Post on 27-Mar-2015
2002ISHLT
LUNG TRANSPLANTATION
Overall
2002ISHLT
NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE
0
200
400
600
800
1000
1200
1400
1600
1800
Nu
mb
er
of
Tra
ns
pla
nts
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
*
Bilateral/Double LungSingle Lung
13 15 47 80185
408
686
902
10691204
1341133714161413140815081554
* Numbers may be low due to delayed reporting.
2002ISHLT
NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND LOCATION
0
200
400
600
800
1000
1200
1400
1600
Nu
mb
er
of
Tra
ns
pla
nts
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
*
* Numbers may be low due to delayed reporting.
2002ISHLT
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
*
Year of Transplant
% o
f T
ran
spla
nts
0-10 11-17 18-34 35-49 50-59 60+
2002ISHLT
AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1985-2001)
0
10
20
30
40
50
% o
f tr
ansp
lan
ts
<1 1-5 6-10 11-17 18-34 35-49 50-64 65+
Recipient Age
2002ISHLT
AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA
0
10
20
30
40
50
<1 1-5
6-10
11-1
7
18-3
4
35-4
9
50-6
465
+ <1 1-5
6-10
11-1
7
18-3
4
35-4
9
50-6
465
+
% o
f tr
ansp
lan
ts
1985-1996 1997-2001
2002ISHLT
LUNG TRANSPLANTATIONActuarial Survival (1990-2000)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10 11
Years Post Transplantation
Sur
viva
l (%
)
Bilateral/Double Lung (N=6,448)
Single Lung (N=7,798)
All Lungs (N=14,246)
Double lung: 1/2-life = 4.9 Years; Conditional 1/2-life = 7.9 YearsSingle lung: 1/2-life = 3.7 Years; Conditional 1/2-life = 5.9 YearsAll lungs: 1/2-life = 4.1 Years; Conditional 1/2-life = 6.5 Years
2002ISHLT
LUNG TRANSPLANTATION
Adult Recipients
2002ISHLT
ADULT LUNG TRANSPLANTATION: Indications (1995-2001)
DIAGNOSIS SLT (N = 4,663) BLT (N = 4,118) TOTAL (N = 8,781)
COPD/Emphysema 2,536 54.4% 926 22.5% 3,462 39.4%
IPF 1,110 23.8% 376 9.1% 1,486 16.9%
CF 52 1.1% 1,360 33.0% 1,412 16.1%
Alpha-1 408 8.7% 407 9.9% 815 9.3%
PPH 61 1.3% 340 8.3% 401 4.6%
Sarcoidosis 126 2.7% 106 2.6% 232 2.6%
Bronchiectasis 14 0.3% 176 4.3% 190 2.2%
Congenital Heart Disease 8 0.2% 95 2.3% 103 1.2%
LAM 42 0.9% 53 1.3% 95 1.1%
Re-TX: OB 44 0.9% 43 1.0% 87 1.0%
OB (Non-ReTX) 32 0.7% 50 1.2% 82 0.9%
Re-TX: Non-OB 33 0.7% 36 0.9% 69 0.8%
Connective Tissue Disorder
20 0.4% 18 0.4% 38 0.4%
Cancer 7 0.2% 28 0.7% 35 0.4%
Histiocytosis X 11 0.2% 8 0.2% 19 0.2%
Other 159 3.4% 96 2.3% 255 2.9%
2002ISHLT
ADULT LUNG TRANSPLANTATION: Indications (1995-2001)
54%
24%
9%
1%
3%
1%2%
6%
22%
34%2%
9%
10%
8%
2%
1%4%
1%
4%
3%
COPD/Emphysema CF Congenital Heart DiseaseBronchiectasis Re-TX IPFAlpha-1 PPH SarcoidosisOB (Non-ReTX) LAM Other
Single Lung Transplants
Bilateral/Double Lung Transplants
2002ISHLT
ADULT LUNG TRANSPLANTATIONIndications By Year
0
20
40
60
80
100
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Transplant Year
% o
f T
ran
sp
lan
ts
Cystic Fibrosis IPF Emphysema PPH
2002ISHLT
ADULT LUNG TRANSPLANTATIONActuarial Survival by Era (1988-2001)
0
25
50
75
100
0 1 2 3 4 5 6 7 8
Years Post-Transplantation
Su
rviv
al (
%)
1988-1992 (N=2,093)1993-1997 (N=5,999)1998-2001 (N=5,595)
Survival comparisons by era1988-1992 vs. 1993-1997: p = 0.0071988-1992 vs. 1998-2001: p < 0.00011993-1997 vs. 1998-2001: p = 0.003
2002ISHLT
ADULT LUNG TRANSPLANTATIONActuarial Survival by Age Group (1990-2001)
0
25
50
75
100
0 1 2 3 4 5 6 7 8
Years Post-Transplantation
Sur
viva
l (%
)
18-34 (N=2,451)35-49 (N=4,114)50-64 (N=6,377)65+ (N=347)
Survival comparisons by age group18-34 vs. 50-64: p < 0.000118-34 vs. 65+: p = 0.000935-49 vs. 50-64: p < 0.000135-49 vs. 65+: p = 0.0004
2002ISHLT
ADULT LUNG TRANSPLANTATIONActuarial Survival By Diagnosis (1990-2001)
0
25
50
75
100
0 1 2 3 4 5 6 7
Years Post-Transplantation
Sur
viva
l (%
)
Alpha-1 Antitrypsin (N=1,288) Cystic Fibrosis (N=1,809)Emphysema/COPD (N=4,643) IPF (N=1,981)PPH (N=714) Sarcoidosis (N = 303)
2002ISHLT
ADULT LUNG TRANSPLANTATIONActuarial Survival By Procedure Type
Diagnosis: Alpha-1 Antitrypsin Deficiency (1990-2001)
0
25
50
75
100
0 1 2 3 4 5 6 7
Years Post-Transplantation
Sur
viva
l (%
)
Single Lung (N = 739)
Double Lung (N=549) P = 0.03
2002ISHLT
ADULT LUNG TRANSPLANTATIONActuarial Survival by Procedure Type
Diagnosis: Emphysema/COPD (1990-2001)
0
25
50
75
100
0 1 2 3 4 5 6 7
Years Post-Transplantation
Sur
viva
l (%
)
Single Lung (N =3,513)
Double Lung (N=1,130)P < 0.0001
2002ISHLT
ADULT LUNG TRANSPLANTATIONActuarial Survival by Procedure Type
Diagnosis: IPF (1990-2001)
0
25
50
75
100
0 1 2 3 4 5 6 7
Years Post-Transplantation
Sur
viva
l (%
)
Single Lung (N =1,547)
Double Lung (N=434)P = 0.2
2002ISHLT
ADULT LUNG TRANSPLANTATIONActuarial Survival by Procedure Type
Diagnosis: PPH (1990-2001)
0
25
50
75
100
0 1 2 3 4 5 6 7
Years Post-Transplantation
Sur
viva
l (%
)
Single Lung (N =250)
Double Lung (N=464)P = 0.4
2002ISHLT
ADULT LUNG TRANSPLANTS (1996-2001) Risk Factors for 1 Year Mortality
In Descending Order of Magnitude
N=5,242
VARIABLE Odds Ratio P-value
95% Confidence
Interval
Diagnosis: Congenital Heart Disease 2.07 0.007 1.22 -3.50
Previous Transplant 2.02 0.0003 1.38 -2.97
Ventilator 1.77 0.03 1.05 -2.98
Total Assistance for ADL 1.52 0.002 1.17 -1.97
In ICU or Hospital 1.48 0.01 1.09 -2.01
Diagnosis: PPH 1.47 0.01 1.08 -2.02
Double Lung TX/Diagnosis: IPF 1.38 0.04 1.01 -1.88
2002ISHLT
ADULT LUNG TRANSPLANTS (1996-2001) Risk Factors for 1 Year Mortality
In Descending Order of Magnitude
N=5,242
VARIABLE Odds Ratio P-value
95% Confidence
Interval
Donor CMV+/Recipient CMV- 1.37 0.0007 1.14 -1.65
Donor COD: Other (not head trauma, CVA, CNS tumor, or anoxia) 1.30 0.02 1.04 -1.62
Year of Transplant: 1996 1.26 0.005 1.07 -1.47
Donor Cigarette History 1.21 0.02 1.03 -1.41
Donor/Recipient Gender Mismatch 1.19 0.02 1.03 -1.37
Diagnosis: COPD 0.55 <.0001 0.47 -0.65
2002ISHLT
ADULT LUNG TRANSPLANTS (1996-2001) Risk Factors for 1 Year Mortality
Continuous Factors
N=5,242
VARIABLE Odds Ratio p-value Recipient Age – linear < 0.0001
20 years 0.52
35 years 0.75
50 years 1.08
65 years 1.55
Donor Age - quadratic 0.001
20 years 1.06
35 years 1.01
50 years 1.21
65 years 1.83
2002ISHLT
ADULT LUNG TRANSPLANTS (1996-2001) Risk Factors for 1 Year Mortality
Continuous Factors
N=5,242
VARIABLE Odds Ratio p-value Recipient BMI – linear 0.004
20 0.91
25 1.06
30 1.23
35 1.43
Center Volume - linear < 0.0001 5 transplants/year 1.21
10 transplants/year 1.14 30 transplants/year 0.92 60 transplants/year 0.67
2002ISHLT
ADULT LUNG TRANSPLANTS (1996-2001) Risk Factors for 1 Year Mortality
Continuous Factors
N=5,242
VARIABLE Odds Ratio p-value Bilirubin (mg/dl) – linear 0.03
1 0.99 5 1.10
10 1.25 25 1.87 50 3.63
2002ISHLT
ADULT LUNG TRANSPLANTS (1996-2001) Factors Not Significant for 1 Year Mortality
•Steroid dependency•Ischemia time•% Predicted FeV1•% Predicted FVC•Transfusions•Diabetes•Weight (donor)•Height (donor)•Donor clinical infection•Donor history of hypertension•Donor given steroids
2002ISHLT
ADULT LUNG TRANSPLANTS (April 1994-December 1996) Risk Factors for 5 Year Mortality
In Descending Order of Magnitude
N=3,098
VARIABLE Odds Ratio P-value
95% Confidence
Interval
Diagnosis: Congenital Heart Disease 3.04 0.0007 1.60 -5.77
In ICU 2.70 0.001 1.48 -4.93
Previous Transplant 2.26 0.0007 1.41 -3.63
Double Lung TX/Diagnosis: IPF 1.73 0.009 1.15 -2.62
Donor CMV+/Recipient CMV- 1.48 0.0009 1.18 -1.87
2002ISHLT
ADULT LUNG TRANSPLANTS (April 1994-December 1996) Risk Factors for 5 Year Mortality
In Descending Order of Magnitude
N=3,098
VARIABLE Odds Ratio P-value
95% Confidence
Interval
Donor COD: Other (not head trauma, CVA, CNS tumor, or anoxia) 1.42 0.004 1.12 -1.81
Donor Cigarette History 1.21 0.046 1.00 -1.45
Female Recipient 0.74 0.002 0.61 -0.90
2002ISHLT
ADULT LUNG TRANSPLANTS (April 1994-December 1996) Risk Factors for 5 Year Mortality
Continuous Factors
N=3,098
VARIABLE Odds Ratio p-value Recipient Age - linear <0.0001
Recipient Age – quadratic 0.0001 20 years 1.22 35 years 0.91 50 years 1.08 65 years 2.01
Donor Age - quadratic < 0.0001
20 years 1.12 35 years 1.02 50 years 1.42 65 years 3.06
2002ISHLT
ADULT LUNG TRANSPLANTS (April 1994-December 1996) Risk Factors for 5 Year Mortality
Continuous Factors
N=3,098
VARIABLE Odds Ratio p-value Recipient BMI – linear 0.004
20 0.80
25 1.15
30 1.64
35 2.34
Center Volume - linear 0.0001
5 transplants/year 1.21
10 transplants/year 1.15
30 transplants/year 0.92
60 transplants/year 0.66
2002ISHLT
ADULT LUNG TRANSPLANTS (April 1994-December 1996) Risk Factors for 5 Year Mortality
Continuous Factors
N=3,098
VARIABLE Odds Ratio p-value Recipient Weight – linear 0.04
40 kg 1.49
60 kg 1.10
80 kg 0.82
100 kg 0.61
2002ISHLT
ADULT LUNG TRANSPLANTS (April 1994-December 1996) Factors Not Significant for 5 Year Mortality
•Steroid dependency•Ventilator•Ischemia time•% Predicted FeV1•% Predicted FVC•Transfusions•Diabetes•Weight (donor)•Height (donor)•Donor clinical infection•Donor history of hypertension•Donor given steroids
2002ISHLT
ADULT LUNG TRANSPLANTS (April 1994-December 1996) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
In Descending Order of Magnitude
N=2,285
VARIABLE Odds Ratio P-value
95% Confidence
Interval Bronchiolitis Obliterans during 1st Year
3.67 <.0001 2.57 -5.24
Donor CMV+/Recipient CMV- 1.36 0.02 1.04 -1.79
Rejection during 1st Year 1.30 0.005 1.08 -1.56
Double Lung Transplant 0.77 0.01 0.62 -0.95
2002ISHLT
ADULT LUNG TRANSPLANTS (April 1994-December 1996)
Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
Continuous Factors
N=2,285
VARIABLE Odds Ratio p-value Recipient Age – linear <.0001
Recipient Age – quadratic <.0001
20 years 1.34
35 years 0.93
50 years 1.08
65 years 2.08
Donor Age - quadratic 0.004
20 years 1.10
35 years 1.01
50 years 1.33
65 years 2.49
2002ISHLT
ADULT LUNG RECIPIENTSFunctional Status (April 1994 – December 2001)
0%
20%
40%
60%
80%
100%
1 Year (N=5,039) 3 Years (N=3,516) 5 Years (N=1,372)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
2002ISHLT
ADULT LUNG RECIPIENTSEmployment Status (U.S.: April 1994 – December 2001)
0%
20%
40%
60%
80%
100%
1 Year (N = 3,738)
3 Years (N=2,229)
5 Years (N = 1,194)
Retired
Not Working
Working Part Time
Working Full Time
2002ISHLT
ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant (April 1994 - December 2001)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N = 4,703)
Between 2 and 3 Years (N = 2,811)
Between 4 and 5 Years (N = 1,541)
No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Only Hospitalized, Infection OnlyHospitalized, Rejection and Infection
2002ISHLT
0
5
10
15
20
25
30
35
40
45
Any Induction (N = 911)
Polyclonal ATG/ALG (N = 456)
OKT3 (N = 94) IL2-R Antagonist (N = 426)
% o
f p
ati
en
tsADULT LUNG RECIPIENTS
Induction Immunosuppression For follow-ups between October 1999 and December 2001
2002ISHLT
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
ati
en
ts
Year 1 (N = 1,417)
Year 5 (N = 625)
ADULT LUNG RECIPIENTS Maintenance Immunosuppression At Any Time During Follow-up Period
For follow-ups between October 1999 and December 2001
2002ISHLT
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone
% o
f P
ati
en
ts
Year 1 (N = 1,177) Year 5 (N = 547)
ADULT LUNG RECIPIENTSMaintenance Immunosuppression At Time of Follow-up
For follow-ups between October 1999 and December 2001
2002ISHLT
0
20
40
60
80
100
CalcineurinInhibitor
CellCycle Prednisone CalcineurinInhibitor
CellCycle Prednisone
% o
f P
ati
en
ts
CyA
TacTac
CyA
AZA
AZA
MMF
MMF
ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
For follow-ups between October 1999 and December 2001
1 Year Follow-up (N = 1,177) 5 Year Follow-up (N = 547)
2002ISHLT
0%
20%
40%
60%
80%
100%
Year 1 (N = 1,177) Year 5 (N = 547)
% o
f P
atie
nts
None Given
Other
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine + MMF
Cyclosporine + AZA
ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
For follow-ups between October 1999 and December 2001
2002ISHLT
POST-LUNG TRANSPLANT MORBIDITYFor Adult Recipients (April 1994-December 2001)
Outcome By 1 Year By 5 Years
Hypertension 49.5% (N=4,580) 87.1% (N=761)
Renal Function (N=4,557) (N=792) Normal 76.1% 61.2% Renal Dysfunction 14.1% 20.8% Creatinine>2.5 mg/dl 8.2% 14.1% Chronic Dialysis 1.6% 2.9% Renal Transplant 0.0% 0.9%
Hyperlipidemia 14.8% (N=4,760) 41.7% (N=823)
Diabetes 17.5% (N=4,535) 25.9% (N=738)
Bronchiolitis Obliterans 9.8% (N=4,237 37.2% (N=562)
2002ISHLT
Freedom from Bronchiolitis Obliterans For Adult Lung Recipients (April 1994-December 2000)
50
60
70
80
90
100
0 12 24 36 48 60
Months
% F
ree
from
CA
V
2002ISHLT
Freedom from Renal Dysfunction*For Adult Lung Recipients (April 1994-December 2000)
50
60
70
80
90
100
0 12 24 36 48 60
Months
% F
reed
om fr
om R
enal
D
ysfu
nctio
n
* Renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant
2002ISHLT
MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTSCumulative Incidence for Survivors (April 1994-December 2001)
Malignancy/Type 1-Year Survivors 5-Year Survivors
No Malignancy 4,583 (96.0%) 731 (87.2%)
Malignancy (all types combined) 189 (4.0%) 107 (12.8%)
Malignancy Type
Skin 37 54
Lymph 91 15
Other 39 21
Lymph + Skin 3
Lymph + Other 4
Skin + Other 2
Type Not Reported 22 8
2002ISHLT
Freedom from MalignancyFor Adult Lung Recipients (April 1994-December 2000)
50
60
70
80
90
100
0 12 24 36 48 60
Months
% F
ree
fro
m M
alig
nan
cy
All malignancy Lymph Skin Other
2002ISHLT
ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (1982-2001)
0-30 Days
(N = 962)
31 Days - 1 Year
(N = 1,230)
>1 Year - 3 Years
(N = 953)>3 Year - 5 Years
(N = 479)
CAD 12 1.2% 10 0.8% 11 1.2% 7 1.5%
Cardiac 89 9.3% 44 3.5% 20 2.1% 15 3.1%
Malignancy, Other 0 0.0% 24 1.9% 39 4.1% 38 7.9%
Lymphoma 1 0.1% 40 3.2% 23 2.4% 8 1.7%
CMV 5 0.5% 51 4.0% 16 1.7% 3 0.6%
Acute Rejection 57 5.9% 55 4.4% 20 2.1% 4 0.8%
Infection, Non-CMV 237 24.6% 484 38.3% 237 24.9% 90 18.8%
Bronchiolitis 7 0.7% 75 5.9% 286 30.0% 158 33.0%
Primary Graft Failure 158 16.4% 75 5.9% 55 5.8% 19 4.0%
Graft Failure - Other 141 14.7% 140 11.1% 97 10.2% 66 13.8%
Technical 85 8.8% 38 3.0% 9 0.9% 1 0.2%
Other 170 17.7% 227 18.0% 140 14.7% 70 14.6%
Total 962 100.0% 1263 100.0% 953 100.0% 479 100.0%
2002ISHLT
ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (1982-2001)
0%
20%
40%
60%
80%
100%
0-30 Days (N = 962)
31 Days - 1 Year (N = 1,230)
>1 Year - 3 Years(N = 953)
>3 Years - 5Years (N =
479)
> 5 Years (N = 301)
Pe
rce
nta
ge
of
De
ath
s
Other
Technical
Graft Failure - Other
Primary Graft Failure
Bronchiolitis
Infection, Non-CMV
Acute Rejection
CMV
Lymphoma
Malignancy, Other
Cardiac
CAD
Timing of Death
2002ISHLT
ADULT LUNG TRANSPLANTS RECIPIENTS: Cause of Death by Era: Deaths in 0-30 Days
0%
20%
40%
60%
80%
100%
1987-1991 (N = 157) 1992-1996 (N = 493) 1997-2001 (N = 311)
Per
cent
age
of d
eath
s
Other
Technical
Graft Failure - Other
Primary Graft Failure
Bronchiolitis
Infection, Non-CMV
Acute Rejection
CMV
Lymphoma
Malignancy, Other
Cardiac
CAD
Year of Transplant
2002ISHLT
ADULT LUNG TRANSPLANTS RECIPIENTS: Cause of Death by Era: Deaths in 31 Days – 1 Year
0%
20%
40%
60%
80%
100%
1987-1991 (N = 149) 1992-1996 (N = 663) 1997-2001 (N = 417)
Per
cent
age
of d
eath
s
Other
Technical
Graft Failure - Other
Primary Graft Failure
Bronchiolitis
Infection, Non-CMV
Acute Rejection
CMV
Lymphoma
Malignancy, Other
Cardiac
CAD
Year of Transplant
2002ISHLT
ADULT LUNG TRANSPLANTS RECIPIENTS: Cause of Death by Era: Deaths in >1 Year – 3 Years
0%
20%
40%
60%
80%
100%
1987-1991 (N = 123) 1992-1996 (N = 598) 1997-2001 (N = 232)
Per
cent
age
of d
eath
s
Other
Technical
Graft Failure - Other
Primary Graft Failure
Bronchiolitis
Infection, Non-CMV
Acute Rejection
CMV
Lymphoma
Malignancy, Other
Cardiac
CAD
Year of Transplant
2002ISHLT
ADULT LUNG TRANSPLANTS RECIPIENTS: Cause of Death by Era: Deaths in >3 Years – 5 Years
0%
20%
40%
60%
80%
100%
1987-1991 (N = 102) 1992-1996 (N = 353) 1997-2001 (N = 24)
Pe
rce
nta
ge
of
de
ath
s
Other
Technical
Graft Failure - Other
Primary Graft Failure
Bronchiolitis
Infection, Non-CMV
Acute Rejection
CMV
Lymphoma
Malignancy, Other
Cardiac
CAD
Year of Transplant
2002ISHLT
ADULT LUNG TRANSPLANTS RECIPIENTS: Cause of Death by Era: Deaths in >5 Years
0%
20%
40%
60%
80%
100%
1992-1996 (N = 110) 1997-2001 (N = 188)
Pe
rce
nta
ge
of
de
ath
s
Other
Technical
Graft Failure - Other
Primary Graft Failure
Bronchiolitis
Infection, Non-CMV
Acute Rejection
CMV
Lymphoma
Malignancy, Other
Cardiac
CAD
Year of Transplant