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
Nu
mb
er o
f T
ran
spla
nts
Bilateral/Double LungSingle Lung
15 15 48 89192
415
706
908
1079
12021323
13401472
14501478
15521599
17251699
ISHLT 2006
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.
1815
J Heart Lung Transplant 2006;25:880-892
AVERAGE CENTER VOLUMELung Transplants: January 1, 1998 - June 30, 2005
61
33 31
1611
3 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
Nu
mb
er
of
ce
nte
rs
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+/yr
Average number of lung transplants per year
Perc
en
tag
e o
f tr
an
sp
lan
ts .
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 T
ran
sp
lan
ts
0-11 12-17 18-34 35-49 50-59 60+
0
5
10
15
20
25
30
35
40
Me
an
do
no
r a
ge
(y
ea
rs)
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 tr
an
sp
lan
ts
ISHLT 2006 J Heart Lung Transplant 2006;25:880-892
AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA
0
5
10
15
20
25
30
35
40
0-11 12-17 18-29 30-39 40-49 50-59 60-64 65+
% o
f tr
ansp
lan
ts
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 tr
ansp
lan
ts
.
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 tr
ansp
lan
ts .
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 tr
ansp
lan
ts .
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 10
Years
Su
rviv
al (%
) .
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 PPH
Double 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 84.6
1991 20.9 79.1 14.9 85.1 95.7 4.3 15.1 84.9 23.8 76.2
1992 27.2 72.8 17.2 82.8 96.8 3.2 9.6 90.4 25.7 74.3
1993 34.1 65.9 15.8 84.2 93.8 6.2 16.7 83.3 51.6 48.4
1994 35.2 64.8 18.3 81.7 83.1 16.9 13.6 86.4 61.0 39.0
1995 48.0 52.0 20.2 79.8 88.3 11.7 26.9 73.1 89.6 10.4
1996 46.6 53.4 26.2 73.8 85.0 15.0 26.8 73.2 81.5 18.5
1997 46.7 53.3 28.1 71.9 92.1 7.9 21.9 78.1 88.7 11.3
1998 50.4 49.6 29.4 70.6 91.8 8.2 19.7 80.3 84.8 15.2
1999 48.3 51.7 27.7 72.3 89.1 10.9 22.1 77.9 83.3 16.7
2000 57.9 42.1 27.7 72.3 94.1 5.9 31.2 68.8 91.3 8.7
2001 59.8 40.2 26.8 73.2 93.5 6.5 26.0 74.0 89.4 10.6
2002 57.1 42.9 38.6 61.4 95.6 4.4 35.8 64.2 86.8 13.2
2003 68.1 31.9 38.7 61.3 95.4 4.6 39.1 60.9 93.5 6.5
2004 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
100
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
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
% o
f tr
an
sp
lan
ts
Bilateral/Double Lung Transplant Single Lung Transplant
AT Def COPD IPF PPH
2006J 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 T
ran
spla
nts
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
Nu
mb
er o
f T
ran
spla
nts
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 10
Years
Su
rviv
al (
%)
.
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
Su
rviv
al (%
) .
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
Su
rviv
al
(%)
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)
YearALPHA-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)
YearALPHA-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)
YearALPHA-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
Su
rviv
al (
%)
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
Su
rviv
al
(%)
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
Su
rviv
al (
%)
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
Su
rviv
al
(%)
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
Su
rviv
al
(%)
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 5
Years
Su
rviv
al (
%)
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 10
Years
Su
rviv
al (
%)
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
Su
rviv
al (
%)
<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 10
Years
Su
rviv
al (
%)
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 10
Years
Su
rviv
al (
%)
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 10
Years
Su
rviv
al (
%)
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 10
Years
Su
rviv
al (
%)
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 10
Years
Su
rviv
al (
%)
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 10
Years
Su
rviv
al (
%)
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
Su
rviv
al (
%)
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 65
Recipient Age
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
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 55
Donor Age
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
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 95
Weight (kg)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
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 R
isk o
f 1 Y
ear
Mo
rtality
.
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 50
Center Volume (cases per year)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
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 R
isk o
f 1 Y
ear
Mo
rtality
.
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 1.75
Recipient Bilirubin (mg/dl)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
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 5
Oxygen Required at Rest (L/min)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
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 9
PVR (Wood units)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
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 Mortality
Recipient 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 65
Recipient Age
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
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 50
Center Volume (cases per year)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
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 95
Weight (kg)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
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 R
isk o
f 1 Y
ear
Mo
rtality
.
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 50
Center Volume (cases per year)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
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 Mortality
Donor BMI
0
0.5
1
1.5
2
18 21 24 27 30
Donor BMI (kg/m2)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
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 = IPFRisk 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 65
Recipient Age
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
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 55
Donor Age
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
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 30
PA Diastolic Pressure
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
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 R
isk o
f 1 Y
ear
Mo
rtality
.
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 R
isk o
f 1 Y
ear
Mo
rtality
.
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 50
Center Volume (cases per year)
Rela
tive R
isk o
f 1 Y
ear
Mo
rtality
.
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 R
isk o
f 1 Y
ear
Mo
rtality
.
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 R
isk o
f 1 Y
ear
Mo
rtality
.
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 65
Recipient Age
Rela
tive R
isk o
f 5 Y
ear
Mo
rtalit
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
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
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)
Rel
ativ
e R
isk
of
5 Y
ear
Mo
rtal
ity
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
155 160 165 170 175 180 185 190
Donor height (cm)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
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 50
Center Volume (Cases per year)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
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 70
Recipent PA systolic pressure (mm Hg)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
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 5
Oxygen required at rest (L/min)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
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 65
Recipient Age
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
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
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
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)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
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)
Re
lati
ve
Ris
k o
f 5
Ye
ar
Mo
rta
lity
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 p
ati
en
tsADULT 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 p
atie
nts
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
Su
rviv
al (
%)
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 4
Years
Su
rviv
al (
%)
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 P
ati
en
ts
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 P
atie
nts
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 P
ati
en
ts
CyA
Tac Tac
CyA
Rapa 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 P
atie
nts
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 P
atie
nts
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
% t
rea
ted
fo
r re
jec
tio
n w
ith
in 1
ye
ar
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
% t
rea
ted
fo
r re
jec
tio
n w
ith
in 1
ye
ar
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
Av
era
ge
nu
mb
er
of
reje
cti
on
ep
iso
de
s
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
Av
era
ge
nu
mb
er
of
reje
cti
on
ep
iso
de
s
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
% t
rea
ted
fo
r re
jec
tio
n w
ith
in 1
ye
ar
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
% t
rea
ted
fo
r re
jec
tio
n w
ith
in 1
ye
ar
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
Av
era
ge
nu
mb
er
of
reje
cti
on
ep
iso
de
s
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
Av
era
ge
nu
mb
er
of
reje
cti
on
ep
iso
de
s
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
fro
m 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
fro
m 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
fro
m S
ever
e R
enal
D
ysfu
nct
ion
* 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 Survivors
No 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 31
Other 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
fro
m M
alig
nan
cy
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