The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-eighth adult lung transplantation report - 2021; Focus on recipient characteristics

Daniel C Chambers, Michael Perch, Andreas Zuckermann, Wida S Cherikh, Michael O Harhay, Don Hayes Jr, Eileen Hsich, Kiran K Khush, Luciano Potena, Aparna Sadavarte, Kelsi Lindblad, Tajinder P Singh, Josef Stehlik, International Society for Heart and Lung Transplantation, Daniel C Chambers, Michael Perch, Andreas Zuckermann, Wida S Cherikh, Michael O Harhay, Don Hayes Jr, Eileen Hsich, Kiran K Khush, Luciano Potena, Aparna Sadavarte, Kelsi Lindblad, Tajinder P Singh, Josef Stehlik, International Society for Heart and Lung Transplantation

Abstract

For over 30 years, the International Society for Heart and Lung Transplantation (ISHLT) International Thoracic Organ Transplant (TTX) Registry has gathered data regarding transplant procedures, donor and recipient characteristics, and outcomes from a global community of transplant centers. Almost 70,000 adult lung transplant procedures have been reported to the Registry since its inception, each one providing an opportunity for a recipient with end-stage lung disease to regain quality of life and longevity. With each year's report, we provide more detailed analyses on a particular focus theme important to recipient outcomes. Since 2013, these have been donor and recipient age; retransplantation; early graft failure; indication for transplant; allograft ischemic time; multiorgan transplantation; and donor and recipient size matching.1-7 In response to a changing regulatory environment, the ISHLT TTX Registry is undergoing an update in data acquisition, and the patient cohort examined in this report is therefore derived from the same data source or datasets as that examined in the 2019 annual reports.2,8-10 We refer the reader to the 2019 and prior reports for a detailed description of the baseline characteristics of the cohort, and additional core analyses not directly related to the focus explored in this year's report. To complement the 2020 report which focussed on donor characteristics, the goal of this year's report was to focus entirely on changes in recipient factors over the past 3 decades and to identify important recipient characteristics and transplant processes that may influence post-transplant outcomes. Due to small numbers, heart-lung transplant recipient characteristics and transplant outcomes have not been included. This 38th annual adult lung transplant report is hence based on data submitted to the ISHLT TTX Registry on 67,493 adult recipients of deceased recipient transplants between January 1, 1992 and June 30, 2018.

Keywords: lung transplantation; morbidity; post-transplant survival; recipient characteristics; registry.

Published by Elsevier Inc.

Figures

Figure 1
Figure 1
Recipient diagnosis by location and era (transplants: January 1992-June 2018).
Figure 2
Figure 2
Median recipient (A) age (transplant: January 1992 − June 2018), (B) body mass index (transplant: January 1992-June 2018), and (C) glomerular filtration rate (GFR) (transplants: January 1994-June 2018), by year, and region. GFR was estimated using the Cockcroft-Gault formula.
Figure 3
Figure 3
Recipient history of (A) malignancy (transplants: January 1994-June 2018), (B) diabetes (transplants: January 1994-June 2018), (C) smoking* (transplants: January 2004-June 2018). *Cigarette use for more than 20 pack years.
Figure 4
Figure 4
Kaplan-Meier survival within (A) 12 months (transplants: January 2000-June 2017), and (B) 5 years conditional on survival to 1 year (transplants: January 1996-June 2013), by transplant era.
Figure 5
Figure 5
Kaplan-Meier survival within 12 months for adult lung transplant recipients by location and era (transplants: January 2000-June 2017).
Figure 6
Figure 6
Kaplan-Meier survival within 12 months for adult lung transplant recipients by recipient age and era (transplants: January 2000-June 2017).
Figure 7
Figure 7
Kaplan-Meier survival within 12 months for adult lung transplant recipients by recipient glomerular filtration rate (GFR) and era (transplants: January 2000-June 2017). GFR was estimated using the Cockcroft-Gault formula.
Figure 8
Figure 8
Kaplan-Meier survival within 5 years conditional on survival to 1 year, for adult lung transplant recipients by recipient age, and era (transplants: January 1996-June 2013).
Figure 9
Figure 9
Kaplan-Meier survival within 5 years conditional on survival to 1 year, for adult lung transplant recipients by history of malignancy (transplants: January 1996-June 2013).
Figure 10
Figure 10
Kaplan-Meier freedom from bronchiolitis obliterans syndrome (BOS) conditional on survival to discharge, for adult lung transplant recipients by era (transplants: January 1996-June 2013).
Figure 11
Figure 11
Statistically significant categorical risk factors for 1-year mortality for adult lung transplant recipients with 95% confidence limits (transplants: January 2000-June 2017, n = 53,072).
Figure 12
Figure 12
Statistically significant categorical risk factors with 95% confidence limits for (A) 1-year mortality (transplants: January 2000-June 2017, n = 53,072) and (B) 5-year mortality (transplants: January 1996-June 2013, (n = 35,214). Transplant era and diagnosis interaction.
Figure 13
Figure 13
(A) Hazard ratio of 1-year mortality for adult lung transplant recipients by recipient age. The reference value for age is 56 years. (B) Transplant era and recipient age interaction (transplants: January 2000-June 2017, n = 53,072).
Figure 14
Figure 14
Hazard ratio of 1-year mortality for adult lung transplant recipients by (A) recipient body mass index (BMI), (B) recipient glomerular filtration rate (eGFR), (C) recipient bilirubin, and (D) donor age (transplants: January 2000-June 2017, n = 53,072). GFR was estimated using the Cockcroft-Gault formula. The reference value for BMI was 24, for eGFR was 95, for bilirubin was 0.5, and for donor age was 39.
Figure 15
Figure 15
Hazard ratio of 1-year mortality for adult lung transplant recipients by (A) ischemic time and (B) center volume in the previous 3 years (transplants: January 2000-June 2017, n = 53,072). The reference value for ischemic time was 5 and for center volume was 100.
Figure 16
Figure 16
Statistically significant categorical risk factors for 5-year mortality conditional on survival to 1 year with 95% confidence limits (transplants: January 1996-June 2013, n = 35,214).
Figure 17
Figure 17
Hazard ratio of 5-year mortality for adult lung transplant recipients by (A) recipient age, (B) recipient body mass index (BMI), and (C) recipient glomerular filtration rate (GFR) (transplants: January 1996-June 2013, n = 35,214). GFR was estimated using the Cockcroft-Gault formula. The reference value for age was 54, for BMI was 23.5, and for GFR was 94.
Figure 18
Figure 18
Hazard ratio of 5-year mortality for adult lung transplant recipients by (A) ischemic time and (B) center volume in the previous 3 years (transplants: January 1996-June 2013, n = 35,214). The reference value for ischemic time was 4.8 and for center volume was 91.
Figure 19
Figure 19
Hazard ratio of bronchiolitis obliterans syndrome (BOS) within 5-years for adult lung transplant recipients by (A) recipient age, (B) recipient body mass index (BMI), (C) recipient bilirubin, and (D) donor age (transplants: January 1996-June 2013, n = 18,830). The reference value for age was 56, for BMI was 24, for bilirubin was 0.5, and for donor age was 31.
Figure 20
Figure 20
Hazard ratio of bronchiolitis obliterans syndrome (BOS) within 5-years for adult lung transplant recipients by (A) ischemic time and (B) center volume in the previous 3 years (transplants: January 1996-June 2013, n = 18,830). The reference value for ischemic time was 4.7 and for center volume was 94.

References

    1. Chambers DC, Cherikh WS, Goldfarb SB, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation: thirty-fifth adult lung and heart-lung transplant report-2018; focus theme: multiorgan transplantation. J Heart Lung Transplant 2018;37:1169–83.
    1. Chambers DC, Cherikh WS, Harhay MO, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation: thirty-sixth adult lung and heart-lung transplantation report-2019; focus theme: donor and recipient size match. J Heart Lung Transplant 2019;38:1042–55.
    1. Chambers DC, Yusen RD, Cherikh WS, et al. The registry of the international society for heart and lung transplantation: thirty-fourth adult lung and heart-lung transplantation report-2017; focus theme: allograft ischemic time. J Heart Lung Transplant 2017;36:1047–59.
    1. Yusen RD, Christie JD, Edwards LB, et al. The registry of the international society for heart and lung transplantation: thirtieth adult lung and heart-lung transplant report−2013; focus theme: age. J Heart Lung Transplant 2013;32:965–78.
    1. Yusen RD, Edwards LB, Dipchand AI, et al. The registry of the international society for heart and lung transplantation: thirty-third adult lung and heart-lung transplant report-2016; focus theme: primary diagnostic indications for transplant. J Heart Lung Transplant 2016;35:1170–84.
    1. Yusen RD, Edwards LB, Kucheryavaya AY, et al. The registry of the international society for heart and lung transplantation: thirty-first adult lung and heart-lung transplant report−2014; focus theme: retransplantation. J Heart Lung Transplant 2014;33:1009–24.
    1. Yusen RD, Edwards LB, Kucheryavaya AY, et al. The registry of the international society for heart and lung transplantation: thirty-second official adult lung and heart-lung transplantation report−2015; focus theme: early graft failure. J Heart Lung Transplant 2015;34:1264–77.
    1. Khush KK, Cherikh WS, Chambers DC, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation: thirty-sixth adult heart transplantation report - 2019; focus theme: donor and recipient size match. J Heart Lung Transplant 2019;38:1056–66.
    1. Rossano JW, Singh TP, Cherikh WS, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation: twenty-second pediatric heart transplantation report −2019; focus theme: donor and recipient size match. J Heart Lung Transplant 2019;38:1028–41.
    1. Hayes D Jr, Cherikh WS, Chambers DC, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation: twenty-second pediatric lung and heart-lung transplantation report-2019; focus theme: donor and recipient size match. J Heart Lung Transplant 2019;38:1015–27.
    1. Hayes D Jr., Harhay MO, Cherikh WS, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation: twenty-fourth pediatric lung transplantation report - 2021; focus on recipient characteristics. J Heart Lung Transplant 2021.
    1. Khush KK, Hsich E, Potena L, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation: 38th adult heart transplantation report-2021; focus on recipient characteristics. J Heart Lung Transplant 2021.
    1. Singh TP, Cherikh WS, Hsich E, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation: 24th pediatric heart transplantation report-2021; focus theme: changing recipient characteristics. J Heart Lung Transplant 2021.
    1. Chambers DC, Zuckermann A, Cherikh WS, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation: 37th adult lung transplantation report - 2020; focus on deceased donor characteristics. J Heart Lung Transplant 2020;39:1016–27.
    1. Kulkarni HS, Cherikh WS, Chambers DC, et al. Bronchiolitis obliterans syndrome-free survival after lung transplantation: an international society for heart and lung transplantation thoracic transplant registry analysis. J Heart Lung Transplant 2019;38:5–16.
    1. Paraskeva MA, Edwards LB, Levvey B, et al. Outcomes of adolescent recipients after lung transplantation: an analysis of the international society for heart and lung transplantation registry. J Heart Lung Transplant 2018;37:323–31.

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