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2002 ISHLT J Heart Lung Transplant 2002; 21: 950-970. LUNG TRANSPLANTATION Overall.

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Presentation on theme: "2002 ISHLT J Heart Lung Transplant 2002; 21: 950-970. LUNG TRANSPLANTATION Overall."— Presentation transcript:

1 2002 ISHLT J Heart Lung Transplant 2002; 21: LUNG TRANSPLANTATION Overall

2 2002 ISHLT J Heart Lung Transplant 2002; 21: NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE * Numbers may be low due to delayed reporting.

3 2002 ISHLT J Heart Lung Transplant 2002; 21: NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND LOCATION * Numbers may be low due to delayed reporting.

4 2002 ISHLT J Heart Lung Transplant 2002; 21: LUNG TRANSPLANTS: Donor Age by Year of Transplant

5 2002 ISHLT J Heart Lung Transplant 2002; 21: AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS ( )

6 2002 ISHLT J Heart Lung Transplant 2002; 21: AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA

7 2002 ISHLT J Heart Lung Transplant 2002; 21: LUNG TRANSPLANTATION Actuarial Survival ( ) Double lung: 1/2-life = 4.9 Years; Conditional 1/2-life = 7.9 Years Single lung: 1/2-life = 3.7 Years; Conditional 1/2-life = 5.9 Years All lungs: 1/2-life = 4.1 Years; Conditional 1/2-life = 6.5 Years

8 2002 ISHLT J Heart Lung Transplant 2002; 21: LUNG TRANSPLANTATION Adult Recipients

9 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTATION: Indications ( ) DIAGNOSISSLT (N = 4,663)BLT (N = 4,118)TOTAL (N = 8,781) COPD/Emphysema2, % %3, % IPF1, %3769.1%1, % CF521.1%1, %1, % Alpha %4079.9%8159.3% PPH611.3%3408.3%4014.6% Sarcoidosis1262.7%1062.6%2322.6% Bronchiectasis140.3%1764.3%1902.2% Congenital Heart Disease80.2%952.3%1031.2% LAM420.9%531.3%951.1% Re-TX: OB440.9%431.0%871.0% OB (Non-ReTX)320.7%501.2%820.9% Re-TX: Non-OB330.7%360.9%690.8% Connective Tissue Disorder 200.4%180.4%380.4% Cancer70.2%280.7%350.4% Histiocytosis X110.2% % Other1593.4%962.3%2552.9%

10 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTATION: Indications ( ) Single Lung Transplants Bilateral/Double Lung Transplants

11 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTATION Indications By Year

12 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTATION Actuarial Survival by Era ( ) Survival comparisons by era vs : p = vs : p < vs : p = 0.003

13 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTATION Actuarial Survival by Age Group ( ) Survival comparisons by age group vs : p < vs. 65+: p = vs : p < vs. 65+: p =

14 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTATION Actuarial Survival By Diagnosis ( )

15 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTATION Actuarial Survival By Procedure Type Diagnosis: Alpha-1 Antitrypsin Deficiency ( ) P = 0.03

16 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTATION Actuarial Survival by Procedure Type Diagnosis: Emphysema/COPD ( ) P <

17 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTATION Actuarial Survival by Procedure Type Diagnosis: IPF ( ) P = 0.2

18 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTATION Actuarial Survival by Procedure Type Diagnosis: PPH ( ) P = 0.4

19 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS ( ) Risk Factors for 1 Year Mortality In Descending Order of Magnitude N=5,242

20 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS ( ) Risk Factors for 1 Year Mortality In Descending Order of Magnitude N=5,242

21 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS ( ) Risk Factors for 1 Year Mortality Continuous Factors N=5,242

22 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS ( ) Risk Factors for 1 Year Mortality Continuous Factors N=5,242

23 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS ( ) Risk Factors for 1 Year Mortality Continuous Factors N=5,242

24 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS ( ) Factors Not Significant for 1 Year Mortality Steroid dependency Ischemia time % Predicted FeV1 % Predicted FVC Transfusions Diabetes Weight (donor) Height (donor) Donor clinical infection Donor history of hypertension Donor given steroids

25 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS (April 1994-December 1996) Risk Factors for 5 Year Mortality In Descending Order of Magnitude N=3,098

26 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS (April 1994-December 1996) Risk Factors for 5 Year Mortality In Descending Order of Magnitude N=3,098

27 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS (April 1994-December 1996) Risk Factors for 5 Year Mortality Continuous Factors N=3,098

28 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS (April 1994-December 1996) Risk Factors for 5 Year Mortality Continuous Factors N=3,098

29 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS (April 1994-December 1996) Risk Factors for 5 Year Mortality Continuous Factors N=3,098

30 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS (April 1994-December 1996) Factors Not Significant for 5 Year Mortality Steroid dependency Ventilator Ischemia time % Predicted FeV1 % Predicted FVC Transfusions Diabetes Weight (donor) Height (donor) Donor clinical infection Donor history of hypertension Donor given steroids

31 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS (April 1994-December 1996) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year In Descending Order of Magnitude N=2,285

32 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS (April 1994-December 1996) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year Continuous Factors N=2,285

33 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG RECIPIENTS Functional Status (April 1994 – December 2001)

34 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG RECIPIENTS Employment Status (U.S.: April 1994 – December 2001)

35 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant (April December 2001)

36 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG RECIPIENTS Induction Immunosuppression For follow-ups between October 1999 and December 2001

37 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG RECIPIENTS Maintenance Immunosuppression At Any Time During Follow-up Period For follow-ups between October 1999 and December 2001

38 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG RECIPIENTS Maintenance Immunosuppression At Time of Follow-up For follow-ups between October 1999 and December 2001

39 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between October 1999 and December Year Follow-up (N = 1,177)5 Year Follow-up (N = 547)

40 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between October 1999 and December 2001

41 2002 ISHLT J Heart Lung Transplant 2002; 21: POST-LUNG TRANSPLANT MORBIDITY For Adult Recipients (April 1994-December 2001)

42 2002 ISHLT J Heart Lung Transplant 2002; 21: Freedom from Bronchiolitis Obliterans For Adult Lung Recipients (April 1994-December 2000)

43 2002 ISHLT J Heart Lung Transplant 2002; 21: Freedom from Renal Dysfunction* For Adult Lung Recipients (April 1994-December 2000) * Renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant

44 2002 ISHLT J Heart Lung Transplant 2002; 21: MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTS Cumulative Incidence for Survivors (April 1994-December 2001) Malignancy/Type1-Year Survivors5-Year Survivors No Malignancy4,583 (96.0%)731 (87.2%) Malignancy (all types combined)189 (4.0%)107 (12.8%) Malignancy Type Skin3754 Lymph9115 Other3921 Lymph + Skin3 Lymph + Other4 Skin + Other2 Type Not Reported228

45 2002 ISHLT J Heart Lung Transplant 2002; 21: Freedom from Malignancy For Adult Lung Recipients (April 1994-December 2000)

46 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death ( ) 0-30 Days (N = 962) 31 Days - 1 Year (N = 1,230) >1 Year - 3 Years (N = 953) >3 Year - 5 Years (N = 479) CAD121.2%100.8%111.2%71.5% Cardiac899.3%443.5%202.1%153.1% Malignancy, Other00.0%241.9%394.1%387.9% Lymphoma10.1%403.2%232.4%81.7% CMV50.5%514.0%161.7%30.6% Acute Rejection575.9%554.4%202.1%40.8% Infection, Non-CMV % % %9018.8% Bronchiolitis70.7%755.9% % % Primary Graft Failure %755.9%555.8%194.0% Graft Failure - Other % %9710.2%6613.8% Technical858.8%383.0%90.9%10.2% Other % % %7014.6% Total % % % %

47 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death ( ) Timing of Death

48 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS RECIPIENTS: Cause of Death by Era: Deaths in 0-30 Days Year of Transplant

49 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS RECIPIENTS: Cause of Death by Era: Deaths in 31 Days – 1 Year Year of Transplant

50 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS RECIPIENTS: Cause of Death by Era: Deaths in >1 Year – 3 Years Year of Transplant

51 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS RECIPIENTS: Cause of Death by Era: Deaths in >3 Years – 5 Years Year of Transplant

52 2002 ISHLT J Heart Lung Transplant 2002; 21: ADULT LUNG TRANSPLANTS RECIPIENTS: Cause of Death by Era: Deaths in >5 Years Year of Transplant


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