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

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.

Figure 1

Recipient diagnosis by location and era (transplants: January 1992-June 2018).

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

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

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

Kaplan-Meier survival within 12 months for adult lung transplant recipients by location and era (transplants: January 2000-June 2017).

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

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

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

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

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

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

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

(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

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

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

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

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

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

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

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.