LUNG TRANSPLANTATION
Overall
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE
0
200
400
600
800
1000
1200
1400
1600
1800
Num
ber o
f Tra
nspl
ants
Bilateral/Double LungSingle Lung
15 15 48 89192
415
706
9081079
12021323
13401472
14501478
15521599
17251699
ISHLT 2006NOTE: 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.
1815
J Heart Lung Transplant 2006;25:880-892
AVERAGE CENTER VOLUMELung Transplants: January 1, 1998 - June 30, 2005
61
33 31
16 113 30
10
20
30
40
50
60
1-4 5-9 10-19 20-29 30-39 40-49 50+Average number of lung transplants per year
Num
ber o
f cen
ters
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
DISTRIBUTION OF TRANSPLANTS BY CENTER VOLUME
Lung Transplants: January 1, 1998 - June 30, 2005
4.39.2
26.922.2 19.5
8 9.9
0
5
10
15
20
25
30
35
1-4/yr 5-9/yr 10-19/yr 20-29/yr 30-39/yr 40-49/yr 50+/yrAverage number of lung transplants per year
Perc
enta
ge o
f tra
nspl
ants
.
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
LUNG TRANSPLANTS: Donor Age by Year of Transplant
0%
20%
40%
60%
80%
100%
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year of Transplant
% o
f Tra
nspl
ants
0-11 12-17 18-34 35-49 50-59 60+
0
5
10
15
20
25
30
35
40
Mea
n do
nor a
ge (y
ears
)
Mean Age
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2005)
0
5
10
15
20
25
30
35
0-11 12-17 18-29 30-39 40-49 50-59 60-64 65+
Recipient Age
% o
f tra
nspl
ants
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA
05
10152025303540
0-11 12-17 18-29 30-39 40-49 50-59 60-64 65+
% o
f tra
nspl
ants
1985-1994 (N = 4,622)1995-1999 (N=7,071)2000-6/2005 (N=9,201)
p < 0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
LUNG TRANSPLANTATION
Adult Recipients
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS (1/1985-6/2005)
0
5
10
15
20
25
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+
Recipient Age
% o
f tra
nspl
ants
.
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA
0
5
10
15
20
25
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+
% o
f tra
nspl
ants
.
1985-1995 (N = 5,642)1996-6/2005 (N =14,262 )
p < 0.0001
ISHLT 2006
Mean age by era1985-1995 = 44.9 years1996-6/2005 = 48.3 years
J Heart Lung Transplant 2006;25:880-892
AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA
0
5
10
15
20
25
18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+
% o
f tra
nspl
ants
.
1985-1994 (N=4,392)1995-1999 (N=6,668)2000-6/2005 (N=8,844)
p < 0.0001
ISHLT 2006
Mean age by era1985-1994 = 44.6 years1995-1999 = 47.3 years2000-6/2005 = 48.8 years
J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1994 - June 2004)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10Years
Surv
ival
(%)
.
Bilateral/Double Lung (N=7,218)Single Lung (N=7,724)All Lungs (N=15,047)
Double lung: 1/2-life = 5.6 Years; Conditional 1/2-life = 8.5 YearsSingle lung: 1/2-life = 4.3 Years; Conditional 1/2-life = 6.3 YearsAll lungs: 1/2-life = 4.8 Years; Conditional 1/2-life = 7.0 Years
P < 0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2005)DIAGNOSIS SLT (N = 6,663) BLT (N = 6,789) TOTAL (N = 13,452)
COPD/Emphysema 3,511 (53%) 1,636 (24%) 5,147 (38%)
Idiopathic Pulmonary Fibrosis 1,731 (26%) 813 (12.0%) 2,544 (19%)
Cystic Fibrosis 159 (2.4%) 2,009 (30%) 2,168 (16%)
Alpha-1 446 (7.0%) 597 (8.8%) 1,063 (7.9%)
Primary Pulmonary Hypertension 64 (1.0%) 461 (6.8%) 525 (3.9%)
Sarcoidosis 141 (2.1%) 195 (2.9%) 336 (2.5%)
Bronchiectasis 25 (0.4%) 328 (4.8%) 353 (2.6%)
LAM 54 (0.8%) 88 (1.3%) 142 (1.1%)
Congenital Heart Disease 13 (0.2%) 115 (1.7%) 128 (1.0%)
Re-Transplant: Obliterative Bronchiolitis
74 (1.1%) 71 (1.0%) 145 (1.1%)
Obliterative Bronchiolitis (Not Re-Transplant)
44 (0.7%) 77 (1.1%) 121 (0.9%)
Re-Transplant: Not Obliterative Bronchiolitis
65 (1.0%) 52 (0.8%) 117 (0.9%)
Connective Tissue Disease 37 (0.6%) 45 (0.7%) 82 (0.6%)
Interstitial Pneumonitis 20 (0.3%) 10 (0.1%) 30 (0.2%)
Cancer 6 (0.1%) 10 (0.1%) 16 (0.1%)
Other 253 (3.8%) 282 (4.2%) 535 (4.0%)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATION: Distribution of Procedure Type for Major Indications (1990-2004)
ISHLT 2006
Year of TX
Alpha-1 COPD Cystic Fibrosis IPF PPHDouble Single Double Single Double Single Double Single Double Single
1990 31.9 68.1 23.0 77.0 94.7 5.3 1.8 98.2 15.4 84.61991 20.9 79.1 14.9 85.1 95.7 4.3 15.1 84.9 23.8 76.21992 27.2 72.8 17.2 82.8 96.8 3.2 9.6 90.4 25.7 74.31993 34.1 65.9 15.8 84.2 93.8 6.2 16.7 83.3 51.6 48.41994 35.2 64.8 18.3 81.7 83.1 16.9 13.6 86.4 61.0 39.01995 48.0 52.0 20.2 79.8 88.3 11.7 26.9 73.1 89.6 10.41996 46.6 53.4 26.2 73.8 85.0 15.0 26.8 73.2 81.5 18.51997 46.7 53.3 28.1 71.9 92.1 7.9 21.9 78.1 88.7 11.31998 50.4 49.6 29.4 70.6 91.8 8.2 19.7 80.3 84.8 15.21999 48.3 51.7 27.7 72.3 89.1 10.9 22.1 77.9 83.3 16.72000 57.9 42.1 27.7 72.3 94.1 5.9 31.2 68.8 91.3 8.72001 59.8 40.2 26.8 73.2 93.5 6.5 26.0 74.0 89.4 10.62002 57.1 42.9 38.6 61.4 95.6 4.4 35.8 64.2 86.8 13.22003 68.1 31.9 38.7 61.3 95.4 4.6 39.1 60.9 93.5 6.52004 75.6 24.4 41.5 58.5 95.4 4.6 43.3 56.7 95.2 4.8
J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONProcedure Type within Indication, by Year
0
10
20
30
40
50
60
70
80
90
10019
9319
9419
9519
9619
9719
9819
9920
0020
0120
0220
0320
04
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
% o
f tra
nspl
ants
Bilateral/Double Lung Transplant Single Lung Transplant
AT Def COPD IPF PPH
2006
J Heart Lung Transplant 2006;25:880-892
ISHLT
ADULT LUNG TRANSPLANTATION: Indications for Single Lung Transplants (Transplants: January 1995 - June 2005)
53%
26%
2%1%
2%
7%
9%
Alpha-1 COPD CF IPF PPH Re-TX Other*
ISHLT 2006
*Other includes:
Sarcoidosis: 2.1%
Bronchiectasis: 0.4%
Congenital Heart Disease: 0.2%
LAM: 0.8%
OB (non-ReTx): 0.7%
Miscellaneous: 4.8%
J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATION: Indications for Bilateral/Double Lung Transplants (Transplants: January 1995 - June 2005)
24%
12%
17%
7%
29%
9%
2%
Alpha-1 COPD CF IPF PPH Other* Re-Tx
ISHLT 2006
*Other includes:
Sarcoidosis: 2.9%
Bronchiectasis: 4.8%
Congenital Heart Disease: 1.7%
LAM: 1.3%
OB (non-ReTx): 1.1%
Miscellaneous: 0.9%
J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONIndications By Year (%)
0
20
40
60
80
100
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Transplant Year
% o
f Tra
nspl
ants
Cystic Fibrosis IPF Emphysema A1A PPH
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONIndications By Year (Number)
0
250
500
750
1000
1250
Transplant Year
Num
ber o
f Tra
nspl
ants
Cystic Fibrosis IPF Emphysema A1A PPH
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Era (Transplants: January 1988 – June 2004)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Surv
ival
(%)
.
1988-1994 (N=4,345)1995-1999 (N=6,668)2000-6/2004 (N=7,217)
1988-1994: 1/2-life = 3.9 Years; Conditional 1/2-life = 7.0 Years1995-1999: 1/2-life = 4.5 Years; Conditional 1/2-life = 7.0 Years2000-6/2004: 1/2-life = 5.0 Years; Conditional 1/2-life = 5.3 Years
Survival comparisons by era1988-94 vs. 1995-99: p = 0.02941988-94: vs. 2000-6/03: p <0.0001 1995-99 vs. 2000-6/03: p <0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Age Group (Transplants: January 1990 – June 2004)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Surv
ival
(%)
.
18-34 (N= 3,298)35-49 (N= 5,413)50-59 (N= 6,370)60-64 (N= 2,320)65+ (N= 567)
Survival comparisons18-34 vs. 50-59: p <0.000118-34 vs. 60-64 and vs. 65+ : p < 0.000135-49 vs. 50-59, 60-64 and 65+: p < 0.000150-59 vs. 60-64: p < 0.000150-59 vs. 65+: p < 0.0001
HALF-LIFE 18-34: 5.0 Years; 35-49: 5.5 Years; 50-59: 4.6 Years; 60-64: 3.8 Years; 65+: 3.4 Years
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Gender (Transplants: January 1994 – June 2004)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Surv
ival
(%)
Male (N=7,851)
Female (N=7,182)
HALF-LIFE Male: 4.8 years; Female: 5.1 Years
p = 0.1074
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1994 – June 2004)
Year ALPHA-1 (N=1,074)
CF (N=1,970)
COPD (N=4,989)
IPF (N=2,318)
PPH (N=557)
SARCOIDOSIS (N=312)
1 76.7 80.4 81.8 71.2 65.8 67.8
3 61.3 65.5 64.0 55.0 56.6 54.9
5 51.2 54.1 48.7 43.1 46.7 49.5
7 41.1 44.9 35.7 33.0 38.5 44.5
10 31.5 33.9 18.8 18.7 26.9 37.1
Survival comparisonsAlpha-1 vs. CF: p = 0.0327 CF vs. IPF: p < 0.0001Alpha-1 vs. IPF: p <0.0001 CF vs. Sarcoidosis: p = 0.0041Alpha-1 vs. PPH: p = 0.0032 PPH vs. COPD: p = 0.0162CF vs. COPD: p < 0.0001 COPD vs. IPF: p <0.0001
Note: Other comparisons are not statistically different.
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on
Survival to 3 Months (Transplants: January 1994 – June 2004)
Year ALPHA-1 (N=905)
CF (N= 1,668)
COPD (N= 4,402)
IPF (N= 1,848)
PPH (N= 393)
SARCOIDOSIS (N=243)
1 88.4 90.9 90.2 86.1 90.0 84.2
3 70.7 74.0 70.6 66.5 77.3 68.2
5 59.1 61.2 53.7 52.1 63.8 61.5
7 47.4 50.7 39.4 39.9 52.6 55.3
10 36.3 38.3 20.7 22.6 36.8 46.1
Survival comparisonsAlpha-1 vs. IPF: p = 0.0004 Alpha-1 vs. COPD: p = 0.0021CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001PPH vs. COPD: p < 0.0001 PPH vs. IPF: p < 0.0001IPF vs. Sarcoidosis: p = 0.0222Note: Other comparisons are not statistically different.
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year (Transplants: January 1994 – June 2004)
Year ALPHA-1 (N=772)
CF (N=1,438)
COPD (N= 3,820)
IPF (N=1,510)
PPH (N= 341)
SARCOIDOSIS (N=196)
1 100.0 100.0 100.0 100.0 100.0 100.0
3 80.0 81.2 78.3 77.2 85.9 81.0
5 66.8 67.1 59.6 60.5 70.9 73.1
7 53.6 55.7 43.6 46.3 58.5 65.7
10 41.0 42.0 23.0 26.2 40.9 54.8
Survival comparisonsAlpha-1 vs. IPF: p = 0.0019 Alpha-1 vs. COPD: p < 0.0001CF 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 = 0.0002 IPF vs. Sarcoidosis: p = 0.0012
Note: Other comparisons are not statistically different.
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis (Transplants: January 1994 – June 2004)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Surv
ival
(%)
Alpha-1 (N=1,074) CF (N= 1,970) COPD (N= 4,989)
IPF (N= 2,318) PPH (N= 557) Sarcoidosis (N=312)
HALF-LIFE Alpha-1: 5.3 Years; CF: 5.8 Years; COPD: 4.8 Years; IPF: 3.9 Years; PPH: 4.5 Years; Sarcoidosis: 4.9 Years
Survival comparisonsAlpha-1 vs. CF: p = 0.0327 CF vs. IPF: p < 0.0001Alpha-1 vs. IPF: p <0.0001CF vs. Sarcoidosis: p = 0.0041Alpha-1 vs. PPH: p = 0.0032PPH vs. COPD: p = 0.0162CF vs. COPD: p < 0.0001COPD vs. IPF: p <0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on
Survival to 3 Months (Transplants: January 1994 – June 2004)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Surv
ival
(%)
Alpha-1 (N=905) CF (N= 1,668)COPD (N= 4,402) IPF (N= 1,848)PPH (N= 393) Sarcoidosis (N=243)
HALF-LIFE Alpha-1: 6.5 Years; CF: 7.2 Years; COPD: 5.5 Years; IPF: 5.3 Years; PPH: 7.4 Years; Sarcoidosis: 7.0 Years
Survival comparisonsAlpha-1 vs. IPF: p = 0.0004 Alpha-1 vs. COPD: p = 0.0021CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001PPH vs. COPD: p < 0.0001 PPH vs. IPF: p < 0.0001IPF vs. Sarcoidosis: p = 0.0222
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year
(Transplants: January 1994 – June 2004)
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Surv
ival
(%)
Alpha-1 (N=772) CF (N= 1,438)COPD (N= 3,820) IPF (N= 1,510)PPH (N= 341) Sarcoidosis (N=196)
HALF-LIFE Alpha-1: 7.7 Years; CF: 8.4 Years; COPD: 6.1 Years; IPF: 6.4 Years; PPH: 8.6 Years; Sarcoidosis: 11.8 Years
Survival comparisonsAlpha-1 vs. IPF: p = 0.0019 Alpha-1 vs. COPD: p < 0.0001CF 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 = 0.0002 IPF vs. Sarcoidosis: p = 0.0012
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival for Eisenmenger’s Syndrome
(Transplants: January 1990 – June 2004)
0
25
50
75
100
0 1 2 3 4 5Years
Surv
ival
(%)
ASD (N= 120) VSD (N= 56)
HALF-LIFE ASD: 2.9 Years; VSD: 1.0 Years
ISHLT 2006
N at risk at 5 years = 35
N at risk at 5 years = 15
P=0.2787
J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Procedure Type
(Transplants: January 1990 – June 2004) Diagnosis: Alpha-1 Antitrypsin Deficiency
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Surv
ival
(%)
Alpha-1/Single lung (N=714)
Alpha-1/Double lung (N=656)P < 0.0001
ISHLT 2006N at risk at 10 years is 46 for Single Lung and 33 for Double Lung.
J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Procedure Type and Age
(Transplants: January 1990 – June 2004) Diagnosis: Alpha-1 Antitrypsin Deficiency
0
25
50
75
100
0 1 2 3 4 5Years
Surv
ival
(%)
Single Lung, < 50 (N=350) Double Lung, <50 (N =402)
Single Lung, 50+ (N = 364) Double Lung, 50+ (N = 254)
ISHLT 2006
N at risk at 5 years:
Single Lung, <50 = 125; Double Lung, <50 = 134; Single Lung, 50+ = 89; Double Lung, 50+ = 48
p = 0.0055
J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type (Transplants: January 1990 – June 2004)
Diagnosis: Emphysema/COPD
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Surv
ival
(%)
COPD/Single lung (N=4,136)
COPD/Double lung (N=1,589) N=134
N=37
P < 0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Age
(Transplants: January 1990 – June 2004) Diagnosis: Emphysema/COPD
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10
Years
Surv
ival
(%)
<50/Single lung (N=625) <50/Double lung (N=525)
50+/Single lung (N=3,511) 50+/Double lung (N=1,064) N=36N=98
N=20N=17
P < 0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type
(Transplants: January 1990 – June 2004)Diagnosis: Idiopathic Pulmonary Fibrosis
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Surv
ival
(%)
IPF/Single lung (N=1,969)
IPF/Double lung (N=703)N=50
N=9
P = 0.2038
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type
(Transplants: January 1990 – June 2004)Diagnosis: Primary Pulmonary Hypertension
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Surv
ival
(%)
PPH/Single lung (N=253)
PPH/Double lung (N=539) N=32 at 10 years
N=26 at 10 years
P = 0.1801
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2004) Diagnosis: Emphysema/COPD, Single Lung
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Surv
ival
(%)
COPD/Single lung/1990-1994 (N=925)
COPD/Single lung/1995-1999 (N=1,569)
COPD/Single lung/2000-6/2004 (N=1,642)
Survival comparisons1990-1994 vs. 1995-1999: p = 0.551990-1994 vs. 2000-6/2004: p = 0.00411995-1999 vs. 2000-6/2004: p = 0.071
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2004) Diagnosis: Emphysema/COPD, Double Lung
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Surv
ival
(%)
COPD/Double lung/1990-1994 (N=191)
COPD/Double lung/1995-1999 (N=566)
COPD/Double lung/2000-6/2004 (N=832)
Survival comparisons1990-1994 vs. 1995-1999: p = 0.19991990-1994 vs. 2000-6/2004: p = 0.48591995-1999 vs. 2000-6/2004: p = 0.0301
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2004) Diagnosis: Idiopathic Pulmonary Fibrosis, Single Lung
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Surv
ival
(%)
IPF/Single lung/1990-1994 (N=437)IPF/Single lung/1995-1999 (N=769)IPF/Single lung/2000-6/2004 (N=763)
Survival comparisons1990-1994 vs. 1995-1999: p = 0.78021990-1994 vs. 2000-6/2004: p = 0.05001995-1999 vs. 2000-6/2004: p = 0.0275
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type and Era
(Transplants: January 1990 – June 2004) Diagnosis: Idiopathic Pulmonary Fibrosis, Double Lung
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10Years
Surv
ival
(%)
IPF/Double lung/1990-1994 (N=63)IPF/Double lung/1995-1999 (N=238)
IPF/Double lung/2000-6/2004 (N=402)
Survival comparisons1990-1994 vs. 1995-1999: p = 0.97601990-1994 vs. 2000-6/2004: p = 0.00091995-1999 vs. 2000-6/2004: p < 0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTATION Kaplan-Meier Survival by Donor CMV status/Recipient CMV status
(Transplants: October 1999 – June 2004)
50
60
70
80
90
100
0 1 2 3
Years
Surv
ival
(%)
D(-)/R(-) (N=800)D(-)/R(+) (N=988)D(+)/R(-) (N=908)D(+)/R(+) (N=1,435)
Survival comparisonsD(-)/R(-) vs. D(-)/R(+): p = 0.3001D(-)/R(-) vs. D(+)/R(-): p = 0.1993D(-)/R(-) vs. D(+)/R(+): p = 0.1163D(-)/R(+) vs. D(+)/R(-): p = 0.0131D(-)/R(+) vs. D(+)/R(+): p = 0.0036D(+)/R(-) vs. D(+)/R(+): p = 0.8747
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2004) Risk Factors for 1 Year Mortality
DIAGNOSIS N
Relative Risk P-value
95% confidence
Interval PPH 474 2.66 <.0001 2.07 -3.41
Pulmonary fibrosis (not IPF) 132 2.09 <.0001 1.53 -2.84
Sarcoidosis 288 1.97 <.0001 1.57 -2.47
IPF 2151 1.50 <.0001 1.30 -1.72
Alpha-1 antitrypsin deficiency 978 1.48 <.0001 1.27 -1.73
Cystic fibrosis 1806 1.37 .0005 1.15 -1.65
Bronchiectasis 310 1.30 .0479 1.00 -1.69
Other diagnoses* 2322 1.21 .0046 1.06 -1.37
(N=13,168)ISHLT 2006
*Other = All diagnoses other than COPD, PPH, IPF, cystic fibrosis, pulmonary fibrosis, bronchiectasis, alpha-1 antitrypsin deficiency, and LAM. J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2004) Risk Factors for 1 Year Mortality
DONOR CHARACTERISTICS N
Relative Risk P-value
95% Confidence
Interval Donor history of diabetes 256 1.51 0.0006 1.19 -1.91
RECIPIENT CHARACTERISTICS
IV inotropes 80 1.90 0.0001 1.37 -2.63
Ventilator 203 1.76 <.0001 1.36 -2.29
Prior malignancy 264 1.30 0.0311 1.02 -1.64
Hospitalized (including ICU) 775 1.20 0.0249 1.02 -1.42
Prior thoracotomy 412 0.78 0.0272 0.63 -0.97
(N=13,168)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2004) Risk Factors for 1 Year Mortality
TRANSPLANT CHARACTERISTICS N Relative Risk P-value
95% Confidence
Interval Repeat transplant 339 2.12 <0.0001 1.74 -2.57
4, 5 or 6 HLA mismatches (vs. 0-3 mismatches)
11637 4,5 or 6 MM 1.22 0.0016 1.08 -1.38
Donor CMV +/ Recipient CMV - 2413 1.21 0.0001 1.10 -1.32
Transplant year = 1995/1996 vs. 1999/2000 2418 1.20 0.0011 1.08 -1.34
Female donor/female recipient 3809 0.82 0.0001 0.75 -0.91
Transplant year = 2001/2002 vs. 1999/2000 3034 0.80 0.0001 0.71 -0.90
Transplant year = 2003/2004 vs. 1999 2344 0.66 <0.0001 0.58 -0.75
(N=13,168)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality
Continuous Factors (see figures) Recipient age
Donor age
Recipient BMI
Donor weight
PVR
Transplant center volume
Bilirubin
Recipient oxygen required at rest
Recipient FEV1 % predicted
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality
Recipient Age
0
0.5
1
1.5
2
25 30 35 40 45 50 55 60 65Recipient Age
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p < 0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality
Donor Age
0
0.5
1
1.5
2
15 20 25 30 35 40 45 50 55Donor Age
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p < 0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality
Donor Weight
0
0.5
1
1.5
2
50 55 60 65 70 75 80 85 90 95Weight (kg)
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p < 0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality
Pre-Transplant Recipient BMI
0
0.5
1
1.5
2
16 20 24 28 32
Recipient BMI (kg/m2)
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p = 0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality
Center volume
0
0.5
1
1.5
2
0 10 20 30 40 50Center Volume (cases per year)
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p < 0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality
Recipient FEV1 (% predicted)
0
0.5
1
1.5
2
25 30 35 40 45 50 55 60 65 70Recipient FEV1 (% predicted)
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
P < 0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality
Recipient Pre-Transplant Bilirubin
0
0.5
1
1.5
2
0.5 0.75 1 1.25 1.5 1.75Recipient Bilirubin (mg/dl)
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p = 0.0039
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality
Recipient Oxygen Required at Rest
0
0.5
1
1.5
2
0 1 2 3 4 5Oxygen Required at Rest (L/min)
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p = 0.0021
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Risk Factors for 1 Year Mortality
Recipient PVR
0
0.5
1
1.5
2
1 2 3 4 5 6 7 8 9PVR (Wood units)
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p = 0.0009
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2003) Factors Not Significant for 1 Year MortalityRecipient factors:pCO2, transfusions, recent infection requiring IV drug therapy, diabetes, sternotomy, dialysis, FVC, creatinine, PRA, chronic steroid use
Donor factors:History of hypertension, history of cancer, cause of death, height
Transplant factors:Height ratio, BMI ratio, ischemia time
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2004) Diagnosis = COPD/EmphysemaRisk Factors for 1 Year Mortality
RECIPIENT CHARACTERISTICS N Relative
Risk P-value 95% Confidence
Interval Ventilator 33 2.97 .0001 1.70 -5.19 Hospitalized (including ICU) 159 1.46 .0337 1.03 -2.07
Chronic steroid use 1777 1.31 .0006 1.12 -1.53
TRANSPLANT CHARACTERISTICS
Repeat transplant 22 3.03 .0003 1.65 -5.55 Donor CMV +/ Recipient CMV - 721 1.30 .0037 1.09 -1.54 Transplant Year: 2001/2002 vs. 1999/2000 1134 0.77 .0129 0.62 -0.95
Transplant Year: 2003/2004 vs. 1999/2000 788 0.71 .0045 0.56 -0.90
DONOR CHARACTERISTICS
Donor history of diabetes 105 1.56 .0339 1.03 -2.35
(N=4,581)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2004) Diagnosis = COPD/Emphysema
Borderline Significant Risk Factors for 1 Year Mortality
N
Relative Risk P-value
95% Confidence
Interval
PRA > 10% 126 1.38 0.0514 1.00 -2.10
Male donor/female recipient 2373 0.86 0.0553 0.74 -1.00
(N=4,581)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004)Diagnosis = COPD/Emphysema
Risk Factors for 1 Year Mortality
Continuous Factors (see figures) Recipient age Donor weight (borderline)
Transplant center volume Recipient FEV1 % predicted
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Diagnosis = COPD/Emphysema
Risk Factors for 1 Year MortalityRecipient Age
0
0.5
1
1.5
2
40 45 50 55 60 65Recipient Age
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p < 0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Diagnosis = COPD/Emphysema
Risk Factors for 1 Year MortalityCenter volume
0
0.5
1
1.5
2
0 10 20 30 40 50Center Volume (cases per year)
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p = 0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Diagnosis = COPD/Emphysema
Risk Factors for 1 Year MortalityDonor Weight
0
0.5
1
1.5
2
50 55 60 65 70 75 80 85 90 95Weight (kg)
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p = 0.053
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Diagnosis = COPD/Emphysema
Risk Factors for 1 Year Mortality Recipient FEV1 (% predicted)
0
0.5
1
1.5
2
25 30 35 40 45Recipient FEV1 (% predicted)
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p = 0.0113
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2004) Diagnosis = Cystic Fibrosis
Risk Factors for 1 Year Mortality
RECIPIENT CHARACTERISTICS N
Relative Risk P-value
95% Confidence
Interval Prior transfusions 65 1.65 .0380 1.03 -2.64
Hospitalized (including ICU) 237 1.48 .0133 1.09 -2.02
TRANSPLANT CHARACTERISTICS
Repeat transplant 23 3.10 .0005 1.65 -5.82
(N=1,806)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2004) Diagnosis = Cystic Fibrosis
Borderline Significant Risk Factors for 1 Year Mortality
CHARACTERISTIC N
Relative Risk P-value
95% Confidence
Interval Donor cause of death = anoxia vs. head trauma 80 0.51 0.0620 0.25 -1.03
(N=1,806)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004)Diagnosis = Cystic Fibrosis
Risk Factors for 1 Year Mortality
Continuous Factors (see figures) Donor BMI (borderline) Transplant center volume
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Diagnosis = Cystic Fibrosis
Risk Factors for 1 Year MortalityCenter volume
0
0.5
1
1.5
2
0 10 20 30 40 50Center Volume (cases per year)
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p = 0.020
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Diagnosis = Cystic Fibrosis
Risk Factors for 1 Year MortalityDonor BMI
0
0.5
1
1.5
2
18 21 24 27 30
Donor BMI (kg/m2)
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p = 0.062
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2004) Diagnosis = IPF
Risk Factors for 1 Year Mortality
RECIPIENT CHARACTERISTICS N Relative Risk P-value 95% Confidence
Interval
Ventilator 37 2.41 .0004 1.49 -3.92
Prior sternotomy 63 1.59 .0305 1.04 -2.43
TRANSPLANT CHARACTERISTICS
Transplant Year: 2001/2002 vs. 1999/2000 482 0.73 .0142 0.57 -0.94
Transplant Year: 2003/2004 vs. 1999/2000 467 0.56 .0001 0.43 -0.75
Donor CMV+ / Recipient CMV- 363 1.28 .0169 1.05 -1.57
DONOR CHARACTERISTICS
Donor clinical infection 360 0.75 .03 0.59 -0.97
(N=2,151)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004)Diagnosis = IPF
Risk Factors for 1 Year Mortality
Continuous Factors (see figures) Recipient age Donor age Recipient BMI Donor weight
Transplant center volume PA diastolic pressure Oxygen required at rest Ischemia time (borderline)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Diagnosis = IPF
Risk Factors for 1 Year MortalityRecipient Age
0
0.5
1
1.5
2
35 40 45 50 55 60 65Recipient Age
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p = 0.0058
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Diagnosis = IPF
Risk Factors for 1 Year MortalityDonor Age
0
0.5
1
1.5
2
15 20 25 30 35 40 45 50 55Donor Age
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p = 0.0011
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Diagnosis = IPF
Risk Factors for 1 Year MortalityRecipient PA Diastolic Pressure
0
0.5
1
1.5
2
10 15 20 25 30PA Diastolic Pressure
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p = 0.0107
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004) Diagnosis = IPF
Risk Factors for 1 Year MortalityDonor Weight
0
0.5
1
1.5
2
55 65 75 85 95
Donor Weight (kg)
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p = 0.025
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004)Diagnosis = IPF
Risk Factors for 1 Year MortalityRecipient O2 Required at Rest
0
0.5
1
1.5
2
0 1 2 3 4 5 6
O2 Required at Rest (L/min)
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p = 0.0071
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004)Diagnosis = IPF
Risk Factors for 1 Year MortalityCenter volume
0
0.5
1
1.5
2
0 10 20 30 40 50Center Volume (cases per year)
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p = 0.011
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004)Diagnosis = IPF
Risk Factors for 1 Year MortalityRecipient BMI
0
0.5
1
1.5
2
18 21 24 27 30
Recipient BMI (kg/m2)
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p = 0.025
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2004)Diagnosis = IPF
Risk Factors for 1 Year MortalityIschemia Time
0
0.5
1
1.5
2
2 3 4 5 6 7
Ischemia time (hours)
Rela
tive
Risk
of 1
Yea
r Mor
talit
y
.
p = 0.059
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2000) Risk Factors for 5 Year Mortality
DIAGNOSIS N Relative
Risk P-value 95% Confidence
Interval Alpha-1 antitrypsin deficiency 567 1.24 0.0017 1.09 -1.42
Idiopathic pulmonary fibrosis 1102 1.22 0.0002 1.10 -1.36
LAM 66 0.56 0.0215 0.34 -0.92
RECIPIENT CHARACTERISTICS
Recipient on IV inotropes 53 1.75 0.001 1.25 -2.43
Recipient on ventilator 117 1.52 0.0018 1.17 -1.98
Recipient with prior sternotomy 160 1.37 0.0016 1.13 -1.68
Recipient history of diabetes 278 1.28 0.0028 1.09 -1.51
Hospitalized (including ICU) 480 1.18 0.0254 1.02 -1.37
(N=7,072)ISHLT 2006
J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2000) Risk Factors for 5 Year Mortality
DONOR CHARACTERISTICS N Relative Risk P-value 95% Confidence
Interval
Donor Cause of Death = Anoxia 217 0.73 0.0049 0.59 -0.91
TRANSPLANT CHARACTERISTICS
Repeat transplant 190 1.72 <0.0001 1.42 -2.10
Transplant year: 1995/1996 vs. 1999/2000 2418 1.19 <0.0001 1.10 -1.30
Donor CMV +/ Recipient CMV - 1237 1.14 0.004 1.04 -1.24
Total mismatches at the HLA A and B loci (relative risk is per mismatch)
1207 (0-2 MM) 4033 (3 MM) 1832 (4 MM)
1.08 0.0006 1.03 -1.13
Female donor/female recipient 1995 0.87 0.0033 0.79 -0.95
(N=7,072)ISHLT 2006
J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2000) Borderline Significant Risk Factors for 5 Year Mortality
VARIABLE N Relative
Risk P-value
95% Confidence
Interval
Diagnosis: PPH 288 1.30 0.0673 0.98 -1.73
(N=7,072)ISHLT 2006
J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality
Continuous Factors (see figures) Recipient age Donor age Recipient BMI Donor height
Center volume Oxygen at rest PA systolic pressure
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality
Recipient Age
0
0.5
1
1.5
2
20 25 30 35 40 45 50 55 60 65Recipient Age
Rela
tive
Risk
of 5
Yea
r Mor
talit
y
p < 0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality
Donor Age
0
0.5
1
1.5
2
15 25 35 45 55Donor Age
Rel
ativ
e R
isk
of 5
Yea
r Mor
talit
y
p < 0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality
Pre-Transplant Recipient BMI
0
0.5
1
1.5
2
17 19 21 23 25 27 29 31
Recipient BMI (kg/m2)
Rela
tive
Risk
of 5
Yea
r Mor
talit
y
p = 0.0003
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality
Donor Height
0
0.5
1
1.5
2
155 160 165 170 175 180 185 190Donor height (cm)
Rel
ativ
e R
isk
of 5
Yea
r Mor
talit
y
p = 0.0017
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality
Center Volume
0
0.5
1
1.5
2
0 10 20 30 40 50Center Volume (Cases per year)
Rel
ativ
e R
isk
of 5
Yea
r Mor
talit
y
p = 0.0002
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality
Recipient PA Systolic Pressure
0
0.5
1
1.5
2
25 30 35 40 45 50 55 60 65 70Recipent PA systolic pressure (mm Hg)
Rel
ativ
e R
isk
of 5
Yea
r Mor
talit
y
p = 0.028
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality
Oxygen Required at Rest
0
0.5
1
1.5
2
0 1 2 3 4 5Oxygen required at rest (L/min)
Rel
ativ
e R
isk
of 5
Yea
r Mor
talit
y
p = 0.024
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2000) Factors Not Significant for 5 Year Mortality
Recipient factors:Chronic steroid use, transfusions, history of malignancy, cardiac output, PRA, FVC, FEV1, PCO2, 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:Ischemia time
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2000) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
DIAGNOSIS N Relative
Risk P-value
95% Confidence
Interval
Cystic Fibrosis vs. COPD 739 0.75 0.0119 0.59 -0.94
LAM vs. COPD 51 0.34 0.0096 0.15 -0.77
(N=5,111)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2000) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
DONOR, RECIPIENT AND TRANSPLANT CHARACTERISTICS N
Relative Risk P-value
95% Confidence
Interval Donor cause of death = anoxia vs. head trauma 168 0.6 0.0013 0.44 -0.82
Recipient sternotomy prior to transplant 100 1.53 0.0032 1.15 -2.03
Recipient diabetes 193 1.37 0.0069 1.09 -1.73
Transplant year: 1995/1996 vs. 1999/2000 1695 1.21 0.0022 1.07 -1.37
2 mismatches at HLA A locus 1768 1.14 0.0096 1.03 -1.26
(N=5,111)ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2000) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year
POST-TRANSPLANT FACTORS N Relative
Risk P-value
95% Confidence
Interval
Bronchiolitis obliterans within 1st year 264 2.26 <0.0001 1.89 -2.69
Dialysis prior to discharge 60 1.49 .0311 1.04 -2.14
Rejection between discharge and 1 year 1145 1.25 .0002 1.11 -1.41
Drug-treated infection prior to discharge 1397 1.23 .0002 1.11 -1.37
(N=5,111)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2000) Borderline Significant Risk Factors for 5 Year Mortality
Conditional on Survival to 1 Year
CHARACTERISTICS N Relative
Risk P-value
95% Confidence
Interval
Double/bilateral procedure vs. single lung 2440 0.89 0.0686 0.79 -1.01
Diagnosis = PPH vs. COPD 167 0.76 0.0907 0.55 -1.04
(N=5,111)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year
Continuous Factors (see figures)
Recipient Age
Donor Age
Recipient BMI
Donor Height (borderline)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival
Recipient Age
0
0.5
1
1.5
2
25 30 35 40 45 50 55 60 65Recipient Age
Rel
ativ
e R
isk
of 5
Yea
r Mor
talit
y
p < 0.0001
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival
Donor Age
0
0.5
1
1.5
2
15 25 35 45 55Donor Age
Rel
ativ
e R
isk
of 5
Yea
r Mor
talit
y
p = 0.0012
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival
Recipient BMI
0
0.5
1
1.5
2
17 19 21 23 25 27 29 31Recipient BMI (kg/m2)
Rel
ativ
e R
isk
of 5
Yea
r Mor
talit
y
p = 0.025
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1/1995-6/2000) Risk Factors for 5 Year Mortality Conditional on 1 Year Survival
Donor Height
0
0.5
1
1.5
2
155 160 165 170 175 180 185 190Donor height (cm)
Rel
ativ
e R
isk
of 5
Yea
r Mor
talit
y
p = 0.060
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2000) Factors Not Significant for Conditional 5 Year Mortality
Recipient factors:Ventilator, inotropes, hospitalized at transplant, pCO2, gender, chronic steroid use, transfusions, history of malignancy, PRA, repeat transplant, FEV1, FVC, PA pressures, O2 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 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANTS (1995-6/2000) 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 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG RECIPIENTSFunctional Status of Surviving Recipients
(Follow-ups: April 1994 – June 2005)
0%
20%
40%
60%
80%
100%
1 Year (N=6,606) 3 Year (N=4,181) 5 Year (N=2,405) 8 Year (N=886)
No Activity Limitations Performs with Some Assistance Requires Total Assistance
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG RECIPIENTSEmployment Status of Surviving Recipients
(Follow-ups: April 1994 – June 2005)
0%
20%
40%
60%
80%
100%
1 Year (N=406) 3 Year(N=3,944)
5 Year(N=2,330)
8 Year (N=895)
Working Part Time
Working Full Time
Retired
Not Working
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant of Surviving Recipients
(Follow-ups: April 1994 - June 2005)
0%
20%
40%
60%
80%
100%
1 Year (N=8,043) 3 Year (N=4,914) 5 Year (N=2,910) 8 Year (N=1,075)
No Hospitalization Hosp: No Rej/No Inf Hosp: Rejection Hosp: Infection Hosp: Rej/Inf
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
0
5
10
15
20
25
30
35
40
45
50
Any Induction (N =1,726)
PolyclonalALG/ATG (N = 464)
OKT3 (N = 27)
IL2R-antagonist (N = 1,253)
% o
f pat
ient
sADULT LUNG RECIPIENTS
Induction Immunosuppression (Transplants: January 2002 - June 2005)Analysis limited to patients receiving prednisone
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
0
10
20
30
40
50
% o
f pat
ient
s
ADULT LUNG RECIPIENTSInduction Immunosuppression (Transplants: January 2000 - December 2004)
Analysis limited to patients receiving prednisone
ISHLT 2006
Any Induction Polyclonal ALG/ATG OKT3 IL2R-antagonist
J Heart Lung Transplant 2006;25:880-892
SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: April 1994-June 2004)
Conditional on survival to 14 days
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10Years
Surv
ival
(%)
No induction (N=5,927)
Induction (N=3,415)
p = 0.0008
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
SURVIVAL BY INDUCTION USAGE For Adult Lung Recipients (Transplants: January 2000-June 2004)
Conditional on survival to 14 days
0
20
40
60
80
100
0 1 2 3 4Years
Surv
ival
(%)
No induction (N=2,568)
Induction (N=2,050)
p =0.0009
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
0
20
40
60
80
100
Cyclosporine Tacrolimus Rapamycin MMF Azathioprine
% o
f Pat
ient
s
Year 1 (N = 3,482) Year 5 (N =1,569 )
ADULT LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2002 through June 2005 Analysis limited to patients receiving prednisone
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
0
20
40
60
80
100
CyA TAC Rapamycin MMF AZA CyA TAC Rapamycin MMF AZA
% o
f Pat
ient
s
1-Year Follow-Up 5-Year Follow-Up
Consecutive bars within each drug type represent follow-ups in 2002, 2003, 2004 and 2005.
ADULT LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2002 through June 2005 Analysis limited to patients receiving prednisone
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
0
20
40
60
80
100
CalcineurinInhibitor
CellCycle Rapamycin CalcineurinInhibitor
CellCycle Rapamycin
% o
f Pat
ient
s
CyA
Tac Tac
CyARapa Rapa
MMF MMF
AZA AZA
ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up
For follow-ups between January 2002 through June 2005Analysis limited to patients receiving prednisone
1 Year Follow-up (N = 3,482) 5 Year Follow-up (N = 1,569)
NOTE: Different patients are analyzed in Year 1 and Year 5
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
0
20
40
60
80
100
Year 1 (N = 3,482) Year 5 (N = 1,569)
% o
f Pat
ient
s
Tacrolimus + MMF
Tacrolimus + AZA
Cyclosporine + MMF
Cyclosporine + AZA
ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
For follow-ups between January 2002 through June 2005Conventional Combinations
Analysis limited to patients receiving prednisone
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
0
10
20
30
40
50
Year 1 (N = 3,482) Year 5 (N = 1,569)
% o
f Pat
ient
s
Other
Rapa + Cellcycle
Rapa + Calcineurin
Tacrolimus
ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up
For follow-ups between January 2002 through June 2005Other Combinations
Analysis limited to patients receiving prednisone
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2004)
05
101520253035404550
Overall
% tr
eate
d fo
r rej
ectio
n w
ithin
1 y
ear
No induction Polyclonal IL2R-antagonist
No induction vs. polyclonal (p < 0.0001); polyclonal vs. IL2R (p = 0.002)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2004)
0
10
20
30
40
50
60
18-49 50-59 60+ F M
% tr
eate
d fo
r rej
ectio
n w
ithin
1 y
ear
No induction Polyclonal IL2R-antagonist
For female: no induction vs. polyclonal (p = 0.003) ; polyclonal vs. IL2R (p = 0.024)For male: no induction vs. polyclonal (p = 0.0044); polyclonal vs. IL2R (p = 0.026)
18-49: no induction vs. polyclonal (p=0.042); 50-59: no induction vs. polyclonal (p=0.041);60+: no induction vs. polyclonal (p = 0.0009); polyclonal vs. IL2R (p=0.010)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
NUMBER OF REJECTION EPISODES FOR ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2004)
00.20.40.60.8
11.21.41.61.8
2
Overall
Ave
rage
num
ber o
f rej
ectio
n ep
isod
es
No induction Polyclonal IL2R-antagonist
No induction vs. polyclonal (p < 0.0001); no induction vs. IL2R (p = 0.009); polyclonal vs. IL2R (p = 0.032).
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
NUMBER OF REJECTION EPISODES FOR ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Type of Induction (Transplants: January 1, 2000 - June 30, 2004)
0
0.5
1
1.5
2
2.5
18-49 50-59 60+ F M
Ave
rage
num
ber o
f rej
ectio
n ep
isod
es
No induction Polyclonal IL2R-antagonist
18-34: no induction vs. polyclonal (p = 0.002); no induction vs. IL2R (p = 0.022);50-59: no induction vs. polyclonal (p = 0.0007); polyclonal vs. IL2R (p = 0.031);Females: no induction vs. polyclonal (p = 0.03); no induction vs. IL2R (p = 0.025);Males: no induction vs. polyclonal (p = 0.0003); polyclonal vs. IL2R (p = 0.0087)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2004)
0
10
20
30
40
50
60
Overall
% tr
eate
d fo
r rej
ectio
n w
ithin
1 y
ear
Cyclosporine + MMF Cyclosporine + AZA Tacrolimus + MMF Tacrolimus + AZA
CyA + MMF vs. TAC + MMF (p = 0.004); CyA + AZA vs. TAC + MMF (p < 0.0001); CyA + AZA vs. TAC + AZA (p < 0.0001)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
PERCENTAGE OF ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2004)
0
10
20
30
40
50
60
70
18-49 50-59 60+ F M
% tr
eate
d fo
r rej
ectio
n w
ithin
1 y
ear
Cyclosporine + MMF Cyclosporine + AZATacrolimus + MMF Tacrolimus + AZA
18-49: CyA + AZA vs. TAC + MMF (p = 0.0138)50-59: CyA + MMF vs. TAC + MMF (p = 0.0062); CyA + MMF vs. TAC + AZA (p = 0.0035); CyA + AZA vs. TAC + MMF (p = 0.0015); CyA + AZA vs. TAC + AZA (p = 0.0015)60+: CyA + AZA vs. TAC + MMF (p = 0.0011); CyA + MMF vs. CyA + AZA (p = 0.0054)Females: CyA + AZA vs. TAC + MMF (p = 0.006); CyA + AZA vs. TAC + AZA (p = 0.0097)Males: CyA + MMF vs. TAC + MMF (p = 0.0078); CyA + AZA vs. TAC + MMF (p < 0.0001); CyA + AZA vs. TAC + AZA (p = 0.0031)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
NUMBER OF REJECTION EPISODES FOR ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2004)
0
0.5
1
1.5
2
2.5
Overall
Ave
rage
num
ber o
f rej
ectio
n ep
isod
es
Cyclosporine + MMF Cyclosporine + AZA Tacrolimus + MMF Tacrolimus + AZA
CyA + MMF vs. CyA + AZA (p = 0.002); CyA + AZA vs. TAC + MMF (p < 0.0001); TAC + MMF vs. TAC + AZA (p = 0.029)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
NUMBER OF REJECTION EPISODES FOR ADULT LUNG TRANSPLANT RECIPIENTS TREATED FOR REJECTION IN 1ST YEAR
Stratified by Maintenance Immunosuppression (Transplants: January 1, 2000 - June 30, 2004)
0
0.5
1
1.5
2
2.5
18-49 50-59 60+ F M
Ave
rage
num
ber o
f rej
ectio
n ep
isod
es
Cyclosporine + MMF Cyclosporine + AZATacrolimus + MMF Tacrolimus + AZA
18-49: CyA + MMF vs. TAC + MMF (p = 0.023); 60+: CyA + MMF vs. CyA + AZA (p = 0.009); CyA +AZA vs. TAC + MMF (p = 0.0038);Female: CyA + AZA vs. TAC + MMF (p = 0.0003); Male: CyA + AZA vs. TAC + MMF (p = 0.047); CyA + MMF vs. CyA + AZA (p = 0.006)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant
(Follow-ups: April 1994 - June 2005)
Follow-ups: April 1994 – June 1999
Follow-ups: July 1999- June 2005
Outcome Within 1 Year
Total number with known response
Within 1 Year
Total number with known response
Hypertension 48.3% (N = 3,162) 53.2% (N = 4,735) Renal Dysfunction 22.2% (N = 3,088) 27.4% (N = 4,870) Abnormal Creatinine < 2.5 mg/dl 12.5% 18.9% Creatinine > 2.5 mg/dl 8.0% 6.7% Chronic Dialysis 1.7% 1.8% Renal Transplant 0.0% 0.1% Hyperlipidemia 11.0% (N = 3,280) 23.9% (N = 5,064)
Diabetes 16.10% (N = 3,129) 26.9% (N = 4,800) Bronchiolitis Obliterans 10.7% (N = 2,817) 7.3% (N = 4,460)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 and 5 Years
Post-Transplant (Follow-ups: April 1994 - June 2005)
Outcome Within 1 Year
Total number with known response
Within 5 Years
Total number with known response
Hypertension 51.3% (N = 7,897) 85.5% (N = 1,822) Renal Dysfunction 25.7% (N = 7,008) 39.4% (N = 1,596) Abnormal Creatinine < 2.5 mg/dl 16.2% 22.7% Creatinine > 2.5 mg/dl 7.6% 12.8% Chronic Dialysis 1.9% 3.2% Renal Transplant 0.0% 0.7% Hyperlipidemia 18.8% (N = 8,344) 49.3% (N = 2,015)
Diabetes 22.6% (N = 7,929) 31.5% (N = 1,805) Bronchiolitis Obliterans 8.6% (N = 7,277) 33.5% (N = 1,466)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 10 Years Post-Transplant
(Follow-ups: April 1994 - June 2004)
Outcome Within 10 Years
Total number with known response
Hypertension 99.3% (N = 146)
Renal Dysfunction 43.2% (N = 169) Abnormal Creatinine < 2.5 mg/dl 23.1% Creatinine > 2.5 mg/dl 10.1% Chronic Dialysis 7.1% Renal Transplant 3.0%
Hyperlipidemia 66.9% (N = 178)
Diabetes 30.0% (N = 150)
Bronchiolitis Obliterans 37.0% (N = 92)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
FREEDOM FROM BRONCHIOLITIS OBLITERANSFor Adult Lung Recipients (Follow-ups: April 1994-June 2005)
Conditional on Survival to 14 days
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10Years
% F
reed
om fr
om O
B
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
FREEDOM FROM BRONCHIOLITIS OBLITERANS STRATIFIED BY INDUCTION USE
For Adult Lung Recipients (Follow-ups: April 1994-June 2004)Conditional on Survival to 14 days
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10Years
% F
reed
om fr
om O
B
No induction (N=4,699)Induction (N=2,454)
p = 0.1561
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
FREEDOM FROM SEVERE RENAL DYSFUNCTION*For Adult Lung Recipients (Follow-ups: April 1994-June 2005)
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10
Years
% F
reed
om fr
om S
ever
e R
enal
D
ysfu
nctio
n
* Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2005)
Malignancy/Type 1-Year Survivors 5-Year Survivors 7-Year SurvivorsNo Malignancy 7968 (96.2%) 1756 (87.5%) 723 (81.3%)
Malignancy (all types combined) 316 (3.8%) 252 (12.5%) 166 (18.7%)Malignancy
Type*Skin 70 132 101
Lymph 152 54 31Other 73 71 51
Type Not Reported 21 10 2
* 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; 2), 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 2006 J Heart Lung Transplant 2006;25:880-892
FREEDOM FROM MALIGNANCYFor Adult Lung Recipients (Follow-ups: April 1994-June 2005)
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10Years
% F
ree
from
Mal
igna
ncy
All malignancy Lymph Skin Other
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January 1992- June 2005)
CAUSE OF DEATH0-30 Days (N = 1,273)
31 Days - 1 Year
(N = 1,886)
>1 Year - 3 Years
(N = 1,581)
>3 Years - 5 Years
(N = 910)
>5 Years (N = 1,001)
BRONCHIOLITIS 5 (0.4%) 87 (4.6%) 414 (26.2%) 263 (28.9%) 265 (26.5%)ACUTE REJECTION 65 (5.1%) 37 (2.0%) 26 (1.6%) 5 (0.5%) 7 (0.7%)LYMPHOMA 1 (0.1%) 51 (2.7%) 35 (2.2%) 14 (1.5%) 31 (3.1%)MALIGNANCY, OTHER 1 (0.1%) 50 (2.7%) 94 (5.9%) 73 (8.0%) 89 (8.9%)CMV 0 69 (3.7%) 21 (1.3%) 4 (0.4%) 3 (0.3%)INFECTION, NON-CMV 270 (21.2%) 685 (36.3%) 395 (25.0%) 172 (18.9%) 180 (18.0%)GRAFT FAILURE 361 (28.4%) 359 (19.0%) 278 (17.6%) 169 (18.6%) 170 (17.0%)CARDIOVASCULAR 131 (10.3%) 82 (4.3%) 53 (3.4%) 43 (4.7%) 52 (5.2%)TECHNICAL 107 (8.4%) 50 (2.7%) 11 (0.7%) 2 (0.2%) 3 (0.3%)OTHER 332 (26.1%) 416 (22.1%) 254 (16.1%) 165 (18.1%) 201 (20.1%)
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892