2004 ISHLT J Heart Lung Transplant 2004; 23: 933-947 LUNG TRANSPLANTATION Pediatric Recipients.
2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. LUNG TRANSPLANTATION Overall.
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Transcript of 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. LUNG TRANSPLANTATION Overall.
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
LUNG TRANSPLANTATION
Overall
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
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
Bilateral/Double LungSingle Lung
13 15 47 80185
408
685
902
10691206
13421337
1417141314101508
1537
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND LOCATION
0
200
400
600
800
1000
1200
1400
1600
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
Nu
mb
er o
f T
ran
spla
nts South America
North America
Europe
Australia/Oceania
Asia
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
AVERAGE CENTER VOLUMELung Transplants: January 1, 1998 - June 30, 2002
42
30 32
15
6 4 20
5
10
15
20
25
30
35
40
45
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
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
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
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
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2002)
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
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA
0
10
20
30
40
50
<1 1-5
6-10
11-1
7
18-3
4
35-4
9
50-6
465
+ <1 1-5
6-10
11-1
7
18-3
4
35-4
9
50-6
465
+
% o
f tr
ansp
lan
ts
p < 0.0001
1985-1996 1/1997-6/2002
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
LUNG TRANSPLANTATIONActuarial Survival (Transplants: January 1990 - June 2001)
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=6,068)
Single Lung (N=7,385)
All Lungs (N=13,453)
Double lung: 1/2-life = 4.8 Years; Conditional 1/2-life = 8.1 YearsSingle lung: 1/2-life = 3.7 Years; Conditional 1/2-life = 5.8 YearsAll lungs: 1/2-life = 4.0 Years; Conditional 1/2-life = 6.5 Years
p < 0.0001
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
LUNG TRANSPLANTATION
Adult Recipients
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2002)
DIAGNOSIS SLT (N = 5,000) BLT (N = 4,488) TOTAL (N = 9,488)
COPD/Emphysema 2,698 ( 54.0% ) 1,000 ( 22.0% ) 3,698 ( 39.0% )
IPF 1,186 ( 24.0% ) 403 ( 9.0% ) 1,589 ( 17.0% )
CF 49 ( 1.0% ) 1,447 ( 32.0% ) 1,496 ( 16.0% )
Alpha-1 429 ( 8.6% ) 434 ( 9.7% ) 863 ( 9.1% )
PPH 66 ( 1.3% ) 361 ( 8.0% ) 427 ( 4.5% )
Sarcoidosis 127 ( 2.5% ) 113 ( 2.5% ) 240 ( 2.5% )
Bronchiectasis 11 ( 0.2% ) 192 ( 4.3% ) 203 ( 2.1% )
Congenital Heart Disease 10 ( 0.2% ) 99 ( 2.2% ) 109 ( 1.1% )
LAM 45 ( 0.9% ) 58 ( 1.3% ) 103 ( 1.1% )
Re-TX: OB 47 ( 0.9% ) 47 ( 1.0% ) 94 ( 1.0% )
OB (Non-ReTX) 30 ( 0.6% ) 52 ( 1.2% ) 82 ( 0.9% )
Re-TX: Non-OB 35 ( 0.7% ) 37 ( 0.8% ) 72 ( 0.8% )
Connective Tissue Disorder 21 ( 0.4% ) 22 ( 0.5% ) 43 ( 0.5% )
Cancer 3 ( 0.1% ) 25 ( 0.6% ) 28 ( 0.3% )
Histiocytosis X 11 ( 0.2% ) 8 ( 0.2% ) 19 ( 0.2% )
Other 232 ( 4.6% ) 190 ( 4.2% ) 422 ( 4.4% )
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTATION: Indications (Transplants: January 1995 - June 2002)
53%
23%
9%1%
6%
3%
1%2%
1%1%
22%
33%2%
9%
10%
8%
2%
1% 5%1%
4%
3%
COPD/Emphysema CF Congenital Heart DiseaseBronchiectasis Re-TX IPFAlpha-1 PPH SarcoidosisOB (Non-ReTX) LAM Other
Single Lung Transplants
Bilateral/Double Lung Transplants
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTATIONIndications By Year
0
20
40
60
80
100
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Transplant Year
% o
f T
ran
sp
lan
ts
Cystic Fibrosis IPF Emphysema A1A PPH
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTATIONActuarial Survival by Era (Transplants: January 1988 – June 2001)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
1988-1992 (N=2,093)1993-1997 (N=6,005)1/1998-6/2001 (N=4,831)
Survival comparisons by era1988-1992 vs. 1993-1997: p = 0.0081988-1992 vs. 1998-2001: p < 0.00011993-1997 vs. 1998-2001: p = 0.3
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTATION Actuarial Survival by Age Group (Transplants: January 1990 – June 2001)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
18-34 (N=2,328)35-49 (N=3,901)50-64 (N=5,980)65+ (N=323)
Survival comparisons18-34 vs. 50-64: p < 0.000118-34 vs. 65+: p = 0.000435-49 vs. 50-64: p < 0.000135-49 vs. 65+: p = 0.0001
HALF-LIFE 18-34: 4.8 Years; 35-49: 4.8 Years; 50-64 3.7 Years; 65+: 3.0 Years
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTATIONActuarial Survival By Diagnosis (Transplants: January 1990 – June 2001)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al (
%)
Alpha-1 Antitrypsin (N=1,234) Cystic Fibrosis (N=1,703)Emphysema/COPD (N=4,353) IPF (N=1,855)PPH (N=691) Sarcoidosis (N = 276)
HALF-LIFE Alpha-1: 4.9 Years; CF: 4.4 Years; COPD: 5.5 Years; IFP: 3.0 Years; PPH: 4.0 Years; Sarcoidosis: 4.7 Years
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTATIONActuarial Survival By Diagnosis Conditional on Survival to 3 Months
(Transplants: January 1990 – June 2001)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al (
%)
Alpha-1 Antitrypsin (N=888) Cystic Fibrosis (N=1,244)Emphysema/COPD (N=3,393) IPF (N=1,288)PPH (N=439) Sarcoidosis (N = 181)
HALF-LIFE CONDITIONAL ON 3 MONTH SURVIVAL Alpha-1: 6.3 Years; CF: 5.1 Years; COPD: 7.1 Years; IFP: 4.7 Years; PPH: 7.0 Years; Sarcoidosis: 7.2 Years
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTATIONActuarial Survival By Diagnosis Conditional on Survival to 1 Year
(Transplants: January 1990 – June 2001)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al (
%)
Alpha-1 Antitrypsin (N=747) Cystic Fibrosis (N=1,056)Emphysema/COPD (N=2,859) IPF (N=1,022)PPH (N=383) Sarcoidosis (N = 146)
HALF-LIFE CONDITIONAL ON 1 YEAR SURVIVAL Alpha-1: 7.2 Years; CF: 5.7 Years; COPD: 8.6 Years; IFP: 5.9 Years; PPH: 7.8 Years; Sarcoidosis: 10.4 Years
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTATIONActuarial Survival for Congenital Diagnosis (Transplants: January 1990 – June 2001)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al (
%)
Eisenmenger's Syndrome (N=196)
Other Congenital (N=22)
Eisenmenger's + Other Congenital (N=218)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTATIONActuarial Survival By Procedure Type (Transplants: January 1990 – June 2001)
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 = 725)
Double Lung (N=509)P = 0.008
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTATIONActuarial Survival by Procedure Type (Transplants: January 1990 – June 2001)
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 =3,299)
Double Lung (N=1,054)
P < 0.0001
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTATIONActuarial Survival by Procedure Type (Transplants: January 1990 – June 2001)
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 =1,461)
Double Lung (N=394)
P = 0.2
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTATIONActuarial Survival by Procedure Type (Transplants: January 1990 – June 2001)
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)
P = 0.3
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1995-6/2001) Risk Factors for 1 Year Mortality
VARIABLE Odds Ratio P-value
95% Confidence
Interval
PPH 2.74 <.0001 2.05 - 3.67
Cystic Fibrosis 1.31 0.04 1.01 - 1.68
IPF 1.91 <.0001 1.60 - 2.29
Alpha-1 Antitrypsin deficiency 1.69 <.0001 1.37 - 2.09
Sarcoidosis 2.15 <.0001 1.51 - 3.07
All other diagnoses (other than COPD)
1.68 <.0001 1.38 - 2.04
(N=7,262)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1995-6/2001) Risk Factors for 1 Year Mortality
VARIABLE Odds Ratio P-value
95% Confidence
Interval
Ventilator 2.42 <.0001 1.65 - 3.55
IV inotropes 1.91 0.03 1.08 - 3.39
Repeat transplant 2.03 <.0001 1.47 - 2.80
PRA > 10% 1.51 0.006 1.13 - 2.03
Donor CMV+/Recipient CMV - 1.29 0.001 1.11 - 1.51
Donor history of diabetes 1.65 0.01 1.13 - 2.42
(N=7,262)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Recipient age
Donor age
Donor/Recipient BMI ratio
Ischemia time
Transplant center volume
Bilirubin
Serum creatinine
Oxygen required at rest
FeV1 % predicted
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
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
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
Donor Age
0
0.5
1
1.5
2
10 15 20 25 30 35 40 45 50 55 60Donor Age
Od
ds
of
1 Y
ear
Mo
rtal
ity
p = 0.0005
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year MortalityBMI Ratio = Donor BMI/Recipient BMI
0
0.5
1
1.5
2
0.5 0.75 1 1.25 1.5 1.75 2
BMI Ratio
Od
ds
of
1 Y
ear
Mo
rtal
ity
p = 0.005
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
Center volume
0
0.5
1
1.5
2
0 10 20 30 40 50 60
Center Volume (cases per year)
Od
ds
of
1 Y
ea
r M
ort
alit
y
p = 0.0003
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
Ischemia time
0
0.5
1
1.5
2
0 1 2 3 4 5 6 7 8 9
Ischemia time (hours)
Od
ds
of
1 Y
ear
Mo
rtal
ity
p = 0.05
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
Creatinine
0
0.5
1
1.5
2
0 1 2 3 4
Serum creatinine (mg/dl)
Od
ds
of
1 Y
ear
Mo
rtal
ity
p = 0.03
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
Oxygen required at rest
0
0.5
1
1.5
2
0 1 2 3 4 5 6 7 8
Oxygen required at rest (L/min)
Od
ds
of
1 Y
ear
Mo
rtal
ity
p = 0.02
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
Predicted FeV1% for IPF patients
0
1
2
3
4
5
10 20 30 40 50 60 70 80FeV1 (% predicted)
Od
ds
of
1 Y
ear
Mo
rtal
ity
p = 0.01
NOTE: FEV1% did not have a significant impact for any diagnosis other than IPF.
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality
Bilirubin
0
0.5
1
1.5
2
0 1 2 3 4 5 6 7 8 9 10 11 12
Bilirubin (mg/dl)
Od
ds
of
1 Y
ear
Mo
rtal
ity
p = 0.0005
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1995-6/2001) Factors Not Significant for 1 Year Mortality
Recipient factors:Hospitalized, pCO2, gender, chronic steroid use, transfusions, history of malignancy, recent infection requiring IV drug therapy
Donor factors:Gender, clinical infection, history of hypertension, history of cancer, COD
Transplant factors:Procedure type, ABO compatibility, HLA mismatch, year of transplant
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1995-6/1997) Risk Factors for 5 Year Mortality
VARIABLE Odds Ratio P-value
95% Confidence
Interval
Cystic Fibrosis 0.68 0.01 0.50 - 0.93
Donor CMV+/Recipient CMV - 1.42 0.004 1.12 - 1.80
Infection requiring IV drug therapy within 2 weeks of transplant
1.57 0.02 1.08 - 2.28
(N=2,771)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality
Continuous Factors (see figures)
Recipient age
Donor age
PA systolic
Bilirubin
pCO2
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality
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
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality
Donor Age
0
0.5
1
1.5
2
2.5
3
10 15 20 25 30 35 40 45 50 55 60Donor Age
Od
ds
of
5 Y
ear
Mo
rtal
ity
p < 0.0001
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality
Bilirubin
0
0.5
1
1.5
2
2.5
3
0 1 2 3 4 5 6
Bilirubin (mg/dl)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p = 0.04
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality
PA Systolic
0
0.5
1
1.5
2
25 30 35 40 45 50 55 60
PA Systolic (mm Hg)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p = 0.03
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality
pCO2
0
0.5
1
1.5
2
25 30 35 40 45 50 55 60
pCO2 (mm Hg)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p = 0.04
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1995-6/1997) Factors Not Significant for 5 Year Mortality
Recipient factors:Ventilator, inotropes, hospitalized, chronic steroid use, transfusions, history of malignancy, PRA, gender, FeV1, FVC, repeat transplant
Donor factors:Gender, clinical infection, history of hypertension, history of cancer, history of diabetes, COD
Transplant factors:Procedure type, ABO compatibility, HLA mismatch
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1995-6/1997) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
VARIABLE Odds Ratio P-value
95% Confidence
Interval
Double lung transplant 0.69 0.002 0.54 - 0.87
Female recipient 0.77 0.05 0.60 - 1.00
Hospitalized for infection within 1st year post-transplant
2.02 <.0001 1.61 - 2.53
Bronchiolitis obliterans within 1st year post-transplant
2.38 <.0001 1.59 - 3.56
(N=1,899)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
Continuous Factors (see figures)
Recipient age
Recipient height
Donor age
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/1997) 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 = 0.0002
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
Donor Age
0
0.5
1
1.5
2
10 15 20 25 30 35 40 45 50 55 60Donor Age
Od
ds
of
5 Y
ear
Mo
rtal
ity
p = 0.002
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
Recipient Height
0
0.5
1
1.5
2
140 150 160 170 180 190Recipient Height (cm)
Od
ds
of
5 Y
ear
Mo
rtal
ity
p = 0.02
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1995-6/1997) Factors Not Significant for Conditional 5 Year Mortality
Recipient factors:Diagnosis, ventilator, inotropes, hospitalized, pCO2,
gender, chronic steroid use, transfusions, history of malignancy, PRA, repeat transplant, FeV1, FVC
Donor factors:Gender, clinical infection, history of hypertension, history of cancer, history of diabetes, COD
Transplant factors:ABO compatibility, HLA mismatch, CMV mismatch
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1995-6/1997) Factors Not Significant for Conditional 5 Year Mortality
Post-transplant factors:Treated for rejection, stroke, dialysis, prolonged graft dysfunction, bronchopleural fistula, airway dehiscence
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG RECIPIENTSFunctional Status (Follow-ups: April 1994 – June 2002)
0%
20%
40%
60%
80%
100%
1 Year (N = 4,470) 3 Years (N = 2,782) 5 Years (N = 1,554)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG RECIPIENTSEmployment Status (Follow-ups: April 1994 – June 2002)
0%
20%
40%
60%
80%
100%
1 Year (N = 4,188) 3 Years (N = 2,486) 5 Years (N = 1,368)
Retired
Not Working
Working Part Time
Working Full Time
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant (Follow-ups: April 1994 - June 2002)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N = 5,218) Between 2 and 3 Years (N = 3,115)
Between 4 and 5 Years (N = 1,744)
No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Only Hospitalized, Infection OnlyHospitalized, Rejection and Infection
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
0
5
10
15
20
25
30
35
40
45
Any Induction (N =1,052)
PolyclonalALG/ATG (N = 473)
OKT3 (N = 74) IL2R-antagonist (N =551)
% o
f p
ati
en
tsADULT LUNG RECIPIENTS
Induction Immunosuppression (Follow-ups: January 2000 - June 2002)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
0
10
20
30
40
50
Any Induction (N = 429)
Polyclonal ALG/ATG (N = 227)
OKT3 (N = 61)
IL2R-antagonist (N = 180)
Any Induction (N = 451)
Polyclonal ALG/ATG (N = 188)
OKT3 (N = 11)
IL2R-antagonist (N = 258)
Any Induction (N = 172)
Polyclonal ALG/ATG (N = 58)
OKT3 (N = 2)
IL2R-antagonist (N = 113)
% o
f p
ati
en
ts 2000 2001 2002(6 months)
ADULT LUNG RECIPIENTSInduction Immunosuppression (Follow-ups: January 2000 - June 2002)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
ati
en
ts
Year 1 (N = 1,608)
Year 5 (N = 791)
ADULT LUNG RECIPIENTS Maintenance Immunosuppression At Any Time During Follow-up Period
For follow-ups between January 2000 through June 2002
NOTE: Different patients are analyzed in Year 1 and Year 5
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
ati
en
ts
Year 1 (N = 1,501) Year 5 (N = 721)
ADULT LUNG RECIPIENTSMaintenance Immunosuppression At Time of Follow-up
For follow-ups between January 2000 through June 2002
NOTE: Different patients are analyzed in Year 1 and Year 5
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
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
For follow-ups between January 2000 through June 2002
1 Year Follow-up (N = 1,501) 5 Year Follow-up (N = 721)NOTE: Different patients are analyzed in Year 1 and Year 5
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
0%
20%
40%
60%
80%
100%
Year 1 (N = 1,501) Year 5 (N = 721)
% 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
For follow-ups between January 2000 through June 2002
NOTE: Different patients are analyzed in Year 1 and Year 5
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994-June 2002)
Outcome Within 1 Year
Hypertension 49.4% (N = 5,157)
Renal Dysfunction 25.0% (N = 6,234) Abnormal Creatinine < 2.5 mg/dl 14.8% Creatinine>2.5 mg/dl 8.3% Chronic Dialysis 1.9% Renal Transplant 0.0%
Hyperlipidemia 15.2% (N = 5,385)
Diabetes 18.6% (N = 5,100)
Bronchiolitis Obliterans 9.9% (N = 4,792)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant
(Follow-ups: April 1994-June 2002)
Outcome Within 5 Years
Hypertension 86.5% (N = 931)
Renal Dysfunction 38.3% (N = 1,025) Abnormal Creatinine < 2.5 mg/dl 20.2% Creatinine>2.5 mg/dl 13.7% Chronic Dialysis 3.4% Renal Transplant 0.9%
Hyperlipidemia 43.4% (N = 1,019)
Diabetes 27.8% (N = 907)
Bronchiolitis Obliterans 36.0% (N = 702)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
Freedom from Bronchiolitis Obliterans For Adult Lung Recipients (Follow-ups: April 1994-June 2002)
0
20
40
60
80
100
0 1 2 3 4 5 6 7Years
% F
reed
om
fro
m O
B
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
Freedom from Severe Renal Dysfunction*For Adult Lung Recipients (Follow-ups: April 1994-June 2002)
0
20
40
60
80
100
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5
Years
% F
ree
do
m f
rom
Se
ve
re R
en
al
Dy
sfu
nc
tio
n
* Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2002)
Malignancy/Type 1-Year Survivors 5-Year Survivors
No Malignancy 5104 (96.1%) 886 (86.9%)
Malignancy (all types combined) 209 (3.9%) 134 (13.1%)
Malignancy Type
Skin 44 61
Lymph 109 21
Other 35 32
Lymph + Skin 3
Lymph + Other 5
Skin + Other 2
Type Not Reported 21 10
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
Freedom from MalignancyFor Adult Lung Recipients (Follow-ups: April 1994-June 2002)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7Years
% F
ree
fro
m M
alig
nan
cy
All malignancy Lymph Skin Other
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1995-6/1997) Risk Factors for Developing Malignancy within 5 Years
VARIABLE Odds Ratio P-value
95% Confidence
Interval
Double lung transplant 0.63 0.03 0.42 - 0.95
Female recipient 0.69 0.03 0.5 - 0.97
Any induction used 0.67 0.04 0.46 - 0.98
(N=1,514)
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for Developing Malignancy within 5 Years
Continuous Factors (see figures)
Recipient age Donor age
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for Developing Malignancy within 5 Years
Recipient Age
0
0.5
1
1.5
2
20 25 30 35 40 45 50 55 60 65
Recipient Age
Od
ds
of
Ma
lig
na
nc
y w
ith
in 5
Ye
ars
p = 0.003
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for Developing Malignancy within 5 Years
Donor Age
0
0.5
1
1.5
2
10 15 20 25 30 35 40 45 50 55 60Donor Age
Od
ds
of
Mal
ign
ancy
wit
hin
5 Y
ears
p = 0.01
2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.
ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January 1992- June 2002)
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%)