J Heart Lung Transplant 2009;28: 989-1049 LUNG TRANSPLANTATION Overall ISHLT 2009.

J Heart Lung Transplant 2009;28: 989-1049

LUNG TRANSPLANTATION

Overall

ISHLT

2009


NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE

5 7 36 78190

419

704

922

10871223

13581338145014601491

16281690

187919302071

23862448

2708

0

250

500

750

1000

1250

1500

1750

2000

2250

2500

2750

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Nu

mb

er

of

Tra

ns

pla

nts

Bilateral/Double LungSingle Lung

ISHLTNOTE: 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.

2009


AVERAGE CENTER VOLUMELung Transplants: January 1, 2000 - June 30, 2008

46

2533

22 17730

10

20

30

40

50

60

1-4 5-9 10-19 20-29 30-39 40-49 50+

Average number of lung transplants per year

Nu

mb

er

of

ce

nte

rs

0

5

10

15

20

25

30

Number of centers Percentage of transplants

Per

cen

tag

e o

f tr

ansp

lan

ts

ISHLT

2009


DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME

Lung Transplants: January 1, 2000 - June 30, 2008

6.6

1922.8 24

20.7

2.84.2

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

Per

cen

tag

e o

f tr

ansp

lan

ts

ISHLT

2009


LUNG TRANSPLANTS: Transplant Recipient Age by Year of Transplant

Transplants: January 1, 1987 – June 30, 2008

0%

20%

40%

60%

80%

100%

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

0

10

20

30

40

50

60

0-11 12-17 18-34 35-49 50-59 60-65 66+ Mean Age

Mea

n r

ecip

ien

t ag

e (y

ears

)

% o

f T

ran

sp

lan

tsrs

Year of Transplant

ISHLT

2009


AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2008)

0

5

10

15

20

25

30

35

0-11 12-17 18-29 30-39 40-49 50-59 60-65 66+

Recipient Age

% o

f tr

an

sp

lan

ts

ISHLT

2009


AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA

0

5

10

15

20

25

30

35

40

0-11 12-17 18-29 30-39 40-49 50-59 60-65 66+

% o

f tr

ansp

lan

ts

1985-1994 (N = 4,650)

1995-1999 (N = 7,088)

2000-6/2008 (N = 17,960)

p < 0.0001

ISHLT

Transplants with unknown recipient age were excluded from this tabulation.2009


LUNG TRANSPLANTS: Donor Age by Year of Transplant

Transplants: January 1, 1987 – June 30, 2008

0%

20%

40%

60%

80%

100%

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Year of Transplant

0

5

10

15

20

25

30

35

40

0-11 12-17 18-34 35-49 50-59 60+ Mean Donor Age

% o

f T

ran

spla

nts

Mea

n d

on

or

age

(yea

rs)

ISHLT

2009


DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS (1/1985-6/2008)

0

5

10

15

20

25

30

35

0-11 12-17 18-29 30-39 40-49 50-59 60-65 66+

Donor Age

% o

f tr

an

sp

lan

ts

ISHLT

2009


DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS BY ERA

0

5

10

15

20

25

30

35

40

0-11 12-17 18-29 30-39 40-49 50-59 60-65 66+

% o

f tr

ansp

lan

ts

1985-1994 (N = 4,547)

1995-1999 (N = 6,931)

2000-6/2008 (N = 17,787)

p < 0.0001

ISHLT

Transplants with unknown donor age were excluded from this tabulation.2009


LUNG TRANSPLANTATION

Adult Recipients

ISHLT

2009


AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS (1/1985-6/2008)

0

5

10

15

20

25

18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 66+

Recipient Age

% o

f tr

an

sp

lan

ts

ISHLT

2009


AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA

0

5

10

15

20

25

18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 66+

% o

f tr

ansp

lan

ts

.

1985-1995 (N = 5,702)

1996-6/2008 (N = 22,718 )

p < 0.0001

Mean age by era1985-1995 = 44.9 years1996-6/2008 = 49.4 years

ISHLT

2009


AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA

0

5

10

15

20

25

18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 66+

% o

f tr

ansp

lan

ts

.

1985-1994 (N=4,426)1995-1999 (N=6,693)2000-6/2008 (N=17,301)

p < 0.0001

Mean age by era1985-1994 = 44.6 years1995-1999 = 47.3 years2000-6/2008 = 49.9 years

ISHLT

2009


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1994 - June 2007)

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=12,246)

Single Lung (N=10,081)

All Lungs (N=22,328)

Double lung: 1/2-life = 6.6 Years; Conditional 1/2-life = 9.0 YearsSingle lung: 1/2-life = 4.6 Years; Conditional 1/2-life = 6.4 YearsAll lungs: 1/2-life = 5.4 Years; Conditional 1/2-life = 7.4 Years

P < 0.0001

ISHLT

2009


ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2008)

DIAGNOSIS SLT (N = 10,190) BLT (N = 13,338) TOTAL (N = 23,528)

COPD/Emphysema 4,994 ( 49.0% ) 3,423 ( 25.7% ) 8,417 ( 35.8% )

Idiopathic Pulmonary Fibrosis 2,967 ( 29.1% ) 1,930 ( 14.5% ) 4,897 ( 20.8% )

Cystic Fibrosis 191 ( 1.9% ) 3,552 ( 26.6% ) 3,743 ( 15.9% )

Alpha-1 662 ( 6.5% ) 1,017 ( 7.6% ) 1,679 ( 7.1% )

Idiopathic Pulmonary Arterial Hypertension 74 ( 0.7% ) 714 ( 5.4% ) 788 ( 3.3% )

Sarcoidosis 212 ( 2.1% ) 391 ( 2.9% ) 603 ( 2.6% )

Bronchiectasis 40 ( 0.4% ) 596 ( 4.5% ) 636 ( 2.7% )

LAM 80 ( 0.8% ) 157 ( 1.2% ) 237 ( 1.0% )

Congenital Heart Disease 19 ( 0.2% ) 144 ( 1.1% ) 163 ( 0.7% )

Re-Transplant: Obliterative Bronchiolitis 160 ( 1.6% ) 134 ( 1.0% ) 294 ( 1.2% )

Obliterative Bronchiolitis

(Not Re-Transplant)

53 ( 0.5% ) 150 ( 1.1% ) 203 ( 0.9% )

Re-Transplant: Not Obliterative Bronchiolitis 105 ( 1.0% ) 97 ( 0.7% ) 202 ( 0.9% )

Connective Tissue Disease 68 ( 0.7% ) 113 ( 0.8% ) 181 ( 0.8% )

Interstitial Pneumonitis 32 ( 0.3% ) 29 ( 0.2% ) 61 ( 0.3% )

Cancer 6 ( 0.1% ) 17 ( 0.1% ) 23 ( 0.1% )

Other 527 ( 5.2% ) 874 ( 6.6% ) 1,401 ( 6.0% )

ISHLT

2009


ADULT LUNG TRANSPLANTATION: Distribution of Procedure Type for Major Indications (1992-2007)

ISHLT

Year of TX

Alpha-1 COPD Cystic Fibrosis IPF IPAH

Double Single Double Single Double Single Double Single Double Single

1992 28.1 71.9 16.4 83.6 97.0 3.0 10.2 89.8 26.6 73.4

1993 38.7 61.3 16.0 84.0 94.9 5.1 16.5 83.5 53.8 46.2

1994 43.0 57.0 18.9 81.1 86.1 13.9 13.9 86.1 64.3 35.7

1995 46.2 53.8 21.4 78.6 89.7 10.3 27.9 72.1 89.3 10.7

1996 47.3 52.7 26.8 73.2 87.0 13.0 27.3 72.7 82.0 18.0

1997 46.4 53.6 26.3 73.7 92.9 7.1 22.2 77.8 90.0 10.0

1998 48.5 51.5 28.8 71.2 92.6 7.4 20.1 79.9 86.8 13.2

1999 47.0 53.0 28.1 71.9 90.8 9.2 23.0 77.0 86.0 14.0

2000 58.1 41.9 29.0 71.0 94.7 5.3 31.8 68.2 92.6 7.4

2001 59.9 40.1 28.6 71.4 94.0 6.0 30.0 69.7 89.8 10.2

2002 56.6 43.4 38.5 61.5 96.2 3.8 35.1 64.9 89.9 10.1

2003 65.4 34.6 42.2 57.8 95.1 4.9 41.8 58.2 95.4 4.6

2004 73.9 26.1 45.3 54.7 96.2 3.8 44.0 56.0 94.4 5.6

2005 77.8 22.2 49.7 50.3 97.7 2.3 46.2 53.8 90.5 9.5

2006 76.3 23.7 58.5 41.5 99.2 0.8 49.3 50.7 100.0 0.0

2007 86.9 13.1 64.5 35.5 97.1 2.9 48.8 51.2 94.1 5.9

2009


ADULT LUNG TRANSPLANTATIONProcedure Type within Indication, by Year

0

10

20

30

40

50

60

70

80

90

100

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

% o

f tr

ansp

lan

ts

Bilateral/Double Lung Transplant Single Lung Transplant

AT Def COPD IPF IPAH

ISHLT 2009


ADULT LUNG TRANSPLANTATION: Indications for Single Lung Transplants (Transplants: January 1995 - June 2008)

ISHLT

*Other includes:

Sarcoidosis: 2.1%

Bronchiectasis: 0.4%

Congenital Heart Disease: 0.2%

LAM: 0.8%

OB (non-ReTx): 0.5%

Miscellaneous: 6.3%

49%

29%

3%1%

2%

6%

10%

Alpha-1 COPD CF IPF IPAH Re-Tx Other*

2009


ADULT LUNG TRANSPLANTATION: Indications for Bilateral/Double Lung Transplants (Transplants: January 1995 - June 2008)

26%

14%2%5%

26%

8%

19%

Alpha-1 COPD CF IPF IPAH Re-Tx Other*

ISHLT

*Other includes:

Sarcoidosis: 2.9%

Bronchiectasis: 4.5%

Congenital Heart Disease: 1.1%

LAM: 1.2%

OB (non-ReTx): 1.1%

Miscellaneous: 7.7%

2009


ADULT LUNG TRANSPLANTATIONIndications By Year (%)

0

20

40

60

80

100

Transplant Year

% o

f T

ran

spla

nts

CF IPF COPD Alpha-1 IPAH Re-Tx

ISHLT

2009


ADULT LUNG TRANSPLANTATIONIndications By Year (Number)

0

250

500

750

1000

1250

1500

1750

2000

2250

Transplant Year

Nu

mb

er o

f T

ran

spla

nts

CF IPF COPD Alpha-1 IPAH Re-Tx

ISHLT

2009


0%

20%

40%

60%

80%

100%

Europe North America Other

% o

f T

ran

sp

lan

ts

18-34 years 35-49 years 50-59 years 60-65 years 66+ years

ADULT LUNG TRANSPLANTS:AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2008

ISHLT

2009


0%

20%

40%

60%

80%

100%


Sarcoidosis

Re-TX

IPAH

Other

IPF

CF

COPD

Bronchiectasis

Alpha-1

Nu

mb

er

of

Tra

ns

pla

nts

ADULT LUNG TRANSPLANTS:DIAGNOSIS DISTRIBUTION BY LOCATION

Transplants between January 2000 and June 2008

ISHLT

2009


0%

20%

40%

60%

80%

100%


1-5 6-10 11-17 18-34 35-49 50-59 60-65 66+

% o

f D

on

ors

ADULT LUNG TRANSPLANTS:DONOR AGE DISTRIBUTION BY LOCATION

Transplants between January 2000 and June 2008

ISHLT

2009


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Era (Transplants: January 1988 – June 2007)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

1988-1994 (N=4,307)1995-1999 (N=6,553)2000-6/2007 (N=14,626)

1988-1994: 1/2-life = 4.2 Years; Conditional 1/2-life = 7.0 Years1995-1999: 1/2-life = 4.7 Years; Conditional 1/2-life = 7.3 Years2000-6/2007: 1/2-life = 5.7 Years; Conditional 1/2-life = 7.6 Years

N at risk = 162

N at risk = 810

N at risk = 765

Survival comparisons by era1988-94 vs. 1995-99: p = 0.00101988-94: vs. 2000-6/07: p <0.0001

1995-99 vs. 2000-6/07: p <0.0001

ISHLT

2009


ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: January 1990 – June 2007)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al

(%)

.

18-34 (N = 4,420)35-49 (N = 6,629)50-59 (N = 9,229)60-65 (N = 4,262)66+ (N = 694)

Survival comparisonsAll p-values significant at p < 0.0001 except 18-34 vs. 35-49: p = 0.7127; 60-65 vs. 66+: p = 0.0007

HALF-LIFE 18-34: 5.9 Years; 35-49: 6.3 Years; 50-59: 5.1 Years; 60-65: 4.2 Years; 66+: 3.2 Years

ISHLT

2009


ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: January 1990 – June 2007)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al

(%)

Male (N=13,251)

Female (N=11,981)

HALF-LIFE Male: 5.0 years; Female: 5.4 Years

p = 0.0006

N at risk at 5 years=3,456

N at risk = 783N at risk at 5 years=3,311

N at risk = 762

ISHLT

2009


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2007)

YearALPHA-1 (N=2,085)

CF (N=3,746)

COPD (N=8,812)

IPF (N=4,695)

IPAH (N=1,065)

SARCOIDOSIS (N=597)

1 78.7 82.6 82.4 74.1 71.1 72.2

3 64.8 67.5 65.3 58.5 60.3 57.8

5 55.7 57.4 50.8 45.9 51.7 51.9

7 45.9 50 38.5 35.4 44.5 43.5

10 32.6 39.6 22.9 22.3 32.4 31.9

Survival comparisonsAlpha-1 vs. CF: p < 0.0001 Alpha-1 vs. COPD: p < 0.0001 Alpha-1 vs. IPF: p < 0.0001 Alpha-1 vs. Sarcoidosis: p = 0.0380CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001CF vs. IPAH: p < 0.0001 CF vs. Sarcoidosis: p < 0.0001IPAH vs. IPF: p = 0.0046 COPD vs. IPF: p < 0.0001

Note: Other comparisons are not statistically different.

ISHLT

2009


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on

Survival to 3 Months (Transplants: January 1990 – June 2007)


CF (N=3,215)

COPD (N=7,680)

IPF (N=3,822)

IPAH (N=770)

SARCOIDOSIS (N=479)

1 89.6 91.0 90.1 86.5 90.6 85.4

3 73.8 74.4 71.4 68.3 76.9 68.4

5 63.4 63.2 55.5 53.6 65.9 61.4

7 52.2 55.1 42.1 41.3 56.7 51.5

10 37.1 43.7 25.0 26.0 41.2 37.7

Survival comparisonsAlpha-1 vs. CF: p = 0.0075 Alpha-1 vs. COPD: p < 0.0001Alpha-1 vs. IPF: p < 0.0001 Alpha-1 vs. IPAH: p = 0.0214CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001 CF vs. Sarcoidosis : p = 0.0131 IPAH vs. COPD: p < 0.0001IPAH vs. IPF: p < 0.0001 IPAH vs. Sarcoidosis: p = 0.0187COPD vs. IPF: p = 0.0476 COPD vs. Sarcoidosis: p = 0.0419IPF vs. Sarcoidosis: p = 0.0116 Note: Other comparisons are not statistically different.ISHLT

2009


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2007)


CF (N=2,779)

COPD (N=6,649)

IPF (N=3,108)

IPAH (N=674)

SARCOIDOSIS (N=396)

1 100.0 100.0 100.0 100.0 100.0 100.0

3 82.4 81.6 79.2 78.9 84.8 80.0

5 70.8 69.4 61.5 61.9 72.7 71.8

7 58.3 60.5 46.7 47.7 62.5 60.2

10 41.4 47.9 27.8 30.1 45.5 44.1

Survival comparisonsAlpha-1 vs. CF: p = 0.0354 Alpha-1 vs. COPD: p < 0.0001Alpha-1 vs. IPF: p < 0.0001 Alpha-1 vs. IPAH: p = 0.0321CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001IPAH vs. COPD: p < 0.0001 IPAH vs. IPF: p < 0.0001COPD vs. Sarcoidosis: p < 0.0001 IPF vs. Sarcoidosis: p = 0.0007

Note: Other comparisons are not statistically different.

ISHLT

2009


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2007)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10 11 12Years

Su

rviv

al

(%)

Alpha-1 (N=2,085) CF (N=3,746) COPD (N=8,812)

IPF (N=4,695) IPAH (N=1,065) Sarcoidosis (N=597)

HALF-LIFE Alpha-1: 6.1 Years; CF: 7.0 Years; COPD: 5.1 Years; IPF: 4.3 Years; IPAH: 5.6 Years; Sarcoidosis: 5.3 Years

ISHLT

Survival comparisonsAlpha-1 vs. CF: p < 0.0001Alpha-1 vs. COPD: p < 0.0001 Alpha-1 vs. IPF: p < 0.0001Alpha-1 vs. Sarcoidosis: p = 0.0380CF vs. COPD: p < 0.0001CF vs. IPF: p < 0.0001CF vs. IPAH: p < 0.0001CF vs. Sarcoidosis: p < 0.0001IPAH vs. IPF: p = 0.0046COPD vs. IPF: p < 0.0001

2009


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on

Survival to 3 Months (Transplants: January 1990 – June 2007)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10 11 12Years

Su

rviv

al

(%)

Alpha-1 (N=1,775) CF (N= 3,215)COPD (N=7,680) IPF (N=3,822)IPAH (N=770) Sarcoidosis (N=479)


ISHLT

Survival comparisonsAlpha-1 vs. CF: p = 0.0075Alpha-1 vs. COPD: p < 0.0001Alpha-1 vs. IPF: p < 0.0001Alpha-1 vs. IPAH: p = 0.0214CF vs. COPD: p < 0.0001CF vs. IPF: p < 0.0001 CF vs. Sarcoidosis : p = 0.0131IPAH vs. COPD: p < 0.0001IPAH vs. IPF: p < 0.0001IPAH vs. Sarcoidosis: p = 0.0187COPD vs. IPF: p = 0.0476COPD vs. Sarcoidosis: p = 0.0419IPF vs. Sarcoidosis: p = 0.0116

2009


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

(Transplants: January 1990 – June 2007)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10 11 12Years

Su

rviv

al

(%)

Alpha-1 (N=1,558) CF (N=2,779)COPD (N=6,649) IPF (N=3,108)IPAH (N=674) Sarcoidosis (N=396)


ISHLT

Survival comparisonsAlpha-1 vs. CF: p = 0.0354Alpha-1 vs. COPD: p < 0.0001Alpha-1 vs. IPF: p < 0.0001Alpha-1 vs. IPAH: p = 0.0321CF vs. COPD: p < 0.0001CF vs. IPF: p < 0.0001IPAH vs. COPD: p < 0.0001IPAH vs. IPF: p < 0.0001COPD vs. Sarcoidosis: p < 0.0001IPF vs. Sarcoidosis: p = 0.0007

2009


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=124) VSD (N= 56)

HALF-LIFE ASD: 4.1 Years; VSD: 1.1 Years

p = 0.0549

N at risk= 40

N at risk = 15

ISHLT

2009


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Procedure Type

(Transplants: January 1990 – June 2007) Diagnosis: Alpha-1 Antitrypsin Deficiency

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10 11 12

Years

Su

rviv

al

(%)

Alpha-1/Single lung (N=989)

Alpha-1/Double lung (N=1,096)p < 0.0001

N at risk at 5 years = 370

N at risk at 5 years = 395 N at risk = 68

N at risk = 70

ISHLT

2009


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Procedure Type and Age

(Transplants: January 1990 – June 2007) Diagnosis: Alpha-1 Antitrypsin Deficiency

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10 11 12

Years

Su

rviv

al (

%)

Single Lung, < 50 (N = 450) Double Lung, <50 (N = 597)

Single Lung, 50+ (N = 539) Double Lung, 50+ (N = 499)

p =0.0091

N at risk at 12 years:

Single Lung, <50 = 47; Double Lung, <50 = 55; Single Lung, 50+ = 23; Double Lung, 50+ = 13

ISHLT

2009


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2007)

Diagnosis: Emphysema/COPD

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10 11 12

Years

Su

rviv

al

(%)

COPD/Single lung (N=5,683)

COPD/Double lung (N=3,129) N=138

N=60

P < 0.0001


N at risk at 5 years = 1,786

ISHLT

2009


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 11 12

Years

Su

rviv

al

(%)

<50/Single lung (N=710) <50/Double lung (N=752)

50+/Single lung (N=4,973) 50+/Double lung (N=2,377)N=38N=100

N=24N=36

P < 0.0001

ISHLT

2009


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type


Diagnosis: Idiopathic Pulmonary Fibrosis

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10 11

Years

Su

rviv

al

(%)

IPF/Single lung (N=3,054)

IPF/Double lung (N=1,640) N=66

N=27

p = 0.0004



ISHLT

2009


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type

(Transplants: January 1990 – June 2007)Diagnosis: Idiopathic Arterial Pulmonary Hypertension

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10 11 12

Years

Su

rviv

al

(%)

IPAH/Single lung (N=259)

IPAH/Double lung (N=806)N=28

N=34N at risk at 5 years = 86


P = 0.0073

ISHLT

2009


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

(%)

COPD/Single lung/1990-1994 (N=999)

COPD/Single lung/1995-1999 (N=1,774)

COPD/Single lung/2000-6/2007 (N=2,910)

Survival comparisons1990-1994 vs. 1995-1999: p = 0.34641990-1994 vs. 2000-6/2007: p < 0.00011995-1999 vs. 2000-6/2007: p = 0.0047

N=45

N=147

N=146

ISHLT

2009




Diagnosis: Emphysema/COPD, Double Lung

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

COPD/Double lung/1990-1994 (N=208)

COPD/Double lung/1995-1999 (N=641)

COPD/Double lung/2000-6/2007 (N=2,280)

Survival comparisons1990-1994 vs. 1995-1999: p = 0.11371990-1994 vs. 2000-6/2007: p = 0.95951995-1999 vs. 2000-6/2007: p = 0.0199

N=18

N=55

N=82

ISHLT

2009




Diagnosis: Idiopathic Pulmonary Fibrosis, Single Lung

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al

(%)

IPF/Single lung/1990-1994 (N=456)

IPF/Single lung/1995-1999 (N=823)

IPF/Single lung/2000-6/2007 (N=1,775)

Survival comparisons1990-1994 vs. 1995-1999: p = 0.51591990-1994 vs. 2000-6/2007: p = 0.00281995-1999 vs. 2000-6/2007: p = 0.0066

N=14

N=62

N=52

ISHLT

2009




Diagnosis: Idiopathic Pulmonary Fibrosis, Double Lung

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al

(%)

IPF/Double lung/1990-1994 (N=67)

IPF/Double lung/1995-1999 (N=263)

IPF/Double lung/2000-6/2007 (N=1,310)

Survival comparisons1990-1994 vs. 1995-1999: p = 0.55111990-1994 vs. 2000-6/2007: p =0.02871995-1999 vs. 2000-6/2007: p < 0.0001

N=11

N=33

N=10

ISHLT

2009


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

(Transplants: October 1999 – June 2007)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7

Years

Su

rviv

al

(%)

D(-)/R(-) (N=1,446)D(-)/R(+) (N=1,863)D(+)/R(-) (N=1,762)D(+)/R(+) (N=2,988)

Survival comparisonsD(-)/R(-) vs. D(+)/R(-): p < 0.0001D(-)/R(-) vs. D(+)/R(+): p < 0.0001D(-)/R(+) vs. D(+)/R(-): p = 0.0011D(-)/R(+) vs. D(+)/R(+): p = 0.0005

ISHLT

2009


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 2008)

0

10

20

30

40

50

60

% e

xper

ien

cin

g r

ejec

tio

n w

ith

in 1

yea

r

D(-)/R(-), Treatment D(-)/R(-), No Treatment D(-)/R(+), Treatment D(-)/R(+), No Treatment

D(+)/R(-), Treatment D(+)/R(-), No Treatment D(+)/R(+), Treatment D(+)/R(+), No Treatment

ISHLT

D(-)/R(-): N = 683D(-)/R(+): N = 848D(+)/R(-): N = 901D(+)/R(+): N = 1,532

No comparisons were statistically significant at 0.05

Analysis is limited to patients who were alive at the time of the follow-up

2009

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.



YEAR FOLLOW-UP

Stratified by Donor/Recipient CMV status (Follow-ups: July 2004 - June 2008)

0

10

20

30

40

50

60

% e

xp

eri

en

cin

g r

eje

cti

on

wit

hin

1 y

ea

r

D(-)/R(-), Treatment D(-)/R(-), No TreatmentD(-)/R(+), Treatment D(-)/R(+), No TreatmentD(+)/R(-), Treatment D(+)/R(-), No TreatmentD(+)/R(+), Treatment D(+)/R(+), No Treatment

ISHLT

18-34 35-49 50-59 60-65 66+ Female Male

50-59: D(+)/R(-) vs. D(+)/R(+) (p=0.009)60-65: D(-)/R(+) vs. D(+)/R(+) (p=0.034)


2009




ADULT LUNG TRANSPLANTS (1995-6/2007) Risk Factors for 1 Year Mortality

DIAGNOSIS Procedure type N

Relative Risk P-value

95% conf. Interval

IPAH All 421 2.78 <0.0001 1.94 -3.97

Pulmonary Fibrosis (not IPF) All 143 2.39 <0.0001 1.73 -3.26

Retransplant All 376 2.02 <0.0001 1.60 -2.49

Sarcoidosis Double 239 1.98 <0.0001 1.50 -2.64

Other* All 669 1.83 <0.0001 1.52 -2.22

Alpha-1 antitrypsin deficiency Single 396 1.71 <0.0001 1.38 -2.13

Sarcoidosis Single 137 1.64 0.0058 1.16 -2.36

IPF Double 965 1.63 <0.0001 1.34 -1.99

IPF Single 1721 1.47 <0.0001 1.24 -1.75

Bronchiectasis All 271 1.42 0.0181 1.06 -1.90

Alpha-1 antitrypsin deficiency Double 444 1.41 0.006 1.10 -1.80

Cystic fibrosis All 1729 1.37 0.0063 1.09 -1.71

(N=12,415)ISHLT

*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

2009



DONOR CHARACTERISTICS N Relative

Risk P-value

95% Confidence

Interval

Donor history of diabetes 402 1.43 0.0005 1.17 -1.75

RECIPIENT CHARACTERISTICS

IV inotropes 70 1.71 0.0018 1.22 -2.39

Ventilator 340 1.59 <0.0001 1.29 -1.97

Hospitalized (including ICU) 1167 1.57 <0.0001 1.37 -1.81

Chronic steroid use 5879 1.14 0.0026 1.05 -1.24

ISHLT

(N=12,415)

2009



TRANSPLANT CHARACTERISTICS N Relative

Risk P-value

95% Confidence

Interval

Transplant year = 1995/1996 vs. 2006/2007 1473 2.02 <0.0001 1.73 -2.28



Transplant year = 2001/2002 vs. 2006/2007 2026 1.32 0.0003 1.14 -1.54

Donor CMV +/ Recipient CMV - 2386 1.23 <0.0001 1.11 -1.35

ISHLT

(N=12,415)

2009


ADULT LUNG TRANSPLANTS (1995-6/2007) Borderline Significant Risk Factors for 1 Year Mortality


Risk P-

value

95% Confidence

Interval

Recipient on dialysis 44 1.53 0.0947 0.93 -2.54

Prior sternotomy 367 1.19 0.0944 0.97 -1.43

COPD/double lung 1567 1.14 0.0955 0.98 -1.34

0-3 HLA mismatches vs. 4-6 mismatches

1630 0.90 0.0888 0.80 -1.02

ISHLT

(N=12,415)

2009


ADULT LUNG TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality

Continuous Factors (see figures)

Recipient age

Transplant center volume

Cardiac output

PCW (borderline)

Bilirubin

Recipient oxygen required at rest

Height difference

Recipient FEV1 % predicted

ISHLT

2009



Recipient Age

0

0.5

1

1.5

2

25 30 35 40 45 50 55 60 65

Recipient Age

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p < 0.0001

ISHLT

2009



Center Volume

0

0.5

1

1.5

2

5 10 15 20 25 30 35 40 45 50

Center Volume (cases per year)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p < 0.0001

ISHLT

2009



Recipient Pre-Transplant Bilirubin

0

0.5

1

1.5

2

2.5

0 0.5 1 1.5 2

Recipient Bilirubin (mg/dl)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0023

ISHLT

2009



Recipient Oxygen Required at Rest

0

0.5

1

1.5

2

0 1 2 3 4 5 6

Oxygen Required at Rest (L/min)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p < 0.0001

ISHLT

2009



Recipient Pre-Transplant Cardiac Output

0

0.5

1

1.5

2

3 4 5 6 7 8

Cardiac output

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0019

ISHLT

2009



Recipient FEV1 (% predicted)

0

0.5

1

1.5

2

25 30 35 40 45 50 55 60 65 70 75 80Recipient FEV1 (% predicted)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.048

ISHLT

2009



Height Difference

0

0.5

1

1.5

2

-15 -10 -5 0 5 10 15 20

Donor Height - Recipient Height (cm)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0086

ISHLT

2009



Recipient PCW

0

0.5

1

1.5

2

5 10 15 20PCW (mm Hg)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.064

ISHLT

2009


ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = COPD/EmphysemaRisk Factors for 1 Year Mortality

RECIPIENT CHARACTERISTICS N


95% Confidence Interval

Ventilator 46 3.32 <0.0001 2.07 -5.32

Hospitalized (including ICU) 223 1.57 0.0049 1.15 -2.18

PRA > 10% 195 1.47 0.0188 1.07 -2.02

Chronic steroid use 2264 1.36 <0.0001 1.17 -1.57

TRANSPLANT CHARACTERISTICS

Transplant Year: 1995/1996 vs. 2006/2007 581 1.85 <0.0001 1.38 -2.49

Transplant Year: 1997/1998 vs. 2006/2007 655 1.60 0.0016 1.19 -2.15


Donor CMV +/ Recipient CMV - 759 1.32 0.0026 1.10 -1.58

DONOR CHARACTERISTICS

Donor history of diabetes 156 1.54 .0142 1.09 -2.18

(N=4,803)ISHLT

2009


ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = COPD/Emphysema

Borderline Significant Risk Factors for 1 Year Mortality

TRANSPLANT CHARACTERISTICS N



Double lung 1570 1.17 0.0733 0.99 -1.39

DONOR CHARACTERISTICS

Donor history of malignancy 63 0.43 0.0624 0.18 -1.04

(N=4,803)ISHLT

2009


ADULT LUNG TRANSPLANTS (1/1995-6/2007)Diagnosis = COPD/Emphysema

Risk Factors for 1 Year Mortality


Recipient age

Oxygen required at rest

Bilirubin (borderline)


PCO2

Recipient weight (borderline)

ISHLT

2009



Risk Factors for 1 Year MortalityRecipient Age

0

0.5

1

1.5

2

45 50 55 60 65

Recipient Age

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p < 0.0001

ISHLT

2009



Risk Factors for 1 Year MortalityCenter volume

0

0.5

1

1.5

2

5 10 15 20 25 30 35 40 45 50


Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p < 0.0001

ISHLT

2009



Risk Factors for 1 Year Mortality Recipient Oxygen Required at Rest

0

0.5

1

1.5

2

0 1 2 3 4Recipient Oxygen Required at Rest (L/min)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.010

ISHLT

2009



Risk Factors for 1 Year Mortality Recipient Pre-Transplant Bilirubin

0

0.5

1

1.5

2

2.5

0 0.5 1 1.5Recipient bilirubin (mg/dl)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.054

ISHLT

2009



Risk Factors for 1 Year Mortality Recipient PCO2 at Transplant

0

0.5

1

1.5

2

35 40 45 50 55 60 65Recipient PCO2 (mm/Hg)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.041

ISHLT

2009



Risk Factors for 1 Year Mortality Recipient Weight at Transplant

0

0.5

1

1.5

2

45 55 65 75 85 95Recipient weight (kg)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.052

ISHLT

2009


ADULT LUNG TRANSPLANTS (1/1995-6/2007)

Diagnosis = IPFRisk Factors for 1 Year Mortality

RECIPIENT CHARACTERISTICS N Relative

Risk P-value

95% Confidence

Interval

Ventilator 80 1.72 0.0102 1.14 -2.61


Previous pregnancy 602 1.53 0.0001 1.24 -1.89

TRANSPLANT CHARACTERISTICS




Donor CMV+ / Recipient CMV- 492 1.54 <0.0001 1.27 -1.85


(N=2,698)

ISHLT

2009


ADULT LUNG TRANSPLANTS (1/1995-6/2007)

Diagnosis = IPFRisk Factors for 1 Year Mortality


Recipient age

Recipient weight

Donor weight

Bilirubin

Cardiac output (borderline)

Center volume

Oxygen required at rest

FVC (% predicted)

Ischemia time (borderline)

PCO2 (borderline)

ISHLT

2009


ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = IPF

Risk Factors for 1 Year MortalityRecipient Age

0

0.5

1

1.5

2

35 40 45 50 55 60 65

Recipient Age

p < 0.0001

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

ISHLT

2009



Risk Factors for 1 Year MortalityRecipient Weight

0

0.5

1

1.5

2

50 60 70 80 90 100

Recipient Weight (kg)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0029

ISHLT

2009



Risk Factors for 1 Year MortalityDonor Weight

0

0.5

1

1.5

2

50 60 70 80 90 100

Donor Weight (kg)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.028

ISHLT

2009


ADULT LUNG TRANSPLANTS (1/1995-6/2007)Diagnosis = IPF

Risk Factors for 1 Year MortalityRecipient O2 Required at Rest

0

0.5

1

1.5

2

0 1 2 3 4 5 6

O2 Required at Rest (L/min)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0011

ISHLT

2009



Risk Factors for 1 Year MortalityCenter volume

0

0.5

1

1.5

2

5 10 15 20 25 30 35 40 45 50


Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p < 0.0001

ISHLT

2009



Risk Factors for 1 Year MortalityIschemia Time

0

0.5

1

1.5

2

2 3 4 5 6 7

Ischemia time (hours)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.084

ISHLT

2009



Risk Factors for 1 Year MortalityRecipient Bilirubin

0

0.5

1

1.5

2

0 0.5 1 1.5 2

Bilirubin (mg/dl)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.00067

ISHLT

2009



Risk Factors for 1 Year MortalityRecipient FVC (% predicted)

0

0.5

1

1.5

2

25 30 35 40 45 50 55 60 65 70

FVC (% predicted)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.036

ISHLT

2009



Risk Factors for 1 Year Mortality Recipient PCO2 at Transplant

0

0.5

1

1.5

2

30 35 40 45 50 55Recipient PCO2 (mm/Hg)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.062

ISHLT

2009



Risk Factors for 1 Year Mortality Recipient Pre-Transplant Cardiac Output

0

0.5

1

1.5

2

3 4 5 6 7 8

Cardiac output

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.077

ISHLT

2009





95% conf. Interval

IPAH All 302 1.68 0.0104 1.13 -2.51

Alpha-1 antitrypsin deficiency

Single 335 1.37 0.0001 1.17 -1.61

Retransplant All 169 1.33 0.0114 1.07 -1.66

Other* All 352 1.21 0.0294 1.02 -1.43

Cystic fibrosis All 1041 0.82 0.0354 0.68 -0.99

LAM All 71 0.58 0.0184 0.37 -0.91

(N=7,296)ISHLT

*Other = All diagnoses other than COPD, IPAH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, retransplant and LAM.


2009




Risk P-value


Donor history of diabetes 179 1.29 0.01 1.06 -1.58

Donor cause of death = anoxia 352 0.8 0.0087 0.67 -0.94


IV inotropes 67 1.84 0.0001 1.36 -2.49

Ventilator 159 1.32 0.0243 1.04 -1.68


Recipient history of diabetes 507 1.21 0.0044 1.06 -1.38


Chronic steroid use 3401 1.09 0.0209 1.01 -1.16

ISHLT

(N=7,296)

2009




Risk P-value

95% Confidence

Interval

Transplant year = 1995/1996 vs. 2001-2003 1473 1.46 <0.0001 1.33 -1.61




0-3 HLA mismatches vs. 4-6 mismatches 988 0.87 0.048 0.79 -0.96

ISHLT

(N=7,296)

2009



RECIPIENT CHARACTERISTICS N Relative

Risk P-

value

95% Confidence

Interval

Prior pulmonary embolism 60 1.32 0.0817 0.97 -1.82

Not ABO identical 587 1.11 0.0924 0.98 -1.24

Diagnosis = COPD, double lung 736 0.89 0.0767 0.79 -1.01

ISHLT

(N=7,296)

2009




Recipient age


Cardiac output (borderline)

Bilirubin

Recipient oxygen required at rest

Donor age

Recipient height

Height difference

ISHLT

2009



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

ISHLT

2009



Donor Age

0

0.5

1

1.5

2

15 20 25 30 35 40 45 50 55

Donor Age

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.00024

ISHLT

2009



Center Volume

0

0.5

1

1.5

2

5 10 15 20 25 30 35 40 45 50


Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p < 0.0001

ISHLT

2009



Recipient Pre-Transplant Bilirubin

0

0.5

1

1.5

2

2.5

0 0.5 1 1.5 2

Recipient Bilirubin (mg/dl)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.0050

ISHLT

2009



Recipient Oxygen Required at Rest

0

0.5

1

1.5

2

0 1 2 3 4 5 6

Oxygen Required at Rest (L/min)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.0016

ISHLT

2009



Recipient Pre-Transplant Cardiac Output

0

0.5

1

1.5

2

3 4 5 6 7 8

Cardiac output

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.064

ISHLT

2009



Height Difference

0

0.5

1

1.5

2

-10 -5 0 5 10 15 20

Donor height - recipient height (cm)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.018

ISHLT

2009



Recipient Height

0

0.5

1

1.5

2

155 160 165 170 175 180 185 190

Recipient height (cm)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.034

ISHLT

2009


ADULT LUNG TRANSPLANTS (1995-6/2003) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year



95% conf. Interval

Alpha-1 antitrypsin deficiency

Double 222 0.66 0.0051 0.50 -0.88

IPF Double 207 0.66 0.0085 0.49 -0.90

Cystic fibrosis All 823 0.55 <0.0001 0.42 -0.72

Pulmonary Fibrosis (other than IPF)

All 35 0.49 0.0467 0.24 -0.99

LAM All 59 0.48 0.0148 0.27 -0.87

PAH All 194 0.48 0.0003 0.32 -0.71

(N=5,251)ISHLT


2009




Risk P-value


Donor cause of death = cerebrovascular/stroke

1910 1.15 0.0068 1.04 -1.27

Donor cause of death = anoxia 274 0.71 0.0047 0.56 -0.90



Recipient history of diabetes 370 1.3 0.0044 1.08 -1.55

ISHLT

(N=5,251)

2009




Risk P-value

95% Confidence

Interval

Male donor/female recipient 1173 1.16 0.0223 1.02 -1.32

Transplant year = 1997/1998 vs. 2001-2003 1222 1.15 0.0318 1.01 -1.31


Mismatches at HLA A locus, per mismatch 0 A MM (N=332) 1 A MM (N=2899) 2 A MM (N=2220)

1.12 0.0038 1.04 -1.21

POST-TRANSPLANT FACTORS

OB within 1 year post-transplant 371 2.49 <0.0001 2.16 -2.88

Treated for infection by discharge 2169 1.18 0.0005 1.07 -1.29

Rejection within 1 year post-transplant 2798 1.15 0.0037 1.05 -1.26

Induction with IL2R-antagonist 887 0.86 0.0415 0.75 -0.99

ISHLT

(N=5,251)

2009



Conditional on Survival to 1 Year

CHARACTERISTICS N Relative

Risk P-value

95% Confidence

Interval

Recipient with infection requiring IV drug therapy within 2 weeks prior to transplant

501 1.17 0.0744 0.98 -1.40

Not ABO identical 414 1.16 0.0771 0.98 -1.36

Transplant year = 1995/1996 vs. 2001-2003 1035 1.14 0.0548 1.00 -1.31

Clinical infection in donor 955 1.11 0.0727 0.99 -1.25

Diagnosis = Other* 236 0.78 0.0565 0.61 -1.01

Diagnosis = Sarcoidosis, double lung 59 0.65 0.0803 0.40 -1.05

ISHLT

(N=5,251)

2009*Other = All diagnoses other than COPD, IPAH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, retransplant and LAM.


ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year


Recipient age


Height difference (borderline)

Ischemia time (borderline)

ISHLT

2009


ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival

Recipient Age

0

0.5

1

1.5

2

2.5

3

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

ISHLT

2009


ADULT LUNG TRANSPLANTS (1/1995-6/2003)Risk Factors for 5 Year Mortality Conditional on 1 Year Survival

Center Volume

0

0.5

1

1.5

2

5 10 15 20 25 30 35 40 45 50


Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.018

ISHLT

2009



Height Difference

0

0.5

1

1.5

2

-10 -5 0 5 10 15 20

Donor height - recipient height (cm)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.066

ISHLT

2009



Ischemia Time

0

0.5

1

1.5

2

2 3 4 5 6 7

Ischemia time (hours)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.089

ISHLT

2009


ADULT LUNG RECIPIENTSFunctional Status of Surviving Recipients

(Follow-ups: April 1994 – June 2008)

0%

20%

40%

60%

80%

100%

1 Year (N = 6,820) 3 Year (N = 4,333) 5 Year (N = 2,492) 10 Years (N = 422)

No Activity Limitations Performs with Some Assistance Requires Total Assistance

ISHLT

2009


ADULT LUNG RECIPIENTSFunctional Status of Surviving Recipients

(Follow-ups: April 1994 – June 2008)For the Same Patients

0%

20%

40%

60%

80%

100%

1 Year (N = 1,62) 3 Year (N = 1,62) 5 Year (N = 1,623)

No Activity Limitations Performs with Some Assistance Requires Total Assistance

ISHLT

2009


ADULT LUNG RECIPIENTSEmployment Status of Surviving Recipients

(Follow-ups: April 1994 – June 2008)

0%

20%

40%

60%

80%

100%

1 Year (N=8,937) 3 Year (N=5,452) 5 Year (N=3,386) 10 year (N=704)

Working (FT/PTStatus unknown)

Working Part Time

Working Full Time

Retired

Not Working

ISHLT

2009


ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients

(Follow-ups: April 1994 - June 2008)

0%

20%

40%

60%

80%

100%

1 Year (N = 11,633) 3 Year ( N = 7,071) 5 Year (N = 4,395) 10 Year (N=874)

No Hospitalization Hosp: No Rej/No Inf Hosp: Rejection

Hosp: Infection Hosp: Rej/Inf

ISHLT

2009


0

5

10

15

20

25

30

35

40

45

50

55

Any Induction (N =4,020)

Polyclonal ALG/ATG (N= 901)

IL2R-antagonist (N =2,733)

Campath (N = 359)

% o

f p

ati

en

tsADULT LUNG RECIPIENTS

Induction Immunosuppression (Transplants: January 2002 - June 2008)Analysis limited to patients receiving prednisone

ISHLT


2009


0

10

20

30

40

50

60

70

Any Induction PolyclonalALG/ATG

IL2R-antagonist Campath

% o

f p

ati

en

ts

1997 2002 1/2008-6/2008

ADULT LUNG RECIPIENTS Induction Immunosuppression

(Transplants: 1997, 2002 and 1/2008-6/2008) Analysis limited to patients receiving prednisone

ISHLT

Analysis is limited to patients who were alive at the time of the follow-up2009


0

10

20

30

40

50

60

70

20002001

20022003

20042005

20062007

20002001

20022003

20042005

20062007

20002001

20022003

20042005

20062007

20002001

20022003

20042005

20062007

% o

f p

ati

en

ts

ADULT LUNG RECIPIENTSInduction Immunosuppression (Transplants: January 2000 - December 2007)

Analysis limited to patients receiving prednisone

ISHLT

Any Induction Polyclonal ALG/ATG IL2R-antagonist Campath


2009


SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: April 1994-June 2007)

Conditional on survival to 14 days

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al

(%)

No induction (N = 7,282)

Induction (N = 5,209)

p = 0.0055

N at risk = 212

N at risk = 462



ISHLT

2009


SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: January 2000-June 2007)

Conditional on survival to 14 days

0

20

40

60

80

100

0 1 2 3 4 5 6 7

Years

Su

rviv

al

(%)

No induction (N = 4,284)

Induction (N = 3,982)

p = 0.0003

N at risk = 276

N at risk = 230

ISHLT

2009


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine

% o

f P

ati

en

ts

Year 1 (N=6,105) Year 5 (N=2,573)

ADULT LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up

For follow-ups between January 2002 through June 2007 Analysis limited to patients receiving prednisone

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

ISHLT


2009


0

20

40

60

80

100

CyA TAC Rapamycin MMF AZA CyA TAC Rapamycin MMF AZA

% o

f P

atie

nts

1-Year Follow-Up 5-Year Follow-Up

Consecutive bars within each drug type represent follow-ups in 2002, 2003, 2004, 2005, 2006, 2007 & 2008.

ADULT LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up


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


2009


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine

% o

f P

ati

en

ts

2000 (N = 554) 2003 (N =798) July 2007 - June 2008 (N = 1,131)

ADULT LUNG RECIPIENTSMaintenance Immunosuppression at Time of 1 Year Follow-up

(Follow-ups: 2000, 2003, 7/2007 – 6/2008) Analysis limited to patients receiving prednisone

NOTE: Different patients are analyzed in each time frame.

ISHLT


2009


0

20

40

60

80

100

CalcineurinInhibitor

CellCycle Rapamycin CalcineurinInhibitor

CellCycle Rapamycin

% o

f P

ati

en

ts

CyA

Tac Tac

CyA

Rapa Rapa

MMF MMF

AZA AZA

ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up

For follow-ups between January 2002 through June 2008Analysis limited to patients receiving prednisone

1 Year Follow-up (N =6,105) 5 Year Follow-up (N = 2,573)

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

ISHLT


2009


0

20

40

60

80

100

Year 1 (N = 6,105) Year 5 (N = 2,573)

% o

f P

atie

nts

Other

Rapa + Cellcycle

Rapa + Calcineurin

Tacrolimus

Tacrolimus + MMF

Tacrolimus + AZA

Cyclosporine + MMF

Cyclosporine + AZA

ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up


ISHLT


2009


PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION BETWEEN TRANSPLANT DISCHARGE AND 1-YEAR FOLLOW-UP

(Follow-ups: July 1, 2004 - June 30, 2008)

0

10

20

30

40

50

60

% e

xp

eri

en

cin

g r

eje

cti

on

wit

hin

1 y

ea

r

No induction, Treatment No induction, No Treatment

Overall 18-34 35-49 50-59 60-65 66+ Female Male

ISHLT


No comparisons were statistically significant at 0.05

Overall: N = 4,41118-34: N = 62335-49: N = 81050-59: N = 1,56360-65: N = 1,14166+: N = 274Female: N = 2,015 Male: N = 2,396



2009



YEAR FOLLOW-UP Stratified by Type of Induction (Follow-ups: July 1, 2004 - June 30, 2008)

0

10

20

30

40

50

60

% e

xp

eri

en

cin

g r

eje

cti

on

wit

hin

1 y

ea

r

No induction, Treatment No induction, No TreatmentPolyclonal, Treatment Polyclonal, No TreatmentIL2R-antagonist, Treatment IL2R-antagonist, No Treatment

No induction vs. polyclonal (p = 0.642); polyclonal vs. IL2R (p < 0.0001); no induction vs. IL2R (p < 0.0001)

ISHLT

No induction: N = 2,151Polyclonal: N = 361IL2R- antagonist: N = 1,612




2009



Stratified by Type of Induction (Follow-ups: July 1, 2004 - June 30, 2008)

0

10

20

30

40

50

60

70

% e

xp

eri

en

cin

g r

eje

cti

on

wit

hin

1 y

ea

r

No induction, Treatment No induction, No TreatmentPolyclonal, Treatment Polyclonal, No TreatmentIL2R-antagonist, Treatment IL2R-antagonist, No Treatment

18-34 35-49 50-59 60-65 66+ Female Male

ISHLT

18-34: N = 59135-49: N = 76750-59: N = 1,45560-65: N = 1,08566+: N = 226Female: N = 1,881 Male: N = 2,243

18-34: no induct vs. IL2 (p=0.012); poly vs. IL2R (p=0.002); 35-49: no induct vs. IL2 (p=0.041); poly vs. IL2R (p =0.041);50-59: no induct vs. IL2R (p<0.0001); 60-65: no induct vs. IL2R (p=0.007); 66+: poly vs. IL2 (p=0.019).For female: no induct vs. IL2R (p<0.0001)For male: no induct vs.IL2R (p<0.0001); poly vs. IL2R (p = 0.0001)




2009



YEAR FOLLOW-UP Stratified by Maintenance Immunosuppression (Follow-ups: July 1, 2004 - June 30, 2008)

0

10

20

30

40

50

60

70

CyA + MMF, Treatment CyA + MMF, No Treatment CyA + AZA, Treatment CyA + AZA, No Treatment

TAC + MMF, Treatment TAC + MMF, No Treatment TAC + AZA, Treatment TAC + AZA, No Treatment

% e

xper

ien

cin

g r

ejec

tio

n w

ith

in 1

yea

r

All comparisons were statistically significant at 0.01

ISHLT

Cyclosporine + MMF: N = 339 Cyclosporine + AZA: N = 495Tacrolimus + MMF: N = 1,829Tacrolimus + AZA: N = 1,153




2009



Stratified by Maintenance Immunosuppression (Follow-ups: July 1, 2004 - June 30, 2008)

0

10

20

30

40

50

60

70

80

CyA + MMF, Treatment CyA + MMF, No TreatmentCyA + AZA, Treatment CyA + AZA, No TreatmentTAC + MMF, Treatment TAC + MMF, No TreatmentTAC + AZA, Treatment TAC + AZA, No Treatment

% e

xp

eri

en

cin

g r

eje

cti

on

wit

hin

1 y

ea

r

18-34: CyA + AZA vs. TAC + MMF (p<0.0001); CyA + AZA vs. TAC + AZA (p=0.005)35-49: all comparisons are statistically significant at 0.05 except CyA + MMF vs. CyA + AZA and TAC + MMF vs. TAC + AZA 50-59: all comparisons were statistically significant at 0.05 except TAC + MMF vs. TAC + AZA 60-65: all comparisons are statistically significant at 0.05 except CyA + MMF vs. TAC + AZA66+: CyA + AZA vs. TAC + MMF (p <0.0001); CyA + AZA vs. TAC + AZA (p=0.041) ; TAC + MMF vs. TAC + AZA (p=0.012)Females: all comparisons were statistically significant at 0,05 except CyA + MMF vs. TAC + AZA Males: all comparisons were statistically significant at 0.01 except TAC + MMF vs. TAC + AZA

ISHLT

18-34 35-49 50-59 60-65 66+ Female Male




2009


PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION BETWEEN TRANSPLANT DISCHARGE AND 3-YEAR FOLLOW-UP Stratified by Maintenance Immunosuppression (Follow-ups: July 1, 2004 - June 30, 2008)

0

10

20

30

40

50

60

70

80

CyA + MMF, Treatment CyA + MMF, No Treatment CyA + AZA, Treatment CyA + AZA, No Treatment

TAC + MMF, Treatment TAC + MMF, No Treatment TAC + AZA, Treatment TAC + AZA, No Treatment

% e

xper

ien

cin

g r

ejec

tio

n w

ith

in 1

yea

r CyA + MMF vs. CyA + AZA (p < 0.0001); CyA + AZA vs. TAC + MMF (p<0.0001); TAC + MMF vs. TAC + AZA (P<0.0001)

ISHLT

Cyclosporine + MMF: N = 136 Cyclosporine + AZA: N = 212Tacrolimus + MMF: N = 491Tacrolimus + AZA: N = 406

Analysis is limited to patients with rejection or no rejection reported on all three annual follow-ups through 3 years



2009


PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION BETWEEN TRANSPLANT DISCHARGE AND 3-YEAR FOLLOW-UP Stratified by Maintenance Immunosuppression (Follow-ups: July 1, 2004 - June 30, 2008)

0

10

2030

40

50

6070

80

90CyA + MMF, Treatment CyA + MMF, No TreatmentCyA + AZA, Treatment CyA + AZA, No TreatmentTAC + MMF, Treatment TAC + MMF, No TreatmentTAC + AZA, Treatment TAC + AZA, No Treatment

% e

xp

eri

en

cin

g r

eje

cti

on

wit

hin

1 y

ea

r

18-34: CyA + AZA vs. TAC + MMF (p=0.037); CyA + AZA vs. TAC + AZA (p=0.021)35-49: CyA + MMF vs. TAC + AZA (p=0.027); CaA + AZA vs. TAC + MMF (p=0.023); CyA + AZA vs. TAC + AZA (p=0.002)50-59: all comparisons were statistically significant at 0.05 except CyA + MMF vs. TAC + MMF, TAC + MMF vs. TAC + AZA 60-65: CyA + MMF vs. CyA + AZA (p=0.009); CaA + AZA vs. TAC + MMF (p=0.010); CyA + AZA vs. TAC + AZA (p=0.024)66+: CyA + MMF vs. CyA + AZA (p=0.013); CyA + AZA vs. TAC + MMF (p=0.040) ; Females: CyA + MMF vs. CyA + AZA (p=0.002); CyA + AZA vs. TAC + MMF (p<0.001) ; CyA + AZA vs. TAC + AZA (p<0.0001)Males: CyA + MMF vs. CyA + AZA (p=0.003); CyA + AZA vs. TAC + MMF (p<0.001) ; CyA + AZA vs. TAC + AZA (p<0.0001)

ISHLT

18-34 35-49 50-59 60-65 66+ Female Male

Analysis is limited to patients with rejection or no rejection reported on all three annual follow-ups through 3 years



2009


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


Follow-ups: April 1994 –

June 2000 Follow-ups: July 2000- June

2008

Outcome Within 1

Year

Total number with known response

Within 1 Year


Hypertension 49.2% (N = 3,758) 54.2% (N = 7,068)

Renal Dysfunction 23.2% (N = 3,676) 25.9% (N = 7,767)

Abnormal Creatinine < 2.5 mg/dl 12.9% 19.5%

Creatinine > 2.5 mg/dl 8.5% 4.6%

Chronic Dialysis 1.8% 1.6%

Renal Transplant 0.0% 0.1%

Hyperlipidemia 13.1% (N = 3,902) 28.3% (N = 7,654)

Diabetes 16.8% (N = 3,718) 30.7% (N = 7,692)

Bronchiolitis Obliterans Syndrome 10.7% (N = 3,452) 8.9% (N = 7,327)

ISHLT

2009


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

Post-Transplant (Follow-ups: April 1994 - June 2008)

Outcome Within 1 Year Total number with known response

Within 5 Years


Hypertension 52.40% (N = 10,826) 85.20% (N = 2,878)

Renal Dysfunction 25.00% (N = 11,443) 36.60% (N = 3,283)

Abnormal Creatinine < 2.5 mg/dl 17.40% 24.10%

Creatinine > 2.5 mg/dl 5.90% 9.00%

Chronic Dialysis 1.60% 3.00%

Renal Transplant 0.10% 0.50%

Hyperlipidemia 23.20% (N = 11,556) 55.50% (N = 3,196)

Diabetes 26.10% (N = 11,410) 37.00% (N = 3,031)

Bronchiolitis Obliterans Syndrome 9.50% (N = 10,779) 35.30% (N = 2,509)

ISHLT

2009


POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 10 Years Post-Transplant


Outcome Within 10

Years


Hypertension 97.30% (N = 337)

Renal Dysfunction 42.10% (N = 484)

Abnormal Creatinine < 2.5 mg/dl 24.20% Creatinine > 2.5 mg/dl 7.40% Chronic Dialysis 7.60% Renal Transplant 2.90%

Hyperlipidemia 68.50% (N = 410)

Diabetes 37.40% (N = 374)

Bronchiolitis Obliterans Syndrome 50.20% (N = 297)

ISHLT

2009


FREEDOM FROM BRONCHIOLITIS OBLITERANS SYNDROME

For Adult Lung Recipients (Follow-ups: April 1994-June 2008)Conditional on Survival to 14 days

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Years

Freedom from Bronchiolitis ObliteransSyndrome (N = 10,835)


N at risk = 61

% F

ree

do

m f

rom

Bro

nc

hio

litis

O

blit

era

ns

Sy

nd

rom

e

ISHLT

2009


FREEDOM FROM BRONCHIOLITIS OBLITERANS SYNDROME STRATIFIED BY INDUCTION USE

For Adult Lung Recipients (Follow-ups: April 1994-June 2008)Conditional on Survival to 14 days

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Years

No induction (N=5,742)

Induction (N=4,248)

p = 0.0073



N at risk = 40

N at risk = 12

% F

ree

do

m f

rom

Bro

nc

hio

litis

O

blit

era

ns

Sy

nd

rom

e

ISHLT

2009


FREEDOM FROM BRONCHIOLITIS OBLITERANS SYNDROME

Stratified by Donor CMV Status/Recipient CMV StatusFor Adult Lung Recipients (Follow-ups: April 1994-June 2008)

Conditional on Survival to 14 days

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Years

D(-)/R(-) (N=1,725)D(-)/R(+) (N=2,369)D(+)/R(-) (N=1,989)D(+)/R(+) (N=3,628)

N at risk = 16

N at risk = 13

N at risk = 16

N at risk = 21

No p-values were significant at p = 0.05 except D(+)/R(-) vs. D(+)/R(+): p = 0.0174

% F

ree

do

m f

rom

Bro

nc

hio

litis

O

blit

era

ns

Sy

nd

rom

e

ISHLT

2009


FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Adult Lung Recipients (Follow-ups: April 1994-June 2008)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Years

% F

ree

do

m f

rom

Se

ve

re R

en

al

Dy

sfu

nc

tio

n

Freedom from Severe RenalDysfunction (N=11,463)


N at risk = 110

* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant

ISHLT

2009


MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2008)

Malignancy/Type 1-Year Survivors 5-Year Survivors 10-Year Survivors

No Malignancy 11,400 (96.5%) 2,930 (87.4%) 359 (71.9%)

Malignancy (all types combined) 419 (3.5%) 423 (12.6%) 140 (28.1%)

Malignancy Type*

Skin 106 240 89

Lymph 183 69 25

Other 112 137 42

Type Not Reported

18 8 0

* 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; 1), breast (1; 5; 2); prostate (0; 5; 1), cervical (1; 1; 0); liver (1; 1; 1); colon (1; 1; 0). Numbers in parentheses represent the number of reported cases within each time period.

ISHLT

2009


FREEDOM FROM MALIGNANCYFor Adult Lung Recipients (Follow-ups: April 1994-June 2008)

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9 10

Years

% F

ree

fro

m M

ali

gn

an

cy

All malignancy Lymph Skin Other

ISHLT

2009


ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January 1992- June 2008)

CAUSE OF DEATH0-30 Days

(N = 1,621)

31 Days –

1 Year

(N = 3,110)

>1 Year –

3 Years

(N = 2,776)

>3 Years –

5 Years

(N = 1,593)

>5 Years – 10 Years

(N = 1,797)

>10 Years

(N = 392)

BRONCHIOLITIS 6 (0.4%) 143 (4.6%) 702 (25.3%) 460 (28.9%) 444 (24.7%) 75 (19.1%)

ACUTE REJECTION 70 (4.3%) 56 (1.8%) 45 (1.6%) 11 (0.7%) 14 (0.8%) 0

LYMPHOMA 1 (0.1%) 82 (2.6%) 59 (2.1%) 27 (1.7%) 40 (2.2%) 20 (5.1%)

MALIGNANCY, OTHER 3 (0.2%) 85 (2.7%) 175 (6.3%) 134 (8.4%) 180 (10.0%) 33 (8.4%)

CMV 0 92 (3.0%) 27 (1.0%) 5 (0.3%) 3 (0.2%) 0

INFECTION, NON-CMV 324 (20.0%) 1,100 (35.4%) 640 (23.1%) 303 (19.0%) 322 (17.9%) 68 (17.3%)

GRAFT FAILURE 467 (28.8%) 547 (17.6%) 524 (18.9%) 301 (18.9%) 340 (18.9%) 72 (18.4%)

CARDIOVASCULAR 179 (11.0%) 134 (4.3%) 102 (3.7%) 74 (4.6%) 89 (5.0%) 24 (6.1%)

TECHNICAL 129 (8.0%) 67 (2.2%) 18 (0.6%) 6 (0.4%) 12 (0.7%) 7 (1.8%)

OTHER 442 (27.3%) 804 (25.9%) 484 (17.4%) 272 (17.1%) 353 (19.6%) 93 (23.7%)

ISHLT

2009


ADULT LUNG TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death

(Deaths: January 1992 - June 2008)

0

10

20

30

40

50

0-30 Days (N= 1,621 )

31 Days – 1Year (N =

3,110)

>1 Year – 3Years (N=2,776 )

>3 Years – 5Years (N =

1,593 )

>5 Years – 10Years (N=1,797 )

>10 Years (N= 392)

Bronchiolitis Malignancy (non-Lymph/PTLD)

Infection (non-CMV) Graft Failure

Cardiovascular

Pe

rce

nta

ge

of

De

ath

s

ISHLT

2009


ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death Stratified by Donor CMV Status/Recipient CMV Status

(Deaths: January 1992- June 2008)

Donor CMV Status/

Recipient CMV Status

Cause of Death 0-30 Days31 Days –

1 Year

>1 Year –

3 Years

>3 Years –

5 Years>5 Years – 10 Years

>10 Years

D(-)/R(-)

(N=1,272)

BRONCHIOLITIS 1 (0.6%) 21 (6.6%) 78 (24.5%) 61 (32.6%) 53 (23.3%) 7 (14.6%)

INFECTION, NON-CMV 30 (17.0%) 111 (35.1%) 77 (24.2%) 31 (16.6%) 29 (12.8%) 12 (25.0%)

GRAFT FAILURE 53 (30.1%) 64 (20.3%) 67 (21.1%) 43 (23.0%) 46 (20.3%) 9 (18.8%)

D(-)/R(+)

(N=1,927)

BRONCHIOLITIS 3 (1.2%) 24 (5.5%) 115 (25.3%) 80 (25.1%) 103 (27.2%) 15 (17.0%)


GRAFT FAILURE 75 (30.2%) 76 (17.3%) 88 (19.4%) 54 (16.9%) 81 (21.4%) 18 (20.5%)

D(+)/R(-)

(N=1,516)

BRONCHIOLITIS 0 11 (2.3%) 94 (24.3%) 53 (25.1%) 50 (25.8%) 2 (5.4%)


GRAFT FAILURE 60 (29.1%) 94 (19.5%) 81 (20.9%) 49 (23.2%) 46 (23.7%) 6 (16.2%)

D(+)/R(+)

(N=2,833)

BRONCHIOLITIS 1 (0.3%) 38 (5.3%) 179 (24.5%) 117 (26.5%) 101 (21.4%) 17 (19.1%)


GRAFT FAILURE 122 (31.8%) 154 (21.5%) 134 (18.3%) 88 (19.9%) 99 (21.0%) 24 (27.0%)

ISHLT

2009

J Heart Lung Transplant 2009;28: 989-1049 LUNG TRANSPLANTATION Overall ISHLT 2009.

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Transcript of J Heart Lung Transplant 2009;28: 989-1049 LUNG TRANSPLANTATION Overall ISHLT 2009.