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LUNG TRANSPLANTATION Overall 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 2 NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE 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. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 3 AVERAGE CENTER VOLUME Lung Transplants: January 1, 2000 - June 30, 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 4 DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Lung Transplants: January 1, 2000 - June 30, 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 5 LUNG TRANSPLANTS: Transplant Recipient Age by Year of Transplant Transplants: January 1, 1987 June 30, 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 6 AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 7 AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA Transplants with unknown recipient age were excluded from this tabulation. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 8 LUNG TRANSPLANTS: Donor Age by Year of Transplant Transplants: January 1, 1987 June 30, 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 9 DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS (1/1985-6/2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 10 DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS BY ERA Transplants with unknown donor age were excluded from this tabulation. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 11 LUNG TRANSPLANTATION Adult Recipients 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 12 AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS (1/1985-6/2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 13 AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 14 AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 15 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1994 - June 2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 16 ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2009) DIAGNOSISSLT (N = 10,925)BLT (N = 15,013)TOTAL (N = 25,938) COPD/Emphysema5,249 ( 48.0% )3,967 ( 26.4% )9,216 ( 35.5% ) Idiopathic Pulmonary Fibrosis3,371 ( 30.9% )2,369 ( 15.8% )5,740 ( 22.1% ) Cystic Fibrosis197 ( 1.8% )3,964 ( 26.4% )4,161 ( 16.0% ) Alpha-1678 ( 6.2% )1,104 ( 7.4% )1,782 ( 6.9% ) Idiopathic Pulmonary Arterial Hypertension75 ( 0.7% )768 ( 5.1% )843 ( 3.3% ) Sarcoidosis221 ( 2.0% )448 ( 3.0% )669 ( 2.6% ) Bronchiectasis46 ( 0.4% )662 ( 4.4% )708 ( 2.7% ) LAM96 ( 0.9% )178 ( 1.2% )274 ( 1.1% ) Congenital Heart Disease34 ( 0.3% )195 ( 1.3% )229 ( 0.9% ) Re-Transplant: Obliterative Bronchiolitis209 ( 1.9% )173 ( 1.2% )382 ( 1.5% ) Obliterative Bronchiolitis (Not Re-Transplant) 57 ( 0.5% )174 ( 1.2% )231 ( 0.9% ) Re-Transplant: Not Obliterative Bronchiolitis114 ( 1.0% )140 ( 0.9% )254 ( 1.0% ) Connective Tissue Disease73 ( 0.7% )144 ( 1.0% )217 ( 0.8% ) Cancer5 ( 0.0% )19 ( 0.1% )24 ( 0.1% ) Other500 ( 4.6% )708 ( 4.7% )1,208 ( 4.7% ) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 17 ADULT LUNG TRANSPLANTATION: Distribution of Procedure Type for Major Indications (1993-2008) Year of TX Alpha-1COPDCystic FibrosisIPFIPAH DoubleSingleDoubleSingleDoubleSingleDoubleSingleDoubleSingle 199338.761.316.084.094.95.116.583.553.846.2 199443.057.018.981.186.113.914.086.063.536.5 199545.954.121.478.690.19.928.072.089.310.7 199647.352.726.972.987.013.027.472.682.018.0 199746.453.626.373.792.57.521.878.290.010.0 199848.551.529.071.092.77.320.080.086.813.2 199947.053.028.171.790.89.222.976.786.213.8 200057.742.329.270.894.75.331.768.392.77.3 200160.139.928.571.594.06.030.769.390.010.0 200256.643.438.661.496.23.835.264.889.910.1 200365.434.642.657.495.24.841.958.195.54.5 200473.925.445.454.696.23.844.655.494.55.5 200578.022.049.850.197.72.346.453.690.69.4 200676.323.758.541.399.20.849.450.6100.00.0 200786.913.164.835.297.12.948.951.194.06.0 200880.619.465.834.297.82.252.048.094.75.3 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 18 ADULT LUNG TRANSPLANTATION Procedure Type within Indication, by Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 19 ADULT LUNG TRANSPLANTATION: Indications for Single Lung Transplants (Transplants: January 1995 - June 2009) *Other includes: Sarcoidosis: 2.0% Bronchiectasis: 0.4% Congenital Heart Disease: 0.3% LAM: 0.9% OB (non-ReTx): 0.5% Miscellaneous:5.3% 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 20 ADULT LUNG TRANSPLANTATION: Indications for Bilateral/Double Lung Transplants (Transplants: January 1995 - June 2009) *Other includes: Sarcoidosis: 3.0% Bronchiectasis: 4.4% Congenital Heart Disease: 1.3% LAM: 1.2% OB (non-ReTx): 1.2% Miscellaneous:5.8% 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 21 ADULT LUNG TRANSPLANTATION Major Indications By Year (%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 22 ADULT LUNG TRANSPLANTATION Major Indications By Year (Number) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 23 ADULT LUNG TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 24 ADULT LUNG TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 25 ADULT LUNG TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 26 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1988 June 2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 27 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: January 1990 June 2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 28 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: January 1990 June 2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 29 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 June 2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 30 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 3 Months (Transplants: January 1990 June 2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 31 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 June 2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 32 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival for Eisenmengers Syndrome (Transplants: January 1990 June 2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 33 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Procedure Type (Transplants: January 1990 June 2008) Diagnosis: Alpha-1 Antitrypsin Deficiency 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 34 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Procedure Type and Age (Transplants: January 1990 June 2008) Diagnosis: Alpha-1 Antitrypsin Deficiency 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 35 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 June 2008) Diagnosis: Emphysema/COPD 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 36 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Age (Transplants: January 1990 June 2008) Diagnosis: Emphysema/COPD 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 37 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 June 2008) Diagnosis: Idiopathic Pulmonary Fibrosis 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 38 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 June 2008) Diagnosis: Idiopathic Arterial Pulmonary Hypertension 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 39 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 June 2008) Diagnosis: Emphysema/COPD, Single Lung 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 40 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 June 2008) Diagnosis: Emphysema/COPD, Double Lung 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 41 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 June 2008) Diagnosis: Idiopathic Pulmonary Fibrosis, Single Lung 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 42 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 June 2008) Diagnosis: Idiopathic Pulmonary Fibrosis, Double Lung 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 43 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Donor CMV status/Recipient CMV status (Transplants: October 1999 June 2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 44 PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up Stratified by Donor/Recipient CMV status (Follow-ups: July 2004 - June 2009) D(-)/R(-): N = 866 D(-)/R(+): N = 1,106 D(+)/R(-): N = 1,218 D(+)/R(+): N = 1,987 No comparisons were statistically significant at 0.05 Analysis is limited to patients who were alive at the time of the follow-up Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti- rejection agent; or (2) have been hospitalized for rejection. No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 45 PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up Stratified by Donor/Recipient CMV status (Follow-ups: July 2004 - June 2009) 18-3435-4950-5960-6566+FemaleMale No comparisons were statistically significant at 0.05 except 50-59: D(+)/R(-) vs. D(+)/R(+) (p=0.0385) Analysis is limited to patients who were alive at the time of the follow-up Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti- rejection agent; or (2) have been hospitalized for rejection. No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 46 ADULT LUNG TRANSPLANTS (1996-6/2008) Risk Factors for 1 Year Mortality (N=13,079) *Other = All diagnoses other than COPD, IPAH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, retransplant and LAM. Reference group = COPD/Emphysema, Single lung 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 47 ADULT LUNG TRANSPLANTS (1996-6/2008) Risk Factors for 1 Year Mortality (N=13,079) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 48 ADULT LUNG TRANSPLANTS (1996-6/2008) Risk Factors for 1 Year Mortality (N=13,079) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 49 ADULT LUNG TRANSPLANTS (1996-6/2008) Borderline Significant Risk Factors for 1 Year Mortality (N=13,079) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 50 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 51 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Recipient Age 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 52 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Center Volume 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 53 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Recipient Pre-Transplant Bilirubin 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 54 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Recipient Oxygen Required at Rest 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 55 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Recipient Pre-Transplant Cardiac Output 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 56 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Height Difference 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 57 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Recipient FEV1 (% predicted) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 58 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Risk Factors for 1 Year Mortality Recipient FVC (% predicted) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 59 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality (N=4,918) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 60 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = COPD/Emphysema Borderline Significant Risk Factors for 1 Year Mortality (N=4,918) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 61 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 62 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Recipient Age 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 63 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Center Volume 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 64 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Recipient Oxygen Required at Rest 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 65 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Recipient Pre-Transplant Cardiac Output 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 66 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = IPF Risk Factors for 1 Year Mortality (N=3,124) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 67 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = IPF Risk Factors for 1 Year Mortality 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 68 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient Age 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 69 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = IPF Risk Factors for 1 Year Mortality Donor Weight 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 70 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient O 2 Required at Rest 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 71 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = IPF Risk Factors for 1 Year Mortality Center volume 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 72 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = IPF Risk Factors for 1 Year Mortality Ischemia Time 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 73 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient Bilirubin 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 74 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient FVC (% predicted) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 75 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient Pre-Transplant Cardiac Output 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 76 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient Creatinine at Transplant 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 77 ADULT LUNG TRANSPLANTS (1/1996-6/2008) Diagnosis = IPF Risk Factors for 1 Year Mortality Height Difference 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 78 ADULT LUNG TRANSPLANTS (1996-6/2004) Risk Factors for 5 Year Mortality (N=7,609) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 79 ADULT LUNG TRANSPLANTS (1996-6/2004) Risk Factors for 5 Year Mortality (N=7,609) Reference group = COPD/Emphysema, Single lung 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 80 ADULT LUNG TRANSPLANTS (1996-6/2004) Risk Factors for 5 Year Mortality (N=7,609) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 81 ADULT LUNG TRANSPLANTS (1996-6/2004) Borderline Significant Risk Factors for 5 Year Mortality (N=7,609) *Other = All diagnoses other than COPD, IPAH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, retransplant and LAM. Reference diagnosis group = COPD/Emphysema, Single lung 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 82 ADULT LUNG TRANSPLANTS (1/1996-6/2004) Risk Factors for 5 Year Mortality 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 83 ADULT LUNG TRANSPLANTS (1/1996-6/2004) Risk Factors for 5 Year Mortality Recipient Age 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 84 ADULT LUNG TRANSPLANTS (1/1996-6/2004) Risk Factors for 5 Year Mortality Donor Age 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 85 ADULT LUNG TRANSPLANTS (1/1996-6/2004) Risk Factors for 5 Year Mortality Center Volume 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 86 ADULT LUNG TRANSPLANTS (1/1996-6/2004) Risk Factors for 5 Year Mortality Recipient Pre-Transplant Bilirubin 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 87 ADULT LUNG TRANSPLANTS (1/1996-6/2004) Risk Factors for 5 Year Mortality Recipient Oxygen Required at Rest 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 88 ADULT LUNG TRANSPLANTS (1/1996-6/2004) Risk Factors for 5 Year Mortality Recipient FEV1 (% predicted) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 89 ADULT LUNG TRANSPLANTS (1/1996-6/2004) Risk Factors for 5 Year Mortality Recipient Pre-Transplant Cardiac Output 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 90 ADULT LUNG TRANSPLANTS (1/1996-6/2004) Risk Factors for 5 Year Mortality Recipient Height 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 91 ADULT LUNG TRANSPLANTS (1996-6/2004) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=5,769) Reference group = COPD/Emphysema, Single lung 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 92 ADULT LUNG TRANSPLANTS (1996-6/2004) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=5,769) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 93 ADULT LUNG TRANSPLANTS (1996-6/2004) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=5,769) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 94 ADULT LUNG TRANSPLANTS (1996-6/2004) Borderline Significant Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=5,769) *Other = All diagnoses other than COPD, IPAH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, retransplant and LAM. Reference group = COPD/Emphysema, Single lung 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 95 ADULT LUNG TRANSPLANTS (1/1996-6/2004) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 96 ADULT LUNG TRANSPLANTS (1/1996-6/2004) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Recipient Age 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 97 ADULT LUNG TRANSPLANTS (1/1996-6/2004) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Center Volume 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 98 ADULT LUNG TRANSPLANTS (1/1996-6/2004) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Height Difference 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 99 ADULT LUNG TRANSPLANTS (1/1996-6/2004) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Donor Age 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 100 ADULT LUNG TRANSPLANTS (1/1996-6/2004) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Recipient Height 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 101 ADULT LUNG TRANSPLANTS (1/1996-6/2004) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Recipient Pre-Transplant Cardiac Output 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 102 ADULT LUNG TRANSPLANTS (1/1996-6/2004) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Recipient FEV1 (% predicted) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 103 ADULT LUNG RECIPIENTS Cross-Sectional Analysis Functional Status of Surviving Recipients (Follow-ups: April 1994 June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 104 ADULT LUNG RECIPIENTS Longitudinal Analysis Functional Status of Surviving Recipients (Follow-ups: April 1994 June 2009) For the Same Patients 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 105 ADULT LUNG RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: March 2005 - June 2009) US Recipients Only 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 106 ADULT LUNG RECIPIENTS Employment Status of Surviving Recipients (Follow-ups: April 1994 June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 107 ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 108 ADULT LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2002 - June 2009) Analysis limited to patients receiving prednisone Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 109 ADULT LUNG RECIPIENTS Induction Immunosuppression (Transplants: 1997, 2002 and 1/2009-6/2009) Analysis limited to patients receiving prednisone Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 110 ADULT LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2000 - December 2008) Analysis limited to patients receiving prednisone Any Induction Polyclonal ALG/ATG IL2R-antagonist Campath Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 111 SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: April 1994-June 2008) Conditional on survival to 14 days 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 112 SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: January 2000-June 2008) Conditional on survival to 14 days 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 113 ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2002 through June 2009 Analysis limited to patients receiving prednisone NOTE: Different patients are analyzed in Year 1 and Year 5 Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 114 ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2002 through June 2009 Analysis limited to patients receiving prednisone NOTE: Different patients are analyzed in Year 1 and Year 5 Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 115 ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of 1 Year Follow-up (Follow-ups: 2000, 2003, 7/2008 6/2009) Analysis limited to patients receiving prednisone NOTE: Different patients are analyzed in each time frame. Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 116 ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2002 through June 2009 Analysis limited to patients receiving prednisone 1 Year Follow-up (N =7,234)5 Year Follow-up (N = 3,021) NOTE: Different patients are analyzed in Year 1 and Year 5 Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 117 ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2002 through June 2009 Analysis limited to patients receiving prednisone Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 118 ADULT LUNG RECIPIENTS Kaplan-Meier Survival by Maintenance Immunosuppression Combinations Conditional on Survival to 1 Year (Transplants: January 2000-June 2008) Analysis limited to patients receiving prednisone 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 119 ADULT LUNG RECIPIENTS Kaplan-Meier Survival by Maintenance Immunosuppression Combinations Conditional on Survival to 1 Year (Transplants: January 2000-June 2008) Analysis limited to patients receiving prednisone Diagnosis: COPD/Emphysema 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 120 ADULT LUNG RECIPIENTS Kaplan-Meier Survival by Maintenance Immunosuppression Combinations Conditional on Survival to 1 Year (Transplants: January 2000-June 2008) Analysis limited to patients receiving prednisone Diagnosis: Idiopathic Pulmonary Fibrosis 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 121 ADULT LUNG RECIPIENTS Kaplan-Meier Survival by Maintenance Immunosuppression Combinations Conditional on Survival to 1 Year (Transplants: January 2000-June 2008) Analysis limited to patients receiving prednisone Diagnosis: Cystic Fibrosis 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 122 PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up (Follow-ups: July 1, 2004 - June 30, 2009) Analysis is limited to patients who were alive at the time of the follow-up Overall: N = 5,672 18-34: N = 787 35-49: N = 1,005 50-59: N = 1,937 60-65: N = 1,514 66+: N = 429 Female: N = 2,540 Male: N = 3,132 Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection. No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 123 PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up Stratified by Type of Induction (Follow-ups: July 1, 2004 - June 30, 2009) No induction: N = 2,624 Polyclonal: N = 502 IL2R- antagonist: N = 2,142 Campath: N = 358 Analysis is limited to patients who were alive at the time of the follow-up Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti- rejection agent; or (2) have been hospitalized for rejection. No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents. 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 124 PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up Stratified by Type of Induction (Follow-ups: July 1, 2004 - June 30, 2009) 18-34: no induct vs. IL2 (p=0.0164); poly vs. IL2R (p=0.007); IL2R vs. Campath (p=0.0084) 35-49: no induct vs. Campath (p=0.0310); IL2R vs. Campath (p=0.0112; 50-59: no induct vs. IL2R (p=0.0005); 60-65: no induct vs. IL2R (p=0.0018); no induct vs. Campath (p=0.0100) 66+: no induct vs. poly (p=0.0014); poly vs. IL2 (p ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January 1992- June 2009) CAUSE OF DEATH 0-30 Days (N = 1,966) 31 Days 1 Year (N = 3,387) >1 Year 3 Years (N = 3,073) >3 Years 5 Years (N = 1,737 ) >5 Years 10 Years (N = 2,014) >10 Years (N = 483) BRONCHIOLITIS6 (0.3%)159 (4.7%)781 (25.4%)508 (29.2%)507 (25.2%)95 (19.7%) ACUTE REJECTION74 (3.8%)61 (1.8%)48 (1.6%)10 (0.6%)15 (0.7%)1 (0.2%) LYMPHOMA1 (0.1%)86 (2.5%)63 (2.1%)28 (1.6%)46 (2.3%)23 (4.8%) MALIGNANCY, OTHER4 (0.2%)100 (3.0%)202 (6.6%)151 (8.7%)219 (10.9%)47 (9.7%) CMV096 (2.8%)29 (0.9%)5 (0.3%)4 (0.2%)0 INFECTION, NON-CMV396 (20.1%)1,205 (35.6%)710 (23.1%)329 (18.9%)363 (18.0%)81 (16.8%) GRAFT FAILURE557 (28.3%)589 (17.4%)591 (19.2%)327 (18.8%)379 (18.8%)87 (18.0%) CARDIOVASCULAR213 (10.8%)144 (4.3%)118 (3.8%)82 (4.7%)99 (4.9%)36 (7.5%) TECHNICAL162 (8.2%)76 (2.2%)18 (0.6%)8 (0.5%)12 (0.6%)6 (1.2%) OTHER553 (28.1%)871 (25.7%)513 (16.7%)289 (16.6%)370 (18.4%)107 (22.2%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 141 ADULT LUNG TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death (Deaths: January 1992 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Slide 142 ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death Stratified by Donor CMV Status/Recipient CMV Status (Deaths: January 1992- June 2009) Donor CMV Status/ Recipient CMV Status Cause of Death0-30 Days 31 Days 1 Year >1 Year 3 Years >3 Years 5 Years >5 Years 10 Years >10 Years D(-)/R(-) (N=1,421) BRONCHIOLITIS1 (0.5%)22 (6.3%)88 (24.6%)68 (32.4%)61 (24.0%)14 (21.5%) INFECTION, NON-CMV31 (16.9%)123 (35.0%)86 (24.0%)39 (18.6%)35 (13.8%)12 (18.5%) GRAFT FAILURE56 (30.6%)70 (19.9%)73 (20.4%)44 (21.0%)50 (19.7%)10 (15.4%) D(-)/R(+) (N=2,106) BRONCHIOLITIS3 (1.1%)26 (5.5%)126 (25.2%)89 (25.7%)111 (26.7%)20 (19.2%) INFECTION, NON-CMV56 (20.8%)188 (39.8%)122 (24.4%)81 (23.4%)67 (16.1%)20 (19.2%) GRAFT FAILURE81 (30.1%)78 (16.5%)94 (18.8%)58 (16.8%)86 (20.7%)20 (19.2%) D(+)/R(-) (N=1,741) BRONCHIOLITIS014 (2.6%)108 (24.0%)60 (25.6%)60 (24.8%)3 (5.8%) INFECTION, NON-CMV42 (18.3%)200 (37.5%)103 (22.9%)41 (17.5%)47 (19.4%)13 (25.0%) GRAFT FAILURE66 (28.8%)109 (20.4%)101 (22.4%)54 (23.1%)56 (23.1%)9 (17.3%) D(+)/R(+) (N=3,130) BRONCHIOLITIS1 (0.2%)40 (5.2%)196 (24.1%)129 (26.9%)118 (21.9%)22 (18.0%) INFECTION, NON-CMV81 (19.8%)280 (36.4%)188 (23.2%)92 (19.2%)94 (17.4%)16 (13.1%) GRAFT FAILURE128 (31.3%)164 (21.3%)153 (18.8%)98 (20.5%)112 (20.8%)28 (23.0%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141