LUNG TRANSPLANTATION
description
Transcript of LUNG TRANSPLANTATION
LUNG TRANSPLANTATION
Overall
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
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
13 15 46 83189
418
708
922
1089
1229
136813771464
14571477
156416021767
1703
ISHLT 2005
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.
J Heart Lung Transplant 2005;24: 945-982
AVERAGE CENTER VOLUMELung Transplants: January 1, 1998 - June 30, 2004
57
2631
179
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
cen
ters
.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME
Lung Transplants: January 1, 1998 - June 30, 2004
5.17.6
26.8 24.5
18.1
7.7 10
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 .
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
LUNG TRANSPLANTS: Donor Age by Year of Transplant
0%
20%
40%
60%
80%
100%
Year of Transplant
% o
f T
ran
sp
lan
ts
0-10 11-17 18-34 35-49 50-59 60+
0
5
10
15
20
25
30
35
40
Mean
do
no
r ag
e (years
)
Mean Age
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2004)
0
10
20
30
40
<10 10-19 20-29 30-39 40-49 50-59 60-64 65+
Recipient Age
% o
f tr
an
sp
lan
ts
.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA
0
5
10
15
20
25
30
35
<10 10-19 20-29 30-39 40-49 50-59 60-64 65+
% o
f tr
an
sp
lan
ts
.
1985-1996 (N = 7,390)
1997-6/2004 (N = 11,807)
p < 0.0001
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
LUNG TRANSPLANTATION
Adult Recipients
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS (1/1985-6/2004)
0
5
10
15
20
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
.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
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 .
1985-1996 (N = 7,390)
1997-6/2004 (N = 11,807)
p < 0.0001
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1994 - June 2003)
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=6,040)
Single Lung (N=7,422)
All Lungs (N=13,462)
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
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2004)
DIAGNOSIS SLT (N = 6,731) BLT (N = 6,276) TOTAL (N = 13,007)
COPD/Emphysema 3,541 (53%) 1,462 (23%) 5,003 (38%)
Idiopathic Pulmonary Fibrosis 1,618 (24%) 639 (10.0%) 2,257 (17%)
Cystic Fibrosis 151 (2.2%) 2,002 (32%) 2,153 (17%)
Alpha-1 554 (8.2%) 571 (9.1%) 1,125 (8.6%)
Primary Pulmonary Hypertension 79 (1.2%) 436 (6.9%) 515 (4%)
Sarcoidosis 157 (2.3%) 166 (2.6%) 323 (2.5%)
Bronchiectasis 45 (0.7%) 309 (4.9%) 354 (2.7%)
LAM 55 (0.8%) 83 (1.3%) 138 (1.1%)
Congenital Heart Disease 13 (0.2%) 118 (1.9%) 131 (1.0%)
Re-Transplant: Obliterative Bronchiolitis
74 (1.1%) 58 (0.9%) 132 (1.0%)
Obliterative Bronchiolitis
(Not Re-Transplant)
39 (0.6%) 80 (1.3%) 119 (0.9%)
Re-Transplant: Not Obliterative Bronchiolitis
55 (0.8%) 46 (0.7%) 101 (0.8%)
Connective Tissue Disease 34 (0.5%) 31 (0.5%) 65 (0.5%)
Histiocytosis X 20 (0.3%) 19 (0.3%) 39 (0.3%)
Cancer 7 (0.1%) 14 (0.2%) 21 (0.2%)
Other 289 (4.3%) 242 (3.8%) 509 (4.1%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATION: Distribution of Procedure Type for Major Indications (1990-2003)
ISHLT 2005
Year of TX
Alpha-1 COPD Cystic Fibrosis IPF PPH
Double/bilateral
Single Double/bilateral
Single Double/bilateral
Single Double/bilateral
Single Double/bilateral
Single
1990 27.8 72.2 21.9 78.1 94.7 5.3 1.8 98.2 15.4 84.6
1991 17.3 82.7 14.2 85.8 95.8 4.2 14.1 85.9 23.4 76.6
1992 23.3 76.7 16.5 83.5 97.0 3.0 9.2 90.8 26.9 73.1
1993 32.7 67.3 16.3 83.7 94.8 5.2 16.7 83.3 52.3 47.7
1994 32.7 67.3 17.0 83.0 85.5 14.5 14.2 85.8 60.5 39.5
1995 40.2 59.8 18.9 81.1 89.3 10.7 26.5 73.5 87.7 12.3
1996 43.8 56.2 25.2 74.8 86.4 13.6 26.3 73.7 81.0 19.0
1997 43.7 56.3 25.5 74.5 92.7 7.3 21.6 78.4 83.3 16.7
1998 45.3 54.7 27.7 72.3 92.5 7.5 18.8 81.3 78.8 21.2
1999 45.0 55.0 27.9 72.1 90.7 9.3 22.3 77.7 83.7 16.3
2000 56.7 43.3 27.8 72.2 95.2 4.8 29.0 71.0 91.3 8.7
2001 57.6 42.4 26.6 73.4 93.7 6.3 25.3 74.7 84.0 16.0
2002 53.5 46.5 36.0 64.0 96.0 4.0 34.7 65.3 81.4 18.6
2003 60.0 40.0 37.9 62.1 95.8 4.2 37.9 62.1 87.8 12.2
J Heart Lung Transplant 2005;24: 945-982
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
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
% o
f tr
an
sp
lan
ts
Bilateral/Double Lung Transplant Single Lung Transplant
AT Def COPD IPF PPH
J Heart Lung Transplant 2005;24: 945-982
2005
ADULT LUNG TRANSPLANTATION: Indications for Single Lung Transplants (Transplants: January 1995 - June 2004)
53%
24%
2%1%
2%
8%
10%
Alpha-1 COPD CF IPF PPH Re-TX Other*
ISHLT 2005
*Other includes:
Sarcoidosis: 2%
Bronchiectasis: 0.7%
Congenital Heart Disease: 0.2%
LAM: 0.8%
OB (non-ReTx): 0.6%
Miscellaneous: 5%
J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATION: Indications for Bilateral/Double Lung Transplants (Transplants: January 1995 - June 2004)
23%
10% 3%7%
11%
32%
9%
5%
Alpha-1 COPD CF IPFPPH Sarcoidosis Bronchiectasis Other*
ISHLT 2005
*Other includes:
Re-Tx: 2%
Congenital Heart Disease: 2%
LAM: 1.3%
OB (non-ReTx): 1.3%
Miscellaneous: 5%
J Heart Lung Transplant 2005;24: 945-982
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
Transplant Year
% o
f T
ran
spla
nts
Cystic Fibrosis IPF Emphysema A1A PPH
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONIndications By Year (Number)
0
250
500
750
1000
1250
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Transplant Year
Nu
mb
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f T
ran
spla
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Cystic Fibrosis IPF Emphysema A1A PPH
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Era (Transplants: January 1988 – June 2003)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
.
1988-1994 (N=4,392)1995-1999 (N=6,726)2000-6/2003 (N=5,553)
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 Years
Survival comparisons by era1988-94 vs. 1995-99: p = 0.011988-94: vs. 2000-6/03: p <0.0001 1995-99 vs. 2000-6/03: p <0.0001
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: January 1990 – June 2003)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (%
) .
18-34 (N= 2,899)35-49 (N= 4,922)50-59 (N= 5,898)60-64 (N= 2,041)65+ (N= 476)
Survival comparisons18-34 vs. 50-59: p = 0.000418-34 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: 5.3 Years; 50-59: 4.5 Years; 60-64: 3.6 Years; 65+: 3.4 Years
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: January 1994 – June 2003)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (%
) .
Male (N= 6,849)
Female (N= 6,440)
HALF-LIFE Male: 4.6 years; Female 5.0 Years
p = 0.0351
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1994 – June 2003)
YearALPHA-1 (N=1,127)
CF
(N=1,934)COPD
(N=4,888)IPF
(N=2,058)PPH
(N=553)SARCOIDOSIS
(N=314)
1 75.7 80.6 81.3 69.4 65.4 67.6
3 60.2 65.2 63.4 53.7 55.5 54.1
5 50.5 53.8 48.4 42.1 46.1 47.3
7 42.2 44.7 35.3 32.8 37.1 42.2
10 31.3 32.1 19.0 15.4 25.5 32.8
Survival comparisonsCOPD vs. IPF: p < 0.0001 Alpha-1 vs. CF: p = 0.0248Alpha-1 vs. IPF: p < 0.0001 Alpha-1 vs. PPH: p = 0.0021CF vs. COPD: p = 0.0006 CF vs. IPF: p < 0.0001CF vs. PPH: p < 0.0001 CF vs. Sarcoidosis: p = 0.0007
Note: Other comparisons are not statistically different.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on
Survival to 3 Months (Transplants: January 1994 – June 2003)
YearALPHA-1 (N=905)
CF
(N= 1,516)COPD
(N= 4,089)IPF
(N= 1,575)PPH
(N= 374)SARCOIDOSIS
(N=225)
1 87.8 91.2 89.9 85.2 89.5 84.0
3 69.7 73.8 70.1 65.9 75.9 67.3
5 58.5 60.9 53.6 51.8 63.1 58.8
7 48.9 50.7 39.1 40.3 50.7 52.4
10 36.3 36.3 21.0 18.9 34.9 40.8
Survival comparisonsAlpha-1 vs. IPF: p = 0.0015 Alpha-1 vs. COPD: p = 0.0073CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001PPH vs. COPD: p = 0.0005 PPH vs. IPF: p = 0.0002
Note: Other comparisons are not statistically different.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1994 – June 2003)
YearALPHA-1 (N=769)
CF
(N=1,300)COPD
(N= 3,468)IPF
(N=1,273)PPH
(N= 322)SARCOIDOSIS
(N=180)
1 100.0 100.0 100.0 100.0 100.0 100.0
3 79.3 80.7 77.9 77.4 84.8 80.1
5 66.6 66.6 59.6 60.7 70.5 70.0
7 55.7 55.4 43.4 47.3 56.7 62.4
10 41.3 39.7 23.3 22.2 39.0 48.6
Survival comparisonsAlpha-1 vs. IPF: p = 0.0103 Alpha-1 vs. COPD: p < 0.0001CF vs. COPD: p < 0.0001 CF vs. IPF: p = 0.0012PPH vs. COPD: p < 0.0001 PPH vs. IPF: p = 0.0017COPD vs. Sarcoidosis: p = 0.0102 IPF vs. Sarcoidosis: p = 0.0408
Note: Other comparisons are not statistically different.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1994 – June 2003)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al (
%)
ALPHA-1 (N=1,127) CF (N= 1,934)COPD (N= 4,888) IPF (N= 2,058)PPH (N= 533) SARCOIDOSIS (N = 314)
HALF-LIFE Alpha-1: 5.1 Years; CF: 5.8 Years; COPD: 4.8 Years; IPF: 3.7 Years; PPH: 4.3 Years; Sarcoidosis: 4.0 Years
Survival comparisonsCOPD vs. IPF: p < 0.0001Alpha-1 vs. CF: p = 0.0248Alpha-1 vs. IPF: p < 0.0001Alpha-1 vs. PPH: p = 0.0021CF vs. COPD: p = 0.0006CF vs. IPF: p < 0.0001CF vs. PPH: p < 0.0001CF vs. Sarcoidosis: p = 0.0007
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on
Survival to 3 Months (Transplants: January 1994 – June 2003)
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= 1,516)COPD (N= 4,089) IPF (N= 1,575)PPH (N= 374) SARCOIDOSIS (N = 225)
HALF-LIFE Alpha-1: 6.6 Years; CF: 7.1 Years; COPD: 5.5 Years; IPF: 5.2 Years; PPH: 7.0 Years; Sarcoidosis: 7.0 Years
Survival comparisonsAlpha-1 vs. IPF: p = 0.0015Alpha-1 vs. COPD: p = 0.0073CF vs. COPD: p < 0.0001CF vs. IPF: p < 0.0001PPH vs. COPD: p = 0.0005PPH vs. IPF: p = 0.0002
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year
(Transplants: January 1994 – June 2003)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al (
%)
ALPHA-1 (N=769) CF (N= 1,300)COPD (N=3,468) IPF (N= 1,273)PPH (N= 3229) SARCOIDOSIS (N = 180)
HALF-LIFE Alpha-1: 8.5 Years; CF: 8.4 Years; COPD: 6.2 Years; IPF: 6.6 Years; PPH: 8.6 Years; Sarcoidosis: 7.2 Years
Survival comparisonsAlpha-1 vs. IPF: p = 0.0103Alpha-1 vs. COPD: p < 0.0001CF vs. COPD: p < 0.0001CF vs. IPF: p = 0.0012PPH vs. COPD: p < 0.0001PPH vs. IPF: p = 0.0017COPD vs. Sarcoidosis: p = 0.0102IPF vs. Sarcoidosis: p = 0.0408
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival for Eisenmenger’s Syndrome
(Transplants: January 1990 – June 2003)
0
25
50
75
100
0 1 2 3 4 5Years
Su
rviv
al (
%)
ASD (N= 118) VSD (N= 58)
HALF-LIFE ASD: 2.8 Years; VSD: 1.0 Years
p = 0.19
ISHLT 2005
N at risk at 5 years = 33
N at risk at 5 years = 15
J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Procedure Type (Transplants: January 1990 – June 2003)
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 (%
) .
Single Lung (N = 865)
Double Lung (N=626)P = 0.0007
ISHLT 2005N at risk at 10 years is 44 for Single Lung and 23 for Double Lung.
J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Procedure Type and Median Age
(Transplants: January 1990 – June 2003) Diagnosis: Alpha-1 Antitrypsin Deficiency
0
25
50
75
100
0 1 2 3 4 5
Years
Su
rviv
al (
%)
.
Single Lung, <50 (N = 435)Double Lung, <50 (N =381)
Single Lung, 50+ (N = 430)Double Lung, 50+ (N = 245)
ISHLT 2005
N at risk at 5 years: Single Lung, <50 = 140; Double Lung, <50 = 126; Single Lung, 50+ = 97; Double Lung, 50+ = 45
p = 0.22
J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2003)
Diagnosis: Emphysema/COPD
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
.
Single Lung (N = 4,246)
Double Lung (N=1,431)N=82
N=28
P < 0.0001
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Age
(Transplants: January 1990 – June 2003)
Diagnosis: Emphysema/COPD
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
.
Single lung, < 50 (N = 691)Double lung, < 50 (N = 463)Single lung, 50+ (N = 3,555)Double lung, 50+ (N = 968)
N=25N=57
N=12N=16
P < 0.0001
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2003)
Diagnosis: Idiopathic Pulmonary Fibrosis
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
.
Single Lung (N =1,849)
Double Lung (N=580)
N=36
N=21
P = 0.5
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2003)
Diagnosis: Primary Pulmonary Hypertension
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
.
Single Lung (N =278)
Double Lung (N=518)N=27
N=16
P = 0.3
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2003)
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 (
%)
.
1990-1995 (N= 1,354)
1996-1999 (N= 1,408)
2000-6/2003 (N= 1,488)
Survival comparisons1990-1995 vs. 1996-1999: p = 0.091990-1995 vs. 2000-6/2003: p = 0.00511996-1999 vs. 2000-6/2003: p = 0.1021
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2003)
Diagnosis: Emphysema/COPD, Double/Bilateral Lung
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
.
1990-1995 (N = 278)
1996-1999 (N = 514)
2000-6/2003 (N = 641)
Survival comparisons1990-1995 vs. 1996-1999: p = 0.43561990-1995 vs. 2000-6/2003: p = 0.38041996-1999 vs. 2000-6/2003: p = 0.2677
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONActual Survival by Procedure Type and Era
(Transplants: January 1990 – December 1999)
Diagnosis: Emphysema/COPD, Double/Bilateral Lung
0
25
50
75
100
0 1 2 3 4 5
Years
Su
rviv
al (
%)
.
1990-1995 (N = 278)
1996-1999 (N = 514)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2003)
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 (
%)
.
1990-1995 (N =577)
1996-1999 (N = 681)
2000-6/2003 (N = 591)
Survival comparisons1990-1995 vs. 1996-1996: p = 0.77 1990-1995 vs. 2000-6/2003: p = 0.181996-1999 vs. 2000-6/2003: p = 0.0292
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2003)
Diagnosis: Idiopathic Pulmonary Fibrosis, Double/Bilateral Lung
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
.
1990-1995 (N = 110)
1996-1999 (N = 198)
2000-6/2003 (N = 272)
Survival comparisons1990-1995 vs. 1996-1996: p = 0.14261990-1995 vs. 2000-6/2003: p < 0.00011996-1999 vs. 2000-6/2003: p < 0.0001
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Donor CMV status/Recipient CMV status
(Transplants: October 1999 – June 2003)
50
60
70
80
90
100
0 1 2 3
Years
Su
rviv
al (
%)
.
D(-)/R(-) (N=618)D(-)/R(+) (N=854)D(+)/R(-) (N=688)D(+)/R(+) (N=1,170)
Survival comparisonsD(-)/R(-) vs. D(-)/R(+): p = 0.07D(-)/R(-) vs. D(+)/R(-): p = 0.49D(-)/R(-) vs. D(+)/R(+): p = 0.23D(-)/R(+) vs. D(+)/R(-): p = 0.008D(-)/R(+) vs. D(+)/R(+): p = 0.0005D(+)/R(-) vs. D(+)/R(+): p = 0.67
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1995-6/2003) Risk Factors for 1 Year Mortality
DIAGNOSIS PROCEDURE TYPE N
Relative Risk P-value
95% Confidence
Interval
Primary Pulmonary Hypertension Single 64 3.16 <0.0001 2.17 -4.62
Pulmonary Fibrosis (not IPF) Double/bilateral 69 2.75 <0.0001 1.85 -4.08
Sarcoidosis Any 274 2.11 <0.0001 1.69 -2.64
Idiopathic Pulmonary Fibrosis Double/bilateral 509 2.05 <0.0001 1.73 -2.44
Primary Pulmonary Hypertension Double/bilateral 390 2.01 <0.0001 1.62 -2.50
Pulmonary Fibrosis (not IPF) Single 107 1.77 .0016 1.24 -2.53
Alpha-1 Single 495 1.68 <0.0001 1.40 -2.03
Bronchiectasis Any 278 1.56 .0006 1.21 -2.02
Idiopathic Pulmonary Fibrosis Single 1343 1.51 <0.0001 1.33 -1.72
Alpha-1 Double 492 1.44 .0007 1.17 -1.77
Other* Any 1189 1.42 <0.0001 1.23 -1.65
Cystic Fibrosis Any 1651 1.34 .0023 1.11 -1.62
COPD Any 4314 1 (ref.) - -
(N=11,291)ISHLT 2005
*Other = All diagnoses other than COPD, PPH, IPF, CF, bronchiectasis, Alpha-1 antitrypsin deficiency, and LAM.
J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1995-6/2003) Risk Factors for 1 Year Mortality
DONOR AND RECIPIENT CHARACTERISTICS
N Relative
Risk P-value
95% Confidence
Interval
Donor history of diabetes 205 1.53 .0009 1.19 -1.97
Ventilator 176 1.85 <0.0001 1.41 -2.44
IV Inotropes 76 1.77 .0010 1.26 -2.48
Donor clinical infection 1345 0.87 .0228 0.76 -0.98
Prior thoracotomy 353 0.72 .0060 0.57 -0.91
(N=11,291)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1995-6/2003) Risk Factors for 1 Year Mortality
TRANSPLANT CHARACTERISTICS N
Relative Risk P-value
95% Confidence
Interval
Repeat transplant 305 1.96 <0.0001 1.59 -2.41
Donor CMV +/ Recipient CMV - 2046 1.12 .0235 1.02 -1.23
HLA mismatch (per mismatch) 1274 (<4 MM) 1.05 .0261 1.01 -1.10
Transplant Year = 2001 vs. 1999 1399 0.82 .0171 0.70 -0.97
Female donor/female recipient 3348 0.80 <0.0001 0.73 -0.89
Transplant Year = 2002/2003 vs. 1999 2260 0.70 <0.0001 0.60 -0.81
(N=11,291)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1995-6/2003) Borderline Significant Risk Factors for 1 Year Mortality
VARIABLE N
Relative Risk P-value
95% Confidence
Interval
Recipient history of malignancy 219 1.27 .0669 0.98 -1.63
Hospitalized prior to transplant 698 1.17 .0753 0.98 -1.38
Transplant Year = 1996 vs. 1999 1200 1.16 .0654 0.99 -1.35
Not ABO identical vs. identical 1110 1.11 .0949 0.98 -1.25
(N=11,291)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Recipient age
Donor age
Recipient BMI
Donor weight
Transplant center volume
Bilirubin
Recipient FEV1 % predicted
Recipient pulmonary vascular resistance
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality
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 1 Y
ear
Mo
rtality
.
p < 0.0001
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality
Donor Age
0
0.5
1
1.5
2
15 20 25 30 35 40 45 50 55 60
Donor Age
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p < 0.0001
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality
Donor Weight
0
0.5
1
1.5
2
40 50 60 70 80 90 100
Weight (kg)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p < 0.0001
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality
Pre-Transplant Recipient BMI
0
0.5
1
1.5
2
15 20 25 30 35
Recipient BMI (kg/m2)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p < 0.0001
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality
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 = 0.0002
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality
FEV1 (% predicted) in Recipients with Idiopathic Pulmonary Fibrosis
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 = 0.01
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality
Pre-Transplant Bilirubin
0
0.5
1
1.5
0 1 2 3 4 5 6 7 8
Recipient Bilirubin (mg/dl)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.013
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality
Recipient Pulmonary Vascular Resistance
0
0.5
1
1.5
2
0 3 6 9 12 15 18
PVR (wood units)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.0074
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1995-6/2003) Factors Not Significant for 1 Year Mortality
Recipient factors:pCO2, PA pressures, transfusions, recent infection requiring IV drug therapy, diabetes, sternotomy, dialysis, FVC, creatinine, PRA, cardiac output, chronic steroid use, weight, height
Donor factors:History of hypertension, history of cancer, cause of death, height, BMI
Transplant factors:Height ratio, BMI ratio, ischemia time
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/2003) 1-Year Predicted Survival – Hypothetical Case #1
50%
60%
70%
80%
90%
100%
0 30 60 90 120 150 180 210 240 270 300 330 360
Time (days)
Pre
dic
ted
Su
rviv
al
.
Recipient: male with alpha-1 antitrypsin deficiency, 45 years old, double lung procedure;
Donor: male, 30 years old
ISHLT 2005
Other characteristics: ABO identical, primary transplant, no IV inotropes, no prior thoracotomy, 3 HLA mismatches, not hospitalized, no history of malignancy, no donor clinical infection, no CMV MM, no donor history of diabetes
J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/2003) 1-Year Predicted Survival – Hypothetical Case #2
50%
60%
70%
80%
90%
100%
0 30 60 90 120 150 180 210 240 270 300 330 360
Time (days)
Pre
dic
ted
Su
rviv
al
.
No Ventilator Ventilator
Recipient: male with COPD, 50 years old, double lung procedure;
Donor: male, 35 years old
ISHLT 2005
Other characteristics: ABO identical, primary transplant, no IV inotropes, no prior thoracotomy, 3 HLA mismatches, not hospitalized, no history of malignancy, no donor clinical infection, no CMV MM, no donor history of diabetes
J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/2003) 1-Year Predicted Survival – Hypothetical Case #3
50%
60%
70%
80%
90%
100%
0 30 60 90 120 150 180 210 240 270 300 330 360
Time (days)
Pre
dic
ted
Su
rviv
al . Recipient: male with IPF, 55 years old, single
lung procedure; FEV1 = 50% predicted
Donor: male, 35 years old
ISHLT 2005Other characteristics: ABO identical, primary transplant, no IV inotropes, no prior thoracotomy, 3 HLA mismatches, not hospitalized, no history of malignancy, no donor clinical infection, no CMV MM, no donor history of diabetes
J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/2003) 1-Year Predicted Survival – Hypothetical Case #4
50%
60%
70%
80%
90%
100%
0 30 60 90 120 150 180 210 240 270 300 330 360
Time (days)
Pre
dic
ted
Su
rviv
al
.
Recipient: male with PPH, 45 years old, double lung procedure;
Donor: male, 30 years old
ISHLT 2005
Other characteristics: ABO identical, primary transplant, no IV inotropes, no prior thoracotomy, 3 HLA mismatches, not hospitalized, no history of malignancy, no donor clinical infection, no CMV MM, no donor history of diabetes
J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1995-6/1999) Risk Factors for 5 Year Mortality
DIAGNOSIS PROCEDURE TYPE N
Relative Risk P-value
95% Confidence
Interval Primary Pulmonary Hypertension
Single 391 2.01 .0023 1.28 -3.15
Pulmonary fibrosis (not IPF) Any 81 1.51 .0055 1.13 -2.02
Idiopathic Pulmonary Fibrosis Double/ bilateral
215 1.47 .0001 1.22 -1.78
Sarcoidosis Any 132 1.45 .0022 1.14 -1.85
Alpha-1 antitrypsin deficiency Single 298 1.45 <0.0001 1.23 -1.71
Idiopathic Pulmonary Fibrosis
Single 697 1.17 .0132 1.03 -1.32
LAM Any 52 0.50 .0189 0.28 -0.89
COPD Any 2039 1 (Ref.) - -
(N=5,637)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1995-6/1999) Risk Factors for 5 Year Mortality
DONOR AND RECIPIENT CHARACTERISTICS N
Relative Risk P-value
95% Confidence
Interval
Donor Cause of Death = Anoxia 167 0.69 .0030 0.54 -0.88
IV inotropes 46 1.75 .0021 1.23 -2.51
Ventilator 92 1.44 .0091 1.09 -1.89
Prior sternotomy 120 1.34 .0125 1.07 -1.69
Recipient history of diabetes 210 1.27 .0130 1.05 -1.52
O2 required at rest (per liter/min) 197 >4 L/min 1.03 .0308 1.00 -1.06
(N=5,637)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1995-6/1999) Risk Factors for 5 Year Mortality
TRANSPLANT FACTORS N Relative
Risk P-value
95% Confidence
Interval
Repeat transplant 156 1.69 <0.0001 1.35 -2.12
Not ABO identical vs. identical 633 1.19 .0027 1.06 -1.33
Transplant year = 1996 vs. 1998/1999
1200 1.11 .0415 1.00 -1.23
HLA mismatch (per mismatch) 634 <4 MM 1.05 .0198 1.01 -1.09
Female donor/female recipient 1574 0.89 .0130 0.80 -0.97
(N=5,637)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1995-6/1999) Borderline Significant Risk Factors for 5 Year Mortality
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Transplant year – 1995 vs. 1998/1999 1221 1.11 .0516 1.00 -1.22
Donor CMV +/Recipient CMV - 976 1.09 .0816 0.99 -1.20
Prior thoracotomy 182 0.82 .0657 0.66 -1.01
(N=5,637)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality
Continuous Factors (see figures)
Recipient age
Donor age
Recipient BMI
Donor weight
Bilirubin
Serum creatinine
PA systolic pressure
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality
Recipient Age
0
0.5
1
1.5
2
20 25 30 35 40 45 50 55 60 65
Recipient Age
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality
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
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality
Pre-Transplant Recipient BMI
0
0.5
1
1.5
2
15 20 25 30 35
Recipient BMI (kg/m2)
Rel
ativ
e R
isk
of
5 Y
ear
Mo
rtal
ity
p = 0.0017
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality
Donor Weight
0
0.5
1
1.5
2
45 55 65 75 85 95 105
Weight (kg)
Rel
ativ
e R
isk
of
5 Y
ear
Mo
rtal
ity
p = 0.0079
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality
Pre-Transplant Bilirubin
0
0.5
1
1.5
0 1 2 3 4 5 6 7 8
Recipient Bilirubin (mg/dl)
Rel
ativ
e R
isk
of
5 Y
ear
Mo
rtal
ity
p = 0.013
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality
Recipient PA Systolic Pressure
0
0.5
1
1.5
2
25 50 75 100
Recipent PA systolic pressure (mm Hg)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0334
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality
Pre-Transplant Creatinine
0
0.5
1
1.5
2
0.5 0.8 1.1 1.4 1.7 2
Recipent creatinine (mg/dl)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.043
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1995-6/1999) Factors Not Significant for 5 Year Mortality
Recipient factors:Hospitalized, 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:CMV mismatch, ischemia time, transplant center volume
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1995-6/1999) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
DIAGNOSIS PROCEDURE TYPE N
Relative Risk P-value
95% Confidence
Interval
Alpha-1 antitrypsin deficiency Single 214 1.35 .0081 1.08 -1.69
Other * Any 444 0.81 .0391 0.67 -0.99
Cystic Fibrosis Any 634 0.68 .0022 0.53 -0.87
Primary Pulmonary Hypertension
Any 150 0.65 .0087 0.47 -0.90
LAM Any 41 0.25 .0063 0.09 -0.68
COPD Any 1568 1 (Ref.) - - -
(N=4,028)
ISHLT 2005
*Other = All diagnoses other than COPD, PPH, IPF, CF, bronchiectasis, Alpha-1 antitrypsin deficiency, and LAM.
J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1995-6/1999) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
DONOR AND RECIPIENT CHARACTERISTICS N
Relative Risk P-value
95% Confidence
Interval
Donor Cause of Death = Anoxia 130 0.54 .0010 0.38 -0.78
Sternotomy prior to transplant 75 1.51 .0151 1.08 -2.09
HLA A mismatches (per mismatch) 227 0 MM 1.11 .0353 1.01 -1.21
(N=4,028)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1995-6/1999) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
POST-TRANSPLANT FACTORS N Relative
Risk P-value
95% Confidence
Interval
Bronchiolitis obliterans within 1st year 218 2.40 <0.0001 1.98 -2.92
Dialysis prior to discharge 46 1.52 .0440 1.01 -2.30
Rejection between discharge and 1 year 902 1.27 .0002 1.12 -1.44
Drug-treated infection prior to discharge 1152 1.16 .0097 1.04 -1.31
Polyclonal induction 855 0.88 .0490 0.77 -1.00
(N=4,028)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1995-6/1999) Borderline Significant Risk Factors for 5 Year Mortality
Conditional on Survival to 1 Year
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Recipient history of diabetes 144 1.25 .0968 0.96 -1.64
Transplant year = 1995 vs. 1998/1999 871 1.15 .0530 1.00 -1.33
Diagnosis = Alpha-1 antitrypsin deficiency/ Double lung transplant
181 0.75 .0615 0.55 -1.01
Diagnosis = Bronchiectasis 96 0.69 .0758 0.46 -1.04
(N=4,028)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
Continuous Factors (see figures) Recipient Age
Donor Age
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival
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
rtality
.
p < 0.0001
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival
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
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1995-6/1999) 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, height, weight, 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
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANTS (1995-6/1999) 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
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG RECIPIENTSFunctional Status of Surviving Recipients
(Follow-ups: April 1994 – June 2004)
0%
20%
40%
60%
80%
100%
1 Year (N = 6,169) 3 Years (N =3,861) 5 Years (N = 2,243) 7 Years (N = 1,170)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG RECIPIENTSEmployment Status of Surviving Recipients
(Follow-ups: April 1994 – June 2004)
0%
20%
40%
60%
80%
100%
1 Year (N = 5,751)
3 Years (N = 3,388)
5 Years (N = 1,964)
7 Years (N = 1,001)
Retired
Not Working
Working Part Time
Working Full Time
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2004)
0%
20%
40%
60%
80%
100%
Up to 1 Year (N = 7,121)
Between 2 and 3Years (N = 4,257)
Between 4 and 5Years (N = 2,479)
Between 6 and 7Years (N = 1,284)
No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Only Hospitalized, Infection OnlyHospitalized, Rejection and Infection
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0
5
10
15
20
25
30
35
40
45
50
Any Induction (N = 1,208)
PolyclonalALG/ATG (N = 364)
OKT3 (N = 17) IL2R-antagonist (N = 837)
% o
f p
atien
tsADULT LUNG RECIPIENTS
Induction Immunosuppression (Follow-ups: January 2002 - June 2004)Analysis limited to patients receiving prednisone
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0
10
20
30
40
50
Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist
% o
f p
ati
en
ts .
2000 2001 2002 2003
ADULT LUNG RECIPIENTSInduction Immunosuppression (Follow-ups: January 2000 - December 2003)
Analysis limited to patients receiving prednisone
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: April 1994-June 2003)
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=6,791)
Induction (N=3,349)
p = 0.0843
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: January 2000-June 2003)
Conditional on Survival to 14 days
0
20
40
60
80
100
0 1 2 3 4
Years
Su
rviv
al (
%)
.
No induction (N=2,472)
Induction (N=1,684)
p =0.241
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine
% o
f P
ati
en
ts .
Year 1 (N = 1,923) Year 5 (N = 861)
ADULT LUNG RECIPIENTSMaintenance Immunosuppression At Time of Follow-up
For follow-ups between January 2001 through June 2004 Analysis limited to patients receiving prednisone
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
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 2001 through June 2004Analysis limited to patients receiving prednisone
1 Year Follow-up (N = 1,928) 5 Year Follow-up (N = 865)
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0
20
40
60
80
100
Year 1 (N = 1,923) Year 5 (N = 861)
% 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 2001 through June 2003Conventional Combinations
Analysis limited to patients receiving prednisone
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
0
10
20
30
40
50
Year 1 (N = 1,923) Year 5 (N = 861)
% 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 2001 through June 2003Other Combinations
Analysis limited to patients receiving prednisone
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2003)
0
10
20
30
40
50
60
Overall 18-34 35-49 50-64 65+ F M
% t
reate
d f
or
reje
cti
on
wit
hin
1 y
ear
.
No induction Polyclonal IL2R-antagonist OKT3
For female: no induction vs. polyclonal (p = 0.04) For male: no induction vs. polyclonal (p = 0.009); polyclonal vs. IL2R (p = 0.015)
Overall: no induction vs. polyclonal (p=0.001); polyclonal vs. IL2R (p = 0.0035)35-49: no induction vs. polyclonal (p=0.049); polyclonal vs. IL2R (p = 0.017)50-64: no induction vs. polyclonal (p = 0.0063)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
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, 2003)
0
0.5
1
1.5
2
2.5
Overall 18-34 35-49 50-64 65+ F M
Avera
ge n
um
ber
of re
jectio
n e
pis
od
es
.
No induction Polyclonal IL2R-antagonist OKT3
Overall: no induction vs. polyclonal (p < 0.0001); no induction vs. IL2R (p = 0.0110); polyclonal vs. IL2R (p = 0.0355). 18-34: no induction vs. polyclonal (p = 0.002); polyclonal vs. IL2R (p = 0.019). 50-64: no induction vs. polyclonal (p = 0.022)
Females: no induction vs. polyclonal (p = 0.04); no induction vs. IL2R (p = 0.04). Males: no induction vs. polyclonal (p = 0.0003); polyclonal vs. IL2R (p = 0.011)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2003)
0
10
20
30
40
50
60
70
Overall 18-34 35-49 50-64 65+ F M
% tre
ate
d fo
r re
jectio
n w
ith
in 1
year
.
Cyclosporin + MMF Cyclosporin + AZATacrolimus + MMF Tacrolimus + AZA
Overall: CyA + MMF vs. TAC + MMF (p = 0.0007); CyA + AZA vs. TAC + MMF (p < 0.0001); CyA + AZA vs. TAC + AZA
(p = 0.0002). 35-49: CyA + MMF vs. TAC + MMF (p = 0.017); CyA + AZA vs. TAC + MMF (p = 0.0004); CyA + AZA vs. TAC + AZA (p = 0.023). 50-64: CyA + MMF vs. TAC + MMF (p = 0.037); CyA + AZA vs. TAC + MMF (p < 0.0001); CyA + MMF vs. CyA + AZA (p = 0.045); CyA + AZA vs. TAC + AZA (p = 0.0003). 65+: CyA + AZA vs. TAC + MMF (p = 0.035); CyA + MMF vs. TAC + MMF
(p = 0.035). Females: CyA + AZA vs. TAC + MMF (p = 0.002); CyA + AZA vs. TAC + AZA (p = 0.014). Males: CyA + MMF vs. TAC + MMF (p = 0.0007); CyA + AZA vs. TAC + MMF (p < 0.0001); CyA + AZA vs. TAC + AZA (p = 0.005); TAC + MMF vs. TAC + AZA (p = 0.04)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
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, 2003)
0
0.5
1
1.5
2
2.5
3
Overall 18-34 35-49 50-64 65+ F M
Avera
ge n
um
ber
of re
jectio
n e
pis
od
es
. Cyclosporin + MMF Cyclosporin + AZATacrolimus + MMF Tacrolimus + AZA
Overall: CyA + MMF vs. CyA + AZA (p = 0.0015); CyA + AZA vs. TAC + MMF (p < 0.0001); TAC + MMF vs. TAC + AZA (p = 0.0257). 18-34: CyA + MMF vs. CyA + AZA (p = 0.046); CyA + AZA vs. TAC + MMF (p = 0.014). 50-64: CyA + MMF vs. CyA + AZA (p = 0.013); CyA +AZA vs. TAC + MMF (p = 0.002); CyA + AZA vs. TAC + AZA (p = 0.02). Female: CyA + AZA vs. TAC + MMF (p = 0.0005).Male: CyA + AZA vs. TAC + MMF (p = 0.04); CyA + MMF vs. CyA + AZA (p = 0.007)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994 - June 2004)
Transplants: April 1994 –
June 1999 Transplants: July 1999-
June 2003
Outcome Within 1
Year
Total number with known response
Within 1 Year
Total number with known response
Hypertension 50.5% (N = 3,607) 53.1% (N = 2,839)
Renal Dysfunction 24.8% (N = 3,526) 28.8% (N = 2,938)
Abnormal Creatinine < 2.5 mg/dl 14.3% 20.3%
Creatinine > 2.5 mg/dl 8.6% 6.5%
Chronic Dialysis 1.8% 2.0%
Renal Transplant 0.0% 0.1%
Hyperlipidemia 15.3% (N = 3,749) 22.6% (N = 3,050)
Diabetes 18.3% (N = 3,564) 27.1% (N = 2,885)
Bronchiolitis Obliterans 10.4% (N = 3,222) 6.5% (N = 2,658)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 and 5 Years
Post-Transplant (Follow-ups: April 1994 - June 2004)
Outcome Within 1
Year
Total number with known response
Within 5 Years
Total number with known response
Hypertension 51.1% (N = 6,994) 85.9% (N = 1,490)
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 17.7% (N = 7,362) 46.8% (N = 1,645)
Diabetes 21.5% (N = 6,995) 30.9% (N = 1,467)
Bronchiolitis Obliterans 8.8% (N = 6,407) 33.0% (N = 1,178)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 8 Years Post-Transplant
(Follow-ups: April 1994 - June 2004)
Outcome Within 8
Years Total number with known response
Hypertension 93.7% (N = 349)
Renal Dysfunction 36.3% (N = 391)
Abnormal Creatinine < 2.5 mg/dl 19.7% Creatinine > 2.5 mg/dl 9.2% Chronic Dialysis 5.9% Renal Transplant 1.5%
Hyperlipidemia 56.8% (N = 400)
Diabetes 28.3% (N = 346)
Bronchiolitis Obliterans 40.5% (N = 242)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
FREEDOM FROM BRONCHIOLITIS OBLITERANSFor Adult Lung Recipients (Follow-ups: April 1994-June 2004)
Conditional on Survival to 90 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
.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
FREEDOM FROM BRONCHIOLITIS OBLITERANS STRATIFIED BY INDUCTION USE
For Adult Lung Recipients (Follow-ups: April 1994-June 2004)Conditional on Survival to 90 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
.
No induction (N=4,699)
Induction (N=2,454)
p = 0.1561
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Adult Lung Recipients (Follow-ups: April 1994-June 2004)
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
Dys
fun
ctio
n
* Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2004)
Malignancy/Type 1-Year Survivors 5-Year Survivors 7-Year Survivors
No Malignancy 7025 (96.1%) 1427 (87%) 553 (81.7%)
Malignancy (all types combined) 284 (3.9%) 213 (13%) 124 (18.3%)
Malignancy Type*
Skin 59 110 81
Lymph 145 45 25
Other 58 60 32
Type Not Reported
22 11 21
* 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; 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.
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
FREEDOM FROM MALIGNANCYFor Adult Lung Recipients (Follow-ups: April 1994-June 2004)
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
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982
ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January 1992- June 2004)
CAUSE OF DEATH0-30 Days
(N = 1146)
31 Days - 1 Year
(N = 1,717)
>1 Year - 3 Years
(N = 1,428)
>3 Years - 5 Years
(N = 800)
>5 Years
(N = 829)
BRONCHIOLITIS 5 (0.4%) 82 (4.8%) 378 (26.5%) 231 (28.9%) 225 (27.1%)
ACUTE REJECTION 63 (5.5%) 35 (2.0%) 25 (1.8%) 4 (0.5%) 5 (0.6%)
LYMPHOMA 1 (0.1%) 47 (2.7%) 32 (2.2%) 11 (1.4%) 27 (3.3%)
MALIGNANCY, OTHER 1 (0.1%) 44 (2.6%) 78 (5.5%) 60 (7.5%) 70 (8.4%)
CMV 0 65 (3.8%) 20 (1.4%) 4 (0.5%) 3 (0.4%)
INFECTION, NON-CMV 245 (21.4%) 639 (37.2%) 352 (24.6%) 162 (20.3%) 150 (18.1%)
GRAFT FAILURE 331 (28.9%) 307 (17.9%) 244 (17.1%) 137 (17.1%) 127 (15.3%)
CARDIOVASCULAR 121 (10.6%) 72 (4.2%) 50 (3.5%) 36 (4.5%) 46 (5.5%)
TECHNICAL 96 (8.4%) 44 (2.6%) 11 (0.8%) 2 (0.3%) 3 (0.4%)
OTHER 283 (24.7%) 382 (22.2%) 238 (16.7%) 153 (19.1%) 173 (20.9%)
ISHLT 2005J Heart Lung Transplant 2005;24: 945-982