OPTN/SRTR 2023 Annual Data Report: Lung

Abstract

The year 2023 marked a year of major transition for the lung transplant community in the United States, as it became the first to adopt the continuous distribution system for organ allocation. Starting on March 9, 2023, the composite allocation score (CAS) was used to rank candidates for access to a lung transplant. Shortly after the adoption of this CAS system, it was amended to better represent the biological disadvantage of candidates with blood type O for accessing a donor organ. Despite the challenges of implementing major changes to the system, the year 2023 marked many successes and milestones in US lung transplantation. A total of 3,049 adult lung transplants were performed, representing the most transplants performed in any single year. Transplant rates continued their increase over time and reached an all-time high of 307.6 transplants per 100 patient-years for adults on the waiting list. By 1 year after listing, 81.2% of adult candidates underwent a deceased donor lung transplant, with 62.6% of them having waited 3 months or less. Adult waitlist mortality rates decreased to their lowest at 13.3 deaths per 100 patient-years, meeting one of the major goals of the organ allocation systems: to decrease waitlist mortality. Survival after lung transplant remained stable over the past decade with 88.5% of adults who underwent transplant in 2022 surviving to 1 year compared with 87.2% of adults who underwent transplant in 2013.

Keywords: Composite allocation score; end-stage lung disease; lung transplantation; transplant outcomes.

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.

Figure LU 5:. Distribution of adults waiting for lung transplant by race and ethnicity.

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.

Figure LU 6:. 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.

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 is determined at the earliest of transplant, death, removal, December 31 of the year, or March 8, 2023. Post-LAS is March 9, 2023, and later. LAS, lung allocation score.

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.

Figure LU 10:. 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.

Figure LU 11:. 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.

Figure LU 12:. Distribution of adults waiting for lung transplant by WLAUC.

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. WLAUC is determined at the earliest of transplant, death, removal, or December 31 of the year. The 2015 WLAUC values are for February 19, 2015, through December 31, 2015. WLAUC, waitlist area under the curve.

Figure LU 13:. 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 waiting time in a given year. Individual listings are counted separately.

Figure LU 14:. 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 waiting 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 15:. Deceased donor lung transplant rates among adult waitlist candidates by race and ethnicity.

Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

Figure LU 16:. 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 waiting time in a given year. Individual listings are counted separately.

Figure LU 17:. 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 waiting time in a given year. Individual listings are counted separately.

Figure LU 18:. 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 waiting time in a given year. Individual listings are counted separately.

Figure LU 19:. Three-year outcomes for adults waiting for lung transplant, new listings in 2018–2020.

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 20:. 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.

Figure LU 21:. 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 time 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 time 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 and ethnicity.

Mortality rates are computed as the number of deaths per 100 patient-years of waiting time 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 race category is composed of Native American and Multiracial categories.

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 time 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 group.

Mortality rates are computed as the number of deaths per 100 patient-years of waiting time 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 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 time 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, if listed March 8, 2023, or earlier. Post-LAS is March 9, 2023, and later. LAS, lung allocation score.

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 time 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 time 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:. Deaths within 6 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.

Figure LU 30:. Deaths within 6 months after removal among adult lung waitlist candidates, by diagnosis group.

Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

Figure LU 31:. Deaths within 6 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 32:. Deaths within 6 months after removal among adult lung waitlist candidates, by race and ethnicity.

Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. The Other race category is composed of Native American and Multiracial categories.

Figure LU 33:. Deaths within 6 months after removal among adult lung waitlist candidates, by sex.

Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

Figure LU 34:. Overall lung transplants.

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

Figure LU 35:. Overall adult lung transplants.

All adult lung transplant recipients, including retransplant and multiorgan recipients.

Figure LU 36:. Adult lung transplants by procedure type.

Adult lung transplant recipients, including retransplant and multiorgan recipients.

Figure LU 37:. Adult lung transplants by age.

Adult lung transplant recipients, including retransplant and multiorgan recipients.

Figure LU 38:. Adult lung transplants by sex.

Adult lung transplant recipients, including retransplant and multiorgan recipients.

Figure LU 39:. Adult lung transplants by race and ethnicity.

Adult lung transplant recipients, including retransplant and multiorgan recipients.

Figure LU 40:. Adult lung transplants by diagnosis group.

Adult lung transplant recipients, including retransplant and multiorgan recipients.

Figure LU 41:. Adult lung transplants by WLAUC at transplant.

Adult lung transplant recipients, including retransplant and multiorgan recipients. The 2015 WLAUC values are for February 19, 2015, through December 31, 2015. WLAUC, waitlist area under the curve.

Figure LU 42:. Adult lung transplants by LAS.

Adult lung transplant recipients, including retransplant and multiorgan recipients. LAS ended on March 8, 2023; post-LAS is March 9, 2023, and later. LAS, lung allocation score.

Figure LU 43:. Induction agent use in adult lung transplant recipients.

Immunosuppression at transplant reported to the OPTN.

Figure LU 44:. Type of induction agent use in adult lung transplant recipients.

Immunosuppression at transplant reported to the OPTN. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.

Figure LU 45:. Immunosuppression regimen use in adult lung transplant recipients.

Immunosuppression regimen at transplant reported to the OPTN. MMF, all mycophenolate agents; Tac, tacrolimus.

Figure LU 46:. Patient death among adult lung transplant recipients.

All adult recipients of deceased donor lungs, including multiorgan transplant recipients.

Figure LU 47:. Patient survival among adult lung transplant recipients, 2016–2018.

Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LU 48:. Patient survival among adult lung transplant recipients, 2016–2018, by age.

Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LU 49:. Patient survival among adult lung transplant recipients, 2016–2018, by race and ethnicity.

Patient survival estimated using unadjusted Kaplan-Meier methods. The Other race category is composed of Native American and Multiracial categories.

Figure LU 50:. Patient survival among adult lung transplant recipients, 2016–2018, by LAS.

Patient survival estimated using unadjusted Kaplan-Meier methods. LAS ended on March 8, 2023; post-LAS is March 9, 2023, and later. LAS, lung allocation score.

Figure LU 51:. Patient survival among adult lung transplant recipients, 2016–2018, by diagnosis group.

Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LU 52:. Patient survival among adult lung transplant recipients, 2016–2018, by sex.

Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LU 53:. 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 54:. Incidence of acute rejection by 1 year posttransplant among adult lung transplant recipients by race and ethnicity.

Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method. The Other race category is composed of Native American and Multiracial categories.

Figure LU 55:. Incidence of PTLD among adult lung transplant recipients by recipient EBV status at transplant, 2012–2018.

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 56:. 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 57:. 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.

Figure LU 58:. 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.

Figure LU 59:. Distribution of deceased lung donors by race and ethnicity.

Deceased donors whose lungs were recovered for transplant. Donors are counted once, regardless of the number of lungs recovered. The Other race category is composed of Native American and Multiracial categories.

Figure LU 60:. Distribution of deceased lung donors by DCD status.

Deceased donors whose lungs were recovered for transplant. DBD, donation after brain death; DCD, donation after circulatory death.

Figure LU 61:. Overall percent of lungs recovered for transplant and not transplanted.

Percentages of lungs not transplanted out of all lungs recovered for transplant.

Figure LU 62:. Percent of lungs recovered for transplant and not transplanted by donor age.

Percentages of lungs not transplanted out of all lungs recovered for transplant.

Figure LU 63:. Percent of lungs recovered for transplant and not transplanted by donor sex.

Percentages of lungs not transplanted out of all lungs recovered for transplant.

Figure LU 64:. Percent of lungs recovered for transplant and not transplanted by donor race and ethnicity.

Percentages of lungs not transplanted out of all lungs recovered for transplant. The Other race category is composed of Native American and Multiracial categories.

Figure LU 65:. 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 66:. 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. “Risk factors” refers to risk criteria for acute transmission of human immunodeficiency virus, hepatitis B virus, or hepatitis C virus from the US Public Health Service Guideline.

Figure LU 67:. Cause of death among deceased lung donors.

Deceased donors with at least one lung recovered for the purposes of transplant. CVA, cerebrovascular accident.

Figure LU 68:. 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 were 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 69:. 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 70:. 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. The 18+ category is for candidates who turned age 18 while waiting.

Figure LU 71:. Distribution of pediatric candidates waiting for lung transplant by race and ethnicity.

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. The Other race category is composed of Native American and Multiracial categories.

Figure LU 72:. 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 73:. 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 74:. Three-year outcomes for newly listed pediatric candidates waiting for lung transplant, 2018–2020.

Pediatric candidates who joined the waiting list in 2018–2020. 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 75:. 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 time in a given year. Individual listings are counted separately.

Figure LU 76:. 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 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. The 18+ category is for candidates who turned age 18 while waiting.

Figure LU 77:. Deceased donor lung transplant rates among pediatric waitlist candidates by race and ethnicity.

Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

Figure LU 78:. 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 time 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 79:. 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 time 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. The 18+ category is for candidates who turned age 18 while waiting.

Figure LU 80:. Overall pediatric lung transplants.

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

Figure LU 81:. Pediatric lung transplants by recipient age.

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

Figure LU 82:. Induction agent use in pediatric lung transplant recipients.

Immunosuppression at transplant reported to the OPTN.

Figure LU 83:. Type of induction agent use in pediatric lung transplant recipients.

Immunosuppression at transplant reported to the OPTN. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.

Figure LU 84:. Immunosuppression regimen use in pediatric lung transplant recipients.

Immunosuppression regimen at transplant reported to the OPTN. MMF, all mycophenolate agents; Tac, tacrolimus.

Figure LU 85:. Incidence of PTLD among pediatric lung transplant recipients by recipient EBV status at transplant, 2012–2018.

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 86:. Patient death among pediatric lung transplant recipients.

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

Figure LU 87:. Overall patient survival among pediatric deceased donor lung transplant recipients, 2016–2018.

Recipient survival estimated using unadjusted Kaplan-Meier methods.