Indications and outcomes in adult lung transplantation

Abstract

Lung transplantation (LTx) is a treatment option for end-stage lung disease that would be otherwise fatal for specific patient populations. The most common indications for LTx in adults remain to be chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis, alpha-1 antitrypsin deficiency, and idiopathic pulmonary arterial hypertension. Recent trends include performing re-transplantation while more patients over the age of 65 years are undergoing LTx. Even with these tendencies, slight improvements in survival have occurred. This article briefly reviews recent developments in adults undergoing LTx.

Keywords: Adults; indications; lung transplantation (LTx); outcomes.

Figure 1

Major indications for lung transplants by year (%) from 1990 to 2011, modified with permission (2). The age distribution of lung transplant recipients was compared between eras using a chi-square test. A significant P value means that at least one of the groups is different than the others but it doesn’t identify which group it is.

Figure 2

Adult lung transplants recipient age distribution by era from 1985 to 2012, modified with permission (2).

Figure 3

Adult lung transplants Kaplan-Meier survival by procedure type (single or bilateral) from January 1994 to June 2011, modified with permission (2). Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not known for all patients. The median survival is the estimated time point at which 50% of all of the recipients have died. The conditional median survival is the estimated time point at which 50% of the recipients who survive to at least 1 year have died. Because the decline in survival is greatest during the first year following transplantation, the conditional survival provides a more realistic expectation of survival time for recipients who survive the early post-transplant period. Survival rates were compared using the log-rank test statistic.

Figure 4

Adult lung transplants Kaplan-Meier survival by era from January 1988 to June 2011, modified with permission (2). Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not known for all patients. The median survival is the estimated time point at which 50% of all of the recipients have died. The conditional median survival is the estimated time point at which 50% of the recipients who survive to at least 1 year have died. Because the decline in survival is greatest during the first year following transplantation, the conditional survival provides a more realistic expectation of survival time for recipients who survive the early post-transplant period. Survival rates were compared using the log-rank test statistic. Adjustments for multiple comparisons were done using Scheffe’s method.