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LUNG TRANSPLANTATION Overall ISHLT 2005 J Heart Lung Transplant 2005;24: 945-982.

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Presentation on theme: "LUNG TRANSPLANTATION Overall ISHLT 2005 J Heart Lung Transplant 2005;24: 945-982."— Presentation transcript:

1 LUNG TRANSPLANTATION Overall ISHLT 2005 J Heart Lung Transplant 2005;24:

2 NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE ISHLT 2005 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 2005;24:

3 AVERAGE CENTER VOLUME Lung Transplants: January 1, June 30, 2004 ISHLT 2005 J Heart Lung Transplant 2005;24:

4 DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Lung Transplants: January 1, June 30, 2004 ISHLT 2005 J Heart Lung Transplant 2005;24:

5 LUNG TRANSPLANTS: Donor Age by Year of Transplant ISHLT 2005 J Heart Lung Transplant 2005;24:

6 AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2004) ISHLT 2005 J Heart Lung Transplant 2005;24:

7 AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA ISHLT 2005 J Heart Lung Transplant 2005;24:

8 LUNG TRANSPLANTATION Adult Recipients ISHLT 2005 J Heart Lung Transplant 2005;24:

9 AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS (1/1985-6/2004) ISHLT 2005 J Heart Lung Transplant 2005;24:

10 AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA ISHLT 2005 J Heart Lung Transplant 2005;24:

11 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January June 2003) P < ISHLT 2005 J Heart Lung Transplant 2005;24:

12 ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2004) DIAGNOSISSLT (N = 6,731)BLT (N = 6,276)TOTAL (N = 13,007) COPD/Emphysema3,541 (53%)1,462 (23%)5,003 (38%) Idiopathic Pulmonary Fibrosis1,618 (24%)639 (10.0%)2,257 (17%) Cystic Fibrosis151 (2.2%)2,002 (32%)2,153 (17%) Alpha-1554 (8.2%)571 (9.1%)1,125 (8.6%) Primary Pulmonary Hypertension79 (1.2%)436 (6.9%)515 (4%) Sarcoidosis157 (2.3%)166 (2.6%)323 (2.5%) Bronchiectasis45 (0.7%)309 (4.9%)354 (2.7%) LAM55 (0.8%)83 (1.3%)138 (1.1%) Congenital Heart Disease13 (0.2%)118 (1.9%)131 (1.0%) Re-Transplant: Obliterative Bronchiolitis 74 (1.1%)58 (0.9%)132 (1.0%) Obliterative Bronchiolitis (Not Re-Transplant) 39 (0.6%)80 (1.3%)119 (0.9%) Re-Transplant: Not Obliterative Bronchiolitis 55 (0.8%)46 (0.7%)101 (0.8%) Connective Tissue Disease34 (0.5%)31 (0.5%)65 (0.5%) Histiocytosis X20 (0.3%)19 (0.3%)39 (0.3%) Cancer7 (0.1%)14 (0.2%)21 (0.2%) Other289 (4.3%)242 (3.8%)509 (4.1%) ISHLT 2005 J Heart Lung Transplant 2005;24:

13 ADULT LUNG TRANSPLANTATION: Distribution of Procedure Type for Major Indications ( ) ISHLT 2005 Year of TX Alpha-1COPDCystic FibrosisIPFPPH Double/ bilateral SingleDouble/ bilateral SingleDouble/ bilateral SingleDouble/ bilateral SingleDouble/ bilateral Single J Heart Lung Transplant 2005;24:

14 ADULT LUNG TRANSPLANTATION Procedure Type within Indication, by Year J Heart Lung Transplant 2005;24:

15 ADULT LUNG TRANSPLANTATION: Indications for Single Lung Transplants (Transplants: January June 2004) ISHLT 2005 *Other includes: Sarcoidosis: 2% Bronchiectasis: 0.7% Congenital Heart Disease: 0.2% LAM: 0.8% OB (non-ReTx): 0.6% Miscellaneous:5% J Heart Lung Transplant 2005;24:

16 ADULT LUNG TRANSPLANTATION: Indications for Bilateral/Double Lung Transplants (Transplants: January June 2004) ISHLT 2005 *Other includes: Re-Tx: 2% Congenital Heart Disease: 2% LAM: 1.3% OB (non-ReTx): 1.3% Miscellaneous:5% J Heart Lung Transplant 2005;24:

17 ADULT LUNG TRANSPLANTATION Indications By Year (%) ISHLT 2005 J Heart Lung Transplant 2005;24:

18 ADULT LUNG TRANSPLANTATION Indications By Year (Number) ISHLT 2005 J Heart Lung Transplant 2005;24:

19 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1988 – June 2003) Survival comparisons by era vs : p = : vs /03: p < vs /03: p < ISHLT 2005 J Heart Lung Transplant 2005;24:

20 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: January 1990 – June 2003) ISHLT 2005 J Heart Lung Transplant 2005;24:

21 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: January 1994 – June 2003) ISHLT 2005 J Heart Lung Transplant 2005;24:

22 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1994 – June 2003) Year ALPHA-1 (N=1,127) CF (N=1,934) COPD (N=4,888) IPF (N=2,058) PPH (N=553) SARCOIDOSIS (N=314) Survival comparisons COPD vs. IPF: p < Alpha-1 vs. CF: p = 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 = Note: Other comparisons are not statistically different. ISHLT 2005 J Heart Lung Transplant 2005;24:

23 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 3 Months (Transplants: January 1994 – June 2003) Year ALPHA-1 (N=905) CF (N= 1,516) COPD (N= 4,089) IPF (N= 1,575) PPH (N= 374) SARCOIDOSIS (N=225) 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 = Note: Other comparisons are not statistically different. ISHLT 2005 J Heart Lung Transplant 2005;24:

24 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1994 – June 2003) Year ALPHA-1 (N=769) CF (N=1,300) COPD (N= 3,468) IPF (N=1,273) PPH (N= 322) SARCOIDOSIS (N=180) 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 2005 J Heart Lung Transplant 2005;24:

25 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1994 – June 2003) ISHLT 2005 J Heart Lung Transplant 2005;24:

26 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 3 Months (Transplants: January 1994 – June 2003) ISHLT 2005 J Heart Lung Transplant 2005;24:

27 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1994 – June 2003) ISHLT 2005 J Heart Lung Transplant 2005;24:

28 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival for Eisenmengers Syndrome (Transplants: January 1990 – June 2003) ISHLT 2005 N at risk at 5 years = 33 N at risk at 5 years = 15 J Heart Lung Transplant 2005;24:

29 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Procedure Type (Transplants: January 1990 – June 2003) Diagnosis: Alpha-1 Antitrypsin Deficiency P = ISHLT 2005 N at risk at 10 years is 44 for Single Lung and 23 for Double Lung. J Heart Lung Transplant 2005;24:

30 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Procedure Type and Median Age (Transplants: January 1990 – June 2003) Diagnosis: Alpha-1 Antitrypsin Deficiency ISHLT 2005 N at risk at 5 years: Single Lung, <50 = 140; Double Lung, <50 = 126; Single Lung, 50+ = 97; Double Lung, 50+ = 45 p = 0.22 J Heart Lung Transplant 2005;24:

31 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2003) Diagnosis: Emphysema/COPD P < ISHLT 2005 J Heart Lung Transplant 2005;24:

32 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Age (Transplants: January 1990 – June 2003) Diagnosis: Emphysema/COPD P < ISHLT 2005 J Heart Lung Transplant 2005;24:

33 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2003) Diagnosis: Idiopathic Pulmonary Fibrosis P = 0.5 ISHLT 2005 J Heart Lung Transplant 2005;24:

34 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2003) Diagnosis: Primary Pulmonary Hypertension P = 0.3 ISHLT 2005 J Heart Lung Transplant 2005;24:

35 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2003) Diagnosis: Emphysema/COPD, Single Lung ISHLT 2005 J Heart Lung Transplant 2005;24:

36 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2003) Diagnosis: Emphysema/COPD, Double/Bilateral Lung ISHLT 2005 J Heart Lung Transplant 2005;24:

37 ADULT LUNG TRANSPLANTATION Actual Survival by Procedure Type and Era (Transplants: January 1990 – December 1999) Diagnosis: Emphysema/COPD, Double/Bilateral Lung ISHLT 2005 J Heart Lung Transplant 2005;24:

38 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2003) Diagnosis: Idiopathic Pulmonary Fibrosis, Single Lung ISHLT 2005 J Heart Lung Transplant 2005;24:

39 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2003) Diagnosis: Idiopathic Pulmonary Fibrosis, Double/Bilateral Lung ISHLT 2005 J Heart Lung Transplant 2005;24:

40 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Donor CMV status/Recipient CMV status (Transplants: October 1999 – June 2003) ISHLT 2005 J Heart Lung Transplant 2005;24:

41 ADULT LUNG TRANSPLANTS (1995-6/2003) Risk Factors for 1 Year Mortality (N=11,291) ISHLT 2005 *Other = All diagnoses other than COPD, PPH, IPF, CF, bronchiectasis, Alpha-1 antitrypsin deficiency, and LAM. J Heart Lung Transplant 2005;24:

42 ADULT LUNG TRANSPLANTS (1995-6/2003) Risk Factors for 1 Year Mortality (N=11,291) ISHLT 2005 J Heart Lung Transplant 2005;24:

43 ADULT LUNG TRANSPLANTS (1995-6/2003) Risk Factors for 1 Year Mortality (N=11,291) ISHLT 2005 J Heart Lung Transplant 2005;24:

44 ADULT LUNG TRANSPLANTS (1995-6/2003) Borderline Significant Risk Factors for 1 Year Mortality (N=11,291) ISHLT 2005 J Heart Lung Transplant 2005;24:

45 ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality ISHLT 2005 J Heart Lung Transplant 2005;24:

46 ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality Recipient Age ISHLT 2005 J Heart Lung Transplant 2005;24:

47 ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality Donor Age ISHLT 2005 J Heart Lung Transplant 2005;24:

48 ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality Donor Weight ISHLT 2005 J Heart Lung Transplant 2005;24:

49 ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality Pre-Transplant Recipient BMI ISHLT 2005 J Heart Lung Transplant 2005;24:

50 ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality Center volume ISHLT 2005 J Heart Lung Transplant 2005;24:

51 ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality FEV1 (% predicted) in Recipients with Idiopathic Pulmonary Fibrosis ISHLT 2005 J Heart Lung Transplant 2005;24:

52 ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality Pre-Transplant Bilirubin ISHLT 2005 J Heart Lung Transplant 2005;24:

53 ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 1 Year Mortality Recipient Pulmonary Vascular Resistance ISHLT 2005 J Heart Lung Transplant 2005;24:

54 ADULT LUNG TRANSPLANTS (1995-6/2003) Factors Not Significant for 1 Year Mortality Recipient factors: pCO 2, PA pressures, transfusions, recent infection requiring IV drug therapy, diabetes, sternotomy, dialysis, FVC, creatinine, PRA, cardiac output, chronic steroid use, weight, height Donor factors: History of hypertension, history of cancer, cause of death, height, BMI Transplant factors: Height ratio, BMI ratio, ischemia time ISHLT 2005 J Heart Lung Transplant 2005;24:

55 ADULT LUNG TRANSPLANTS (1/1995-6/2003) 1-Year Predicted Survival – Hypothetical Case #1 ISHLT 2005 Other characteristics: ABO identical, primary transplant, no IV inotropes, no prior thoracotomy, 3 HLA mismatches, not hospitalized, no history of malignancy, no donor clinical infection, no CMV MM, no donor history of diabetes J Heart Lung Transplant 2005;24:

56 ADULT LUNG TRANSPLANTS (1/1995-6/2003) 1-Year Predicted Survival – Hypothetical Case #2 ISHLT 2005 Other characteristics: ABO identical, primary transplant, no IV inotropes, no prior thoracotomy, 3 HLA mismatches, not hospitalized, no history of malignancy, no donor clinical infection, no CMV MM, no donor history of diabetes J Heart Lung Transplant 2005;24:

57 ADULT LUNG TRANSPLANTS (1/1995-6/2003) 1-Year Predicted Survival – Hypothetical Case #3 ISHLT 2005 Other characteristics: ABO identical, primary transplant, no IV inotropes, no prior thoracotomy, 3 HLA mismatches, not hospitalized, no history of malignancy, no donor clinical infection, no CMV MM, no donor history of diabetes J Heart Lung Transplant 2005;24:

58 ADULT LUNG TRANSPLANTS (1/1995-6/2003) 1-Year Predicted Survival – Hypothetical Case #4 ISHLT 2005 Other characteristics: ABO identical, primary transplant, no IV inotropes, no prior thoracotomy, 3 HLA mismatches, not hospitalized, no history of malignancy, no donor clinical infection, no CMV MM, no donor history of diabetes J Heart Lung Transplant 2005;24:

59 ADULT LUNG TRANSPLANTS (1995-6/1999) Risk Factors for 5 Year Mortality (N=5,637) ISHLT 2005 J Heart Lung Transplant 2005;24:

60 ADULT LUNG TRANSPLANTS (1995-6/1999) Risk Factors for 5 Year Mortality (N=5,637) ISHLT 2005 J Heart Lung Transplant 2005;24:

61 ADULT LUNG TRANSPLANTS (1995-6/1999) Risk Factors for 5 Year Mortality (N=5,637) ISHLT 2005 J Heart Lung Transplant 2005;24:

62 ADULT LUNG TRANSPLANTS (1995-6/1999) Borderline Significant Risk Factors for 5 Year Mortality (N=5,637) ISHLT 2005 J Heart Lung Transplant 2005;24:

63 ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality ISHLT 2005 J Heart Lung Transplant 2005;24:

64 ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality Recipient Age ISHLT 2005 J Heart Lung Transplant 2005;24:

65 ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality Donor Age ISHLT 2005 J Heart Lung Transplant 2005;24:

66 ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Pre-Transplant Recipient BMI ISHLT 2005 J Heart Lung Transplant 2005;24:

67 ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality Donor Weight ISHLT 2005 J Heart Lung Transplant 2005;24:

68 ADULT LUNG TRANSPLANTS (1/1995-6/2003) Risk Factors for 5 Year Mortality Pre-Transplant Bilirubin ISHLT 2005 J Heart Lung Transplant 2005;24:

69 ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality Recipient PA Systolic Pressure ISHLT 2005 J Heart Lung Transplant 2005;24:

70 ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality Pre-Transplant Creatinine ISHLT 2005 J Heart Lung Transplant 2005;24:

71 ADULT LUNG TRANSPLANTS (1995-6/1999) Factors Not Significant for 5 Year Mortality Recipient factors: Hospitalized, chronic steroid use, transfusions, history of malignancy, cardiac output, PRA, FVC, FEV1, PCO 2, pulmonary vascular resistance, dialysis, recent infection requiring IV drug therapy Donor factors: Clinical infection, history of hypertension, history of cancer, history of diabetes, height Transplant factors: CMV mismatch, ischemia time, transplant center volume ISHLT 2005 J Heart Lung Transplant 2005;24:

72 ADULT LUNG TRANSPLANTS (1995-6/1999) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=4,028) ISHLT 2005 *Other = All diagnoses other than COPD, PPH, IPF, CF, bronchiectasis, Alpha-1 antitrypsin deficiency, and LAM. J Heart Lung Transplant 2005;24:

73 ADULT LUNG TRANSPLANTS (1995-6/1999) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=4,028) ISHLT 2005 J Heart Lung Transplant 2005;24:

74 ADULT LUNG TRANSPLANTS (1995-6/1999) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=4,028) ISHLT 2005 J Heart Lung Transplant 2005;24:

75 ADULT LUNG TRANSPLANTS (1995-6/1999) Borderline Significant Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=4,028) ISHLT 2005 J Heart Lung Transplant 2005;24:

76 ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year ISHLT 2005 J Heart Lung Transplant 2005;24:

77 ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Recipient Age ISHLT 2005 J Heart Lung Transplant 2005;24:

78 ADULT LUNG TRANSPLANTS (1/1995-6/1999) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Donor Age ISHLT 2005 J Heart Lung Transplant 2005;24:

79 ADULT LUNG TRANSPLANTS (1995-6/1999) 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, height, weight, 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, height, weight ISHLT 2005 J Heart Lung Transplant 2005;24:

80 ADULT LUNG TRANSPLANTS (1995-6/1999) Factors Not Significant for Conditional 5 Year Mortality Transplant factors: ABO compatibility, CMV mismatch, transplant center volume Post-transplant factors: Stroke prior to discharge, prolonged graft dysfunction prior to discharge, treated for rejection prior to discharge ISHLT 2005 J Heart Lung Transplant 2005;24:

81 ADULT LUNG RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2004) ISHLT 2005 J Heart Lung Transplant 2005;24:

82 ADULT LUNG RECIPIENTS Employment Status of Surviving Recipients (Follow-ups: April 1994 – June 2004) ISHLT 2005 J Heart Lung Transplant 2005;24:

83 ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April June 2004) ISHLT 2005 J Heart Lung Transplant 2005;24:

84 ADULT LUNG RECIPIENTS Induction Immunosuppression (Follow-ups: January June 2004) Analysis limited to patients receiving prednisone ISHLT 2005 J Heart Lung Transplant 2005;24:

85 ADULT LUNG RECIPIENTS Induction Immunosuppression (Follow-ups: January December 2003) Analysis limited to patients receiving prednisone ISHLT 2005 J Heart Lung Transplant 2005;24:

86 SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: April 1994-June 2003) Conditional on survival to 14 days ISHLT 2005 J Heart Lung Transplant 2005;24:

87 SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: January 2000-June 2003) Conditional on Survival to 14 days ISHLT 2005 J Heart Lung Transplant 2005;24:

88 ADULT LUNG RECIPIENTS Maintenance Immunosuppression At Time of Follow-up For follow-ups between January 2001 through June 2004 Analysis limited to patients receiving prednisone NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT 2005 J Heart Lung Transplant 2005;24:

89 ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2001 through June 2004 Analysis limited to patients receiving prednisone 1 Year Follow-up (N = 1,928)5 Year Follow-up (N = 865) NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT 2005 J Heart Lung Transplant 2005;24:

90 ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2001 through June 2003 Conventional Combinations Analysis limited to patients receiving prednisone ISHLT 2005 J Heart Lung Transplant 2005;24:

91 ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2001 through June 2003 Other Combinations Analysis limited to patients receiving prednisone ISHLT 2005 J Heart Lung Transplant 2005;24:

92 PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January 1, June 30, 2003) ISHLT 2005 J Heart Lung Transplant 2005;24:

93 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, 2003) Overall: no induction vs. polyclonal (p < ); no induction vs. IL2R (p = ); polyclonal vs. IL2R (p = ) : no induction vs. polyclonal (p = 0.002); polyclonal vs. IL2R (p = 0.019) : no induction vs. polyclonal (p = 0.022) Females: no induction vs. polyclonal (p = 0.04); no induction vs. IL2R (p = 0.04). Males: no induction vs. polyclonal (p = ); polyclonal vs. IL2R (p = 0.011) ISHLT 2005 J Heart Lung Transplant 2005;24:

94 PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, June 30, 2003) Overall: CyA + MMF vs. TAC + MMF (p = ); CyA + AZA vs. TAC + MMF (p < ); CyA + AZA vs. TAC + AZA (p = ) : CyA + MMF vs. TAC + MMF (p = 0.017); CyA + AZA vs. TAC + MMF (p = ); CyA + AZA vs. TAC + AZA (p = 0.023) : CyA + MMF vs. TAC + MMF (p = 0.037); CyA + AZA vs. TAC + MMF (p < ); CyA + MMF vs. CyA + AZA (p = 0.045); CyA + AZA vs. TAC + AZA (p = ). 65+: CyA + AZA vs. TAC + MMF (p = 0.035); CyA + MMF vs. TAC + MMF (p = 0.035). Females: CyA + AZA vs. TAC + MMF (p = 0.002); CyA + AZA vs. TAC + AZA (p = 0.014). Males: CyA + MMF vs. TAC + MMF (p = ); CyA + AZA vs. TAC + MMF (p < ); CyA + AZA vs. TAC + AZA (p = 0.005); TAC + MMF vs. TAC + AZA (p = 0.04) ISHLT 2005 J Heart Lung Transplant 2005;24:

95 NUMBER OF REJECTION EPISODES FOR ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, June 30, 2003) Overall: CyA + MMF vs. CyA + AZA (p = ); CyA + AZA vs. TAC + MMF (p < ); TAC + MMF vs. TAC + AZA (p = ) : CyA + MMF vs. CyA + AZA (p = 0.046); CyA + AZA vs. TAC + MMF (p = 0.014) : CyA + MMF vs. CyA + AZA (p = 0.013); CyA +AZA vs. TAC + MMF (p = 0.002); CyA + AZA vs. TAC + AZA (p = 0.02). Female: CyA + AZA vs. TAC + MMF (p = ). Male: CyA + AZA vs. TAC + MMF (p = 0.04); CyA + MMF vs. CyA + AZA (p = 0.007) ISHLT 2005 J Heart Lung Transplant 2005;24:

96 POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April June 2004) ISHLT 2005 J Heart Lung Transplant 2005;24:

97 POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 and 5 Years Post-Transplant (Follow-ups: April June 2004) ISHLT 2005 J Heart Lung Transplant 2005;24:

98 POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 8 Years Post-Transplant (Follow-ups: April June 2004) ISHLT 2005 J Heart Lung Transplant 2005;24:

99 FREEDOM FROM BRONCHIOLITIS OBLITERANS For Adult Lung Recipients (Follow-ups: April 1994-June 2004) Conditional on Survival to 90 days ISHLT 2005 J Heart Lung Transplant 2005;24:

100 FREEDOM FROM BRONCHIOLITIS OBLITERANS STRATIFIED BY INDUCTION USE For Adult Lung Recipients (Follow-ups: April 1994-June 2004) Conditional on Survival to 90 days ISHLT 2005 J Heart Lung Transplant 2005;24:

101 FREEDOM FROM SEVERE RENAL DYSFUNCTION * For Adult Lung Recipients (Follow-ups: April 1994-June 2004) * Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant ISHLT 2005 J Heart Lung Transplant 2005;24:

102 MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTS Cumulative Prevalence in Survivors (Follow-ups: April June 2004) Malignancy/Type1-Year Survivors5-Year Survivors7-Year Survivors No Malignancy 7025 (96.1%)1427 (87%)553 (81.7%) Malignancy (all types combined) 284 (3.9%)213 (13%)124 (18.3%) 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); liver (1; 1; 1). Numbers in parentheses represent the number of reported cases within each time period. ISHLT 2005 J Heart Lung Transplant 2005;24:

103 FREEDOM FROM MALIGNANCY For Adult Lung Recipients (Follow-ups: April 1994-June 2004) ISHLT 2005 J Heart Lung Transplant 2005;24:

104 ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January June 2004) CAUSE OF DEATH 0-30 Days (N = 1146) 31 Days - 1 Year (N = 1,717) >1 Year - 3 Years (N = 1,428) >3 Years - 5 Years (N = 800) >5 Years (N = 829) BRONCHIOLITIS 5 (0.4%)82 (4.8%)378 (26.5%)231 (28.9%)225 (27.1%) ACUTE REJECTION 63 (5.5%)35 (2.0%)25 (1.8%)4 (0.5%)5 (0.6%) LYMPHOMA 1 (0.1%)47 (2.7%)32 (2.2%)11 (1.4%)27 (3.3%) MALIGNANCY, OTHER 1 (0.1%)44 (2.6%)78 (5.5%)60 (7.5%)70 (8.4%) CMV 065 (3.8%)20 (1.4%)4 (0.5%)3 (0.4%) INFECTION, NON-CMV 245 (21.4%)639 (37.2%)352 (24.6%)162 (20.3%)150 (18.1%) GRAFT FAILURE 331 (28.9%)307 (17.9%)244 (17.1%)137 (17.1%)127 (15.3%) CARDIOVASCULAR 121 (10.6%)72 (4.2%)50 (3.5%)36 (4.5%)46 (5.5%) TECHNICAL 96 (8.4%)44 (2.6%)11 (0.8%)2 (0.3%)3 (0.4%) OTHER 283 (24.7%)382 (22.2%)238 (16.7%)153 (19.1%)173 (20.9%) ISHLT 2005 J Heart Lung Transplant 2005;24:


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