Slide 1

LUNG TRANSPLANTATION Overall 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 2 NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE NOTE: This figure includes only the lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as representing changes in the number of lung transplants performed worldwide. ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 3 AVERAGE CENTER VOLUME Lung Transplants: January 1, 2000 - June 30, 2010 ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 4 DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Lung Transplants: January 1, 2000 - June 30, 2010 ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 5 LUNG TRANSPLANTS: Transplant Recipient Age by Year of Transplant Transplants: January 1, 1987 June 30, 2010 ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 6 AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 7 AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA Transplants with unknown recipient age were excluded from this tabulation. ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 8 LUNG TRANSPLANTS: Donor Age by Year of Transplant Transplants: January 1, 1987 June 30, 2010 ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 9 DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS (1/1985-6/2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 10 DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS BY ERA Transplants with unknown donor age were excluded from this tabulation. ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 11 LUNG TRANSPLANTATION Adult Recipients ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 12 AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS (1/1985-6/2010) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 13 AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 14 AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 15 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1994 - June 2009) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 16 ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2010) DIAGNOSISSLT (N = 12,339)BLT (N = 18,334)TOTAL (N = 30,673) COPD/Emphysema5,769 ( 46.8% )4,839 ( 26.4% )10,608 ( 34.6% ) Idiopathic Pulmonary Fibrosis3,995 ( 32.4% )2,938 ( 16.0% )6,933 ( 22.6% ) Cystic Fibrosis214 ( 1.7% )4,941 ( 26.9% )5,155 ( 16.8% ) Alpha-1728 ( 5.9% )1,225 ( 6.7% )1,953 ( 6.4% ) Idiopathic Pulmonary Arterial Hypertension78 ( 0.6% )894 ( 4.9% )972 ( 3.2% ) Pulmonary Fibrosis, Other424 ( 3.4% )537 ( 2.9% )961 ( 3.1% ) Bronchiectasis50 ( 0.4% )815 ( 4.4% )865 ( 2.8% ) Sarcoidosis236 ( 1.9% )547 ( 3.0% )783 ( 2.6% ) Re-Transplant: Obliterative Bronchiolitis253 ( 2.1% )219 ( 1.2% )472 ( 1.5% ) Connective Tissue Disease127 ( 1.0% )232 ( 1.3% )359 ( 1.2% ) Obliterative Bronchiolitis (Not Re- Transplant) 80 ( 0.6% )237 ( 1.3% )317 ( 1.0% ) LAM101 ( 0.8% )207 ( 1.1% )308 ( 1.0% ) Re-Transplant: Not Obliterative Bronchiolitis127 ( 1.0% )162 ( 0.9% )289 ( 0.9% ) Congenital Heart Disease43 ( 0.3% )224 ( 1.2% )267 ( 0.9% ) Cancer6 ( 0.0% )26 ( 0.1% )32 ( 0.1% ) Other108 ( 0.9% )291 ( 1.6% )399 ( 1.3% ) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 17 ADULT LUNG TRANSPLANTATION: Distribution of Procedure Type for Major Indications (1994-2009) Year of TX Alpha-1COPDCystic FibrosisIPFIPAH DoubleSingleDoubleSingleDoubleSingleDoubleSingleDoubleSingle 199444.855.218.881.286.913.113.686.464.036.0 199545.554.522.078.090.29.828.271.889.310.7 199647.352.727.772.186.813.228.171.981.718.3 199746.453.627.572.592.67.421.578.590.39.7 199848.251.830.269.893.26.819.180.987.013.0 199946.653.427.971.991.38.723.376.486.413.6 200057.942.129.370.794.25.830.769.393.07.0 200159.940.130.269.893.96.131.468.690.010.0 200256.443.639.061.096.23.835.065.089.610.4 200365.234.843.256.895.64.441.358.795.74.3 200473.625.745.854.296.33.744.155.994.55.5 200578.022.049.350.697.32.745.954.192.67.4 200672.627.458.141.898.51.546.653.4100.00.0 200783.616.463.836.297.32.749.150.994.85.2 200880.419.665.234.898.41.651.348.793.86.2 200986.513.566.533.599.80.251.248.898.61.4 ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 18 ADULT LUNG TRANSPLANTATION Procedure Type within Indication, by Year ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 19 ADULT LUNG TRANSPLANTATION: Indications for Single Lung Transplants (Transplants: January 1995 - June 2010) *Other includes: Pulmonary Fibrosis, Other:3.4% Sarcoidosis: 1.9% Bronchiectasis: 0.4% Congenital Heart Disease: 0.3% LAM: 0.8% Connective Tissue Disease:1.0% OB (non-ReTx): 0.6% Miscellaneous:0.9% ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 20 ADULT LUNG TRANSPLANTATION: Indications for Bilateral/Double Lung Transplants (Transplants: January 1995 - June 2010) *Other includes: Pulmonary Fibrosis, Other:2.9% Sarcoidosis: 3.0% Bronchiectasis: 4.4% Congenital Heart Disease: 1.2% LAM: 1.1% Connective Tissue Disease:1.3% OB (non-ReTx): 1.3% Miscellaneous:1.7% ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 21 ADULT LUNG TRANSPLANTATION Major Indications By Year (%) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 22 ADULT LUNG TRANSPLANTATION Major Indications By Year (Number) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 23 ADULT LUNG TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010 ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 24 ADULT LUNG TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010 ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 25 ADULT LUNG TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2010 ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 26 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1988 June 2009) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 27 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: January 1990 June 2009) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 28 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: January 1990 June 2009) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 29 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 June 2009) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 30 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 3 Months (Transplants: January 1990 June 2009) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 31 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 June 2009) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 32 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival for Eisenmengers Syndrome (Transplants: January 1990 June 2009) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 33 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Procedure Type (Transplants: January 1990 June 2009) Diagnosis: Alpha-1 Antitrypsin Deficiency ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 34 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Procedure Type and Age (Transplants: January 1990 June 2009) Diagnosis: Alpha-1 Antitrypsin Deficiency ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 35 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 June 2009) Diagnosis: Emphysema/COPD ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 36 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Age (Transplants: January 1990 June 2009) Diagnosis: Emphysema/COPD ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 37 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 June 2009) Diagnosis: Idiopathic Pulmonary Fibrosis ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 38 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 June 2009) Diagnosis: Idiopathic Arterial Pulmonary Hypertension ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 39 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 June 2009) Diagnosis: Emphysema/COPD, Single Lung ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 40 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 June 2009) Diagnosis: Emphysema/COPD, Double Lung ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 41 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 June 2009) Diagnosis: Cystic Fibrosis, Double Lung ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 42 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 June 2009) Diagnosis: Idiopathic Pulmonary Fibrosis, Single Lung ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 43 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 June 2009) Diagnosis: Idiopathic Pulmonary Fibrosis, Double Lung ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 44 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Donor CMV status/Recipient CMV status (Transplants: October 1999 June 2009) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 45 PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up Stratified by Donor/Recipient CMV status (Follow-ups: July 2004 - June 2010) D(-)/R(-): N = 1,110 D(-)/R(+): N = 1,378 D(+)/R(-): N = 1,533 D(+)/R(+): N = 2,463 No comparisons were statistically significant at 0.05 Analysis is limited to patients who were alive at the time of the follow-up Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti- rejection agent; or (2) have been hospitalized for rejection. No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents. ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 46 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 2010) 18-3435-4950-5960-65>65FemaleMale No comparisons were statistically significant at 0.05 except D(+)/R(-) vs. D(+)/R(+): 35-49 (p=0.0147) and 50- 59: (p=0.0330) 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. ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Slide 47 ADULT LUNG TRANSPLANTS (1997-6/2009) Risk Factors for 1 Year Mortality (N=13,937) *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 ISHLT 2011 DIAGNOSISProcedure type NRelative Risk P-value95% Conf. Interval IPAHAll3792.06 ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death Stratified by Donor CMV Status/Recipient CMV Status (Deaths: January 1992- June 2010) Donor CMV Status/ Recipient CMV Status Cause of Death0-30 Days 31 Days 1 Year >1 Year 3 Years >3 Years 5 Years >5 Years 10 Years >10 Years D(-)/R(-) (N=1,520) BRONCHIOLITIS1 (0.6%)22 (6.0%)96 (24.7%)74 (31.9%)65 (23.9%)17 (20.5%) INFECTION, NON-CMV31 (17.2%)132 (36.2%)93 (24.0%)44 (19.0%)37 (13.6%)14 (16.9%) GRAFT FAILURE55 (30.6%)68 (18.6%)83 (21.4%)49 (21.1%)54 (19.9%)18 (21.7%) D(-)/R(+) (N=2,281) BRONCHIOLITIS3 (1.1%)27 (5.4%)139 (25.7%)94 (24.8%)120 (26.1%)27 (20.9%) INFECTION, NON-CMV60 (21.7%)201 (40.5%)131 (24.2%)90 (23.7%)76 (16.6%)24 (18.6%) GRAFT FAILURE82 (29.6%)81 (16.3%)106 (19.6%)63 (16.6%)92 (20.0%)22 (17.1%) D(+)/R(-) (N=1,943) BRONCHIOLITIS019 (3.2%)118 (23.0%)67 (25.7%)67 (23.8%)4 (6.5%) INFECTION, NON-CMV42 (17.9%)220 (37.2%)118 (23.0%)45 (17.2%)51 (18.1%)20 (32.3%) GRAFT FAILURE68 (28.9%)116 (19.6%)115 (22.5%)58 (22.2%)69 (24.5%)9 (14.5%) D(+)/R(+) (N=3,466) BRONCHIOLITIS1 (0.2%)44 (5.3%)222 (24.7%)148 (27.3%)133 (22.1%)26 (16.7%) INFECTION, NON-CMV84 (19.3%)305 (36.7%)207 (23.1%)104 (19.2%)105 (17.4%)21 (13.5%) GRAFT FAILURE135 (31.0%)178 (21.4%)169 (18.8%)113 (20.8%)130 (21.6%)33 (21.2%) ISHLT 2011 ISHLT J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132