HEART TRANSPLANTATION Overall ISHLT 2005 J Heart Lung Transplant 2005;24: 945-982.
LUNG TRANSPLANTATION Overall ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795.
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Transcript of LUNG TRANSPLANTATION Overall ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795.
LUNG TRANSPLANTATION
Overall
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE
0
200
400
600
800
1000
1200
1400
1600
1800
2000
2200
Nu
mb
er o
f T
ran
spla
nts
Bilateral/Double LungSingle Lung
ISHLT 2007
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.
14 15 46 83189
418
707
9221088
12311369
13701462
14581479
15791591
17881915
2169
1791
J Heart Lung Transplant 2007;26: 782-795
AVERAGE CENTER VOLUMELung Transplants: January 1, 1998 - June 30, 2006
52
27 29
15 16
2 50
10
20
30
40
50
60
1-4 5-9 10-19 20-29 30-39 40-49 50+
Average number of lung transplants per year
Nu
mb
er
of
ce
nte
rs
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME
Lung Transplants: January 1, 2000 - June 30, 2006
3.47.7
21.718.5
28.1
4.9
15.8
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
Pe
rce
nta
ge
of
tra
ns
pla
nts
.
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2006)
0
5
10
15
20
25
30
35
0-11 12-17 18-29 30-39 40-49 50-59 60-64 65+
Recipient Age
% o
f tr
an
sp
lan
ts
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA
0
5
10
15
20
25
30
35
40
0-11 12-17 18-29 30-39 40-49 50-59 60-64 65+
% o
f tr
ansp
lan
ts
1985-1994 (N = 4,658)
1995-1999 (N=7,116)
2000-6/2006 (N=11,851)
p < 0.0001
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
LUNG TRANSPLANTS: Donor Age by Year of Transplant
0%
20%
40%
60%
80%
100%
Year of Transplant
% o
f T
ran
sp
lan
ts
0-11 12-17 18-34 35-49 50-59 60+
0
5
10
15
20
25
30
35
40
Me
an
do
no
r a
ge
(y
ea
rs)
Mean Age
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS (1/1985-6/2006)
0
5
10
15
20
25
30
35
0-11 12-17 18-29 30-39 40-49 50-59 60-64 65+
Donor Age
% o
f tr
an
sp
lan
ts
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS BY ERA
0
5
10
15
20
25
30
35
40
0-11 12-17 18-29 30-39 40-49 50-59 60-64 65+
% o
f tr
ansp
lan
ts
1985-1994 (N = 4,658)
1995-1999 (N=7,116)
2000-6/2006 (N=11,851)
p < 0.0001
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
LUNG TRANSPLANTATION
Adult Recipients
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS (1/1985-6/2006)
0
5
10
15
20
25
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+
Recipient Age
% o
f tr
an
sp
lan
ts
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA
0
5
10
15
20
25
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+
% o
f tr
ansp
lan
ts .
1985-1995 (N = 5,722)
1996-6/2006 (N =16,856 )
p < 0.0001
ISHLT 2007
Mean age by era1985-1995 = 45.0 years1996-6/2006 = 48.9 years
J Heart Lung Transplant 2007;26: 782-795
AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA
0
5
10
15
20
25
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+
% o
f tr
ansp
lan
ts
.
1985-1994 (N=4,437)1995-1999 (N=6,726)2000-6/2006 (N=11,415)
p < 0.0001
ISHLT 2007
Mean age by era1985-1994 = 44.7 years1995-1999 = 47.3 years2000-6/2006 = 49.5 years
J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1994 - June 2005)
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=8,658)
Single Lung (N=8,369)
All Lungs (N=17,027)
Double lung: 1/2-life = 5.9 Years; Conditional 1/2-life = 8.6 YearsSingle lung: 1/2-life = 4.4 Years; Conditional 1/2-life = 6.3 YearsAll lungs: 1/2-life = 5.0 Years; Conditional 1/2-life = 7.1 Years
P < 0.0001
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2006)
DIAGNOSIS SLT (N = 8,316) BLT (N = 9,300) TOTAL (N = 17,616)
COPD/Emphysema 4,305 (52%) 2,225 (24%) 6,530 (37%)
Idiopathic Pulmonary Fibrosis 2,193 (26%) 1,217 (13%) 3,410 (19%)
Cystic Fibrosis 167 (2.0%) 2,722 (29%) 2,889 (16%)
Alpha-1 626 (7.5%) 795 (8.5%) 1,421 (8.1%)
Primary Pulmonary Hypertension 65 (0.8%) 575 (6.2%) 640 (3.6%)
Sarcoidosis 178 (2.1%) 260 (2.8%) 438 (2.5%)
Bronchiectasis 30 (0.4%) 473 (5.1%) 503 (2.9%)
LAM 59 (0.7%) 116 (1.2%) 175 (1.0%)
Congenital Heart Disease 16 (0.2%) 132 (1.4%) 148 (0.8%)
Re-Transplant: Obliterative Bronchiolitis
111 (1.3%) 85 (0.9%) 196 (1.1%)
Obliterative Bronchiolitis
(Not Re-Transplant)
46 (0.6%) 103 (1.1%) 149 (0.8%)
Re-Transplant: Not Obliterative Bronchiolitis
76 (0.9%) 70 (0.8%) 146 (0.8%)
Connective Tissue Disease 51 (0.6%) 65 (0.7%) 116 (0.7%)
Interstitial Pneumonitis 24 (0.3%) 13 (0.1%) 37 (0.2%)
Cancer 7 (0.1%) 12 (0.1%) 19 (0.1%)
Other 362 (4.4%) 437 (4.7%) 799 (4.5%)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATION: Distribution of Procedure Type for Major Indications (1991-2005)
ISHLT 2007
Year of TX
Alpha-1 COPD Cystic Fibrosis IPF PPH
Double Single Double Single Double Single Double Single Double Single
1991 19.0 81.0 14.2 85.8 95.7 4.3 15.1 84.9 23.4 76.6
1992 28.1 71.9 16.1 83.9 97.0 3.0 9.2 90.8 26.6 73.4
1993 38.7 61.3 16.0 84.0 94.9 5.1 16.5 83.5 53.8 46.2
1994 42.6 57.4 18.7 81.3 85.5 14.5 14.0 86.0 64.3 35.7
1995 45.8 54.2 21.5 78.5 89.6 10.4 27.6 72.4 90.4 9.6
1996 46.4 53.6 26.9 73.1 86.8 13.2 27.5 72.5 82.0 18.0
1997 45.7 54.3 26.8 73.2 92.8 7.2 22.2 77.8 90.0 10.0
1998 46.6 53.4 28.9 71.1 92.6 7.4 20.2 79.8 86.8 13.2
1999 46.8 53.2 27.3 72.7 90.5 9.5 23.1 76.9 85.7 14.3
2000 56.8 43.2 28.5 71.5 95.0 5.0 32.9 67.1 92.0 8.0
2001 59.4 40.6 27.7 72.3 94.1 8.9 28.7 71.3 90.6 9.4
2002 53.2 46.8 37.3 62.7 96.4 3.6 35.0 65.0 88.3 11.7
2003 65.1 34.9 39.8 60.2 96.1 3.9 40.7 59.3 94.3 5.7
2004 71.7 28.3 43.0 57.0 96.2 3.8 43.2 56.8 95.8 4.2
2005 75.7 24.3 48.0 52.0 97.8 2.2 45.9 54.1 89.5 10.5
J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONProcedure Type within Indication, by Year
0
10
20
30
40
50
60
70
80
90
100
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
% o
f tr
ansp
lan
ts
Bilateral/Double Lung Transplant Single Lung Transplant
AT Def COPD IPF PPH
2007
ISHLTJ Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATION: Indications for Single Lung Transplants (Transplants: January 1996 - June 2006)
52%
26%
9%
8%
2%1%
2%
Alpha-1 COPD CF IPF PPH Re-TX Other*
ISHLT 2007
*Other includes:
Sarcoidosis: 2.1%
Bronchiectasis: 0.4%
Congenital Heart Disease: 0.2%
LAM: 0.7%
OB (non-ReTx): 0.6%
Miscellaneous: 5.4%
J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATION: Indications for Bilateral/Double Lung Transplants (Transplants: January 1996 - June 2006)
24%
13%
17%
9%
29%
6% 2%
Alpha-1 COPD CF IPF PPH Re-Tx Other*
ISHLT 2007
*Other includes:
Sarcoidosis: 2.8%
Bronchiectasis: 5.1%
Congenital Heart Disease: 1.4%
LAM: 1.2%
OB (non-ReTx): 1.1%
Miscellaneous: 5.6%
J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONIndications By Year (%)
0
20
40
60
80
100
Transplant Year
% o
f T
ran
spla
nts
CF IPF COPD Alpha-1 PPH
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONIndications By Year (Number)
0
250
500
750
1000
1250
1500
1750
Transplant Year
Nu
mb
er o
f T
ran
spla
nts
CF IPF COPD Alpha-1 PPH
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f T
ran
sp
lan
ts
18-34 years 35-49 years 50-59 years 60-64 years 65+ years
ADULT LUNG TRANSPLANTS:AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
0%
20%
40%
60%
80%
100%
Europe North America Other
Nu
mb
er
of T
ran
sp
lan
ts-
Sarcoidosis
Re-TX
PPH
Other
IPF
CF
COPD
Bronchiectasis
Alpha-1
ADULT LUNG TRANSPLANTS:DIAGNOSIS DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2006
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
0%
20%
40%
60%
80%
100%
Europe North America Other
% o
f Do
nors
1-5 6-10 11-17 18-34 35-49 50-59 60-64 65+
ADULT LUNG TRANSPLANTS:DONOR AGE DISTRIBUTION BY LOCATION
Transplants between January 2000 and June 2006
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Era (Transplants: January 1988 – June 2005)
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)2000-6/2005 (N=9,419)
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 = 7.1 Years2000-6/2005: 1/2-life = 5.3 Years; Conditional 1/2-life = 6.4 Years
Survival comparisons by era1988-94 vs. 1995-99: p = 0.00571988-94: vs. 2000-6/05: p <0.0001 1995-99 vs. 2000-6/05: p <0.0001
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: January 1990 – June 2005)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (%
) .
18-34 (N= 3,718)35-49 (N= 5,687)50-59 (N= 7,402)60-64 (N= 2,764)65+ (N= 710)
Survival comparisons18-34 vs. 50-59: p <0.000118-34 vs. 60-64 and vs. 65+ : p < 0.000135-49 vs. 50-59, 60-64 and 65+: p < 0.000150-59 vs. 60-64 and vs. 65+: p < 0.000160-64 vs. 65+: p =.0548
HALF-LIFE 18-34: 5.2 Years; 35-49: 5.6 Years; 50-59: 4.7 Years; 60-64: 3.9 Years; 65+: 3.4 Years
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: January 1990 – June 2005)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (%
) Male (N=8,997)
Female (N=8,319)
HALF-LIFE Male: 4.8 years; Female: 5.2 Years
p = 0.0135
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2005)
YearALPHA-1 (N=1,844)
CF
(N=2,947)COPD
(N=7,113)IPF
(N=3,362)PPH
(N=926)SARCOIDOSIS
(N=429)
1 77.4 81.0 81.5 71.6 66.6 68.2
3 63.2 65.2 64.0 56.4 56.4 54.9
5 53.2 54.8 49.0 44.0 47.7 49.0
7 43.3 47.0 36.2 33.3 40.4 42.9
10 31.0 36.6 20.5 19.7 28.8 33.4
Survival comparisonsAlpha-1 vs. CF: p = 0.0031 CF vs. COPD: p < 0.0001Alpha-1 vs. COPD: p = 0.0005 CF vs. IPF: p < 0.0001Alpha-1 vs. IPF: p <0.0001 CF vs. PPH: p = 0.0001Alpha-1 vs. PPH: p = 0.0007 CF vs. Sarcoidosis: p = 0.0002Alpha-1 vs. Sarcoidosis p = .0492 COPD vs. IPF: p <0.0001
Note: Other comparisons are not statistically different. ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on
Survival to 3 Months (Transplants: January 1990 – June 2005)
YearALPHA-1 (N=1,547)
CF
(N= 2,508)COPD
(N= 6,220)IPF
(N= 2,685)PPH
(N= 656)SARCOIDOSIS
(N=341)
1 89.1 90.7 89.9 86.0 90.1 82.6
3 72.8 72.9 70.6 67.7 76.3 66.4
5 61.2 61.3 54.1 52.8 64.5 59.3
7 49.8 52.6 39.9 40.0 54.6 51.9
10 35.7 40.9 22.6 23.6 39.0 40.4
Survival comparisonsAlpha-1 vs. CF: p =.0472 PPH vs. COPD: p < 0.0001Alpha-1 vs. COPD: p < 0.0001 PPH vs. IPF: p < 0.0001Alpha-1 vs. IPF: p < 0.0001 IPF vs. Sarcoidosis: p = 0.0209 CF vs. COPD: p < 0.0001CF vs. IPF: p < 0.0001
Note: Other comparisons are not statistically different.ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2005)
YearALPHA-1 (N=1,343)
CF
(N=2,178)COPD
(N=5,378)IPF
(N=2,178)PPH
(N= 573)SARCOIDOSIS
(273)
1 100.0 99.9 100.0 100.0 99.8 100.0
3 81.7 80.3 78.5 78.7 84.5 80.4
5 68.7 67.5 60.1 61.4 71.5 71.8
7 55.9 57.9 44.4 46.6 60.5 62.9
10 40.1 45.0 25.2 27.4 43.2 48.9
Survival comparisonsAlpha-1 vs. IPF: p < 0.0001 Alpha-1 vs. COPD: p < 0.0001CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001PPH vs. COPD: p < 0.0001 PPH vs. IPF: p < 0.0001COPD vs. Sarcoidosis: p < 0.0001 IPF vs. Sarcoidosis: p = 0.0002
Note: Other comparisons are not statistically different.
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2005)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al (
%)
Alpha-1 (N=1,844) CF (N= 2,947) COPD (N= 7,113)
IPF (N= 3,362) PPH (N= 926) Sarcoidosis (N=429)
HALF-LIFE Alpha-1: 5.7 Years; CF: 6.2 Years; COPD: 4.8 Years; IPF: 3.9 Years; PPH: 4.5 Years; Sarcoidosis: 4.8 Years
ISHLT 2007
Survival comparisonsAlpha-1 vs. CF: p = 0.0031Alpha-1 vs. COPD p = 0.0005Alpha-1 vs. IPF p < 0.0001Alpha-1 vs. PPH: p = 0.0007 Alpha-1 vs. Sarcoidosis: p = 0.0492CF vs. COPD: p < 0.0001CF vs. IPF: p < 0.0001CF vs. PPH: p < 0.0001CF vs. Sarcoidosis: p = 0.0002COPD vs. IPF: p <0.0001
J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on
Survival to 3 Months (Transplants: January 1990 – June 2005)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al (
%)
Alpha-1 (N=1,547) CF (N= 2,508)COPD (N= 6,220) IPF (N= 2,685)PPH (N= 656) Sarcoidosis (N=341)
HALF-LIFE Alpha-1: 7.0 Years; CF: 7.6 Years; COPD: 5.5 Years; IPF: 5.4 Years; PPH: 8.1 Years; Sarcoidosis: 7.0 Years
Survival comparisonsAlpha-1 vs. CF: p = 0.0472Alpha-1 vs. IPF: p < 0.0001 Alpha-1 vs. COPD: p < 0.0001CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001PPH vs. COPD: p < 0.0001 PPH vs. IPF: p < 0.0001IPF vs. Sarcoidosis: p = 0.0209
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year
(Transplants: January 1990 – June 2005)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al (
%)
Alpha-1 (N=1,343) CF (N= 2,178)COPD (N= 5,378) IPF (N= 2,178)PPH (N= 573) Sarcoidosis (N=273)
HALF-LIFE Alpha-1: 7.9 Years; CF: 8.8 Years; COPD: 6.2 Years; IPF: 6.7 Years; PPH: 8.9 Years; Sarcoidosis: 9.4 Years
Survival comparisonsAlpha-1 vs. IPF: p < 0.0001 Alpha-1 vs. COPD: p < 0.0001CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001PPH vs. COPD: p < 0.0001 PPH vs. IPF: p < 0.0001COPD vs. Sarcoidosis: p < 0.0001 IPF vs. Sarcoidosis: p = 0.0002
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival for Eisenmenger’s Syndrome
(Transplants: January 1990 – June 2005)
0
25
50
75
100
0 1 2 3 4 5Years
Su
rviv
al (%
)
ASD (N= 123) VSD (N= 57)
HALF-LIFE ASD: 2.9 Years; VSD: 1.0 Years
ISHLT 2007
p = 0.2632
N= 38
N= 15
J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Procedure Type
(Transplants: January 1990 – June 2005) Diagnosis: Alpha-1 Antitrypsin Deficiency
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (%
)
Alpha-1/Single lung (N=944)
Alpha-1/Double lung (N=900)P = 0.0001
ISHLT 2007
N at risk at 10 years is 87 for Single Lung and 74 for Double Lung.
J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Procedure Type and Age
(Transplants: January 1990 – June 2005) 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, < 50 (N=438) Double Lung, <50 (N =516)
Single Lung, 50+ (N = 506) Double Lung, 50+ (N = 384)
ISHLT 2007
N at risk at 10 years:
Single Lung, <50 = 57; Double Lung, <50 = 62; Single Lung, 50+ = 30; Double Lung, 50+ = 12
p = 0.0724
J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2005)
Diagnosis: Emphysema/COPD
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
COPD/Single lung (N=4,990)
COPD/Double lung (N=2,123) N=182
N=75
P < 0.0001
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Age
(Transplants: January 1990 – June 2005)
Diagnosis: Emphysema/COPD
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
<50/Single lung (N=683) <50/Double lung (N=606)
50+/Single lung (N=4,307) 50+/Double lung (N=1,517)N=51N=131
N=33N=42
P < 0.0001
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type
(Transplants: January 1990 – June 2005)
Diagnosis: Idiopathic Pulmonary Fibrosis
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
IPF/Single lung (N=2,350)
IPF/Double lung (N=1,012)
N=64
N=18
P = 0.0301
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type
(Transplants: January 1990 – June 2005)Diagnosis: Primary Pulmonary Hypertension
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
PPH/Single lung (N=264)
PPH/Double lung (N=662)
N=35 at 10 years
N=43 at 10 years
P = 0.0532
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2005)
Diagnosis: Emphysema/COPD, Single Lung
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
COPD/Single lung/1990-1994 (N=1000)
COPD/Single lung/1995-1999 (N=1,761)
COPD/Single lung/2000-6/2005 (N=2,229)
Survival comparisons1990-1994 vs. 1995-1999: p = 0.51291990-1994 vs. 2000-6/2005: p = 0.00131995-1999 vs. 2000-6/2005: p = 0.0761
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2005)
Diagnosis: Emphysema/COPD, Double Lung
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
COPD/Double lung/1990-1994 (N=204)
COPD/Double lung/1995-1999 (N=633)
COPD/Double lung/2000-6/2005 (N=1,286)
Survival comparisons1990-1994 vs. 1995-1999: p = 0.17311990-1994 vs. 2000-6/2005: p = 0.41371995-1999 vs. 2000-6/2005: p = 0.0168
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2005)
Diagnosis: Idiopathic Pulmonary Fibrosis, Single Lung
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
IPF/Single lung/1990-1994 (N=456)
IPF/Single lung/1995-1999 (N=810)
IPF/Single lung/2000-6/2005 (N=1,084)
Survival comparisons1990-1994 vs. 1995-1999: p = 0.96241990-1994 vs. 2000-6/2005: p = 0.00481995-1999 vs. 2000-6/2005: p = 0.0015
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2005)
Diagnosis: Idiopathic Pulmonary Fibrosis, Double Lung
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Su
rviv
al (
%)
IPF/Double lung/1990-1994 (N=66)
IPF/Double lung/1995-1999 (N=259)
IPF/Double lung/2000-6/2005 (N=687)
Survival comparisons1990-1994 vs. 1995-1999: p = 0.95261990-1994 vs. 2000-6/2005: p = 0.00261995-1999 vs. 2000-6/2005: p < 0.0001
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Donor CMV status/Recipient CMV status
(Transplants: October 1999 – June 2005)
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5
Years
Su
rviv
al (
%)
D(-)/R(-) (N=954)D(-)/R(+) (N=1,215)D(+)/R(-) (N=1,113)D(+)/R(+) (N=1,827)
Survival comparisonsD(-)/R(-) vs. D(+)/R(-): p = 0.0119D(-)/R(-) vs. D(+)/R(+): p = 0.0093D(-)/R(+) vs. D(+)/R(-): p = 0.0127D(-)/R(+) vs. D(+)/R(+): p = 0.0111
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2005) Risk Factors for 1 Year Mortality
DIAGNOSIS N
Relative Risk P-value
95% confidence
Interval
PPH 389 2.35 <.0001 1.74 -3.19
Pulmonary fibrosis (not IPF) 90 2.31 <.0001 1.60 -3.32
Sarcoidosis 276 1.82 <.0001 1.42 -2.34
Other diagnoses* 772 1.72 <.0001 1.42 -2.08
IPF 1961 1.53 <.0001 1.30 -1.80
Alpha-1 antitrypsin deficiency 826 1.48 <.0001 1.25 -1.75
Cystic fibrosis 1507 1.42 0.0029 1.13 -1.79
(N=10,415)
ISHLT 2007
*Other = All diagnoses other than COPD, PPH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, and LAM.
J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2005) Risk Factors for 1 Year Mortality
DONOR CHARACTERISTICS N
Relative Risk P-value
95% Confidence
Interval
Donor history of diabetes 290 1.48 0.0008 1.18 -1.85
RECIPIENT CHARACTERISTICS
IV inotropes 72 1.78 0.0007 1.27 -2.49
Ventilator 234 1.75 <.0001 1.36 -2.24
Hospitalized (including ICU) 798 1.42 <.0001 1.21 -1.68
Prior sternotomy 384 1.24 0.0363 1.01 -1.51
Chronic steroid use 4801 1.10 0.0382 1.01 -1.20
Prior thoracotomy 854 0.81 0.0334 0.67 -0.98
ISHLT 2007
(N=10,415)
J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2005) Risk Factors for 1 Year Mortality
TRANSPLANT CHARACTERISTICS N Relative
Risk P-value
95% Confidence
Interval
Repeat transplant 248 1.53 0.0104 1.10 -2.11
Transplant year = 1995/1996 vs. 1999/2000
1716 1.23 0.0027 1.08 -1.41
Donor CMV +/ Recipient CMV - 1895 1.22 0.0002 1.10 -1.36
4, 5 or 6 HLA mismatches (vs. 0-3 mismatches)
9106 with 4, 5 or 6 HLA MM 1.18 0.0136 1.04 -1.34
Transplant year = 2001/2002 vs. 1999/2000
2207 0.81 0.0028 0.71 -0.93
Transplant year = 2003/2005 vs. 1999/2000
3087 0.68 <.0001 0.60 -0.78
ISHLT 2007
(N=10,415)
J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Recipient age
Donor age (borderline)
Recipient weight
Donor weight
PVR
Transplant center volume
Bilirubin
Recipient oxygen required at rest
Recipient FEV1 % predicted
Cardiac output
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality
Recipient Age
0
0.5
1
1.5
2
25 30 35 40 45 50 55 60 65
Recipient Age
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p < 0.0001
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality
Donor Age
0
0.5
1
1.5
2
15 20 25 30 35 40 45 50 55
Donor Age
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.083
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality
Donor Weight
0
0.5
1
1.5
2
50 55 60 65 70 75 80 85 90 95
Donor Weight (kg)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.012
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality
Pre-Transplant Recipient Weight
0
0.5
1
1.5
2
45 55 65 75 85 95
Recipient weight (kg)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.0078
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality
Center volume
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40 45 50
Center Volume (cases per year)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p < 0.0001
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality
Recipient FEV1 (% predicted)
0
0.5
1
1.5
2
25 30 35 40 45 50 55 60 65 70Recipient FEV1 (% predicted)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
P = 0.024
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality
Recipient Pre-Transplant Bilirubin
0
0.5
1
1.5
2
2.5
0 0.5 1 1.5 2 2.5 3
Recipient Bilirubin (mg/dl)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.0033
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality
Recipient Oxygen Required at Rest
0
0.5
1
1.5
2
0 1 2 3 4 5 6
Oxygen Required at Rest (L/min)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p < 0.0001
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality
Recipient Pre-Transplant Cardiac Output
0
0.5
1
1.5
2
3 4 5 6 7
Cardiac output
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.009
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality
Recipient PVR
0
0.5
1
1.5
2
1 2 3 4 5 6 7 8 9
PVR (Wood units)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.022
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2005) Factors Not Significant for 1 Year Mortality
Recipient factors:Transfusions, recent infection requiring IV drug therapy, diabetes, sternotomy, dialysis, FVC, creatinine, PRA, chronic steroid use, height, gender, history of cancer
Donor factors:History of hypertension, history of cancer, cause of death, height, clinical infection, gender
Transplant factors:Ischemia time
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2005) Risk Factors for 1 Year Mortality
Model including BMI
DIAGNOSIS N
Relative Risk P-value
95% confidence
Interval
PPH 389 2.40 <.0001 1.77 -3.25
Pulmonary fibrosis (not IPF) 90 2.35 <.0001 1.63 -3.38
Sarcoidosis 276 1.85 <.0001 1.44 -2.37
Other diagnoses* 772 1.73 <.0001 1.43 -2.09
IPF 1961 1.57 <.0001 1.33 -1.84
Alpha-1 antitrypsin deficiency 826 1.50 <.0001 1.27 -1.78
Cystic fibrosis 1507 1.38 0.0062 1.10 -1.74
(N=10,415)
ISHLT 2007
*Other = All diagnoses other than COPD, PPH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, and LAM.
J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2005) Risk Factors for 1 Year Mortality
Model including BMI
DONOR CHARACTERISTICS N
Relative Risk P-value
95% Confidence
Interval
Donor history of diabetes 290 1.48 0.0008 1.17 -1.85
RECIPIENT CHARACTERISTICS
IV inotropes 72 1.81 0.0005 1.29 -2.53
Ventilator 234 1.74 <.0001 1.36 -2.23
Hospitalized (including ICU) 798 1.42 <.0001 1.20 -1.67
Prior sternotomy 384 1.24 0.0362 1.01 -1.51
Chronic steroid use 4801 1.10 0.0416 1.00 -1.20
Prior thoracotomy 854 0.81 0.0331 0.67 -0.98
ISHLT 2007
(N=10,415)
J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2005) Risk Factors for 1 Year Mortality
Model including BMI
TRANSPLANT CHARACTERISTICS N Relative Risk
P-value 95%
Confidence Interval
Repeat transplant 248 1.51 0.0129 1.09 -2.09
Transplant year = 1995/1996 vs. 1999/2000
1716 1.23 0.0030 1.07 -1.41
Donor CMV +/ Recipient CMV - 1895 1.22 0.0002 1.10 -1.36
4, 5 or 6 HLA mismatches (vs. 0-3 mismatches)
9106 with 4, 5 or 6 HLA MM
1.18 0.0143 1.03 -1.35
Transplant year = 2001/2002 vs. 1999/2000
2207 0.81 0.0027 0.71 -0.93
Transplant year = 2003/2005 vs. 1999/2000
3087 0.68 <.0001 0.60 -0.78
ISHLT 2007
(N=10,415)
J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality
Model including BMI
Continuous Factors (see figures)
Recipient age
Recipient BMI (borderline)
Donor weight (borderline)
PVR
Transplant center volume
Bilirubin
Recipient oxygen required at rest
Recipient FEV1 % predicted
Cardiac output
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI)
Recipient Age
0
0.5
1
1.5
2
25 30 35 40 45 50 55 60 65
Recipient Age
p < 0.0001
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI)
Donor Weight
0
0.5
1
1.5
2
50 55 60 65 70 75 80 85 90 95
Donor Weight (kg)
p = 0.058
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI)
Pre-Transplant Recipient BMI
0
0.5
1
1.5
2
17 20 23 26 29 32
Recipient BMI (kg/m2)
p = 0.092
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI)
Center volume
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40 45 50
Center Volume (cases per year)
p < 0.0001
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI)
Recipient FEV1 (% predicted)
0
0.5
1
1.5
2
25 30 35 40 45 50 55 60 65 70Recipient FEV1 (% predicted)
p = 0.0320
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI)
Recipient Pre-Transplant Bilirubin
0
0.5
1
1.5
2
2.5
0 0.5 1 1.5 2 2.5 3
Recipient Bilirubin (mg/dl)
p = 0.0013
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI)
Recipient Oxygen Required at Rest
0
0.5
1
1.5
2
0 1 2 3 4 5 6
Oxygen Required at Rest (L/min)
p < 0.0001
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI)
Recipient Pre-Transplant Cardiac Output
0
0.5
1
1.5
2
3 4 5 6 7
Cardiac output
p = 0.0254
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI)
Recipient PVR
0
0.5
1
1.5
2
1 2 3 4 5 6 7 8 9
PVR (Wood units)
p = 0.018
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2005) Diagnosis = COPD/EmphysemaRisk Factors for 1 Year Mortality
RECIPIENT CHARACTERISTICS N
Relative Risk P-value
95% Confidence Interval
Ventilator 44 2.66 .0002 1.60 -4.42
Hospitalized (including ICU) 160 1.61 .0090 1.13 -2.31
Chronic steroid use 2001 1.34 .0001 1.15 -1.55
TRANSPLANT CHARACTERISTICS
Transplant Year: 2001/2002 vs. 1999/2000 952 0.78 .0396 0.62 -0.99
Transplant Year: 2003/2005 vs. 1999/2000 1159 0.77 .0221 0.61 -0.96
Donor CMV +/ Recipient CMV - 617 1.32 .0045 1.09 -1.60
DONOR CHARACTERISTICS
Donor history of diabetes 119 1.53 .0301 1.04 -2.26
(N=4,235)ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005)Diagnosis = COPD/Emphysema
Risk Factors for 1 Year Mortality
Continuous Factors (see figures)
Recipient age
Oxygen required at rest
Cardiac output
Transplant center volume
Recipient FEV1 % predicted
PCO2 (borderline)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = COPD/Emphysema
Risk Factors for 1 Year MortalityRecipient Age
0
0.5
1
1.5
2
40 45 50 55 60 65
Recipient Age
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.0001
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = COPD/Emphysema
Risk Factors for 1 Year MortalityCenter volume
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40 45 50
Center Volume (cases per year)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.024
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = COPD/Emphysema
Risk Factors for 1 Year MortalityCardiac Output
0
0.5
1
1.5
2
3 4 5 6 7
Cardiac Output
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.029
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = COPD/Emphysema
Risk Factors for 1 Year Mortality Recipient Oxygen Required at Rest
0
0.5
1
1.5
2
0 1 2 3 4 5 6Recipient Oxygen Required at Rest (L/min)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.008
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = COPD/Emphysema
Risk Factors for 1 Year Mortality Ischemia Time
0
0.5
1
1.5
2
0 1 2 3 4 5 6Ischemia time (hours)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.029
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = COPD/Emphysema
Risk Factors for 1 Year Mortality Recipient PCO2 at Transplant
0
0.5
1
1.5
2
25 30 35 40 45 50 55 60 65 70Recipient PCO2 (mm/Hg)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.064
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2005) Diagnosis = IPF
Risk Factors for 1 Year Mortality
RECIPIENT CHARACTERISTICS N Relative
Risk P-value
95% Confidence
Interval
Ventilator 43 2.54 0.0001 1.61 -3.99
Prior sternotomy 63 1.62 0.0228 1.07 -2.47
Prior thoracotomy 223 0.65 0.0077 0.47 -0.89
TRANSPLANT CHARACTERISTICS
Donor CMV+ / Recipient CMV- 350 1.51 0.0001 1.23 -1.87
Transplant Year: 2001/02 vs. 1999/2000 400 0.72 0.0223 0.54 -0.95
Transplant Year: 2003/05 vs. 1999/2000 741 0.60 0.0001 0.46 -0.78
(N=1,961)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005)
Diagnosis = IPFRisk Factors for 1 Year Mortality
Continuous Factors (see figures)
Recipient age
Donor age
Recipient BMI (borderline)
Donor weight
Bilirubin
Center volume (borderline)
PA diastolic pressure
Wedge pressure (borderline)
Oxygen required at rest
Cardiac output (borderline)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = IPF
Risk Factors for 1 Year MortalityRecipient Age
0
0.5
1
1.5
2
35 40 45 50 55 60 65
Recipient Age
p = 0.048
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = IPF
Risk Factors for 1 Year MortalityDonor Age
0
0.5
1
1.5
2
15 20 25 30 35 40 45 50 55
Donor Age
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.039
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = IPF
Risk Factors for 1 Year MortalityRecipient PA Diastolic Pressure
0
0.5
1
1.5
2
10 15 20 25 30
PA Diastolic Pressure
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.011
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = IPF
Risk Factors for 1 Year MortalityDonor Weight
0
0.5
1
1.5
2
50 60 70 80 90 100
Donor Weight (kg)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.022
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005)Diagnosis = IPF
Risk Factors for 1 Year MortalityRecipient O2 Required at Rest
0
0.5
1
1.5
2
0 1 2 3 4 5 6
O2 Required at Rest (L/min)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p < 0.0001
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005)Diagnosis = IPF
Risk Factors for 1 Year MortalityCenter volume
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40 45 50
Center Volume (cases per year)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.058
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005)Diagnosis = IPF
Risk Factors for 1 Year MortalityRecipient BMI
0
0.5
1
1.5
2
20 22 24 26 28 30 32
Recipient BMI (kg/m2)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.078
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005)Diagnosis = IPF
Risk Factors for 1 Year MortalityRecipient Bilirubin
0
0.5
1
1.5
2
0 0.5 1 1.5 2
Bilirubin (mg/dl)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.026
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005)Diagnosis = IPF
Risk Factors for 1 Year MortalityRecipient Cardiac Output
0
0.5
1
1.5
2
3 4 5 6 7
Cardiac Output
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.0505
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2005)Diagnosis = IPF
Risk Factors for 1 Year MortalityRecipient Wedge Pressure
0
0.5
1
1.5
2
4 7 10 13 16 19
Pulmonary Capillary Wedge Pressure (mm/Hg)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
p = 0.0682
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2001) Risk Factors for 5 Year Mortality
DIAGNOSIS N Relative
Risk P-value 95% Confidence
Interval
PPH 238 1.60 .0089 1.13 -2.28
Other diagnoses* 401 1.25 .0118 1.05 -1.49
Alpha-1 antitrypsin deficiency 511 1.25 .0019 1.08 -1.44
LAM 59 0.53 .0155 0.32 -0.89
RECIPIENT CHARACTERISTICS
Recipient on IV inotropes 53 1.94 .0001 1.40 -2.69
Recipient on ventilator 135 1.43 .0060 1.11 -1.84
Recipient with prior sternotomy 199 1.31 .0035 1.09 -1.57
Recipient history of diabetes 335 1.24 .0048 1.07 -1.45
Hospitalized (including ICU) 454 1.23 .0090 1.05 -1.44
(N=5,640)
ISHLT 2007
*Other = All diagnoses other than COPD, PPH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, and LAM.
J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2001) Risk Factors for 5 Year Mortality
DONOR CHARACTERISTICS N Relative
Risk P-value
95% Confidence Interval
Donor history of diabetes 125 1.40 .0030 1.12 -1.76
Donor cause of death = Anoxia 254 0.72 .0012 0.59 -0.88
TRANSPLANT CHARACTERISTICS
4-6 total HLA mismatches 4907 1.23 .0005 1.09 -1.37
Transplant year: 1995/1996 vs. 1999/2000 1581 1.21 <.0001 1.11 -1.32
Donor CMV +/ Recipient CMV - 980 1.17 .0011 1.07 -1.29
(N=5,640)ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2001) Borderline Significant Risk Factors for 5 Year Mortality
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Repeat transplant 122 1.28 .0792 0.97 -1.68
DIagnosis: IPF 903 1.15 .0562 1.00 -1.34
Female donor/female recipient 1550 0.91 .0659 0.82 -1.01
Diagnosis: Cystic fibrosis 826 0.84 .0816 0.69 -1.02
(N=5,640)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality
Continuous Factors (see figures)
Recipient age
Donor age
Donor height
Recipient BSA
Center volume
Oxygen at rest
FEV1 % predicted (borderline)
PA diastolic
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality
Recipient Age
0
0.5
1
1.5
2
25 30 35 40 45 50 55 60 65
Recipient Age
Rela
tive R
isk o
f 5 Y
ear
Mo
rtalit
y
p < 0.0001
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality
Donor Age
0
0.5
1
1.5
2
15 25 35 45 55Donor Age
Rela
tive R
isk o
f 5 Y
ear
Mo
rtalit
y
p = 0.008
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality
Donor Height
0
0.5
1
1.5
2
155 160 165 170 175 180 185
Donor height (cm)
Rel
ativ
e R
isk
of
5 Y
ear
Mo
rtal
ity
p = 0.0013
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality
Pre-Transplant Recipient Body Surface Area
0
0.5
1
1.5
2
1.5 1.6 1.7 1.8 1.9 2
Recipient BSA (m2)
Rel
ativ
e R
isk
of
5 Y
ear
Mo
rtal
ity
p = 0.0028
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality
Pre-Transplant Recipient PA Diastolic Pressure
0
0.5
1
1.5
2
10 15 20 25 30 35 40
PA Diastolic (mm/Hg)
Rela
tive R
isk o
f 5 Y
ear
Mo
rtality
p = 0.029
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality
Center Volume
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40 45 50
Center Volume (Cases per year)
Rela
tive R
isk o
f 5 Y
ear
Mo
rtality
p < 0.0001
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality
Pre-Transplant Recipient FEV1 (% predicted)
0
0.5
1
1.5
2
10 20 30 40 50 60 70
Recipent FEV1 (% predicted)
Rela
tive R
isk o
f 5 Y
ear
Mo
rtalit
y
p = 0.08
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality
Oxygen Required at Rest
0
0.5
1
1.5
2
0 1 2 3 4 5 6
Oxygen required at rest (L/min)
Rela
tive R
isk o
f 5 Y
ear
Mo
rtalit
y
p = 0.012
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2000) Factors Not Significant for 5 Year Mortality
Recipient factors:Transfusions, history of malignancy, cardiac output, PRA, FVC, PCO2, dialysis, recent infection requiring IV
drug therapy, PRA, bilirubin, creatinine
Donor factors:Clinical infection, history of hypertension, history of cancer, weight
Transplant factors:Ischemia time
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2001) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
DIAGNOSIS N Relative
Risk P-value
95% Confidence
Interval
PPH vs. COPD 148 0.71 0.0321 0.52 -0.97
Cystic Fibrosis vs. COPD 652 0.61 0.0002 0.47 -0.79
LAM vs. COPD 48 0.42 0.0151 0.21 -0.84
Pulmonary Fibrosis (not IPF) vs. COPD
28 0.37 0.0268 0.15 -0.89
(N=4,205)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2001) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
DONOR, RECIPIENT AND TRANSPLANT CHARACTERISTICS N
Relative Risk P-value
95% Confidence
Interval
Donor cause of death = anoxia vs. head trauma
201 0.62 0.0006 0.47 -0.81
Recipient sternotomy prior to transplant
132 1.52 0.001 1.18 -1.95
Recipient diabetes 238 1.37 0.0034 1.11 -1.69
Transplant year: 1995/1996 vs. 1999-6/2001
1126 1.16 0.0192 1.02 -1.31
Transplant year: 1997/1998 vs. 1999-6/2001
1290 1.14 0.0308 1.01 -1.29
Number of mismatches at HLA A locus
2244 1 A MM; 1692 2 A MM
1.12 per MM
0.0112 1.03 -1.22
(N=4,205)ISHLT 2007
J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2001) 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 302 2.26 <.0001 1.92 -2.66
Dialysis prior to discharge 82 1.39 .0467 1.00 -1.93
Rejection between discharge and 1 year 1403 1.29 <.0001 1.16 -1.43
Drug-treated infection prior to discharge 1630 1.24 <.0001 1.12 -1.38
(N=4,205)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2001) Borderline Significant Risk Factors for 5 Year Mortality
Conditional on Survival to 1 Year
CHARACTERISTICS N Relative
Risk P-value
95% Confidence
Interval
Diagnosis = Sarcoidosis vs. COPD 96 0.7 0.0708 0.47 -1.03
(N=4,205)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
Continuous Factors (see figures)
Recipient Age
Donor Age
Center Volume
Recipient BMI (borderline)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival
Recipient Age
0
0.5
1
1.5
2
2.5
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 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2001) 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 = 0.026
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival
Recipient BMI
0
0.5
1
1.5
2
18 20 22 24 26 28 30Recipient BMI (kg/m2)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.09
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival
Center Volume
0
0.5
1
1.5
2
5 10 15 20 25 30 35 40 45 50Center volume (cases per year)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
p = 0.004
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2000) Factors Not Significant for Conditional 5 Year Mortality
Recipient factors:Ventilator, inotropes, hospitalized at transplant, pCO2, gender,
chronic steroid use, transfusions, history of malignancy, PRA, repeat transplant, FEV1, FVC, PA pressures, O2 required,
bilirubin, creatinine, recent infection requiring use of IV drug therapy, thoracotomy, cardiac output
Donor factors:Gender, clinical infection, history of hypertension, history of cancer, history of diabetes, weight
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANTS (1995-6/2000) Factors Not Significant for Conditional 5 Year Mortality
Transplant factors:ABO compatibility, CMV mismatch
Post-transplant factors:Induction, stroke prior to discharge, prolonged graft dysfunction prior to discharge, treated for rejection prior to discharge
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG RECIPIENTSFunctional Status of Surviving Recipients
(Follow-ups: April 1994 – June 2006)
0%
20%
40%
60%
80%
100%
1 Year (N=6,596) 3 Year (N=4,176) 5 Year (N=2,402) 10 Year (N=398)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG RECIPIENTSEmployment Status of Surviving Recipients
(Follow-ups: April 1994 – June 2006)
0%
20%
40%
60%
80%
100%
1 Year (N=7,327) 3 Year (N=4,443) 5 Year (N=2,648) 10 Year (N= 507)
Working (FT/PTStatus unknown)
Working Part Time
Working Full Time
Retired
Not Working
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2006)
0%
20%
40%
60%
80%
100%
1 Year (N=9,129) 3 Year (N=5,589) 5 Year (N=3,338) 10 Year (N=592)
No Hospitalization Hosp: No Rej/No Inf Hosp: Rejection Hosp: Infection Hosp: Rej/Inf
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
0
5
10
15
20
25
30
35
40
45
50
Any Induction (N =2,482)
Polyclonal ALG/ATG (N= 565)
IL2R-antagonist (N =1,752)
Campath (N = 148)
% o
f p
atien
tsADULT LUNG RECIPIENTS
Induction Immunosuppression (Transplants: January 2002 - June 2006)Analysis limited to patients receiving prednisone
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
0
10
20
30
40
50
% o
f p
ati
en
ts
ADULT LUNG RECIPIENTSInduction Immunosuppression (Transplants: January 2000 - December 2005)
Analysis limited to patients receiving prednisone
ISHLT 2007
Any Induction Polyclonal ALG/ATG IL2R-antagonist Campath
J Heart Lung Transplant 2007;26: 782-795
SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: April 1994-June 2005)
Conditional on survival to 14 days
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10Years
Su
rviv
al (
%)
No induction (N=6,589)
Induction (N=3,994)
p = 0.0001
ISHLT 2007
At 10 years there were 105 patients at risk in the induction group and 219 in the no induction group.
J Heart Lung Transplant 2007;26: 782-795
SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: January 2000-June 2005)
Conditional on survival to 14 days
0
20
40
60
80
100
0 1 2 3 4 5
Years
Su
rviv
al (
%)
No induction (N=3,225)
Induction (N=2,605)
p =0.0004
ISHLT 2007
At 5 years there were 279 patients at risk in the induction group and 382 in the no induction group.
J Heart Lung Transplant 2007;26: 782-795
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine
% o
f P
ati
en
ts
Year 1 (N=4,488) Year 5 (N=1,973)
ADULT LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2002 through June 2006 Analysis limited to patients receiving prednisone
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
0
20
40
60
80
100
CyA TAC Rapamycin MMF AZA CyA TAC Rapamycin MMF AZA
% o
f P
atie
nts
1-Year Follow-Up 5-Year Follow-Up
Consecutive bars within each drug type represent follow-ups in 2002, 2003, 2004, 2005, & 2006.
ADULT LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2002 through June 2006 Analysis limited to patients receiving prednisone
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
0
20
40
60
80
100
CalcineurinInhibitor
CellCycle Rapamycin CalcineurinInhibitor
CellCycle Rapamycin
% o
f P
ati
en
ts
CyA
Tac Tac
CyA
Rapa Rapa
MMF MMF
AZA AZA
ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2002 through June 2006Analysis limited to patients receiving prednisone
1 Year Follow-up (N = 4,488) 5 Year Follow-up (N = 1,973)
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
0
20
40
60
80
100
Year 1 (N = 4,488) Year 5 (N = 1,973)
% o
f P
atie
nts
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine + MMF
Cyclosporine + AZA
ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
For follow-ups between January 2002 through June 2006Conventional Combinations
Analysis limited to patients receiving prednisone
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
0
10
20
30
40
50
Year 1 (N = 4,488) Year 5 (N = 1,973)
% o
f P
atie
nts
Other
Rapa + Cellcycle
Rapa + Calcineurin
Tacrolimus
ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
For follow-ups between January 2002 through June 2006Other Combinations
Analysis limited to patients receiving prednisone
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2005)
0
10
20
30
40
50
60
Overall
% tre
ate
d fo
r re
jectio
n w
ith
in 1
year
No induction (N=3,329) Polyclonal (N=862) IL2R-antagonist (N=1,700)
No induction vs. polyclonal (p < 0.0001); polyclonal vs. IL2R (p = 0.002); no induction vs. IL2R (p = 0.12)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2005)
0
10
20
30
40
50
60
70
18-34(N=866)
35-49(N=1,361)
50-59(N=2,254)
60-64(N=1,200)
65+(N=345)
F(N=2,927)
M(N=3,099)
% tre
ate
d fo
r re
jectio
n w
ith
in 1
year
No induction Polyclonal IL2R-antagonist
For female: no induction vs. polyclonal (p = 0.0017) ; polyclonal vs. IL2R (p = 0.067)For male: no induction vs. polyclonal (p = 0.0006); polyclonal vs. IL2R (p = 0.011)
35-49: no induct vs. poly (p=0.065); poly vs. IL2 (p = 0.046); 50-59: no induct vs. poly (p=0.015); no induct vs. IL2 (p = 0.091)60-64: no induct vs. poly (p = 0.0004); poly vs. IL2R (p=0.018); 65+: no induct vs. poly (p=0.077); poly vs IL2 (p = 0.027)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
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, 2005)
00.20.40.60.8
11.21.41.61.8
2
Overall
Avera
ge n
um
ber
of re
jectio
n e
pis
od
es
No induction Polyclonal IL2R-antagonist
No induction vs. polyclonal (p < 0.0001); no induction vs. IL2R (p = 0.008); polyclonal vs. IL2R (p = 0.034).
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
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, 2005)
0
0.5
1
1.5
2
2.5
18-34 35-49 50-59 60-64 65+ F M
Avera
ge n
um
ber
of re
jectio
n e
pis
od
es
No induction Polyclonal IL2R-antagonist
18-34: no induct vs. poly (p=0.002); poly vs. IL2R (p=0.019); 35-49: no induct vs. IL2R (p=0.055)
50-59: no induct vs. poly (p=0.0007); poly vs. IL2R (p=0.028); 65+: no induct vs. poly (p=0.07); poly vs. IL2R (p=0.062)
Females: no induction vs. polyclonal (p = 0.030); no induction vs. IL2R (p = 0.025);
Males: no induction vs. polyclonal (p = 0.0003); polyclonal vs. IL2R (p = 0.0096)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2005)
0
10
20
30
40
50
60
OverallCyclosporine + MMF (N=956) Cyclosporine + AZA (N=1,392) Tacrolimus + MMF (N=1,491) Tacrolimus + AZA (N=1,249)
% tre
ate
d fo
r re
jectio
n w
ith
in 1
year
CyA + MMF vs. TAC + AZA (p = 0.068); CyA + AZA vs. TAC + MMF (p = 0.0065); CyA + AZA vs. TAC + AZA (p = 0.0004)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2005)
0
10
20
30
40
50
60
70
80
18-34 35-49 50-59 60-64 65+ F M
Cyclosporine + MMF Cyclosporine + AZATacrolimus + MMF Tacrolimus + AZA
% tre
ate
d fo
r re
jectio
n w
ith
in 1
year
35-49: CyA + AZA vs. TAC + AZA (p = 0.0202)
50-59: CyA + MMF vs. TAC + MMF (p = 0.077); CyA + MMF vs. TAC + AZA (p = 0.0043); CyA + AZA vs. TAC + MMF (p = 0.056);
CyA + AZA vs. TAC + AZA (p = 0.0019)
60-64: CyA + MMF vs. CyA + AZA (p = 0.0103)
60+: CyA + AZA vs. TAC + MMF (p = 0.0466)
Females: CyA + AZA vs. TAC + AZA (p = 0.0214)
Males: CyA + MMF vs. TAC + MMF (p = 0.0037); CyA + AZA vs. TAC + AZA (p = 0.0081)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
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, 2005)
0
0.5
1
1.5
2
2.5
Overall
Avera
ge n
um
ber
of re
jectio
n e
pis
od
es
Cyclosporine + MMF Cyclosporine + AZA Tacrolimus + MMF Tacrolimus + AZA
CyA + MMF vs. CyA + AZA (p = 0.002); CyA + AZA vs. TAC + MMF (p < 0.0001); TAC + MMF vs. TAC + AZA (p = 0.026) ; CyA + AZA vs. TAC + AZA (p = 0.0682)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
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, 2005)
0
0.5
1
1.5
2
2.5
3
18-34 35-49 50-59 60-64 65+ F M
Avera
ge n
um
ber
of re
jectio
n e
pis
od
es
Cyclosporine + MMF Cyclosporine + AZATacrolimus + MMF Tacrolimus + AZA
18-34: CyA + AZA vs. TAC + MMF (p = 0.0119); TAC + MMF vs. TAC + AZA (p = 0.099) 50-59: CyA + AZA vs. TAC + MMF (p = 0.0644)60-64: CyA + MMF vs. CyA + AZA (p = 0.0232); CyA + AZA vs. TAC + MMF (p = 0.0103); CyA + TAC + AZA (p = 0.0944)65+: CyA + MMF vs. CyA + AZA (p = 0.0232)Female: CyA + MMF vs. TAC + MMF (p = 0.0633); CyA + AZA vs. TAC + MMF (p = 0.0003); CyA + AZA vs. TAC + AZA (p = 0.085); TAC + MMF vs. TAC + AZA (p = 0.0610)Male: CyA + MMF vs. CyA + AZA (p = 0.0072); CyA + AZA vs. TAC + MMF (p = 0.0391)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994 - June 2006)
Follow-ups: April 1994 –
June 2000 Follow-ups: July 2000-
June 2006
Outcome Within 1
Year
Total number with known response
Within 1 Year
Total number with known response
Hypertension 48.9% (N = 3,805) 54.0% (N = 5,131)
Renal Dysfunction 23.2% (N = 3,722) 27.1% (N = 5,329)
Abnormal Creatinine < 2.5 mg/dl 12.9% 19.8%
Creatinine > 2.5 mg/dl 8.5% 5.5%
Chronic Dialysis 1.7% 1.7%
Renal Transplant 0.0% 0.1%
Hyperlipidemia 13.1% (N = 3,952) 26.0% (N = 5,514)
Diabetes 17.0% (N = 3,764) 29.6% (N = 5,254)
Bronchiolitis Obliterans 10.6% (N = 3,424) 7.3% (N = 4,872)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 and 5 Years
Post-Transplant (Follow-ups: April 1994 - June 2006)
Outcome Within 1
Year
Total number with known response
Within 5 Years
Total number with known response
Hypertension 51.9% (N = 8,936) 85.6% (N = 2,177)
Renal Dysfunction 25.5% (N = 9,051) 37.8% (N = 2,344)
Abnormal Creatinine < 2.5 mg/dl 17.0% 23.0%
Creatinine > 2.5 mg/dl 6.8% 11.0%
Chronic Dialysis 1.7% 3.2%
Renal Transplant 0.0% 0.6%
Hyperlipidemia 20.6% (N = 9,466) 52.2% (N = 2,413)
Diabetes 24.3% (N = 9,018) 33.5% (N = 2,160)
Bronchiolitis Obliterans 8.7% (N = 8,296) 33.3% (N = 1,771)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 10 Years Post-Transplant
(Follow-ups: April 1994 - June 2006)
Outcome Within 10
Years
Total number with known response
Hypertension 98.2% (N = 227)
Renal Dysfunction 40.5% (N = 262)
Abnormal Creatinine < 2.5 mg/dl 21.4% Creatinine > 2.5 mg/dl 9.2% Chronic Dialysis 7.3% Renal Transplant 2.7%
Hyperlipidemia 65.1% (N = 272)
Diabetes 33.2% (N = 229)
Bronchiolitis Obliterans 42.7% (N = 150)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
FREEDOM FROM BRONCHIOLITIS OBLITERANSFor Adult Lung Recipients (Follow-ups: April 1994-June 2006)
Conditional on Survival to 14 days
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10Years
% F
reed
om
fro
m O
B
Freedom from Bronch Oblit (N=10,173)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
FREEDOM FROM BRONCHIOLITIS OBLITERANS STRATIFIED BY INDUCTION USE
For Adult Lung Recipients Follow-ups: April 1994-June 2006)Conditional on Survival to 14 days
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10Years
% F
reed
om
fro
m O
B
No induction (N=5,047)
Induction (N=3,057)
p = 0.9244
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Adult Lung Recipients (Follow-ups: April 1994-June 2006)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
% F
reed
om
fro
m S
ever
e R
enal
D
ysfu
nct
ion
* Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795
MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2006)
Malignancy/Type 1-Year Survivors 5-Year Survivors 10-Year Survivors
No Malignancy 9064 (96.3%) 2108 (87.6%) 204 (75.0%)
Malignancy (all types combined) 346 (3.7%) 299 (12.4%) 68 (25.0%)
Malignancy Type*
Skin 82 160 45
Lymph 161 59 16
Other 83 91 15
Type Not Reported
20 11 1
* 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; 0), 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 2007 J Heart Lung Transplant 2007;26: 782-795
FREEDOM FROM MALIGNANCYFor Adult Lung Recipients (Follow-ups: April 1994-June 2006)
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 2007 J Heart Lung Transplant 2007;26: 782-795
ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January 1992- June 2006)
CAUSE OF DEATH0-30 Days
(N = 1,427)
31 Days –
1 Year
(N = 2,128)
>1 Year –
3 Years
(N = 1,827)
>3 Years –
5 Years
(N = 1063)
>5 Years – 10 Years
(N = 1,097)
>10 Years
(N = 148)
BRONCHIOLITIS 6 (0.4%) 103 (4.8%) 505 (27.6%) 319 (30.0%) 295 (26.9%) 35 (23.6%)
ACUTE REJECTION 67 (4.7%) 43 (2.0%) 34 (1.9%) 9 (0.8%) 8 (0.7%) 0
LYMPHOMA 1 (0.1%) 55 (2.6%) 39 (2.1%) 17 (1.6%) 31 (2.8%) 7 (4.7%)
MALIGNANCY, OTHER 1 (0.1%) 55 (2.6%) 104 (5.7%) 83 (7.8%) 94 (8.6%) 11 (7.4%)
CMV 0 72 (3.4%) 22 (1.2%) 4 (0.4%) 3 (0.3%) 0
INFECTION, NON-CMV 290 (20.3%) 775 (36.4%) 439 (24.0%) 195 (18.3%) 198 (18.0%) 24 (16.2%)
GRAFT FAILURE 404 (28.3%) 409 (19.2%) 335 (18.3%) 200 (18.8%) 197 (18.0%) 34 (23.0%)
CARDIOVASCULAR 154 (10.8%) 89 (4.2%) 57 (3.1%) 51 (4.8%) 57 (5.2%) 9 (6.1%)
TECHNICAL 117 (8.2%) 58 (2.7%) 13 (0.7%) 3 (0.3%) 3 (0.3%) 1 (0.7%)
OTHER 387 (27.1%) 469 (22.0%) 279 (15.3%) 185 (17.1%) 211 (19.2%) 27 (18.2%)
ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795