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2004 ISHLT J Heart Lung Transplant 2004; 23: 804-15 LUNG TRANSPLANTATION Overall.

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Presentation on theme: "2004 ISHLT J Heart Lung Transplant 2004; 23: 804-15 LUNG TRANSPLANTATION Overall."— Presentation transcript:

1 2004 ISHLT J Heart Lung Transplant 2004; 23: LUNG TRANSPLANTATION Overall

2 2004 ISHLT J Heart Lung Transplant 2004; 23: NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE

3 2004 ISHLT J Heart Lung Transplant 2004; 23: AVERAGE CENTER VOLUME Lung Transplants: January 1, June 30, 2003

4 2004 ISHLT J Heart Lung Transplant 2004; 23: DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Lung Transplants: January 1, June 30, 2003

5 2004 ISHLT J Heart Lung Transplant 2004; 23: LUNG TRANSPLANTS: Donor Age by Year of Transplant

6 2004 ISHLT J Heart Lung Transplant 2004; 23: AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2003)

7 2004 ISHLT J Heart Lung Transplant 2004; 23: AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA

8 2004 ISHLT J Heart Lung Transplant 2004; 23: LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January June 2002)

9 2004 ISHLT J Heart Lung Transplant 2004; 23: LUNG TRANSPLANTATION Adult Recipients

10 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2003) DIAGNOSISSLT (N = 5,793)BLT (N = 5,166)TOTAL (N = 10,959) COPD/Emphysema3,091 ( 53% )1,201 ( 23% )4,292 ( 39% ) IPF1,369 ( 24% )503 ( 9.7% )1,872 ( 17% ) CF131 ( 2.3% )1,615 ( 31% )1,746 ( 16% ) Alpha-1493 ( 8.5% )491 ( 9.5% )984 ( 9.0% ) PPH66 ( 1.1% )391 ( 7.6% )457 ( 4.2% ) Sarcoidosis143 ( 2.5% )144 ( 2.8% )287 ( 2.6% ) Bronchiectasis21 ( 0.4% )254 ( 4.9% )275 ( 2.5% ) LAM50 ( 0.9% )72 ( 1.4% )122 ( 1.1% ) Congenital Heart Disease13 ( 0.2% )107 ( 2.1% )120 ( 1.1% ) Re-TX: OB67 ( 1.2% )48 ( 0.9% )115 ( 1.0% ) OB (Non-ReTX)33 ( 0.6% )65 ( 1.3% )98 ( 0.9% ) Re-TX: Non-OB49 ( 0.8% )42 ( 0.8% )91 ( 0.8% ) Connective Tissue Disease29 ( 0.5% )27 ( 0.5% )56 ( 0.5% ) Histiocytosis X18 ( 0.3% )17 ( 0.3% )35 ( 0.3% ) Cancer5 ( 0.1% )11 ( 0.2% )16 ( 0.1% ) Other215 ( 3.7% )178 ( 3.4% )393 ( 3.6% )

11 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION: Indications (Transplants: January June 2003) Single Lung Transplants Bilateral/Double Lung Transplants

12 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Indications By Year (%)

13 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Indications By Year (Number)

14 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1988 – June 2002) Survival comparisons by era vs : p = vs : p < vs : p =

15 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: January 1990 – June 2002)

16 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: January 1990 – June 2002)

17 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2002) Year ALPHA-1 (N=1,356) CF (N= 1,923) COPD (N= 4,955) IPF (N= 2,119) PPH (N= 737) SARCOIDOSIS (N = 317) Survival comparisons Alpha-1 vs. IPF: p < Alpha-1 vs. PPH: p = CF vs. COPD: p = CF vs. IPF: p < CF vs. PPH: p < CF vs. Sarcoidosis: p =

18 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 3 Months (Transplants: January 1990 – June 2002) Year ALPHA-1 (N=1,075) CF (N= 1,541) COPD (N= 4,152) IPF (N= 1,618) PPH (N= 503) SARCOIDOSIS (N = 222) Survival comparisons Alpha-1 vs. IPF: p < Alpha-1 vs. COPD: p = CF vs. COPD: p < CF vs. IPF: p < PPH vs. COPD: p < PPH vs. IPF: p < COPD vs. IPF: p = 0.002

19 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2002) Year ALPHA-1 (N=898) CF (N= 1,298) COPD (N=3,508) IPF (N= 1,279) PPH (N= 429) SARCOIDOSIS (N = 176) Survival comparisons Alpha-1 vs. IPF: p = Alpha-1 vs. COPD: p < CF vs. COPD: p < CF vs. IPF: p < PPH vs. COPD: p < PPH vs. IPF: p <

20 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2002)

21 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 3 Months (Transplants: January 1990 – June 2002)

22 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2002)

23 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival for Eisenmengers Syndrome (Transplants: January 1990 – June 2002)

24 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Procedure Type (Transplants: January 1990 – June 2002) Diagnosis: Alpha-1 Antitrypsin Deficiency P = 0.02

25 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2002) Diagnosis: Emphysema/COPD P <

26 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2002) Diagnosis: IPF P = 0.5

27 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2002) Diagnosis: PPH P = 0.3

28 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2002) Diagnosis: Emphysema/COPD, Single Lung

29 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2002) Diagnosis: Emphysema/COPD, Double/Bilateral Lung

30 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2002) Diagnosis: IPF, Single Lung

31 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2002) Diagnosis: IPF, Double/Bilateral Lung

32 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Donor CMV status/Recipient CMV status (Transplants: October 1999 – June 2002)

33 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 1 Year Mortality (N=8,043)

34 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 1 Year Mortality (N=8,043)

35 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 1 Year Mortality (N=8,043)

36 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality

37 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality Recipient Age

38 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality Center volume

39 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality Recipient Pulmonary Vascular Resistance (PVR)

40 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality FEV1 (% predicted) in Recipients with IPF

41 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 1 Year Mortality Recipient Bilirubin

42 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1995-6/2002) Factors Not Significant for 1 Year Mortality Recipient factors: pCO 2, chronic steroid use, transfusions, recent infection requiring IV drug therapy Donor factors: Clinical infection, history of hypertension, history of cancer Transplant factors: Procedure type, ABO compatibility, HLA mismatch, year of transplant, height ratio

43 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1995-6/1998) Risk Factors for 5 Year Mortality (N=4,178)

44 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality

45 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Recipient Age

46 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Donor Age

47 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Donor weight

48 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Recipient Pulmonary Vascular Resistance (PVR)

49 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1995-6/1998) Factors Not Significant for 5 Year Mortality Recipient factors: Hospitalized, chronic steroid use, transfusions, history of malignancy, PRA, gender, FVC, FEV1, height, weight Donor factors: Gender, clinical infection, history of hypertension, history of cancer, history of diabetes, height Transplant factors: Procedure type, ABO compatibility

50 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1995-6/1998) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=2,982)

51 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

52 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1/1995-6/1998) Risk Factors for 5 Year Mortality Condtional on Survival to 1 Year Recipient Age

53 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1995-6/1997) Factors Not Significant for Conditional 5 Year Mortality Recipient factors: Diagnosis, ventilator, inotropes, hospitalized at transplant, pCO 2, gender, chronic steroid use, transfusions, history of malignancy, PRA, repeat transplant, FeV1, FVC, height, weight Donor factors: Gender, clinical infection, history of hypertension, history of cancer, history of diabetes, COD, age, height, weight Transplant factors: ABO compatibility, HLA mismatch, CMV mismatch

54 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANTS (1995-6/1997) Factors Not Significant for Conditional 5 Year Mortality Post-transplant factors: Hospitalized for infection, stroke, dialysis, prolonged graft dysfunction

55 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG RECIPIENTS Functional Status (Follow-ups: April 1994 – June 2003)

56 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG RECIPIENTS Employment Status (Follow-ups: April 1994 – June 2003)

57 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant (Follow-ups: April June 2003)

58 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG RECIPIENTS Induction Immunosuppression (Follow-ups: January June 2003)

59 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG RECIPIENTS Induction Immunosuppression (Follow-ups: January December 2002)

60 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG RECIPIENTS Maintenance Immunosuppression At Time of Follow-up For follow-ups between January 2000 through June 2003 NOTE: Different patients are analyzed in Year 1 and Year 5

61 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2000 through June Year Follow-up (N = 1,753)5 Year Follow-up (N = 814) NOTE: Different patients are analyzed in Year 1 and Year 5

62 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2000 through June 2003 NOTE: Different patients are analyzed in Year 1 and Year 5

63 2004 ISHLT J Heart Lung Transplant 2004; 23: POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April June 2003)

64 2004 ISHLT J Heart Lung Transplant 2004; 23: POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant (Follow-ups: April June 2003)

65 2004 ISHLT J Heart Lung Transplant 2004; 23: POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 7 Years Post-Transplant (Follow-ups: April June 2003)

66 2004 ISHLT J Heart Lung Transplant 2004; 23: Freedom from Bronchiolitis Obliterans For Adult Lung Recipients (Follow-ups: April 1994-June 2003)

67 2004 ISHLT J Heart Lung Transplant 2004; 23: Freedom from Severe Renal Dysfunction* For Adult Lung Recipients (Follow-ups: April 1994-June 2003) * Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant

68 2004 ISHLT J Heart Lung Transplant 2004; 23: MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTS Cumulative Prevalence in Survivors (Follow-ups: April June 2003) Malignancy/Type1-Year Survivors5-Year Survivors7-Year Survivors No Malignancy 6006 (96.2%)1137 (87%)386 (81.4%) Malignancy (all types combined) 237 (3.8%)170 (13%)88 (18.6%) Malignancy Type* Skin Lymph Other Type Not Reported * 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; 2), breast (1; 5; 4); prostate (0; 5; 3), cervical (1; 1; 1). Numbers in parentheses represent the number of reported cases within each time period.

69 2004 ISHLT J Heart Lung Transplant 2004; 23: Freedom from Malignancy For Adult Lung Recipients (Follow-ups: April 1994-June 2003)

70 2004 ISHLT J Heart Lung Transplant 2004; 23: ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January June 2003) 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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