LUNG TRANSPLANTATION Overall ISHLT 2006 J Heart Lung Transplant 2006;25:880-892.

LUNG TRANSPLANTATION

Overall

ISHLT 2006 J Heart Lung Transplant 2006;25:880-892

NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE

0

200

400

600

800

1000

1200

1400

1600

1800

Nu

mb

er o

f T

ran

spla

nts

Bilateral/Double LungSingle Lung

15 15 48 89192

415

706

908

1079

12021323

13401472

14501478

15521599

17251699

ISHLT 2006

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.

1815

J Heart Lung Transplant 2006;25:880-892

AVERAGE CENTER VOLUMELung Transplants: January 1, 1998 - June 30, 2005

61

33 31

1611

3 30

10

20

30

40

50

60

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

Average number of lung transplants per year

Nu

mb

er

of

ce

nte

rs


DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME

Lung Transplants: January 1, 1998 - June 30, 2005

4.39.2

26.922.2

19.5

8 9.9

0

5

10

15

20

25

30

35

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

Average number of lung transplants per year

Perc

en

tag

e o

f tr

an

sp

lan

ts .


LUNG TRANSPLANTS: Donor Age by Year of Transplant

0%

20%

40%

60%

80%

100%

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

Year of Transplant

% o

f T

ran

sp

lan

ts

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

0

5

10

15

20

25

30

35

40

Me

an

do

no

r a

ge

(y

ea

rs)

Mean Age


AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2005)

0

5

10

15

20

25

30

35

0-11 12-17 18-29 30-39 40-49 50-59 60-64 65+

Recipient Age

% o

f tr

an

sp

lan

ts


AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA

0

5

10

15

20

25

30

35

40

0-11 12-17 18-29 30-39 40-49 50-59 60-64 65+

% o

f tr

ansp

lan

ts

1985-1994 (N = 4,622)

1995-1999 (N=7,071)

2000-6/2005 (N=9,201)

p < 0.0001


LUNG TRANSPLANTATION

Adult Recipients


AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS (1/1985-6/2005)

0

5

10

15

20

25

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

Recipient Age

% o

f tr

ansp

lan

ts

.


AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA

0

5

10

15

20

25

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

% o

f tr

ansp

lan

ts .

1985-1995 (N = 5,642)

1996-6/2005 (N =14,262 )

p < 0.0001

ISHLT 2006

Mean age by era1985-1995 = 44.9 years1996-6/2005 = 48.3 years


AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA

0

5

10

15

20

25

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

% o

f tr

ansp

lan

ts .

1985-1994 (N=4,392)1995-1999 (N=6,668)2000-6/2005 (N=8,844)

p < 0.0001

ISHLT 2006

Mean age by era1985-1994 = 44.6 years1995-1999 = 47.3 years2000-6/2005 = 48.8 years


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1994 - June 2004)

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=7,218)

Single Lung (N=7,724)

All Lungs (N=15,047)

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

P < 0.0001


ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2005)

DIAGNOSIS SLT (N = 6,663) BLT (N = 6,789) TOTAL (N = 13,452)

COPD/Emphysema 3,511 (53%) 1,636 (24%) 5,147 (38%)

Idiopathic Pulmonary Fibrosis 1,731 (26%) 813 (12.0%) 2,544 (19%)

Cystic Fibrosis 159 (2.4%) 2,009 (30%) 2,168 (16%)

Alpha-1 446 (7.0%) 597 (8.8%) 1,063 (7.9%)

Primary Pulmonary Hypertension 64 (1.0%) 461 (6.8%) 525 (3.9%)

Sarcoidosis 141 (2.1%) 195 (2.9%) 336 (2.5%)

Bronchiectasis 25 (0.4%) 328 (4.8%) 353 (2.6%)

LAM 54 (0.8%) 88 (1.3%) 142 (1.1%)

Congenital Heart Disease 13 (0.2%) 115 (1.7%) 128 (1.0%)

Re-Transplant: Obliterative Bronchiolitis

74 (1.1%) 71 (1.0%) 145 (1.1%)

Obliterative Bronchiolitis

(Not Re-Transplant)

44 (0.7%) 77 (1.1%) 121 (0.9%)

Re-Transplant: Not Obliterative Bronchiolitis

65 (1.0%) 52 (0.8%) 117 (0.9%)

Connective Tissue Disease 37 (0.6%) 45 (0.7%) 82 (0.6%)

Interstitial Pneumonitis 20 (0.3%) 10 (0.1%) 30 (0.2%)

Cancer 6 (0.1%) 10 (0.1%) 16 (0.1%)

Other 253 (3.8%) 282 (4.2%) 535 (4.0%)


ADULT LUNG TRANSPLANTATION: Distribution of Procedure Type for Major Indications (1990-2004)

ISHLT 2006

Year of TX

Alpha-1 COPD Cystic Fibrosis IPF PPH

Double Single Double Single Double Single Double Single Double Single

1990 31.9 68.1 23.0 77.0 94.7 5.3 1.8 98.2 15.4 84.6

1991 20.9 79.1 14.9 85.1 95.7 4.3 15.1 84.9 23.8 76.2

1992 27.2 72.8 17.2 82.8 96.8 3.2 9.6 90.4 25.7 74.3

1993 34.1 65.9 15.8 84.2 93.8 6.2 16.7 83.3 51.6 48.4

1994 35.2 64.8 18.3 81.7 83.1 16.9 13.6 86.4 61.0 39.0

1995 48.0 52.0 20.2 79.8 88.3 11.7 26.9 73.1 89.6 10.4

1996 46.6 53.4 26.2 73.8 85.0 15.0 26.8 73.2 81.5 18.5

1997 46.7 53.3 28.1 71.9 92.1 7.9 21.9 78.1 88.7 11.3

1998 50.4 49.6 29.4 70.6 91.8 8.2 19.7 80.3 84.8 15.2

1999 48.3 51.7 27.7 72.3 89.1 10.9 22.1 77.9 83.3 16.7

2000 57.9 42.1 27.7 72.3 94.1 5.9 31.2 68.8 91.3 8.7

2001 59.8 40.2 26.8 73.2 93.5 6.5 26.0 74.0 89.4 10.6

2002 57.1 42.9 38.6 61.4 95.6 4.4 35.8 64.2 86.8 13.2

2003 68.1 31.9 38.7 61.3 95.4 4.6 39.1 60.9 93.5 6.5

2004 75.6 24.4 41.5 58.5 95.4 4.6 43.3 56.7 95.2 4.8


ADULT LUNG TRANSPLANTATIONProcedure Type within Indication, by Year

0

10

20

30

40

50

60

70

80

90

100

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

% o

f tr

an

sp

lan

ts

Bilateral/Double Lung Transplant Single Lung Transplant

AT Def COPD IPF PPH

2006J Heart Lung Transplant 2006;25:880-892

ISHLT

ADULT LUNG TRANSPLANTATION: Indications for Single Lung Transplants (Transplants: January 1995 - June 2005)

53%

26%

2%1%

2%

7%

9%

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

ISHLT 2006

*Other includes:

Sarcoidosis: 2.1%

Bronchiectasis: 0.4%

Congenital Heart Disease: 0.2%

LAM: 0.8%

OB (non-ReTx): 0.7%

Miscellaneous: 4.8%


ADULT LUNG TRANSPLANTATION: Indications for Bilateral/Double Lung Transplants (Transplants: January 1995 - June 2005)

24%

12%

17%

7%

29%

9%

2%

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

ISHLT 2006

*Other includes:

Sarcoidosis: 2.9%

Bronchiectasis: 4.8%

Congenital Heart Disease: 1.7%

LAM: 1.3%

OB (non-ReTx): 1.1%

Miscellaneous: 0.9%


ADULT LUNG TRANSPLANTATIONIndications By Year (%)

0

20

40

60

80

100

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Transplant Year

% o

f T

ran

spla

nts

Cystic Fibrosis IPF Emphysema A1A PPH


ADULT LUNG TRANSPLANTATIONIndications By Year (Number)

0

250

500

750

1000

1250

Transplant Year

Nu

mb

er o

f T

ran

spla

nts

Cystic Fibrosis IPF Emphysema A1A PPH


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Era (Transplants: January 1988 – June 2004)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

.

1988-1994 (N=4,345)1995-1999 (N=6,668)2000-6/2004 (N=7,217)

1988-1994: 1/2-life = 3.9 Years; Conditional 1/2-life = 7.0 Years1995-1999: 1/2-life = 4.5 Years; Conditional 1/2-life = 7.0 Years2000-6/2004: 1/2-life = 5.0 Years; Conditional 1/2-life = 5.3 Years

Survival comparisons by era1988-94 vs. 1995-99: p = 0.02941988-94: vs. 2000-6/03: p <0.0001 1995-99 vs. 2000-6/03: p <0.0001


ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: January 1990 – June 2004)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (%

) .

18-34 (N= 3,298)35-49 (N= 5,413)50-59 (N= 6,370)60-64 (N= 2,320)65+ (N= 567)

Survival comparisons18-34 vs. 50-59: p <0.000118-34 vs. 60-64 and vs. 65+ : p < 0.000135-49 vs. 50-59, 60-64 and 65+: p < 0.000150-59 vs. 60-64: p < 0.000150-59 vs. 65+: p < 0.0001

HALF-LIFE 18-34: 5.0 Years; 35-49: 5.5 Years; 50-59: 4.6 Years; 60-64: 3.8 Years; 65+: 3.4 Years


ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: January 1994 – June 2004)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al

(%)

Male (N=7,851)

Female (N=7,182)

HALF-LIFE Male: 4.8 years; Female: 5.1 Years

p = 0.1074


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1994 – June 2004)

YearALPHA-1 (N=1,074)

CF

(N=1,970)COPD

(N=4,989)IPF

(N=2,318)PPH

(N=557)SARCOIDOSIS

(N=312)

1 76.7 80.4 81.8 71.2 65.8 67.8

3 61.3 65.5 64.0 55.0 56.6 54.9

5 51.2 54.1 48.7 43.1 46.7 49.5

7 41.1 44.9 35.7 33.0 38.5 44.5

10 31.5 33.9 18.8 18.7 26.9 37.1

Survival comparisonsAlpha-1 vs. CF: p = 0.0327 CF vs. IPF: p < 0.0001Alpha-1 vs. IPF: p <0.0001 CF vs. Sarcoidosis: p = 0.0041Alpha-1 vs. PPH: p = 0.0032 PPH vs. COPD: p = 0.0162CF vs. COPD: p < 0.0001 COPD vs. IPF: p <0.0001

Note: Other comparisons are not statistically different.


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on

Survival to 3 Months (Transplants: January 1994 – June 2004)

YearALPHA-1 (N=905)

CF

(N= 1,668)COPD

(N= 4,402)IPF

(N= 1,848)PPH

(N= 393)SARCOIDOSIS

(N=243)

1 88.4 90.9 90.2 86.1 90.0 84.2

3 70.7 74.0 70.6 66.5 77.3 68.2

5 59.1 61.2 53.7 52.1 63.8 61.5

7 47.4 50.7 39.4 39.9 52.6 55.3

10 36.3 38.3 20.7 22.6 36.8 46.1

Survival comparisonsAlpha-1 vs. IPF: p = 0.0004 Alpha-1 vs. COPD: p = 0.0021CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001PPH vs. COPD: p < 0.0001 PPH vs. IPF: p < 0.0001IPF vs. Sarcoidosis: p = 0.0222Note: Other comparisons are not statistically different.


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1994 – June 2004)

YearALPHA-1 (N=772)

CF

(N=1,438)COPD

(N= 3,820)IPF

(N=1,510)PPH

(N= 341)SARCOIDOSIS

(N=196)

1 100.0 100.0 100.0 100.0 100.0 100.0

3 80.0 81.2 78.3 77.2 85.9 81.0

5 66.8 67.1 59.6 60.5 70.9 73.1

7 53.6 55.7 43.6 46.3 58.5 65.7

10 41.0 42.0 23.0 26.2 40.9 54.8

Survival comparisonsAlpha-1 vs. IPF: p = 0.0019 Alpha-1 vs. COPD: p < 0.0001CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001PPH vs. COPD: p < 0.0001 PPH vs. IPF: p < 0.0001COPD vs. Sarcoidosis: p = 0.0002 IPF vs. Sarcoidosis: p = 0.0012

Note: Other comparisons are not statistically different.


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1994 – June 2004)

0

25

50

75

100

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

Su

rviv

al (

%)

Alpha-1 (N=1,074) CF (N= 1,970) COPD (N= 4,989)

IPF (N= 2,318) PPH (N= 557) Sarcoidosis (N=312)

HALF-LIFE Alpha-1: 5.3 Years; CF: 5.8 Years; COPD: 4.8 Years; IPF: 3.9 Years; PPH: 4.5 Years; Sarcoidosis: 4.9 Years

Survival comparisonsAlpha-1 vs. CF: p = 0.0327 CF vs. IPF: p < 0.0001Alpha-1 vs. IPF: p <0.0001CF vs. Sarcoidosis: p = 0.0041Alpha-1 vs. PPH: p = 0.0032PPH vs. COPD: p = 0.0162CF vs. COPD: p < 0.0001COPD vs. IPF: p <0.0001


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on

Survival to 3 Months (Transplants: January 1994 – June 2004)

0

25

50

75

100

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

Su

rviv

al

(%)

Alpha-1 (N=905) CF (N= 1,668)COPD (N= 4,402) IPF (N= 1,848)PPH (N= 393) Sarcoidosis (N=243)


Survival comparisonsAlpha-1 vs. IPF: p = 0.0004 Alpha-1 vs. COPD: p = 0.0021CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001PPH vs. COPD: p < 0.0001 PPH vs. IPF: p < 0.0001IPF vs. Sarcoidosis: p = 0.0222


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

(Transplants: January 1994 – June 2004)

0

25

50

75

100

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

Su

rviv

al (

%)

Alpha-1 (N=772) CF (N= 1,438)COPD (N= 3,820) IPF (N= 1,510)PPH (N= 341) Sarcoidosis (N=196)


Survival comparisonsAlpha-1 vs. IPF: p = 0.0019 Alpha-1 vs. COPD: p < 0.0001CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001PPH vs. COPD: p < 0.0001 PPH vs. IPF: p < 0.0001COPD vs. Sarcoidosis: p = 0.0002 IPF vs. Sarcoidosis: p = 0.0012


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= 120) VSD (N= 56)

HALF-LIFE ASD: 2.9 Years; VSD: 1.0 Years

ISHLT 2006

N at risk at 5 years = 35

N at risk at 5 years = 15

P=0.2787


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Procedure Type

(Transplants: January 1990 – June 2004) Diagnosis: Alpha-1 Antitrypsin Deficiency

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al

(%)

Alpha-1/Single lung (N=714)

Alpha-1/Double lung (N=656)P < 0.0001

ISHLT 2006N at risk at 10 years is 46 for Single Lung and 33 for Double Lung.


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Procedure Type and Age

(Transplants: January 1990 – June 2004) Diagnosis: Alpha-1 Antitrypsin Deficiency

0

25

50

75

100

0 1 2 3 4 5

Years

Su

rviv

al (

%)

Single Lung, < 50 (N=350) Double Lung, <50 (N =402)

Single Lung, 50+ (N = 364) Double Lung, 50+ (N = 254)

ISHLT 2006

N at risk at 5 years:

Single Lung, <50 = 125; Double Lung, <50 = 134; Single Lung, 50+ = 89; Double Lung, 50+ = 48

p = 0.0055


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2004)

Diagnosis: Emphysema/COPD

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

COPD/Single lung (N=4,136)

COPD/Double lung (N=1,589) N=134

N=37

P < 0.0001


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Age


Diagnosis: Emphysema/COPD

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

<50/Single lung (N=625) <50/Double lung (N=525)

50+/Single lung (N=3,511) 50+/Double lung (N=1,064)N=36N=98

N=20N=17

P < 0.0001


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

Years

Su

rviv

al (

%)

IPF/Single lung (N=1,969)

IPF/Double lung (N=703)

N=50

N=9

P = 0.2038


ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type

(Transplants: January 1990 – June 2004)Diagnosis: Primary Pulmonary Hypertension

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

PPH/Single lung (N=253)

PPH/Double lung (N=539) N=32 at 10 years

N=26 at 10 years

P = 0.1801


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=925)

COPD/Single lung/1995-1999 (N=1,569)

COPD/Single lung/2000-6/2004 (N=1,642)

Survival comparisons1990-1994 vs. 1995-1999: p = 0.551990-1994 vs. 2000-6/2004: p = 0.00411995-1999 vs. 2000-6/2004: p = 0.071




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=191)

COPD/Double lung/1995-1999 (N=566)

COPD/Double lung/2000-6/2004 (N=832)





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=437)

IPF/Single lung/1995-1999 (N=769)

IPF/Single lung/2000-6/2004 (N=763)





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=63)

IPF/Double lung/1995-1999 (N=238)

IPF/Double lung/2000-6/2004 (N=402)

Survival comparisons1990-1994 vs. 1995-1999: p = 0.97601990-1994 vs. 2000-6/2004: p = 0.00091995-1999 vs. 2000-6/2004: p < 0.0001


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

(Transplants: October 1999 – June 2004)

50

60

70

80

90

100

0 1 2 3

Years

Su

rviv

al (

%)

D(-)/R(-) (N=800)D(-)/R(+) (N=988)D(+)/R(-) (N=908)D(+)/R(+) (N=1,435)

Survival comparisonsD(-)/R(-) vs. D(-)/R(+): p = 0.3001D(-)/R(-) vs. D(+)/R(-): p = 0.1993D(-)/R(-) vs. D(+)/R(+): p = 0.1163D(-)/R(+) vs. D(+)/R(-): p = 0.0131D(-)/R(+) vs. D(+)/R(+): p = 0.0036D(+)/R(-) vs. D(+)/R(+): p = 0.8747


ADULT LUNG TRANSPLANTS (1995-6/2004) Risk Factors for 1 Year Mortality

DIAGNOSIS N

Relative Risk P-value

95% confidence

Interval

PPH 474 2.66 <.0001 2.07 -3.41

Pulmonary fibrosis (not IPF) 132 2.09 <.0001 1.53 -2.84

Sarcoidosis 288 1.97 <.0001 1.57 -2.47

IPF 2151 1.50 <.0001 1.30 -1.72

Alpha-1 antitrypsin deficiency 978 1.48 <.0001 1.27 -1.73

Cystic fibrosis 1806 1.37 .0005 1.15 -1.65

Bronchiectasis 310 1.30 .0479 1.00 -1.69

Other diagnoses* 2322 1.21 .0046 1.06 -1.37

(N=13,168)ISHLT 2006

*Other = All diagnoses other than COPD, PPH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, and LAM. J Heart Lung Transplant 2006;25:880-892


DONOR CHARACTERISTICS

N Relative

Risk P-value

95% Confidence

Interval

Donor history of diabetes 256 1.51 0.0006 1.19 -1.91

RECIPIENT CHARACTERISTICS

IV inotropes 80 1.90 0.0001 1.37 -2.63

Ventilator 203 1.76 <.0001 1.36 -2.29

Prior malignancy 264 1.30 0.0311 1.02 -1.64

Hospitalized (including ICU) 775 1.20 0.0249 1.02 -1.42

Prior thoracotomy 412 0.78 0.0272 0.63 -0.97

(N=13,168)



TRANSPLANT CHARACTERISTICS N Relative

Risk P-value

95% Confidence

Interval

Repeat transplant 339 2.12 <0.0001 1.74 -2.57

4, 5 or 6 HLA mismatches (vs. 0-3 mismatches)

11637 4,5 or 6 MM

1.22 0.0016 1.08 -1.38

Donor CMV +/ Recipient CMV - 2413 1.21 0.0001 1.10 -1.32

Transplant year = 1995/1996 vs. 1999/2000 2418 1.20 0.0011 1.08 -1.34

Female donor/female recipient 3809 0.82 0.0001 0.75 -0.91

Transplant year = 2001/2002 vs. 1999/2000 3034 0.80 0.0001 0.71 -0.90

Transplant year = 2003/2004 vs. 1999 2344 0.66 <0.0001 0.58 -0.75

(N=13,168)


ADULT LUNG TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality

Continuous Factors (see figures)

Recipient age

Donor age

Recipient BMI

Donor weight

PVR

Transplant center volume

Bilirubin

Recipient oxygen required at rest

Recipient FEV1 % predicted



Recipient Age

0

0.5

1

1.5

2

25 30 35 40 45 50 55 60 65

Recipient Age

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p < 0.0001



Donor Age

0

0.5

1

1.5

2

15 20 25 30 35 40 45 50 55

Donor Age

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p < 0.0001



Donor Weight

0

0.5

1

1.5

2

50 55 60 65 70 75 80 85 90 95

Weight (kg)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p < 0.0001



Pre-Transplant Recipient BMI

0

0.5

1

1.5

2

16 20 24 28 32

Recipient BMI (kg/m2)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.0001



Center volume

0

0.5

1

1.5

2

0 10 20 30 40 50

Center Volume (cases per year)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p < 0.0001



Recipient FEV1 (% predicted)

0

0.5

1

1.5

2

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

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

P < 0.0001



Recipient Pre-Transplant Bilirubin

0

0.5

1

1.5

2

0.5 0.75 1 1.25 1.5 1.75

Recipient Bilirubin (mg/dl)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.0039



Recipient Oxygen Required at Rest

0

0.5

1

1.5

2

0 1 2 3 4 5

Oxygen Required at Rest (L/min)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.0021



Recipient PVR

0

0.5

1

1.5

2

1 2 3 4 5 6 7 8 9

PVR (Wood units)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.0009


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

Recipient factors:pCO2, transfusions, recent infection requiring IV drug therapy, diabetes, sternotomy, dialysis, FVC, creatinine, PRA, chronic steroid use

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

Transplant factors:Height ratio, BMI ratio, ischemia time


ADULT LUNG TRANSPLANTS (1995-6/2004) Diagnosis = COPD/EmphysemaRisk Factors for 1 Year Mortality

RECIPIENT CHARACTERISTICS N


95% Confidence Interval

Ventilator 33 2.97 .0001 1.70 -5.19

Hospitalized (including ICU) 159 1.46 .0337 1.03 -2.07

Chronic steroid use 1777 1.31 .0006 1.12 -1.53

TRANSPLANT CHARACTERISTICS

Repeat transplant 22 3.03 .0003 1.65 -5.55

Donor CMV +/ Recipient CMV - 721 1.30 .0037 1.09 -1.54

Transplant Year: 2001/2002 vs. 1999/2000 1134 0.77 .0129 0.62 -0.95



Donor history of diabetes 105 1.56 .0339 1.03 -2.35

(N=4,581)


ADULT LUNG TRANSPLANTS (1995-6/2004) Diagnosis = COPD/Emphysema

Borderline Significant Risk Factors for 1 Year Mortality

N Relative

Risk P-value

95% Confidence

Interval

PRA > 10% 126 1.38 0.0514 1.00 -2.10

Male donor/female recipient 2373 0.86 0.0553 0.74 -1.00

(N=4,581)


ADULT LUNG TRANSPLANTS (1/1995-6/2004)Diagnosis = COPD/Emphysema

Risk Factors for 1 Year Mortality


Recipient age

Donor weight (borderline)


Recipient FEV1 % predicted


ADULT LUNG TRANSPLANTS (1/1995-6/2004) Diagnosis = COPD/Emphysema

Risk Factors for 1 Year MortalityRecipient Age

0

0.5

1

1.5

2

40 45 50 55 60 65

Recipient Age

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p < 0.0001



Risk Factors for 1 Year MortalityCenter volume

0

0.5

1

1.5

2

0 10 20 30 40 50


Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.0001



Risk Factors for 1 Year MortalityDonor Weight

0

0.5

1

1.5

2

50 55 60 65 70 75 80 85 90 95

Weight (kg)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.053



Risk Factors for 1 Year Mortality Recipient FEV1 (% predicted)

0

0.5

1

1.5

2

25 30 35 40 45Recipient FEV1 (% predicted)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.0113


ADULT LUNG TRANSPLANTS (1995-6/2004) Diagnosis = Cystic Fibrosis



N Relative

Risk P-value

95% Confidence

Interval

Prior transfusions 65 1.65 .0380 1.03 -2.64

Hospitalized (including ICU) 237 1.48 .0133 1.09 -2.02


Repeat transplant 23 3.10 .0005 1.65 -5.82

(N=1,806)


ADULT LUNG TRANSPLANTS (1995-6/2004) Diagnosis = Cystic Fibrosis

Borderline Significant Risk Factors for 1 Year Mortality

CHARACTERISTIC

N Relative

Risk P-value

95% Confidence

Interval

Donor cause of death = anoxia vs. head trauma

80 0.51 0.0620 0.25 -1.03

(N=1,806)


ADULT LUNG TRANSPLANTS (1/1995-6/2004)Diagnosis = Cystic Fibrosis



Donor BMI (borderline) Transplant center volume


ADULT LUNG TRANSPLANTS (1/1995-6/2004) Diagnosis = Cystic Fibrosis


0

0.5

1

1.5

2

0 10 20 30 40 50


Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.020


ADULT LUNG TRANSPLANTS (1/1995-6/2004)

Diagnosis = Cystic Fibrosis Risk Factors for 1 Year Mortality

Donor BMI

0

0.5

1

1.5

2

18 21 24 27 30

Donor BMI (kg/m2)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.062


ADULT LUNG TRANSPLANTS (1995-6/2004) Diagnosis = IPF


RECIPIENT CHARACTERISTICS N Relative

Risk P-value


Ventilator 37 2.41 .0004 1.49 -3.92

Prior sternotomy 63 1.59 .0305 1.04 -2.43




Donor CMV+ / Recipient CMV- 363 1.28 .0169 1.05 -1.57


Donor clinical infection 360 0.75 .03 0.59 -0.97

(N=2,151)


ADULT LUNG TRANSPLANTS (1/1995-6/2004)

Diagnosis = IPFRisk Factors for 1 Year Mortality


Recipient age

Donor age

Recipient BMI

Donor weight


PA diastolic pressure

Oxygen required at rest

Ischemia time (borderline)


ADULT LUNG TRANSPLANTS (1/1995-6/2004) 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

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.0058



Risk Factors for 1 Year MortalityDonor Age

0

0.5

1

1.5

2

15 20 25 30 35 40 45 50 55

Donor Age

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.0011



Risk Factors for 1 Year MortalityRecipient PA Diastolic Pressure

0

0.5

1

1.5

2

10 15 20 25 30

PA Diastolic Pressure

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.0107



Risk Factors for 1 Year MortalityDonor Weight

0

0.5

1

1.5

2

55 65 75 85 95

Donor Weight (kg)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.025


ADULT LUNG TRANSPLANTS (1/1995-6/2004)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)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.0071




0

0.5

1

1.5

2

0 10 20 30 40 50


Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.011



Risk Factors for 1 Year MortalityRecipient BMI

0

0.5

1

1.5

2

18 21 24 27 30


Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.025



Risk Factors for 1 Year MortalityIschemia Time

0

0.5

1

1.5

2

2 3 4 5 6 7

Ischemia time (hours)

Rela

tive R

isk o

f 1 Y

ear

Mo

rtality

.

p = 0.059



DIAGNOSIS N Relative

Risk P-value 95% Confidence

Interval

Alpha-1 antitrypsin deficiency 567 1.24 0.0017 1.09 -1.42

Idiopathic pulmonary fibrosis 1102 1.22 0.0002 1.10 -1.36

LAM 66 0.56 0.0215 0.34 -0.92


Recipient on IV inotropes 53 1.75 0.001 1.25 -2.43

Recipient on ventilator 117 1.52 0.0018 1.17 -1.98

Recipient with prior sternotomy 160 1.37 0.0016 1.13 -1.68

Recipient history of diabetes 278 1.28 0.0028 1.09 -1.51

Hospitalized (including ICU) 480 1.18 0.0254 1.02 -1.37

(N=7,072)



DONOR CHARACTERISTICS N Relative

Risk P-value


Donor Cause of Death = Anoxia 217 0.73 0.0049 0.59 -0.91


Repeat transplant 190 1.72 <0.0001 1.42 -2.10

Transplant year: 1995/1996 vs. 1999/2000 2418 1.19 <0.0001 1.10 -1.30

Donor CMV +/ Recipient CMV - 1237 1.14 0.004 1.04 -1.24

Total mismatches at the HLA A and B loci (relative risk is per mismatch)

1207 (0-2 MM) 4033 (3 MM) 1832 (4 MM)

1.08 0.0006 1.03 -1.13

Female donor/female recipient 1995 0.87 0.0033 0.79 -0.95

(N=7,072)ISHLT 2006 J Heart Lung Transplant 2006;25:880-892

ADULT LUNG TRANSPLANTS (1995-6/2000) Borderline Significant Risk Factors for 5 Year Mortality

VARIABLE N Relative

Risk P-value

95% Confidence

Interval

Diagnosis: PPH 288 1.30 0.0673 0.98 -1.73

(N=7,072)




Recipient age

Donor age

Recipient BMI

Donor height

Center volume

Oxygen at rest

PA systolic pressure



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Rela

tive R

isk o

f 5 Y

ear

Mo

rtalit

y

p < 0.0001



Donor Age

0

0.5

1

1.5

2

15 25 35 45 55Donor Age

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p < 0.0001



Pre-Transplant Recipient BMI

0

0.5

1

1.5

2

17 19 21 23 25 27 29 31


Rel

ativ

e R

isk

of

5 Y

ear

Mo

rtal

ity

p = 0.0003



Donor Height

0

0.5

1

1.5

2

155 160 165 170 175 180 185 190

Donor height (cm)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.0017



Center Volume

0

0.5

1

1.5

2

0 10 20 30 40 50

Center Volume (Cases per year)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.0002



Recipient PA Systolic Pressure

0

0.5

1

1.5

2

25 30 35 40 45 50 55 60 65 70

Recipent PA systolic pressure (mm Hg)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.028



Oxygen Required at Rest

0

0.5

1

1.5

2

0 1 2 3 4 5

Oxygen required at rest (L/min)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.024


ADULT LUNG TRANSPLANTS (1995-6/2000) Factors Not Significant for 5 Year Mortality

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

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

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

Transplant factors:Ischemia time


ADULT LUNG TRANSPLANTS (1995-6/2000) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year

DIAGNOSIS N Relative

Risk P-value

95% Confidence

Interval

Cystic Fibrosis vs. COPD 739 0.75 0.0119 0.59 -0.94

LAM vs. COPD 51 0.34 0.0096 0.15 -0.77

(N=5,111)



DONOR, RECIPIENT AND TRANSPLANT CHARACTERISTICS N


95% Confidence

Interval

Donor cause of death = anoxia vs. head trauma

168 0.6 0.0013 0.44 -0.82

Recipient sternotomy prior to transplant

100 1.53 0.0032 1.15 -2.03

Recipient diabetes 193 1.37 0.0069 1.09 -1.73

Transplant year: 1995/1996 vs. 1999/2000

1695 1.21 0.0022 1.07 -1.37

2 mismatches at HLA A locus 1768 1.14 0.0096 1.03 -1.26

(N=5,111)ISHLT 2006



POST-TRANSPLANT FACTORS N Relative

Risk P-value

95% Confidence

Interval

Bronchiolitis obliterans within 1st year 264 2.26 <0.0001 1.89 -2.69

Dialysis prior to discharge 60 1.49 .0311 1.04 -2.14

Rejection between discharge and 1 year 1145 1.25 .0002 1.11 -1.41

Drug-treated infection prior to discharge 1397 1.23 .0002 1.11 -1.37

(N=5,111)


ADULT LUNG TRANSPLANTS (1995-6/2000) Borderline Significant Risk Factors for 5 Year Mortality

Conditional on Survival to 1 Year

CHARACTERISTICS N Relative

Risk P-value

95% Confidence

Interval

Double/bilateral procedure vs. single lung 2440 0.89 0.0686 0.79 -1.01

Diagnosis = PPH vs. COPD 167 0.76 0.0907 0.55 -1.04

(N=5,111)


ADULT LUNG TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year


Recipient Age

Donor Age

Recipient BMI

Donor Height (borderline)


ADULT LUNG TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival

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 5

Ye

ar

Mo

rta

lity

p < 0.0001



Donor Age

0

0.5

1

1.5

2

15 25 35 45 55Donor Age

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.0012



Recipient BMI

0

0.5

1

1.5

2

17 19 21 23 25 27 29 31Recipient BMI (kg/m2)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.025



Donor Height

0

0.5

1

1.5

2

155 160 165 170 175 180 185 190Donor height (cm)

Re

lati

ve

Ris

k o

f 5

Ye

ar

Mo

rta

lity

p = 0.060


ADULT LUNG TRANSPLANTS (1995-6/2000) Factors Not Significant for Conditional 5 Year Mortality

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

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

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

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


ADULT LUNG TRANSPLANTS (1995-6/2000) Factors Not Significant for Conditional 5 Year Mortality

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

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


ADULT LUNG RECIPIENTSFunctional Status of Surviving Recipients

(Follow-ups: April 1994 – June 2005)

0%

20%

40%

60%

80%

100%

1 Year (N=6,606) 3 Year (N=4,181) 5 Year (N=2,405) 8 Year (N=886)

No Activity Limitations Performs with Some Assistance Requires Total Assistance


ADULT LUNG RECIPIENTSEmployment Status of Surviving Recipients

(Follow-ups: April 1994 – June 2005)

0%

20%

40%

60%

80%

100%

1 Year (N=406) 3 Year(N=3,944)

5 Year(N=2,330)

8 Year (N=895)

Working Part Time

Working Full Time

Retired

Not Working


ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients

(Follow-ups: April 1994 - June 2005)

0%

20%

40%

60%

80%

100%

1 Year (N=8,043) 3 Year (N=4,914) 5 Year (N=2,910) 8 Year (N=1,075)

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


0

5

10

15

20

25

30

35

40

45

50

Any Induction (N =1,726)

PolyclonalALG/ATG (N = 464)

OKT3 (N = 27)

IL2R-antagonist (N = 1,253)

% o

f p

ati

en

tsADULT LUNG RECIPIENTS

Induction Immunosuppression (Transplants: January 2002 - June 2005)Analysis limited to patients receiving prednisone


0

10

20

30

40

50

% o

f p

atie

nts

ADULT LUNG RECIPIENTSInduction Immunosuppression (Transplants: January 2000 - December 2004)

Analysis limited to patients receiving prednisone

ISHLT 2006

Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist


SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: April 1994-June 2004)

Conditional on survival to 14 days

0

20

40

60

80

100

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

Su

rviv

al (

%)

No induction (N=5,927)

Induction (N=3,415)

p = 0.0008


SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: January 2000-June 2004)

Conditional on survival to 14 days

0

20

40

60

80

100

0 1 2 3 4

Years

Su

rviv

al (

%)


Induction (N=2,050)

p =0.0009


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine

% o

f P

ati

en

ts

Year 1 (N = 3,482) Year 5 (N =1,569 )

ADULT LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up

For follow-ups between January 2002 through June 2005 Analysis limited to patients receiving prednisone

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


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 and 2005.

ADULT LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up

For follow-ups between January 2002 through June 2005 Analysis limited to patients receiving prednisone



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 2005Analysis limited to patients receiving prednisone

1 Year Follow-up (N = 3,482) 5 Year Follow-up (N = 1,569)



0

20

40

60

80

100

Year 1 (N = 3,482) Year 5 (N = 1,569)

% o

f P

atie

nts

Tacrolimus + MMF

Tacrolimus + AZA

Cyclosporine + MMF

Cyclosporine + AZA

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

For follow-ups between January 2002 through June 2005Conventional Combinations



0

10

20

30

40

50

Year 1 (N = 3,482) Year 5 (N = 1,569)

% o

f P

atie

nts

Other

Rapa + Cellcycle

Rapa + Calcineurin

Tacrolimus

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

For follow-ups between January 2002 through June 2005Other Combinations



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

Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2004)

05

101520253035404550

Overall

% t

rea

ted

fo

r re

jec

tio

n w

ith

in 1

ye

ar

No induction Polyclonal IL2R-antagonist

No induction vs. polyclonal (p < 0.0001); polyclonal vs. IL2R (p = 0.002)




0

10

20

30

40

50

60

18-49 50-59 60+ F M

% t

rea

ted

fo

r re

jec

tio

n w

ith

in 1

ye

ar


For female: no induction vs. polyclonal (p = 0.003) ; polyclonal vs. IL2R (p = 0.024)For male: no induction vs. polyclonal (p = 0.0044); polyclonal vs. IL2R (p = 0.026)

18-49: no induction vs. polyclonal (p=0.042); 50-59: no induction vs. polyclonal (p=0.041);60+: no induction vs. polyclonal (p = 0.0009); polyclonal vs. IL2R (p=0.010)


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


00.20.40.60.8

11.21.41.61.8

2

Overall

Av

era

ge

nu

mb

er

of

reje

cti

on

ep

iso

de

s


No induction vs. polyclonal (p < 0.0001); no induction vs. IL2R (p = 0.009); polyclonal vs. IL2R (p = 0.032).


NUMBER OF REJECTION EPISODES FOR ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2004)

0

0.5

1

1.5

2

2.5

18-49 50-59 60+ F M

Av

era

ge

nu

mb

er

of

reje

cti

on

ep

iso

de

s


18-34: no induction vs. polyclonal (p = 0.002); no induction vs. IL2R (p = 0.022);

50-59: no induction vs. polyclonal (p = 0.0007); polyclonal vs. IL2R (p = 0.031);

Females: no induction vs. polyclonal (p = 0.03); no induction vs. IL2R (p = 0.025);

Males: no induction vs. polyclonal (p = 0.0003); polyclonal vs. IL2R (p = 0.0087)



Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2004)

0

10

20

30

40

50

60

Overall

% t

rea

ted

fo

r re

jec

tio

n w

ith

in 1

ye

ar

Cyclosporine + MMF Cyclosporine + AZA Tacrolimus + MMF Tacrolimus + AZA

CyA + MMF vs. TAC + MMF (p = 0.004); CyA + AZA vs. TAC + MMF (p < 0.0001); CyA + AZA vs. TAC + AZA (p < 0.0001)




0

10

20

30

40

50

60

70

18-49 50-59 60+ F M

% t

rea

ted

fo

r re

jec

tio

n w

ith

in 1

ye

ar

Cyclosporine + MMF Cyclosporine + AZATacrolimus + MMF Tacrolimus + AZA

18-49: CyA + AZA vs. TAC + MMF (p = 0.0138)

50-59: CyA + MMF vs. TAC + MMF (p = 0.0062); CyA + MMF vs. TAC + AZA (p = 0.0035); CyA + AZA vs. TAC + MMF (p = 0.0015);

CyA + AZA vs. TAC + AZA (p = 0.0015)

60+: CyA + AZA vs. TAC + MMF (p = 0.0011); CyA + MMF vs. CyA + AZA (p = 0.0054)

Females: CyA + AZA vs. TAC + MMF (p = 0.006); CyA + AZA vs. TAC + AZA (p = 0.0097)

Males: CyA + MMF vs. TAC + MMF (p = 0.0078); CyA + AZA vs. TAC + MMF (p < 0.0001); CyA + AZA vs. TAC + AZA (p = 0.0031)


NUMBER OF REJECTION EPISODES FOR ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2004)

0

0.5

1

1.5

2

2.5

Overall

Av

era

ge

nu

mb

er

of

reje

cti

on

ep

iso

de

s

Cyclosporine + MMF Cyclosporine + AZA Tacrolimus + MMF Tacrolimus + AZA

CyA + MMF vs. CyA + AZA (p = 0.002); CyA + AZA vs. TAC + MMF (p < 0.0001); TAC + MMF vs. TAC + AZA (p = 0.029)


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


0

0.5

1

1.5

2

2.5

18-49 50-59 60+ F M

Av

era

ge

nu

mb

er

of

reje

cti

on

ep

iso

de

s

Cyclosporine + MMF Cyclosporine + AZATacrolimus + MMF Tacrolimus + AZA

18-49: CyA + MMF vs. TAC + MMF (p = 0.023); 60+: CyA + MMF vs. CyA + AZA (p = 0.009); CyA +AZA vs. TAC + MMF (p = 0.0038);Female: CyA + AZA vs. TAC + MMF (p = 0.0003); Male: CyA + AZA vs. TAC + MMF (p = 0.047); CyA + MMF vs. CyA + AZA (p = 0.006)


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


Follow-ups: April 1994 –

June 1999 Follow-ups: July 1999-

June 2005

Outcome Within 1

Year

Total number with known response

Within 1 Year


Hypertension 48.3% (N = 3,162) 53.2% (N = 4,735)

Renal Dysfunction 22.2% (N = 3,088) 27.4% (N = 4,870)

Abnormal Creatinine < 2.5 mg/dl 12.5% 18.9%

Creatinine > 2.5 mg/dl 8.0% 6.7%

Chronic Dialysis 1.7% 1.8%

Renal Transplant 0.0% 0.1%

Hyperlipidemia 11.0% (N = 3,280) 23.9% (N = 5,064)

Diabetes 16.10% (N = 3,129) 26.9% (N = 4,800)

Bronchiolitis Obliterans 10.7% (N = 2,817) 7.3% (N = 4,460)


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

Post-Transplant (Follow-ups: April 1994 - June 2005)

Outcome Within 1

Year


Within 5 Years


Hypertension 51.3% (N = 7,897) 85.5% (N = 1,822)

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

Abnormal Creatinine < 2.5 mg/dl 16.2% 22.7%

Creatinine > 2.5 mg/dl 7.6% 12.8%

Chronic Dialysis 1.9% 3.2%

Renal Transplant 0.0% 0.7%

Hyperlipidemia 18.8% (N = 8,344) 49.3% (N = 2,015)

Diabetes 22.6% (N = 7,929) 31.5% (N = 1,805)

Bronchiolitis Obliterans 8.6% (N = 7,277) 33.5% (N = 1,466)


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


Outcome Within 10

Years Total number with known response

Hypertension 99.3% (N = 146)

Renal Dysfunction 43.2% (N = 169)

Abnormal Creatinine < 2.5 mg/dl 23.1% Creatinine > 2.5 mg/dl 10.1% Chronic Dialysis 7.1% Renal Transplant 3.0%

Hyperlipidemia 66.9% (N = 178)

Diabetes 30.0% (N = 150)

Bronchiolitis Obliterans 37.0% (N = 92)


FREEDOM FROM BRONCHIOLITIS OBLITERANSFor Adult Lung Recipients (Follow-ups: April 1994-June 2005)

Conditional on Survival to 14 days

0

20

40

60

80

100

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

% F

reed

om

fro

m O

B


FREEDOM FROM BRONCHIOLITIS OBLITERANS STRATIFIED BY INDUCTION USE

For Adult Lung Recipients (Follow-ups: April 1994-June 2004)Conditional on Survival to 14 days

0

20

40

60

80

100

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

% F

reed

om

fro

m O

B


Induction (N=2,454)

p = 0.1561


FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Adult Lung Recipients (Follow-ups: April 1994-June 2005)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Years

% F

reed

om

fro

m S

ever

e R

enal

D

ysfu

nct

ion

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


MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2005)

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

No Malignancy 7968 (96.2%) 1756 (87.5%) 723 (81.3%)

Malignancy (all types combined) 316 (3.8%) 252 (12.5%) 166 (18.7%)

Malignancy Type*

Skin 70 132 101

Lymph 152 54 31

Other 73 71 51

Type Not Reported

21 10 2

* 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; 2), bladder (2; 1; 0), lung (2; 4; 2), breast (1; 5; 4); prostate (0; 5; 3), cervical (1; 1; 1); liver (1; 1; 1). Numbers in parentheses represent the number of reported cases within each time period.


FREEDOM FROM MALIGNANCYFor Adult Lung Recipients (Follow-ups: April 1994-June 2005)

50

60

70

80

90

100

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

% F

ree

fro

m M

alig

nan

cy

All malignancy Lymph Skin Other


ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January 1992- June 2005)

CAUSE OF DEATH0-30 Days

(N = 1,273)

31 Days - 1 Year

(N = 1,886)

>1 Year - 3 Years

(N = 1,581)

>3 Years - 5 Years

(N = 910)

>5 Years

(N = 1,001)

BRONCHIOLITIS 5 (0.4%) 87 (4.6%) 414 (26.2%) 263 (28.9%) 265 (26.5%)

ACUTE REJECTION 65 (5.1%) 37 (2.0%) 26 (1.6%) 5 (0.5%) 7 (0.7%)

LYMPHOMA 1 (0.1%) 51 (2.7%) 35 (2.2%) 14 (1.5%) 31 (3.1%)

MALIGNANCY, OTHER 1 (0.1%) 50 (2.7%) 94 (5.9%) 73 (8.0%) 89 (8.9%)

CMV 0 69 (3.7%) 21 (1.3%) 4 (0.4%) 3 (0.3%)

INFECTION, NON-CMV 270 (21.2%) 685 (36.3%) 395 (25.0%) 172 (18.9%) 180 (18.0%)

GRAFT FAILURE 361 (28.4%) 359 (19.0%) 278 (17.6%) 169 (18.6%) 170 (17.0%)

CARDIOVASCULAR 131 (10.3%) 82 (4.3%) 53 (3.4%) 43 (4.7%) 52 (5.2%)

TECHNICAL 107 (8.4%) 50 (2.7%) 11 (0.7%) 2 (0.2%) 3 (0.3%)

OTHER 332 (26.1%) 416 (22.1%) 254 (16.1%) 165 (18.1%) 201 (20.1%)


LUNG TRANSPLANTATION Overall ISHLT 2006 J Heart Lung Transplant 2006;25:880-892.

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Transcript of LUNG TRANSPLANTATION Overall ISHLT 2006 J Heart Lung Transplant 2006;25:880-892.