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LUNG TRANSPLANTATION Overall ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795.

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Presentation on theme: "LUNG TRANSPLANTATION Overall ISHLT 2007 J Heart Lung Transplant 2007;26: 782-795."— Presentation transcript:

1 LUNG TRANSPLANTATION Overall ISHLT 2007 J Heart Lung Transplant 2007;26:

2 NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE 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 J Heart Lung Transplant 2007;26:

3 AVERAGE CENTER VOLUME Lung Transplants: January 1, June 30, 2006 ISHLT 2007 J Heart Lung Transplant 2007;26:

4 DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Lung Transplants: January 1, June 30, 2006 ISHLT 2007 J Heart Lung Transplant 2007;26:

5 AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

6 AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA ISHLT 2007 J Heart Lung Transplant 2007;26:

7 LUNG TRANSPLANTS: Donor Age by Year of Transplant ISHLT 2007 J Heart Lung Transplant 2007;26:

8 DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS (1/1985-6/2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

9 DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS BY ERA ISHLT 2007 J Heart Lung Transplant 2007;26:

10 LUNG TRANSPLANTATION Adult Recipients ISHLT 2007 J Heart Lung Transplant 2007;26:

11 AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS (1/1985-6/2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

12 AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA ISHLT 2007 Mean age by era = 45.0 years /2006 = 48.9 years J Heart Lung Transplant 2007;26:

13 AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA ISHLT 2007 Mean age by era = 44.7 years = 47.3 years /2006 = 49.5 years J Heart Lung Transplant 2007;26:

14 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January June 2005) P < ISHLT 2007 J Heart Lung Transplant 2007;26:

15 ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2006) DIAGNOSISSLT (N = 8,316)BLT (N = 9,300)TOTAL (N = 17,616) COPD/Emphysema4,305 (52%)2,225 (24%)6,530 (37%) Idiopathic Pulmonary Fibrosis2,193 (26%)1,217 (13%)3,410 (19%) Cystic Fibrosis167 (2.0%)2,722 (29%)2,889 (16%) Alpha-1626 (7.5%)795 (8.5%)1,421 (8.1%) Primary Pulmonary Hypertension65 (0.8%)575 (6.2%)640 (3.6%) Sarcoidosis178 (2.1%)260 (2.8%)438 (2.5%) Bronchiectasis30 (0.4%)473 (5.1%)503 (2.9%) LAM59 (0.7%)116 (1.2%)175 (1.0%) Congenital Heart Disease16 (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 Disease51 (0.6%)65 (0.7%)116 (0.7%) Interstitial Pneumonitis24 (0.3%)13 (0.1%)37 (0.2%) Cancer7 (0.1%)12 (0.1%)19 (0.1%) Other362 (4.4%)437 (4.7%)799 (4.5%) ISHLT 2007 J Heart Lung Transplant 2007;26:

16 ADULT LUNG TRANSPLANTATION: Distribution of Procedure Type for Major Indications ( ) ISHLT 2007 Year of TX Alpha-1COPDCystic FibrosisIPFPPH DoubleSingleDoubleSingleDoubleSingleDoubleSingleDoubleSingle J Heart Lung Transplant 2007;26:

17 ADULT LUNG TRANSPLANTATION Procedure Type within Indication, by Year 2007 ISHLT J Heart Lung Transplant 2007;26:

18 ADULT LUNG TRANSPLANTATION: Indications for Single Lung Transplants (Transplants: January June 2006) 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:

19 ADULT LUNG TRANSPLANTATION: Indications for Bilateral/Double Lung Transplants (Transplants: January June 2006) 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:

20 ADULT LUNG TRANSPLANTATION Indications By Year (%) ISHLT 2007 J Heart Lung Transplant 2007;26:

21 ADULT LUNG TRANSPLANTATION Indications By Year (Number) ISHLT 2007 J Heart Lung Transplant 2007;26:

22 ADULT LUNG TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT 2007 J Heart Lung Transplant 2007;26:

23 ADULT LUNG TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT 2007 J Heart Lung Transplant 2007;26:

24 ADULT LUNG TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2006 ISHLT 2007 J Heart Lung Transplant 2007;26:

25 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1988 – June 2005) Survival comparisons by era vs : p = : vs /05: p < vs /05: p < ISHLT 2007 J Heart Lung Transplant 2007;26:

26 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: January 1990 – June 2005) ISHLT 2007 J Heart Lung Transplant 2007;26:

27 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: January 1990 – June 2005) ISHLT 2007 J Heart Lung Transplant 2007;26:

28 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2005) Year ALPHA-1 (N=1,844) CF (N=2,947) COPD (N=7,113) IPF (N=3,362) PPH (N=926) SARCOIDOSIS (N=429) Survival comparisons Alpha-1 vs. CF: p = CF vs. COPD: p < Alpha-1 vs. COPD: p = CF vs. IPF: p < Alpha-1 vs. IPF: p <0.0001CF vs. PPH: p = Alpha-1 vs. PPH: p = CF vs. Sarcoidosis: p = Alpha-1 vs. Sarcoidosis p =.0492COPD vs. IPF: p < Note: Other comparisons are not statistically different. ISHLT 2007 J Heart Lung Transplant 2007;26:

29 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 3 Months (Transplants: January 1990 – June 2005) Year ALPHA-1 (N=1,547) CF (N= 2,508) COPD (N= 6,220) IPF (N= 2,685) PPH (N= 656) SARCOIDOSIS (N=341) Survival comparisons Alpha-1 vs. CF: p =.0472 PPH vs. COPD: p < Alpha-1 vs. COPD: p < PPH vs. IPF: p < Alpha-1 vs. IPF: p < IPF vs. Sarcoidosis: p = CF vs. COPD: p < CF vs. IPF: p < Note: Other comparisons are not statistically different. ISHLT 2007 J Heart Lung Transplant 2007;26:

30 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2005) Year ALPHA-1 (N=1,343) CF (N=2,178) COPD (N=5,378) IPF (N=2,178) PPH (N= 573) SARCOIDOSIS (273) 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. Sarcoidosis: p < IPF vs. Sarcoidosis: p = Note: Other comparisons are not statistically different. ISHLT 2007 J Heart Lung Transplant 2007;26:

31 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2005) ISHLT 2007 Survival comparisons Alpha-1 vs. CF: p = Alpha-1 vs. COPD p = Alpha-1 vs. IPF p < Alpha-1 vs. PPH: p = Alpha-1 vs. Sarcoidosis: p = CF vs. COPD: p < CF vs. IPF: p < CF vs. PPH: p < CF vs. Sarcoidosis: p = COPD vs. IPF: p < J Heart Lung Transplant 2007;26:

32 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 3 Months (Transplants: January 1990 – June 2005) ISHLT 2007 J Heart Lung Transplant 2007;26:

33 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2005) ISHLT 2007 J Heart Lung Transplant 2007;26:

34 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival for Eisenmengers Syndrome (Transplants: January 1990 – June 2005) ISHLT 2007 p = N= 38 N= 15 J Heart Lung Transplant 2007;26:

35 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Procedure Type (Transplants: January 1990 – June 2005) Diagnosis: Alpha-1 Antitrypsin Deficiency P = ISHLT 2007 N at risk at 10 years is 87 for Single Lung and 74 for Double Lung. J Heart Lung Transplant 2007;26:

36 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Procedure Type and Age (Transplants: January 1990 – June 2005) Diagnosis: Alpha-1 Antitrypsin Deficiency 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 = J Heart Lung Transplant 2007;26:

37 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2005) Diagnosis: Emphysema/COPD P < ISHLT 2007 J Heart Lung Transplant 2007;26:

38 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Age (Transplants: January 1990 – June 2005) Diagnosis: Emphysema/COPD P < ISHLT 2007 J Heart Lung Transplant 2007;26:

39 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2005) Diagnosis: Idiopathic Pulmonary Fibrosis P = ISHLT 2007 J Heart Lung Transplant 2007;26:

40 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2005) Diagnosis: Primary Pulmonary Hypertension P = ISHLT 2007 J Heart Lung Transplant 2007;26:

41 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2005) Diagnosis: Emphysema/COPD, Single Lung ISHLT 2007 J Heart Lung Transplant 2007;26:

42 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2005) Diagnosis: Emphysema/COPD, Double Lung ISHLT 2007 J Heart Lung Transplant 2007;26:

43 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2005) Diagnosis: Idiopathic Pulmonary Fibrosis, Single Lung ISHLT 2007 J Heart Lung Transplant 2007;26:

44 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2005) Diagnosis: Idiopathic Pulmonary Fibrosis, Double Lung ISHLT 2007 J Heart Lung Transplant 2007;26:

45 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Donor CMV status/Recipient CMV status (Transplants: October 1999 – June 2005) ISHLT 2007 J Heart Lung Transplant 2007;26:

46 ADULT LUNG TRANSPLANTS (1995-6/2005) Risk Factors for 1 Year Mortality (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:

47 ADULT LUNG TRANSPLANTS (1995-6/2005) Risk Factors for 1 Year Mortality ISHLT 2007 (N=10,415) J Heart Lung Transplant 2007;26:

48 ADULT LUNG TRANSPLANTS (1995-6/2005) Risk Factors for 1 Year Mortality ISHLT 2007 (N=10,415) J Heart Lung Transplant 2007;26:

49 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality ISHLT 2007 J Heart Lung Transplant 2007;26:

50 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality Recipient Age ISHLT 2007 J Heart Lung Transplant 2007;26:

51 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality Donor Age ISHLT 2007 J Heart Lung Transplant 2007;26:

52 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality Donor Weight ISHLT 2007 J Heart Lung Transplant 2007;26:

53 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality Pre-Transplant Recipient Weight ISHLT 2007 J Heart Lung Transplant 2007;26:

54 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality Center volume ISHLT 2007 J Heart Lung Transplant 2007;26:

55 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality Recipient FEV1 (% predicted) ISHLT 2007 J Heart Lung Transplant 2007;26:

56 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality Recipient Pre-Transplant Bilirubin ISHLT 2007 J Heart Lung Transplant 2007;26:

57 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality Recipient Oxygen Required at Rest ISHLT 2007 J Heart Lung Transplant 2007;26:

58 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality Recipient Pre-Transplant Cardiac Output ISHLT 2007 J Heart Lung Transplant 2007;26:

59 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality Recipient PVR ISHLT 2007 J Heart Lung Transplant 2007;26:

60 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:

61 ADULT LUNG TRANSPLANTS (1995-6/2005) Risk Factors for 1 Year Mortality Model including BMI (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:

62 ADULT LUNG TRANSPLANTS (1995-6/2005) Risk Factors for 1 Year Mortality Model including BMI ISHLT 2007 (N=10,415) J Heart Lung Transplant 2007;26:

63 ADULT LUNG TRANSPLANTS (1995-6/2005) Risk Factors for 1 Year Mortality Model including BMI ISHLT 2007 (N=10,415) J Heart Lung Transplant 2007;26:

64 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality Model including BMI ISHLT 2007 J Heart Lung Transplant 2007;26:

65 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI) Recipient Age ISHLT 2007 J Heart Lung Transplant 2007;26:

66 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI) Donor Weight ISHLT 2007 J Heart Lung Transplant 2007;26:

67 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI) Pre-Transplant Recipient BMI ISHLT 2007 J Heart Lung Transplant 2007;26:

68 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI) Center volume ISHLT 2007 J Heart Lung Transplant 2007;26:

69 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI) Recipient FEV1 (% predicted) ISHLT 2007 J Heart Lung Transplant 2007;26:

70 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI) Recipient Pre-Transplant Bilirubin ISHLT 2007 J Heart Lung Transplant 2007;26:

71 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI) Recipient Oxygen Required at Rest ISHLT 2007 J Heart Lung Transplant 2007;26:

72 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI) Recipient Pre-Transplant Cardiac Output ISHLT 2007 J Heart Lung Transplant 2007;26:

73 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Risk Factors for 1 Year Mortality (Model including BMI) Recipient PVR ISHLT 2007 J Heart Lung Transplant 2007;26:

74 ADULT LUNG TRANSPLANTS (1995-6/2005) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality (N=4,235) ISHLT 2007 J Heart Lung Transplant 2007;26:

75 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality ISHLT 2007 J Heart Lung Transplant 2007;26:

76 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Recipient Age ISHLT 2007 J Heart Lung Transplant 2007;26:

77 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Center volume ISHLT 2007 J Heart Lung Transplant 2007;26:

78 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Cardiac Output ISHLT 2007 J Heart Lung Transplant 2007;26:

79 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Recipient Oxygen Required at Rest ISHLT 2007 J Heart Lung Transplant 2007;26:

80 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Ischemia Time ISHLT 2007 J Heart Lung Transplant 2007;26:

81 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Recipient PCO 2 at Transplant ISHLT 2007 J Heart Lung Transplant 2007;26:

82 ADULT LUNG TRANSPLANTS (1995-6/2005) Diagnosis = IPF Risk Factors for 1 Year Mortality (N=1,961) ISHLT 2007 J Heart Lung Transplant 2007;26:

83 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = IPF Risk Factors for 1 Year Mortality ISHLT 2007 J Heart Lung Transplant 2007;26:

84 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient Age ISHLT 2007 J Heart Lung Transplant 2007;26:

85 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = IPF Risk Factors for 1 Year Mortality Donor Age ISHLT 2007 J Heart Lung Transplant 2007;26:

86 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient PA Diastolic Pressure ISHLT 2007 J Heart Lung Transplant 2007;26:

87 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = IPF Risk Factors for 1 Year Mortality Donor Weight ISHLT 2007 J Heart Lung Transplant 2007;26:

88 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient O 2 Required at Rest ISHLT 2007 J Heart Lung Transplant 2007;26:

89 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = IPF Risk Factors for 1 Year Mortality Center volume ISHLT 2007 J Heart Lung Transplant 2007;26:

90 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient BMI ISHLT 2007 J Heart Lung Transplant 2007;26:

91 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient Bilirubin ISHLT 2007 J Heart Lung Transplant 2007;26:

92 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient Cardiac Output ISHLT 2007 J Heart Lung Transplant 2007;26:

93 ADULT LUNG TRANSPLANTS (1/1995-6/2005) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient Wedge Pressure ISHLT 2007 J Heart Lung Transplant 2007;26:

94 ADULT LUNG TRANSPLANTS (1995-6/2001) Risk Factors for 5 Year Mortality (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:

95 ADULT LUNG TRANSPLANTS (1995-6/2001) Risk Factors for 5 Year Mortality (N=5,640) ISHLT 2007 J Heart Lung Transplant 2007;26:

96 ADULT LUNG TRANSPLANTS (1995-6/2001) Borderline Significant Risk Factors for 5 Year Mortality (N=5,640) ISHLT 2007 J Heart Lung Transplant 2007;26:

97 ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality ISHLT 2007 J Heart Lung Transplant 2007;26:

98 ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Recipient Age ISHLT 2007 J Heart Lung Transplant 2007;26:

99 ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Donor Age ISHLT 2007 J Heart Lung Transplant 2007;26:

100 ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Donor Height ISHLT 2007 J Heart Lung Transplant 2007;26:

101 ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Pre-Transplant Recipient Body Surface Area ISHLT 2007 J Heart Lung Transplant 2007;26:

102 ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Pre-Transplant Recipient PA Diastolic Pressure ISHLT 2007 J Heart Lung Transplant 2007;26:

103 ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Center Volume ISHLT 2007 J Heart Lung Transplant 2007;26:

104 ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Pre-Transplant Recipient FEV1 (% predicted) ISHLT 2007 J Heart Lung Transplant 2007;26:

105 ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Oxygen Required at Rest ISHLT 2007 J Heart Lung Transplant 2007;26:

106 ADULT LUNG TRANSPLANTS (1995-6/2000) Factors Not Significant for 5 Year Mortality Recipient factors: Transfusions, history of malignancy, cardiac output, PRA, FVC, PCO 2, 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:

107 ADULT LUNG TRANSPLANTS (1995-6/2001) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=4,205) ISHLT 2007 J Heart Lung Transplant 2007;26:

108 ADULT LUNG TRANSPLANTS (1995-6/2001) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=4,205) ISHLT 2007 J Heart Lung Transplant 2007;26:

109 ADULT LUNG TRANSPLANTS (1995-6/2001) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=4,205) ISHLT 2007 J Heart Lung Transplant 2007;26:

110 ADULT LUNG TRANSPLANTS (1995-6/2001) Borderline Significant Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=4,205) ISHLT 2007 J Heart Lung Transplant 2007;26:

111 ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year ISHLT 2007 J Heart Lung Transplant 2007;26:

112 ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Recipient Age ISHLT 2007 J Heart Lung Transplant 2007;26:

113 ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Donor Age ISHLT 2007 J Heart Lung Transplant 2007;26:

114 ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Recipient BMI ISHLT 2007 J Heart Lung Transplant 2007;26:

115 ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Center Volume ISHLT 2007 J Heart Lung Transplant 2007;26:

116 ADULT LUNG TRANSPLANTS (1995-6/2000) Factors Not Significant for Conditional 5 Year Mortality Recipient factors: Ventilator, inotropes, hospitalized at transplant, pCO 2, gender, chronic steroid use, transfusions, history of malignancy, PRA, repeat transplant, FEV1, FVC, PA pressures, O 2 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:

117 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:

118 ADULT LUNG RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

119 ADULT LUNG RECIPIENTS Employment Status of Surviving Recipients (Follow-ups: April 1994 – June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

120 ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

121 ADULT LUNG RECIPIENTS Induction Immunosuppression (Transplants: January June 2006) Analysis limited to patients receiving prednisone ISHLT 2007 J Heart Lung Transplant 2007;26:

122 ADULT LUNG RECIPIENTS Induction Immunosuppression (Transplants: January December 2005) Analysis limited to patients receiving prednisone ISHLT 2007 Any Induction Polyclonal ALG/ATG IL2R-antagonist Campath J Heart Lung Transplant 2007;26:

123 SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: April 1994-June 2005) Conditional on survival to 14 days 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:

124 SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: January 2000-June 2005) Conditional on survival to 14 days 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:

125 ADULT LUNG RECIPIENTS Maintenance 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:

126 ADULT LUNG RECIPIENTS Maintenance 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:

127 ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2002 through June 2006 Analysis 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:

128 ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2002 through June 2006 Conventional Combinations Analysis limited to patients receiving prednisone ISHLT 2007 J Heart Lung Transplant 2007;26:

129 ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2002 through June 2006 Other Combinations Analysis limited to patients receiving prednisone ISHLT 2007 J Heart Lung Transplant 2007;26:

130 PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January 1, June 30, 2005) ISHLT 2007 J Heart Lung Transplant 2007;26:

131 PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January 1, June 30, 2005) ISHLT 2007 J Heart Lung Transplant 2007;26:

132 NUMBER OF REJECTION EPISODES FOR ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January 1, June 30, 2005) No induction vs. polyclonal (p < ); no induction vs. IL2R (p = 0.008); polyclonal vs. IL2R (p = 0.034). ISHLT 2007 J Heart Lung Transplant 2007;26:

133 NUMBER OF REJECTION EPISODES FOR ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January 1, June 30, 2005) 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 = ); polyclonal vs. IL2R (p = ) ISHLT 2007 J Heart Lung Transplant 2007;26:

134 PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, June 30, 2005) CyA + MMF vs. TAC + AZA (p = 0.068); CyA + AZA vs. TAC + MMF (p = ); CyA + AZA vs. TAC + AZA (p = ) ISHLT 2007 J Heart Lung Transplant 2007;26:

135 PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, June 30, 2005) 35-49: CyA + AZA vs. TAC + AZA (p = ) 50-59: CyA + MMF vs. TAC + MMF (p = 0.077); CyA + MMF vs. TAC + AZA (p = ); CyA + AZA vs. TAC + MMF (p = 0.056); CyA + AZA vs. TAC + AZA (p = ) 60-64: CyA + MMF vs. CyA + AZA (p = ) 60+: CyA + AZA vs. TAC + MMF (p = ) Females: CyA + AZA vs. TAC + AZA (p = ) Males: CyA + MMF vs. TAC + MMF (p = ); CyA + AZA vs. TAC + AZA (p = ) ISHLT 2007 J Heart Lung Transplant 2007;26:

136 NUMBER OF REJECTION EPISODES FOR ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, June 30, 2005) CyA + MMF vs. CyA + AZA (p = 0.002); CyA + AZA vs. TAC + MMF (p < ); TAC + MMF vs. TAC + AZA (p = 0.026) ; CyA + AZA vs. TAC + AZA (p = ) ISHLT 2007 J Heart Lung Transplant 2007;26:

137 NUMBER OF REJECTION EPISODES FOR ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, June 30, 2005) 18-34: CyA + AZA vs. TAC + MMF (p = ); TAC + MMF vs. TAC + AZA (p = 0.099) 50-59: CyA + AZA vs. TAC + MMF (p = ) 60-64: CyA + MMF vs. CyA + AZA (p = ); CyA + AZA vs. TAC + MMF (p = ); CyA + TAC + AZA (p = ) 65+: CyA + MMF vs. CyA + AZA (p = ) Female: CyA + MMF vs. TAC + MMF (p = ); CyA + AZA vs. TAC + MMF (p = ); CyA + AZA vs. TAC + AZA (p = 0.085); TAC + MMF vs. TAC + AZA (p = ) Male: CyA + MMF vs. CyA + AZA (p = ); CyA + AZA vs. TAC + MMF (p = ) ISHLT 2007 J Heart Lung Transplant 2007;26:

138 POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

139 POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 and 5 Years Post-Transplant (Follow-ups: April June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

140 POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 10 Years Post-Transplant (Follow-ups: April June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

141 FREEDOM FROM BRONCHIOLITIS OBLITERANS For Adult Lung Recipients (Follow-ups: April 1994-June 2006) Conditional on Survival to 14 days ISHLT 2007 J Heart Lung Transplant 2007;26:

142 FREEDOM FROM BRONCHIOLITIS OBLITERANS STRATIFIED BY INDUCTION USE For Adult Lung Recipients Follow-ups: April 1994-June 2006) Conditional on Survival to 14 days ISHLT 2007 J Heart Lung Transplant 2007;26:

143 FREEDOM FROM SEVERE RENAL DYSFUNCTION * For Adult Lung Recipients (Follow-ups: April 1994-June 2006) * Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant ISHLT 2007 J Heart Lung Transplant 2007;26:

144 MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTS Cumulative Prevalence in Survivors (Follow-ups: April June 2006) Malignancy/Type1-Year Survivors5-Year Survivors10-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 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; 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:

145 FREEDOM FROM MALIGNANCY For Adult Lung Recipients (Follow-ups: April 1994-June 2006) ISHLT 2007 J Heart Lung Transplant 2007;26:

146 ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January June 2006) CAUSE OF DEATH 0-30 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) BRONCHIOLITIS6 (0.4%)103 (4.8%)505 (27.6%)319 (30.0%)295 (26.9%)35 (23.6%) ACUTE REJECTION67 (4.7%)43 (2.0%)34 (1.9%)9 (0.8%)8 (0.7%)0 LYMPHOMA1 (0.1%)55 (2.6%)39 (2.1%)17 (1.6%)31 (2.8%)7 (4.7%) MALIGNANCY, OTHER1 (0.1%)55 (2.6%)104 (5.7%)83 (7.8%)94 (8.6%)11 (7.4%) CMV072 (3.4%)22 (1.2%)4 (0.4%)3 (0.3%)0 INFECTION, NON-CMV290 (20.3%)775 (36.4%)439 (24.0%)195 (18.3%)198 (18.0%)24 (16.2%) GRAFT FAILURE404 (28.3%)409 (19.2%)335 (18.3%)200 (18.8%)197 (18.0%)34 (23.0%) CARDIOVASCULAR154 (10.8%)89 (4.2%)57 (3.1%)51 (4.8%)57 (5.2%)9 (6.1%) TECHNICAL117 (8.2%)58 (2.7%)13 (0.7%)3 (0.3%) 1 (0.7%) OTHER387 (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:


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