LUNG TRANSPLANTATION Overall ISHLT 2005 J Heart Lung Transplant 2005;24: 945-982.

LUNG TRANSPLANTATION

Overall

ISHLT 2005J Heart Lung Transplant 2005;24: 945-982

NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE

0

200

400

600

800

1000

1200

1400

1600

1800

Nu

mb

er o

f T

ran

spla

nts

.

Bilateral/Double LungSingle Lung

13 15 46 83189

418

708

922

1089

1229

136813771464

14571477

156416021767

1703

ISHLT 2005

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.

J Heart Lung Transplant 2005;24: 945-982

AVERAGE CENTER VOLUMELung Transplants: January 1, 1998 - June 30, 2004

57

2631

179

3 30

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

cen

ters

.


DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME

Lung Transplants: January 1, 1998 - June 30, 2004

5.17.6

26.8 24.5

18.1

7.7 10

0

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

Perc

en

tag

e o

f tr

an

sp

lan

ts .


LUNG TRANSPLANTS: Donor Age by Year of Transplant

0%

20%

40%

60%

80%

100%

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

Mean

do

no

r ag

e (years

)

Mean Age


AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2004)

0

10

20

30

40

<10 10-19 20-29 30-39 40-49 50-59 60-64 65+

Recipient Age

% o

f tr

an

sp

lan

ts

.


AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA

0

5

10

15

20

25

30

35

<10 10-19 20-29 30-39 40-49 50-59 60-64 65+

% o

f tr

an

sp

lan

ts

.

1985-1996 (N = 7,390)

1997-6/2004 (N = 11,807)

p < 0.0001


LUNG TRANSPLANTATION

Adult Recipients


AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS (1/1985-6/2004)

0

5

10

15

20

18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

Recipient Age

% o

f tr

ansp

lan

ts

.


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 60-64 65+

% o

f tr

ansp

lan

ts .

1985-1996 (N = 7,390)

1997-6/2004 (N = 11,807)

p < 0.0001


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1994 - June 2003)

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=6,040)

Single Lung (N=7,422)

All Lungs (N=13,462)

Double lung: 1/2-life = 5.6 Years; Conditional 1/2-life = 8.5 YearsSingle lung: 1/2-life = 4.3 Years; Conditional 1/2-life = 6.3 YearsAll lungs: 1/2-life = 4.8 Years; Conditional 1/2-life = 7.0 Years

P < 0.0001


ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2004)

DIAGNOSIS SLT (N = 6,731) BLT (N = 6,276) TOTAL (N = 13,007)

COPD/Emphysema 3,541 (53%) 1,462 (23%) 5,003 (38%)

Idiopathic Pulmonary Fibrosis 1,618 (24%) 639 (10.0%) 2,257 (17%)

Cystic Fibrosis 151 (2.2%) 2,002 (32%) 2,153 (17%)

Alpha-1 554 (8.2%) 571 (9.1%) 1,125 (8.6%)

Primary Pulmonary Hypertension 79 (1.2%) 436 (6.9%) 515 (4%)

Sarcoidosis 157 (2.3%) 166 (2.6%) 323 (2.5%)

Bronchiectasis 45 (0.7%) 309 (4.9%) 354 (2.7%)

LAM 55 (0.8%) 83 (1.3%) 138 (1.1%)

Congenital Heart Disease 13 (0.2%) 118 (1.9%) 131 (1.0%)

Re-Transplant: Obliterative Bronchiolitis

74 (1.1%) 58 (0.9%) 132 (1.0%)

Obliterative Bronchiolitis

(Not Re-Transplant)

39 (0.6%) 80 (1.3%) 119 (0.9%)

Re-Transplant: Not Obliterative Bronchiolitis

55 (0.8%) 46 (0.7%) 101 (0.8%)

Connective Tissue Disease 34 (0.5%) 31 (0.5%) 65 (0.5%)

Histiocytosis X 20 (0.3%) 19 (0.3%) 39 (0.3%)

Cancer 7 (0.1%) 14 (0.2%) 21 (0.2%)

Other 289 (4.3%) 242 (3.8%) 509 (4.1%)


ADULT LUNG TRANSPLANTATION: Distribution of Procedure Type for Major Indications (1990-2003)

ISHLT 2005

Year of TX

Alpha-1 COPD Cystic Fibrosis IPF PPH

Double/bilateral

Single Double/bilateral




Single

1990 27.8 72.2 21.9 78.1 94.7 5.3 1.8 98.2 15.4 84.6

1991 17.3 82.7 14.2 85.8 95.8 4.2 14.1 85.9 23.4 76.6

1992 23.3 76.7 16.5 83.5 97.0 3.0 9.2 90.8 26.9 73.1

1993 32.7 67.3 16.3 83.7 94.8 5.2 16.7 83.3 52.3 47.7

1994 32.7 67.3 17.0 83.0 85.5 14.5 14.2 85.8 60.5 39.5

1995 40.2 59.8 18.9 81.1 89.3 10.7 26.5 73.5 87.7 12.3

1996 43.8 56.2 25.2 74.8 86.4 13.6 26.3 73.7 81.0 19.0

1997 43.7 56.3 25.5 74.5 92.7 7.3 21.6 78.4 83.3 16.7

1998 45.3 54.7 27.7 72.3 92.5 7.5 18.8 81.3 78.8 21.2

1999 45.0 55.0 27.9 72.1 90.7 9.3 22.3 77.7 83.7 16.3

2000 56.7 43.3 27.8 72.2 95.2 4.8 29.0 71.0 91.3 8.7

2001 57.6 42.4 26.6 73.4 93.7 6.3 25.3 74.7 84.0 16.0

2002 53.5 46.5 36.0 64.0 96.0 4.0 34.7 65.3 81.4 18.6

2003 60.0 40.0 37.9 62.1 95.8 4.2 37.9 62.1 87.8 12.2


ADULT LUNG TRANSPLANTATIONProcedure Type within Indication, by Year

0

10

20

30

40

50

60

70

80

90

100

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

% o

f tr

an

sp

lan

ts

Bilateral/Double Lung Transplant Single Lung Transplant

AT Def COPD IPF PPH


2005

ADULT LUNG TRANSPLANTATION: Indications for Single Lung Transplants (Transplants: January 1995 - June 2004)

53%

24%

2%1%

2%

8%

10%

Alpha-1 COPD CF IPF PPH Re-TX Other*

ISHLT 2005

*Other includes:

Sarcoidosis: 2%

Bronchiectasis: 0.7%

Congenital Heart Disease: 0.2%

LAM: 0.8%

OB (non-ReTx): 0.6%

Miscellaneous: 5%


ADULT LUNG TRANSPLANTATION: Indications for Bilateral/Double Lung Transplants (Transplants: January 1995 - June 2004)

23%

10% 3%7%

11%

32%

9%

5%

Alpha-1 COPD CF IPFPPH Sarcoidosis Bronchiectasis Other*

ISHLT 2005

*Other includes:

Re-Tx: 2%

Congenital Heart Disease: 2%

LAM: 1.3%

OB (non-ReTx): 1.3%

Miscellaneous: 5%


ADULT LUNG TRANSPLANTATIONIndications By Year (%)

0

20

40

60

80

100

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Transplant Year

% o

f T

ran

spla

nts

Cystic Fibrosis IPF Emphysema A1A PPH


ADULT LUNG TRANSPLANTATIONIndications By Year (Number)

0

250

500

750

1000

1250

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Transplant Year

Nu

mb

er o

f T

ran

spla

nts

Cystic Fibrosis IPF Emphysema A1A PPH


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Era (Transplants: January 1988 – June 2003)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

.

1988-1994 (N=4,392)1995-1999 (N=6,726)2000-6/2003 (N=5,553)

1988-1994: 1/2-life = 3.9 Years; Conditional 1/2-life = 7.0 Years1995-1999: 1/2-life = 4.5 Years; Conditional 1/2-life = 7.0 Years

Survival comparisons by era1988-94 vs. 1995-99: p = 0.011988-94: vs. 2000-6/03: p <0.0001 1995-99 vs. 2000-6/03: p <0.0001


ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: January 1990 – June 2003)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (%

) .

18-34 (N= 2,899)35-49 (N= 4,922)50-59 (N= 5,898)60-64 (N= 2,041)65+ (N= 476)

Survival comparisons18-34 vs. 50-59: p = 0.000418-34 vs. 60-64 and vs. 65+ : p < 0.000135-49 vs. 50-59, 60-64 and 65+: p < 0.000150-59 vs. 60-64: p < 0.000150-59 vs. 65+: p = 0.0001

HALF-LIFE 18-34: 5.0 Years; 35-49: 5.3 Years; 50-59: 4.5 Years; 60-64: 3.6 Years; 65+: 3.4 Years


ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: January 1994 – June 2003)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (%

) .

Male (N= 6,849)

Female (N= 6,440)

HALF-LIFE Male: 4.6 years; Female 5.0 Years

p = 0.0351


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1994 – June 2003)

YearALPHA-1 (N=1,127)

CF

(N=1,934)COPD

(N=4,888)IPF

(N=2,058)PPH

(N=553)SARCOIDOSIS

(N=314)

1 75.7 80.6 81.3 69.4 65.4 67.6

3 60.2 65.2 63.4 53.7 55.5 54.1

5 50.5 53.8 48.4 42.1 46.1 47.3

7 42.2 44.7 35.3 32.8 37.1 42.2

10 31.3 32.1 19.0 15.4 25.5 32.8

Survival comparisonsCOPD vs. IPF: p < 0.0001 Alpha-1 vs. CF: p = 0.0248Alpha-1 vs. IPF: p < 0.0001 Alpha-1 vs. PPH: p = 0.0021CF vs. COPD: p = 0.0006 CF vs. IPF: p < 0.0001CF vs. PPH: p < 0.0001 CF vs. Sarcoidosis: p = 0.0007

Note: Other comparisons are not statistically different.


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on

Survival to 3 Months (Transplants: January 1994 – June 2003)

YearALPHA-1 (N=905)

CF

(N= 1,516)COPD

(N= 4,089)IPF

(N= 1,575)PPH

(N= 374)SARCOIDOSIS

(N=225)

1 87.8 91.2 89.9 85.2 89.5 84.0

3 69.7 73.8 70.1 65.9 75.9 67.3

5 58.5 60.9 53.6 51.8 63.1 58.8

7 48.9 50.7 39.1 40.3 50.7 52.4

10 36.3 36.3 21.0 18.9 34.9 40.8

Survival comparisonsAlpha-1 vs. IPF: p = 0.0015 Alpha-1 vs. COPD: p = 0.0073CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001PPH vs. COPD: p = 0.0005 PPH vs. IPF: p = 0.0002



ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1994 – June 2003)

YearALPHA-1 (N=769)

CF

(N=1,300)COPD

(N= 3,468)IPF

(N=1,273)PPH

(N= 322)SARCOIDOSIS

(N=180)

1 100.0 100.0 100.0 100.0 100.0 100.0

3 79.3 80.7 77.9 77.4 84.8 80.1

5 66.6 66.6 59.6 60.7 70.5 70.0

7 55.7 55.4 43.4 47.3 56.7 62.4

10 41.3 39.7 23.3 22.2 39.0 48.6

Survival comparisonsAlpha-1 vs. IPF: p = 0.0103 Alpha-1 vs. COPD: p < 0.0001CF vs. COPD: p < 0.0001 CF vs. IPF: p = 0.0012PPH vs. COPD: p < 0.0001 PPH vs. IPF: p = 0.0017COPD vs. Sarcoidosis: p = 0.0102 IPF vs. Sarcoidosis: p = 0.0408



ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1994 – June 2003)

0

25

50

75

100

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

Su

rviv

al (

%)

ALPHA-1 (N=1,127) CF (N= 1,934)COPD (N= 4,888) IPF (N= 2,058)PPH (N= 533) SARCOIDOSIS (N = 314)

HALF-LIFE Alpha-1: 5.1 Years; CF: 5.8 Years; COPD: 4.8 Years; IPF: 3.7 Years; PPH: 4.3 Years; Sarcoidosis: 4.0 Years

Survival comparisonsCOPD vs. IPF: p < 0.0001Alpha-1 vs. CF: p = 0.0248Alpha-1 vs. IPF: p < 0.0001Alpha-1 vs. PPH: p = 0.0021CF vs. COPD: p = 0.0006CF vs. IPF: p < 0.0001CF vs. PPH: p < 0.0001CF vs. Sarcoidosis: p = 0.0007


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on

Survival to 3 Months (Transplants: January 1994 – June 2003)

0

25

50

75

100

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

Su

rviv

al (

%)

ALPHA-1 (N=905) CF (N= 1,516)COPD (N= 4,089) IPF (N= 1,575)PPH (N= 374) SARCOIDOSIS (N = 225)


Survival comparisonsAlpha-1 vs. IPF: p = 0.0015Alpha-1 vs. COPD: p = 0.0073CF vs. COPD: p < 0.0001CF vs. IPF: p < 0.0001PPH vs. COPD: p = 0.0005PPH vs. IPF: p = 0.0002


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

(Transplants: January 1994 – June 2003)

0

25

50

75

100

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

Su

rviv

al (

%)

ALPHA-1 (N=769) CF (N= 1,300)COPD (N=3,468) IPF (N= 1,273)PPH (N= 3229) SARCOIDOSIS (N = 180)


Survival comparisonsAlpha-1 vs. IPF: p = 0.0103Alpha-1 vs. COPD: p < 0.0001CF vs. COPD: p < 0.0001CF vs. IPF: p = 0.0012PPH vs. COPD: p < 0.0001PPH vs. IPF: p = 0.0017COPD vs. Sarcoidosis: p = 0.0102IPF vs. Sarcoidosis: p = 0.0408


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival for Eisenmenger’s Syndrome


0

25

50

75

100

0 1 2 3 4 5Years

Su

rviv

al (

%)

ASD (N= 118) VSD (N= 58)

HALF-LIFE ASD: 2.8 Years; VSD: 1.0 Years

p = 0.19

ISHLT 2005

N at risk at 5 years = 33

N at risk at 5 years = 15


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Procedure Type (Transplants: January 1990 – June 2003)

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 = 865)

Double Lung (N=626)P = 0.0007

ISHLT 2005N at risk at 10 years is 44 for Single Lung and 23 for Double Lung.


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Procedure Type and Median Age

(Transplants: January 1990 – June 2003) Diagnosis: Alpha-1 Antitrypsin Deficiency

0

25

50

75

100

0 1 2 3 4 5

Years

Su

rviv

al (

%)

.

Single Lung, <50 (N = 435)Double Lung, <50 (N =381)

Single Lung, 50+ (N = 430)Double Lung, 50+ (N = 245)

ISHLT 2005

N at risk at 5 years: Single Lung, <50 = 140; Double Lung, <50 = 126; Single Lung, 50+ = 97; Double Lung, 50+ = 45

p = 0.22


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2003)

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 = 4,246)

Double Lung (N=1,431)N=82

N=28

P < 0.0001


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Age


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, < 50 (N = 691)Double lung, < 50 (N = 463)Single lung, 50+ (N = 3,555)Double lung, 50+ (N = 968)

N=25N=57

N=12N=16

P < 0.0001



Diagnosis: Idiopathic Pulmonary Fibrosis

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

.

Single Lung (N =1,849)

Double Lung (N=580)

N=36

N=21

P = 0.5



Diagnosis: Primary Pulmonary Hypertension

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

.

Single Lung (N =278)

Double Lung (N=518)N=27

N=16

P = 0.3


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era


Diagnosis: Emphysema/COPD, Single Lung

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

.

1990-1995 (N= 1,354)

1996-1999 (N= 1,408)

2000-6/2003 (N= 1,488)

Survival comparisons1990-1995 vs. 1996-1999: p = 0.091990-1995 vs. 2000-6/2003: p = 0.00511996-1999 vs. 2000-6/2003: p = 0.1021




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 (

%)

.

1990-1995 (N = 278)

1996-1999 (N = 514)

2000-6/2003 (N = 641)

Survival comparisons1990-1995 vs. 1996-1999: p = 0.43561990-1995 vs. 2000-6/2003: p = 0.38041996-1999 vs. 2000-6/2003: p = 0.2677


ADULT LUNG TRANSPLANTATIONActual Survival by Procedure Type and Era

(Transplants: January 1990 – December 1999)

Diagnosis: Emphysema/COPD, Double/Bilateral Lung

0

25

50

75

100

0 1 2 3 4 5

Years

Su

rviv

al (

%)

.

1990-1995 (N = 278)

1996-1999 (N = 514)




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 (

%)

.

1990-1995 (N =577)

1996-1999 (N = 681)

2000-6/2003 (N = 591)

Survival comparisons1990-1995 vs. 1996-1996: p = 0.77 1990-1995 vs. 2000-6/2003: p = 0.181996-1999 vs. 2000-6/2003: p = 0.0292




Diagnosis: Idiopathic Pulmonary Fibrosis, Double/Bilateral Lung

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

.

1990-1995 (N = 110)

1996-1999 (N = 198)

2000-6/2003 (N = 272)

Survival comparisons1990-1995 vs. 1996-1996: p = 0.14261990-1995 vs. 2000-6/2003: p < 0.00011996-1999 vs. 2000-6/2003: p < 0.0001


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

(Transplants: October 1999 – June 2003)

50

60

70

80

90

100

0 1 2 3

Years

Su

rviv

al (

%)

.

D(-)/R(-) (N=618)D(-)/R(+) (N=854)D(+)/R(-) (N=688)D(+)/R(+) (N=1,170)

Survival comparisonsD(-)/R(-) vs. D(-)/R(+): p = 0.07D(-)/R(-) vs. D(+)/R(-): p = 0.49D(-)/R(-) vs. D(+)/R(+): p = 0.23D(-)/R(+) vs. D(+)/R(-): p = 0.008D(-)/R(+) vs. D(+)/R(+): p = 0.0005D(+)/R(-) vs. D(+)/R(+): p = 0.67


ADULT LUNG TRANSPLANTS (1995-6/2003) Risk Factors for 1 Year Mortality

DIAGNOSIS PROCEDURE TYPE N

Relative Risk P-value

95% Confidence

Interval

Primary Pulmonary Hypertension Single 64 3.16 <0.0001 2.17 -4.62

Pulmonary Fibrosis (not IPF) Double/bilateral 69 2.75 <0.0001 1.85 -4.08

Sarcoidosis Any 274 2.11 <0.0001 1.69 -2.64

Idiopathic Pulmonary Fibrosis Double/bilateral 509 2.05 <0.0001 1.73 -2.44

Primary Pulmonary Hypertension Double/bilateral 390 2.01 <0.0001 1.62 -2.50

Pulmonary Fibrosis (not IPF) Single 107 1.77 .0016 1.24 -2.53

Alpha-1 Single 495 1.68 <0.0001 1.40 -2.03

Bronchiectasis Any 278 1.56 .0006 1.21 -2.02

Idiopathic Pulmonary Fibrosis Single 1343 1.51 <0.0001 1.33 -1.72

Alpha-1 Double 492 1.44 .0007 1.17 -1.77

Other* Any 1189 1.42 <0.0001 1.23 -1.65

Cystic Fibrosis Any 1651 1.34 .0023 1.11 -1.62

COPD Any 4314 1 (ref.) - -

(N=11,291)ISHLT 2005

*Other = All diagnoses other than COPD, PPH, IPF, CF, bronchiectasis, Alpha-1 antitrypsin deficiency, and LAM.



DONOR AND RECIPIENT CHARACTERISTICS

N Relative

Risk P-value

95% Confidence

Interval

Donor history of diabetes 205 1.53 .0009 1.19 -1.97

Ventilator 176 1.85 <0.0001 1.41 -2.44

IV Inotropes 76 1.77 .0010 1.26 -2.48

Donor clinical infection 1345 0.87 .0228 0.76 -0.98

Prior thoracotomy 353 0.72 .0060 0.57 -0.91

(N=11,291)



TRANSPLANT CHARACTERISTICS N


95% Confidence

Interval

Repeat transplant 305 1.96 <0.0001 1.59 -2.41

Donor CMV +/ Recipient CMV - 2046 1.12 .0235 1.02 -1.23

HLA mismatch (per mismatch) 1274 (<4 MM) 1.05 .0261 1.01 -1.10

Transplant Year = 2001 vs. 1999 1399 0.82 .0171 0.70 -0.97

Female donor/female recipient 3348 0.80 <0.0001 0.73 -0.89

Transplant Year = 2002/2003 vs. 1999 2260 0.70 <0.0001 0.60 -0.81

(N=11,291)


ADULT LUNG TRANSPLANTS (1995-6/2003) Borderline Significant Risk Factors for 1 Year Mortality

VARIABLE N


95% Confidence

Interval

Recipient history of malignancy 219 1.27 .0669 0.98 -1.63

Hospitalized prior to transplant 698 1.17 .0753 0.98 -1.38

Transplant Year = 1996 vs. 1999 1200 1.16 .0654 0.99 -1.35

Not ABO identical vs. identical 1110 1.11 .0949 0.98 -1.25

(N=11,291)


ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality

Continuous Factors (see figures)

Recipient age

Donor age

Recipient BMI

Donor weight

Transplant center volume

Bilirubin

Recipient FEV1 % predicted

Recipient pulmonary vascular resistance



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p < 0.0001



Donor Age

0

0.5

1

1.5

2

15 20 25 30 35 40 45 50 55 60

Donor Age

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p < 0.0001



Donor Weight

0

0.5

1

1.5

2

40 50 60 70 80 90 100

Weight (kg)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p < 0.0001



Pre-Transplant Recipient BMI

0

0.5

1

1.5

2

15 20 25 30 35

Recipient BMI (kg/m2)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p < 0.0001



Center volume

0

0.5

1

1.5

2

0 10 20 30 40 50

Center Volume (cases per year)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.0002



FEV1 (% predicted) in Recipients with Idiopathic Pulmonary Fibrosis

0

0.5

1

1.5

2

25 30 35 40 45 50 55 60 65 70Recipient FEV1 (% predicted)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.01



Pre-Transplant Bilirubin

0

0.5

1

1.5

0 1 2 3 4 5 6 7 8

Recipient Bilirubin (mg/dl)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.013



Recipient Pulmonary Vascular Resistance

0

0.5

1

1.5

2

0 3 6 9 12 15 18

PVR (wood units)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.0074


ADULT LUNG TRANSPLANTS (1995-6/2003) Factors Not Significant for 1 Year Mortality

Recipient factors:pCO2, PA pressures, transfusions, recent infection requiring IV drug therapy, diabetes, sternotomy, dialysis, FVC, creatinine, PRA, cardiac output, chronic steroid use, weight, height

Donor factors:History of hypertension, history of cancer, cause of death, height, BMI

Transplant factors:Height ratio, BMI ratio, ischemia time


ADULT LUNG TRANSPLANTS (1/1995-6/2003) 1-Year Predicted Survival – Hypothetical Case #1

50%

60%

70%

80%

90%

100%

0 30 60 90 120 150 180 210 240 270 300 330 360

Time (days)

Pre

dic

ted

Su

rviv

al

.

Recipient: male with alpha-1 antitrypsin deficiency, 45 years old, double lung procedure;

Donor: male, 30 years old

ISHLT 2005

Other characteristics: ABO identical, primary transplant, no IV inotropes, no prior thoracotomy, 3 HLA mismatches, not hospitalized, no history of malignancy, no donor clinical infection, no CMV MM, no donor history of diabetes



50%

60%

70%

80%

90%

100%

0 30 60 90 120 150 180 210 240 270 300 330 360

Time (days)

Pre

dic

ted

Su

rviv

al

.

No Ventilator Ventilator

Recipient: male with COPD, 50 years old, double lung procedure;


ISHLT 2005




50%

60%

70%

80%

90%

100%

0 30 60 90 120 150 180 210 240 270 300 330 360

Time (days)

Pre

dic

ted

Su

rviv

al . Recipient: male with IPF, 55 years old, single

lung procedure; FEV1 = 50% predicted


ISHLT 2005Other characteristics: ABO identical, primary transplant, no IV inotropes, no prior thoracotomy, 3 HLA mismatches, not hospitalized, no history of malignancy, no donor clinical infection, no CMV MM, no donor history of diabetes



50%

60%

70%

80%

90%

100%

0 30 60 90 120 150 180 210 240 270 300 330 360

Time (days)

Pre

dic

ted

Su

rviv

al

.

Recipient: male with PPH, 45 years old, double lung procedure;


ISHLT 2005






95% Confidence

Interval Primary Pulmonary Hypertension

Single 391 2.01 .0023 1.28 -3.15

Pulmonary fibrosis (not IPF) Any 81 1.51 .0055 1.13 -2.02

Idiopathic Pulmonary Fibrosis Double/ bilateral

215 1.47 .0001 1.22 -1.78

Sarcoidosis Any 132 1.45 .0022 1.14 -1.85

Alpha-1 antitrypsin deficiency Single 298 1.45 <0.0001 1.23 -1.71

Idiopathic Pulmonary Fibrosis

Single 697 1.17 .0132 1.03 -1.32

LAM Any 52 0.50 .0189 0.28 -0.89

COPD Any 2039 1 (Ref.) - -

(N=5,637)



DONOR AND RECIPIENT CHARACTERISTICS N


95% Confidence

Interval

Donor Cause of Death = Anoxia 167 0.69 .0030 0.54 -0.88

IV inotropes 46 1.75 .0021 1.23 -2.51

Ventilator 92 1.44 .0091 1.09 -1.89

Prior sternotomy 120 1.34 .0125 1.07 -1.69

Recipient history of diabetes 210 1.27 .0130 1.05 -1.52

O2 required at rest (per liter/min) 197 >4 L/min 1.03 .0308 1.00 -1.06

(N=5,637)



TRANSPLANT FACTORS N Relative

Risk P-value

95% Confidence

Interval

Repeat transplant 156 1.69 <0.0001 1.35 -2.12

Not ABO identical vs. identical 633 1.19 .0027 1.06 -1.33

Transplant year = 1996 vs. 1998/1999

1200 1.11 .0415 1.00 -1.23

HLA mismatch (per mismatch) 634 <4 MM 1.05 .0198 1.01 -1.09

Female donor/female recipient 1574 0.89 .0130 0.80 -0.97

(N=5,637)



VARIABLE N Relative

Risk P-value

95% Confidence

Interval

Transplant year – 1995 vs. 1998/1999 1221 1.11 .0516 1.00 -1.22

Donor CMV +/Recipient CMV - 976 1.09 .0816 0.99 -1.20

Prior thoracotomy 182 0.82 .0657 0.66 -1.01

(N=5,637)



Continuous Factors (see figures)

Recipient age

Donor age

Recipient BMI

Donor weight

Bilirubin

Serum creatinine

PA systolic pressure



Recipient Age

0

0.5

1

1.5

2

20 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



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 < 0.0001



Pre-Transplant Recipient BMI

0

0.5

1

1.5

2

15 20 25 30 35

Recipient BMI (kg/m2)

Rel

ativ

e R

isk

of

5 Y

ear

Mo

rtal

ity

p = 0.0017



Donor Weight

0

0.5

1

1.5

2

45 55 65 75 85 95 105

Weight (kg)

Rel

ativ

e R

isk

of

5 Y

ear

Mo

rtal

ity

p = 0.0079



Pre-Transplant Bilirubin

0

0.5

1

1.5

0 1 2 3 4 5 6 7 8

Recipient Bilirubin (mg/dl)

Rel

ativ

e R

isk

of

5 Y

ear

Mo

rtal

ity

p = 0.013



Recipient PA Systolic Pressure

0

0.5

1

1.5

2

25 50 75 100

Recipent PA systolic pressure (mm Hg)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.0334



Pre-Transplant Creatinine

0

0.5

1

1.5

2

0.5 0.8 1.1 1.4 1.7 2

Recipent creatinine (mg/dl)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.043


ADULT LUNG TRANSPLANTS (1995-6/1999) Factors Not Significant for 5 Year Mortality

Recipient factors:Hospitalized, chronic steroid use, transfusions, history of malignancy, cardiac output, PRA, FVC, FEV1, PCO2,

pulmonary vascular resistance, dialysis, recent infection requiring IV drug therapy

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

Transplant factors:CMV mismatch, ischemia time, transplant center volume


ADULT LUNG TRANSPLANTS (1995-6/1999) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year



95% Confidence

Interval

Alpha-1 antitrypsin deficiency Single 214 1.35 .0081 1.08 -1.69

Other * Any 444 0.81 .0391 0.67 -0.99

Cystic Fibrosis Any 634 0.68 .0022 0.53 -0.87

Primary Pulmonary Hypertension

Any 150 0.65 .0087 0.47 -0.90

LAM Any 41 0.25 .0063 0.09 -0.68

COPD Any 1568 1 (Ref.) - - -

(N=4,028)

ISHLT 2005

*Other = All diagnoses other than COPD, PPH, IPF, CF, bronchiectasis, Alpha-1 antitrypsin deficiency, and LAM.



DONOR AND RECIPIENT CHARACTERISTICS N


95% Confidence

Interval

Donor Cause of Death = Anoxia 130 0.54 .0010 0.38 -0.78

Sternotomy prior to transplant 75 1.51 .0151 1.08 -2.09

HLA A mismatches (per mismatch) 227 0 MM 1.11 .0353 1.01 -1.21

(N=4,028)



POST-TRANSPLANT FACTORS N Relative

Risk P-value

95% Confidence

Interval

Bronchiolitis obliterans within 1st year 218 2.40 <0.0001 1.98 -2.92

Dialysis prior to discharge 46 1.52 .0440 1.01 -2.30

Rejection between discharge and 1 year 902 1.27 .0002 1.12 -1.44

Drug-treated infection prior to discharge 1152 1.16 .0097 1.04 -1.31

Polyclonal induction 855 0.88 .0490 0.77 -1.00

(N=4,028)



Conditional on Survival to 1 Year

VARIABLE N Relative

Risk P-value

95% Confidence

Interval

Recipient history of diabetes 144 1.25 .0968 0.96 -1.64

Transplant year = 1995 vs. 1998/1999 871 1.15 .0530 1.00 -1.33

Diagnosis = Alpha-1 antitrypsin deficiency/ Double lung transplant

181 0.75 .0615 0.55 -1.01

Diagnosis = Bronchiectasis 96 0.69 .0758 0.46 -1.04

(N=4,028)


ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

Continuous Factors (see figures) Recipient Age

Donor Age


ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival

Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Rela

tive R

isk o

f 5 Y

ear

Mo

rtality

.

p < 0.0001


ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival

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 < 0.0001


ADULT LUNG TRANSPLANTS (1995-6/1999) Factors Not Significant for Conditional 5 Year Mortality

Recipient factors:Ventilator, inotropes, hospitalized at transplant, pCO2, gender,

chronic steroid use, transfusions, history of malignancy, PRA, repeat transplant, FEV1, FVC, height, weight, PA pressures, O2

required, bilirubin, creatinine, recent infection requiring use of IV drug therapy, thoracotomy, cardiac output

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


ADULT LUNG TRANSPLANTS (1995-6/1999) Factors Not Significant for Conditional 5 Year Mortality

Transplant factors:ABO compatibility, CMV mismatch, transplant center volume

Post-transplant factors:Stroke prior to discharge, prolonged graft dysfunction prior to discharge, treated for rejection prior to discharge


ADULT LUNG RECIPIENTSFunctional Status of Surviving Recipients

(Follow-ups: April 1994 – June 2004)

0%

20%

40%

60%

80%

100%

1 Year (N = 6,169) 3 Years (N =3,861) 5 Years (N = 2,243) 7 Years (N = 1,170)

No Activity Limitations Performs with Some Assistance Requires Total Assistance


ADULT LUNG RECIPIENTSEmployment Status of Surviving Recipients

(Follow-ups: April 1994 – June 2004)

0%

20%

40%

60%

80%

100%

1 Year (N = 5,751)

3 Years (N = 3,388)

5 Years (N = 1,964)

7 Years (N = 1,001)

Retired

Not Working

Working Part Time

Working Full Time


ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients

(Follow-ups: April 1994 - June 2004)

0%

20%

40%

60%

80%

100%

Up to 1 Year (N = 7,121)

Between 2 and 3Years (N = 4,257)



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


0

5

10

15

20

25

30

35

40

45

50

Any Induction (N = 1,208)

PolyclonalALG/ATG (N = 364)

OKT3 (N = 17) IL2R-antagonist (N = 837)

% o

f p

atien

tsADULT LUNG RECIPIENTS

Induction Immunosuppression (Follow-ups: January 2002 - June 2004)Analysis limited to patients receiving prednisone


0

10

20

30

40

50

Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist

% o

f p

ati

en

ts .

2000 2001 2002 2003

ADULT LUNG RECIPIENTSInduction Immunosuppression (Follow-ups: January 2000 - December 2003)

Analysis limited to patients receiving prednisone


SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: April 1994-June 2003)

Conditional on survival to 14 days

0

20

40

60

80

100

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

Su

rviv

al (

%)

.

No induction (N=6,791)

Induction (N=3,349)

p = 0.0843


SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: January 2000-June 2003)

Conditional on Survival to 14 days

0

20

40

60

80

100

0 1 2 3 4

Years

Su

rviv

al (

%)

.


Induction (N=1,684)

p =0.241


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine

% o

f P

ati

en

ts .

Year 1 (N = 1,923) Year 5 (N = 861)

ADULT LUNG RECIPIENTSMaintenance Immunosuppression At Time of Follow-up

For follow-ups between January 2001 through June 2004 Analysis limited to patients receiving prednisone

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


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 2001 through June 2004Analysis limited to patients receiving prednisone

1 Year Follow-up (N = 1,928) 5 Year Follow-up (N = 865)

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


0

20

40

60

80

100

Year 1 (N = 1,923) Year 5 (N = 861)

% 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 2001 through June 2003Conventional Combinations



0

10

20

30

40

50

Year 1 (N = 1,923) Year 5 (N = 861)

% 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 2001 through June 2003Other Combinations



PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR

Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2003)

0

10

20

30

40

50

60

Overall 18-34 35-49 50-64 65+ F M

% t

reate

d f

or

reje

cti

on

wit

hin

1 y

ear

.

No induction Polyclonal IL2R-antagonist OKT3

For female: no induction vs. polyclonal (p = 0.04) For male: no induction vs. polyclonal (p = 0.009); polyclonal vs. IL2R (p = 0.015)

Overall: no induction vs. polyclonal (p=0.001); polyclonal vs. IL2R (p = 0.0035)35-49: no induction vs. polyclonal (p=0.049); polyclonal vs. IL2R (p = 0.017)50-64: no induction vs. polyclonal (p = 0.0063)


NUMBER OF REJECTION EPISODES FOR ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR

Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2003)

0

0.5

1

1.5

2

2.5

Overall 18-34 35-49 50-64 65+ F M

Avera

ge n

um

ber

of re

jectio

n e

pis

od

es

.

No induction Polyclonal IL2R-antagonist OKT3

Overall: no induction vs. polyclonal (p < 0.0001); no induction vs. IL2R (p = 0.0110); polyclonal vs. IL2R (p = 0.0355). 18-34: no induction vs. polyclonal (p = 0.002); polyclonal vs. IL2R (p = 0.019). 50-64: no induction vs. polyclonal (p = 0.022)

Females: no induction vs. polyclonal (p = 0.04); no induction vs. IL2R (p = 0.04). Males: no induction vs. polyclonal (p = 0.0003); polyclonal vs. IL2R (p = 0.011)


PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR

Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2003)

0

10

20

30

40

50

60

70

Overall 18-34 35-49 50-64 65+ F M

% tre

ate

d fo

r re

jectio

n w

ith

in 1

year

.

Cyclosporin + MMF Cyclosporin + AZATacrolimus + MMF Tacrolimus + AZA

Overall: CyA + MMF vs. TAC + MMF (p = 0.0007); CyA + AZA vs. TAC + MMF (p < 0.0001); CyA + AZA vs. TAC + AZA

(p = 0.0002). 35-49: CyA + MMF vs. TAC + MMF (p = 0.017); CyA + AZA vs. TAC + MMF (p = 0.0004); CyA + AZA vs. TAC + AZA (p = 0.023). 50-64: CyA + MMF vs. TAC + MMF (p = 0.037); CyA + AZA vs. TAC + MMF (p < 0.0001); CyA + MMF vs. CyA + AZA (p = 0.045); CyA + AZA vs. TAC + AZA (p = 0.0003). 65+: CyA + AZA vs. TAC + MMF (p = 0.035); CyA + MMF vs. TAC + MMF

(p = 0.035). Females: CyA + AZA vs. TAC + MMF (p = 0.002); CyA + AZA vs. TAC + AZA (p = 0.014). Males: CyA + MMF vs. TAC + MMF (p = 0.0007); CyA + AZA vs. TAC + MMF (p < 0.0001); CyA + AZA vs. TAC + AZA (p = 0.005); TAC + MMF vs. TAC + AZA (p = 0.04)


NUMBER OF REJECTION EPISODES FOR ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2003)

0

0.5

1

1.5

2

2.5

3

Overall 18-34 35-49 50-64 65+ F M

Avera

ge n

um

ber

of re

jectio

n e

pis

od

es

. Cyclosporin + MMF Cyclosporin + AZATacrolimus + MMF Tacrolimus + AZA

Overall: CyA + MMF vs. CyA + AZA (p = 0.0015); CyA + AZA vs. TAC + MMF (p < 0.0001); TAC + MMF vs. TAC + AZA (p = 0.0257). 18-34: CyA + MMF vs. CyA + AZA (p = 0.046); CyA + AZA vs. TAC + MMF (p = 0.014). 50-64: CyA + MMF vs. CyA + AZA (p = 0.013); CyA +AZA vs. TAC + MMF (p = 0.002); CyA + AZA vs. TAC + AZA (p = 0.02). Female: CyA + AZA vs. TAC + MMF (p = 0.0005).Male: CyA + AZA vs. TAC + MMF (p = 0.04); CyA + MMF vs. CyA + AZA (p = 0.007)


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


Transplants: April 1994 –

June 1999 Transplants: July 1999-

June 2003

Outcome Within 1

Year

Total number with known response

Within 1 Year


Hypertension 50.5% (N = 3,607) 53.1% (N = 2,839)

Renal Dysfunction 24.8% (N = 3,526) 28.8% (N = 2,938)

Abnormal Creatinine < 2.5 mg/dl 14.3% 20.3%

Creatinine > 2.5 mg/dl 8.6% 6.5%

Chronic Dialysis 1.8% 2.0%

Renal Transplant 0.0% 0.1%

Hyperlipidemia 15.3% (N = 3,749) 22.6% (N = 3,050)

Diabetes 18.3% (N = 3,564) 27.1% (N = 2,885)

Bronchiolitis Obliterans 10.4% (N = 3,222) 6.5% (N = 2,658)


POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 and 5 Years

Post-Transplant (Follow-ups: April 1994 - June 2004)

Outcome Within 1

Year


Within 5 Years


Hypertension 51.1% (N = 6,994) 85.9% (N = 1,490)

Renal Dysfunction 25.7% (N = 7,008) 39.4% (N = 1,596)

Abnormal Creatinine < 2.5 mg/dl 16.2% 22.7%

Creatinine > 2.5 mg/dl 7.6% 12.8%

Chronic Dialysis 1.9% 3.2%

Renal Transplant 0.0% 0.7%

Hyperlipidemia 17.7% (N = 7,362) 46.8% (N = 1,645)

Diabetes 21.5% (N = 6,995) 30.9% (N = 1,467)

Bronchiolitis Obliterans 8.8% (N = 6,407) 33.0% (N = 1,178)


POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 8 Years Post-Transplant


Outcome Within 8

Years Total number with known response

Hypertension 93.7% (N = 349)

Renal Dysfunction 36.3% (N = 391)

Abnormal Creatinine < 2.5 mg/dl 19.7% Creatinine > 2.5 mg/dl 9.2% Chronic Dialysis 5.9% Renal Transplant 1.5%

Hyperlipidemia 56.8% (N = 400)

Diabetes 28.3% (N = 346)

Bronchiolitis Obliterans 40.5% (N = 242)


FREEDOM FROM BRONCHIOLITIS OBLITERANSFor Adult Lung Recipients (Follow-ups: April 1994-June 2004)

Conditional on Survival to 90 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

.


FREEDOM FROM BRONCHIOLITIS OBLITERANS STRATIFIED BY INDUCTION USE

For Adult Lung Recipients (Follow-ups: April 1994-June 2004)Conditional on Survival to 90 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

.


Induction (N=2,454)

p = 0.1561


FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Adult Lung Recipients (Follow-ups: April 1994-June 2004)

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

Dys

fun

ctio

n

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


MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2004)

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

No Malignancy 7025 (96.1%) 1427 (87%) 553 (81.7%)

Malignancy (all types combined) 284 (3.9%) 213 (13%) 124 (18.3%)

Malignancy Type*

Skin 59 110 81

Lymph 145 45 25

Other 58 60 32

Type Not Reported

22 11 21

* 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); liver (1; 1; 1). Numbers in parentheses represent the number of reported cases within each time period.


FREEDOM FROM MALIGNANCYFor Adult Lung Recipients (Follow-ups: April 1994-June 2004)

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


ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January 1992- June 2004)

CAUSE OF DEATH0-30 Days

(N = 1146)

31 Days - 1 Year

(N = 1,717)

>1 Year - 3 Years

(N = 1,428)

>3 Years - 5 Years

(N = 800)

>5 Years

(N = 829)

BRONCHIOLITIS 5 (0.4%) 82 (4.8%) 378 (26.5%) 231 (28.9%) 225 (27.1%)

ACUTE REJECTION 63 (5.5%) 35 (2.0%) 25 (1.8%) 4 (0.5%) 5 (0.6%)

LYMPHOMA 1 (0.1%) 47 (2.7%) 32 (2.2%) 11 (1.4%) 27 (3.3%)

MALIGNANCY, OTHER 1 (0.1%) 44 (2.6%) 78 (5.5%) 60 (7.5%) 70 (8.4%)

CMV 0 65 (3.8%) 20 (1.4%) 4 (0.5%) 3 (0.4%)

INFECTION, NON-CMV 245 (21.4%) 639 (37.2%) 352 (24.6%) 162 (20.3%) 150 (18.1%)

GRAFT FAILURE 331 (28.9%) 307 (17.9%) 244 (17.1%) 137 (17.1%) 127 (15.3%)

CARDIOVASCULAR 121 (10.6%) 72 (4.2%) 50 (3.5%) 36 (4.5%) 46 (5.5%)

TECHNICAL 96 (8.4%) 44 (2.6%) 11 (0.8%) 2 (0.3%) 3 (0.4%)

OTHER 283 (24.7%) 382 (22.2%) 238 (16.7%) 153 (19.1%) 173 (20.9%)


LUNG TRANSPLANTATION Overall ISHLT 2005 J Heart Lung Transplant 2005;24: 945-982.

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Transcript of LUNG TRANSPLANTATION Overall ISHLT 2005 J Heart Lung Transplant 2005;24: 945-982.