LUNG TRANSPLANTATION
description
Transcript of LUNG TRANSPLANTATION
LUNG TRANSPLANTATION
Overall
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
0
500
1000
1500
2000
2500
3000
3500
4000
5 7 38 89204
450
758
9701160
128914121389
15101547 1559
17001784
19742012
2218
2569
279429202981
3278
3519
Total
Bilateral/Double Lung
Nu
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of
Tra
ns
pla
nts
NOTE: This figure includes only the lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as representing changes in the number of lung transplants performed worldwide.ISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AVERAGE CENTER VOLUMELung Transplants: January 1, 2000 - June 30, 2011
1-4 5-9 10-19 20-29 30-39 40-49 50+0
10
20
30
40
50
60
0
4
8
12
16
20
24
52
3238
26
158 7
Number of centers Percentage of transplants
Average number of lung transplants per year
Nu
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ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
LUNG TRANSPLANTS Transplant Recipient Age by Year of Transplant
(Transplants: January 1, 1987 – June 30, 2011)
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0%
20%
40%
60%
80%
100%
0
12
24
36
48
60
0-11 12-17 18-34 35-49 50-59 60-65 >65 Median Age
Year of Transplant
% o
f T
ran
sp
lan
ts
Me
dia
n r
ec
ipie
nt
ag
e (
ye
ars
)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2011)
0-11 12-17 18-29 30-39 40-49 50-59 60-65 >650
5
10
15
20
25
30
35
Recipient Age
% o
f T
ran
sp
lan
ts
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA
0-11 12-17 18-29 30-39 40-49 50-59 60-65 >650
5
10
15
20
25
30
35
40
1985-1994 (N = 4,973)
1995-2003 (N = 14,884)
2004-6/2011 (N = 21,742)
Recipient Age
% o
f T
ran
sp
lan
ts
p < 0.0001
Transplants with unknown recipient age were excluded from this tabulation.ISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
LUNG TRANSPLANTS Donor Age by Year of Transplant
(Transplants: January 1, 1987 – June 30, 2011)
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0%
20%
40%
60%
80%
100%
0
10
20
30
40
50
0-11 12-17 18-29 30-39 40-49 50-59 60-65 >65 Median Donor Age
Year of Transplant
% o
f T
ran
sp
lan
ts
Med
ian
do
no
r ag
e (y
ears
)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS (1/1985-6/2011)
0-11 12-17 18-29 30-39 40-49 50-59 60-65 >650
5
10
15
20
25
30
35
Donor Age
% o
f T
ran
sp
lan
ts
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS BY ERA
0-11 12-17 18-29 30-39 40-49 50-59 60-65 >650
5
10
15
20
25
30
35
40
1985-1994 (N = 4,524)
1995-2003 (N = 14,623)
2004-6/2011 (N = 21,617)
Donor Age
% o
f T
ran
sp
lan
ts
p < 0.0001
Transplants with unknown donor age were excluded from this tabulation.ISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
LUNG TRANSPLANTATION
Adult Recipients
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS (1/1985-6/2011)
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 >650
5
10
15
20
Recipient Age
% o
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ran
sp
lan
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ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 >650
5
10
15
20
25
1985-1998 (N = 10,223)
1999-6/2011 (N = 29,606)
Recipient Age
% o
f T
ran
sp
lan
ts
p < 0.0001
Median age by era1985-1998 = 48 years1999-6/2011 = 54 years
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 >650
5
10
15
20
251985-1994 (N=4,740)1995-2003 (N=14,145)2004-6/2011 (N=20,499)
Recipient Age
% o
f T
ran
sp
lan
ts
p < 0.0001
Median age by era1985-1994 = 47 years1995-2003 = 51 years2004-6/2011 = 55 years
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTSKaplan-Meier Survival
(Transplants: January 1994 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 160
25
50
75
100
Bilateral/Double Lung (N=19,566)
Single Lung (N=13,276)
All Lungs (N=32,842)
Years
Su
rviv
al (
%)
Double lung: 1/2-life = 6.7 Years; Conditional 1/2-life = 9.4 YearsSingle lung: 1/2-life = 4.6 Years; Conditional 1/2-life = 6.5 YearsAll lungs: 1/2-life = 5.5 Years; Conditional 1/2-life = 7.7 Years
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTSIndications (Transplants: January 1995 - June 2011)
Diagnosis SLT (N = 13,271) BLT (N = 20,831) TOTAL (N = 34,102)
COPD/Emphysema 6,048 ( 45.6% ) 5,539 ( 26.6% ) 11,587 ( 34.0% )
Idiopathic Pulmonary Fibrosis 4,430 ( 33.4% ) 3,495 ( 16.8% ) 7,925 ( 23.2% )
Cystic Fibrosis 219 ( 1.7% ) 5,469 ( 26.3% ) 5,688 ( 16.7% )
Alpha-1 741 ( 5.6% ) 1,332 ( 6.4% ) 2,073 ( 6.1% )
Idiopathic Pulmonary Arterial Hypertension 82 ( 0.6% ) 982 ( 4.7% ) 1,064 ( 3.1% )
Pulmonary Fibrosis, Other 498 ( 3.8% ) 659 ( 3.2% ) 1,157 ( 3.4% )
Bronchiectasis 54 ( 0.4% ) 891 ( 4.3% ) 945 ( 2.8% )
Sarcoidosis 251 ( 1.9% ) 614 ( 2.9% ) 865 ( 2.5% )
Re-Transplant: Obliterative Bronchiolitis 259 ( 2.0% ) 254 ( 1.2% ) 513 ( 1.5% )
Connective Tissue Disease 140 ( 1.1% ) 281 ( 1.3% ) 421 ( 1.2% )
Obliterative Bronchiolitis (Not Re-Transplant) 91 ( 0.7% ) 260 ( 1.2% ) 351 ( 1.0% )
LAM 122 ( 0.9% ) 241 ( 1.2% ) 363 ( 1.1% )
Re-Transplant: Not Obliterative Bronchiolitis 166 ( 1.3% ) 191 ( 0.9% ) 357 ( 1.0% )
Congenital Heart Disease 45 ( 0.3% ) 248 ( 1.2% ) 293 ( 0.9% )
Cancer 6 ( 0.0% ) 28 ( 0.1% ) 34 ( 0.1% )
Other 119 ( 0.9% ) 347 ( 1.7% ) 466 ( 1.4% )
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTSDistribution of Procedure Type for Major Indications by Year
Year of TX
Alpha-1 COPD Cystic Fibrosis IPF IPAH
Double Single Double Single Double Single Double Single Double Single
1995 45.5 54.5 22.0 78.0 90.2 9.8 28.2 71.8 89.3 10.7
1996 47.3 52.7 27.8 72.2 86.8 13.2 28.1 71.9 81.7 18.3
1997 46.4 53.6 27.5 72.5 92.6 7.4 21.5 78.5 90.3 9.7
1998 48.2 51.8 30.2 69.8 93.6 6.4 19.1 80.9 87.0 13.0
1999 46.6 53.4 28.0 72.0 91.3 8.7 23.3 76.7 86.4 13.6
2000 57.9 42.1 29.2 70.8 94.2 5.8 30.7 69.3 93.0 7.0
2001 59.9 40.1 30.2 69.8 93.9 6.1 31.2 68.8 90.0 10.0
2002 56.1 43.9 38.9 61.1 96.2 3.8 35.0 65.0 88.1 11.9
2003 65.2 34.8 43.2 56.8 95.6 4.4 41.3 58.7 95.6 4.4
2004 73.9 26.1 45.8 54.2 96.3 3.7 44.1 55.9 94.5 5.5
2005 78.0 22.0 49.4 50.6 97.3 2.7 45.9 54.1 92.6 7.4
2006 72.8 27.2 58.4 41.6 98.5 1.5 46.8 53.2 100.0 0
2007 83.6 16.4 63.6 36.4 97.3 2.7 49.1 50.9 94.8 5.2
2008 80.2 19.8 65.6 34.4 98.6 1.4 51.3 48.7 93.9 6.1
2009 86.4 13.6 66.4 33.6 99.8 0.2 51.0 49.0 98.6 1.4
2010 86.2 13.8 70.4 29.6 99.2 0.8 55.2 44.8 95.7 4.3
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Procedure Type within Indication, by Year
1996
1998
2000
2002
2004
2006
2008
2010
1996
1998
2000
2002
2004
2006
2008
2010
1996
1998
2000
2002
2004
2006
2008
2010
1996
1998
2000
2002
2004
2006
2008
2010
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%Bilateral/Double Lung Transplant Single Lung Transplant
% o
f T
ran
sp
lan
ts
AT Def COPD IPF IPAH
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Indications for Single Lung Transplants
(Transplants: January 1995 - June 2011)
6%
46%
2%
33%
1%
3%
10%
Alpha-1 COPD CF IPF IPAH Re-Tx Other*
*Other includes:
Pulmonary Fibrosis, Other: 3.8%
Sarcoidosis: 1.9%
Bronchiectasis: 0.4%
Congenital Heart Disease: 0.3%
LAM: 0.9%
Connective Tissue Disease: 1.1%
OB (non-ReTx): 0.7%
Miscellaneous: 0.9%
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Indications for Bilateral/Double Lung Transplants
(Transplants: January 1995 - June 2011)
6%
27%
26%
17% 5%2%
17%
Alpha-1 COPD CF IPF IPAH Re-Tx Other*
*Other includes:
Pulmonary Fibrosis, Other: 3.2%
Sarcoidosis: 2.9%
Bronchiectasis: 4.3%
Congenital Heart Disease: 1.2%
LAM: 1.2%
Connective Tissue Disease: 1.3%
OB (non-ReTx): 1.2%
Miscellaneous: 1.8%%
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTSMajor Indications By Year (%)
19901991
19921993
19941995
19961997
19981999
20002001
20022003
20042005
20062007
20082009
20100
20
40
60
80
100 CF IPF COPD Alpha-1 IPAH Re-Tx
Transplant Year
% o
f T
ran
sp
lan
ts
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTSMajor Indications By Year (Number)
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
0
250
500
750
1,000
1,250
1,500
1,750
2,000
2,250
2,500
2,750CF IPF COPD Alpha-1 IPAH Re-Tx
Transplant Year
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ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTSAge Distribution By Location
(Transplants: January 2000 – June 2011)
Europe North America Other0%
20%
40%
60%
80%
100%
18-34 years 35-49 years 50-59 years 60-65 years >65 years
% o
f T
ran
sp
lan
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ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTSDiagnosis Distribution By Location(Transplants: January 2000 – June 2011)
0%
20%
40%
60%
80%
100%
Europe North America Other
Other
Sarcoidosis
Re-TX
Pulmonary Fibrosis, Other
IPAH
IPF
CF
COPD
Bronchiectasis
Alpha-1% o
f T
ran
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lan
ts
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTSDiagnosis Distribution By Location and Era
(Transplants: January 2000 – June 2011)
0%
20%
40%
60%
80%
100%
Alpha-1 Bronchiectasis COPD CF IPF IPAH Pulmonary Fibrosis, Other Re-TX Sarcoidosis
Other
% o
f T
ran
sp
lan
ts
2005 - 6/2011
Europe North America Other
2005 - 6/20112005 - 6/20112000 - 2004 2000 - 2004 2000 - 2004
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Donor Age Distribution By Location
(Transplants: January 2000 – June 2011)
Europe North America Other0%
20%
40%
60%
80%
100%1-10 11-17 18-34 35-49 50-59 60-65 >65
% o
f D
on
ors
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTSKaplan-Meier Survival by Era
(Transplants: January 1988 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 140
20
40
60
80
1001988-1995 (N=5,949)1996-2003 (N=12,632)2004-6/2010 (N=17,715)
Years
Su
rviv
al (
%)
N at risk = 1,055
N at risk = 192
N at risk = 585
1988-1995: 1/2-life = 3.9 Years; Conditional 1/2-life = 7.0 Years1996-2003: 1/2-life = 5.3 Years; Conditional 1/2-life = 7.9 Years2004-6/2010: 1/2-life = 5.9 Years; Conditional 1/2-life = NA
1988-95 vs. 1996-2003: p < 0.00011988-95 vs. 2004-6/2010: p <0.0001 1996-2003 vs. 2004-6/2010: p <0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTSKaplan-Meier Survival by Age Group
(Transplants: January 1990 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 140
20
40
60
80
100
18-34 (N = 6,355)
35-49 (N = 8,860)
50-59 (N = 12,690)
60-65 (N = 6,515)
>65 (N = 1,595)
Years
Su
rviv
al (
%)
HALF-LIFE 18-34: 6.3 Years; 35-49: 6.5 Years; 50-59: 5.2 Years; 60-65: 4.4 Years; >65: 3.6 Years
All pair-wise comparisons are significant at p < 0.05
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTSKaplan-Meier Survival by Gender(Transplants: January 1990 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170
20
40
60
80
100
Male (N=19,569)
Female (N=16,445)
Years
Su
rviv
al (
%)
HALF-LIFE Male: 5.1 years; Female: 5.6 years
N at risk at 10 years = 1,342
N at risk at 10 years = 1,337
p < 0.0001
N at risk = 119
N at risk = 102
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTSKaplan-Meier Survival by Diagnosis
(Transplants: January 1990 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 140
20
40
60
80
100
Alpha-1 (N=2,490) CF (N=5,608) COPD (N=11,948)
IPF (N=7,540) IPAH (N=1,308) Sarcoidosis (N=849)
Years
Su
rviv
al (
%)
HALF-LIFE Alpha-1: 6.2 Years; CF: 7.5 Years; COPD: 5.3 Years; IPF: 4.4 Years; IPAH: 5.0 Years; Sarcoidosis: 5.3 Years
All comparisons with Alpha-1 and CF are statistically significant at < 0.05
COPD vs. IPF: p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTSKaplan-Meier Survival by Diagnosis Conditional on
Survival to 3 Months (Transplants: January 1990 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 140
20
40
60
80
100
Alpha-1 (N=2,119) CF (N=4,828)
COPD (N=10,315) IPF (N=6,188)
IPAH (N=948) Sarcoidosis (N=687)
Years
Su
rviv
al (
%)
HALF-LIFE Alpha-1: 7.6 Years; CF: 9.0 Years; COPD: 6.0 Years;IPF: 5.8 Years; IPAH: 8.8 Years; Sarcoidosis: 7.0 Years
All comparisons are statistically significant at 0.05 except Alpha-1 vs. COPD and CF vs. IPAH
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTSKaplan-Meier Survival by Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 - June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 140
20
40
60
80
100
Alpha-1 (N=1,860) CF (N=4,217)COPD (N=8,968) IPF (N=5,079)IPAH (N=831) Sarcoidosis (N=573)
Years
Su
rviv
al (
%)
HALF-LIFE Alpha-1: 8.6 Years; CF: 10.4 Years; COPD: 6.8 Years;IPF: 6.8 Years; IPAH: 10.0 Years; Sarcoidosis: 8.4 Years
All comparisons are statistically significant at 0.05 except Alpha-1 vs. Sarcoidosis, CF vs. IPAH and COPD vs. IPF
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Kaplan-Meier Survival By Procedure Type
(Transplants: January 1990 - June 2010) Diagnosis: Alpha-1 Antitrypsin Deficiency
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
100
Alpha-1/Single lung (N=1,086)
Alpha-1/Double lung (N=1,403)
Years
Su
rviv
al (
%)
N at risk = 42
N at risk = 41
N at risk at 10 years = 168
N at risk at 10 years = 168
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Kaplan-Meier Survival By Procedure Type
(Transplants: January 1990 - June 2010) Diagnosis: Alpha-1 Antitrypsin Deficiency
0 1 2 3 4 5 6 7 8 9 10 11 12 130
20
40
60
80
100
Single Lung, < 50 (N = 471) Double Lung, <50 (N = 714)
Single Lung, 50+ (N = 615) Double Lung, 50+ (N = 869)
Years
Su
rviv
al (
%)
N at risk at 13 years:Single Lung, <50 = 58; Double Lung, <50 = 64; Single Lung, 50+ = 23; Double Lung, 50+ = 13
p = 0.0008
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Kaplan-Meier Survival By Procedure Type
(Transplants: January 1990 - June 2010) Diagnosis: Emphysema/COPD
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
100
COPD/Single lung (N=6,797)
COPD/Double lung (N=5,147)
Years
Su
rviv
al (
%)
N at risk = 59
N at risk = 40N at risk at 10 years = 534
N at risk at 10 years = 261
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Kaplan-Meier Survival By Procedure Type
(Transplants: January 1990 - June 2010) Diagnosis: Emphysema/COPD
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
100
<50/Single lung (N=799) <50/Double lung (N=1,091)
50+/Single lung (N=5,998) 50+/Double lung (N=4,056)
Years
Su
rviv
al (
%)
N at risk at 15 years:Single Lung, <50 = 27; Double Lung, <50 = 17; Single Lung, 50+ = 32; Double Lung, 50+ = 23
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Kaplan-Meier Survival By Procedure Type
(Transplants: January 1990 - June 2010) Diagnosis: Idiopathic Pulmonary Fibrosis
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
100
IPF/Single lung (N=4,481)
IPF/Double lung (N=3,057)
Years
Su
rviv
al (
%)
N at risk = 31
N at risk = 12
N at risk at 10 years = 213
N at risk at 10 years = 96
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Kaplan-Meier Survival By Procedure Type
(Transplants: January 1990 - June 2010) Diagnosis: Idiopathic Arterial Pulmonary Hypertension
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
100
IPAH/Single lung (N=271)
IPAH/Double lung (N=1,037)
Years
Su
rviv
al (
%)
N at risk = 20
N at risk = 26
N at risk at 10 years = 43
N at risk at 10 years = 117
p = 0.0003
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Kaplan-Meier Survival By Procedure Type and Era
(Transplants: January 1990 - June 2010) Diagnosis: Emphysema/COPD, Single Lung
0 1 2 3 4 5 6 7 8 9 10 11 120
20
40
60
80
100
COPD/Single lung/1990-1997 (N=2,035)
COPD/Single lung/1998-2004 (N=2,941)
COPD/Single lung/2005-6/2010 (N=1,821)
Years
Su
rviv
al (
%)
N at risk = 192
N at risk = 66
N at risk = 210
1990-1997 vs. 1998-2004: p < 0.00011990-1997 vs. 2005-6/2010: p < 0.00011998-2004 vs. 2005-6/2010: p = 0.8250
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Kaplan-Meier Survival By Procedure Type and Era
(Transplants: January 1990 - June 2010) Diagnosis: Emphysema/COPD, Double Lung
0 1 2 3 4 5 6 7 8 9 10 11 120
20
40
60
80
100
COPD/Double lung/1990-1997 (N=576)
COPD/Double lung/1998-2004 (N=1,629)
COPD/Double lung/2005-6/2010 (N=2,942)
Years
Su
rviv
al (
%)
N at risk = 103
N at risk = 34
N at risk = 253
1990-1997 vs. 1998-2004: p = 0.00411990-1997 vs. 2005-6/2010: p = 0.01061998-2004 vs. 2005-6/2010: p = 0.6989
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Kaplan-Meier Survival By Procedure Type and Era
(Transplants: January 1990 - June 2010) Diagnosis: Cystic Fibrosis, Double Lung
0 1 2 3 4 5 6 7 8 9 10 11 120
20
40
60
80
100CF/Double lung/1990-1997 (N=1,100)
CF/Double lung/1998-2004 (N=1,947)
CF/Double lung/2005-6/2010 (N=2,457)
Years
Su
rviv
al (
%)
N at risk = 234
N at risk = 79
N at risk = 225
1990-1997 vs. 1998-2004: p < 0.00011990-1997 vs. 2005-6/2010: p < 0.00011998-2004 vs. 2005-6/2010: p = 0.1703
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Kaplan-Meier Survival By Procedure Type and Era
(Transplants: January 1990 - June 2010) Diagnosis: Idiopathic Pulmonary Fibrosis, Single Lung
0 1 2 3 4 5 6 7 8 9 10 11 120
20
40
60
80
100
IPF/Single lung/1990-1997 (N=944)
IPF/Single lung/1998-2004 (N=1,454)
IPF/Single lung/2005-6/2010 (N=2,083)
Years
Su
rviv
al (
%)
N at risk = 81
N at risk = 28
N at risk = 174
1990-1997 vs. 1998-2004: p = 0.01011990-1997 vs. 2005-6/2010: p = 0.00031998-2004 vs. 2005-6/2010: p = 0.1816
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Kaplan-Meier Survival By Procedure Type and Era
(Transplants: January 1990 - June 2010) Diagnosis: Idiopathic Pulmonary Fibrosis, Double Lung
0 1 2 3 4 5 6 7 8 9 10 110
20
40
60
80
100
IPF/Double lung/1990-1997 (N=254)
IPF/Double lung/1998-2004 (N=750)
IPF/Double lung/2005-6/2010 (N=2,053)
Years
Su
rviv
al (
%)
N at risk = 44
N at risk = 26
N at risk = 147
1990-1997 vs. 1998-2004: p = 0.00061990-1997 vs. 2005-6/2010: p < 0.00011998-2004 vs. 2005-6/2010: p = 0.0082
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Kaplan-Meier Survival by Donor CMV status/Recipient CMV status
(Transplants: October 1999 – June 2010)
0 1 2 3 4 5 6 7 8 9 100
20
40
60
80
100
D(-)/R(-) (N=2,192)
D(-)/R(+) (N=2,799)
D(+)/R(-) (N=2,892)
D(+)/R(+) (N=4,640)
Years
Su
rviv
al (
%)
D(-)/R(-) vs. D(+)/R(-): p < 0.0001D(-)/R(-) vs. D(+)/R(+): p < 0.0001D(-)/R(+) vs. D(+)/R(-): p < 0.0001D(-)/R(+) vs. D(+)/R(+): p = 0.0006
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Kaplan-Meier Survival by Era
(Transplants: October 1999 – June 2010) Donor CMV status/Recipient CMV status = D(-)/R(-)
0 1 2 3 4 50
20
40
60
80
100
10/1999-2004 (N=892)
Years
Su
rviv
al (
%)
p = 0.4120
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Kaplan-Meier Survival by Era
(Transplants: October 1999 – June 2010) Donor CMV status/Recipient CMV status = D(-)/R(+)
0 1 2 3 4 50
20
40
60
80
100
10/1999-2004 (N=1,182)
2005-6/2010 (N=1,617)
Years
Su
rviv
al (
%)
p = 0.7314
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Kaplan-Meier Survival by Era
(Transplants: October 1999 – June 2010) Donor CMV status/Recipient CMV status = D(+)/R(-)
0 1 2 3 4 50
20
40
60
80
100
10/1999-2004 (N=1,016)
2005-6/2010 (N=1,876)
Years
Su
rviv
al (
%)
p = 0.1570
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS Kaplan-Meier Survival by Era
(Transplants: October 1999 – June 2010) Donor CMV status/Recipient CMV status = D(+)/R(+)
0 1 2 3 4 50
20
40
60
80
100
10/1999-2004 (N=1,751)
2005-6/2010 (N=2,889)
Years
Su
rviv
al (
%)
p = 0.9050
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up Stratified by Donor/Recipient CMV Status (Follow-ups: July 2004 - June 2011)
0
10
20
30
40
50
D(-)/R(-), Treatment D(-)/R(-), No Treatment D(-)/R(+), Treatment D(-)/R(+), No Treatment
D(+)/R(-), Treatment D(+)/R(-), No Treatment D(+)/R(+), Treatment D(+)/R(+), No Treatment
% e
xper
ien
cin
g re
ject
ion
wit
hin
1 y
ear
Analysis is limited to patients who were alive at the time of the follow-up No comparisons were statistically significant at 0.05
ISHLT 2012
D(-)/R(-): N = 1,362D(-)/R(+): N = 1,672D(+)/R(-): N = 1,859D(+)/R(+): N = 2,979J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
Stratified Donor/Recipient CMV Status (Follow-ups: July 2004 - June 2011)
0
10
20
30
40
50
60D(-)/R(-), Treatment D(-)/R(-), No TreatmentD(-)/R(+), Treatment D(-)/R(+), No TreatmentD(+)/R(-), Treatment D(+)/R(-), No TreatmentD(+)/R(+), Treatment D(+)/R(+), No Treatment
% e
xp
eri
en
cin
g r
eje
cti
on
wit
hin
1 y
ea
r
18-34 35-49 50-59 60-65 >65
No comparisons were statistically significant at 0.05 except D(+)/R(-) vs. D(-)/R(+): 35-49 (p=0.0188) and D(+)/R(-) vs. D(+)/R(+): 35-49 (p=0.0199) and 50-59: (p=0.0078)
Female Male
Analysis is limited to patients who were alive at the time of the follow-up
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Risk Factors For 1 Year MortalityDIAGNOSIS Procedure
typeN Relative
RiskP-value 95% Confidence
Interval
Retransplant All 526 2.09 <.0001 1.71 - 2.56
IPAH All 376 1.73 0.0003 1.28 - 2.34
Other* All 972 1.68 <.0001 1.38 - 2.03
Sarcoidosis Double 326 1.66 0.0004 1.25 - 2.19
Alpha-1 antitrypsin deficiency Single 272 1.65 0.0002 1.27 - 2.16
Bronchiectasis All 286 1.36 0.0436 1.01 - 1.83
Alpha-1 antitrypsin deficiency Double 447 1.33 0.0307 1.03 - 1.73
Pulmonary Fibrosis (not IPF) All 483 1.32 0.0134 1.06 - 1.65
IPF All 3,906 1.26 0.0064 1.07 - 1.49
COPD/Emphysema Double 2,147 1.20 0.0142 1.04 - 1.39
N = 14,762Reference group = COPD/Emphysema, Single lung
*Other = All diagnoses other than COPD, IPAH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, retransplant and LAM.ISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Risk Factors For 1 Year Mortality
TRANSPLANT CHARACTERISTICS N Relative Risk
P-value 95% Confidence
Interval
Transplant year = 1998/1999 vs. 2009/2010 1,587 2.24 <.0001 1.92 - 2.62
Transplant year = 2000/2001 vs. 2009/2010 1,863 1.93 <.0001 1.65 - 2.24
Transplant year = 2002/2003 vs. 2009/2010 2,053 1.45 <.0001 1.24 - 1.69
Transplant year = 2004/2005 vs. 2009/2010 2,529 1.34 <.0001 1.16 - 1.54
Transplant year = 2006/2007 vs. 2009/2010 2,791 1.23 0.0026 1.08 - 1.41
Donor CMV +/ Recipient CMV - 3,117 1.22 <.0001 1.11 - 1.34
N = 14,762
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Risk Factors For 1 Year Mortality
DONOR CHARACTERISTICS N Relative Risk
P-value 95% Confidence
Interval
Donor history of diabetes 658 1.52 <.0001 1.29 - 1.79
RECIPIENT CHARACTERISTICS
Recipient on dialysis 65 2.44 <.0001 1.67 - 3.55
Hospitalized (including ICU) 1,718 1.71 <.0001 1.51 - 1.93
Ventilator 599 1.53 <.0001 1.29 - 1.82
N = 14,762
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Borderline Significant Risk Factors For 1 Year MortalityRECIPIENT CHARACTERISTICS N Relative
RiskP-value 95%
Confidence Interval
IV inotropes 42 1.50 0.0800 0.95 - 2.38
Diagnosis = Sarcoidosis, single lung 116 1.44 0.0813 0.96 - 2.18
Diagnosis = Cystic Fibrosis 1,928 1.23 0.0816 0.97 - 1.54
Prior transfusion 728 1.17 0.0601 0.99 - 1.38
Donor history of cancer 254 0.75 0.0974 0.53 - 1.05
N = 14,762Reference group = COPD/Emphysema, Single lung
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Risk Factors For 1 Year Mortality
Continuous Factors (see figures)
Recipient age Bilirubin
Transplant center volume Recipient oxygen required at rest
Cardiac output Height difference
Recipient FVC % predicted
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Age
25 30 35 40 45 50 55 60 650.0
0.5
1.0
1.5
2.0
Recipient Age
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Center Volume
5 10 15 20 25 30 35 40 45 500.0
0.5
1.0
1.5
2.0
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Bilirubin
0.0 0.5 1.0 1.5 2.00.0
0.5
1.0
1.5
2.0
Recipient Bilirubin (mg/dl)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0032
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Oxygen Required at Rest
0 1 2 3 4 5 60.0
0.5
1.0
1.5
2.0
Oxygen Required at Rest (L/min)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Cardiac Output
3 4 5 6 7 80.0
0.5
1.0
1.5
2.0
Cardiac output
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Height Difference
-15 -10 -5 0 5 10 15 200.0
0.5
1.0
1.5
2.0
Donor Height - Recipient Height (cm)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0148
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Risk Factors For 1 Year Mortality with 95% Confidence Limits Recipient FVC (% predicted)
25 30 35 40 45 50 55 60 65 70 75 800.0
0.5
1.0
1.5
2.0
Recipient FVC (% predicted)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0037
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = COPD/EmphysemaRisk Factors For 1 Year Mortality
N = 5,169
RECIPIENT CHARACTERISTICS N Relative Risk
P-value 95% Confidence Interval
Hospitalized (including ICU) 278 2.05 <.0001 1.59 - 2.66
Ventilator 96 1.62 0.0183 1.09 - 2.42
Chronic steroid use 2,296 1.27 0.0010 1.10 - 1.47
TRANSPLANT CHARACTERISTICS
Transplant Year: 1998/1999 vs. 2009/2010 691 1.93 <.0001 1.44 - 2.59
Transplant Year: 2000/2001 vs. 2009/2010 864 1.66 0.0006 1.24 - 2.22
Transplant Year: 2004/2005 vs. 2009/2010 879 1.35 0.0412 1.01 - 1.80
Donor CMV +/ Recipient CMV - 886 1.21 0.0337 1.01 - 1.45
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = COPD/EmphysemaRisk Factors For 1 Year Mortality
N = 5,169
DONOR CHARACTERISTICS N Relative Risk
P-value 95% Confidence Interval
Donor history of diabetes 221 1.65 0.0010 1.23 - 2.23
Donor history of cancer 82 0.33 0.0126 0.13 - 0.79
BORDERLINE SIGNIFICANT
Female recipient 2,627 0.86 0.0594 0.73 - 1.01
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = COPD/Emphysema Risk Factors For 1 Year Mortality
Continuous Factors (see figures)
Recipient age Transplant center volume
Recipient oxygen required at rest Cardiac output
Recipient PCW (borderline)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = COPD/Emphysema Risk Factors For 1 Year Mortality with 95% Confidence Limits
Recipient Age
25 30 35 40 45 50 55 60 650.0
0.5
1.0
1.5
2.0
Recipient Age
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = COPD/Emphysema Risk Factors For 1 Year Mortality with 95% Confidence Limits
Center Volume
5 10 15 20 25 30 35 40 45 500.0
0.5
1.0
1.5
2.0
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0018
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = COPD/Emphysema Risk Factors For 1 Year Mortality with 95% Confidence Limits
Recipient Oxygen Required at Rest
0 1 2 3 40.0
0.5
1.0
1.5
2.0
Oxygen Required at Rest (L/min)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0039
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = COPD/Emphysema Risk Factors For 1 Year Mortality with 95% Confidence Limits
Recipient Pre-Transplant Cardiac Output
3 4 5 6 7 80.0
0.5
1.0
1.5
2.0
2.5
Cardiac output
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0004
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = COPD/Emphysema Risk Factors For 1 Year Mortality with 95% Confidence Limits
Recipient PCW
5 10 15 200.0
0.5
1.0
1.5
2.0
PCW (mm/Hg)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0659
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = IPFRisk Factors For 1 Year Mortality
N = 3,920
TRANSPLANT CHARACTERISTICS N Relative Risk
P-value 95% Confidence Interval
Transplant Year: 1998/1999 vs. 2009/2010 274 3.42 <.0001 2.56 - 4.56
Transplant Year: 2000/2001 vs. 2009/2010 295 2.41 <.0001 1.78 - 3.26
Transplant Year: 2002/2003 vs. 2009/2010 443 1.74 0.0002 1.30 - 2.31
Transplant Year: 2004/2005 vs. 2009/2010 663 1.57 0.0006 1.21 - 2.03
Transplant Year: 2006/2007 vs. 2009/2010 879 1.48 0.0009 1.18 - 1.86
Donor CMV +/ Recipient CMV - 808 1.43 <.0001 1.21 - 1.69
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = IPFRisk Factors For 1 Year Mortality
N = 3,920
RECIPIENT CHARACTERISTICS N Relative Risk
P-value 95% Confidence Interval
Hospitalized (including ICU) 482 1.80 <.0001 1.44 - 2.25
Ventilator 166 1.75 0.0005 1.28 - 2.39
Prior transfusion 124 1.45 0.0320 1.03 - 2.02
Previous pregnancy 775 1.29 0.0217 1.04 - 1.60
BORDERLINE CHARACTERISTICS
Donor cause of death = anoxia 363 0.76 0.0542 0.57 - 1.01
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = IPF Risk Factors For 1 Year Mortality
Continuous Factors (see figures)
Recipient age PCO2
Transplant center volume Donor height (borderline)
Recipient oxygen required at rest FVC % predicted (borderline)
Bilirubin PA Systolic Pressure (borderline)
Creatinine
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = IPF Risk Factors For 1 Year Mortality with 95% Confidence Limits
Recipient Age
35 40 45 50 55 60 650.0
0.5
1.0
1.5
2.0
Recipient Age
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = IPF Risk Factors For 1 Year Mortality with 95% Confidence Limits
Center Volume
5 10 15 20 25 30 35 40 45 500.0
0.5
1.0
1.5
2.0
2.5
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = IPF Risk Factors For 1 Year Mortality with 95% Confidence Limits
Recipient Oxygen Required at Rest
0 1 2 3 4 5 60.0
0.5
1.0
1.5
2.0
Oxygen Required at Rest (L/min)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0394
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = IPF Risk Factors For 1 Year Mortality with 95% Confidence Limits
Recipient Bilirubin
0.0 0.5 1.0 1.50.0
0.5
1.0
1.5
2.0
Bilirubin (mg/dl)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = IPF Risk Factors For 1 Year Mortality with 95% Confidence Limits
Recipient Creatinine at Transplant
0.50 0.75 1.00 1.25 1.500.0
0.5
1.0
1.5
2.0
Creatinine
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0042
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = IPF Risk Factors For 1 Year Mortality with 95% Confidence Limits
Recipient PCO2
30 35 40 45 50 550.0
0.5
1.0
1.5
2.0
PCO2
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0255
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = IPF Risk Factors For 1 Year Mortality with 95% Confidence Limits
Donor Height
150 160 170 180 1900.0
0.5
1.0
1.5
2.0
Donor Height (cm)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0601
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = IPF Risk Factors For 1 Year Mortality with 95% Confidence Limits
Recipient FVC (% predicted)
25 30 35 40 45 50 55 60 65 700.0
0.5
1.0
1.5
2.0
FVC (% predicted)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0717
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2010)
Diagnosis = IPF Risk Factors For 1 Year Mortality with 95% Confidence Limits
Recipient PA Systolic Pressure
10 15 20 25 30 35 40 45 50 55 600.0
0.5
1.0
1.5
2.0
PA Systolic (mm Hg)
Re
lati
ve
Ris
k o
f 1
Ye
ar
Mo
rta
lity
p = 0.0941
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality
N = 8,759
DIAGNOSIS* N Relative Risk
P-value 95% Confidence Interval
Alpha-1 antitrypsin deficiency, single lung 245 1.30 0.0064 1.08 - 1.56
COPD/Emphysema, double lung 1,119 0.87 0.0183 0.78 - 0.98
Cystic Fibrosis 1,218 0.77 0.0056 0.64 - 0.93
LAM 75 0.52 0.0053 0.33 - 0.82
TRANSPLANT CHARACTERISTICS
Transplant Year: 1998/1999 vs. 2004-2006 1,587 1.35 <.0001 1.23 - 1.47
Transplant Year: 2000/2001 vs. 2004-2006 1,863 1.20 <.0001 1.10 - 1.31
Female recipient/male donor vs. male recipient/male donor 4,170 1.12 0.0247 1.01 - 1.23
Donor CMV +/ Recipient CMV - 1,684 1.11 0.0086 1.03 - 1.20
Female recipient/female donor vs. male recipient/male donor 2,468 0.83 0.0074 0.73 - 0.95
ISHLT 2012
* Reference group = COPD/Emphysema, Single lung
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality
N = 8,759
DONOR CHARACTERISTICS N Relative Risk
P-value 95% Confidence Interval
Donor history of diabetes 278 1.36 0.0002 1.16 - 1.61
Donor cause of death = anoxia vs. other* 546 0.83 0.0113 0.72 - 0.96
RECIPIENT CHARACTERISTICS
IV inotropes 37 2.13 0.0002 1.43 - 3.19
Recipient on dialysis 30 1.79 0.0073 1.17 - 2.74
Pulmonary embolism 77 1.46 0.0124 1.09 - 1.97
Hospitalized (including ICU) 724 1.35 <.0001 1.19 - 1.53
Prior sternotomy 295 1.29 0.0017 1.10 - 1.51
Recipient history of diabetes 923 1.19 0.0009 1.08 - 1.32
Chronic steroid use 4,150 1.14 <.0001 1.07 - 1.22
BORDERLINE SIGNIFICANT
Diagnosis = Retransplant 242 1.20 0.0677 0.99 - 1.47
ISHLT 2012 *Other = All causes of death other than anoxia and stroke.
Reference group = COPD/Emphysema, Single lung
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Continuous Factors (see figures)
Recipient age Cardiac output
Transplant center volume Height difference
Recipient oxygen required at rest PA Systolic Pressure (borderline)
ISHLT 2012
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient Age
20 25 30 35 40 45 50 55 60 650.0
0.5
1.0
1.5
2.0
Recipient Age
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Center Volume
5 10 15 20 25 30 35 40 45 500.0
0.5
1.0
1.5
2.0
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient Oxygen Required at Rest
0 1 2 3 4 5 60.0
0.5
1.0
1.5
2.0
Oxygen Required at Rest (L/min)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0010
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient Pre-Transplant Cardiac Output
3 4 5 6 7 80.0
0.5
1.0
1.5
2.0
Cardiac output
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0009
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Height Difference
-15 -10 -5 0 5 10 15 200.0
0.5
1.0
1.5
2.0
Donor Height - Recipient Height (cm)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0462
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Recipient PA Systolic Pressure
10 15 20 25 30 35 40 45 50 55 600.0
0.5
1.0
1.5
2.0
PA Systolic (mm Hg)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0829
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality Conditional on Survival to 1 Year
N = 6,788ISHLT 2012
DIAGNOSIS Procedure type
N Relative Risk
P-value 95% Confidence Interval
COPD/Emphysema Double 902 0.79 0.0014 0.68 - 0.91
IPF Double 492 0.73 0.0051 0.59 - 0.91
Sarcoidosis All 188 0.73 0.0424 0.54 - 0.99
Alpha-1 antitrypsin deficiency Double 255 0.63 0.0008 0.48 - 0.82
Cystic Fibrosis All 1,015 0.60 <.0001 0.47 - 0.77
IPAH All 195 0.59 0.0085 0.40 - 0.87
LAM All 66 0.51 0.0138 0.29 - 0.87
Other* Single 104 0.51 0.0018 0.33 - 0.78
*Other = All diagnoses other than COPD, IPAH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, retransplant and LAM.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
N = 6,788
DONOR CHARACTERISTICS N Relative Risk
P-value 95% Confidence Interval
Donor cause of death = Anoxia vs. Other* 437 0.76 0.0048 0.63 - 0.92
RECIPIENT CHARACTERISTICS
Pulmonary embolism 51 1.71 0.0119 1.13 - 2.61
Prior sternotomy 212 1.36 0.0050 1.10 - 1.68
History of diabetes 702 1.25 0.0015 1.09 - 1.43
Hospitalized (including ICU) 472 1.23 0.0194 1.03 - 1.47
Chronic steroid use 3,162 1.12 0.0107 1.03 - 1.22
Ventilator 124 0.65 0.0247 0.45 - 0.95
ISHLT 2012
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality Conditional on Survival to 1 Year
*Other = All causes of death other than anoxia and stroke.
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
N = 6,788
TRANSPLANT CHARACTERISTICS N Relative Risk
P-value 95% Confidence Interval
Donor CMV +/ Recipient CMV - 1,292 1.12 0.0309 1.01 - 1.24
Female recipient/male donor vs. male recipient/male donor 1,345 1.15 0.0191 1.02 - 1.30
POST-TRANSPLANT CHARACTERISTICS
OB within 1 year post-transplant 496 1.97 <.0001 1.72 - 2.24
Post-transplant dialysis prior to discharge 167 1.51 0.0009 1.18 - 1.93
Rejection between discharge and 1 year 2,911 1.24 <.0001 1.14 - 1.35
Treated for infection by discharge 2,756 1.11 0.0153 1.02 - 1.21
ISHLT 2012
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality Conditional on Survival to 1 Year
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
N = 6,788
CHARACTERISTICS N Relative Risk
P-value 95% Confidence Interval
Donor history of diabetes 197 1.22 0.0947 0.97 - 1.54
OKT3 used for induction 89 1.33 0.0832 0.96 - 1.85
Mismatches at HLA A locus, per mismatch
0 A MM = 4221 A MM = 2,9292 A MM = 3,437
1.14 0.0679 0.99 - 1.30
IL-2R antagonist used for induction 1,954 0.91 0.0657 0.82 - 1.01
ISHLT 2012
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Borderline Significant Risk Factors For 5 Year Mortality Conditional on Survival to 1 Year
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Continuous Factors (see figures)
Recipient age PVR
Transplant center volume Height difference (borderline)
Cardiac output
ISHLT 2012
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality Conditional on Survival to 1 Year
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year
Recipient Age
20 25 30 35 40 45 50 55 60 650.0
0.5
1.0
1.5
2.0
2.5
3.0
Recipient Age
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year
Center Volume
5 10 15 20 25 30 35 40 45 500.0
0.5
1.0
1.5
2.0
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0010
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year
Recipient Pre-Transplant Cardiac Output
3 4 5 6 7 80.0
0.5
1.0
1.5
2.0
2.5
Cardiac output
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0168
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year
Recipient PVR
1 2 3 4 5 60.0
0.5
1.0
1.5
2.0
Recipient PVR
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0296
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1998-6/2006)
Risk Factors For 5 Year Mortality with 95% Confidence Limits Conditional on Survival to 1 Year
Height Difference
-15 -10 -5 0 5 10 15 200.0
0.5
1.0
1.5
2.0
Donor Height - Recipient Height (cm)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.0790
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1995-6/2001)
Risk Factors For 10 Year Mortality
N = 5,202
DIAGNOSIS* N Relative Risk
P-value 95% Confidence Interval
Retransplant 115 1.44 0.0015 1.15 -1.80
Alpha-1 antitrypsin deficiency, single lung 276 1.26 0.0031 1.08 -1.47
COPD/Emphysema, double lung 485 0.82 0.0013 0.72 -0.92
Cystic Fibrosis 744 0.79 0.0120 0.65 -0.95
LAM 51 0.58 0.0096 0.38 -0.88
DONOR CHARACTERISTICS
Donor history of diabetes 119 1.47 0.0002 1.20 -1.80
Donor history of cancer 60 1.38 0.0250 1.04 -1.83
ISHLT 2012
* Reference group = COPD/Emphysema, Single lung
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1995-6/2001)
Risk Factors For 10 Year Mortality
N = 5,202
RECIPIENT CHARACTERISTICS N Relative Risk
P-value 95% Confidence Interval
IV inotropes 54 1.92 <.0001 1.41 - 2.61
Ventilator 126 1.28 0.0458 1.00 - 1.64
Recipient history of diabetes 316 1.25 0.0017 1.09 - 1.44
Prior sternotomy 191 1.24 0.0109 1.05 - 1.47
Hospitalized (including ICU) 412 1.17 0.0371 1.01 - 1.35
Chronic steroid use 2,407 1.08 0.0357 1.00 - 1.15
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1995-6/2001)
Risk Factors For 10 Year Mortality
N = 5,202
TRANSPLANT CHARACTERISTICS N Relative Risk
P-value 95% Confidence
Interval
Transplant year = 1995/1996 vs. 2000/2001 1,442 1.24 <.0001 1.14 - 1.36
Donor CMV +/ Recipient CMV - 926 1.18 0.0002 1.08 - 1.28
Not ABO identical 420 1.17 0.0095 1.04 - 1.32
Transplant year = 1997/1998 vs. 2000/2001 1,626 1.10 0.0297 1.01 - 1.20
HLA mismatches, per mismatch
0 MM = 41 MM = 212MM = 1463 MM = 519
4MM = 1,1375 MM = 2,3946 MM = 981
1.06 0.0031 1.02 - 1.09
BORDERLINE SIGNIFICANT
Donor cause of death = anoxia 239 0.86 0.0772 0.73 - 1.02
Diagnosis = Alpha-1 antitrypsin deficiency, double lung 191 0.82 0.0592 0.67 - 1.01
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Continuous Factors (see figures)
Recipient age Recipient weight
Transplant center volume Donor height
Donor Age Height difference
ISHLT 2012
ADULT LUNG TRANSPLANTS (1/1995-6/2001)
Risk Factors For 10 Year Mortality
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1995-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence LimitsRecipient Age
20 25 30 35 40 45 50 55 60 650.0
0.5
1.0
1.5
2.0
Recipient Age
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1995-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits Center Volume
5 10 15 20 25 30 35 40 45 500.0
0.5
1.0
1.5
2.0
Center Volume (cases per year)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y
p = 0.0002
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1995-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence LimitsDonor Age
15 20 25 30 35 40 45 50 550.0
0.5
1.0
1.5
2.0
Recipient Age
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y
p = 0.0012
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1995-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits Recipient Weight
50 60 70 80 90 1000.0
0.5
1.0
1.5
2.0
Recipient Weight (kg)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y
p = 0.0004
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1995-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits Donor Height
150 160 170 180 1900.0
0.5
1.0
1.5
2.0
Donor Height (cm)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y
p = 0.0005
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTS (1/1995-6/2001)
Risk Factors For 10 Year Mortality with 95% Confidence Limits Height Difference
-15 -10 -5 0 5 10 15 200.0
0.5
1.0
1.5
2.0
Donor Height - Recipient Height (cm)
Re
lati
ve
Ris
k o
f 1
0 Y
ea
r M
ort
alit
y
p = 0.0406
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG RECIPIENTS Cross-Sectional Analysis
Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2011)
1 Year (N = 6,935) 3 Years (N = 4,448) 5 Years (N = 2,581)0%
20%
40%
60%
80%
100%
No Activity Limitations Performs with Assistance Total Assistance
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG RECIPIENTSFunctional Status of Surviving Recipients
US Recipients Only(Follow-ups: March 2005 – June 2011)
0%
20%
40%
60%
80%
100%
1 Year (N = 7,578)
2 Years (N = 5,972)
3 Years (N = 4,906)
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG RECIPIENTSEmployment Status of Surviving Recipients
(Follow-ups: April 1994 – June 2011)
0%
20%
40%
60%
80%
100%
1 Year (N = 11,669)
3 Years (N = 7,276)
5 Years (N = 4,702)
Working (FT/PT Status unknown)
Working Part Time
Working Full Time
Retired
Not Working
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG RECIPIENTSRehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 – June 2011)
0%
20%
40%
60%
80%
100%
1 Year (N = 15,839)
3 Years (N = 9,853)
5 Years (N = 6,390)
No Hospitalization Hospitalized, Not Rejection/Not Infection
Hospitalized, Rejection Hospitalized, Infection Only
Hospitalized, Rejection + Infection
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG RECIPIENTSInduction Immunosuppression
Analysis limited to patients receiving prednisone(Transplants: January 2002 – June 2011)
Any Induction (N=6,632)
Polyclonal ALG/ATG (N=1,426)
IL-2R Antagonist (N=4,521)
Alemtuzumab (N=684)
0
10
20
30
40
50
60
% o
f p
ati
en
ts
Analysis is limited to patients who were alive at the time of the dischargeISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG RECIPIENTSInduction Immunosuppression
Analysis limited to patients receiving prednisone(Transplants: 2002, 2006 and 1/2011–6/2011)
Any Induction Polyclonal ALG/ATG
IL-2R Antagonist Alemtuzumab0
10
20
30
40
50
60
70
2002 2006 1/2011-6/2011
% o
f p
ati
en
ts
Analysis is limited to patients who were alive at the time of the follow-upISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG RECIPIENTSInduction Immunosuppression
Analysis limited to patients receiving prednisone(Transplants: January 2000 – December 2010)
Analysis is limited to patients who were alive at the time of the discharge
2000
2002
2004
2006
2008
2010
2000
2002
2004
2006
2008
2010
2000
2002
2004
2006
2008
2010
2000
2002
2004
2006
2008
2010
0
10
20
30
40
50
60
70
% o
f p
ati
en
ts
Any Induction Polyclonal ALG/ATG IL-2R Antagonist Alemtuzumab
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG RECIPIENTS Survival by Induction Usage Conditional on Survival to 14 Days
(Transplants: April 1994 – June 2010)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
25
50
75
100
No induction (N = 9,020)
Induction (N = 7,775)
Years
Su
rviv
al (
%) N at risk at 5 years = 2,350
N at risk = 87
N at risk = 37
p < 0.0001
N at risk at 5 years = 3,456
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG RECIPIENTS Survival by Induction Usage Conditional on Survival to 14 Days
(Transplants: January 2000 – June 2010)
0 1 2 3 4 5 6 7 8 9 100
25
50
75
100
No induction (N = 6,027)
Induction (N = 6,574)
Years
Su
rviv
al (
%)
N at risk at 5 years = 1,748
N at risk = 153
N at risk = 143
p < 0.0001
N at risk at 5 years = 1,905
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up
Analysis limited to patients receiving prednisone(Follow-ups: January 2002 – June 2011)
Cyclosporine Tacrolimus Sirolimus/ Everolimus
MMF/MPA Azathioprine0
20
40
60
80
100
Year 1 (N = 9,801) Year 5 (N = 4,147)
% o
f p
ati
en
ts
NOTE: Different patients are analyzed in Year 1 and Year 5
Analysis is limited to patients who were alive at the time of the follow-upISHLT 2012
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Analysis is limited to patients who were alive at the time of the discharge
CyA TAC Sirolimus/
Everolimus
MMF/MPA
AZA CyA TAC Sirolimus/
Everolimus
MMF/MPA
AZA0
20
40
60
80
100
% o
f p
ati
en
ts
1-Year Follow-Up 5-Year Follow-Up
Consecutive bars within each drug type represent follow-ups in 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010 & 2011.
ADULT LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up
Analysis limited to patients receiving prednisone(Follow-ups: January 2002 – June 2011)
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of 1 Year Follow-up
Analysis limited to patients receiving prednisone(Follow-ups: 2002, 2006 and 7/2010–6/2011)
Cyclosporine Tacrolimus Sirolimus/Everolimus
MMF/MPA
Azathioprine0
20
40
60
80
1002002 (N = 732) 2006 (N = 1,099) 7/2010-6/2011 (N = 1,352)
% o
f p
ati
en
ts
Analysis is limited to patients who were alive at the time of the follow-up
NOTE: Different patients are analyzed in each time frame
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
Analysis limited to patients receiving prednisone(Follow-ups: January 2002 – June 2011)
Cal-cineurin Inhibitor
CellCycle Sirolimus/Everolimu
s
Cal-cineurin Inhibitor
CellCycle Sirolimus/Everolimu
s
0
20
40
60
80
100
% o
f p
ati
en
ts
NOTE: Different patients are analyzed in Year 1 and Year 5
Tac
CyA
Tac
CyAAZA AZA
MMF/MPA
MMF
1 Year Follow-up (N = 9,801) 5 Year Follow-up (N = 4,147)
Analysis is limited to patients who were alive at the time of the follow-up
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
Analysis limited to patients receiving prednisone(Follow-ups: January 2002 – June 2011)
0%
20%
40%
60%
80%
100%
Year 1 (N = 9,801)
Year 5 (N = 4,147)
Other
Sirolimus/Everolimus + Calcineurin + Cellcycle
Sirolimus/Everolimus + Cellcycle
Sirolimus/Everolimus + Calcineurin
Tacrolimus
Tacrolimus + MMF/MPA
Tacrolimus + AZA
Cyclosporine + MMF/MPA
Cyclosporine + AZA
% o
f P
ati
en
ts
Analysis is limited to patients who were alive at the time of the follow-up
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG RECIPIENTSKaplan-Meier Survival by Maintenance Immunosuppression
Combinations Conditional on Survival to 1 Year (Transplants: January 2000 – June 2010)
Analysis limited to patients receiving prednisone
0 1 2 3 4 5 6 7 8 9 100
25
50
75
100
Tacrolimus + MMF/MPA use at discharge and 1 year (N=3,137)
Tacrolimus + AZA use at discharge and 1 year (N=1,381)
Cyclosporine + MM/MPA use at discharge and 1 year (N=453)
Cyclosporine + AZA use at discharge and 1 year (N=498)
Years
Su
rviv
al (
%)
p = 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG RECIPIENTSKaplan-Meier Survival by Maintenance Immunosuppression
Combinations Conditional on Survival to 1 Year (Transplants: January 2000 – June 2010)
Analysis limited to patients receiving prednisone Diagnosis: COPD/Emphysema
0 1 2 3 4 5 6 7 8 90
25
50
75
100
Tacrolimus + MMF/MPA use at discharge and 1 year (N=974)
Tacrolimus + AZA use at discharge and 1 year (N=482)
Cyclosporine + MM/MPA use at discharge and 1 year (N=201)
Cyclosporine + AZA use at discharge and 1 year (N=228)
Years
Su
rviv
al (
%)
p = 0.0121
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG RECIPIENTSKaplan-Meier Survival by Maintenance Immunosuppression
Combinations Conditional on Survival to 1 Year (Transplants: January 2000 – June 2010)
Analysis limited to patients receiving prednisone Diagnosis: Idiopathic Pulmonary Fibrosis
0 1 2 3 4 5 6 70
25
50
75
100
Tacrolimus + MMF/MPA use at discharge and 1 year (N=961)
Tacrolimus + AZA use at discharge and 1 year (N=397)
Cyclosporine + MM/MPA use at discharge and 1 year (N=108)
Cyclosporine + AZA use at discharge and 1 year (N=80)
Years
Su
rviv
al (
%)
p = 0.0389
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG RECIPIENTSKaplan-Meier Survival by Maintenance Immunosuppression
Combinations Conditional on Survival to 1 Year (Transplants: January 2000 – June 2010)
Analysis limited to patients receiving prednisone Diagnosis: Cystic Fibrosis
0 1 2 3 4 5 6 70
25
50
75
100
Tacrolimus + MMF/MPA use at discharge and 1 year (N=468)Tacrolimus + AZA use at discharge and 1 year (N=180)Cyclosporine + MM/MPA use at discharge and 1 year (N=39)Cyclosporine + AZA use at discharge and 1 year (N=78)
Years
Su
rviv
al (
%)
p = 0.3808
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF ADULT LUNG RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
(Follow-ups: July 2004 – June 2011)
0
10
20
30
40
50
60Rejection, Treatment Rejection, No Treatment
Overall: N = 8,55318-34: N = 1,13335-49: N = 1,45950-59: N = 2,75160-65: N = 2,28666+: N = 924Female: N = 3,721 Male: N = 4,832
% e
xper
ien
cin
g re
ject
ion
wit
hin
1
year
18-34 35-49 50-59 60-65 >65 Female Male
Analysis is limited to patients who were alive at the time of the follow-up
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
All comparisons with 18-34 are statistically significant at < 0.05
Overall
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF ADULT LUNG RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
Stratified by Type of Induction (Follow-ups: July 2004 – June 2011)
0
10
20
30
40
50
60
No induction, Treatment No induction, No Treatment Polyclonal, Treatment
Polyclonal, No Treatment IL-2R Antagonist, Treatment IL-2R Antagonist, No Treatment
Alemtuzumab, Treatment Alemtuzumab, No Treatment
No induction: N = 3,809Polyclonal: N = 868IL-2R Antagonist: N = 3,254Alemtuzumab: N = 575
% e
xper
ien
cin
g re
ject
ion
wit
hin
1
year
Analysis is limited to patients who were alive at the time of the follow-up
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
No induction vs. IL-2R: p = 0.0030Polyclonal vs. IL-2R: p = 0.0441 IL-2R vs. Alemtuzumab: p = 0.0014
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF ADULT LUNG RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
Stratified by Type of Induction (Follow-ups: July 1, 2004 – June 30, 2011)
0
10
20
30
40
50
60
70 No induction, Treatment No induction, No TreatmentPolyclonal, Treatment Polyclonal, No TreatmentIL-2R Antagonist, Treatment IL-2R Antagonist, No TreatmentAlemtuzumab, Treatment Alemtuzumab, No Treatment
% e
xp
eri
en
cin
g r
eje
cti
on
wit
hin
1 y
ea
r
18-34 (N=1,129) 35-49 (N=1,453) 50-59 (N=2,731) 60-65 (N=2,274) >65 (N=919)
18-34: Polyclonal vs. IL-2R (p=0.0035); IL-2R vs. Alemtuzumab (p=0.0062)35-49: No induction vs. Alemtuzumab (p=0.0183); IL-2R vs. Alemtuzumab (p=0.0126)50-59: No induction vs. Polyclonal (p=0.0113); No induction vs. IL-2R (p=0.0220); Polyclonal vs. Alemtuzumab (p=0.0024); IL-2R vs. Alemtuzumab (p=0.0067)66+: No induct vs. Polyclonal (p=0.0002); Polyclonal vs. IL-2R (p=0.0014); Polyclonal vs. Alemtuzumab (p=0.0119)
Analysis is limited to patients who were alive at the time of the follow-up
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF ADULT LUNG RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
Stratified by Type of Induction (Follow-ups: July 1, 2004 – June 30, 2011)
0
10
20
30
40
50
60
70 No induction, Treatment No induction, No TreatmentPolyclonal, Treatment Polyclonal, No TreatmentIL-2R Antagonist, Treatment IL-2R Antagonist, No TreatmentAlemtuzumab, Treatment Alemtuzumab, No Treatment
% e
xp
eri
en
cin
g r
eje
cti
on
wit
hin
1 y
ea
r
Female (N=3,705) Male (N=4,801)
Female: No induction vs. Alemtuzumab (p=0.0120); Polyclonal vs. Alemtuzumab (p=0.0212); IL-2R vs. Alemtuzumab (p=0.0008)Male: No induction vs. IL-2R (p=0.0093); Polyclonal vs. IL-2R (p=0.0331)
Analysis is limited to patients who were alive at the time of the follow-up
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF ADULT LUNG RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
Stratified by Maintenance Immunosuppression(Follow-ups: July 2004 – June 2011)
0
10
20
30
40
50
60
70
CyA + MMF/MPA, Treatment CyA + MMF/MPA, No Treatment CyA + AZA, Treatment
CyA + AZA, No Treatment TAC + MMF/MPA, Treatment TAC + MMF/MPA, No Treatment
TAC + AZA, Treatment TAC + AZA, No Treatment
Cyclosporine + MMF/MPA: N = 454Cyclosporine + AZA: N = 668Tacrolimus + MMF/MPA: N = 4,328Tacrolimus + AZA: N = 2,137
% e
xper
ien
cin
g re
ject
ion
wit
hin
1
year
Analysis is limited to patients who were alive at the time of the follow-up
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
All comparisons are statistically significant at p < 0.0001 except CyA + MMF/MPA vs. TAC + AZA (p=0.1521)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF ADULT LUNG RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
Stratified by Maintenance Immunosuppression (Follow-ups: July 1, 2004 – June 30, 2011)
0
10
20
30
40
50
60
70
80
90 CyA + MMF/MPA, Treatment CyA + MMF/MPA, No TreatmentCyA + AZA, Treatment CyA + AZA, No TreatmentTAC + MMF/MPA, Treatment TAC + MMF/MPA, No TreatmentTAC + AZA, Treatment TAC + AZA, No Treatment
% e
xp
eri
en
cin
g r
eje
cti
on
wit
hin
1 y
ea
r
18-34 (N=1,009) 35-49 (N=1,297) 50-59 (N=2,428) 60-65 (N=2,039) >65 (N=814)
All age groups: all comparisons with CyA + AZA are significant at 0.05; all TAC + MMF/MPA vs. TAC + AZA comparisons are significant at 0.05 except 35-49.35-49: CyA + MMF/MPA vs. TAC + MMF/MPA ( p=0.0230); CyA + MMF/MPA vs. TAC + AZA (p=0.0426) 50-59: CyA + MMF/MPA vs. TAC + MMF/MPA (p=0.0013) 60-65: CyA + MMF/MPA vs. TAC + MMF/MPA (p=0.0035)
Analysis is limited to patients who were alive at the time of the follow-up
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF ADULT LUNG RECIPIENTS Experiencing Rejection between Transplant Discharge and 1-Year Follow-Up
Stratified by Maintenance Immunosuppression (Follow-ups: July 1, 2004 – June 30, 2011)
0
10
20
30
40
50
60
70
80
90 CyA + MMF/MPA, Treatment CyA + MMF/MPA, No TreatmentCyA + AZA, Treatment CyA + AZA, No TreatmentTAC + MMF/MPA, Treatment TAC + MMF/MPA, No TreatmentTAC + AZA, Treatment TAC + AZA, No Treatment
% e
xp
eri
en
cin
g r
eje
cti
on
wit
hin
1 y
ea
r
Female (N=3,318) Male (N=4,269)
All comparisons are statistically significant at 0.001 except CyA + MMF/MPA vs. TAC + AZA (female: p=0.4533; male: p=0.2053)
Analysis is limited to patients who were alive at the time of the follow-up
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF ADULT LUNG RECIPIENTS Experiencing Rejection between Transplant Discharge and 3-Year Follow-Up
Stratified by Maintenance Immunosuppression(Follow-ups: July 2004 – June 2011)
0
10
20
30
40
50
60
70
80
CyA + MMF/MPA, Treatment CyA + MMF/MPA, No Treatment CyA + AZA, Treatment
CyA + AZA, No Treatment TAC + MMF/MPA, Treatment TAC + MMF/MPA, No Treatment
TAC + AZA, Treatment TAC + AZA, No Treatment
Cyclosporine + MMF/MPA: N = 238Cyclosporine + AZA: N = 385Tacrolimus + MMF/MPA: N = 1,888Tacrolimus + AZA: N = 1,135
% e
xper
ien
cin
g re
ject
ion
wit
hin
3
year
s
Analysis is limited to patients with rejection or no rejection reported on all three annual follow-ups through 3 years
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
All comparisons with CyA + AZA are significant at p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
PERCENTAGE OF ADULT LUNG RECIPIENTS Experiencing Rejection between Transplant Discharge and 3-Year Follow-Up
Stratified by Maintenance Immunosuppression (Follow-ups: July 1, 2004 – June 30, 2011)
0
10
20
30
40
50
60
70
80
90
100 CyA + MMF/MPA, Treatment CyA + MMF/MPA, No TreatmentCyA + AZA, Treatment CyA + AZA, No TreatmentTAC + MMF/MPA, Treatment TAC + MMF/MPA, No TreatmentTAC + AZA, Treatment TAC + AZA, No Treatment
% e
xp
eri
en
cin
g r
eje
cti
on
wit
hin
1 y
ea
r
18-34 35-49 50-59 60-65 >65
All age groups and genders: all comparisons with CyA + AZA are significant at 0.05 except CyA+ MMF/MPA vs. CyA + AZA for 35-49 and 66+ groups
Female Male
Analysis is limited to patients with rejection or no rejection reported on all three annual follow-ups through 3 years
Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection.No rejection = Recipient had (i) no acute rejection episodes and (ii) was reported either as not hospitalized for rejection or did not receive anti-rejection agents.
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTSCumulative Morbidity Rates in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994 - June 2011)
Outcome
Follow-ups: April 1994 – June 2003
Follow-ups: July 2003– June 2011
Within 1 Year
Total number
with known response
Within 1 Year
Total number
with known response
Hypertension 50.8% (N = 6,021) 52.9% (N = 7,983)
Renal Dysfunction 26.1% (N = 6,012) 22.2% (N = 9,641)
Abnormal Creatinine < 2.5 mg/dl 15.8% 16.9%
Creatinine > 2.5 mg/dl 8.3% 3.7%
Chronic Dialysis 1.9% 1.5%
Renal Transplant 0.0% 0.1%
Hyperlipidemia 16.5% (N = 6,293) 31.4% (N = 8,428)
Diabetes 20.1% (N = 5,987) 28.9% (N = 9,607)
Bronchiolitis Obliterans Syndrome 9.4% (N = 5,623) 9.5% (N = 9,096)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTSCumulative Morbidity Rates in Survivors within 1 and 5 Years
Post-Transplant (Follow-ups: April 1994 - June 2011)
Outcome Within 1 Year
Total number
with known response
Within 5 Years
Total number
with known response
Hypertension 52.0% (N = 14,004) 82.9% (N = 4,098)
Renal Dysfunction 23.7% (N = 15,653) 56.1% (N = 4,895)
Abnormal Creatinine < 2.5 mg/dl 16.5% 36.7%
Creatinine > 2.5 mg/dl 5.4% 15.5%
Chronic Dialysis 1.7% 3.2%
Renal Transplant 0.1% 0.8%
Hyperlipidemia 25.0% (N = 14,721) 57.9% (N = 4,443)
Diabetes 25.5% (N = 15,594) 40.5% (N = 4,831)
Bronchiolitis Obliterans Syndrome 9.5% (N = 14,719) 38.9% (N = 4,099)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTSCumulative Morbidity Rates in Survivors within 10 Years Post-Transplant
(Follow-ups: April 1994 - June 2011)
Outcome Within 10 Years
Total number with known response
Renal Dysfunction 75.4% (N = 855)
Abnormal Creatinine < 2.5 mg/dl 40.6%
Creatinine > 2.5 mg/dl 20.5%
Chronic Dialysis 9.0%
Renal Transplant 5.4%
Bronchiolitis Obliterans Syndrome 61.6% (N = 614)
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Bronchiolitis Obliterans SyndromeFor Adult Lung Recipients (Follow-ups: April 1994 – June 2011)
Conditional on Survival to 14 days
0 1 2 3 4 5 6 7 8 9 10 11 12 13 140
20
40
60
80
100
Freedom from Bronchiolitis Oblit-erans Syndrome (N = 14,762)
Years
% F
ree
fro
m B
ron
ch
iolit
is O
blit
-e
ran
s S
yn
dro
me
N at risk = 30
N at risk at 5 years = 2,079
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Bronchiolitis Obliterans SyndromeStratified by Age Group
For Adult Lung Recipients (Follow-ups: April 1994 – June 2011)Conditional on Survival to 14 days
0 1 2 3 4 5 6 7 8 9 100
20
40
60
80
100
18-34 (N = 2,091) 35-49 (N = 3,137)
50-59 (N = 5,110) 60-65 (N = 3,373)
>65 (N = 1,051)
Years
% F
ree
fro
m B
ron
ch
iolit
is O
blit
-e
ran
s S
yn
dro
me
p = 0.1362
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Bronchiolitis Obliterans SyndromeStratified by Diagnosis
For Adult Lung Recipients (Follow-ups: April 1994 – June 2011)Conditional on Survival to 14 days
0 1 2 3 4 5 6 7 8 9 100
20
40
60
80
100
Alpha-1 (N=863) CF (N=2,104)
COPD (N=5,410) IPF (N=3,587)
IPAH (N=420) Sarcoidosis (N=425)
Years
% F
ree
fro
m B
ron
ch
iolit
is O
blit
-e
ran
s S
yn
dro
me
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Bronchiolitis Obliterans SyndromeStratified by Induction Use
For Adult Lung Recipients (Follow-ups: April 1994 – June 2011)Conditional on Survival to 14 days
0 1 2 3 4 5 6 7 8 9 10 11 120
20
40
60
80
100No induction (N = 7,274)Induction (N = 6,523)
Years
% F
ree
fro
m B
ron
ch
iolit
is O
blit
-e
ran
s S
yn
dro
me
N at risk = 49
N at risk = 21N at risk at 5 years = 1,136
N at risk at 5 years = 818
p = 0.0002
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Bronchiolitis Obliterans SyndromeStratified by Induction Use
For Adult Lung Recipients (Follow-ups: April 1994 – June 2011)Conditional on Survival to 1 Year
0 1 2 3 4 5 6 7 8 9 10 11 120
20
40
60
80
100No induction (N = 6,462)Induction (N = 5,841)
Years
% F
ree
fro
m B
ron
ch
iolit
is O
blit
-e
ran
s S
yn
dro
me
N at risk = 49
N at risk = 21N at risk at 5 years = 1,136
N at risk at 5 years = 818
p = 0.0004
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Bronchiolitis Obliterans SyndromeStratified by Donor CMV Status/Recipient CMV Status
For Adult Lung Recipients (Follow-ups: April 1994 – June 2011)Conditional on Survival to 14 Days
0 1 2 3 4 5 6 7 8 9 10 11 120
20
40
60
80
100
D(-)/R(-) (N = 2,352) D(-)/R(+) (N = 3,134)
D(+)/R(-) (N = 2,915) D(+)/R(+) (N = 4,999)
Years
% F
ree
fro
m B
ron
ch
iolit
is O
blit
-e
ran
s S
yn
dro
me
N at risk = 17
N at risk = 30
N at risk = 14
N at risk = 17
No p-values are significant at p < 0.05 except D(-)/R(-) vs. D(+)/R(-): p = 0.0098D(-)/R(+) vs. D(+)/R(+): p = 0.0265D(+)/R(-) vs. D(+)/R(+): p = 0.0010
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Bronchiolitis Obliterans SyndromeStratified by Donor CMV Status/Recipient CMV Status
For Adult Lung Recipients (Follow-ups: April 1994 – June 2011)Conditional on Survival to 1 Year
0 1 2 3 4 5 6 7 8 9 10 11 120
20
40
60
80
100
D(-)/R(-) (N = 2,106) D(-)/R(+) (N = 2,811)
D(+)/R(-) (N = 2,523) D(+)/R(+) (N = 4,471)
Years
% F
ree
fro
m B
ron
ch
iolit
is O
blit
-e
ran
s S
yn
dro
me
N at risk = 17
N at risk = 30
N at risk = 14
N at risk = 17
No p-values are significant at p = 0.05 except D(-)/R(-) vs. D(+)/R(-): p = 0.0102D(-)/R(+) vs. D(+)/R(+): p = 0.0194D(+)/R(-) vs. D(+)/R(+): p = 0.0013
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Severe Renal Dysfunction* For Adult Lung Recipients (Follow-ups: April 1994 – June 2011)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 140
20
40
60
80
100
Freedom from Severe Re-nal Dysfunction (N=15,661)
Years
% F
ree
fro
m S
ev
ere
Re
na
l Dy
s-
fun
cti
on
N at risk = 60
N at risk at 5 years = 3,249
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Severe Renal Dysfunction* For Adult Lung Recipients (Follow-ups: April 1994 – June 2011)
Conditional on Survival to 1 Year
0 1 2 3 4 5 6 7 8 9 10 11 12 13 140
20
40
60
80
100
Freedom from Severe Renal Dysfunction (N=13,866)
Years
% F
ree
fro
m S
ev
ere
Re
na
l Dy
s-
fun
cti
on
N at risk = 60
N at risk at 5 years = 3,249
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from Severe Renal Dysfunction* by Maintenance Immunosuppression Combinations at Discharge
For Adult Lung Recipients (Transplants: January 2000 – June 2010)Analysis limited to patients receiving prednisone
Conditional on Survival to 14 Days
0 1 2 3 4 5 6 7 8 90
20
40
60
80
100
TAC+MMF/MPA (N = 4,798) TAC+AZA (N = 2,671)
CyA+MMF/MPA (N = 956) CyA+AZA (N = 1,464)
Years
% F
ree
fro
m S
ev
ere
Re
na
l Dy
s-
fun
cti
on
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
p < 0.0001
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
MALIGNANCY POST-LUNG TRANSPLANT FOR ADULTSCumulative Morbidity Rates in Survivors
(Follow-ups: April 1994 – June 2011)
Malignancy/Type 1-Year Survivors
5-Year Survivors
10-Year Survivors
No Malignancy 15,493 (96.5%) 4,485 (85.9%) 713 (72.8%)
Malignancy (all types combined) 563 (3.5%) 739 (14.1%) 267 (27.2%)
Malignancy Type*
Skin 169 486 182
Lymphoma 222 82 35
Other 148 199 81
Type Not Reported 24 9 0
* Recipients may have experienced more than one type of malignancy so sum of individual malignancy types may be greater than total number with malignancy.
Other malignancies reported include: adenocarcinoma (2; 2; 1), bladder (2; 1; 0), lung (2; 4; 0), breast (1; 5; 2); prostate (0; 5; 1), cervical (1; 1; 0); liver (1; 1; 1); colon (1; 1; 0). Numbers in parentheses represent the number of reported cases within each time period.
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from MalignancyFor Adult Lung Recipients (Follow-ups: April 1994 – June 2011)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
100
All malignancy Lymphoma Skin Other
Years
% F
ree
fro
m M
alig
na
nc
y
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
Freedom from MalignancyFor Adult Lung Recipients (Follow-ups: April 1994 – June 2011)
Conditional on Survival to 1 Year
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
20
40
60
80
100
All malignancy Lymphoma Skin Other
Years
% F
ree
fro
m M
alig
na
nc
y
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANT RECIPIENTSCause of Death (Deaths: January 1992 – June 2011)
CAUSE OF DEATH 0-30 Days (N = 2,504)
31 Days - 1 Year
(N = 4,347)
>1 Year - 3 Years
(N = 3,910)
>3 Years - 5 Years
(N = 2,217)
>5 Years – 10 Years (N = 2,615)
>10 Years (N = 756)
BRONCHIOLITIS 8 (0.3%) 199 (4.6%) 1,018 (26.0%) 647 (29.2%) 659 (25.2%) 157 (20.8%)
ACUTE REJECTION 89 (3.6%) 77 (1.8%) 59 (1.5%) 11 (0.5%) 16 (0.6%) 1 (0.1%)
LYMPHOMA 1 (0.0%) 109 (2.5%) 82 (2.1%) 36 (1.6%) 60 (2.3%) 30 (4.0%)
MALIGNANCY, NON-LYMPHOMA
3 (0.1%) 117 (2.7%) 273 (7.0%) 218 (9.8%) 324 (12.4%) 90 (11.9%)
CMV 0 108 (2.5%) 38 (1.0%) 7 (0.3%) 4 (0.2%) 1 (0.1%)
INFECTION, NON-CMV 503 (20.1%) 1,561 (35.9%) 894 (22.9%) 434 (19.6%) 472 (18.0%) 127 (16.8%)
GRAFT FAILURE 652 (26.0%) 740 (17.0%) 727 (18.6%) 403 (18.2%) 466 (17.8%) 132 (17.5%)
CARDIOVASCULAR 268 (10.7%) 195 (4.5%) 154 (3.9%) 106 (4.8%) 133 (5.1%) 50 (6.6%)
TECHNICAL 262 (10.5%) 146 (3.4%) 35 (0.9%) 15 (0.7%) 25 (1.0%) 8 (1.1%)
OTHER 718 (28.7%) 1,095 (25.2%) 630 (16.1%) 340 (15.3%) 456 (17.4%) 160 (21.2%)
ISHLT 2012 Percentages represent % of deaths in the respective time period
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANT RECIPIENTS Relative Incidence of Leading Causes of Death
(Deaths: January 1992 - June 2011)
0-30 Days (N=2,504)
31 Days – 1 Year (N=4,347)
>1 Year – 3 Years
(N=3,910)
>3 Years – 5 Years
(N=2,217)
>5 Years – 10 Years
(N=2,615)
>10 Years (N=756)
0
10
20
30
40
50Bronchiolitis Malignancy (non-Lymph/PTLD)Infection (non-CMV) Graft FailureCardiovascular
% o
f D
ea
ths
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANT RECIPIENTSCause of Death Stratified by Donor CMV Status/Recipient CMV Status
(Deaths: January 1992 – June 2011)
ISHLT 2012
Donor CMV Status/
Recipient CMV Status
CAUSE OF DEATH
0-30 Days 31 Days - 1 Year
>1 Year - 3 Years
>3 Years - 5 Years
>5 Years – 10 Years >10 Years
D(-)/R(-)(N=1,572)
BRONCHIOLITIS 1 (0.6%) 24 (6.4%) 101 (24.9%) 78 (32.0%) 69 (24.8%) 19 (20.9%)
INFECTION, NON-CMV 31 (17.4%) 134 (35.6%) 96 (23.7%) 41 (16.8%) 39 (14.0%) 12 (13.2%)
GRAFT FAILURE 50 (28.1%) 69 (18.4%) 80 (19.8%) 49 (20.1%) 51 (18.3%) 18 (19.8%)
D(-)/R(+)(N=2,350)
BRONCHIOLITIS 3 (1.1%) 29 (5.6%) 148 (27.2%) 95 (24.5%) 132 (27.1%) 33 (23.9%)
INFECTION, NON-CMV 56 (20.1%) 204 (39.6%) 128 (23.5%) 90 (23.2%) 79 (16.2%) 24 (17.4%)
GRAFT FAILURE 79 (28.4%) 87 (16.9%) 103 (18.9%) 64 (16.5%) 96 (19.7%) 23 (16.7%)
D(+)/R(-)(N=2,076)
BRONCHIOLITIS 0 20 (3.2%) 128 (23.3%) 70 (25.2%) 79 (25.5%) 7 (9.3%)
INFECTION, NON-CMV 43 (18.0%) 228 (36.5%) 127 (23.1%) 47 (16.9%) 52 (16.8%) 21 (28.0%)
GRAFT FAILURE 64 (26.8%) 125 (20.0%) 115 (20.9%) 60 (21.6%) 73 (23.5%) 15 (20.0%)
D(+)/R(+)(N=3,628)
BRONCHIOLITIS 1 (0.2%) 45 (5.2%) 242 (25.6%) 157 (27.6%) 147 (23.3%) 31 (17.9%)
INFECTION, NON-CMV 81 (18.5%) 316 (36.2%) 211 (22.3%) 114 (20.0%) 113 (17.9%) 24 (13.9%)
GRAFT FAILURE 134 (30.6%) 193 (22.1%) 179 (18.9%) 111 (19.5%) 128 (20.3%) 37 (21.4%)
J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095