2003 ishlt j heart lung transplant 2003; 22: 610-72. lung transplantation overall

2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.

LUNG TRANSPLANTATION

Overall


NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE

0

200

400

600

800

1000

1200

1400

1600

1800

Nu

mb

er

of

Tra

ns

pla

nts

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

Bilateral/Double LungSingle Lung

13 15 47 80185

408

685

902

10691206

13421337

1417141314101508

1537


NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND LOCATION

0

200

400

600

800

1000

1200

1400

1600

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

Nu

mb

er o

f T

ran

spla

nts South America

North America

Europe

Australia/Oceania

Asia


AVERAGE CENTER VOLUMELung Transplants: January 1, 1998 - June 30, 2002

42

30 32

15

6 4 20

5

10

15

20

25

30

35

40

45

1-4 5-9 10-19 20-29 30-39 40-49 50+

Average number of lung transplants per year

Nu

mb

er o

f ce

nte

rs


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

Year of Transplant

% o

f T

ran

sp

lan

ts

0-10 11-17 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


AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS (1/1985-6/2002)

0

10

20

30

40

50

% o

f tr

ansp

lan

ts

<1 1-5 6-10 11-17 18-34 35-49 50-64 65+

Recipient Age


AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS BY ERA

0

10

20

30

40

50

<1 1-5

6-10

11-1

7

18-3

4

35-4

9

50-6

465

+ <1 1-5

6-10

11-1

7

18-3

4

35-4

9

50-6

465

+

% o

f tr

ansp

lan

ts

p < 0.0001

1985-1996 1/1997-6/2002


LUNG TRANSPLANTATIONActuarial Survival (Transplants: January 1990 - June 2001)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12

Years

Su

rviv

al

(%)

Bilateral/Double Lung (N=6,068)

Single Lung (N=7,385)

All Lungs (N=13,453)

Double lung: 1/2-life = 4.8 Years; Conditional 1/2-life = 8.1 YearsSingle lung: 1/2-life = 3.7 Years; Conditional 1/2-life = 5.8 YearsAll lungs: 1/2-life = 4.0 Years; Conditional 1/2-life = 6.5 Years

p < 0.0001


LUNG TRANSPLANTATION

Adult Recipients


ADULT LUNG TRANSPLANTATION: Indications (1/1995-6/2002)

DIAGNOSIS SLT (N = 5,000) BLT (N = 4,488) TOTAL (N = 9,488)

COPD/Emphysema 2,698 ( 54.0% ) 1,000 ( 22.0% ) 3,698 ( 39.0% )

IPF 1,186 ( 24.0% ) 403 ( 9.0% ) 1,589 ( 17.0% )

CF 49 ( 1.0% ) 1,447 ( 32.0% ) 1,496 ( 16.0% )

Alpha-1 429 ( 8.6% ) 434 ( 9.7% ) 863 ( 9.1% )

PPH 66 ( 1.3% ) 361 ( 8.0% ) 427 ( 4.5% )

Sarcoidosis 127 ( 2.5% ) 113 ( 2.5% ) 240 ( 2.5% )

Bronchiectasis 11 ( 0.2% ) 192 ( 4.3% ) 203 ( 2.1% )

Congenital Heart Disease 10 ( 0.2% ) 99 ( 2.2% ) 109 ( 1.1% )

LAM 45 ( 0.9% ) 58 ( 1.3% ) 103 ( 1.1% )

Re-TX: OB 47 ( 0.9% ) 47 ( 1.0% ) 94 ( 1.0% )

OB (Non-ReTX) 30 ( 0.6% ) 52 ( 1.2% ) 82 ( 0.9% )

Re-TX: Non-OB 35 ( 0.7% ) 37 ( 0.8% ) 72 ( 0.8% )

Connective Tissue Disorder 21 ( 0.4% ) 22 ( 0.5% ) 43 ( 0.5% )

Cancer 3 ( 0.1% ) 25 ( 0.6% ) 28 ( 0.3% )

Histiocytosis X 11 ( 0.2% ) 8 ( 0.2% ) 19 ( 0.2% )

Other 232 ( 4.6% ) 190 ( 4.2% ) 422 ( 4.4% )


ADULT LUNG TRANSPLANTATION: Indications (Transplants: January 1995 - June 2002)

53%

23%

9%1%

6%

3%

1%2%

1%1%

22%

33%2%

9%

10%

8%

2%

1% 5%1%

4%

3%

COPD/Emphysema CF Congenital Heart DiseaseBronchiectasis Re-TX IPFAlpha-1 PPH SarcoidosisOB (Non-ReTX) LAM Other

Single Lung Transplants

Bilateral/Double Lung Transplants


ADULT LUNG TRANSPLANTATIONIndications By Year

0

20

40

60

80

100

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Transplant Year

% o

f T

ran

sp

lan

ts

Cystic Fibrosis IPF Emphysema A1A PPH


ADULT LUNG TRANSPLANTATIONActuarial Survival by Era (Transplants: January 1988 – June 2001)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

1988-1992 (N=2,093)1993-1997 (N=6,005)1/1998-6/2001 (N=4,831)

Survival comparisons by era1988-1992 vs. 1993-1997: p = 0.0081988-1992 vs. 1998-2001: p < 0.00011993-1997 vs. 1998-2001: p = 0.3


ADULT LUNG TRANSPLANTATION Actuarial Survival by Age Group (Transplants: January 1990 – June 2001)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

18-34 (N=2,328)35-49 (N=3,901)50-64 (N=5,980)65+ (N=323)

Survival comparisons18-34 vs. 50-64: p < 0.000118-34 vs. 65+: p = 0.000435-49 vs. 50-64: p < 0.000135-49 vs. 65+: p = 0.0001

HALF-LIFE 18-34: 4.8 Years; 35-49: 4.8 Years; 50-64 3.7 Years; 65+: 3.0 Years


ADULT LUNG TRANSPLANTATIONActuarial Survival By Diagnosis (Transplants: January 1990 – June 2001)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10Years

Su

rviv

al (

%)

Alpha-1 Antitrypsin (N=1,234) Cystic Fibrosis (N=1,703)Emphysema/COPD (N=4,353) IPF (N=1,855)PPH (N=691) Sarcoidosis (N = 276)

HALF-LIFE Alpha-1: 4.9 Years; CF: 4.4 Years; COPD: 5.5 Years; IFP: 3.0 Years; PPH: 4.0 Years; Sarcoidosis: 4.7 Years


ADULT LUNG TRANSPLANTATIONActuarial Survival By Diagnosis Conditional on Survival to 3 Months

(Transplants: January 1990 – June 2001)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10Years

Su

rviv

al (

%)

Alpha-1 Antitrypsin (N=888) Cystic Fibrosis (N=1,244)Emphysema/COPD (N=3,393) IPF (N=1,288)PPH (N=439) Sarcoidosis (N = 181)

HALF-LIFE CONDITIONAL ON 3 MONTH SURVIVAL Alpha-1: 6.3 Years; CF: 5.1 Years; COPD: 7.1 Years; IFP: 4.7 Years; PPH: 7.0 Years; Sarcoidosis: 7.2 Years


ADULT LUNG TRANSPLANTATIONActuarial Survival By Diagnosis Conditional on Survival to 1 Year

(Transplants: January 1990 – June 2001)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10Years

Su

rviv

al (

%)

Alpha-1 Antitrypsin (N=747) Cystic Fibrosis (N=1,056)Emphysema/COPD (N=2,859) IPF (N=1,022)PPH (N=383) Sarcoidosis (N = 146)

HALF-LIFE CONDITIONAL ON 1 YEAR SURVIVAL Alpha-1: 7.2 Years; CF: 5.7 Years; COPD: 8.6 Years; IFP: 5.9 Years; PPH: 7.8 Years; Sarcoidosis: 10.4 Years


ADULT LUNG TRANSPLANTATIONActuarial Survival for Congenital Diagnosis (Transplants: January 1990 – June 2001)

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10Years

Su

rviv

al (

%)

Eisenmenger's Syndrome (N=196)

Other Congenital (N=22)

Eisenmenger's + Other Congenital (N=218)


ADULT LUNG TRANSPLANTATIONActuarial Survival By Procedure Type (Transplants: January 1990 – June 2001)

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 (

%)

Single Lung (N = 725)

Double Lung (N=509)P = 0.008


ADULT LUNG TRANSPLANTATIONActuarial Survival by Procedure Type (Transplants: January 1990 – June 2001)

Diagnosis: Emphysema/COPD

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

Single Lung (N =3,299)

Double Lung (N=1,054)

P < 0.0001



Diagnosis: IPF

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

Single Lung (N =1,461)

Double Lung (N=394)

P = 0.2



Diagnosis: PPH

0

25

50

75

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al (

%)

Single Lung (N =247)

Double Lung (N=444)

P = 0.3


ADULT LUNG TRANSPLANTS (1995-6/2001) Risk Factors for 1 Year Mortality

VARIABLE Odds Ratio P-value

95% Confidence

Interval

PPH 2.74 <.0001 2.05 - 3.67

Cystic Fibrosis 1.31 0.04 1.01 - 1.68

IPF 1.91 <.0001 1.60 - 2.29

Alpha-1 Antitrypsin deficiency 1.69 <.0001 1.37 - 2.09

Sarcoidosis 2.15 <.0001 1.51 - 3.07

All other diagnoses (other than COPD)

1.68 <.0001 1.38 - 2.04

(N=7,262)




95% Confidence

Interval

Ventilator 2.42 <.0001 1.65 - 3.55

IV inotropes 1.91 0.03 1.08 - 3.39

Repeat transplant 2.03 <.0001 1.47 - 2.80

PRA > 10% 1.51 0.006 1.13 - 2.03

Donor CMV+/Recipient CMV - 1.29 0.001 1.11 - 1.51

Donor history of diabetes 1.65 0.01 1.13 - 2.42

(N=7,262)


ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality

Continuous Factors (see figures)

Recipient age

Donor age

Donor/Recipient BMI ratio

Ischemia time

Transplant center volume

Bilirubin

Serum creatinine

Oxygen required at rest

FeV1 % predicted



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

1 Y

ear

Mo

rtal

ity

p < 0.0001



Donor Age

0

0.5

1

1.5

2

10 15 20 25 30 35 40 45 50 55 60Donor Age

Od

ds

of

1 Y

ear

Mo

rtal

ity

p = 0.0005


ADULT LUNG TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year MortalityBMI Ratio = Donor BMI/Recipient BMI

0

0.5

1

1.5

2

0.5 0.75 1 1.25 1.5 1.75 2

BMI Ratio

Od

ds

of

1 Y

ear

Mo

rtal

ity

p = 0.005



Center volume

0

0.5

1

1.5

2

0 10 20 30 40 50 60

Center Volume (cases per year)

Od

ds

of

1 Y

ea

r M

ort

alit

y

p = 0.0003



Ischemia time

0

0.5

1

1.5

2

0 1 2 3 4 5 6 7 8 9

Ischemia time (hours)

Od

ds

of

1 Y

ear

Mo

rtal

ity

p = 0.05



Creatinine

0

0.5

1

1.5

2

0 1 2 3 4

Serum creatinine (mg/dl)

Od

ds

of

1 Y

ear

Mo

rtal

ity

p = 0.03



Oxygen required at rest

0

0.5

1

1.5

2

0 1 2 3 4 5 6 7 8

Oxygen required at rest (L/min)

Od

ds

of

1 Y

ear

Mo

rtal

ity

p = 0.02



Predicted FeV1% for IPF patients

0

1

2

3

4

5

10 20 30 40 50 60 70 80FeV1 (% predicted)

Od

ds

of

1 Y

ear

Mo

rtal

ity

p = 0.01

NOTE: FEV1% did not have a significant impact for any diagnosis other than IPF.



Bilirubin

0

0.5

1

1.5

2

0 1 2 3 4 5 6 7 8 9 10 11 12

Bilirubin (mg/dl)

Od

ds

of

1 Y

ear

Mo

rtal

ity

p = 0.0005


ADULT LUNG TRANSPLANTS (1995-6/2001) Factors Not Significant for 1 Year Mortality

Recipient factors:Hospitalized, pCO2, gender, chronic steroid use, transfusions, history of malignancy, recent infection requiring IV drug therapy

Donor factors:Gender, clinical infection, history of hypertension, history of cancer, COD

Transplant factors:Procedure type, ABO compatibility, HLA mismatch, year of transplant




95% Confidence

Interval

Cystic Fibrosis 0.68 0.01 0.50 - 0.93

Donor CMV+/Recipient CMV - 1.42 0.004 1.12 - 1.80

Infection requiring IV drug therapy within 2 weeks of transplant

1.57 0.02 1.08 - 2.28

(N=2,771)




Recipient age

Donor age

PA systolic

Bilirubin

pCO2



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

5 Y

ear

Mo

rtal

ity

p < 0.0001



Donor Age

0

0.5

1

1.5

2

2.5

3

10 15 20 25 30 35 40 45 50 55 60Donor Age

Od

ds

of

5 Y

ear

Mo

rtal

ity

p < 0.0001



Bilirubin

0

0.5

1

1.5

2

2.5

3

0 1 2 3 4 5 6

Bilirubin (mg/dl)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.04



PA Systolic

0

0.5

1

1.5

2

25 30 35 40 45 50 55 60

PA Systolic (mm Hg)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.03



pCO2

0

0.5

1

1.5

2

25 30 35 40 45 50 55 60

pCO2 (mm Hg)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.04


ADULT LUNG TRANSPLANTS (1995-6/1997) Factors Not Significant for 5 Year Mortality

Recipient factors:Ventilator, inotropes, hospitalized, chronic steroid use, transfusions, history of malignancy, PRA, gender, FeV1, FVC, repeat transplant

Donor factors:Gender, clinical infection, history of hypertension, history of cancer, history of diabetes, COD

Transplant factors:Procedure type, ABO compatibility, HLA mismatch


ADULT LUNG TRANSPLANTS (1995-6/1997) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year


95% Confidence

Interval

Double lung transplant 0.69 0.002 0.54 - 0.87

Female recipient 0.77 0.05 0.60 - 1.00

Hospitalized for infection within 1st year post-transplant

2.02 <.0001 1.61 - 2.53

Bronchiolitis obliterans within 1st year post-transplant

2.38 <.0001 1.59 - 3.56

(N=1,899)


ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year


Recipient age

Recipient height

Donor age


ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Condtional on Survival to 1 Year

Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.0002


ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

Donor Age

0

0.5

1

1.5

2

10 15 20 25 30 35 40 45 50 55 60Donor Age

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.002


ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

Recipient Height

0

0.5

1

1.5

2

140 150 160 170 180 190Recipient Height (cm)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.02


ADULT LUNG TRANSPLANTS (1995-6/1997) Factors Not Significant for Conditional 5 Year Mortality

Recipient factors:Diagnosis, ventilator, inotropes, hospitalized, pCO2,

gender, chronic steroid use, transfusions, history of malignancy, PRA, repeat transplant, FeV1, FVC

Donor factors:Gender, clinical infection, history of hypertension, history of cancer, history of diabetes, COD

Transplant factors:ABO compatibility, HLA mismatch, CMV mismatch


ADULT LUNG TRANSPLANTS (1995-6/1997) Factors Not Significant for Conditional 5 Year Mortality

Post-transplant factors:Treated for rejection, stroke, dialysis, prolonged graft dysfunction, bronchopleural fistula, airway dehiscence


ADULT LUNG RECIPIENTSFunctional Status (Follow-ups: April 1994 – June 2002)

0%

20%

40%

60%

80%

100%

1 Year (N = 4,470) 3 Years (N = 2,782) 5 Years (N = 1,554)

No Activity Limitations Performs with Some Assistance Requires Total Assistance


ADULT LUNG RECIPIENTSEmployment Status (Follow-ups: April 1994 – June 2002)

0%

20%

40%

60%

80%

100%

1 Year (N = 4,188) 3 Years (N = 2,486) 5 Years (N = 1,368)

Retired

Not Working

Working Part Time

Working Full Time


ADULT LUNG RECIPIENTS: Rehospitalization Post-transplant (Follow-ups: April 1994 - June 2002)

0%

20%

40%

60%

80%

100%

Up to 1 Year (N = 5,218) Between 2 and 3 Years (N = 3,115)

Between 4 and 5 Years (N = 1,744)

No Hospitalization Hospitalized, Not Rejection/Not InfectionHospitalized, Rejection Only Hospitalized, Infection OnlyHospitalized, Rejection and Infection


0

5

10

15

20

25

30

35

40

45

Any Induction (N =1,052)

PolyclonalALG/ATG (N = 473)

OKT3 (N = 74) IL2R-antagonist (N =551)

% o

f p

ati

en

tsADULT LUNG RECIPIENTS

Induction Immunosuppression (Follow-ups: January 2000 - June 2002)


0

10

20

30

40

50

Any Induction (N = 429)

Polyclonal ALG/ATG (N = 227)

OKT3 (N = 61)

IL2R-antagonist (N = 180)



OKT3 (N = 11)




OKT3 (N = 2)


% o

f p

ati

en

ts 2000 2001 2002(6 months)

ADULT LUNG RECIPIENTSInduction Immunosuppression (Follow-ups: January 2000 - June 2002)


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

ati

en

ts

Year 1 (N = 1,608)

Year 5 (N = 791)

ADULT LUNG RECIPIENTS Maintenance Immunosuppression At Any Time During Follow-up Period

For follow-ups between January 2000 through June 2002

NOTE: Different patients are analyzed in Year 1 and Year 5


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

ati

en

ts

Year 1 (N = 1,501) Year 5 (N = 721)

ADULT LUNG RECIPIENTSMaintenance Immunosuppression At Time of Follow-up




0

20

40

60

80

100

CalcineurinInhibitor

CellCycle Prednisone CalcineurinInhibitor

CellCycle Prednisone

% o

f P

ati

en

ts

CyA

Tac Tac

CyA

AZA AZA

MMF MMF

ADULT LUNG RECIPIENTS Maintenance Immunosuppression at Time of Follow-up


1 Year Follow-up (N = 1,501) 5 Year Follow-up (N = 721)NOTE: Different patients are analyzed in Year 1 and Year 5


0%

20%

40%

60%

80%

100%

Year 1 (N = 1,501) Year 5 (N = 721)

% o

f P

atie

nts

Other

Tacrolimus + MMF

Tacrolimus + AZA

Cyclosporine + MMF

Cyclosporine + AZA

ADULT LUNG RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up




POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant

(Follow-ups: April 1994-June 2002)

Outcome Within 1 Year

Hypertension 49.4% (N = 5,157)

Renal Dysfunction 25.0% (N = 6,234) Abnormal Creatinine < 2.5 mg/dl 14.8% Creatinine>2.5 mg/dl 8.3% Chronic Dialysis 1.9% Renal Transplant 0.0%

Hyperlipidemia 15.2% (N = 5,385)

Diabetes 18.6% (N = 5,100)

Bronchiolitis Obliterans 9.9% (N = 4,792)


POST-LUNG TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant

(Follow-ups: April 1994-June 2002)

Outcome Within 5 Years

Hypertension 86.5% (N = 931)

Renal Dysfunction 38.3% (N = 1,025) Abnormal Creatinine < 2.5 mg/dl 20.2% Creatinine>2.5 mg/dl 13.7% Chronic Dialysis 3.4% Renal Transplant 0.9%

Hyperlipidemia 43.4% (N = 1,019)

Diabetes 27.8% (N = 907)

Bronchiolitis Obliterans 36.0% (N = 702)


Freedom from Bronchiolitis Obliterans For Adult Lung Recipients (Follow-ups: April 1994-June 2002)

0

20

40

60

80

100

0 1 2 3 4 5 6 7Years

% F

reed

om

fro

m O

B


Freedom from Severe Renal Dysfunction*For Adult Lung Recipients (Follow-ups: April 1994-June 2002)

0

20

40

60

80

100

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5

Years

% F

ree

do

m f

rom

Se

ve

re R

en

al

Dy

sfu

nc

tio

n

* Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant


MALIGNANCY POST-LUNG TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994 - June 2002)

Malignancy/Type 1-Year Survivors 5-Year Survivors

No Malignancy 5104 (96.1%) 886 (86.9%)

Malignancy (all types combined) 209 (3.9%) 134 (13.1%)

Malignancy Type

Skin 44 61

Lymph 109 21

Other 35 32

Lymph + Skin 3

Lymph + Other 5

Skin + Other 2

Type Not Reported 21 10


Freedom from MalignancyFor Adult Lung Recipients (Follow-ups: April 1994-June 2002)

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7Years

% F

ree

fro

m M

alig

nan

cy

All malignancy Lymph Skin Other


ADULT LUNG TRANSPLANTS (1995-6/1997) Risk Factors for Developing Malignancy within 5 Years


95% Confidence

Interval

Double lung transplant 0.63 0.03 0.42 - 0.95

Female recipient 0.69 0.03 0.5 - 0.97

Any induction used 0.67 0.04 0.46 - 0.98

(N=1,514)


ADULT LUNG TRANSPLANTS (1/1995-6/1997) Risk Factors for Developing Malignancy within 5 Years


Recipient age Donor age



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

Ma

lig

na

nc

y w

ith

in 5

Ye

ars

p = 0.003



Donor Age

0

0.5

1

1.5

2

10 15 20 25 30 35 40 45 50 55 60Donor Age

Od

ds

of

Mal

ign

ancy

wit

hin

5 Y

ears

p = 0.01


ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death (Deaths: January 1992- June 2002)

CAUSE OF DEATH0-30 Days

(N = 937)

31 Days - 1 Year

(N = 1,345)

>1 Year - 3 Years

(N = 1,096)

>3 Years - 5 Years

(N = 572)

>5 Years

(N = 456)

BRONCHIOLITIS 5 (0.5%) 74 (5.5%) 313 (28.6%) 185 (32.3%) 142 (31.1%)

ACUTE REJECTION 46 (4.9%) 27 (2.0%) 21 (1.9%) 4 (0.7%) 2 (0.4%)

LYMPHOMA 1 (0.1%) 44 (3.3%) 23 (2.1%) 9 (1.6%) 18 (3.9%)

MALIGNANCY, OTHER 27 (2.0%) 52 (4.7%) 43 (7.5%) 40 (8.8%)

CMV 1 (0.1%) 56 (4.2%) 17 (1.6%) 4 (0.7%) 2 (0.4%)

INFECTION, NON-CMV 220 (23.5%) 521 (38.7%) 284 (25.9%) 113 (19.8%) 79 (17.3%)

GRAFT FAILURE 286 (30.5%) 236 (17.5%) 175 (16.0%) 99 (17.3%) 58 (12.7%)

CARDIOVASCULAR 108 (11.5%) 58 (4.3%) 36 (3.3%) 24 (4.2%) 21 (4.6%)

TECHNICAL 78 (8.3%) 37 (2.8%) 12 (1.1%) 1 (0.2%) 2 (0.4%)

OTHER 192 (20.5%) 265 (19.7%) 163 (14.9%) 90 (15.7%) 92 (20.2%)

2003 ishlt j heart lung transplant 2003; 22: 610-72. lung transplantation overall

Documents

ishlt j heart lung transplant

adult lung transplants

number of lung transplants

year of transplant slide

year slide

year transplants

year mortality slide

location slide