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LUNG TRANSPLANTATION

LUNG TRANSPLANTATION. Adult Recipients. 2019. citation. Table of Contents. Donor, recipient and center characteristics: slides 3-11 Post-transplant survival and rejection: slides 12-30 Functional and employment status and rehospitalization post transplant: slides 31-36

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LUNG TRANSPLANTATION

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  1. LUNG TRANSPLANTATION Adult Recipients 2019 citation

  2. Table of Contents • Donor, recipient and center characteristics: slides 3-11 • Post-transplant survival and rejection: slides 12-30 • Functional and employment status and rehospitalization post transplant: slides 31-36 • Induction and maintenance immunosuppression: slides 37-51 • Post transplant morbidities: slides 52-69 • Multivariable analyses: slides 70-86 • Focus theme - Size mismatch: slides 87-151 • Select characteristics by size mismatch: slides 88-103 • Post-transplant survival: slides 104-124 • Multivariable analyses: slides 125-151 2019 citation

  3. Donor, Recipient and Center Characteristics 2019 citation

  4. Adult Lung TransplantsNumber of Transplants by Year and Procedure Type NOTE: This figure includes only the adult lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as representing changes in the number of adult lung transplants performed worldwide. 2019 citation

  5. Adult Lung Transplants Average Center Volume by Location (Transplants: January 2010 – June 2018) 2019 citation

  6. Adult Lung Transplants Diagnoses (Transplants: January 1995 – June 2018) 2019 citation

  7. Adult Lung TransplantsProcedure Type within Diagnosis by Transplant Year 2019 citation

  8. Adult Lung TransplantsMajor Diagnoses by Year (%) 2019 citation

  9. Adult Lung TransplantsMajor Diagnoses by Year (Number) 2019 citation

  10. Adult Lung TransplantsDiagnosis Distribution by Location (Transplants: January 2005 – June 2018) 2019 citation

  11. Adult Lung TransplantsDiagnosis Distribution by Location and Era (Transplants: January 2005 – June 2018) 2019 citation

  12. Post-Transplant Survival and Rejection 2019 citation

  13. Adult Lung TransplantsKaplan-Meier Survival by Procedure Type for Primary Transplant Recipients (Transplants: January 1992 – June 2017) Median survival (years): Double Lung = 7.8; Conditional = 10.2 Single Lung = 4.8; Conditional = 6.5 p<0.0001 2019 citation

  14. Adult Lung TransplantsKaplan-Meier Survival by Era (Transplants: January 1992 – June 2017) Median survival (years): 1992-2001: 4.7; Conditional=7.5; 2002-2009: 6.5; Conditional=8.8; 2010-6/2017: 6.7; Conditional=NA 1992-2001 vs. 2002-2009: p<0.0001 1992-2001 vs. 2010-6/2017: p<0.0001 2002-2009 vs. 2010-6/2017: p<0.0001 2019 citation

  15. Adult Lung TransplantsKaplan-Meier Survival Conditional on Survival to 1 Yearby Era and Transplant Type (Transplants: January 1992 – June 2017) No pairwise comparisons between transplant types within each era and between eras within each transplant type were significant at p < 0.05 except for 2002-2009: Primary vs. Retx 2010-6/2017: Primary vs. Retx Primary: 1992-2001 vs. 2002-2009 Primary: 1992-2001 vs. 2010-6/2017 Median survival (years): Primary: 1992-2001 = 7.5; 2002-2009 = 8.9; 2010-6/2017 = NA; Retx: 1992-2001 = 7.0; 2002-2009 = 6.9; 2010-6/2017 = 6.2 2019 citation

  16. Adult Lung TransplantsKaplan-Meier Survival by Sex (Transplants: January 1992 – June 2017) p<0.0001 Median survival (years): Male=5.9; Female=6.6 2019 citation

  17. Adult Lung TransplantsKaplan-Meier Survival by Transplant Type and Sex (Transplants: January 1992 – June 2017) All pairwise comparisons were significant at p < 0.05 except Retx: Male vs. Female. Median survival (years): Primary: Male=6.0, Female=6.7; First Retx: Male=3.4, Female=3.3 2019 citation

  18. Adult Lung TransplantsKaplan-Meier Survival by Major Diagnosis (Transplants: January 1992 – June 2017) Median survival (years): A1ATD: 7.1; CF: 9.9; COPD: 6.0; IIP: 5.2; ILD-not IIP: 6.7; IPAH: 7.0 All pairwise comparisons were significant at p < 0.05 except A1ATD vs. ILD-non IIP, A1ATD vs. IPAH, COPD vs. ILD-non IIP, and ILD-non IIP vs. IPAH. 2019 citation

  19. Adult Lung TransplantsKaplan-Meier Survival by Major Diagnosis Conditional on Survival to 3 Months (Transplants: January 1992 – June 2017) All pairwise comparisons were significant at p < 0.05 except A1ATD vs. ILD-non IIP and CF vs. IPAH. Median survival (years): A1ATD: 8.4; CF: 11.2; COPD: 6.7; IIP: 6.3; ILD-not IIP: 7.6; IPAH: 10.6 2019 citation

  20. Adult Lung TransplantsKaplan-Meier Survival by Major Diagnosis Conditional on Survival to 1 Year (Transplants: January 1992 – June 2017) All pairwise comparisons were significant at p < 0.05 except A1ATD vs. ILD-non IIP, CF vs. IPAH, and COPD vs. IIP. Median survival (years): A1ATD: 9.3; CF: 12.4; COPD: 7.4; IIP: 7.3; ILD-not IIP: 8.5; IPAH: 12.0 2019 citation

  21. Adult Lung TransplantsKaplan-Meier Survival by Procedure Type Diagnosis: A1ATD (Transplants: January 1992 – June 2017) p<0.0001 2019 citation

  22. Adult Lung TransplantsKaplan-Meier Survival by Procedure Type Diagnosis: COPD (Transplants: January 1992 – June 2017) p<0.0001 2019 citation

  23. Adult Lung TransplantsKaplan-Meier Survival by Procedure Type Diagnosis: IIP (Transplants: January 1992 – June 2017) p<0.0001 2019 citation

  24. Adult Lung TransplantsKaplan-Meier Survival by Procedure Type Diagnosis: ILD-not IIP (Transplants: January 1992 – June 2017) p<0.0001 2019 citation

  25. Adult Lung TransplantsKaplan-Meier Survival by Procedure Type and Era Diagnosis: CF, Bilateral/Double Lung (Transplants: January 1992 – June 2017) 1992-2001 vs. 2002-2009: p<0.0001 1992-2001 vs. 2010-6/2017: p<0.0001 2002-2009 vs. 2010-6/2017: p = 0.0039 2019 citation

  26. Adult Lung TransplantsPercentage Experiencing Treated Rejection between Discharge and 1-Year Follow-Up (Follow-ups: January 2005 – June 2018) No pairwise comparisons were significant at < 0.05 except 18-34 vs. all other age groups and 50-59 vs. 60-65. Analysis is limited to patients who were alive at follow-up. Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection. 2019 citation

  27. Adult Lung TransplantsPercentage Experiencing Any Rejection between Discharge and 1-Year Follow-Up (Follow-ups: January 2005 – June 2018) No pairwise comparisons were significant at < 0.05 except 18-34 vs. all other age groups. Analysis is limited to patients who were alive at follow-up. No rejection = Recipient had (1) no acute rejection episodes and (2) was reported either as not hospitalized for rejection or did not receive anti-rejection agents. 2019 citation

  28. Adult Lung TransplantsPercentage Experiencing Treated Rejection between Discharge and 1-Year Follow-Up (Follow-ups: January 2005– June 2018) No pairwise comparisons were significant at < 0.05. Analysis is limited to patients who were alive at follow-up Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection. 2019 citation

  29. Adult Lung TransplantsPercentage Experiencing Any Rejection between Discharge and 1-Year Follow-Up (Follow-ups: January 2005 – June 2018) No pairwise comparisons were significant at < 0.05. Analysis is limited to patients who were alive at follow-up No rejection = Recipient had (1) no acute rejection episodes and (2) was reported either as not hospitalized for rejection or did not receive anti-rejection agents. 2019 citation

  30. Adult Lung TransplantsKaplan-Meier Survival by Donor/Recipient CMV Status (Transplants: January 2005 – June 2017) All pairwise comparisons were significant at p < 0.05 except D(+)/R(+) vs. D(+)/R(-). 2019 citation

  31. Functional and Employment Status and Rehospitalization Post Transplant 2019 citation

  32. Adult Lung Transplants Length of Stay by Era (Transplants: January 2005 – 6/2018) 2019 citation

  33. Adult Lung Transplants Length of Stay by Location (Transplants: January 2005 – 6/2018) 2019 citation

  34. Adult Lung TransplantsFunctional Status of Surviving Recipients by Karnofsky Score (Follow-ups: January 2010 – June 2018) 2019 citation

  35. Adult Lung TransplantsSurviving Recipients Working Post-Transplant (Follow-ups: January 2010 – June 2018) 2019 citation

  36. Adult Lung TransplantsRehospitalization Post Transplant of Surviving Recipients (Follow-ups: January 2010 – June 2018) 2019 citation

  37. Induction and Maintenance Immunosuppression 2019 citation

  38. Adult Lung TransplantsInduction ImmunosuppressionAnalysis limited to patients receiving prednisone (Transplants: January 2005 – June 2018) N = 23,333 2019 Analysis is limited to patients who were alive at discharge. citation

  39. Adult Lung TransplantsInduction ImmunosuppressionAnalysis limited to patients receiving prednisone (Transplants: 2005, 2010, January 2018 – June 2018) 2019 Analysis is limited to patients who were alive at discharge. citation

  40. Adult Lung TransplantsInduction ImmunosuppressionAnalysis limited to patients receiving prednisone (Transplants: January 2005 – December 2017) 2019 Analysis is limited to patients who were alive at discharge. citation

  41. Adult Lung TransplantsSurvival by Induction Usage Conditional on Survival to 14 Days (Transplants: January 1995 – June 2017) p<0.0001 2019 citation

  42. Adult Lung TransplantsSurvival by Induction Usage Conditional on Survival to 14 Days (Transplants: January 2005 – June 2017) p<0.0001 2019 citation

  43. Adult Lung TransplantsMaintenance Immunosuppression at Time of 1-Year Follow-upAnalysis limited to patients receiving prednisone (Follow-ups: January 2005 – June 2018) N = 19,173 2019 Analysis is limited to patients who were alive at follow-up. citation

  44. Adult Lung TransplantsMaintenance Immunosuppression at Time of 1-Year Follow-upAnalysis limited to patients receiving prednisone • (Follow-ups: January 2005 – June 2018) Consecutive bars within each drug type represent follow-ups in years from 2005 through 6/2018 2019 Analysis is limited to patients who were alive at follow-up. citation

  45. Adult Lung TransplantsMaintenance Immunosuppression Drug Combinations at Analysis limited to patients receiving prednisone Time of 1-Year Follow-up (Follow-ups: January 2005 – June 2018) 2019 Analysis is limited to patients who were alive at follow-up. citation

  46. Adult Lung TransplantsKaplan-Meier Survival by Maintenance Immunosuppression Combinations Analysis limited to patients receiving prednisone Conditional on Survival to 1 Year (Transplants: January 2005 – June 2017) p = 0.0001 2019 citation

  47. Adult Lung TransplantsKaplan-Meier Survival by Maintenance Immunosuppression Combinations Analysis limited to patients receiving prednisone Diagnosis: CF Conditional on Survival to 1 Year (Transplants: January 2005 – June 2017) p<0.0001 2019 citation

  48. Adult Lung TransplantsPercentage Experiencing Treated Rejection between Discharge and 1-Year Follow-Up by Induction Type (Follow-ups: January 2005 – June 2018) No pairwise comparisons were significant at p < 0.05 except all comparisons with IL-2R. Analysis is limited to patients who were alive at follow-up. Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection. 2019 citation

  49. Adult Lung TransplantsPercentage Experiencing Any Rejection between Discharge and 1-Year Follow-Up by Induction Type (Follow-ups: January 2005 – June 2018) No pairwise comparisons were significant at p < 0.05 except No induction vs. IL-2R and Alemtuzumab and Polyclonal vs. IL-2R. Analysis is limited to patients who were alive at follow-up. No rejection = Recipient had (1) no acute rejection episodes and (2) was reported either as not hospitalized for rejection or did not receive anti-rejection agents. 2019 citation

  50. Adult Lung TransplantsPercentage Experiencing Treated Rejection between Discharge and 1-Year Follow-Up by Maintenance Immunosuppression (Follow-ups: January 2005 – June 2018) All pairwise comparisons were significant at p < 0.05 except CyA+MMF/MPA vs. TAC+AZA Analysis is limited to patients who were alive at follow-up. Treated rejection = Recipient was reported to (1) have at least one acute rejection episode that was treated with an anti-rejection agent; or (2) have been hospitalized for rejection. 2019 citation

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