LUNG TRANSPLANTATION

LUNG TRANSPLANTATION

Overall

ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

0

500

1000

1500

2000

2500

3000

3500

4000

5 7 38 89204

450

758

9701160

128914121389

15101547 1559

17001784

19742012

2218

2569

279429202981

3278

3519

Total

Bilateral/Double Lung

Nu

mb

er

of

Tra

ns

pla

nts

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.ISHLT 2012

J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

AVERAGE CENTER VOLUMELung Transplants: January 1, 2000 - June 30, 2011

1-4 5-9 10-19 20-29 30-39 40-49 50+0

10

20

30

40

50

60

0

4

8

12

16

20

24

52

3238

26

158 7

Number of centers Percentage of transplants

Average number of lung transplants per year

Nu

mb

er

of

Ce

nte

rs

% o

f T

ran

sp

lan

ts


LUNG TRANSPLANTS Transplant Recipient Age by Year of Transplant

(Transplants: January 1, 1987 – June 30, 2011)

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0%

20%

40%

60%

80%

100%

0

12

24

36

48

60

0-11 12-17 18-34 35-49 50-59 60-65 >65 Median Age

Year of Transplant

% o

f T

ran

sp

lan

ts

Me

dia

n r

ec

ipie

nt

ag

e (

ye

ars

)


AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2011)

0-11 12-17 18-29 30-39 40-49 50-59 60-65 >650

5

10

15

20

25

30

35

Recipient Age

% o

f T

ran

sp

lan

ts


AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA

0-11 12-17 18-29 30-39 40-49 50-59 60-65 >650

5

10

15

20

25

30

35

40

1985-1994 (N = 4,973)

1995-2003 (N = 14,884)

2004-6/2011 (N = 21,742)

Recipient Age

% o

f T

ran

sp

lan

ts

p < 0.0001

Transplants with unknown recipient age were excluded from this tabulation.ISHLT 2012


LUNG TRANSPLANTS Donor Age by Year of Transplant

(Transplants: January 1, 1987 – June 30, 2011)

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0%

20%

40%

60%

80%

100%

0

10

20

30

40

50

0-11 12-17 18-29 30-39 40-49 50-59 60-65 >65 Median Donor Age

Year of Transplant

% o

f T

ran

sp

lan

ts

Med

ian

do

no

r ag

e (y

ears

)


DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS (1/1985-6/2011)

0-11 12-17 18-29 30-39 40-49 50-59 60-65 >650

5

10

15

20

25

30

35

Donor Age

% o

f T

ran

sp

lan

ts


DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS BY ERA

0-11 12-17 18-29 30-39 40-49 50-59 60-65 >650

5

10

15

20

25

30

35

40

1985-1994 (N = 4,524)

1995-2003 (N = 14,623)

2004-6/2011 (N = 21,617)

Donor Age

% o

f T

ran

sp

lan

ts

p < 0.0001

Transplants with unknown donor age were excluded from this tabulation.ISHLT 2012


LUNG TRANSPLANTATION

Adult Recipients


AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS (1/1985-6/2011)

18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 >650

5

10

15

20

Recipient Age

% o

f T

ran

sp

lan

ts


AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA

18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 >650

5

10

15

20

25

1985-1998 (N = 10,223)

1999-6/2011 (N = 29,606)

Recipient Age

% o

f T

ran

sp

lan

ts

p < 0.0001

Median age by era1985-1998 = 48 years1999-6/2011 = 54 years


AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA

18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 >650

5

10

15

20

251985-1994 (N=4,740)1995-2003 (N=14,145)2004-6/2011 (N=20,499)

Recipient Age

% o

f T

ran

sp

lan

ts

p < 0.0001

Median age by era1985-1994 = 47 years1995-2003 = 51 years2004-6/2011 = 55 years


ADULT LUNG TRANSPLANTSKaplan-Meier Survival

(Transplants: January 1994 - June 2010)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 160

25

50

75

100

Bilateral/Double Lung (N=19,566)

Single Lung (N=13,276)

All Lungs (N=32,842)

Years

Su

rviv

al (

%)

Double lung: 1/2-life = 6.7 Years; Conditional 1/2-life = 9.4 YearsSingle lung: 1/2-life = 4.6 Years; Conditional 1/2-life = 6.5 YearsAll lungs: 1/2-life = 5.5 Years; Conditional 1/2-life = 7.7 Years

p < 0.0001


ADULT LUNG TRANSPLANTSIndications (Transplants: January 1995 - June 2011)

Diagnosis SLT (N = 13,271) BLT (N = 20,831) TOTAL (N = 34,102)

COPD/Emphysema 6,048 ( 45.6% ) 5,539 ( 26.6% ) 11,587 ( 34.0% )

Idiopathic Pulmonary Fibrosis 4,430 ( 33.4% ) 3,495 ( 16.8% ) 7,925 ( 23.2% )

Cystic Fibrosis 219 ( 1.7% ) 5,469 ( 26.3% ) 5,688 ( 16.7% )

Alpha-1 741 ( 5.6% ) 1,332 ( 6.4% ) 2,073 ( 6.1% )

Idiopathic Pulmonary Arterial Hypertension 82 ( 0.6% ) 982 ( 4.7% ) 1,064 ( 3.1% )

Pulmonary Fibrosis, Other 498 ( 3.8% ) 659 ( 3.2% ) 1,157 ( 3.4% )

Bronchiectasis 54 ( 0.4% ) 891 ( 4.3% ) 945 ( 2.8% )

Sarcoidosis 251 ( 1.9% ) 614 ( 2.9% ) 865 ( 2.5% )

Re-Transplant: Obliterative Bronchiolitis 259 ( 2.0% ) 254 ( 1.2% ) 513 ( 1.5% )

Connective Tissue Disease 140 ( 1.1% ) 281 ( 1.3% ) 421 ( 1.2% )

Obliterative Bronchiolitis (Not Re-Transplant) 91 ( 0.7% ) 260 ( 1.2% ) 351 ( 1.0% )

LAM 122 ( 0.9% ) 241 ( 1.2% ) 363 ( 1.1% )

Re-Transplant: Not Obliterative Bronchiolitis 166 ( 1.3% ) 191 ( 0.9% ) 357 ( 1.0% )

Congenital Heart Disease 45 ( 0.3% ) 248 ( 1.2% ) 293 ( 0.9% )

Cancer 6 ( 0.0% ) 28 ( 0.1% ) 34 ( 0.1% )

Other 119 ( 0.9% ) 347 ( 1.7% ) 466 ( 1.4% )


ADULT LUNG TRANSPLANTSDistribution of Procedure Type for Major Indications by Year

Year of TX

Alpha-1 COPD Cystic Fibrosis IPF IPAH

Double Single Double Single Double Single Double Single Double Single

1995 45.5 54.5 22.0 78.0 90.2 9.8 28.2 71.8 89.3 10.7

1996 47.3 52.7 27.8 72.2 86.8 13.2 28.1 71.9 81.7 18.3

1997 46.4 53.6 27.5 72.5 92.6 7.4 21.5 78.5 90.3 9.7

1998 48.2 51.8 30.2 69.8 93.6 6.4 19.1 80.9 87.0 13.0

1999 46.6 53.4 28.0 72.0 91.3 8.7 23.3 76.7 86.4 13.6

2000 57.9 42.1 29.2 70.8 94.2 5.8 30.7 69.3 93.0 7.0

2001 59.9 40.1 30.2 69.8 93.9 6.1 31.2 68.8 90.0 10.0

2002 56.1 43.9 38.9 61.1 96.2 3.8 35.0 65.0 88.1 11.9

2003 65.2 34.8 43.2 56.8 95.6 4.4 41.3 58.7 95.6 4.4

2004 73.9 26.1 45.8 54.2 96.3 3.7 44.1 55.9 94.5 5.5

2005 78.0 22.0 49.4 50.6 97.3 2.7 45.9 54.1 92.6 7.4

2006 72.8 27.2 58.4 41.6 98.5 1.5 46.8 53.2 100.0 0

2007 83.6 16.4 63.6 36.4 97.3 2.7 49.1 50.9 94.8 5.2

2008 80.2 19.8 65.6 34.4 98.6 1.4 51.3 48.7 93.9 6.1

2009 86.4 13.6 66.4 33.6 99.8 0.2 51.0 49.0 98.6 1.4

2010 86.2 13.8 70.4 29.6 99.2 0.8 55.2 44.8 95.7 4.3


ADULT LUNG TRANSPLANTS Procedure Type within Indication, by Year

1996

1998

2000

2002

2004

2006

2008

2010

1996

1998

2000

2002

2004

2006

2008

2010

1996

1998

2000

2002

2004

2006

2008

2010

1996

1998

2000

2002

2004

2006

2008

2010

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Bilateral/Double Lung Transplant Single Lung Transplant

% o

f T

ran

sp

lan

ts

AT Def COPD IPF IPAH


ADULT LUNG TRANSPLANTS Indications for Single Lung Transplants


6%

46%

2%

33%

1%

3%

10%

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

*Other includes:

Pulmonary Fibrosis, Other: 3.8%

Sarcoidosis: 1.9%

Bronchiectasis: 0.4%

Congenital Heart Disease: 0.3%

LAM: 0.9%

Connective Tissue Disease: 1.1%

OB (non-ReTx): 0.7%

Miscellaneous: 0.9%


ADULT LUNG TRANSPLANTS Indications for Bilateral/Double Lung Transplants


6%

27%

26%

17% 5%2%

17%

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

*Other includes:

Pulmonary Fibrosis, Other: 3.2%

Sarcoidosis: 2.9%

Bronchiectasis: 4.3%

Congenital Heart Disease: 1.2%

LAM: 1.2%

Connective Tissue Disease: 1.3%

OB (non-ReTx): 1.2%

Miscellaneous: 1.8%%


ADULT LUNG TRANSPLANTSMajor Indications By Year (%)

19901991

19921993

19941995

19961997

19981999

20002001

20022003

20042005

20062007

20082009

20100

20

40

60

80

100 CF IPF COPD Alpha-1 IPAH Re-Tx

Transplant Year

% o

f T

ran

sp

lan

ts


ADULT LUNG TRANSPLANTSMajor Indications By Year (Number)

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

0

250

500

750

1,000

1,250

1,500

1,750

2,000

2,250

2,500

2,750CF IPF COPD Alpha-1 IPAH Re-Tx

Transplant Year

Nu

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of

Tra

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pla

nts


ADULT LUNG TRANSPLANTSAge Distribution By Location

(Transplants: January 2000 – June 2011)

Europe North America Other0%

20%

40%

60%

80%

100%

18-34 years 35-49 years 50-59 years 60-65 years >65 years

% o

f T

ran

sp

lan

ts


ADULT LUNG TRANSPLANTSDiagnosis Distribution By Location(Transplants: January 2000 – June 2011)

0%

20%

40%

60%

80%

100%

Europe North America Other

Other

Sarcoidosis

Re-TX

Pulmonary Fibrosis, Other

IPAH

IPF

CF

COPD

Bronchiectasis

Alpha-1% o

f T

ran

sp

lan

ts


ADULT LUNG TRANSPLANTSDiagnosis Distribution By Location and Era


0%

20%

40%

60%

80%

100%

Alpha-1 Bronchiectasis COPD CF IPF IPAH Pulmonary Fibrosis, Other Re-TX Sarcoidosis

Other

% o

f T

ran

sp

lan

ts

2005 - 6/2011

Europe North America Other

2005 - 6/20112005 - 6/20112000 - 2004 2000 - 2004 2000 - 2004


ADULT LUNG TRANSPLANTS Donor Age Distribution By Location


Europe North America Other0%

20%

40%

60%

80%

100%1-10 11-17 18-34 35-49 50-59 60-65 >65

% o

f D

on

ors


ADULT LUNG TRANSPLANTSKaplan-Meier Survival by Era


0 1 2 3 4 5 6 7 8 9 10 11 12 13 140

20

40

60

80

1001988-1995 (N=5,949)1996-2003 (N=12,632)2004-6/2010 (N=17,715)

Years

Su

rviv

al (

%)

N at risk = 1,055

N at risk = 192

N at risk = 585

1988-1995: 1/2-life = 3.9 Years; Conditional 1/2-life = 7.0 Years1996-2003: 1/2-life = 5.3 Years; Conditional 1/2-life = 7.9 Years2004-6/2010: 1/2-life = 5.9 Years; Conditional 1/2-life = NA

1988-95 vs. 1996-2003: p < 0.00011988-95 vs. 2004-6/2010: p <0.0001 1996-2003 vs. 2004-6/2010: p <0.0001


ADULT LUNG TRANSPLANTSKaplan-Meier Survival by Age Group


0 1 2 3 4 5 6 7 8 9 10 11 12 13 140

20

40

60

80

100

18-34 (N = 6,355)

35-49 (N = 8,860)

50-59 (N = 12,690)

60-65 (N = 6,515)

>65 (N = 1,595)

Years

Su

rviv

al (

%)

HALF-LIFE 18-34: 6.3 Years; 35-49: 6.5 Years; 50-59: 5.2 Years; 60-65: 4.4 Years; >65: 3.6 Years

All pair-wise comparisons are significant at p < 0.05


ADULT LUNG TRANSPLANTSKaplan-Meier Survival by Gender(Transplants: January 1990 - June 2010)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170

20

40

60

80

100

Male (N=19,569)

Female (N=16,445)

Years

Su

rviv

al (

%)

HALF-LIFE Male: 5.1 years; Female: 5.6 years

N at risk at 10 years = 1,342


p < 0.0001

N at risk = 119

N at risk = 102


ADULT LUNG TRANSPLANTSKaplan-Meier Survival by Diagnosis


0 1 2 3 4 5 6 7 8 9 10 11 12 13 140

20

40

60

80

100

Alpha-1 (N=2,490) CF (N=5,608) COPD (N=11,948)

IPF (N=7,540) IPAH (N=1,308) Sarcoidosis (N=849)

Years

Su

rviv

al (

%)

HALF-LIFE Alpha-1: 6.2 Years; CF: 7.5 Years; COPD: 5.3 Years; IPF: 4.4 Years; IPAH: 5.0 Years; Sarcoidosis: 5.3 Years

All comparisons with Alpha-1 and CF are statistically significant at < 0.05

COPD vs. IPF: p < 0.0001


ADULT LUNG TRANSPLANTSKaplan-Meier Survival by Diagnosis Conditional on

Survival to 3 Months (Transplants: January 1990 - June 2010)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 140

20

40

60

80

100

Alpha-1 (N=2,119) CF (N=4,828)

COPD (N=10,315) IPF (N=6,188)

IPAH (N=948) Sarcoidosis (N=687)

Years

Su

rviv

al (

%)

HALF-LIFE Alpha-1: 7.6 Years; CF: 9.0 Years; COPD: 6.0 Years;IPF: 5.8 Years; IPAH: 8.8 Years; Sarcoidosis: 7.0 Years

All comparisons are statistically significant at 0.05 except Alpha-1 vs. COPD and CF vs. IPAH


ADULT LUNG TRANSPLANTSKaplan-Meier Survival by Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 - June 2010)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 140

20

40

60

80

100

Alpha-1 (N=1,860) CF (N=4,217)COPD (N=8,968) IPF (N=5,079)IPAH (N=831) Sarcoidosis (N=573)

Years

Su

rviv

al (

%)

HALF-LIFE Alpha-1: 8.6 Years; CF: 10.4 Years; COPD: 6.8 Years;IPF: 6.8 Years; IPAH: 10.0 Years; Sarcoidosis: 8.4 Years

All comparisons are statistically significant at 0.05 except Alpha-1 vs. Sarcoidosis, CF vs. IPAH and COPD vs. IPF


ADULT LUNG TRANSPLANTS Kaplan-Meier Survival By Procedure Type

(Transplants: January 1990 - June 2010) Diagnosis: Alpha-1 Antitrypsin Deficiency

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

20

40

60

80

100

Alpha-1/Single lung (N=1,086)

Alpha-1/Double lung (N=1,403)

Years

Su

rviv

al (

%)

N at risk = 42

N at risk = 41

N at risk at 10 years = 168


p < 0.0001



(Transplants: January 1990 - June 2010) Diagnosis: Alpha-1 Antitrypsin Deficiency

0 1 2 3 4 5 6 7 8 9 10 11 12 130

20

40

60

80

100

Single Lung, < 50 (N = 471) Double Lung, <50 (N = 714)

Single Lung, 50+ (N = 615) Double Lung, 50+ (N = 869)

Years

Su

rviv

al (

%)

N at risk at 13 years:Single Lung, <50 = 58; Double Lung, <50 = 64; Single Lung, 50+ = 23; Double Lung, 50+ = 13

p = 0.0008



(Transplants: January 1990 - June 2010) Diagnosis: Emphysema/COPD

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

20

40

60

80

100

COPD/Single lung (N=6,797)

COPD/Double lung (N=5,147)

Years

Su

rviv

al (

%)

N at risk = 59

N at risk = 40N at risk at 10 years = 534


p < 0.0001



(Transplants: January 1990 - June 2010) Diagnosis: Emphysema/COPD

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

20

40

60

80

100

<50/Single lung (N=799) <50/Double lung (N=1,091)

50+/Single lung (N=5,998) 50+/Double lung (N=4,056)

Years

Su

rviv

al (

%)

N at risk at 15 years:Single Lung, <50 = 27; Double Lung, <50 = 17; Single Lung, 50+ = 32; Double Lung, 50+ = 23

p < 0.0001



(Transplants: January 1990 - June 2010) Diagnosis: Idiopathic Pulmonary Fibrosis

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

20

40

60

80

100

IPF/Single lung (N=4,481)

IPF/Double lung (N=3,057)

Years

Su

rviv

al (

%)

N at risk = 31

N at risk = 12



p < 0.0001



(Transplants: January 1990 - June 2010) Diagnosis: Idiopathic Arterial Pulmonary Hypertension

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

20

40

60

80

100

IPAH/Single lung (N=271)

IPAH/Double lung (N=1,037)

Years

Su

rviv

al (

%)

N at risk = 20

N at risk = 26



p = 0.0003


ADULT LUNG TRANSPLANTS Kaplan-Meier Survival By Procedure Type and Era

(Transplants: January 1990 - June 2010) Diagnosis: Emphysema/COPD, Single Lung

0 1 2 3 4 5 6 7 8 9 10 11 120

20

40

60

80

100

COPD/Single lung/1990-1997 (N=2,035)

COPD/Single lung/1998-2004 (N=2,941)

COPD/Single lung/2005-6/2010 (N=1,821)

Years

Su

rviv

al (

%)

N at risk = 192

N at risk = 66

N at risk = 210

1990-1997 vs. 1998-2004: p < 0.00011990-1997 vs. 2005-6/2010: p < 0.00011998-2004 vs. 2005-6/2010: p = 0.8250



(Transplants: January 1990 - June 2010) Diagnosis: Emphysema/COPD, Double Lung

0 1 2 3 4 5 6 7 8 9 10 11 120

20

40

60

80

100

COPD/Double lung/1990-1997 (N=576)

COPD/Double lung/1998-2004 (N=1,629)

COPD/Double lung/2005-6/2010 (N=2,942)

Years

Su

rviv

al (

%)

N at risk = 103

N at risk = 34

N at risk = 253

1990-1997 vs. 1998-2004: p = 0.00411990-1997 vs. 2005-6/2010: p = 0.01061998-2004 vs. 2005-6/2010: p = 0.6989



(Transplants: January 1990 - June 2010) Diagnosis: Cystic Fibrosis, Double Lung

0 1 2 3 4 5 6 7 8 9 10 11 120

20

40

60

80

100CF/Double lung/1990-1997 (N=1,100)

CF/Double lung/1998-2004 (N=1,947)

CF/Double lung/2005-6/2010 (N=2,457)

Years

Su

rviv

al (

%)

N at risk = 234

N at risk = 79

N at risk = 225

1990-1997 vs. 1998-2004: p < 0.00011990-1997 vs. 2005-6/2010: p < 0.00011998-2004 vs. 2005-6/2010: p = 0.1703



(Transplants: January 1990 - June 2010) Diagnosis: Idiopathic Pulmonary Fibrosis, Single Lung

0 1 2 3 4 5 6 7 8 9 10 11 120

20

40

60

80

100

IPF/Single lung/1990-1997 (N=944)

IPF/Single lung/1998-2004 (N=1,454)

IPF/Single lung/2005-6/2010 (N=2,083)

Years

Su

rviv

al (

%)

N at risk = 81

N at risk = 28

N at risk = 174

1990-1997 vs. 1998-2004: p = 0.01011990-1997 vs. 2005-6/2010: p = 0.00031998-2004 vs. 2005-6/2010: p = 0.1816



(Transplants: January 1990 - June 2010) Diagnosis: Idiopathic Pulmonary Fibrosis, Double Lung

0 1 2 3 4 5 6 7 8 9 10 110

20

40

60

80

100

IPF/Double lung/1990-1997 (N=254)

IPF/Double lung/1998-2004 (N=750)

IPF/Double lung/2005-6/2010 (N=2,053)

Years

Su

rviv

al (

%)

N at risk = 44

N at risk = 26

N at risk = 147

1990-1997 vs. 1998-2004: p = 0.00061990-1997 vs. 2005-6/2010: p < 0.00011998-2004 vs. 2005-6/2010: p = 0.0082


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

(Transplants: October 1999 – June 2010)

0 1 2 3 4 5 6 7 8 9 100

20

40

60

80

100

D(-)/R(-) (N=2,192)

D(-)/R(+) (N=2,799)

D(+)/R(-) (N=2,892)

D(+)/R(+) (N=4,640)

Years

Su

rviv

al (

%)

D(-)/R(-) vs. D(+)/R(-): p < 0.0001D(-)/R(-) vs. D(+)/R(+): p < 0.0001D(-)/R(+) vs. D(+)/R(-): p < 0.0001D(-)/R(+) vs. D(+)/R(+): p = 0.0006


ADULT LUNG TRANSPLANTS Kaplan-Meier Survival by Era

(Transplants: October 1999 – June 2010) Donor CMV status/Recipient CMV status = D(-)/R(-)

0 1 2 3 4 50

20

40

60

80

100

10/1999-2004 (N=892)

Years

Su

rviv

al (

%)

p = 0.4120



(Transplants: October 1999 – June 2010) Donor CMV status/Recipient CMV status = D(-)/R(+)

0 1 2 3 4 50

20

40

60

80

100

10/1999-2004 (N=1,182)

2005-6/2010 (N=1,617)

Years

Su

rviv

al (

%)

p = 0.7314



(Transplants: October 1999 – June 2010) Donor CMV status/Recipient CMV status = D(+)/R(-)

0 1 2 3 4 50

20

40

60

80

100

10/1999-2004 (N=1,016)

2005-6/2010 (N=1,876)

Years

Su

rviv

al (

%)

p = 0.1570



(Transplants: October 1999 – June 2010) Donor CMV status/Recipient CMV status = D(+)/R(+)

0 1 2 3 4 50

20

40

60

80

100

10/1999-2004 (N=1,751)

2005-6/2010 (N=2,889)

Years

Su

rviv

al (

%)

p = 0.9050


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 2011)

0

10

20

30

40

50

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

% e

xper

ien

cin

g re

ject

ion

wit

hin

1 y

ear

Analysis is limited to patients who were alive at the time of the follow-up No comparisons were statistically significant at 0.05

ISHLT 2012

D(-)/R(-): N = 1,362D(-)/R(+): N = 1,672D(+)/R(-): N = 1,859D(+)/R(+): N = 2,979J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095

PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up

Stratified Donor/Recipient CMV Status (Follow-ups: July 2004 - June 2011)

0

10

20

30

40

50

60D(-)/R(-), Treatment D(-)/R(-), No TreatmentD(-)/R(+), Treatment D(-)/R(+), No TreatmentD(+)/R(-), Treatment D(+)/R(-), No TreatmentD(+)/R(+), Treatment D(+)/R(+), No Treatment

% e

xp

eri

en

cin

g r

eje

cti

on

wit

hin

1 y

ea

r

18-34 35-49 50-59 60-65 >65

No comparisons were statistically significant at 0.05 except D(+)/R(-) vs. D(-)/R(+): 35-49 (p=0.0188) and D(+)/R(-) vs. D(+)/R(+): 35-49 (p=0.0199) and 50-59: (p=0.0078)

Female Male

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

Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.


ADULT LUNG TRANSPLANTS (1/1998-6/2010)

Risk Factors For 1 Year MortalityDIAGNOSIS Procedure

typeN Relative

RiskP-value 95% Confidence

Interval

Retransplant All 526 2.09 <.0001 1.71 - 2.56

IPAH All 376 1.73 0.0003 1.28 - 2.34

Other* All 972 1.68 <.0001 1.38 - 2.03

Sarcoidosis Double 326 1.66 0.0004 1.25 - 2.19

Alpha-1 antitrypsin deficiency Single 272 1.65 0.0002 1.27 - 2.16

Bronchiectasis All 286 1.36 0.0436 1.01 - 1.83

Alpha-1 antitrypsin deficiency Double 447 1.33 0.0307 1.03 - 1.73

Pulmonary Fibrosis (not IPF) All 483 1.32 0.0134 1.06 - 1.65

IPF All 3,906 1.26 0.0064 1.07 - 1.49

COPD/Emphysema Double 2,147 1.20 0.0142 1.04 - 1.39

N = 14,762Reference group = COPD/Emphysema, Single lung

*Other = All diagnoses other than COPD, IPAH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, retransplant and LAM.ISHLT 2012



Risk Factors For 1 Year Mortality

TRANSPLANT CHARACTERISTICS N Relative Risk

P-value 95% Confidence

Interval

Transplant year = 1998/1999 vs. 2009/2010 1,587 2.24 <.0001 1.92 - 2.62




Transplant year = 2006/2007 vs. 2009/2010 2,791 1.23 0.0026 1.08 - 1.41

Donor CMV +/ Recipient CMV - 3,117 1.22 <.0001 1.11 - 1.34

N = 14,762




DONOR CHARACTERISTICS N Relative Risk


Interval

Donor history of diabetes 658 1.52 <.0001 1.29 - 1.79

RECIPIENT CHARACTERISTICS

Recipient on dialysis 65 2.44 <.0001 1.67 - 3.55

Hospitalized (including ICU) 1,718 1.71 <.0001 1.51 - 1.93

Ventilator 599 1.53 <.0001 1.29 - 1.82

N = 14,762



Borderline Significant Risk Factors For 1 Year MortalityRECIPIENT CHARACTERISTICS N Relative

RiskP-value 95%

Confidence Interval

IV inotropes 42 1.50 0.0800 0.95 - 2.38

Diagnosis = Sarcoidosis, single lung 116 1.44 0.0813 0.96 - 2.18

Diagnosis = Cystic Fibrosis 1,928 1.23 0.0816 0.97 - 1.54

Prior transfusion 728 1.17 0.0601 0.99 - 1.38

Donor history of cancer 254 0.75 0.0974 0.53 - 1.05

N = 14,762Reference group = COPD/Emphysema, Single lung




Continuous Factors (see figures)

Recipient age Bilirubin

Transplant center volume Recipient oxygen required at rest

Cardiac output Height difference

Recipient FVC % predicted



Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Age

25 30 35 40 45 50 55 60 650.0

0.5

1.0

1.5

2.0

Recipient Age

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p < 0.0001



Risk Factors For 1 Year Mortality with 95% Confidence Limits Center Volume

5 10 15 20 25 30 35 40 45 500.0

0.5

1.0

1.5

2.0

Center Volume (cases per year)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p < 0.0001



Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Bilirubin

0.0 0.5 1.0 1.5 2.00.0

0.5

1.0

1.5

2.0

Recipient Bilirubin (mg/dl)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0032



Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Oxygen Required at Rest

0 1 2 3 4 5 60.0

0.5

1.0

1.5

2.0

Oxygen Required at Rest (L/min)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p < 0.0001



Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Cardiac Output

3 4 5 6 7 80.0

0.5

1.0

1.5

2.0

Cardiac output

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p < 0.0001



Risk Factors For 1 Year Mortality with 95% Confidence Limits Height Difference

-15 -10 -5 0 5 10 15 200.0

0.5

1.0

1.5

2.0

Donor Height - Recipient Height (cm)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0148



Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient FVC (% predicted)

25 30 35 40 45 50 55 60 65 70 75 800.0

0.5

1.0

1.5

2.0

Recipient FVC (% predicted)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0037



Diagnosis = COPD/EmphysemaRisk Factors For 1 Year Mortality

N = 5,169

RECIPIENT CHARACTERISTICS N Relative Risk

P-value 95% Confidence Interval

Hospitalized (including ICU) 278 2.05 <.0001 1.59 - 2.66

Ventilator 96 1.62 0.0183 1.09 - 2.42

Chronic steroid use 2,296 1.27 0.0010 1.10 - 1.47

TRANSPLANT CHARACTERISTICS

Transplant Year: 1998/1999 vs. 2009/2010 691 1.93 <.0001 1.44 - 2.59

Transplant Year: 2000/2001 vs. 2009/2010 864 1.66 0.0006 1.24 - 2.22


Donor CMV +/ Recipient CMV - 886 1.21 0.0337 1.01 - 1.45



Diagnosis = COPD/EmphysemaRisk Factors For 1 Year Mortality

N = 5,169



Donor history of diabetes 221 1.65 0.0010 1.23 - 2.23

Donor history of cancer 82 0.33 0.0126 0.13 - 0.79

BORDERLINE SIGNIFICANT

Female recipient 2,627 0.86 0.0594 0.73 - 1.01



Diagnosis = COPD/Emphysema Risk Factors For 1 Year Mortality


Recipient age Transplant center volume

Recipient oxygen required at rest Cardiac output

Recipient PCW (borderline)



Diagnosis = COPD/Emphysema Risk Factors For 1 Year Mortality with 95% Confidence Limits

Recipient Age

25 30 35 40 45 50 55 60 650.0

0.5

1.0

1.5

2.0

Recipient Age

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p < 0.0001




Center Volume

5 10 15 20 25 30 35 40 45 500.0

0.5

1.0

1.5

2.0


Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0018




Recipient Oxygen Required at Rest

0 1 2 3 40.0

0.5

1.0

1.5

2.0


Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0039




Recipient Pre-Transplant Cardiac Output

3 4 5 6 7 80.0

0.5

1.0

1.5

2.0

2.5

Cardiac output

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0004




Recipient PCW

5 10 15 200.0

0.5

1.0

1.5

2.0

PCW (mm/Hg)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0659



Diagnosis = IPFRisk Factors For 1 Year Mortality

N = 3,920








Donor CMV +/ Recipient CMV - 808 1.43 <.0001 1.21 - 1.69



Diagnosis = IPFRisk Factors For 1 Year Mortality

N = 3,920




Ventilator 166 1.75 0.0005 1.28 - 2.39

Prior transfusion 124 1.45 0.0320 1.03 - 2.02

Previous pregnancy 775 1.29 0.0217 1.04 - 1.60

BORDERLINE CHARACTERISTICS

Donor cause of death = anoxia 363 0.76 0.0542 0.57 - 1.01



Diagnosis = IPF Risk Factors For 1 Year Mortality


Recipient age PCO2

Transplant center volume Donor height (borderline)

Recipient oxygen required at rest FVC % predicted (borderline)

Bilirubin PA Systolic Pressure (borderline)

Creatinine



Diagnosis = IPF Risk Factors For 1 Year Mortality with 95% Confidence Limits

Recipient Age

35 40 45 50 55 60 650.0

0.5

1.0

1.5

2.0

Recipient Age

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p < 0.0001




Center Volume

5 10 15 20 25 30 35 40 45 500.0

0.5

1.0

1.5

2.0

2.5


Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p < 0.0001




Recipient Oxygen Required at Rest

0 1 2 3 4 5 60.0

0.5

1.0

1.5

2.0


Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0394




Recipient Bilirubin

0.0 0.5 1.0 1.50.0

0.5

1.0

1.5

2.0

Bilirubin (mg/dl)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p < 0.0001




Recipient Creatinine at Transplant

0.50 0.75 1.00 1.25 1.500.0

0.5

1.0

1.5

2.0

Creatinine

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0042




Recipient PCO2

30 35 40 45 50 550.0

0.5

1.0

1.5

2.0

PCO2

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0255




Donor Height

150 160 170 180 1900.0

0.5

1.0

1.5

2.0

Donor Height (cm)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0601




Recipient FVC (% predicted)

25 30 35 40 45 50 55 60 65 700.0

0.5

1.0

1.5

2.0

FVC (% predicted)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0717




Recipient PA Systolic Pressure

10 15 20 25 30 35 40 45 50 55 600.0

0.5

1.0

1.5

2.0

PA Systolic (mm Hg)

Re

lati

ve

Ris

k o

f 1

Ye

ar

Mo

rta

lity

p = 0.0941




N = 8,759

DIAGNOSIS* N Relative Risk


Alpha-1 antitrypsin deficiency, single lung 245 1.30 0.0064 1.08 - 1.56

COPD/Emphysema, double lung 1,119 0.87 0.0183 0.78 - 0.98

Cystic Fibrosis 1,218 0.77 0.0056 0.64 - 0.93

LAM 75 0.52 0.0053 0.33 - 0.82

TRANSPLANT CHARACTERISTICS

Transplant Year: 1998/1999 vs. 2004-2006 1,587 1.35 <.0001 1.23 - 1.47

Transplant Year: 2000/2001 vs. 2004-2006 1,863 1.20 <.0001 1.10 - 1.31

Female recipient/male donor vs. male recipient/male donor 4,170 1.12 0.0247 1.01 - 1.23

Donor CMV +/ Recipient CMV - 1,684 1.11 0.0086 1.03 - 1.20

Female recipient/female donor vs. male recipient/male donor 2,468 0.83 0.0074 0.73 - 0.95

ISHLT 2012

* Reference group = COPD/Emphysema, Single lung




N = 8,759




Donor cause of death = anoxia vs. other* 546 0.83 0.0113 0.72 - 0.96


IV inotropes 37 2.13 0.0002 1.43 - 3.19

Recipient on dialysis 30 1.79 0.0073 1.17 - 2.74

Pulmonary embolism 77 1.46 0.0124 1.09 - 1.97


Prior sternotomy 295 1.29 0.0017 1.10 - 1.51

Recipient history of diabetes 923 1.19 0.0009 1.08 - 1.32

Chronic steroid use 4,150 1.14 <.0001 1.07 - 1.22


Diagnosis = Retransplant 242 1.20 0.0677 0.99 - 1.47

ISHLT 2012 *Other = All causes of death other than anoxia and stroke.

Reference group = COPD/Emphysema, Single lung



Recipient age Cardiac output

Transplant center volume Height difference

Recipient oxygen required at rest PA Systolic Pressure (borderline)

ISHLT 2012





Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient Age

20 25 30 35 40 45 50 55 60 650.0

0.5

1.0

1.5

2.0

Recipient Age

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p < 0.0001




5 10 15 20 25 30 35 40 45 500.0

0.5

1.0

1.5

2.0


Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p < 0.0001



Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient Oxygen Required at Rest

0 1 2 3 4 5 60.0

0.5

1.0

1.5

2.0


Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.0010



Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Cardiac Output

3 4 5 6 7 80.0

0.5

1.0

1.5

2.0

Cardiac output

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.0009




-15 -10 -5 0 5 10 15 200.0

0.5

1.0

1.5

2.0


Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.0462



Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient PA Systolic Pressure

10 15 20 25 30 35 40 45 50 55 600.0

0.5

1.0

1.5

2.0

PA Systolic (mm Hg)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.0829



Risk Factors For 5 Year Mortality Conditional on Survival to 1 Year

N = 6,788ISHLT 2012

DIAGNOSIS Procedure type

N Relative Risk


COPD/Emphysema Double 902 0.79 0.0014 0.68 - 0.91

IPF Double 492 0.73 0.0051 0.59 - 0.91

Sarcoidosis All 188 0.73 0.0424 0.54 - 0.99

Alpha-1 antitrypsin deficiency Double 255 0.63 0.0008 0.48 - 0.82

Cystic Fibrosis All 1,015 0.60 <.0001 0.47 - 0.77

IPAH All 195 0.59 0.0085 0.40 - 0.87

LAM All 66 0.51 0.0138 0.29 - 0.87

Other* Single 104 0.51 0.0018 0.33 - 0.78

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


N = 6,788



Donor cause of death = Anoxia vs. Other* 437 0.76 0.0048 0.63 - 0.92


Pulmonary embolism 51 1.71 0.0119 1.13 - 2.61


History of diabetes 702 1.25 0.0015 1.09 - 1.43

Hospitalized (including ICU) 472 1.23 0.0194 1.03 - 1.47


Ventilator 124 0.65 0.0247 0.45 - 0.95

ISHLT 2012



*Other = All causes of death other than anoxia and stroke.


N = 6,788



Donor CMV +/ Recipient CMV - 1,292 1.12 0.0309 1.01 - 1.24

Female recipient/male donor vs. male recipient/male donor 1,345 1.15 0.0191 1.02 - 1.30

POST-TRANSPLANT CHARACTERISTICS

OB within 1 year post-transplant 496 1.97 <.0001 1.72 - 2.24

Post-transplant dialysis prior to discharge 167 1.51 0.0009 1.18 - 1.93

Rejection between discharge and 1 year 2,911 1.24 <.0001 1.14 - 1.35

Treated for infection by discharge 2,756 1.11 0.0153 1.02 - 1.21

ISHLT 2012




N = 6,788

CHARACTERISTICS N Relative Risk



OKT3 used for induction 89 1.33 0.0832 0.96 - 1.85

Mismatches at HLA A locus, per mismatch

0 A MM = 4221 A MM = 2,9292 A MM = 3,437

1.14 0.0679 0.99 - 1.30

IL-2R antagonist used for induction 1,954 0.91 0.0657 0.82 - 1.01

ISHLT 2012


Borderline Significant Risk Factors For 5 Year Mortality Conditional on Survival to 1 Year



Recipient age PVR

Transplant center volume Height difference (borderline)

Cardiac output

ISHLT 2012





Risk Factors For 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year

Recipient Age

20 25 30 35 40 45 50 55 60 650.0

0.5

1.0

1.5

2.0

2.5

3.0

Recipient Age

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p < 0.0001




Center Volume

5 10 15 20 25 30 35 40 45 500.0

0.5

1.0

1.5

2.0


Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.0010




Recipient Pre-Transplant Cardiac Output

3 4 5 6 7 80.0

0.5

1.0

1.5

2.0

2.5

Cardiac output

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.0168




Recipient PVR

1 2 3 4 5 60.0

0.5

1.0

1.5

2.0

Recipient PVR

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.0296




Height Difference

-15 -10 -5 0 5 10 15 200.0

0.5

1.0

1.5

2.0


Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.0790




N = 5,202

DIAGNOSIS* N Relative Risk


Retransplant 115 1.44 0.0015 1.15 -1.80

Alpha-1 antitrypsin deficiency, single lung 276 1.26 0.0031 1.08 -1.47

COPD/Emphysema, double lung 485 0.82 0.0013 0.72 -0.92

Cystic Fibrosis 744 0.79 0.0120 0.65 -0.95

LAM 51 0.58 0.0096 0.38 -0.88

DONOR CHARACTERISTICS

Donor history of diabetes 119 1.47 0.0002 1.20 -1.80

Donor history of cancer 60 1.38 0.0250 1.04 -1.83

ISHLT 2012

* Reference group = COPD/Emphysema, Single lung




N = 5,202



IV inotropes 54 1.92 <.0001 1.41 - 2.61

Ventilator 126 1.28 0.0458 1.00 - 1.64

Recipient history of diabetes 316 1.25 0.0017 1.09 - 1.44


Hospitalized (including ICU) 412 1.17 0.0371 1.01 - 1.35





N = 5,202



Interval


Donor CMV +/ Recipient CMV - 926 1.18 0.0002 1.08 - 1.28

Not ABO identical 420 1.17 0.0095 1.04 - 1.32

Transplant year = 1997/1998 vs. 2000/2001 1,626 1.10 0.0297 1.01 - 1.20

HLA mismatches, per mismatch

0 MM = 41 MM = 212MM = 1463 MM = 519

4MM = 1,1375 MM = 2,3946 MM = 981

1.06 0.0031 1.02 - 1.09


Donor cause of death = anoxia 239 0.86 0.0772 0.73 - 1.02

Diagnosis = Alpha-1 antitrypsin deficiency, double lung 191 0.82 0.0592 0.67 - 1.01



Recipient age Recipient weight

Transplant center volume Donor height

Donor Age Height difference

ISHLT 2012





Risk Factors For 10 Year Mortality with 95% Confidence LimitsRecipient Age

20 25 30 35 40 45 50 55 60 650.0

0.5

1.0

1.5

2.0

Recipient Age

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

alit

y

p < 0.0001




5 10 15 20 25 30 35 40 45 500.0

0.5

1.0

1.5

2.0


Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

alit

y

p = 0.0002



Risk Factors For 10 Year Mortality with 95% Confidence LimitsDonor Age

15 20 25 30 35 40 45 50 550.0

0.5

1.0

1.5

2.0

Recipient Age

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

alit

y

p = 0.0012



Risk Factors For 10 Year Mortality with 95% Confidence Limits Recipient Weight

50 60 70 80 90 1000.0

0.5

1.0

1.5

2.0

Recipient Weight (kg)

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

alit

y

p = 0.0004



Risk Factors For 10 Year Mortality with 95% Confidence Limits Donor Height

150 160 170 180 1900.0

0.5

1.0

1.5

2.0

Donor Height (cm)

Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

alit

y

p = 0.0005




-15 -10 -5 0 5 10 15 200.0

0.5

1.0

1.5

2.0


Re

lati

ve

Ris

k o

f 1

0 Y

ea

r M

ort

alit

y

p = 0.0406


ADULT LUNG RECIPIENTS Cross-Sectional Analysis

Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2011)

1 Year (N = 6,935) 3 Years (N = 4,448) 5 Years (N = 2,581)0%

20%

40%

60%

80%

100%

No Activity Limitations Performs with Assistance Total Assistance


ADULT LUNG RECIPIENTSFunctional Status of Surviving Recipients

US Recipients Only(Follow-ups: March 2005 – June 2011)

0%

20%

40%

60%

80%

100%

1 Year (N = 7,578)

2 Years (N = 5,972)

3 Years (N = 4,906)

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


ADULT LUNG RECIPIENTSEmployment Status of Surviving Recipients

(Follow-ups: April 1994 – June 2011)

0%

20%

40%

60%

80%

100%

1 Year (N = 11,669)

3 Years (N = 7,276)

5 Years (N = 4,702)

Working (FT/PT Status unknown)

Working Part Time

Working Full Time

Retired

Not Working


ADULT LUNG RECIPIENTSRehospitalization Post-transplant of Surviving Recipients


0%

20%

40%

60%

80%

100%

1 Year (N = 15,839)

3 Years (N = 9,853)

5 Years (N = 6,390)

No Hospitalization Hospitalized, Not Rejection/Not Infection

Hospitalized, Rejection Hospitalized, Infection Only

Hospitalized, Rejection + Infection


ADULT LUNG RECIPIENTSInduction Immunosuppression

Analysis limited to patients receiving prednisone(Transplants: January 2002 – June 2011)

Any Induction (N=6,632)

Polyclonal ALG/ATG (N=1,426)

IL-2R Antagonist (N=4,521)

Alemtuzumab (N=684)

0

10

20

30

40

50

60

% o

f p

ati

en

ts

Analysis is limited to patients who were alive at the time of the dischargeISHLT 2012



Analysis limited to patients receiving prednisone(Transplants: 2002, 2006 and 1/2011–6/2011)

Any Induction Polyclonal ALG/ATG

IL-2R Antagonist Alemtuzumab0

10

20

30

40

50

60

70

2002 2006 1/2011-6/2011

% o

f p

ati

en

ts

Analysis is limited to patients who were alive at the time of the follow-upISHLT 2012



Analysis limited to patients receiving prednisone(Transplants: January 2000 – December 2010)

Analysis is limited to patients who were alive at the time of the discharge

2000

2002

2004

2006

2008

2010

2000

2002

2004

2006

2008

2010

2000

2002

2004

2006

2008

2010

2000

2002

2004

2006

2008

2010

0

10

20

30

40

50

60

70

% o

f p

ati

en

ts

Any Induction Polyclonal ALG/ATG IL-2R Antagonist Alemtuzumab


ADULT LUNG RECIPIENTS Survival by Induction Usage Conditional on Survival to 14 Days

(Transplants: April 1994 – June 2010)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

25

50

75

100

No induction (N = 9,020)

Induction (N = 7,775)

Years

Su

rviv

al (

%) N at risk at 5 years = 2,350

N at risk = 87

N at risk = 37

p < 0.0001



ADULT LUNG RECIPIENTS Survival by Induction Usage Conditional on Survival to 14 Days


0 1 2 3 4 5 6 7 8 9 100

25

50

75

100

No induction (N = 6,027)

Induction (N = 6,574)

Years

Su

rviv

al (

%)


N at risk = 153

N at risk = 143

p < 0.0001



ADULT LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up

Analysis limited to patients receiving prednisone(Follow-ups: January 2002 – June 2011)

Cyclosporine Tacrolimus Sirolimus/ Everolimus

MMF/MPA Azathioprine0

20

40

60

80

100

Year 1 (N = 9,801) Year 5 (N = 4,147)

% o

f p

ati

en

ts

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

Analysis is limited to patients who were alive at the time of the follow-upISHLT 2012


Analysis is limited to patients who were alive at the time of the discharge

CyA TAC Sirolimus/

Everolimus

MMF/MPA

AZA CyA TAC Sirolimus/

Everolimus

MMF/MPA

AZA0

20

40

60

80

100

% o

f p

ati

en

ts

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, 2009, 2010 & 2011.

ADULT LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up




ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of 1 Year Follow-up

Analysis limited to patients receiving prednisone(Follow-ups: 2002, 2006 and 7/2010–6/2011)

Cyclosporine Tacrolimus Sirolimus/Everolimus

MMF/MPA

Azathioprine0

20

40

60

80

1002002 (N = 732) 2006 (N = 1,099) 7/2010-6/2011 (N = 1,352)

% o

f p

ati

en

ts


NOTE: Different patients are analyzed in each time frame


ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up


Cal-cineurin Inhibitor

CellCycle Sirolimus/Everolimu

s

Cal-cineurin Inhibitor

CellCycle Sirolimus/Everolimu

s

0

20

40

60

80

100

% o

f p

ati

en

ts


Tac

CyA

Tac

CyAAZA AZA

MMF/MPA

MMF

1 Year Follow-up (N = 9,801) 5 Year Follow-up (N = 4,147)



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


0%

20%

40%

60%

80%

100%

Year 1 (N = 9,801)

Year 5 (N = 4,147)

Other

Sirolimus/Everolimus + Calcineurin + Cellcycle

Sirolimus/Everolimus + Cellcycle

Sirolimus/Everolimus + Calcineurin

Tacrolimus

Tacrolimus + MMF/MPA

Tacrolimus + AZA

Cyclosporine + MMF/MPA

Cyclosporine + AZA

% o

f P

ati

en

ts




ADULT LUNG RECIPIENTSKaplan-Meier Survival by Maintenance Immunosuppression

Combinations Conditional on Survival to 1 Year (Transplants: January 2000 – June 2010)

Analysis limited to patients receiving prednisone

0 1 2 3 4 5 6 7 8 9 100

25

50

75

100

Tacrolimus + MMF/MPA use at discharge and 1 year (N=3,137)

Tacrolimus + AZA use at discharge and 1 year (N=1,381)

Cyclosporine + MM/MPA use at discharge and 1 year (N=453)

Cyclosporine + AZA use at discharge and 1 year (N=498)

Years

Su

rviv

al (

%)

p = 0.0001




Analysis limited to patients receiving prednisone Diagnosis: COPD/Emphysema

0 1 2 3 4 5 6 7 8 90

25

50

75

100

Tacrolimus + MMF/MPA use at discharge and 1 year (N=974)

Tacrolimus + AZA use at discharge and 1 year (N=482)



Years

Su

rviv

al (

%)

p = 0.0121




Analysis limited to patients receiving prednisone Diagnosis: Idiopathic Pulmonary Fibrosis

0 1 2 3 4 5 6 70

25

50

75

100

Tacrolimus + MMF/MPA use at discharge and 1 year (N=961)

Tacrolimus + AZA use at discharge and 1 year (N=397)



Years

Su

rviv

al (

%)

p = 0.0389




Analysis limited to patients receiving prednisone Diagnosis: Cystic Fibrosis

0 1 2 3 4 5 6 70

25

50

75

100

Tacrolimus + MMF/MPA use at discharge and 1 year (N=468)Tacrolimus + AZA use at discharge and 1 year (N=180)Cyclosporine + MM/MPA use at discharge and 1 year (N=39)Cyclosporine + AZA use at discharge and 1 year (N=78)

Years

Su

rviv

al (

%)

p = 0.3808


PERCENTAGE OF ADULT LUNG RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up

(Follow-ups: July 2004 – June 2011)

0

10

20

30

40

50

60Rejection, Treatment Rejection, No Treatment

Overall: N = 8,55318-34: N = 1,13335-49: N = 1,45950-59: N = 2,75160-65: N = 2,28666+: N = 924Female: N = 3,721 Male: N = 4,832

% e

xper

ien

cin

g re

ject

ion

wit

hin

1

year

18-34 35-49 50-59 60-65 >65 Female Male



All comparisons with 18-34 are statistically significant at < 0.05

Overall



Stratified by Type of Induction (Follow-ups: July 2004 – June 2011)

0

10

20

30

40

50

60

No induction, Treatment No induction, No Treatment Polyclonal, Treatment

Polyclonal, No Treatment IL-2R Antagonist, Treatment IL-2R Antagonist, No Treatment

Alemtuzumab, Treatment Alemtuzumab, No Treatment

No induction: N = 3,809Polyclonal: N = 868IL-2R Antagonist: N = 3,254Alemtuzumab: N = 575

% e

xper

ien

cin

g re

ject

ion

wit

hin

1

year



No induction vs. IL-2R: p = 0.0030Polyclonal vs. IL-2R: p = 0.0441 IL-2R vs. Alemtuzumab: p = 0.0014



Stratified by Type of Induction (Follow-ups: July 1, 2004 – June 30, 2011)

0

10

20

30

40

50

60

70 No induction, Treatment No induction, No TreatmentPolyclonal, Treatment Polyclonal, No TreatmentIL-2R Antagonist, Treatment IL-2R Antagonist, No TreatmentAlemtuzumab, Treatment Alemtuzumab, No Treatment

% e

xp

eri

en

cin

g r

eje

cti

on

wit

hin

1 y

ea

r

18-34 (N=1,129) 35-49 (N=1,453) 50-59 (N=2,731) 60-65 (N=2,274) >65 (N=919)

18-34: Polyclonal vs. IL-2R (p=0.0035); IL-2R vs. Alemtuzumab (p=0.0062)35-49: No induction vs. Alemtuzumab (p=0.0183); IL-2R vs. Alemtuzumab (p=0.0126)50-59: No induction vs. Polyclonal (p=0.0113); No induction vs. IL-2R (p=0.0220); Polyclonal vs. Alemtuzumab (p=0.0024); IL-2R vs. Alemtuzumab (p=0.0067)66+: No induct vs. Polyclonal (p=0.0002); Polyclonal vs. IL-2R (p=0.0014); Polyclonal vs. Alemtuzumab (p=0.0119)





Stratified by Type of Induction (Follow-ups: July 1, 2004 – June 30, 2011)

0

10

20

30

40

50

60

70 No induction, Treatment No induction, No TreatmentPolyclonal, Treatment Polyclonal, No TreatmentIL-2R Antagonist, Treatment IL-2R Antagonist, No TreatmentAlemtuzumab, Treatment Alemtuzumab, No Treatment

% e

xp

eri

en

cin

g r

eje

cti

on

wit

hin

1 y

ea

r

Female (N=3,705) Male (N=4,801)

Female: No induction vs. Alemtuzumab (p=0.0120); Polyclonal vs. Alemtuzumab (p=0.0212); IL-2R vs. Alemtuzumab (p=0.0008)Male: No induction vs. IL-2R (p=0.0093); Polyclonal vs. IL-2R (p=0.0331)





Stratified by Maintenance Immunosuppression(Follow-ups: July 2004 – June 2011)

0

10

20

30

40

50

60

70

CyA + MMF/MPA, Treatment CyA + MMF/MPA, No Treatment CyA + AZA, Treatment

CyA + AZA, No Treatment TAC + MMF/MPA, Treatment TAC + MMF/MPA, No Treatment

TAC + AZA, Treatment TAC + AZA, No Treatment

Cyclosporine + MMF/MPA: N = 454Cyclosporine + AZA: N = 668Tacrolimus + MMF/MPA: N = 4,328Tacrolimus + AZA: N = 2,137

% e

xper

ien

cin

g re

ject

ion

wit

hin

1

year



All comparisons are statistically significant at p < 0.0001 except CyA + MMF/MPA vs. TAC + AZA (p=0.1521)



Stratified by Maintenance Immunosuppression (Follow-ups: July 1, 2004 – June 30, 2011)

0

10

20

30

40

50

60

70

80

90 CyA + MMF/MPA, Treatment CyA + MMF/MPA, No TreatmentCyA + AZA, Treatment CyA + AZA, No TreatmentTAC + MMF/MPA, Treatment TAC + MMF/MPA, 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 (N=1,009) 35-49 (N=1,297) 50-59 (N=2,428) 60-65 (N=2,039) >65 (N=814)

All age groups: all comparisons with CyA + AZA are significant at 0.05; all TAC + MMF/MPA vs. TAC + AZA comparisons are significant at 0.05 except 35-49.35-49: CyA + MMF/MPA vs. TAC + MMF/MPA ( p=0.0230); CyA + MMF/MPA vs. TAC + AZA (p=0.0426) 50-59: CyA + MMF/MPA vs. TAC + MMF/MPA (p=0.0013) 60-65: CyA + MMF/MPA vs. TAC + MMF/MPA (p=0.0035)






0

10

20

30

40

50

60

70

80


% e

xp

eri

en

cin

g r

eje

cti

on

wit

hin

1 y

ea

r

Female (N=3,318) Male (N=4,269)

All comparisons are statistically significant at 0.001 except CyA + MMF/MPA vs. TAC + AZA (female: p=0.4533; male: p=0.2053)





Stratified by Maintenance Immunosuppression(Follow-ups: July 2004 – June 2011)

0

10

20

30

40

50

60

70

80

CyA + MMF/MPA, Treatment CyA + MMF/MPA, No Treatment CyA + AZA, Treatment

CyA + AZA, No Treatment TAC + MMF/MPA, Treatment TAC + MMF/MPA, No Treatment

TAC + AZA, Treatment TAC + AZA, No Treatment

Cyclosporine + MMF/MPA: N = 238Cyclosporine + AZA: N = 385Tacrolimus + MMF/MPA: N = 1,888Tacrolimus + AZA: N = 1,135

% e

xper

ien

cin

g re

ject

ion

wit

hin

3

year

s

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


All comparisons with CyA + AZA are significant at p < 0.0001




0

10

20

30

40

50

60

70

80

90


% e

xp

eri

en

cin

g r

eje

cti

on

wit

hin

1 y

ea

r

18-34 35-49 50-59 60-65 >65

All age groups and genders: all comparisons with CyA + AZA are significant at 0.05 except CyA+ MMF/MPA vs. CyA + AZA for 35-49 and 66+ groups

Female Male

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



POST-LUNG TRANSPLANT MORBIDITY FOR ADULTSCumulative Morbidity Rates in Survivors within 1 Year Post-Transplant

(Follow-ups: April 1994 - June 2011)

Outcome

Follow-ups: April 1994 – June 2003

Follow-ups: July 2003– June 2011

Within 1 Year

Total number

with known response

Within 1 Year

Total number

with known response

Hypertension 50.8% (N = 6,021) 52.9% (N = 7,983)

Renal Dysfunction 26.1% (N = 6,012) 22.2% (N = 9,641)

Abnormal Creatinine < 2.5 mg/dl 15.8% 16.9%

Creatinine > 2.5 mg/dl 8.3% 3.7%

Chronic Dialysis 1.9% 1.5%

Renal Transplant 0.0% 0.1%

Hyperlipidemia 16.5% (N = 6,293) 31.4% (N = 8,428)

Diabetes 20.1% (N = 5,987) 28.9% (N = 9,607)

Bronchiolitis Obliterans Syndrome 9.4% (N = 5,623) 9.5% (N = 9,096)


POST-LUNG TRANSPLANT MORBIDITY FOR ADULTSCumulative Morbidity Rates in Survivors within 1 and 5 Years

Post-Transplant (Follow-ups: April 1994 - June 2011)

Outcome Within 1 Year

Total number

with known response

Within 5 Years

Total number

with known response

Hypertension 52.0% (N = 14,004) 82.9% (N = 4,098)

Renal Dysfunction 23.7% (N = 15,653) 56.1% (N = 4,895)

Abnormal Creatinine < 2.5 mg/dl 16.5% 36.7%

Creatinine > 2.5 mg/dl 5.4% 15.5%

Chronic Dialysis 1.7% 3.2%

Renal Transplant 0.1% 0.8%

Hyperlipidemia 25.0% (N = 14,721) 57.9% (N = 4,443)

Diabetes 25.5% (N = 15,594) 40.5% (N = 4,831)

Bronchiolitis Obliterans Syndrome 9.5% (N = 14,719) 38.9% (N = 4,099)


POST-LUNG TRANSPLANT MORBIDITY FOR ADULTSCumulative Morbidity Rates in Survivors within 10 Years Post-Transplant

(Follow-ups: April 1994 - June 2011)

Outcome Within 10 Years

Total number with known response

Renal Dysfunction 75.4% (N = 855)

Abnormal Creatinine < 2.5 mg/dl 40.6%

Creatinine > 2.5 mg/dl 20.5%

Chronic Dialysis 9.0%

Renal Transplant 5.4%

Bronchiolitis Obliterans Syndrome 61.6% (N = 614)


Freedom from Bronchiolitis Obliterans SyndromeFor Adult Lung Recipients (Follow-ups: April 1994 – June 2011)

Conditional on Survival to 14 days

0 1 2 3 4 5 6 7 8 9 10 11 12 13 140

20

40

60

80

100

Freedom from Bronchiolitis Oblit-erans Syndrome (N = 14,762)

Years

% F

ree

fro

m B

ron

ch

iolit

is O

blit

-e

ran

s S

yn

dro

me

N at risk = 30



Freedom from Bronchiolitis Obliterans SyndromeStratified by Age Group

For Adult Lung Recipients (Follow-ups: April 1994 – June 2011)Conditional on Survival to 14 days

0 1 2 3 4 5 6 7 8 9 100

20

40

60

80

100

18-34 (N = 2,091) 35-49 (N = 3,137)

50-59 (N = 5,110) 60-65 (N = 3,373)

>65 (N = 1,051)

Years

% F

ree

fro

m B

ron

ch

iolit

is O

blit

-e

ran

s S

yn

dro

me

p = 0.1362


Freedom from Bronchiolitis Obliterans SyndromeStratified by Diagnosis


0 1 2 3 4 5 6 7 8 9 100

20

40

60

80

100

Alpha-1 (N=863) CF (N=2,104)

COPD (N=5,410) IPF (N=3,587)

IPAH (N=420) Sarcoidosis (N=425)

Years

% F

ree

fro

m B

ron

ch

iolit

is O

blit

-e

ran

s S

yn

dro

me

p < 0.0001


Freedom from Bronchiolitis Obliterans SyndromeStratified by Induction Use


0 1 2 3 4 5 6 7 8 9 10 11 120

20

40

60

80

100No induction (N = 7,274)Induction (N = 6,523)

Years

% F

ree

fro

m B

ron

ch

iolit

is O

blit

-e

ran

s S

yn

dro

me

N at risk = 49

N at risk = 21N at risk at 5 years = 1,136


p = 0.0002


Freedom from Bronchiolitis Obliterans SyndromeStratified by Induction Use

For Adult Lung Recipients (Follow-ups: April 1994 – June 2011)Conditional on Survival to 1 Year

0 1 2 3 4 5 6 7 8 9 10 11 120

20

40

60

80

100No induction (N = 6,462)Induction (N = 5,841)

Years

% F

ree

fro

m B

ron

ch

iolit

is O

blit

-e

ran

s S

yn

dro

me

N at risk = 49

N at risk = 21N at risk at 5 years = 1,136


p = 0.0004


Freedom from Bronchiolitis Obliterans SyndromeStratified by Donor CMV Status/Recipient CMV Status

For Adult Lung Recipients (Follow-ups: April 1994 – June 2011)Conditional on Survival to 14 Days

0 1 2 3 4 5 6 7 8 9 10 11 120

20

40

60

80

100

D(-)/R(-) (N = 2,352) D(-)/R(+) (N = 3,134)

D(+)/R(-) (N = 2,915) D(+)/R(+) (N = 4,999)

Years

% F

ree

fro

m B

ron

ch

iolit

is O

blit

-e

ran

s S

yn

dro

me

N at risk = 17

N at risk = 30

N at risk = 14

N at risk = 17

No p-values are significant at p < 0.05 except D(-)/R(-) vs. D(+)/R(-): p = 0.0098D(-)/R(+) vs. D(+)/R(+): p = 0.0265D(+)/R(-) vs. D(+)/R(+): p = 0.0010


Freedom from Bronchiolitis Obliterans SyndromeStratified by Donor CMV Status/Recipient CMV Status

For Adult Lung Recipients (Follow-ups: April 1994 – June 2011)Conditional on Survival to 1 Year

0 1 2 3 4 5 6 7 8 9 10 11 120

20

40

60

80

100

D(-)/R(-) (N = 2,106) D(-)/R(+) (N = 2,811)

D(+)/R(-) (N = 2,523) D(+)/R(+) (N = 4,471)

Years

% F

ree

fro

m B

ron

ch

iolit

is O

blit

-e

ran

s S

yn

dro

me

N at risk = 17

N at risk = 30

N at risk = 14

N at risk = 17

No p-values are significant at p = 0.05 except D(-)/R(-) vs. D(+)/R(-): p = 0.0102D(-)/R(+) vs. D(+)/R(+): p = 0.0194D(+)/R(-) vs. D(+)/R(+): p = 0.0013


Freedom from Severe Renal Dysfunction* For Adult Lung Recipients (Follow-ups: April 1994 – June 2011)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 140

20

40

60

80

100

Freedom from Severe Re-nal Dysfunction (N=15,661)

Years

% F

ree

fro

m S

ev

ere

Re

na

l Dy

s-

fun

cti

on

N at risk = 60


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


Freedom from Severe Renal Dysfunction* For Adult Lung Recipients (Follow-ups: April 1994 – June 2011)

Conditional on Survival to 1 Year

0 1 2 3 4 5 6 7 8 9 10 11 12 13 140

20

40

60

80

100

Freedom from Severe Renal Dysfunction (N=13,866)

Years

% F

ree

fro

m S

ev

ere

Re

na

l Dy

s-

fun

cti

on

N at risk = 60




Freedom from Severe Renal Dysfunction* by Maintenance Immunosuppression Combinations at Discharge

For Adult Lung Recipients (Transplants: January 2000 – June 2010)Analysis limited to patients receiving prednisone

Conditional on Survival to 14 Days

0 1 2 3 4 5 6 7 8 90

20

40

60

80

100

TAC+MMF/MPA (N = 4,798) TAC+AZA (N = 2,671)

CyA+MMF/MPA (N = 956) CyA+AZA (N = 1,464)

Years

% F

ree

fro

m S

ev

ere

Re

na

l Dy

s-

fun

cti

on


p < 0.0001


MALIGNANCY POST-LUNG TRANSPLANT FOR ADULTSCumulative Morbidity Rates in Survivors


Malignancy/Type 1-Year Survivors

5-Year Survivors

10-Year Survivors

No Malignancy 15,493 (96.5%) 4,485 (85.9%) 713 (72.8%)

Malignancy (all types combined) 563 (3.5%) 739 (14.1%) 267 (27.2%)

Malignancy Type*

Skin 169 486 182

Lymphoma 222 82 35

Other 148 199 81

Type Not Reported 24 9 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; 0), 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.


Freedom from MalignancyFor Adult Lung Recipients (Follow-ups: April 1994 – June 2011)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

20

40

60

80

100

All malignancy Lymphoma Skin Other

Years

% F

ree

fro

m M

alig

na

nc

y


Freedom from MalignancyFor Adult Lung Recipients (Follow-ups: April 1994 – June 2011)

Conditional on Survival to 1 Year

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150

20

40

60

80

100

All malignancy Lymphoma Skin Other

Years

% F

ree

fro

m M

alig

na

nc

y


ADULT LUNG TRANSPLANT RECIPIENTSCause of Death (Deaths: January 1992 – June 2011)

CAUSE OF DEATH 0-30 Days (N = 2,504)

31 Days - 1 Year

(N = 4,347)

>1 Year - 3 Years

(N = 3,910)

>3 Years - 5 Years

(N = 2,217)

>5 Years – 10 Years (N = 2,615)

>10 Years (N = 756)

BRONCHIOLITIS 8 (0.3%) 199 (4.6%) 1,018 (26.0%) 647 (29.2%) 659 (25.2%) 157 (20.8%)

ACUTE REJECTION 89 (3.6%) 77 (1.8%) 59 (1.5%) 11 (0.5%) 16 (0.6%) 1 (0.1%)

LYMPHOMA 1 (0.0%) 109 (2.5%) 82 (2.1%) 36 (1.6%) 60 (2.3%) 30 (4.0%)

MALIGNANCY, NON-LYMPHOMA

3 (0.1%) 117 (2.7%) 273 (7.0%) 218 (9.8%) 324 (12.4%) 90 (11.9%)

CMV 0 108 (2.5%) 38 (1.0%) 7 (0.3%) 4 (0.2%) 1 (0.1%)

INFECTION, NON-CMV 503 (20.1%) 1,561 (35.9%) 894 (22.9%) 434 (19.6%) 472 (18.0%) 127 (16.8%)

GRAFT FAILURE 652 (26.0%) 740 (17.0%) 727 (18.6%) 403 (18.2%) 466 (17.8%) 132 (17.5%)

CARDIOVASCULAR 268 (10.7%) 195 (4.5%) 154 (3.9%) 106 (4.8%) 133 (5.1%) 50 (6.6%)

TECHNICAL 262 (10.5%) 146 (3.4%) 35 (0.9%) 15 (0.7%) 25 (1.0%) 8 (1.1%)

OTHER 718 (28.7%) 1,095 (25.2%) 630 (16.1%) 340 (15.3%) 456 (17.4%) 160 (21.2%)

ISHLT 2012 Percentages represent % of deaths in the respective time period


ADULT LUNG TRANSPLANT RECIPIENTS Relative Incidence of Leading Causes of Death

(Deaths: January 1992 - June 2011)

0-30 Days (N=2,504)

31 Days – 1 Year (N=4,347)

>1 Year – 3 Years

(N=3,910)

>3 Years – 5 Years

(N=2,217)

>5 Years – 10 Years

(N=2,615)

>10 Years (N=756)

0

10

20

30

40

50Bronchiolitis Malignancy (non-Lymph/PTLD)Infection (non-CMV) Graft FailureCardiovascular

% o

f D

ea

ths


ADULT LUNG TRANSPLANT RECIPIENTSCause of Death Stratified by Donor CMV Status/Recipient CMV Status

(Deaths: January 1992 – June 2011)

ISHLT 2012

Donor CMV Status/

Recipient CMV Status

CAUSE OF DEATH

0-30 Days 31 Days - 1 Year

>1 Year - 3 Years

>3 Years - 5 Years

>5 Years – 10 Years >10 Years

D(-)/R(-)(N=1,572)

BRONCHIOLITIS 1 (0.6%) 24 (6.4%) 101 (24.9%) 78 (32.0%) 69 (24.8%) 19 (20.9%)

INFECTION, NON-CMV 31 (17.4%) 134 (35.6%) 96 (23.7%) 41 (16.8%) 39 (14.0%) 12 (13.2%)

GRAFT FAILURE 50 (28.1%) 69 (18.4%) 80 (19.8%) 49 (20.1%) 51 (18.3%) 18 (19.8%)

D(-)/R(+)(N=2,350)

BRONCHIOLITIS 3 (1.1%) 29 (5.6%) 148 (27.2%) 95 (24.5%) 132 (27.1%) 33 (23.9%)


GRAFT FAILURE 79 (28.4%) 87 (16.9%) 103 (18.9%) 64 (16.5%) 96 (19.7%) 23 (16.7%)

D(+)/R(-)(N=2,076)

BRONCHIOLITIS 0 20 (3.2%) 128 (23.3%) 70 (25.2%) 79 (25.5%) 7 (9.3%)


GRAFT FAILURE 64 (26.8%) 125 (20.0%) 115 (20.9%) 60 (21.6%) 73 (23.5%) 15 (20.0%)

D(+)/R(+)(N=3,628)

BRONCHIOLITIS 1 (0.2%) 45 (5.2%) 242 (25.6%) 157 (27.6%) 147 (23.3%) 31 (17.9%)


GRAFT FAILURE 134 (30.6%) 193 (22.1%) 179 (18.9%) 111 (19.5%) 128 (20.3%) 37 (21.4%)


LUNG TRANSPLANTATION

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