The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Adult Lung and Heart-Lung Transplant Report—2013; Focus Theme: Age

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Data collection and statistical methods

Standard statistical methods were used for analyses and reporting. Where appropriate, a more detailed explanation about the analytical methodology accompanies the Web site slides (in the “Notes Page” view).

The Kaplan-Meier method was used for assessing time-to-event rates (eg, survival). Survival graphs (ie, time-to-event graphs) were truncated when the number of analyzable individuals fell below 10. Censoring occurred at the time a patient was last reported to be alive (eg, most recent annual

Centers and transplant activity

The Registry now contains data from 42,069 adult recipients who underwent lung transplantation (including retransplants) before 2012. From 132 participating transplant centers, the Registry obtained data for 3,640 adult lung transplantation procedures performed in 2011, which represented the highest number reported of any year to date (Figure 1). The increased number of procedures primarily occurred due to the consistent growth in the number of bilateral lung transplants since the mid-1990s;

Survival

Adults who underwent lung transplantation in the era of January 1994 through June 2011 had a median survival of 5.6 years (Figure 8), with unadjusted survival rates of 88% at 3 months, 79% at 1 year, 64% at 3 years, 53% at 5 years, and 31% at 10 years. Recipients who survived to 1 year after transplant had a conditional median survival of 7.9 years. Patients undergoing bilateral lung transplantation had higher overall and conditional unadjusted survival rates than those undergoing unilateral

Complications and morbidities

Morbidities commonly caused or exacerbated by immunosuppressive medicines (eg, hypertension, renal dysfunction, diabetes, and hyperlipidemia) occurred frequently after lung transplantation (Table 4). Within the first year after transplantation, recipients aged > 65 years had similar rates of hypertension, diabetes, renal dysfunction, acute rejection, and BOS compared with younger adults.2 However, the older group had a higher rate of hyperlipidemia.

The complication rates rose significantly over

Centers and transplant activity

The Registry now contains data from 3,677 adult recipients who underwent heart-lung transplantation (includes retransplantation) before 2012 (Figure 19). Twenty-nine participating centers reported 63 adult heart-lung transplants performed in 2011. After a rapid rise in the 1980s and a peak at the end of that decade, an overall decline in reported heart-lung transplants occurred throughout the 1990s and into the first few years of the next decade. However, the number of reported adult heart-lung

Survival

Figure 29 presents overall survival for 3,620 heart-lung transplants performed between January 1982 and June 2011. Compared with lung-only transplantation, heart-lung transplantation had a more pronounced early mortality and a better long-term survival. Heart-lung transplant recipients had survival rates of 71% at 3 months, 63% at 1 year, 51% at 3 years, 44% at 5 years, and 31% at 10 years. Recipients who survived the first year had a median survival of 10.0 years.

Survival showed improvement

Conclusions

On the basis of Registry reporting, international lung transplantation rates showed continued growth, whereas heart-lung transplantation rates plateaued. Survival for both transplant types improved over time, mainly due to improved survival in the early post-transplant period. Morbidities after lung and heart-lung transplantation frequently occurred, and the main long-term contributors to decreased long-term survival consisted of BOS of the lung and infections. Older donor age showed an

Disclosure statement

All relevant disclosures for the Registry Director, Executive Committee Members and authors are on file with the ISHLT and can be made available for review by contacting the Executive Director of the ISHLT.

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