosis, Double Lung
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al
(%)
IPF/Double lung/1990-1994 (N=67)
IPF/Double lung/1995-1999 (N=257)
IPF/Double lung/2000-6/2006 (N=966)
Survival comparisons1990-1994 vs. 1995-1999: p = 0.73311990-1994 vs. 2000-6/2006: p = 0.00631995-1999 vs. 2000-6/2006: p < 0.0001
N=40
N=20
N=10
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Donor CMV status/Recipient CMV status
(Transplants: October 1999 – June 2006)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5
Years
Su
rviv
al (
%)
D(-)/R(-) (N=1,175)D(-)/R(+) (N=1,560)D(+)/R(-) (N=1,396)D(+)/R(+) (N=2,438)
Survival comparisonsD(-)/R(-) vs. D(+)/R(-): p = 0.0003D(-)/R(-) vs. D(+)/R(+): p < 0.0001D(-)/R(+) vs. D(+)/R(-): p = 0.0019D(-)/R(+) vs. D(+)/R(+): p = 0.0004
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1995-6/2006) Risk Factors for 1 Year Mortality
DIAGNOSIS Procedure type N
Relative Risk P-value
95% conf. Interval
PPH All 398 2.53 <0.0001 1.87 -3.42
Pulmonary Fibrosis (not IPF)
All 111 2.3 <0.0001 1.63 -3.25
Sarcoidosis Double 194 2.02 <0.0001 1.50 -2.72
Other* All 852 1.89 <0.0001 1.59 -2.24
Alpha-1 antitrypsin deficiency
Single 387 1.68 <0.0001 1.35 -2.10
IPF Double 775 1.64 <0.0001 1.33 -2.02
Sarcoidosis Single 129 1.62 0.009 1.13 -2.33
IPF Single 1495 1.4 0.0002 1.17 -1.67
Alpha-1 antitrypsin deficiency
Double 424 1.37 0.0134 1.07 -1.76
Cystic fibrosis All 1569 1.31 0.0257 1.03 -1.66
(N=11,079)
ISHLT 2008
*Other = All diagnoses other than COPD, PPH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, and LAM.
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1995-6/2006) Risk Factors for 1 Year Mortality
DONOR CHARACTERISTICS N Relative
Risk P-value
95% Confidence
Interval
Donor history of diabetes 327 1.40 0.0032 1.12 -1.74
RECIPIENT CHARACTERISTICS
IV inotropes 70 1.75 0.0014 1.24 -2.45
Ventilator 274 1.60 0.0001 1.27 -2.02
Hospitalized (including ICU) 934 1.51 <0.0001 1.29 -1.76
Prior sternotomy 367 1.20 0.0813 0.98 -1.47
Chronic steroid use 5224 1.15 0.0015 1.06 -1.26
ISHLT 2008
(N=11,079)
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1995-6/2006) Risk Factors for 1 Year Mortality
TRANSPLANT CHARACTERISTICS N Relative
Risk P-value
95% Confidence
Interval
Transplant year = 1995/1996 vs. 2005/2006
1473 1.93 <0.0001 1.66 -2.25
Transplant year = 1997/1998 vs. 2005/2006
1632 1.58 <0.0001 1.35 -1.84
Transplant year = 1999/2000 vs. 2005/2006
1656 1.56 <0.0001 1.34 -1.81
Donor CMV +/ Recipient CMV - 2070 1.22 0.0002 1.10 -1.35
Male donor/female recipient 5317 0.88 0.0487 0.78 -1.00
ISHLT 2008
(N=11,079)
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1995-6/2006) Borderline Significant Risk Factors for 1 Year Mortality
TRANSPLANT CHARACTERISTICS N Relative
Risk P-value
95% Confidence
Interval
0-3 HLA mismatches vs. 4-6 mismatches
1470 0.89 0.065 0.78 -1.01
ISHLT 2008
(N=11,079)
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Recipient age
Transplant center volume
Cardiac output
PVR (borderline)
Bilirubin
Recipient oxygen required at rest
Recipient FEV1 % predicted (borderline)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality
Recipient Age
0
0.5
1
1.5
2
25 30 35 40 45 50 55 60 65
Recipient Age
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality
Center Volume
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40 45 50
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality
Recipient Pre-Transplant Bilirubin
0
0.5
1
1.5
2
2.5
0 0.5 1 1.5 2
Recipient Bilirubin (mg/dl)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0133
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality
Recipient Oxygen Required at Rest
0
0.5
1
1.5
2
0 1 2 3 4 5 6
Oxygen Required at Rest (L/min)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality
Recipient Pre-Transplant Cardiac Output
0
0.5
1
1.5
2
3 4 5 6 7
Cardiac output
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.018
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality
Recipient FEV1 (% predicted)
0
0.5
1
1.5
2
25 30 35 40 45 50 55 60 65 70Recipient FEV1 (% predicted)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.069
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality
Recipient PVR
0
0.5
1
1.5
2
1 2 3 4 5 6 7 8 9
PVR (Wood units)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.083
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1995-6/2006) Diagnosis = COPD/EmphysemaRisk Factors for 1 Year Mortality
RECIPIENT CHARACTERISTICS N
Relative Risk P-value
95% Confidence Interval
Ventilator 44 3.20 .0000 1.97 -5.20
Hospitalized (including ICU) 181 1.69 .0023 1.21 -2.37
Chronic steroid use 2073 1.39 .0000 1.20 -1.62
TRANSPLANT CHARACTERISTICS
Transplant Year: 1995/1996 vs. 2005/2006 581 1.58 .0016 1.19 -2.10
Transplant Year: 1997/1998 vs. 2005/2006 655 1.34 .0418 1.01 -1.77
Donor CMV +/ Recipient CMV - 665 1.31 .0050 1.09 -1.58
DONOR CHARACTERISTICS
Donor history of diabetes 132 1.64 .0084 1.14 -2.37
(N=4,384)ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1995-6/2006) Diagnosis = COPD/Emphysema
Borderline Significant Risk Factors for 1 Year Mortality
TRANSPLANT CHARACTERISTICS N
Relative Risk P-value
95% Confidence Interval
Transplant Year: 1999/2000 vs. 2005/2006 754 1.30 .0619 0.99 -1.70
DONOR CHARACTERISTICS
Donor history of malignancy 61 0.47 .0968 0.20 -1.14
(N=4,384)ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006)Diagnosis = COPD/Emphysema
Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Recipient age
Oxygen required at rest
Bilirubin (borderline)
Transplant center volume
PCO2 (borderline)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = COPD/Emphysema
Risk Factors for 1 Year MortalityRecipient Age
0
0.5
1
1.5
2
40 45 50 55 60 65
Recipient Age
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = COPD/Emphysema
Risk Factors for 1 Year MortalityCenter volume
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40 45 50
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006)Diagnosis = COPD/Emphysema
Risk Factors for 1 Year Mortality Recipient Oxygen Required at Rest
0
0.5
1
1.5
2
0 1 2 3 4 5 6Recipient Oxygen Required at Rest (L/min)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.028
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006)Diagnosis = COPD/Emphysema
Risk Factors for 1 Year Mortality Recipient Pre-Transplant Bilirubin
0
0.5
1
1.5
2
2.5
0 0.5 1 1.5 2Recipient bilirubin (mg/dl)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.072
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006)Diagnosis = COPD/Emphysema
Risk Factors for 1 Year Mortality Recipient PCO2 at Transplant
0
0.5
1
1.5
2
30 35 40 45 50 55 60 65 70Recipient PCO2 (mm/Hg)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.10
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1995-6/2006)
Diagnosis = IPFRisk Factors for 1 Year Mortality
RECIPIENT CHARACTERISTICS N Relative
Risk P-value
95% Confidence
Interval
Ventilator 58 1.77 0.0217 1.09 -2.89
Previous pregnancy 510 1.47 0.0008 1.17 -1.84
TRANSPLANT CHARACTERISTICS
Transplant Year: 1995/96 vs. 2005/06 229 2.01 <0.0001 1.48 -2.75
Transplant Year: 1999/2000 vs. 2005/06 277 2.01 <0.0001 1.50 -2.68
Transplant Year: 1997/1998 vs. 2005/06 259 1.84 0.0001 1.35 -2.49
Donor CMV+ / Recipient CMV- 407 1.55 <0.0001 1.27 -1.90
(N=2,270)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1995-6/2006)
Diagnosis = IPFBorderline Significant Risk Factors for 1 Year Mortality
RECIPIENT CHARACTERISTICS N Relative
Risk P-value
95% Confidence
Interval
Hospitalized (including ICU) 185 1.37 0.068 0.98 -1.91
TRANSPLANT CHARACTERISTICS
Transplant Year: 2001/02 vs. 2005/06 368 1.32 0.058 0.99 -1.77
(N=2,270)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006)
Diagnosis = IPFRisk Factors for 1 Year Mortality
Continuous Factors (see figures)
Recipient age
Recipient weight
Donor weight
Bilirubin
Center volume
Oxygen required at rest
FEV1 (% predicted)
Ischemia time
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = IPF
Risk Factors for 1 Year MortalityRecipient Age
0
0.5
1
1.5
2
35 40 45 50 55 60 65
Recipient Age
p < 0.0001
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = IPF
Risk Factors for 1 Year MortalityRecipient Weight
0
0.5
1
1.5
2
50 60 70 80 90 100
Recipient Weight (kg)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0099
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = IPF
Risk Factors for 1 Year MortalityDonor Weight
0
0.5
1
1.5
2
50 60 70 80 90 100
Donor Weight (kg)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.026
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006)Diagnosis = IPF
Risk Factors for 1 Year MortalityRecipient O2 Required at Rest
0
0.5
1
1.5
2
0 1 2 3 4 5 6
O2 Required at Rest (L/min)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0012
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006)Diagnosis = IPF
Risk Factors for 1 Year MortalityCenter volume
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40 45 50
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006)Diagnosis = IPF
Risk Factors for 1 Year MortalityIschemia Time
0
0.5
1
1.5
2
2 4 6 8
Ischemia time (hours)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0067
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006)Diagnosis = IPF
Risk Factors for 1 Year MortalityRecipient Bilirubin
0
0.5
1
1.5
2
0 0.5 1 1.5 2
Bilirubin (mg/dl)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0086
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2006)Diagnosis = IPF
Risk Factors for 1 Year MortalityRecipient FEV1 (% predicted)
0
0.5
1
1.5
2
25 30 35 40 45 50 55 60 65 70
FEV1 (% predicted)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.013
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 5 Year Mortality
DIAGNOSIS Procedure Type N
Relative Risk
P-value
95% Confidence
Interval
PPH All 261 1.84 0.0008 1.29 2.63
Alpha-1 antitrypsin deficiency Single 305 1.39 0.0001 1.17 1.64
Other diagnoses* Double 237 1.31 0.011 1.06 1.61
IPF Single 780 1.17 0.0092 1.04 1.31
COPD Double 612 0.87 0.0457 0.76 1.00
LAM All 64 0.62 0.044 0.39 0.99
(N=6,273)
ISHLT 2008
*Other = All diagnoses other than COPD, PPH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, and LAM.
NOTE: COPD/Single lung is the reference group
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 5 Year Mortality
RECIPIENT CHARACTERISTICS N Relative
Risk P-value
95% Confidence
Interval
Recipient on dialysis 15 2.06 0.0154 1.15 -3.68
Recipient on IV inotropes 61 1.88 0.0001 1.37 -2.56
Recipient on ventilator 145 1.37 0.0144 1.06 -1.76
Recipient with prior sternotomy 241 1.29 0.0031 1.09 -1.53
Hospitalized (including ICU) 498 1.22 0.0096 1.05 -1.42
Recipient history of diabetes 421 1.15 0.0489 1.00 -1.33
Chronic steroid use 2932 1.09 0.0313 1.01 1.17
(N=6,273)
ISHLT 2008
*Other = All diagnoses other than COPD, PPH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, and LAM.
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 5 Year Mortality
DONOR CHARACTERISTICS N Relative
Risk P-value
95% Confidence Interval
Donor history of diabetes 151 1.4 0.0017 1.13 -1.72
Donor cause of death = Anoxia 288 0.74 0.0022 0.62 -0.90
TRANSPLANT CHARACTERISTICS
Transplant year: 1995/1996 vs. 2001/2002 1473 1.39 <0.0001 1.25 -1.54
Transplant year: 1997/1998 vs. 2001/2002 1632 1.24 <0.0001 1.12 -1.38
Donor CMV +/ Recipient CMV - 1129 1.21 <0.0001 1.10 -1.32
Transplant year: 1999/2000 vs. 2001/2002 1656 1.17 0.0022 1.06 -1.30
Number of HLA mismatches (A+B+DR) per mismatch
853 0-3 MM 1.06 0.0016 1.02 -1.10
(N=6,273)ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1995-6/2002) Borderline Significant Risk Factors for 5 Year Mortality
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Female donor/female recipient 1732 0.88 0.0982 0.75 -1.02
(N=6,273)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality
Continuous Factors (see figures)
Recipient age
Donor age
Donor height
Recipient BSA
Center volume
Oxygen at rest
Height ratio (borderline)
PA mean (borderline)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality
Recipient Age
0
0.5
1
1.5
2
25 30 35 40 45 50 55 60 65
Recipient Age
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality
Donor Age
0
0.5
1
1.5
2
15 25 35 45 55Donor Age
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0008
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality
Oxygen Required at Rest
0
0.5
1
1.5
2
0 1 2 3 4 5 6
Oxygen required at rest (L/min)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0055
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality
Center Volume
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40 45 50
Center Volume (Cases per year)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality
Pre-Transplant Recipient Body Surface Area
0
0.5
1
1.5
2
1.3 1.4 1.5 1.6 1.7 1.8 1.9 2
Recipient BSA (m2)
Rel
ativ
e R
isk
of
5 Y
ear
Mo
rtal
ity
p = 0.0005
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality
Donor Height
0
0.5
1
1.5
2
155 160 165 170 175 180 185
Donor height (cm)
Rel
ativ
e R
isk
of
5 Y
ear
Mo
rtal
ity
p < 0.0001
ISHLT 2008
NOTE: Results should be considered in the context of height ratio (next slide)J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality
Donor/Recipient Height Ratio
0
0.5
1
1.5
2
0.8 0.9 1 1.1 1.2
Donor height (cm)
Rel
ativ
e R
isk
of
5 Y
ear
Mo
rtal
ity
p = 0.0667
ISHLT 2008
NOTE: Results should be considered in the context of donor height (previous slide)J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
DIAGNOSIS Procedure
Type N Relative
Risk P-value
95% Confidence
Interval
Alpha-1 antitrypsin deficiency Double 193 0.69 0.0158 0.50 -0.93
PPH All 166 0.65 0.0346 0.44 -0.97
IPF Double 161 0.63 0.009 0.44 -0.89
Cystic Fibrosis All 712 0.58 0.0003 0.43 -0.78
LAM All 52 0.51 0.0317 0.28 -0.94
Pulmonary Fibrosis (not IPF) All 30 0.38 0.0201 0.17 -0.86
(N=4,735)
ISHLT 2008
NOTE: COPD/single lung is the reference group.
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
DONOR, RECIPIENT AND TRANSPLANT CHARACTERISTICS N
Relative Risk P-value
95% Confidence
Interval Donor cause of death = anoxia vs. head trauma
231 0.68 0.0046 0.53 -0.89
Recipient sternotomy prior to transplant
165 1.54 0.0002 1.23 -1.94
Recipient diabetes 309 1.24 0.0299 1.02 -1.51
Transplant year: 1997/1998 vs. 2001/2002
1230 1.19 0.0186 1.03 -1.37
Transplant year: 1995/1996 vs. 2001/2002
1040 1.18 0.0307 1.02 -1.37
# of mismatches at HLA A locus 2515 1 A MM; 1922 2 A MM 1.13 0.0047 1.04 -1.22
Female donor/female recipient 1333 0.80 0.0421 0.65 -0.99
(N=4,735)ISHLT 2008
J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
POST-TRANSPLANT FACTORS N Relative
Risk P-value
95% Confidence
Interval
Bronchiolitis obliterans within 1st year 337 2.49 <0.0001 2.13 2.91
Rejection prior to discharge and rejection between discharge and 1 year
469 1.31 0.0007 1.12 1.54
Drug-treated infection prior to discharge 1871 1.19 0.0008 1.07 1.31
Rejection between discharge and 1 year but no rejection prior to discharge
1212 1.15 0.0221 1.02 1.3
(N=4,735)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1995-6/2002) Borderline Significant Risk Factors for 5 Year Mortality
Conditional on Survival to 1 Year
CHARACTERISTICS N Relative
Risk P-value
95% Confidence
Interval
Stroke prior to discharge 78 1.4 0.0529 1.00 -1.98
Donor cause of death = cerebrovascular/stroke vs. head trauma
1665 1.12 0.0621 0.99 -1.27
(N=4,735)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
Continuous Factors (see figures)
Recipient Age Donor Height Weight Ratio
Bilirubin
Center Volume Recipient BSA (borderline)
FEV1 (borderline) Ischemia time (borderline)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival
Recipient Age
0
0.5
1
1.5
2
2.5
25 30 35 40 45 50 55 60 65
Recipient Age
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival
Donor/Recipient Weight Ratio
0
0.5
1
1.5
2
0.7 0.8 0.9 1 1.1 1.2 1.3 1.4 1.5 1.6 1.7
Donor/Recipient Weight Ratio
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.046
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2002)Risk Factors for 5 Year Mortality Conditional on 1 Year Survival
Donor Height
0
0.5
1
1.5
2
150 160 170 180 190Donor Height (cm)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0141
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival
Center Volume
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40 45 50Center volume (cases per year)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.044
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2002)Risk Factors for 5 Year Mortality Conditional on 1 Year Survival
Recipient BSA
0
0.5
1
1.5
2
1.3 1.4 1.5 1.6 1.7 1.8 1.9 2Recipient BSA (m2)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.053
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival
Recipient Pre-Transplant FEV1
0
0.5
1
1.5
2
10 15 20 25 30 35 40 45 50 55 60 65 70 75
Pre-Transplant FEV1 (% predicted)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.08
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG RECIPIENTSFunctional Status of Surviving Recipients
(Follow-ups: April 1994 – June 2007)
0%
20%
40%
60%
80%
100%
1 Year (N =6,863) 3 Year (N=4,355) 5 Year (N=2,503) 10 Years (N=419)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG RECIPIENTSEmployment Status of Surviving Recipients
(Follow-ups: April 1994 – June 2007)
0%
20%
40%
60%
80%
100%
1 Year (N=8,204) 3 Year (N=4,952) 5 Year (N=3,029) 10 year (N=635)
Working (FT/PTStatus unknown)
Working Part Time
Working Full Time
Retired
Not Working
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2007)
0%
20%
40%
60%
80%
100%
1 Year (N = 10,471) 3 Year ( N=6,330) 5 Year (N=3,888) 10 Year (N=770)
No Hospitalization Hosp: No Rej/No Inf Hosp: Rejection Hosp: Infection Hosp: Rej/Inf
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
0
5
10
15
20
25
30
35
40
45
50
55
Any Induction (N =3,219)
Polyclonal ALG/ATG (N= 757)
IL2R-antagonist (N =2,183)
Campath (N = 252)
% o
f p
ati
en
tsADULT LUNG RECIPIENTS
Induction Immunosuppression (Transplants: January 2002 - June 2007)Analysis limited to patients receiving prednisone
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
20002001
20022003
20042005
20062000
20012002
20032004
20052006
20002001
20022003
20042005
20062000
20012002
20032004
20052006
% o
f p
ati
en
ts
ADULT LUNG RECIPIENTSInduction Immunosuppression (Transplants: January 2000 - December 2006)
Analysis limited to patients receiving prednisone
ISHLT 2008
Any Induction Polyclonal ALG/ATG IL2R-antagonist Campath
Analysis is limited to patients who were alive at the time of the follow-up
J Heart Lung Transplant 2008;27: 937-983
SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: April 1994-June 2006)
Conditional on survival to 14 days
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
No induction (N = 6,879)
Induction (N = 4,466)
p = 0.0075
N at risk = 161
N at risk = 328
N at risk at 5 years = 1,112
N at risk at 5 years = 2,246
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: January 2000-June 2006)
Conditional on survival to 14 days
0
20
40
60
80
100
0 1 2 3 4 5
Years
Su
rviv
al (
%)
No induction (N = 3,826)
Induction (N = 3,232)
p =0.0003
N at risk = 669
N at risk = 506
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine
% o
f P
ati
en
ts
Year 1 (N=5,001) Year 5 (N=2,178)
ADULT LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2002 through June 2007 Analysis limited to patients receiving prednisone
NOTE: Different patients are analyzed in Year 1 and Year 5
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
20
40
60
80
100
CyA TAC Rapamycin MMF AZA CyA TAC Rapamycin MMF AZA
% o
f P
atie
nts
1-Year Follow-Up 5-Year Follow-Up
Consecutive bars within each drug type represent follow-ups in 2002, 2003, 2004, 2005, 2006, & 2007.
ADULT LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2002 through June 2007 Analysis limited to patients receiving prednisone
NOTE: Different patients are analyzed in Year 1 and Year 5ISHLT 2008
Analysis is limited to patients who were alive at the time of the follow-upJ Heart Lung Transplant 2008;27: 937-983
0
20
40
60
80
100
CalcineurinInhibitor
CellCycle Rapamycin CalcineurinInhibitor
CellCycle Rapamycin
% o
f P
ati
en
ts
CyA
Tac Tac
CyA
Rapa Rapa
MMF MMF
AZA AZA
ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2002 through June 2007Analysis limited to patients receiving prednisone
1 Year Follow-up (N = 5,001) 5 Year Follow-up (N = 2,178)
NOTE: Different patients are analyzed in Year 1 and Year 5
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
20
40
60
80
100
Year 1 (N = 5,001) Year 5 (N = 2,178)
% o
f P
atie
nts
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine + MMF
Cyclosporine + AZA
ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
For follow-ups between January 2002 through June 2007Conventional Combinations
Analysis limited to patients receiving prednisone
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
Year 1 (N = 5,001) Year 5 (N =2,178)
% o
f P
atie
nts
Other
Rapa + Cellcycle
Rapa + Calcineurin
Tacrolimus
ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
For follow-ups between January 2002 through June 2007Other Combinations
Analysis limited to patients receiving prednisone
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
PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION IN 1ST YEAR
Stratified by Type of Induction (Follow-ups: July 1, 2004 - June 30, 2007)
0
10
20
30
40
50
60
% e
xp
eri
en
cin
g r
eje
cti
on
wit
hin
1 y
ea
r
No induction, Treatment No induction, No TreatmentPolyclonal, Treatment Polyclonal, No TreatmentIL2R-antagonist, Treatment IL2R-antagonist, No Treatment
No induction vs. polyclonal (p = 0.8004); polyclonal vs. IL2R (p < 0.0001); no induction vs. IL2R (p = 0.0006)
ISHLT 2008
No induction: N = 1,897Polyclonal: N = 358IL2R- antagonist: N = 1,186
Analysis is limited to patients who were alive at the time of the follow-upJ Heart Lung Transplant 2008;27: 937-983
PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION IN 1ST YEAR
Stratified by Type of Induction (Follow-ups: July 1, 2004 - June 30, 2007)
0
10
20
30
40
50
60
70
% e
xp
eri
en
cin
g r
eje
cti
on
wit
hin
1 y
ea
r
No induction, Treatment No induction, No TreatmentPolyclonal, Treatment Polyclonal, No TreatmentIL2R-antagonist, Treatment IL2R-antagonist, No Treatment
ISHLT 2008
18-34: N = 52835-49: N = 67650-59: N = 1,35660-65: N = 87766+: N = 177Female: N = 1,684 Male: N = 1,930
18-34 35-49 50-59 60-65 66+ Female Male18-34: no induct vs. IL2 (p=0.041); poly vs. IL2R (p=0.009); 35-49: poly vs. IL2R (p =0.020);50-59: no induct vs. IL2R (p<0.0001); 60-65: no induct vs. poly (p=0.044); no induct vs. IL2R (p=0.016); 66+: no induct vs. IL2R (p=0.004).For female: no induct vs. IL2R (p<0.0001)For male: no induct vs.IL2R (p<0.0001); poly vs. IL2R (p = 0.002)
Analysis is limited to patients who were alive at the time of the follow-upJ Heart Lung Transplant 2008;27: 937-983
PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression (Follow-ups: July 1, 2004 - June 30, 2007)
0
10
20
30
40
50
60
70
CyA + MMF, Treatment CyA + MMF, No Treatment CyA + AZA, Treatment CyA + AZA, No Treatment
TAC + MMF, Treatment TAC + MMF, No Treatment TAC + AZA, Treatment TAC + AZA, No Treatment
% e
xper
ien
cin
g r
ejec
tio
n w
ith
in 1
yea
r
all comparisons were statistically significant at 0.05 except TAC + MMF vs. TAC+ AZA
ISHLT 2008
Cyclosporine + MMF: N = 330 Cyclosporine + AZA: N = 551Tacrolimus + MMF: N = 1,297Tacrolimus + AZA: N = 898
Analysis is limited to patients who were alive at the time of the follow-upJ Heart Lung Transplant 2008;27: 937-983
PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression (Follow-ups: July 1, 2004 - June 30, 2007)
0
10
20
30
40
50
60
70
80
CyA + MMF, Treatment CyA + MMF, No TreatmentCyA + AZA, Treatment CyA + AZA, No TreatmentTAC + MMF, Treatment TAC + MMF, No TreatmentTAC + AZA, Treatment TAC + AZA, No Treatment
% e
xp
eri
en
cin
g r
eje
cti
on
wit
hin
1 y
ea
r
18-34: CyA + MMF vs. Cya + AZA (p=0.039); CyA + AZA vs. TAC + MMF (p=0.0001); CyA + AZA vs. TAC + AZA (p=0.002)35-49: all comparisons are statistically significant at 0.05 except CyA + MMF vs. Cya + AZA and TAC + MMF vs. TAC + AZA 50-59: all comparisons were statistically significant at 0.01 except TAC + MMF vs. TAC + AZA 60-65: all comparisons are statistically significant at 0.05 except CyA + MMF vs. TAC + AZA and TAC + MMF vs. TAC + AZA 66+: CyA + AZA vs. TAC + MMF (p <0.0001); CyA + AZA vs. TAC + AZA (p=0.011) Females: all comparisons were statistically significant at 0,05 except TAC + MMF vs. TAC + AZA Males: all comparisons were statistically significant at 0.01 except TAC + MMF vs. TAC + AZA
ISHLT 2008
18-34 35-49 50-59 60-65 66+ Female Male
Analysis is limited to patients who were alive at the time of the follow-upJ Heart Lung Transplant 2008;27: 937-983
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994 - June 2007)
Follow-ups: April 1994 –
June 2000 Follow-ups: July 2000-
June 2007
Outcome Within 1
Year
Total number with known response
Within 1 Year
Total number with known response
Hypertension 48.90% (N = 3,802) 54.00% (N = 6,180)
Renal Dysfunction 23.1% (N = 3,719) 26.6% (N = 6,586)
Abnormal Creatinine < 2.5 mg/dl 12.90% 19.60%
Creatinine > 2.5 mg/dl 8.50% 5.20%
Chronic Dialysis 1.70% 1.70%
Renal Transplant 0.00% 0.10%
Hyperlipidemia 13.10% (N = 3,949) 27.50% (N = 6,690)
Diabetes 17.10% (N = 3,761) 30.60% (N = 6,508)
Bronchiolitis Obliterans 10.60% (N = 3,496) 8.20% (N = 6,203)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 and 5 Years
Post-Transplant (Follow-ups: April 1994 - June 2007)
Outcome Within 1
Year
Total number with known response
Within 5 Years
Total number with known response
Hypertension 52.10% (N = 9,982) 85.30% (N = 2,538)
Renal Dysfunction 25.3% (N = 10,305) 37.0% (N = 2,798)
Abnormal Creatinine < 2.5 mg/dl 17.20% 23.40%
Creatinine > 2.5 mg/dl 6.40% 10.00%
Chronic Dialysis 1.70% 3.10%
Renal Transplant 0.00% 0.50%
Hyperlipidemia 22.20% (N = 10,639) 53.60% (N = 2,829)
Diabetes 25.70% (N = 10,269) 35.50% (N = 2,582)
Bronchiolitis Obliterans 9.10% (N = 9,699) 33.70% (N = 2,128)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 10 Years Post-Transplant
(Follow-ups: April 1994 - June 2007)
Outcome Within 10
Years
Total number with known response
Hypertension 97.70% (N = 298)
Renal Dysfunction 41.1% (N = 358)
Abnormal Creatinine < 2.5 mg/dl 21.80% Creatinine > 2.5 mg/dl 8.40% Chronic Dialysis 7.30% Renal Transplant 3.60%
Hyperlipidemia 67.10% (N = 359)
Diabetes 37.80% (N = 315)
Bronchiolitis Obliterans 46.30% (N = 214)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
FREEDOM FROM BRONCHIOLITIS OBLITERANSFor Adult Lung Recipients (Follow-ups: April 1994-June 2007)
Conditional on Survival to 14 days
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10Years
% F
ree
do
m f
rom
OB
Freedom from Bronch Oblit (N = 17,443)
N at risk at 5 years = 1,139
N at risk = 49
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
FREEDOM FROM BRONCHIOLITIS OBLITERANS STRATIFIED BY INDUCTION USE
For Adult Lung Recipients Follow-ups: April 1994-June 2007)Conditional on Survival to 14 days
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10Years
% F
reed
om
fro
m O
B
No induction (N=6,913)
Induction (N=4,357)
p = 0.4056
N at risk at 5 years = 382
N at risk at 5 years = 676
N at risk = 30
N at risk = 11
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Adult Lung Recipients (Follow-ups: April 1994-June 2007)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
% F
reed
om
fro
m S
ever
e R
enal
D
ysfu
nct
ion
Freedom from Severe RenalDysfunction (N=17,452)
N at risk at 5 years = 1,602
N at risk = 81
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2007)
Malignancy/Type 1-Year Survivors 5-Year Survivors 10-Year Survivors
No Malignancy 10,279 (96.4%) 2,514 (87.7%) 268 (72.2%)
Malignancy (all types combined) 386 (3.6%) 351 (12.3%) 103 (27.8%)
Malignancy Type*
Skin 94 194 65
Lymph 173 63 21
Other 99 110 29
Type Not Reported
20 11 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.
Other malignancies reported include: adenocarcinoma (2; 2; 0), bladder (2; 1; 0), lung (2; 4; 0), breast (1; 5; 2); prostate (0; 5; 1), cervical (1; 1; 0); liver (1; 1; 1); colon (1; 1; 0). Numbers in parentheses represent the number of reported cases within each time period.
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
FREEDOM FROM MALIGNANCYFor Adult Lung Recipients (Follow-ups: April 1994-June 2007)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10Years
% F
ree
fro
m M
alig
nan
cy
All malignancy Lymph Skin Other
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983
ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January 1992- June 2007)
CAUSE OF DEATH0-30 Days
(N = 1,622)
31 Days –
1 Year
(N = 2,781)
>1 Year –
3 Years
(N = 2,481)
>3 Years –
5 Years
(N = 1,445)
>5 Years – 10 Years
(N = 1,592)
>10 Years
(N = 310)
BRONCHIOLITIS 8 (0.5%) 129 (4.6%) 648 (26.1%) 412 (28.5%) 394 (24.7%) 62 (20.0%)
ACUTE REJECTION 70 (4.3%) 50 (1.8%) 40 (1.6%) 10 (0.7%) 11 (0.7%) 0
LYMPHOMA 1 (0.1%) 74 (2.7%) 56 (2.3%) 26 (1.8%) 41 (2.6%) 15 (4.8%)
MALIGNANCY, OTHER 2 (0.1%) 71 (2.6%) 145 (5.8%) 114 (7.9%) 151 (9.5%) 22 (7.1%)
CMV 0 86 (3.1%) 25 (1.0%) 5 (0.3%) 3 (0.2%) 0
INFECTION, NON-CMV 330 (20.3%) 1,011 (36.4%) 578 (23.3%) 278 (19.2%) 292 (18.3%) 59 (19.0%)
GRAFT FAILURE 458 (28.2%) 504 (18.1%) 462 (18.6%) 274 (19.0%) 286 (18.0%) 61 (19.7%)
CARDIOVASCULAR 180 (11.1%) 109 (3.9%) 77 (3.1%) 63 (4.4%) 76 (4.8%) 17 (5.5%)
TECHNICAL 134 (8.3%) 63 (2.3%) 16 (0.6%) 4 (0.3%) 11 (0.7%) 4 (1.3%)
OTHER 439 (27.1%) 684 (24.6%) 434 (17.5%) 259 (17.9%) 327 (20.5%) 70 (22.6%)
ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983