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2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. LUNG TRANSPLANTATION Overall.

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Presentation on theme: "2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. LUNG TRANSPLANTATION Overall."— Presentation transcript:

1 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. LUNG TRANSPLANTATION Overall

2 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE 13 1547 80 185 408 685 902 1069 1206 1342 1337 1417 1413 1410 1508 1537

3 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND LOCATION

4 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. AVERAGE CENTER VOLUME Lung Transplants: January 1, 1998 - June 30, 2002

5 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. LUNG TRANSPLANTS: Donor Age by Year of Transplant

6 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2002)

7 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA 1985-19961/1997-6/2002

8 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. LUNG TRANSPLANTATION Actuarial Survival (Transplants: January 1990 - June 2001)

9 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. LUNG TRANSPLANTATION Adult Recipients

10 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2002) DIAGNOSISSLT (N = 5,000)BLT (N = 4,488)TOTAL (N = 9,488) COPD/Emphysema2,698 ( 54.0% )1,000 ( 22.0% )3,698 ( 39.0% ) IPF1,186 ( 24.0% )403 ( 9.0% )1,589 ( 17.0% ) CF49 ( 1.0% )1,447 ( 32.0% )1,496 ( 16.0% ) Alpha-1429 ( 8.6% )434 ( 9.7% )863 ( 9.1% ) PPH66 ( 1.3% )361 ( 8.0% )427 ( 4.5% ) Sarcoidosis127 ( 2.5% )113 ( 2.5% )240 ( 2.5% ) Bronchiectasis11 ( 0.2% )192 ( 4.3% )203 ( 2.1% ) Congenital Heart Disease10 ( 0.2% )99 ( 2.2% )109 ( 1.1% ) LAM45 ( 0.9% )58 ( 1.3% )103 ( 1.1% ) Re-TX: OB47 ( 0.9% )47 ( 1.0% )94 ( 1.0% ) OB (Non-ReTX)30 ( 0.6% )52 ( 1.2% )82 ( 0.9% ) Re-TX: Non-OB35 ( 0.7% )37 ( 0.8% )72 ( 0.8% ) Connective Tissue Disorder21 ( 0.4% )22 ( 0.5% )43 ( 0.5% ) Cancer3 ( 0.1% )25 ( 0.6% )28 ( 0.3% ) Histiocytosis X11 ( 0.2% )8 ( 0.2% )19 ( 0.2% ) Other232 ( 4.6% )190 ( 4.2% )422 ( 4.4% )

11 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTATION: Indications (Transplants: January 1995 - June 2002) Single Lung Transplants Bilateral/Double Lung Transplants

12 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTATION Indications By Year

13 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTATION Actuarial Survival by Era (Transplants: January 1988 – June 2001) Survival comparisons by era 1988-1992 vs. 1993-1997: p = 0.008 1988-1992 vs. 1998-2001: p < 0.0001 1993-1997 vs. 1998-2001: p = 0.3

14 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTATION Actuarial Survival by Age Group (Transplants: January 1990 – June 2001)

15 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTATION Actuarial Survival By Diagnosis (Transplants: January 1990 – June 2001)

16 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTATION Actuarial Survival By Diagnosis Conditional on Survival to 3 Months (Transplants: January 1990 – June 2001)

17 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTATION Actuarial Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2001)

18 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTATION Actuarial Survival for Congenital Diagnosis (Transplants: January 1990 – June 2001)

19 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTATION Actuarial Survival By Procedure Type (Transplants: January 1990 – June 2001) Diagnosis: Alpha-1 Antitrypsin Deficiency P = 0.008

20 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTATION Actuarial Survival by Procedure Type (Transplants: January 1990 – June 2001) Diagnosis: Emphysema/COPD P < 0.0001

21 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTATION Actuarial Survival by Procedure Type (Transplants: January 1990 – June 2001) Diagnosis: IPF P = 0.2

22 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTATION Actuarial Survival by Procedure Type (Transplants: January 1990 – June 2001) Diagnosis: PPH P = 0.3

23 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1995-6/2001) Risk Factors for 1 Year Mortality (N=7,262)

24 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1995-6/2001) Risk Factors for 1 Year Mortality (N=7,262)

25 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality

26 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Recipient Age

27 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Donor Age

28 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality BMI Ratio = Donor BMI/Recipient BMI

29 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Center volume

30 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Ischemia time

31 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Creatinine

32 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Oxygen required at rest

33 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Predicted FeV1% for IPF patients

34 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality Bilirubin

35 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1995-6/2001) Factors Not Significant for 1 Year Mortality Recipient factors: Hospitalized, pCO 2, gender, chronic steroid use, transfusions, history of malignancy, recent infection requiring IV drug therapy Donor factors: Gender, clinical infection, history of hypertension, history of cancer, COD Transplant factors: Procedure type, ABO compatibility, HLA mismatch, year of transplant

36 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1995-6/1997) Risk Factors for 5 Year Mortality (N=2,771)

37 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality

38 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Recipient Age

39 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Donor Age

40 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Bilirubin

41 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality PA Systolic

42 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality pCO 2

43 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1995-6/1997) Factors Not Significant for 5 Year Mortality Recipient factors: Ventilator, inotropes, hospitalized, chronic steroid use, transfusions, history of malignancy, PRA, gender, FeV1, FVC, repeat transplant Donor factors: Gender, clinical infection, history of hypertension, history of cancer, history of diabetes, COD Transplant factors: Procedure type, ABO compatibility, HLA mismatch

44 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=1,899)

45 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

46 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Condtional on Survival to 1 Year Recipient Age

47 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year Donor Age

48 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year Recipient Height

49 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1995-6/1997) Factors Not Significant for Conditional 5 Year Mortality Recipient factors: Diagnosis, ventilator, inotropes, hospitalized, pCO 2, gender, chronic steroid use, transfusions, history of malignancy, PRA, repeat transplant, FeV1, FVC Donor factors: Gender, clinical infection, history of hypertension, history of cancer, history of diabetes, COD Transplant factors: ABO compatibility, HLA mismatch, CMV mismatch

50 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1995-6/1997) Factors Not Significant for Conditional 5 Year Mortality Post-transplant factors: Treated for rejection, stroke, dialysis, prolonged graft dysfunction, bronchopleural fistula, airway dehiscence

51 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG RECIPIENTS Functional Status (Follow-ups: April 1994 – June 2002)

52 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG RECIPIENTS Employment Status (Follow-ups: April 1994 – June 2002)

53 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant (Follow-ups: April 1994 - June 2002)

54 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG RECIPIENTS Induction Immunosuppression (Follow-ups: January 2000 - June 2002)

55 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG RECIPIENTS Induction Immunosuppression (Follow-ups: January 2000 - June 2002)

56 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG RECIPIENTS Maintenance Immunosuppression At Any Time During Follow-up Period For follow-ups between January 2000 through June 2002 NOTE: Different patients are analyzed in Year 1 and Year 5

57 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG RECIPIENTS Maintenance Immunosuppression At Time of Follow-up For follow-ups between January 2000 through June 2002 NOTE: Different patients are analyzed in Year 1 and Year 5

58 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2000 through June 2002 1 Year Follow-up (N = 1,501)5 Year Follow-up (N = 721) NOTE: Different patients are analyzed in Year 1 and Year 5

59 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2000 through June 2002 NOTE: Different patients are analyzed in Year 1 and Year 5

60 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April 1994-June 2002)

61 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant (Follow-ups: April 1994-June 2002)

62 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. Freedom from Bronchiolitis Obliterans For Adult Lung Recipients (Follow-ups: April 1994-June 2002)

63 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. Freedom from Severe Renal Dysfunction* For Adult Lung Recipients (Follow-ups: April 1994-June 2002) * Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant

64 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTS Cumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2002) Malignancy/Type1-Year Survivors5-Year Survivors No Malignancy 5104 (96.1%) 886 (86.9%) Malignancy (all types combined) 209 (3.9%) 134 (13.1%) Malignancy Type Skin4461 Lymph10921 Other3532 Lymph + Skin3 Lymph + Other5 Skin + Other2 Type Not Reported2110

65 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. Freedom from Malignancy For Adult Lung Recipients (Follow-ups: April 1994-June 2002)

66 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1995-6/1997) Risk Factors for Developing Malignancy within 5 Years (N=1,514)

67 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for Developing Malignancy within 5 Years

68 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for Developing Malignancy within 5 Years Recipient Age

69 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for Developing Malignancy within 5 Years Donor Age

70 2003 ISHLT J Heart Lung Transplant 2003; 22: 610-72. ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January 1992- June 2002) CAUSE OF DEATH 0-30 Days (N = 937) 31 Days - 1 Year (N = 1,345) >1 Year - 3 Years (N = 1,096) >3 Years - 5 Years (N = 572) >5 Years (N = 456) BRONCHIOLITIS5 (0.5%)74 (5.5%)313 (28.6%)185 (32.3%)142 (31.1%) ACUTE REJECTION46 (4.9%)27 (2.0%)21 (1.9%)4 (0.7%)2 (0.4%) LYMPHOMA1 (0.1%)44 (3.3%)23 (2.1%)9 (1.6%)18 (3.9%) MALIGNANCY, OTHER27 (2.0%)52 (4.7%)43 (7.5%)40 (8.8%) CMV1 (0.1%)56 (4.2%)17 (1.6%)4 (0.7%)2 (0.4%) INFECTION, NON-CMV220 (23.5%)521 (38.7%)284 (25.9%)113 (19.8%)79 (17.3%) GRAFT FAILURE286 (30.5%)236 (17.5%)175 (16.0%)99 (17.3%)58 (12.7%) CARDIOVASCULAR108 (11.5%)58 (4.3%)36 (3.3%)24 (4.2%)21 (4.6%) TECHNICAL78 (8.3%)37 (2.8%)12 (1.1%)1 (0.2%)2 (0.4%) OTHER192 (20.5%)265 (19.7%)163 (14.9%)90 (15.7%)92 (20.2%)


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