OPTN/SRTR 2023 Annual Data Report: Lung

OPTN/SRTR 2023 Annual Data Report: Lung

Maryam Valapour1,2, Carli J. Lehr2, David P. Schladt1, Kaitlin Swanner3, Kelley Poff3, Dzhuliyana Handarova3, Samantha Weiss3, Chelsea J. Hawkins3, Ajay K. Israni1,4, Jon J. Snyder1,5,6

1Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN

2Department of Pulmonary Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH

3Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA

4Department of Medicine, University of Texas Medical Branch, Galveston, TX

5Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN

6Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN

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

1 Introduction

In 2023, there were 3,049 adult and 31 pediatric lung transplants performed in the United States, continuing the trend of increasing lung transplants every year. The annual number of new candidates added to the waiting list also increased, with 3,385 adult and 42 pediatric candidates added. Adult waitlist mortality rates have decreased 27.1% over the past decade to 13.3 deaths per 100 patient-years, meeting one of the major goals of the organ allocation systems: to decrease waitlist mortality.

Lung transplantation in the United States underwent fundamental changes during this year. On March 9, 2023, lung was the first organ allocation system to adopt the continuous distribution framework, replacing the previous lung allocation score (LAS) system that had been in effect for nearly 18 years prior. The lung composite allocation score (CAS) was created to capture all considerations in the system-level allocation of a donor lung to a candidate. The CAS is used to prioritize adult and pediatric lung transplant candidates for an organ allocation based on their estimated 1-year waitlist mortality; 5-year posttransplant survival; biology that includes blood type, height, and calculated panel-reactive antibody (cPRA); pediatric status; prior living donor status; and placement efficiency. Shortly after the CAS was implemented, an unexpected decline in transplant rates for blood type O candidates was observed, likely due to the removal of the LAS system’s prioritization of blood type O candidates for lungs from blood type O donors. The CAS blood type point distribution was modified effective September 27, 2023. Therefore, this 2023 report encompasses three distinct periods: January 1 – March 8, pre–continuous distribution with LAS still used; March 9 – September 26, continuous distribution with CAS used to rank candidates; and September 27 – December 31, continuous distribution with CAS plus ABO modification used. For calculations of medical urgency and posttransplant survival, adult candidates are categorized into four main diagnostic groups by shared diagnostic criteria or disease behavior into group A, obstructive lung disease; group B, pulmonary vascular disease; group C, cystic fibrosis and other immunodeficiency disorders; and group D, restrictive lung disease.

The Adult Lung Transplant section in this report includes information on all lung transplant candidates and recipients aged 18 years or older at the time of placement on the waiting list. The Pediatric Lung Transplant section includes information on all lung transplant candidates and recipients younger than 18 years at the time of placement on the waiting list. Reports from 2019 and earlier separated adult and pediatric sections at the age of 12 years, but this was changed in 2020 to align with international reporting. This chapter includes data on all lung and multiorgan lung transplant recipients in the United States.

2 Adult Lung Transplant

2.1 Waiting List

2.1.1 Characteristics of waitlist candidates

In 2023, there were 3,385 new adult candidates added to the lung transplant waiting list, which represents the highest number of new listings in any single year and an increase of 37.4% over the past decade (Figure LU 1). There were 4,365 candidates on the list at any time during the year (Figure LU 2). Adults aged 50-64 years represented the largest group at 44.1% of the candidates, and the proportion of adults aged 65 years or older continued to grow, reaching 38.3% of the waitlisted population (Figure LU 3). Overall, the distribution remained stable by sex, with male candidates representing 53.4% of the waiting list (Figure LU 4). Although White candidates remained the majority, the proportion of individuals of minority race and ethnicity have increased over time. Hispanic candidates made up 14.1% of the waiting list in 2023, a 117.2% increase since 2013; Black candidates made up 11.1% of the list in 2023, a 16.3% increase since 2013 (Figure LU 5). Waitlist trends by diagnosis group remained consistent. At the extremes, candidates in group D continued to represent the majority (67.9%) of the waiting list, and the proportion of candidates in group C continued its decline noted since 2019, representing a mere 2.0% of the list in 2023—a trend attributed to the therapeutic efficacy and widespread use of highly effective modulator therapy. The proportion of candidates in group A was 21.5%, representing a 37.1% decrease over the past decade, and group B made up 8.5% of the waiting list (Figure LU 6).

The CAS incorporates in its calculation biological factors that affect a lung candidate’s likelihood of finding a suitable donor match, including blood type, height, and cPRA. In 2023, individuals with blood type O continued to make up the highest proportion of the list at 48.9% of the waitlist population, followed by type A (36.6%), type B (11.4%), and type AB (3.2%) (Figure LU 10). The distribution of height categories remained largely stable over the past decade. At the extremes of height, adults < 150 cm (59 in) constituted 3.5% of the waiting list and those 180 cm (70 in) or taller, 16.1% (Figure LU 9). The implication of candidates’ height on transplant access varies depending on whether a candidate is listed for a single or bilateral lung transplant, and on their diagnosis group, with candidates in group A generally requiring donors taller than the candidate and candidates in group D requiring shorter donors.

One of the key contributors to a candidate’s final CAS is their estimated waitlist mortality over the next year without a transplant, which is reported as waitlist area under the curve (WLAUC; range, 0-365 days). This value has been calculated for all candidates since the implementation of LAS in 2005 and was used to derive the LAS, which largely reflected the risk of waitlist mortality. Until this year, the Annual Data Report only reported the final LAS value for ease of understanding. However, because the CAS incorporates multiple attributes in its calculation, starting with this report, the WLAUC values will be reported for candidates to represent the medical urgency status of those awaiting transplant. The WLAUC values are also shown in accompanying figures for longitudinal comparison of trends. In 2023, the proportion of transplant candidates whose estimated medical urgency over the next year was expressed by WLAUC of <210 days was 23.0%; of 210-<300 days, 16.9%; of 300-<335 days, 24.2%; and of 335 or more days, 36.0% (Figure LU 12).

In 2023, lung transplant candidates primarily lived in metropolitan areas, with only 13.4% residing in a nonmetropolitan region. While over half of candidates lived within 50 miles of their transplant center, 8.5% traveled 250 miles or more to their center (Table LU 1).

2.1.2 Outcomes of waitlist candidates

Deceased donor lung transplant rates continued their increase over time for adult candidates: 307.6 transplants per 100 patient-years for those on the waiting list in 2023 compared with 114.74 transplants per 100 patient-years in 2013 (Figure LU 13). By 1 year after listing, 81.2% of individuals underwent a deceased donor lung transplant, an increase of 24.4% over the past decade (Figure LU 20). Most of the candidates (65.0%) on the waiting list in 2023 waited less than 90 days for a lung transplant, 13.0% waited 3-<6 months, 11.1% waited 6-<12 months, and only 10.9% waited 1 year or longer (Figure LU 7).

Transplant rates have increased for all age categories of candidates over the past decade, but between 2022 and 2023, they plateaued for those aged 65 years or older. Candidates aged 65 years or older still had the highest transplant rate at 336.9 transplants per 100 patient-years (Figure LU 14). In terms of race and ethnicity, transplant rates were the lowest for Black candidates at 208.3 transplants per 100 patient-years compared with the highest rates of 465.6 and 328.4 transplants per 100 patient-years for candidates in the Other and White categories, respectively (Figure LU 15). Of note, the Other racial and ethnic category is composed of Multiracial, Native American, and unreported race candidates, who constituted 1.6% of candidates (Figure LU 5), leading to unstable estimates for reporting. Transplant rates have increased for candidates in all diagnosis groups over the past decade, with candidates in group D having the highest transplant rates, at 361.8 transplants per 100 patient-years (Figure LU 16). Transplant rates have diverged by blood type over the past decade, with candidates of blood type AB having the highest transplant rates and those with type O the lowest (Figure LU 17). The tallest candidates still had the highest transplant rates in 2023, and transplant rates were lower for candidates of shorter heights (Figure LU 18).

Adult candidate mortality rates have had a 27.1% decrease over the past decade, to 13.3 deaths per 100 patient-years in 2023 (Figure LU 21). Pretransplant mortality converged for age groups over time across a relatively narrow range of 11.6 to 17.1 deaths per 100 patient-years (Figure LU 22). There was a small variation in pretransplant mortality by race and ethnicity, although the rate decreased in all categories between the years 2022 and 2023, especially for Black and Hispanic candidates. The observed highest pretransplant mortality for Asian candidates in 2023 may reflect the smaller population sample size yielding unstable estimates (Figure LU 5 and Figure LU 23). Male candidates have historically had higher pretransplant mortality rates, which remained the case in 2023, but the rates for male and female candidates converged at 14.3 and 12.5 deaths per 100 patient-years, respectively (Figure LU 24). For the first time in the past decade, the pretransplant mortality rate for candidates in diagnosis group B exceeded that for candidates in group D. Group B candidates had the highest mortality rate at 23.5 deaths per 100 patient-years, and Group C reached a landmark statistic of zero deaths (Figure LU 25). Pretransplant mortality rates were the highest for candidates with blood type AB, followed by those with types B, O, and A; however, note that these rates are expressed as a function of the time candidates spent waiting (Figure LU 27). Candidates with blood type AB also had the highest transplant rate in 2023 (Figure LU 17), which suggests that both trends likely reflect the small proportion of these candidates on the list (Figure LU 10). Pretransplant mortality rates converged for candidates of all heights except those in the shortest height category of <150 cm, who had the highest rate at 23.3 deaths per 100 patient-years (Figure LU 28). Of those removed from the waiting list, 23.5% died within 6 months of waitlist removal (Figure LU 29), with the highest rates for candidates in diagnosis group D (Figure LU 30), those aged 65 years or older (Figure LU 31), and Hispanic candidates (Figure LU 32).

2.2 Transplant

2.2.1 Characteristics of transplant recipients

In 2023, a total of 3,049 adult lung transplants were performed (Figure LU 35), representing an increase of 327 from the year prior and the most transplants performed in any single year. The preferred lung transplant procedure continued to be bilateral, at 83.6% of all transplants (Figure LU 36). The number of transplants remained relatively stable for individuals aged 18-49 years but continued its dramatic increase for those aged 50 years or older, and was especially notable for those aged 50-64 years (Figure LU 37). Annually more transplants have occurred in male compared with female patients; however, this gap narrowed in 2023, with 1,724 male and 1,325 female transplant recipients (Figure LU 38). Since 2013, the number of transplants increased across all racial and ethnic categories, with transplants in Hispanic, Asian, and Black recipients increasing by 283.2% (n = 433 in 2023), 431.6% (n = 101 in 2023), and 79.4% (n = 296 in 2023), respectively (Figure LU 39). With more transplants performed each year over the past decade, candidates in diagnosis groups A, B, and D also had increases in transplants, with recipients in these groups representing 20.0%, 6.3%, and 71.8% of adult lung transplants in 2023, respectively. Group C recipients represented only 1.8% of the population (Figure LU 40). Of the 3,049 adult lung transplants performed in 2023, 96 (3.1%) transplants were part of multiorgan transplants, including 53 heart-lung, 22 liver-lung, and 21 kidney-lung transplants (Table LU 8).

The proportion of transplant recipients whose estimated waitlist mortality over the next year was expressed by WLAUC of <210 days was 27.7%; of 210-<300 days, 17.3%; of 300-<335 days, 22.7%; and of 335 or more days, 32.3% (Figure LU 41). When compared with prior years over the past decade, the greatest increases in proportions of transplants were observed for the sickest (those with WLAUC of <210 days) and the least sick (those with WLAUC of 335 or more days).

Finally, the highly selected population of lung transplant candidates has an exceptionally high rate of health insurance, ensuring coverage for the significant expenses related to lung transplant. In 2023, most (55.2%) lung transplant recipients had public insurance (46.1% Medicare, 9.1% Medicaid) while 40.5% had private insurance (Table LU 6).

2.2.2 Outcomes of transplant recipients

The use of induction agents has increased over time, with use in 86.5% of adult lung transplant recipients in 2023 (Figure LU 43). Among adult lung transplant recipients, 82.1% received interleukin-2 receptor antibody (IL2Ab) agents and 3.5% received T-cell–depleting agents (Figure LU 44). Triple-drug therapy remained the mainstay of immunosuppression with tacrolimus, a mycophenolate agent, and a steroid used in 86.7% of lung transplant recipients (Figure LU 45). Survival trends after lung transplant remained stable over the past decade, with 88.5% of recipients in 2022 surviving to 1 year, 71.3% of recipients in 2020 surviving to 3 years, 59.7% of recipients in 2018 surviving to 5 years, and 31.8% of recipients in 2013 surviving to 10 years (Figure LU 46). For those who underwent transplant in 2016-2018, 1-year patient survival was 89.0%, 3-year patient survival was 74.3%, and 5-year patient survival was 60.1% (Figure LU 47). At 5 years, 68.5% of recipients aged 35-49 years remained alive, followed by 64.9% aged 18-34 years, 62.4% aged 50-64 years, and 52.6% aged 65 years or older (Figure LU 48). Patient survival was similar across sex (Figure LU 52) and racial and ethnic groups (Figure LU 49). Transplant recipients in diagnosis group C had the highest unadjusted 5-year patient survival at 70.7%, compared with 57.8% to 61.9% across the other diagnosis groups (Figure LU 51).

The incidence of acute rejection in the first year after transplant remained the highest for lung transplant recipients aged 18-34 years, at 16.3% (Figure LU 53). For transplant recipients who were Epstein-Barr virus (EBV) negative, the incidence of posttransplant lymphoproliferative disorder (PTLD) was 8.0% by 5 years after transplant, while the incidence was lower at 1.3% for those who were EBV positive (Figure LU 55).

3 Donation

In 2023, there were 3,276 deceased donors with at least one lung recovered—a substantial increase from 1,896 deceased donors in 2013 (Figure LU 56). In terms of age, 82.2% of deceased donors were aged 18-54 years, followed by 11.9% aged 55 years or older and 5.9% younger than 18 years (Figure LU 57). For sex distribution, 60.4% were male donors (Figure LU 58). The largest proportion of donors by race and ethnicity was 59.7% White, followed by 18.0% Hispanic and 17.7% Black (Figure LU 59). The proportion of donation after circulatory death (DCD) donors continued its steady increase observed over the past decade, reaching 13.5% in 2023 from 2.3% in 2013 (Figure LU 60). In 2023, 9.0% of lungs recovered for transplant were ultimately not transplanted (Figure LU 61). This nonuse rate was highest for donors who were aged 55 years or older (Figure LU 62) and male (Figure LU 63). Nonuse rates were similar across donor cause of death (Figure LU 65) and Public Health Service Guideline risk factor status (Figure LU 66). The most common donor cause of death among deceased lung donors was anoxia, followed by head trauma and cerebrovascular accident/stroke (Figure LU 67).

4 Pediatric Lung Transplant

4.1 Waiting List

4.1.1 Characteristics of waitlist candidates

In 2023, there were 73 pediatric candidates on the lung waiting list (Figure LU 69), with 42 new candidates added during the year (Figure LU 68). The waiting list was made up of 49.1% candidates aged 12-17 years, 30.1% aged 6-11 years, 15.1% aged 1-5 years, 2.7% younger than 1 year, and 2.7% aged 18 years or older (turned 18 while waiting) (Figure LU 70). The waitlist composition by race and ethnicity included 56.2% White, 19.2% Hispanic, 13.7% Black, 9.6% Asian, and 1.4% candidates in the Other category (Figure LU 71). For distribution by sex, 53.4% of candidates were female (Figure LU 72). Candidates with blood type A made up 60% of the waiting list; type B, 25%; and type O, 15% (Table LU 10).

4.1.2 Outcomes of waitlist candidates

Regarding time on the waiting list, 37.0% of pediatric candidates were on the list for less than 90 days while 30.1% of candidates waited 1 year or more (Figure LU 73). Of candidates on the waiting list on December 31, 2023, 10.0% had waited less than 90 days; 20.0%, 3-<6 months; 15.0%, 6-<12 months; 35.0%, 1-<2 years; and 20.0%, 2 years or more (Table LU 11). Most candidates who underwent transplant did so by 1 year after listing, whereas by 3 years after listing 24.8% were removed from the waiting list and 12.4% died (Figure LU 74). The deceased donor lung transplant rate increased to 112.9 transplants per 100 patient-years in 2023, from 76.8 transplants per 100 patient-years in 2022 (Figure LU 75). Transplant rates were highest for candidates younger than 1 year, followed by those aged 12-17 years, 6-11 years, and 1-5 years (Figure LU 76). Although transplant rates by race and ethnicity are shown (Figure LU 77), it is difficult to interpret trends for transplant access by race and ethnicity in the pediatric population because the numbers are small in each category (Figure LU 69 and Figure LU 71). For distance to transplant center, 30.0% of pediatric candidates resided 250 miles or farther from their center; 15.0% resided in a nonmetropolitan area (Table LU 9).

The pediatric pretransplant mortality rate has increased to 33.3 deaths per 100 patient-years in 2023, from its lowest point in the past decade of 17.5 in 2021 (Figure LU 78). Pretransplant mortality was highest in 2023 for children younger than 1 year, at 128.1 deaths per 100 patient-years (Figure LU 79), although the trends may not be meaningful because the numbers are small in each category (Figure LU 69 and Figure LU 70). In 2023, nine pediatric candidates died on the waiting list, eight were removed due to having improved, and one was removed for being too sick for transplant (Table LU 13).

4.2 Transplant

4.2.1 Characteristics of transplant recipients

In 2023, there were 31 pediatric lung transplants performed (Figure LU 80): 20 recipients aged 12-17 years, 8 aged 6-11 years, 2 younger than 1 year, and 1 aged 1-5 years (Table LU 14 and Figure LU 81). By race and ethnicity, 19 recipients were White; 6, Black; 4, Hispanic; 1, Asian; and 1, Multiracial. Most of the recipients had private insurance (n = 15), followed by Medicaid (9) and Medicare (2). One candidate was supported with mechanical ventilation, 4 with extracorporeal membrane oxygenation (ECMO), and 4 with mechanical ventilation and ECMO (Table LU 15). For cause of lung disease, most pediatric transplant recipients were in the other/unknown diagnosis category (n = 17), followed by pulmonary hypertension (7), pulmonary fibrosis (4), and cystic fibrosis (3); the cystic fibrosis group has continued to decrease over the past few years. Retransplants accounted for 6.5% of pediatric lung transplants, while heart-lung transplants accounted for 3.2% (Table LU 16).

4.2.2 Outcomes of transplant recipients

Most pediatric lung transplant recipients (87.1%) received induction therapy (Figure LU 82), with 48.4% receiving T-cell–depleting agents and 38.7% receiving IL2Ab agents (Figure LU 83). Most transplant recipients were maintained on a regimen of tacrolimus, a mycophenolate agent, and a steroid, but the proportion of recipients who were maintained on tacrolimus and mycophenolate only increased to 19.4% (Figure LU 84). Although it remained a relatively uncommon occurrence, PTLD was higher at 5 years for EBV-negative recipients at 7.1% than for EBV-positive recipients at 1.3% (Figure LU 85). Slight variations in survival occurred, likely due to small sample sizes. Among transplant recipients in 2022, 81.0% of recipients survived to 1 year; of recipients in 2020, 63.9% survived to 3 years; of recipients in 2018, 57.5% survived to 5 years; and of recipients in 2013, 33.3% survived to 10 years (Figure LU 86). For those who underwent transplant in 2016-2018, 58.1% of pediatric lung transplant recipients survived to 5 years (Figure LU 87).

List of Figures

List of Tables




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




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

Figure LU 34: Overall lung transplants. All lung transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.




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

Figure LU 35: Overall adult lung transplants. All adult lung transplant recipients, including retransplant and multiorgan recipients.




**Adult lung transplants by procedure type.** 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.




**Adult lung transplants by age.** 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.




**Adult lung transplants by sex.** 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.




**Adult lung transplants by race and ethnicity.** 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.




**Adult lung transplants by diagnosis group.** 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.




**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 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.




**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 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.




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

Figure LU 43: Induction agent use in adult lung transplant recipients. Immunosuppression at transplant reported to the OPTN.




**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 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.




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

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.




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

Figure LU 46: Patient death among adult lung transplant recipients. All adult recipients of deceased donor lungs, including multiorgan transplant recipients.




**Patient survival among adult lung transplant recipients, 2016-2018.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LU 47: Patient survival among adult lung transplant recipients, 2016-2018. Patient survival estimated using unadjusted Kaplan-Meier methods.




**Patient survival among adult lung transplant recipients, 2016-2018, by age.** 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.




**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 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.




**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 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.




**Patient survival among adult lung transplant recipients, 2016-2018, by diagnosis group.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure LU 51: Patient survival among adult lung transplant recipients, 2016-2018, by diagnosis group. Patient survival estimated using unadjusted Kaplan-Meier methods.




**Patient survival among adult lung transplant recipients, 2016-2018, by sex.** 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




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

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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 67: Cause of death among deceased lung donors. Deceased donors with at least one lung recovered for the purposes of transplant. CVA, cerebrovascular accident.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




**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 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.




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

Figure LU 80: Overall pediatric lung transplants. All pediatric lung transplant recipients, including retransplant and multiorgan recipients.




**Pediatric lung transplants by recipient age.** 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.




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

Figure LU 82: Induction agent use in pediatric lung transplant recipients. Immunosuppression at transplant reported to the OPTN.




**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 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.




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

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.




**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 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.




**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 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.




**Overall patient survival among pediatric deceased donor lung transplant recipients, 2016-2018.** Recipient survival estimated using unadjusted 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.