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J Heart Lung Transplant 2009;28: 989-1049 LUNG TRANSPLANTATION Overall ISHLT 2009.

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Presentation on theme: "J Heart Lung Transplant 2009;28: 989-1049 LUNG TRANSPLANTATION Overall ISHLT 2009."— Presentation transcript:

1 J Heart Lung Transplant 2009;28: LUNG TRANSPLANTATION Overall ISHLT 2009

2 J Heart Lung Transplant 2009;28: NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE ISHLT 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. 2009

3 J Heart Lung Transplant 2009;28: AVERAGE CENTER VOLUME Lung Transplants: January 1, June 30, 2008 ISHLT 2009

4 J Heart Lung Transplant 2009;28: DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Lung Transplants: January 1, June 30, 2008 ISHLT 2009

5 J Heart Lung Transplant 2009;28: LUNG TRANSPLANTS: Transplant Recipient Age by Year of Transplant Transplants: January 1, 1987 – June 30, 2008 ISHLT 2009

6 J Heart Lung Transplant 2009;28: AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2008) ISHLT 2009

7 J Heart Lung Transplant 2009;28: AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA ISHLT Transplants with unknown recipient age were excluded from this tabulation. 2009

8 J Heart Lung Transplant 2009;28: LUNG TRANSPLANTS: Donor Age by Year of Transplant Transplants: January 1, 1987 – June 30, 2008 ISHLT 2009

9 J Heart Lung Transplant 2009;28: DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS (1/1985-6/2008) ISHLT 2009

10 J Heart Lung Transplant 2009;28: DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS BY ERA ISHLT Transplants with unknown donor age were excluded from this tabulation. 2009

11 J Heart Lung Transplant 2009;28: LUNG TRANSPLANTATION Adult Recipients ISHLT 2009

12 J Heart Lung Transplant 2009;28: AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS (1/1985-6/2008) ISHLT 2009

13 J Heart Lung Transplant 2009;28: AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA ISHLT 2009

14 J Heart Lung Transplant 2009;28: AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA ISHLT 2009

15 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January June 2007) ISHLT 2009

16 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2008) DIAGNOSISSLT (N = 10,190)BLT (N = 13,338)TOTAL (N = 23,528) COPD/Emphysema4,994 ( 49.0% )3,423 ( 25.7% )8,417 ( 35.8% ) Idiopathic Pulmonary Fibrosis2,967 ( 29.1% )1,930 ( 14.5% )4,897 ( 20.8% ) Cystic Fibrosis191 ( 1.9% )3,552 ( 26.6% )3,743 ( 15.9% ) Alpha-1662 ( 6.5% )1,017 ( 7.6% )1,679 ( 7.1% ) Idiopathic Pulmonary Arterial Hypertension74 ( 0.7% )714 ( 5.4% )788 ( 3.3% ) Sarcoidosis212 ( 2.1% )391 ( 2.9% )603 ( 2.6% ) Bronchiectasis40 ( 0.4% )596 ( 4.5% )636 ( 2.7% ) LAM80 ( 0.8% )157 ( 1.2% )237 ( 1.0% ) Congenital Heart Disease19 ( 0.2% )144 ( 1.1% )163 ( 0.7% ) Re-Transplant: Obliterative Bronchiolitis160 ( 1.6% )134 ( 1.0% )294 ( 1.2% ) Obliterative Bronchiolitis (Not Re-Transplant) 53 ( 0.5% )150 ( 1.1% )203 ( 0.9% ) Re-Transplant: Not Obliterative Bronchiolitis105 ( 1.0% )97 ( 0.7% )202 ( 0.9% ) Connective Tissue Disease68 ( 0.7% )113 ( 0.8% )181 ( 0.8% ) Interstitial Pneumonitis32 ( 0.3% )29 ( 0.2% )61 ( 0.3% ) Cancer6 ( 0.1% )17 ( 0.1% )23 ( 0.1% ) Other527 ( 5.2% )874 ( 6.6% )1,401 ( 6.0% ) ISHLT 2009

17 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION: Distribution of Procedure Type for Major Indications ( ) ISHLT Year of TX Alpha-1COPDCystic FibrosisIPFIPAH DoubleSingleDoubleSingleDoubleSingleDoubleSingleDoubleSingle

18 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Procedure Type within Indication, by Year ISHLT 2009

19 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION: Indications for Single Lung Transplants (Transplants: January June 2008) ISHLT *Other includes: Sarcoidosis: 2.1% Bronchiectasis: 0.4% Congenital Heart Disease: 0.2% LAM: 0.8% OB (non-ReTx): 0.5% Miscellaneous:6.3% 2009

20 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION: Indications for Bilateral/Double Lung Transplants (Transplants: January June 2008) ISHLT *Other includes: Sarcoidosis: 2.9% Bronchiectasis: 4.5% Congenital Heart Disease: 1.1% LAM: 1.2% OB (non-ReTx): 1.1% Miscellaneous:7.7% 2009

21 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Indications By Year (%) ISHLT 2009

22 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Indications By Year (Number) ISHLT 2009

23 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2008 ISHLT 2009

24 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2008 ISHLT 2009

25 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2008 ISHLT 2009

26 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1988 – June 2007) ISHLT 2009

27 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: January 1990 – June 2007) ISHLT 2009

28 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: January 1990 – June 2007) ISHLT 2009

29 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2007) Year ALPHA-1 (N=2,085) CF (N=3,746) COPD (N=8,812) IPF (N=4,695) IPAH (N=1,065) SARCOIDOSIS (N=597) Survival comparisons Alpha-1 vs. CF: p < Alpha-1 vs. COPD: p < Alpha-1 vs. IPF: p < Alpha-1 vs. Sarcoidosis: p = CF vs. COPD: p < CF vs. IPF: p < CF vs. IPAH: p < CF vs. Sarcoidosis: p < IPAH vs. IPF: p = COPD vs. IPF: p < Note: Other comparisons are not statistically different. ISHLT 2009

30 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 3 Months (Transplants: January 1990 – June 2007) Year ALPHA-1 (N=1,775) CF (N=3,215) COPD (N=7,680) IPF (N=3,822) IPAH (N=770) SARCOIDOSIS (N=479) Survival comparisons Alpha-1 vs. CF: p = Alpha-1 vs. COPD: p < Alpha-1 vs. IPF: p < Alpha-1 vs. IPAH: p = CF vs. COPD: p < CF vs. IPF: p < CF vs. Sarcoidosis : p = IPAH vs. COPD: p < IPAH vs. IPF: p < IPAH vs. Sarcoidosis: p = COPD vs. IPF: p = COPD vs. Sarcoidosis: p = IPF vs. Sarcoidosis: p = Note: Other comparisons are not statistically different. ISHLT 2009

31 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2007) Year ALPHA-1 (N=1,558) CF (N=2,779) COPD (N=6,649) IPF (N=3,108) IPAH (N=674) SARCOIDOSIS (N=396) Survival comparisons Alpha-1 vs. CF: p = Alpha-1 vs. COPD: p < Alpha-1 vs. IPF: p < Alpha-1 vs. IPAH: p = CF vs. COPD: p < CF vs. IPF: p < IPAH vs. COPD: p < IPAH vs. IPF: p < COPD vs. Sarcoidosis: p < IPF vs. Sarcoidosis: p = Note: Other comparisons are not statistically different. ISHLT 2009

32 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2007) ISHLT Survival comparisons Alpha-1 vs. CF: p < Alpha-1 vs. COPD: p < Alpha-1 vs. IPF: p < Alpha-1 vs. Sarcoidosis: p = CF vs. COPD: p < CF vs. IPF: p < CF vs. IPAH: p < CF vs. Sarcoidosis: p < IPAH vs. IPF: p = COPD vs. IPF: p <

33 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 3 Months (Transplants: January 1990 – June 2007) ISHLT Survival comparisons Alpha-1 vs. CF: p = Alpha-1 vs. COPD: p < Alpha-1 vs. IPF: p < Alpha-1 vs. IPAH: p = CF vs. COPD: p < CF vs. IPF: p < CF vs. Sarcoidosis : p = IPAH vs. COPD: p < IPAH vs. IPF: p < IPAH vs. Sarcoidosis: p = COPD vs. IPF: p = COPD vs. Sarcoidosis: p = IPF vs. Sarcoidosis: p =

34 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2007) ISHLT Survival comparisons Alpha-1 vs. CF: p = Alpha-1 vs. COPD: p < Alpha-1 vs. IPF: p < Alpha-1 vs. IPAH: p = CF vs. COPD: p < CF vs. IPF: p < IPAH vs. COPD: p < IPAH vs. IPF: p < COPD vs. Sarcoidosis: p < IPF vs. Sarcoidosis: p =

35 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival for Eisenmengers Syndrome (Transplants: January 1990 – June 2007) ISHLT 2009

36 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Procedure Type (Transplants: January 1990 – June 2007) Diagnosis: Alpha-1 Antitrypsin Deficiency ISHLT 2009

37 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Procedure Type and Age (Transplants: January 1990 – June 2007) Diagnosis: Alpha-1 Antitrypsin Deficiency ISHLT 2009

38 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2007) Diagnosis: Emphysema/COPD ISHLT 2009

39 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Age (Transplants: January 1990 – June 2007) Diagnosis: Emphysema/COPD ISHLT 2009

40 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2007) Diagnosis: Idiopathic Pulmonary Fibrosis ISHLT 2009

41 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2007) Diagnosis: Idiopathic Arterial Pulmonary Hypertension ISHLT 2009

42 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2007) Diagnosis: Emphysema/COPD, Single Lung ISHLT 2009

43 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2007) Diagnosis: Emphysema/COPD, Double Lung ISHLT 2009

44 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2007) Diagnosis: Idiopathic Pulmonary Fibrosis, Single Lung ISHLT 2009

45 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2007) Diagnosis: Idiopathic Pulmonary Fibrosis, Double Lung ISHLT 2009

46 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Donor CMV status/Recipient CMV status (Transplants: October 1999 – June 2007) ISHLT 2009

47 J Heart Lung Transplant 2009;28: 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 June 2008) ISHLT D(-)/R(-): N = 683 D(-)/R(+): N = 848 D(+)/R(-): N = 901 D(+)/R(+): N = 1,532 No comparisons were statistically significant at 0.05 Analysis is limited to patients who were alive at the time of the follow-up 2009 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.

48 J Heart Lung Transplant 2009;28: 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 June 2008) ISHLT FemaleMale 50-59: D(+)/R(-) vs. D(+)/R(+) (p=0.009) 60-65: D(-)/R(+) vs. D(+)/R(+) (p=0.034) Analysis is limited to patients who were alive at the time of the follow-up 2009 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.

49 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1995-6/2007) Risk Factors for 1 Year Mortality (N=12,415) ISHLT *Other = All diagnoses other than COPD, IPAH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, retransplant and LAM. Reference group = COPD/Emphysema, Single lung 2009

50 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1995-6/2007) Risk Factors for 1 Year Mortality ISHLT (N=12,415) 2009

51 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1995-6/2007) Risk Factors for 1 Year Mortality ISHLT (N=12,415) 2009

52 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1995-6/2007) Borderline Significant Risk Factors for 1 Year Mortality ISHLT (N=12,415) 2009

53 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality ISHLT 2009

54 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality Recipient Age ISHLT 2009

55 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality Center Volume ISHLT 2009

56 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality Recipient Pre-Transplant Bilirubin ISHLT 2009

57 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality Recipient Oxygen Required at Rest ISHLT 2009

58 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality Recipient Pre-Transplant Cardiac Output ISHLT 2009

59 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality Recipient FEV1 (% predicted) ISHLT 2009

60 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality Height Difference ISHLT 2009

61 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Risk Factors for 1 Year Mortality Recipient PCW ISHLT 2009

62 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality (N=4,803) ISHLT 2009

63 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = COPD/Emphysema Borderline Significant Risk Factors for 1 Year Mortality (N=4,803) ISHLT 2009

64 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality ISHLT 2009

65 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Recipient Age ISHLT 2009

66 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Center volume ISHLT 2009

67 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Recipient Oxygen Required at Rest ISHLT 2009

68 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Recipient Pre-Transplant Bilirubin ISHLT 2009

69 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Recipient PCO 2 at Transplant ISHLT 2009

70 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Recipient Weight at Transplant ISHLT 2009

71 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = IPF Risk Factors for 1 Year Mortality (N=2,698) ISHLT 2009

72 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = IPF Risk Factors for 1 Year Mortality ISHLT 2009

73 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient Age ISHLT 2009

74 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient Weight ISHLT 2009

75 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = IPF Risk Factors for 1 Year Mortality Donor Weight ISHLT 2009

76 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient O 2 Required at Rest ISHLT 2009

77 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = IPF Risk Factors for 1 Year Mortality Center volume ISHLT 2009

78 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = IPF Risk Factors for 1 Year Mortality Ischemia Time ISHLT 2009

79 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient Bilirubin ISHLT 2009

80 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient FVC (% predicted) ISHLT 2009

81 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient PCO 2 at Transplant ISHLT 2009

82 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2007) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient Pre-Transplant Cardiac Output ISHLT 2009

83 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1995-6/2003) Risk Factors for 5 Year Mortality (N=7,296) ISHLT *Other = All diagnoses other than COPD, IPAH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, retransplant and LAM. Reference group = COPD/Emphysema, Single lung 2009

84 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1995-6/2003) Risk Factors for 5 Year Mortality ISHLT (N=7,296) 2009

85 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1995-6/2003) Risk Factors for 5 Year Mortality ISHLT (N=7,296) 2009

86 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1995-6/2003) Borderline Significant Risk Factors for 5 Year Mortality ISHLT (N=7,296) 2009

87 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality ISHLT 2009

88 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Recipient Age ISHLT 2009

89 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Donor Age ISHLT 2009

90 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Center Volume ISHLT 2009

91 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Recipient Pre-Transplant Bilirubin ISHLT 2009

92 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Recipient Oxygen Required at Rest ISHLT 2009

93 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Recipient Pre-Transplant Cardiac Output ISHLT 2009

94 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Height Difference ISHLT 2009

95 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Recipient Height ISHLT 2009

96 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1995-6/2003) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=5,251) ISHLT Reference group = COPD/Emphysema, Single lung 2009

97 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1995-6/2003) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year ISHLT (N=5,251) 2009

98 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1995-6/2003) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year ISHLT (N=5,251) 2009

99 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1995-6/2003) Borderline Significant Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year ISHLT (N=5,251) 2009 *Other = All diagnoses other than COPD, IPAH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, retransplant and LAM.

100 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year ISHLT 2009

101 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Recipient Age ISHLT 2009

102 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Center Volume ISHLT 2009

103 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Height Difference ISHLT 2009

104 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Ischemia Time ISHLT 2009

105 J Heart Lung Transplant 2009;28: ADULT LUNG RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2008) ISHLT 2009

106 J Heart Lung Transplant 2009;28: ADULT LUNG RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2008) For the Same Patients ISHLT 2009

107 J Heart Lung Transplant 2009;28: ADULT LUNG RECIPIENTS Employment Status of Surviving Recipients (Follow-ups: April 1994 – June 2008) ISHLT 2009

108 J Heart Lung Transplant 2009;28: ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April June 2008) ISHLT 2009

109 J Heart Lung Transplant 2009;28: ADULT LUNG RECIPIENTS Induction Immunosuppression (Transplants: January June 2008) Analysis limited to patients receiving prednisone ISHLT Analysis is limited to patients who were alive at the time of the follow-up 2009

110 J Heart Lung Transplant 2009;28: ADULT LUNG RECIPIENTS Induction Immunosuppression (Transplants: 1997, 2002 and 1/2008-6/2008) Analysis limited to patients receiving prednisone ISHLT Analysis is limited to patients who were alive at the time of the follow-up 2009

111 J Heart Lung Transplant 2009;28: ADULT LUNG RECIPIENTS Induction Immunosuppression (Transplants: January December 2007) Analysis limited to patients receiving prednisone ISHLT Any Induction Polyclonal ALG/ATG IL2R-antagonist Campath Analysis is limited to patients who were alive at the time of the follow-up 2009

112 J Heart Lung Transplant 2009;28: SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: April 1994-June 2007) Conditional on survival to 14 days ISHLT 2009

113 J Heart Lung Transplant 2009;28: SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: January 2000-June 2007) Conditional on survival to 14 days ISHLT 2009

114 J Heart Lung Transplant 2009;28: ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2002 through June 2007 Analysis limited to patients receiving prednisone NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT Analysis is limited to patients who were alive at the time of the follow-up 2009

115 J Heart Lung Transplant 2009;28: ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2002 through June 2008 Analysis limited to patients receiving prednisone NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT Analysis is limited to patients who were alive at the time of the follow-up 2009

116 J Heart Lung Transplant 2009;28: ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of 1 Year Follow-up (Follow-ups: 2000, 2003, 7/2007 – 6/2008) Analysis limited to patients receiving prednisone NOTE: Different patients are analyzed in each time frame. ISHLT Analysis is limited to patients who were alive at the time of the follow-up 2009

117 J Heart Lung Transplant 2009;28: ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2002 through June 2008 Analysis limited to patients receiving prednisone 1 Year Follow-up (N =6,105)5 Year Follow-up (N = 2,573) NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT Analysis is limited to patients who were alive at the time of the follow-up 2009

118 J Heart Lung Transplant 2009;28: ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2002 through June 2008 Analysis limited to patients receiving prednisone ISHLT Analysis is limited to patients who were alive at the time of the follow-up 2009

119 J Heart Lung Transplant 2009;28: PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION BETWEEN TRANSPLANT DISCHARGE AND 1-YEAR FOLLOW-UP (Follow-ups: July 1, June 30, 2008) ISHLT Analysis is limited to patients who were alive at the time of the follow-up No comparisons were statistically significant at 0.05 Overall: N = 4, : N = : N = : N = 1, : N = 1, : N = 274 Female: N = 2,015 Male: N = 2,396 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. 2009

120 J Heart Lung Transplant 2009;28: PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION BETWEEN TRANSPLANT DISCHARGE AND 1- YEAR FOLLOW-UP Stratified by Type of Induction (Follow-ups: July 1, June 30, 2008) ISHLT No induction: N = 2,151 Polyclonal: N = 361 IL2R- antagonist: N = 1,612 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. 2009

121 J Heart Lung Transplant 2009;28: PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION BETWEEN TRANSPLANT DISCHARGE AND 1-YEAR FOLLOW-UP Stratified by Type of Induction (Follow-ups: July 1, June 30, 2008) ISHLT 18-34: N = : N = : N = 1, : N = 1, : N = 226 Female: N = 1,881 Male: N = 2, : no induct vs. IL2 (p=0.012); poly vs. IL2R (p=0.002); 35-49: no induct vs. IL2 (p=0.041); poly vs. IL2R (p =0.041); 50-59: no induct vs. IL2R (p<0.0001); 60-65: no induct vs. IL2R (p=0.007); 66+: poly vs. IL2 (p=0.019). For female: no induct vs. IL2R (p<0.0001) For male: no induct vs.IL2R (p<0.0001); poly vs. IL2R (p = ) 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. 2009

122 J Heart Lung Transplant 2009;28: PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION BETWEEN TRANSPLANT DISCHARGE AND 1- YEAR FOLLOW-UP Stratified by Maintenance Immunosuppression (Follow-ups: July 1, June 30, 2008) All comparisons were statistically significant at 0.01 ISHLT Cyclosporine + MMF: N = 339 Cyclosporine + AZA: N = 495 Tacrolimus + MMF: N = 1,829 Tacrolimus + AZA: N = 1,153 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. 2009

123 J Heart Lung Transplant 2009;28: PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION BETWEEN TRANSPLANT DISCHARGE AND 1-YEAR FOLLOW-UP Stratified by Maintenance Immunosuppression (Follow-ups: July 1, June 30, 2008) 18-34: CyA + AZA vs. TAC + MMF (p<0.0001); CyA + AZA vs. TAC + AZA (p=0.005) 35-49: all comparisons are statistically significant at 0.05 except CyA + MMF vs. CyA + AZA and TAC + MMF vs. TAC + AZA 50-59: all comparisons were statistically significant at 0.05 except TAC + MMF vs. TAC + AZA 60-65: all comparisons are statistically significant at 0.05 except CyA + MMF vs. TAC + AZA 66+: CyA + AZA vs. TAC + MMF (p <0.0001); CyA + AZA vs. TAC + AZA (p=0.041) ; TAC + MMF vs. TAC + AZA (p=0.012) Females: all comparisons were statistically significant at 0,05 except CyA + MMF vs. TAC + AZA Males: all comparisons were statistically significant at 0.01 except TAC + MMF vs. TAC + AZA ISHLT 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. 2009

124 J Heart Lung Transplant 2009;28: PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION BETWEEN TRANSPLANT DISCHARGE AND 3-YEAR FOLLOW-UP Stratified by Maintenance Immunosuppression (Follow-ups: July 1, June 30, 2008) CyA + MMF vs. CyA + AZA (p < ); CyA + AZA vs. TAC + MMF (p<0.0001); TAC + MMF vs. TAC + AZA (P<0.0001) ISHLT Cyclosporine + MMF: N = 136 Cyclosporine + AZA: N = 212 Tacrolimus + MMF: N = 491 Tacrolimus + AZA: N = 406 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. 2009

125 J Heart Lung Transplant 2009;28: PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION BETWEEN TRANSPLANT DISCHARGE AND 3-YEAR FOLLOW-UP Stratified by Maintenance Immunosuppression (Follow-ups: July 1, June 30, 2008) 18-34: CyA + AZA vs. TAC + MMF (p=0.037); CyA + AZA vs. TAC + AZA (p=0.021) 35-49: CyA + MMF vs. TAC + AZA (p=0.027); CaA + AZA vs. TAC + MMF (p=0.023); CyA + AZA vs. TAC + AZA (p=0.002) 50-59: all comparisons were statistically significant at 0.05 except CyA + MMF vs. TAC + MMF, TAC + MMF vs. TAC + AZA 60-65: CyA + MMF vs. CyA + AZA (p=0.009); CaA + AZA vs. TAC + MMF (p=0.010); CyA + AZA vs. TAC + AZA (p=0.024) 66+: CyA + MMF vs. CyA + AZA (p=0.013); CyA + AZA vs. TAC + MMF (p=0.040) ; Females: CyA + MMF vs. CyA + AZA (p=0.002); CyA + AZA vs. TAC + MMF (p<0.001) ; CyA + AZA vs. TAC + AZA (p<0.0001) Males: CyA + MMF vs. CyA + AZA (p=0.003); CyA + AZA vs. TAC + MMF (p<0.001) ; CyA + AZA vs. TAC + AZA (p<0.0001) ISHLT 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. 2009

126 J Heart Lung Transplant 2009;28: POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April June 2008) ISHLT 2009

127 J Heart Lung Transplant 2009;28: POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 and 5 Years Post-Transplant (Follow-ups: April June 2008) ISHLT 2009

128 J Heart Lung Transplant 2009;28: POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 10 Years Post-Transplant (Follow-ups: April June 2008) ISHLT 2009

129 J Heart Lung Transplant 2009;28: FREEDOM FROM BRONCHIOLITIS OBLITERANS SYNDROME For Adult Lung Recipients (Follow-ups: April 1994-June 2008) Conditional on Survival to 14 days ISHLT 2009

130 J Heart Lung Transplant 2009;28: FREEDOM FROM BRONCHIOLITIS OBLITERANS SYNDROME STRATIFIED BY INDUCTION USE For Adult Lung Recipients (Follow-ups: April 1994-June 2008) Conditional on Survival to 14 days ISHLT 2009

131 J Heart Lung Transplant 2009;28: FREEDOM FROM BRONCHIOLITIS OBLITERANS SYNDROME Stratified by Donor CMV Status/Recipient CMV Status For Adult Lung Recipients ( Follow-ups: April 1994-June 2008) Conditional on Survival to 14 days ISHLT 2009

132 J Heart Lung Transplant 2009;28: FREEDOM FROM SEVERE RENAL DYSFUNCTION* For Adult Lung Recipients (Follow-ups: April 1994-June 2008) ISHLT 2009

133 J Heart Lung Transplant 2009;28: MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTS Cumulative Prevalence in Survivors (Follow-ups: April June 2008) Malignancy/Type1-Year Survivors5-Year Survivors10-Year Survivors No Malignancy 11,400 (96.5%)2,930 (87.4%)359 (71.9%) Malignancy (all types combined) 419 (3.5%)423 (12.6%)140 (28.1%) Malignancy Type* Skin Lymph Other Type Not Reported 1880 * 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; 1), 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 2009

134 J Heart Lung Transplant 2009;28: FREEDOM FROM MALIGNANCY For Adult Lung Recipients (Follow-ups: April 1994-June 2008) ISHLT 2009

135 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January June 2008) CAUSE OF DEATH 0-30 Days (N = 1,621) 31 Days – 1 Year (N = 3,110) >1 Year – 3 Years (N = 2,776) >3 Years – 5 Years (N = 1,593) >5 Years – 10 Years (N = 1,797) >10 Years (N = 392) BRONCHIOLITIS6 (0.4%)143 (4.6%)702 (25.3%)460 (28.9%)444 (24.7%)75 (19.1%) ACUTE REJECTION70 (4.3%)56 (1.8%)45 (1.6%)11 (0.7%)14 (0.8%)0 LYMPHOMA1 (0.1%)82 (2.6%)59 (2.1%)27 (1.7%)40 (2.2%)20 (5.1%) MALIGNANCY, OTHER3 (0.2%)85 (2.7%)175 (6.3%)134 (8.4%)180 (10.0%)33 (8.4%) CMV092 (3.0%)27 (1.0%)5 (0.3%)3 (0.2%)0 INFECTION, NON-CMV324 (20.0%)1,100 (35.4%)640 (23.1%)303 (19.0%)322 (17.9%)68 (17.3%) GRAFT FAILURE467 (28.8%)547 (17.6%)524 (18.9%)301 (18.9%)340 (18.9%)72 (18.4%) CARDIOVASCULAR179 (11.0%)134 (4.3%)102 (3.7%)74 (4.6%)89 (5.0%)24 (6.1%) TECHNICAL129 (8.0%)67 (2.2%)18 (0.6%)6 (0.4%)12 (0.7%)7 (1.8%) OTHER442 (27.3%)804 (25.9%)484 (17.4%)272 (17.1%)353 (19.6%)93 (23.7%) ISHLT 2009

136 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death (Deaths: January June 2008) ISHLT 2009

137 J Heart Lung Transplant 2009;28: ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death Stratified by Donor CMV Status/Recipient CMV Status (Deaths: January June 2008) Donor CMV Status/ Recipient CMV Status Cause of Death0-30 Days 31 Days – 1 Year >1 Year – 3 Years >3 Years – 5 Years >5 Years – 10 Years >10 Years D(-)/R(-) (N=1,272) BRONCHIOLITIS1 (0.6%)21 (6.6%)78 (24.5%)61 (32.6%)53 (23.3%)7 (14.6%) INFECTION, NON-CMV30 (17.0%)111 (35.1%)77 (24.2%)31 (16.6%)29 (12.8%)12 (25.0%) GRAFT FAILURE53 (30.1%)64 (20.3%)67 (21.1%)43 (23.0%)46 (20.3%)9 (18.8%) D(-)/R(+) (N=1,927) BRONCHIOLITIS3 (1.2%)24 (5.5%)115 (25.3%)80 (25.1%)103 (27.2%)15 (17.0%) INFECTION, NON-CMV53 (21.4%)170 (38.6%)110 (24.2%)78 (24.5%)63 (16.7%)17 (19.3%) GRAFT FAILURE75 (30.2%)76 (17.3%)88 (19.4%)54 (16.9%)81 (21.4%)18 (20.5%) D(+)/R(-) (N=1,516) BRONCHIOLITIS011 (2.3%)94 (24.3%)53 (25.1%)50 (25.8%)2 (5.4%) INFECTION, NON-CMV39 (18.9%)187 (38.9%)89 (23.0%)37 (17.5%)38 (19.6%)13 (35.1%) GRAFT FAILURE60 (29.1%)94 (19.5%)81 (20.9%)49 (23.2%)46 (23.7%)6 (16.2%) D(+)/R(+) (N=2,833) BRONCHIOLITIS1 (0.3%)38 (5.3%)179 (24.5%)117 (26.5%)101 (21.4%)17 (19.1%) INFECTION, NON-CMV76 (19.8%)262 (36.6%)172 (23.5%)85 (19.2%)83 (17.6%)9 (10.1%) GRAFT FAILURE122 (31.8%)154 (21.5%)134 (18.3%)88 (19.9%)99 (21.0%)24 (27.0%) ISHLT 2009


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