2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. HEART-LUNG TRANSPLANTATION Overall.
2004 ISHLT J Heart Lung Transplant 2004; 23: 804-15 LUNG TRANSPLANTATION Overall.
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Transcript of 2004 ISHLT J Heart Lung Transplant 2004; 23: 804-15 LUNG TRANSPLANTATION Overall.
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
LUNG TRANSPLANTATION
Overall
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
LUNG TRANSPLANTATION
Adult Recipients
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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% )
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 3 Months
(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=1,075) CF (N= 1,541)COPD (N= 4,152) IPF (N= 1,618)PPH (N= 503) SARCOIDOSIS (N = 222)
HALF-LIFE Alpha-1: 6.3 Years; CF: 7.3 Years; COPD: 5.3 Years; IPF: 4.9 Years; PPH: 7.2 Years; Sarcoidosis: 7.0 Years
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year
(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=898) CF (N= 1,298)COPD (N=3,508) IPF (N= 1,279)PPH (N= 429) SARCOIDOSIS (N = 176)
HALF-LIFE Alpha-1: 7.5 Years; CF: 8.4 Years; COPD: 5.9 Years; IPF: 6.2 Years; PPH: 8.2 Years; Sarcoidosis: 8.5 Years
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival for Eisenmenger’s Syndrome
(Transplants: January 1990 – June 2002)
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2002)
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2002)
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2002)
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2002)
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)
Survival comparisons1990-1994 vs. 1995-1997: p = 0.23 1990-1994 vs. 1998-6/2002: p = 0.981995-1997 vs. 1998-6/2002: p = 0.33
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2002)
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)
Survival comparisons1990-1994 vs. 1995-1997: p = 0.69 1990-1994 vs. 1998-6/2002: p = 0.891995-1997 vs. 1998-6/2002: p = 0.26
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2002)
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)
Survival comparisons1990-1994 vs. 1995-1997: p = 0.76 1990-1994 vs. 1998-6/2002: p = 0.191995-1997 vs. 1998-6/2002: p = 0.008
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 1 Year Mortality
VARIABLE Odds Ratio P-value
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)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 1 Year Mortality
VARIABLE Odds Ratio P-value
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)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTS (1/1995-6/2002) 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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTS (1995-6/1998) Risk Factors for 5 Year Mortality
VARIABLE Odds Ratio P-value
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)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality
Continuous Factors (see figures)
Recipient age
Donor age
Donor weight
Recipient PVR
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTS (1/1995-6/1998) 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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTS (1995-6/1998) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
VARIABLE Odds Ratio P-value
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)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
ADULT LUNG TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
Continuous Factors (see figure)
Recipient age
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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 2003
1 Year Follow-up (N = 1,753) 5 Year Follow-up (N = 814)NOTE: Different patients are analyzed in Year 1 and Year 5
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
For follow-ups between January 2000 through June 2003
NOTE: Different patients are analyzed in Year 1 and Year 5
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant
(Follow-ups: April 1994 - June 2003)
Outcome Within 5
Years Total number with known response
Hypertension 86.4% (N = 1,196)
Renal Dysfunction 38.4% (N = 1,275)
Abnormal Creatinine < 2.5 mg/dl 21.3% Creatinine > 2.5 mg/dl 12.9% Chronic Dialysis 3.4% Renal Transplant 0.7%
Hyperlipidemia 45.4% (N = 1,315)
Diabetes 29.4% (N = 1,172)
Bronchiolitis Obliterans 34.4% (N = 921)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 7 Years Post-Transplant
(Follow-ups: April 1994 - June 2003)
Outcome Within 7
Years Total number with known response
Hypertension 92.0% (N = 424)
Renal Dysfunction 42.0% (N = 462)
Abnormal Creatinine < 2.5 mg/dl 22.7% Creatinine > 2.5 mg/dl 12.3% Chronic Dialysis 5.4% Renal Transplant 1.5%
Hyperlipidemia 52.9% (N = 476)
Diabetes 26.9% (N = 412)
Bronchiolitis Obliterans 42.9% (N = 294)
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
Freedom from Bronchiolitis Obliterans For Adult Lung Recipients (Follow-ups: April 1994-June 2003)
0
20
40
60
80
100
0 1 2 3 4 5Years
% F
reed
om
fro
m O
B
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
en
al
Dy
sfu
nc
tio
n
* Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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.
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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
ree
fro
m M
alig
nan
cy
All malignancy Lymph Skin Other
2004ISHLTJ Heart Lung Transplant 2004; 23: 804-15
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%)