OPTN/SRTR 2021 Annual Data Report: Lung

Abstract

The number of lung transplants has continued to decline since 2020, a period that coincides with the onset of the COVID-19 pandemic. Lung allocation policy continues to undergo considerable change in preparation for adoption of the Composite Allocation Score system in 2023, beginning with multiple adaptations to the calculation of the Lung Allocation Score that occurred in 2021. The number of candidates added to the waiting list increased after a decline in 2020, while waitlist mortality has increased slightly with a decreased number of transplants. Time to transplant continues to improve, with 38.0% of candidates waiting fewer than 90 days for a transplant. Posttransplant survival remains stable, with 85.3% of transplant recipients surviving to 1 year; 67%, to 3 years; and 54.3%, to 5 years.

Keywords: End-stage lung disease; Lung Allocation Score; lung transplant; organ allocation; revised Lung Allocation Score; transplant outcomes.

Graphical abstract

Figure LU 1

New adult candidates added to the lung transplant waiting list. A new adult candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Active and inactive patients are included.

Figure LU 2

All adult candidates on the lung transplant waiting list. Adult candidates on the list at any time during the year. Candidates listed at more than one center are counted once per listing.

Figure LU 3

Distribution of adults waiting for lung transplant by age. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. Age is determined at the earliest of transplant, death, removal, or December 31 of the year.

Figure LU 4

Distribution of adults waiting for lung transplant by sex. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

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Distribution of adults waiting for lung transplant by race. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

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Distribution of adults waiting for lung transplant by diagnosis group. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included. The Other/unknown group includes a small number of heart-lung candidates prior to 2015 who did not have an A/B/C/D diagnosis group specified.

Figure LU 7

Distribution of adults waiting for lung transplant by waiting time. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Time on the waiting list is determined at the earliest of transplant, death, removal, or December 31 of the year. Active and inactive candidates are included.

Figure LU 8

Distribution of adult candidates waiting for lung transplant by LAS. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. LAS, lung allocation score. LAS is determined at the earliest of transplant, death, removal, or December 31 of the year.

Figure LU 9

Distribution of adult candidates waiting for lung transplant by height. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

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Distribution of adults waiting for lung transplant by blood type. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

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Distribution of adults waiting for lung transplant by prior transplant status. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

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Overall deceased donor lung transplant rates among adult waitlist candidates. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.

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Deceased donor lung transplant rates among adult waitlist candidates by age. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

Figure LU 14

Deceased donor lung transplant rates among adult waitlist candidates by race. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.

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Deceased donor lung transplant rates among adult waitlist candidates by diagnosis group. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately. The Other/unknown group includes a small number of heart-lung candidates prior to 2015 who did not have an A/B/C/D diagnosis group specified.

Figure LU 16

Deceased donor lung transplant rates among adult waitlist candidates by blood type. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.

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Deceased donor lung transplant rates among adult waitlist candidates by height. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately.

Figure LU 18: Deceased donor lung transplant rates among adult waitlist candidates by metropolitan vs. non-metropolitan residence. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately. Urban/rural determination is made using the RUCA (rural-urban commuting area) designation of the candidate’s permanent zip code.

Figure LU 19

Three-year outcomes for adults waiting for lung transplant, new listings in 2016-2018. Candidates listed at more than one center are counted once per listing. Removed from list includes all reasons except transplant and death. DD, deceased donor.

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Percentage of adults who underwent deceased donor lung transplant within a given period of listing. Candidates listed at more than one center are counted once per listing.

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Overall pretransplant mortality rates among adults waitlisted for lung transplant. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure LU 22

Pretransplant mortality rates among adults waitlisted for lung transplant by age. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

Figure LU 23

Pretransplant mortality rates among adults waitlisted for lung transplant by race. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure LU 24

Pretransplant mortality rates among adults waitlisted for lung transplant by sex. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure LU 25

Pretransplant mortality rates among adults waitlisted for lung transplant by diagnosis. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. The Other/unknown group includes a small number of heart-lung candidates prior to 2015 who did not have an A/B/C/D diagnosis group specified.

Figure LU 26

Pretransplant mortality rates among adults waitlisted for lung transplant by LAS. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. LAS is determined at the later of listing date or January 1 of the given year.

Figure LU 27

Pretransplant mortality rates among adults waitlisted for lung transplant by blood type. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure LU 28

Pretransplant mortality rates among adults waitlisted for lung transplant by height. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure LU 29: Pretransplant mortality rates among adults waitlisted for lung transplant by metropolitan vs. non-metropolitan residence. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Urban/rural determination is made using the RUCA (rural-urban commuting area) designation of the candidate’s permanent zip code.

Figure LU 30

Pretransplant mortality rates among adults waitlisted for lung transplant in 2021 by DSA. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure LU 31

Deaths within six months after removal among adult lung waitlist candidates, overall. Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

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Deaths within six months after removal among adult lung waitlist candidates, by diagnosis. Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. The Other/unknown group includes a small number of heart-lung candidates prior to 2015 who did not have an A/B/C/D diagnosis group specified.

Figure LU 33

Deaths within six months after removal among adult lung waitlist candidates, by age. Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. Age is determined at removal.

Figure LU 34

Overall deceased lung donor count. Count of deceased donors with at least one lung recovered. Donors are counted once, regardless of the number of lungs recovered.

Figure LU 35: Deceased lung donor count by age. Count of deceased donors with at least one lung recovered. Donors are counted once, regardless of the number of lungs recovered.

Figure LU 36

Distribution of deceased lung donors by age. Deceased donors whose lungs were recovered for transplant. Donors are counted once, regardless of the number of lungs recovered.

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Distribution of deceased lung donors by sex. Deceased donors whose lungs were recovered for transplant. Donors are counted once, regardless of the number of lungs recovered.

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Distribution of deceased lung donors by race. Deceased donors whose lungs were recovered for transplant. Donors are counted once, regardless of the number of lungs recovered.

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Overall percent of lungs recovered for transplant and not transplanted. Percentages of lungs not transplanted out of all lungs recovered for transplant.

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Percent of lungs recovered for transplant and not transplanted by donor age. Percentages of lungs not transplanted out of all lungs recovered for transplant.

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Percent of lungs recovered for transplant and not transplanted by donor cause of death. Percentages of lungs not transplanted out of all lungs recovered for transplant. CVA, cerebrovascular accident.

Figure LU 42

Percent of lungs recovered for transplant and not transplanted, by donor risk of disease transmission. Percentages of lungs not transplanted out of all lungs recovered for transplant. “Increased risk” is defined by criteria from the US Public Health Service Guidelines for increased risk for HIV, hepatitis B, and hepatitis C transmission.

Figure LU 43

Cause of death among deceased lung donors. Deceased donors with a lung recovered for the purposes of transplant. CVA, cerebrovascular accident.

Figure LU 44

Overall lung transplants. All lung transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

Figure LU 45

Total lung transplants by procedure type. All lung transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

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Total lung transplants by age. All lung transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

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Total lung transplants by sex. All lung transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

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Total lung transplants by race. All lung transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

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Total lung transplants by diagnosis. All lung transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients. The Other/unknown group includes a small number of heart-lung recipients prior to 2015 who did not have an A/B/C/D diagnosis group specified.

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Total lung transplants by LAS. All lung transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

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Induction agent use in adult lung transplant recipients. Immunosuppression at transplant reported to the OPTN.

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Immunosuppression regimen use in adult lung transplant recipients. Immunosuppression regimen at transplant reported to the OPTN. Tac, tacrolimus. MMF, all mycophenolate agents.

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Patient death among adult lung transplant recipients. All adult recipients of deceased donor lungs, including multiorgan transplants.

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Patient survival among adult lung transplant recipients, 2014-2016, by age. Patient survival estimated using unadjusted Kaplan-Meier methods.

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Patient survival among adult lung transplant recipients, 2014-2016, by race. Patient survival estimated using unadjusted Kaplan-Meier methods.

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Patient survival among adult lung transplant recipients, 2014-2016, by LAS. Patient survival estimated using unadjusted Kaplan-Meier methods.

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Patient survival among adult lung transplant recipients, 2014-2016, by transplant type. Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LU 58

Patient survival among adult lung transplant recipients, 2014-2016, by diagnosis group. Patient survival estimated using unadjusted Kaplan-Meier methods. The Other/unknown group includes a small number of heart-lung recipients prior to 2015 who did not have an A/B/C/D diagnosis group specified.

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Patient survival among adult lung transplant recipients, 2014-2016, by sex. Patient survival estimated using unadjusted Kaplan-Meier methods.

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Patient survival among adult lung transplant recipients, 2014-2016, by metropolitan vs. non-metropolitan recipient residence. Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LU 61: Incidence of acute rejection by 1 year posttransplant among adult lung transplant recipients by age. Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.

Figure LU 62: Incidence of acute rejection by 1 year posttransplant among adult lung transplant recipients by induction agent. Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.

Figure LU 63: Incidence of PTLD among adult lung transplant recipients by recipient EBV status at transplant, 2010-2016. Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin’s disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.

Figure LU 64

New pediatric candidates added to the lung transplant waiting list. A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure LU 65

All pediatric candidates on the lung transplant waiting list. Pediatric candidates listed at any time during the year. Candidates listed at more than one center are counted once per listing.

Figure LU 66

Distribution of pediatric candidates waiting for lung transplant by age. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. Age is determined at the earliest of transplant, death, removal, or December 31 of the year.

Figure LU 67

Distribution of pediatric candidates waiting for lung transplant by race. Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included.

Figure LU 68: Distribution of pediatric candidates waiting for lung transplant by sex. Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure LU 69

Distribution of pediatric candidates waiting for lung transplant by waiting time. Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Time on the waiting list is determined at the earliest of transplant, death, removal, or December 31 of the year. Active and inactive candidates are included.

Figure LU 70

Three-year outcomes for newly listed pediatric candidates waiting for lung transplant, 2016-2018. Pediatric candidates who joined the waiting list in 2016-2018. Pediatric candidates listed at more than one center are counted once per listing. Removed from list includes all reasons except transplant and death. DD, deceased donor.

Figure LU 71

Overall deceased donor lung transplant rates among pediatric waitlist candidates. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately.

Figure LU 72

Deceased donor lung transplant rates among pediatric waitlist candidates by age. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

Figure LU 73

Deceased donor lung transplant rates among pediatric waitlist candidates by race. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting in a given year. Individual listings are counted separately.

Figure LU 74

Overall pretransplant mortality rates among pediatric candidates waitlisted for lung. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure LU 75

Pretransplant mortality rates among pediatric candidates waitlisted for lung transplant by age. Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

Figure LU 76

Overall pediatric lung transplants. All pediatric lung transplant recipients, including retransplant, and multiorgan recipients.

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Pediatric lung transplants by recipient age. All pediatric lung transplant recipients, including retransplant, and multiorgan recipients.

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Induction agent use in pediatric lung transplant recipients. Immunosuppression at transplant reported to the OPTN.

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Immunosuppression regimen use in pediatric lung transplant recipients. Immunosuppression regimen at transplant reported to the OPTN. Tac, tacrolimus. MMF, all mycophenolate agents.

Figure LU 80

Incidence of PTLD among pediatric lung transplant recipients by recipient EBV status at transplant, 2010-2016. Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or on the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin’s disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus. PTLD, posttransplant lymphoproliferative disorder.

Figure LU 81

Patient death among pediatric lung transplant recipients. All pediatric recipients of deceased donor lungs, including multiorgan transplants. Estimates are unadjusted, computed using unadjusted Kaplan-Meier methods.

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Overall patient survival among pediatric deceased donor lung transplant recipients, 2014-2016. Recipient survival estimated using unadjusted Kaplan-Meier methods.