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LUNG TRANSPLANTATION Overall ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983.

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Presentation on theme: "LUNG TRANSPLANTATION Overall ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983."— Presentation transcript:

1 LUNG TRANSPLANTATION Overall ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

2 NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE ISHLT 2008 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. 14 15 45 83 189 418 707 923 1087 1229 1366 1375 1461 1457 1481 1574 1615 1788 2196 2168 1789 1924 J Heart Lung Transplant 2008;27: 937-983

3 AVERAGE CENTER VOLUME Lung Transplants: January 1, 2000 - June 30, 2007 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

4 DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME Lung Transplants: January 1, 2000 - June 30, 2007 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

5 LUNG TRANSPLANTS: Transplant Recipient Age by Year of Transplant ISHLT 2008 Transplants between January 1987 and June 2007 J Heart Lung Transplant 2008;27: 937-983

6 AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2007) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

7 AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA ISHLT 2008 Transplants with unknown recipient age were excluded from this tabulation. J Heart Lung Transplant 2008;27: 937-983

8 LUNG TRANSPLANTS: Donor Age by Year of Transplant ISHLT 2008 Transplants between January 1987 and June 2007 J Heart Lung Transplant 2008;27: 937-983

9 DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS (1/1985-6/2007) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

10 DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS BY ERA ISHLT 2008 Transplants with unknown donor age were excluded from this tabulation. J Heart Lung Transplant 2008;27: 937-983

11 LUNG TRANSPLANTATION Adult Recipients ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

12 AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS (1/1985-6/2007) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

13 AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA ISHLT 2008 Mean age by era 1985-1995 = 45.0 years 1996-6/2006 = 49.1 years J Heart Lung Transplant 2008;27: 937-983

14 AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA ISHLT 2008 Mean age by era 1985-1994 = 44.7 years 1995-1999 = 47.3 years 2000-6/2007 = 49.8 years J Heart Lung Transplant 2008;27: 937-983

15 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival (Transplants: January 1994 - June 2006) P < 0.0001 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

16 ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2007) DIAGNOSISSLT (N = 9,017)BLT (N = 10,775)TOTAL (N = 19,792) COPD/Emphysema4,549 ( 50% )2,637 ( 24% )7,186 ( 36% ) Idiopathic Pulmonary Fibrosis2,497 ( 28% )1,472 ( 14% )3,969 ( 20% ) Cystic Fibrosis169 ( 1.9% )3,049 ( 28% )3,218 ( 16% ) Alpha-1644 ( 7.1% )865 ( 8.0% )1,509 ( 7.6% ) Primary Pulmonary Hypertension67 ( 0.7% )622 ( 5.8% )689 ( 3.5% ) Sarcoidosis191 ( 2.1% )324 ( 3.0% )515 ( 2.6% ) Bronchiectasis35 ( 0.4% )519 ( 4.8% )554 ( 2.8% ) LAM64 ( 0.7% )130 ( 1.2% )194 ( 1.0% ) Congenital Heart Disease17 ( 0.2% )138 ( 1.3% )155 ( 0.8% ) Re-Transplant: Obliterative Bronchiolitis 124 ( 1.4% )109 ( 1.0% )233 ( 1.2% ) Obliterative Bronchiolitis (Not Re-Transplant) 48 ( 0.5% )114 ( 1.1% )162 ( 0.8% ) Re-Transplant: Not Obliterative Bronchiolitis 93 ( 1.0% )81 ( 0.8% )174 ( 0.9% ) Connective Tissue Disease61 ( 0.7% )92 ( 0.9% )153 ( 0.8% ) Interstitial Pneumonitis29 ( 0.3% )16 ( 0.1% )45 ( 0.2% ) Cancer6 ( 0.1% )13 ( 0.1% )19 ( 0.1% ) Other423 ( 4.7% )594 ( 5.5% )1,017 ( 5.1% ) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

17 ADULT LUNG TRANSPLANTATION: Distribution of Procedure Type for Major Indications (1992-2006) ISHLT 2008 Year of TX Alpha-1COPDCystic FibrosisIPFPPH DoubleSingleDoubleSingleDoubleSingleDoubleSingleDoubleSingle 199227.073.015.784.397.03.010.389.726.373.7 199338.161.915.584.594.85.216.583.553.846.2 199441.758.317.982.185.814.214.086.064.635.4 199543.756.320.979.189.510.527.972.190.59.5 199644.355.726.673.487.013.026.673.482.018.0 199745.754.326.773.392.87.222.277.890.010.0 199847.352.728.971.192.57.520.179.986.813.2 199947.352.727.172.990.59.523.176.986.014.0 200057.142.928.471.695.05.032.667.492.08.0 200158.941.127.672.494.55.528.771.390.79.3 200253.546.537.262.896.43.635.164.988.311.7 200365.134.939.960.196.13.940.959.194.55.5 200472.127.943.556.596.23.843.456.693.96.1 200575.524.548.052.097.82.245.654.488.111.9 200676.423.657.442.699.10.949.250.8100.00.0 J Heart Lung Transplant 2008;27: 937-983

18 ADULT LUNG TRANSPLANTATION Procedure Type within Indication, by Year 2008 ISHLT J Heart Lung Transplant 2008;27: 937-983

19 ADULT LUNG TRANSPLANTATION: Indications for Single Lung Transplants (Transplants: January 1995 - June 2007) ISHLT 2008 *Other includes: Sarcoidosis: 2.1% Bronchiectasis: 0.4% Congenital Heart Disease: 0.2% LAM: 0.7% OB (non-ReTx): 0.5% Miscellaneous:5.8% J Heart Lung Transplant 2008;27: 937-983

20 ADULT LUNG TRANSPLANTATION: Indications for Bilateral/Double Lung Transplants (Transplants: January 1995 - June 2007) ISHLT 2008 *Other includes: Sarcoidosis: 3.0% Bronchiectasis: 4.8% Congenital Heart Disease: 1.3% LAM: 1.2% OB (non-ReTx): 1.1% Miscellaneous:6.6% J Heart Lung Transplant 2008;27: 937-983

21 ADULT LUNG TRANSPLANTATION Indications By Year (%) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

22 ADULT LUNG TRANSPLANTATION Indications By Year (Number) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

23 ADULT LUNG TRANSPLANTS: AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2007 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

24 ADULT LUNG TRANSPLANTS: DIAGNOSIS DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2007 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

25 ADULT LUNG TRANSPLANTS: DONOR AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2007 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

26 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Era (Transplants: January 1988 – June 2006) Survival comparisons by era 1988-94 vs. 1995-99: p = 0.0009 1988-94: vs. 2000-6/06: p <0.0001 1995-99 vs. 2000-6/06: p <0.0001 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

27 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: January 1990 – June 2006) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

28 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: January 1990 – June 2006) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

29 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2006) Year ALPHA-1 (N=1,925) CF (N=3,275) COPD (N=7,760) IPF (N=3,931) PPH (N=970) SARCOIDOSIS (N=506) 177.981.882.172.567.269.9 363.966.26557.15756.5 554.1565044.648.550.8 74448.337.433.841.542.7 1031.238.621.821.13031 Survival comparisons Alpha-1 vs. CF: p = 0.0003 CF vs. COPD: p < 0.0001 Alpha-1 vs. COPD: p = 0.0009CF vs. IPF: p < 0.0001 Alpha-1 vs. IPF: p < 0.0001CF vs. PPH: p < 0.0001 Alpha-1 vs. PPH: p = 0.0027 CF vs. Sarcoidosis: p < 0.0001 Alpha-1 vs. Sarcoidosis p = 0.0263COPD vs. IPF: p <0.0001 Note: Other comparisons are not statistically different. ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

30 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 3 Months (Transplants: January 1990 – June 2006) Year ALPHA-1 (N=1,655) CF (N=2,851) COPD (N=6,892) IPF (N=3,197) PPH (N=697) SARCOIDOSIS (N=410) 189.391.190.286.490.884.2 373.273.871.46876.968 56262.454.953.265.461.1 750.553.841.140.356.151.4 1035.84323.925.140.537.3 Survival comparisons Alpha-1 vs. CF: p = 0.0081 CF vs. Sarcoidosis : p = 0.0137 Alpha-1 vs. COPD: p < 0.0001 PPH vs. COPD: p < 0.0001 Alpha-1 vs. IPF: p < 0.0001 PPH vs. IPF: p < 0.0001 Alpha-1 vs. PPH: p = 0.0094 PPH vs. Sarcoidosis: p = 0.0105 CF vs. COPD: p < 0.0001 COPD vs. IPF: p = 0.0319 CF vs. IPF: p < 0.0001 IPF vs. Sarcoidosis: p = 0.0252 Note: Other comparisons are not statistically different. ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

31 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2006) Year ALPHA-1 (N=1,442) CF (N=2,475) COPD (N=5,983) IPF (N=2,595) PPH (N=616) SARCOIDOSIS (N=319) 110099.810099.999.8100 38280.979.178.684.680.8 569.468.460.861.57272.6 756.558.945.546.661.761.1 1040.147.226.52944.644.3 Survival comparisons Alpha-1 vs. IPF: p < 0.0001 Alpha-1 vs. COPD: p < 0.0001 Alpha-1 vs. PPH: p = 0.0200CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001PPH vs. COPD: p < 0.0001 PPH vs. IPF: p < 0.0001COPD vs. Sarcoidosis: p = 0.0001 IPF vs. Sarcoidosis: p = 0.0006 Note: Other comparisons are not statistically different. ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

32 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis (Transplants: January 1990 – June 2006) ISHLT 2008 Survival comparisons Alpha-1 vs. CF: p = 0.0003 Alpha-1 vs. COPD p = 0.0009 Alpha-1 vs. IPF p < 0.0001 Alpha-1 vs. PPH: p = 0.0027 Alpha-1 vs. Sarcoidosis: p = 0.0263 CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001 CF vs. PPH: p < 0.0001 CF vs. Sarcoidosis: p < 0.0001 COPD vs. IPF: p <0.0001 J Heart Lung Transplant 2008;27: 937-983

33 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 3 Months (Transplants: January 1990 – June 2006) ISHLT 2008 Survival comparisons Alpha-1 vs. CF: p = 0.0081 Alpha-1 vs. IPF: p < 0.0001 Alpha-1 vs. COPD: p < 0.0001 Alpha-1 vs. PPH: p = 0.0094 CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001 CF vs. Sarcoidosis: p = 0.0137 PPH vs. COPD: p < 0.0001 PPH vs. IPF: p < 0.0001 PPH vs. Sarcoidosis: p = 0.0105 COPD vs. IPF: p = 0.0319 IPF vs. Sarcoidosis: p = 0.0252 J Heart Lung Transplant 2008;27: 937-983

34 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1990 – June 2006) ISHLT 2008 Survival comparisons Alpha-1 vs. IPF: p < 0.0001 Alpha-1 vs. COPD: p < 0.0001 Alpha-1 vs. PPH: p=0.0200 CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001 PPH vs. COPD: p < 0.0001 PPH vs. IPF: p < 0.0001 COPD vs. Sarcoidosis: p = 0.0001 IPF vs. Sarcoidosis: p = 0.0006 J Heart Lung Transplant 2008;27: 937-983

35 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival for Eisenmengers Syndrome (Transplants: January 1990 – June 2006) ISHLT 2008 p = 0.0860 N at risk= 35 N at risk = 14 J Heart Lung Transplant 2008;27: 937-983

36 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Procedure Type (Transplants: January 1990 – June 2006) Diagnosis: Alpha-1 Antitrypsin Deficiency P = 0.0012 ISHLT 2008 N at risk = 80 N at risk = 106 N at risk at 5 years = 354 N at risk at 5 years = 303 J Heart Lung Transplant 2008;27: 937-983

37 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival By Procedure Type and Age (Transplants: January 1990 – June 2006) Diagnosis: Alpha-1 Antitrypsin Deficiency ISHLT 2008 N at risk at 10 years: Single Lung, <50 = 67; Double Lung, <50 = 65; Single Lung, 50+ = 39; Double Lung, 50+ = 15 p = 0.0654 J Heart Lung Transplant 2008;27: 937-983

38 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2006) Diagnosis: Emphysema/COPD P < 0.0001 ISHLT 2008 N at risk at 5 years = 580 N at risk at 5 years = 1,571 J Heart Lung Transplant 2008;27: 937-983

39 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Age (Transplants: January 1990 – June 2006) Diagnosis: Emphysema/COPD P < 0.0001 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

40 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2006) Diagnosis: Idiopathic Pulmonary Fibrosis P = 0.0133 ISHLT 2008 N at risk at 5 years = 196 N at risk at 5 years = 566 J Heart Lung Transplant 2008;27: 937-983

41 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2006) Diagnosis: Primary Pulmonary Hypertension P = 0.0051 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

42 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2006) Diagnosis: Emphysema/COPD, Single Lung ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

43 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2006) Diagnosis: Emphysema/COPD, Double Lung ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

44 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2006) Diagnosis: Idiopathic Pulmonary Fibrosis, Single Lung ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

45 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Procedure Type and Era (Transplants: January 1990 – June 2006) Diagnosis: Idiopathic Pulmonary Fibrosis, Double Lung ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

46 ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Donor CMV status/Recipient CMV status (Transplants: October 1999 – June 2006) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

47 ADULT LUNG TRANSPLANTS (1995-6/2006) Risk Factors for 1 Year Mortality (N=11,079) ISHLT 2008 *Other = All diagnoses other than COPD, PPH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, and LAM. J Heart Lung Transplant 2008;27: 937-983

48 ADULT LUNG TRANSPLANTS (1995-6/2006) Risk Factors for 1 Year Mortality ISHLT 2008 (N=11,079) J Heart Lung Transplant 2008;27: 937-983

49 ADULT LUNG TRANSPLANTS (1995-6/2006) Risk Factors for 1 Year Mortality ISHLT 2008 (N=11,079) J Heart Lung Transplant 2008;27: 937-983

50 ADULT LUNG TRANSPLANTS (1995-6/2006) Borderline Significant Risk Factors for 1 Year Mortality ISHLT 2008 (N=11,079) J Heart Lung Transplant 2008;27: 937-983

51 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

52 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality Recipient Age ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

53 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality Center Volume ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

54 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality Recipient Pre-Transplant Bilirubin ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

55 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality Recipient Oxygen Required at Rest ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

56 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality Recipient Pre-Transplant Cardiac Output ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

57 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality Recipient FEV1 (% predicted) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

58 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Risk Factors for 1 Year Mortality Recipient PVR ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

59 ADULT LUNG TRANSPLANTS (1995-6/2006) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality (N=4,384) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

60 ADULT LUNG TRANSPLANTS (1995-6/2006) Diagnosis = COPD/Emphysema Borderline Significant Risk Factors for 1 Year Mortality (N=4,384) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

61 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

62 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Recipient Age ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

63 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Center volume ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

64 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Recipient Oxygen Required at Rest ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

65 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Recipient Pre-Transplant Bilirubin ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

66 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = COPD/Emphysema Risk Factors for 1 Year Mortality Recipient PCO 2 at Transplant ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

67 ADULT LUNG TRANSPLANTS (1995-6/2006) Diagnosis = IPF Risk Factors for 1 Year Mortality (N=2,270) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

68 ADULT LUNG TRANSPLANTS (1995-6/2006) Diagnosis = IPF Borderline Significant Risk Factors for 1 Year Mortality (N=2,270) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

69 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = IPF Risk Factors for 1 Year Mortality ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

70 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient Age ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

71 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient Weight ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

72 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = IPF Risk Factors for 1 Year Mortality Donor Weight ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

73 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient O 2 Required at Rest ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

74 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = IPF Risk Factors for 1 Year Mortality Center volume ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

75 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = IPF Risk Factors for 1 Year Mortality Ischemia Time ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

76 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient Bilirubin ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

77 ADULT LUNG TRANSPLANTS (1/1995-6/2006) Diagnosis = IPF Risk Factors for 1 Year Mortality Recipient FEV1 (% predicted) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

78 ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 5 Year Mortality (N=6,273) ISHLT 2008 *Other = All diagnoses other than COPD, PPH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, and LAM. NOTE: COPD/Single lung is the reference group J Heart Lung Transplant 2008;27: 937-983

79 ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 5 Year Mortality (N=6,273) ISHLT 2008 *Other = All diagnoses other than COPD, PPH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, and LAM. J Heart Lung Transplant 2008;27: 937-983

80 ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 5 Year Mortality (N=6,273) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

81 ADULT LUNG TRANSPLANTS (1995-6/2002) Borderline Significant Risk Factors for 5 Year Mortality (N=6,273) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

82 ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

83 ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Recipient Age ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

84 ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Donor Age ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

85 ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Oxygen Required at Rest ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

86 ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Center Volume ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

87 ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Pre-Transplant Recipient Body Surface Area ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

88 ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Donor Height ISHLT 2008 NOTE: Results should be considered in the context of height ratio (next slide) J Heart Lung Transplant 2008;27: 937-983

89 ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Donor/Recipient Height Ratio ISHLT 2008 NOTE: Results should be considered in the context of donor height (previous slide) J Heart Lung Transplant 2008;27: 937-983

90 ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=4,735) ISHLT 2008 NOTE: COPD/single lung is the reference group. J Heart Lung Transplant 2008;27: 937-983

91 ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=4,735) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

92 ADULT LUNG TRANSPLANTS (1995-6/2002) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=4,735) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

93 ADULT LUNG TRANSPLANTS (1995-6/2002) Borderline Significant Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year (N=4,735) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

94 ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

95 ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Recipient Age ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

96 ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Donor/Recipient Weight Ratio ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

97 ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Donor Height ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

98 ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Center Volume ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

99 ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Recipient BSA ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

100 ADULT LUNG TRANSPLANTS (1/1995-6/2002) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival Recipient Pre-Transplant FEV1 ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

101 ADULT LUNG RECIPIENTS Functional Status of Surviving Recipients (Follow-ups: April 1994 – June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

102 ADULT LUNG RECIPIENTS Employment Status of Surviving Recipients (Follow-ups: April 1994 – June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

103 ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients (Follow-ups: April 1994 - June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

104 ADULT LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2002 - June 2007) Analysis limited to patients receiving prednisone ISHLT 2008 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

105 ADULT LUNG RECIPIENTS Induction Immunosuppression (Transplants: January 2000 - December 2006) Analysis limited to patients receiving prednisone ISHLT 2008 Any Induction Polyclonal ALG/ATG IL2R-antagonist Campath Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

106 SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: April 1994-June 2006) Conditional on survival to 14 days ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

107 SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: January 2000-June 2006) Conditional on survival to 14 days ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

108 ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2002 through June 2007 Analysis limited to patients receiving prednisone NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT 2008 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

109 ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2002 through June 2007 Analysis limited to patients receiving prednisone NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT 2008 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

110 ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up For follow-ups between January 2002 through June 2007 Analysis limited to patients receiving prednisone 1 Year Follow-up (N = 5,001)5 Year Follow-up (N = 2,178) NOTE: Different patients are analyzed in Year 1 and Year 5 ISHLT 2008 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

111 ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2002 through June 2007 Conventional Combinations Analysis limited to patients receiving prednisone ISHLT 2008 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

112 ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up For follow-ups between January 2002 through June 2007 Other Combinations Analysis limited to patients receiving prednisone ISHLT 2008 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

113 PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION IN 1ST YEAR Stratified by Type of Induction (Follow-ups: July 1, 2004 - June 30, 2007) ISHLT 2008 No induction: N = 1,897 Polyclonal: N = 358 IL2R- antagonist: N = 1,186 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

114 PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION IN 1ST YEAR Stratified by Type of Induction (Follow-ups: July 1, 2004 - June 30, 2007) ISHLT 2008 18-34: N = 528 35-49: N = 676 50-59: N = 1,356 60-65: N = 877 66+: N = 177 Female: N = 1,684 Male: N = 1,930 18-3435-4950-5960-6566+FemaleMale 18-34: no induct vs. IL2 (p=0.041); poly vs. IL2R (p=0.009); 35-49: poly vs. IL2R (p =0.020); 50-59: no induct vs. IL2R (p<0.0001); 60-65: no induct vs. poly (p=0.044); no induct vs. IL2R (p=0.016); 66+: no induct vs. IL2R (p=0.004). For female: no induct vs. IL2R (p<0.0001) For male: no induct vs.IL2R (p<0.0001); poly vs. IL2R (p = 0.002) Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

115 PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Follow-ups: July 1, 2004 - June 30, 2007) all comparisons were statistically significant at 0.05 except TAC + MMF vs. TAC+ AZA ISHLT 2008 Cyclosporine + MMF: N = 330 Cyclosporine + AZA: N = 551 Tacrolimus + MMF: N = 1,297 Tacrolimus + AZA: N = 898 Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

116 PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS EXPERIENCING REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Follow-ups: July 1, 2004 - June 30, 2007) 18-34: CyA + MMF vs. Cya + AZA (p=0.039); CyA + AZA vs. TAC + MMF (p=0.0001); CyA + AZA vs. TAC + AZA (p=0.002) 35-49: all comparisons are statistically significant at 0.05 except CyA + MMF vs. Cya + AZA and TAC + MMF vs. TAC + AZA 50-59: all comparisons were statistically significant at 0.01 except TAC + MMF vs. TAC + AZA 60-65: all comparisons are statistically significant at 0.05 except CyA + MMF vs. TAC + AZA and TAC + MMF vs. TAC + AZA 66+: CyA + AZA vs. TAC + MMF (p <0.0001); CyA + AZA vs. TAC + AZA (p=0.011) Females: all comparisons were statistically significant at 0,05 except TAC + MMF vs. TAC + AZA Males: all comparisons were statistically significant at 0.01 except TAC + MMF vs. TAC + AZA ISHLT 2008 18-3435-4950-5960-65 66+ Female Male Analysis is limited to patients who were alive at the time of the follow-up J Heart Lung Transplant 2008;27: 937-983

117 POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April 1994 - June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

118 POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 and 5 Years Post-Transplant (Follow-ups: April 1994 - June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

119 POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 10 Years Post-Transplant (Follow-ups: April 1994 - June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

120 FREEDOM FROM BRONCHIOLITIS OBLITERANS For Adult Lung Recipients (Follow-ups: April 1994-June 2007) Conditional on Survival to 14 days ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

121 FREEDOM FROM BRONCHIOLITIS OBLITERANS STRATIFIED BY INDUCTION USE For Adult Lung Recipients Follow-ups: April 1994-June 2007) Conditional on Survival to 14 days ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

122 FREEDOM FROM SEVERE RENAL DYSFUNCTION * For Adult Lung Recipients (Follow-ups: April 1994-June 2007) * Severe renal dysfunction = Creatinine > 2.5 mg/dl (221 μmol/L), dialysis or renal transplant ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

123 MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTS Cumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2007) Malignancy/Type1-Year Survivors5-Year Survivors10-Year Survivors No Malignancy 10,279 (96.4%)2,514 (87.7%)268 (72.2%) Malignancy (all types combined) 386 (3.6%)351 (12.3%)103 (27.8%) Malignancy Type* Skin 9419465 Lymph 1736321 Other 9911029 Type Not Reported 20112 * 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 2008 J Heart Lung Transplant 2008;27: 937-983

124 FREEDOM FROM MALIGNANCY For Adult Lung Recipients (Follow-ups: April 1994-June 2007) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983

125 ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January 1992- June 2007) CAUSE OF DEATH 0-30 Days (N = 1,622) 31 Days – 1 Year (N = 2,781) >1 Year – 3 Years (N = 2,481) >3 Years – 5 Years (N = 1,445) >5 Years – 10 Years (N = 1,592) >10 Years (N = 310) BRONCHIOLITIS8 (0.5%)129 (4.6%)648 (26.1%)412 (28.5%)394 (24.7%)62 (20.0%) ACUTE REJECTION70 (4.3%)50 (1.8%)40 (1.6%)10 (0.7%)11 (0.7%)0 LYMPHOMA1 (0.1%)74 (2.7%)56 (2.3%)26 (1.8%)41 (2.6%)15 (4.8%) MALIGNANCY, OTHER2 (0.1%)71 (2.6%)145 (5.8%)114 (7.9%)151 (9.5%)22 (7.1%) CMV086 (3.1%)25 (1.0%)5 (0.3%)3 (0.2%)0 INFECTION, NON-CMV330 (20.3%)1,011 (36.4%)578 (23.3%)278 (19.2%)292 (18.3%)59 (19.0%) GRAFT FAILURE458 (28.2%)504 (18.1%)462 (18.6%)274 (19.0%)286 (18.0%)61 (19.7%) CARDIOVASCULAR180 (11.1%)109 (3.9%)77 (3.1%)63 (4.4%)76 (4.8%)17 (5.5%) TECHNICAL134 (8.3%)63 (2.3%)16 (0.6%)4 (0.3%)11 (0.7%)4 (1.3%) OTHER439 (27.1%)684 (24.6%)434 (17.5%)259 (17.9%)327 (20.5%)70 (22.6%) ISHLT 2008 J Heart Lung Transplant 2008;27: 937-983


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