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Lung

OPTN/SRTR 2016 Annual Data Report: Lung

Abstract

In 2016, 2692 candidates aged 12 years or older were added to the lung transplant waiting list; 2345 transplants were performed, the largest number of any prior year. The median waiting time for listed candidates in 2016 was 2.5 months, and waiting times were shortest for group D candidates. The transplant rate increased to 191.9 transplants per 100 waitlist years in 2016, with a slight decrease in waitlist mortality to 15.1 deaths per 100 waitlist years. Short-term survival continued to improve, with a 6-month death rate of 6.6% and a 1-year death rate of 10.8% among recipients in 2015 compared with 8.0% and 13.3%, respectively, among recipients in 2014. Long-term survival rates remained unchanged; 55.6% of recipients were alive at 5 years. In 2016, 23 new candidates aged 0-11 years were added to the waiting list and 16 lung transplants were performed. Incidence of posttransplant mortality for lung transplant recipients aged 0-11 years who underwent transplant in 2014-2015 was 13.8% at 6 months and 19.6% at 1 year. Changes in waitlist and transplant demographic features continued to evolve following implementation of the revised lung allocation score in 2015. Some early trends that may be attributable to the revised LAS are shorter waiting times, stabilization of the number of group D candidates listed for transplant, and convergence of LAS with lower prevalence of extremely high scores.

Introduction

Lung transplant is increasingly used as a treatment for US patients with end-stage lung diseases, and the number of annual lung transplants peaked in 2016 at 2345 (Figure LU 33). The demand for transplant continued to outpace donations; 9.8% of candidates aged 12 years or older died within 3 years of listing while waiting for transplant (Figure LU 14). Risk of waitlist mortality plays an important role in organ allocation in the US, where lungs are allocated to candidates aged 12 years or older based on the lung allocation score (LAS), age, geography, ABO compatibility, and, if necessary, waiting time. Candidates aged younger than 12 years access transplant through an illness-based priority status, age, geography, blood type (ABO) compatibility, and waiting time.

The Organ Procurement and Transplantation Network (OPTN) monitors and modifies the US lung allocation system to improve access for candidates most at risk for mortality on the waiting list. Recent important changes to the system include the February 2015 implementation of the LAS revision and the March 2017 implementation of changes to pediatric allocation. The former is a change in how the LAS is calculated. The latter includes broader geographic sharing of organs for pediatric candidates, and allows for transplant of organs from donors of any blood type for candidates aged younger than 2 years.

The LAS calculation largely reflects the risk of waitlist mortality while avoiding transplants in candidates with poor likelihood of posttransplant survival. The LAS applies to adolescent (aged 12-17 years) and adult (aged 18 years or older) candidates. To calculate the LAS, pulmonary diagnoses are categorized into four main groups based on survival probability and pathophysiology of the underlying disease. The four groups are: group A, obstructive lung disease (e.g., chronic obstructive lung disease/emphysema); group B, pulmonary vascular disease (e.g., idiopathic pulmonary arterial hypertension); group C, cystic fibrosis and immunodeficiency disorders; and group D, restrictive lung disease (e.g., idiopathic pulmonary fibrosis). The first major revision of the LAS calculation was implemented in February 2015. It included modifications to the variables used in the LAS calculation and to the relative weight of the variables used to predict risk of death in the next year without transplant and in the first year posttransplant. In this chapter, we display the revised LAS longitudinally with the LAS data from prior years. We caution readers about comparing the revised LAS with the original LAS in the figures. Given the differences in how these scores are calculated, they may not be comparable. In time, the full impact of the revised LAS on waitlist and posttransplant outcomes will be evident.

In this report, all lung transplant candidates and recipients aged 12 years or older are included under Adult Lung Transplant, and those aged 0-11 years are included under Lung Transplant in Children. Heart-lung patients are included in all tabulations.

Adult Lung Transplant

Waiting Listing

Characteristics of US candidates waiting for a lung transplant

In 2016, 2692 new candidates were added to the lung transplant waiting list, continuing a trend of increased use of lung transplant as a treatment for end-stage lung diseases (Figure LU 1). At the end of the year, 1395 candidates were on the waiting list, a decremental change seen annually across the prior decade (Figure LU 2). Despite the 2015 LAS revision, some trends attributable to the LAS persisted; older candidates and those in diagnosis group D continued to make up the largest proportion of the waiting list (Figure LU 3, Figure LU 5). However, the prior trend of listing candidates in the highest LAS categories was reversed. This may represent a drift in scores due to changes in calculating the revised LAS rather than a true change in listing practices (Figure LU 7).

As older candidates made up a larger proportion of the waiting list, candidates aged younger than 50 years made up a smaller proportion. Candidates aged 65 years or older made up 26.6% of the waiting list in 2016 compared with 11.2% in 2007. However, those aged 50-64 years still accounted for 49.2% of waitlist candidates in 2016. There was a concurrent decrease in candidates aged younger than 50 years over the past decade, from 34.7% of the waiting list in 2007 to 24.2% in 2016 (Figure LU 3).

Since implementation of the original LAS in 2005, listing of candidates with restrictive lung diseases (diagnosis group D) continued to increase, but that trend has stabilized since 2014. The proportion represented by each diagnosis group remained relatively stable over the past 2 years: group D, 50.1%; group A, 32.5%; group C, 12.3%; and group B, 5.1% (Figure LU 5).

The trend toward steady increases in candidates with the highest LAS following implementation of the LAS suggests that sicker candidates were being considered for transplant each year. Although the median LAS at transplant was relatively stable, the 75th percentile score continued to increase, peaking at 61.8 in 2014 (Figure LU 40). However, over the past 2 years, the proportion of candidates with LAS 50-100 decreased in favor of an increased proportion of candidates in the middle range of LAS, 30-40. In 2016, proportions of candidate revised LASs were: <30, 0.05%; 30-<35, 29.1%; 35-<40, 25.4%; 40-<50, 20.4%; and 50-100, 24.8% (Figure LU 7). It is difficult to compare these trends in listing according to LAS as implementation of the revised LAS took effect in 2015 and a given calculated value of LAS compared with revised LAS may not indicate the same level of disease severity.

Outcome of US candidates listed for lung transplant

Lung transplants in the US are increasing every year with the highest rate to date in 2016, at 191.9 per 100 waitlist years (Figure LU 11). In 2016, 29.3% of active candidates had been listed for 30 days or less in the year, and 65.0% for 6 months or less, compared with 24.5% and 60.7%, respectively, in 2015 (Figure LU 6). The median waiting time for candidates listed in 2016 was 2.5 months, ranging from 1.9 months for group D to 3.8 months for group A, and representing a decrease across all groups compared with candidates listed in 2015 (Figure LU 15). This trend is likely due to more donor organs, as lung donor counts increased by 7% from 2014-2015 and by a further 13.9% from 2015-2016 (Figure LU 32). The largest decrease in waiting time was for group B candidates, from 8.9 months in 2015 to 3.5 months in 2016 (Figure LU 15). This trend is an expected consequence of the revised LAS, which includes cardiac index, central venous pressure, and bilirubin, predictors of waitlist mortality for group B candidates. By diagnosis, transplant rates remained highest for candidates in group D, 268.7 per 100 active waitlist years, following prior trends that began after the initial implementation of the LAS in 2005 (Figure LU 11). Transplant rates in diagnosis group C increased substantially compared with rate increases in other diagnosis groups, at 221.0 per 100 active waitlist years in 2016 compared with 157.1 in 2015 (Figure LU 11). Median LAS by diagnosis changed since the revised LAS went into effect, with convergence of LAS in groups B, C, and D. In 2016, median revised LAS scores were 46.9 for group B, 43.9 for group D, 43.3 for group C, and 33.6 for group A (Figure LU 41).

Key allocation variables not accounted for by the revised LAS calculation, such as height, blood type, and geographic region, continued to play an important role in access to lung transplant. Regarding height, transplant rates remained the lowest for candidates shorter than 160 cm, 110.7 per 100 active waitlist years (Figure LU 13). Regarding blood type, transplant rates were lowest for candidates with blood type O, 171.5 per 100 active waitlist years (Figure LU 12). Access differed by geographic region; the percentage of candidates who underwent transplant within a year of listing varied from 37% to 100%, depending on donation service area (Figure LU 17).

Despite consistent increases in transplant rates, waitlist mortality remained relatively stable since 2009-2010, at 15.1 deaths per 100 waitlist years in 2015-2016 (Figure LU 19). This represents a slight decrease from 15.4 deaths per 100 waitlist years in 2013-2014 and 16.7 deaths per 100 waitlist years in 2012-2013. By age, waitlist mortality was highest in candidates aged 12-17 years, at 29.1 deaths per 100 waitlist years, and next highest in those aged 65 years or older, at 19.8 deaths per 100 waitlist years; waitlist mortality was lowest in those aged 35-64 years, at 13.1-13.5 deaths per 100 waitlist years (Figure LU 18). While understanding increased waitlist mortality in candidates aged 65 years or older may be intuitive, understanding why adolescents experience the highest waitlist mortality rates is less intuitive. In response to this persistent trend, US organ allocation has given adolescents preferential access to lungs for transplant. Despite increased access to organs, the observed trend of increased mortality in this group may be explained by their smaller stature and lack of appropriately sized donors.

By diagnosis, candidates in group D continued to experience the highest waitlist mortality, with a rate of 25.5 deaths per 100 waitlist years (Figure LU 21). By LAS, waitlist mortality was highest for those with LAS above 50, at 189.4 deaths per 100 waitlist years, followed by those with LAS below 30, at 29.9 deaths per 100 waitlist years (Figure LU 22). Height limits access to transplant for candidates of shorter stature, below 160 cm; however, waitlist mortality was not higher for these candidates compared with candidates in other height quintiles (Figure LU 24).

Transplant

Characteristics of US lung transplant recipients

In 2016, more lung transplants were performed than in any other year, 2345, including adult, pediatric, and multi-organ recipients (Figure LU 33). The increase in numbers of donors largely explains this trend; however, use of advanced technologies may also contribute, with increased use of extracorporeal membrane oxygenation (ECMO), donation after circulatory death (DCD), and ex-vivo lung perfusion (EVLP) technology. ECMO use, alone or with mechanical ventilation, increased from 2.3% of transplants in 2011 to 5.8% in 2016 (Table LU 7). Use of DCD donors increased from 1.0% to 4.0% over the past 5 years, possibly due in part to improved EVLP technology (Table LU 8). The number of bilateral lung transplants continued to increase; 1757 were performed in 2016 compared with 588 single lung transplants. The proportion of bilateral transplants continued to increase annually, and reached 74.9% of all lung transplants in 2016, with a decrease in the proportion of single lung transplants (Figure LU 33).

Numbers of transplants performed by age followed the distribution of waitlist candidates by age category (Table LU 1); ages 12-17, 18-34, 35-49, 50-64, and 65 years or older underwent 1.0%, 10.6%, 11.5%, 47.4%, and 29.5% of transplants, respectively (Table LU 6). Lung transplants among children aged younger than 12 years made up less than 1% of all lung transplants performed in 2016.

Among lung recipients aged 12 years or older, 48.0% had a LAS of 35-< 50 at transplant Table LU 7). Group D diagnoses remained the most common indications for transplant, at 57.1% of transplants in 2016, followed by group A, 26.9%; group C, 12.0%; and group B, 4.0% (Table LU 7). Male recipients continued to undergo more transplants than female recipients annually, but numbers of transplants were higher for both groups in 2016, 1354 for men and 975 for women (Table LU 6). This difference in transplant distribution by sex may be due to the higher proportion of men with restrictive lung disease, the most common indication for lung transplant. For the first time since implementation of the original LAS, the median revised LAS for group B, 46.9, was higher than the median for group D, 43.9, which may reflect changes in the calculation of the revised LAS (Figure LU 41).

The number of adult lung transplants performed by each of 70 US transplant programs varied widely; the few highest-volume programs experienced the largest growth and accounted for a considerable proportion of US lung transplants. The median number of transplants performed by program was 25 per year, a stable number over the past 4 years. Since 2008, the number of transplants performed in programs ranked in the top 5% by volume increased from 57 to 104 per year (Figure LU 49), and accounted for 14.3% of adult lung transplants in 2016 (Figure LU 50). In 2016, 39.2% of lung transplants were performed at programs with volumes of 15 to 45 (26th to 75th percentile of volume), and 40.2% of transplants were performed at programs with volumes of 46 to 104 (76th to 95th percentile, Figure LU 50).

Outcomes of US lung transplant recipients

The number of people living in the US with a functioning lung allograft continued to increase, to 13,059 in 2016, an increase of 6923 since 2005. Of those alive with a functioning graft in 2016, 8773 were aged 50 years or older at the time of transplant, 3883 were aged 18-49 years, and 403 were aged 18 years or younger (Figure LU 58). The proportion of re-transplants remained low, at 3.3% (Table LU 8). For recipients aged 12 years or older who underwent transplant in 2009-2011, posttransplant survival was 93.3% at 3 months, 85.0% at 1 year, 68.2% at 3 years, and 55.5% at 5 years (Figure LU 51). Despite prior trends toward transplants in sicker candidates, 1- and 3-year death rates continued to decline (Figure LU 57). Five-year death rates did not decline, which may be due to a combination of candidate selection and lack of effective treatment for long-term complications of lung transplant, such as bronchiolitis obliterans syndrome (BOS) or chronic rejection.

Recipients who were the sickest, at extremes of age, in diagnosis group D, or who underwent single lung transplants experienced lower posttransplant survival than other groups. Those with the highest LAS, 60-100, experienced the lowest survival at all time points compared with recipients with lower LAS (Figure LU 53). By age, posttransplant survival was highest for recipients aged 35-49 years, 67.7% at 5 years (Figure LU 51). Five-year survival was 44.9% and 47.9% for recipients aged 65 years or older and 12-17 years, respectively. As the trend toward older age for lung transplant recipients persisted, a higher proportion of recipients had Medicare coverage (43.7%) in 2016 than in 2011 (38.6%) (Table LU 6). By diagnosis group, posttransplant survival was lower for recipients in group D than for recipients in all other diagnosis groups, which became more pronounced as time from transplant increased (Figure LU 55). Recipients of bilateral lung transplants seemed to have greater survival 2 to 5 years posttransplant, but this difference may be overemphasized in an unadjusted survival analysis (Figure LU 54). When grouped by primary diagnosis and transplant type, recipients of bilateral transplants had better 5-year survival than recipients of single lung transplants with similar diagnosis, which may be explained by bias toward performing bilateral transplants in younger and more fit recipients (Figure LU 56).

Major gains in survival are hindered by complications following lung transplant. Incidence of acute rejection remained unchanged, 17.1% in the first year posttransplant (Figure LU 59). Acute rejection incidence was fairly similar across age groups and eras, but higher in recipients aged 18-34 years in 2012-2013. This similarity may be explained by unchanged clinical practice regarding therapy for immunosuppression and treatment of rejection. In the first 6 months posttransplant, cardiac or cerebrovascular events were the primary causes of death (Figure LU 61). From 6 months to 3 years posttransplant, the most common cause of death was infection. After 3 years posttransplant, graft failure became the most prevalent cause of death (Figure LU 62). At 1 year, 87.7% of recipients were BOS free, and at 5 years, 57% were BOS free. Proportion of recipients with creatinine above 2.5 was 4.3% in the first year and 12.8% at 5 years. The incidence of dialysis dependence was 1.3% in the first year and 2.6% at 5 years. Proportions of recipients undergoing renal transplant were 0.1% in the first year and 1.0% at 5 years. Incidence of malignancy was 3.6% at 1 year and 23.2% at 5 years. Functional impairment was low; 81.7% and 78.6% of recipients were functionally unimpaired at 1 and 5 years, respectively (Table LU 10).

Lung Transplant in Children

Waiting List

In 2016, 23 new child (ages 0-11 years) candidates were added to the lung transplant waiting list; 6 were inactive at the time of listing (Figure LU 63). The number of prevalent child candidates (i.e., on the waiting list on December 31 of a given year) steadily decreased from a peak of 123 in 2005 to 21 in 2016 (Figure LU 64). The largest age group of child candidates on the waiting list during 2016 was 6-11 years; these candidates made up 55.9% of the waiting list, followed by candidates aged 1-5 years, 29.4%, and younger than 1 year, 14.7% (Figure LU 65). Most child lung transplant candidates were white (47.1%), with increasing proportions of Hispanic (32.4%), black (11.8%), and Asian (8.8%) candidates (Figure LU 66). Of child candidates in 2016, 55.9% were on the waiting list for less than 6 months, 17.6% for 6 months to less than 1 year, 17.6% for 1 to less than 2 years, and 8.8% for 2 or more years (Figure LU 68). Snapshots on December 31, 2006, and December 31, 2016, revealed changes in the waiting list, most notably in numbers of candidates and age distribution (Table LU 11). At year end 2016, 21.4% of candidates were on the waiting list for 60 days or less, compared with 8.9% in 2006 (Table LU 13). In 2016, 92.9% of candidates were listed for lung-only transplant, compared with 83.9% in 2006.

Of 22 candidates removed from the waiting list in 2016, 15 (68.2%) were removed due to undergoing transplant, 4 (18.2%) due to death, and 2 (9.1%) due to improved condition (Tables LU 14, LU 15). Regarding 3-year outcomes for child lung transplant candidates listed in 2013, 60.5% underwent deceased donor transplant, 23.7% died waiting, and 15.8% were removed from the list for reasons other than transplant or death (Figure LU 69). The overall child lung transplant rate peaked in 2013 at 170.1 per 100 waitlist years, and was 141.4 per 100 waitlist years in 2016 (Figure LU 70). Pretransplant mortality increased in 2015-2016 to 32.3 deaths per 100 waitlist years for all candidates aged 0-11 years (Figure LU 71). This increase in mortality rate may be due to fewer candidates on the list during this period or to the different diagnoses. Rates were higher for candidates aged younger than 6 years than for those aged 6-11 years, 67.4 versus 18.1 per 100 waitlist years.

Transplant

In 2016, a total of 16 lung transplants were performed in recipients aged 0-11 years, 3 in recipients aged younger than 1 year, 5 in recipients aged 1-5 years, and 8 in recipients aged 6-11 years (Figure LU 72). Seven out of 70 programs were characterized as pediatric programs in 2015, compared with 55 adult-only programs (Figure LU 73). In 2014-2016, the proportion of child lung transplant recipients aged 1-5 years was larger than in 2004-2006, and more recipients were Hispanic (Table LU 16). Similar proportions of patients were on a ventilator, ECMO, or both at the time of transplant (28.9% in 2014-2016, 31.4% in 2004-2006) (Table LU 17). The procedure of choice was bilateral transplant, performed in all patients in 2014-2016. In 2014-2016, lung-only transplants increased to 94.2% from 85.1% in 2004-2006 (Table LU 18).

Pediatric Immunosuppression and Outcomes

Substantial changes in immunosuppression occurred in pediatric lung transplantation compared with a decade prior. In 2015-2016, the most common induction therapy changed; use of T-cell-depleting agents increased to 51.4% of recipients and use of interleukin-2 receptor antagonists decreased to 28.6%. No induction therapy was reported in 22.9% of recipients (Figure LU 74). The initial immunosuppression agents used most commonly in 2015-2016 were tacrolimus (97.1%, Figure LU 75), mycophenolate (100%, Figure LU 76), and steroids (100%, Figure LU 77). Steroid use at 1 year posttransplant was reported in 88.2% of recipients (Figure LU 77). The overall incidence of first acute rejection in the first posttransplant year was 14.9% for child lung transplant recipients in 2009-2014 (data not shown). The incidence of posttransplant lymphoproliferative disorder among Epstein-Barr virus (EBV)-negative recipients who underwent transplant in 2004-2014 was 6.7% at 5 years posttransplant, compared with 1.1% among EBV-positive recipients (Figure LU 79). Incidence of death was 13.8% at 6 months and 19.6% at 1 year for transplants in 2014-2015, 22.0% at 3 years for transplants in 2012-2013, 29.5% at 5 years for transplants in 2010-2011, and 46.5% at 10 years for transplants in 2004-2005 (Figure LU 80). For children who underwent transplant in 2004-2011, overall 1-, 3-, and 5-year patient survival was 82.6%, 64.5%, and 58.1%, respectively (Figure LU 81). By age, patient survival rates were highest for recipients aged 6-11 years at all time points. The diagnosis of cystic fibrosis was associated with higher survival rates compared with the diagnosis of pulmonary hypertension (Figure LU 82). Leading causes of death were infection at 1 year posttransplant (4.8%, Figure LU 83), and graft failure at 5 years (11.0%), followed by respiratory (6.6%), infection (5.1%), and cerebro-/cardiovascular causes (4.4%, Figure LU 84).

Among pediatric lung transplant recipients in 2012-2016, the combination of a cytomegalovirus (CMV)-positive donor and CMV-negative recipient occurred in 16.3% of transplants; this combination for EBV occurred in 38.0% of transplants (Table LU 19).

Complication rates in child lung transplant recipients increased with time posttransplant, including BOS (4.7% at 1 year and 38.6% at 5 years) (Table LU 20). For most surviving child lung transplant recipients (93.2%), functional status was reported as fully active at 5 years posttransplant.

Figure List

Waiting list

Figure LU 1. New candidates aged 12 years or older added to the lung transplant waiting list
Figure LU 2. Candidates aged 12 years or older waiting for lung transplant
Figure LU 3. Distribution of candidates aged 12 years or older actively waiting for lung transplant by age
Figure LU 4. Distribution of candidates aged 12 years or older actively waiting for lung transplant by race
Figure LU 5. Distribution of candidates aged 12 years or older actively waiting for lung transplant by diagnosis group
Figure LU 6. Distribution of candidates aged 12 years or older actively waiting for lung transplant by waiting time
Figure LU 7. Distribution of candidates aged 12 years or older actively waiting for lung transplant by LAS
Figure LU 8. Distribution of candidates aged 12 years or older actively waiting for lung transplant by height
Figure LU 9. Distribution of candidates aged 12 years or older actively waiting for lung transplant by blood type
Figure LU 10. Deceased donor lung transplant rates among active waitlist candidates aged 12 years or older by age
Figure LU 11. Deceased donor lung transplant rates among active waitlist candidates aged 12 years or older by diagnosis group
Figure LU 12. Deceased donor lung transplant rates among active waitlist candidates aged 12 years or older by blood type
Figure LU 13. Deceased donor lung transplant rates among active waitlist candidates aged 12 years or older by height
Figure LU 14. Three-year outcomes for candidates aged 12 years or older waiting for lung transplant, new listings in 2013
Figure LU 15. Median months to lung transplant for waitlisted candidates aged 12 years or older, by diagnosis group
Figure LU 16. Percentage of adults who underwent deceased donor lung transplant within a given time period of listing
Figure LU 17. Percentage of candidates aged 12 years or older who underwent deceased donor lung transplant within 1 year of listing in 2015 by DSA
Figure LU 18. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by age
Figure LU 19. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by race
Figure LU 20. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by sex
Figure LU 21. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by diagnosis group
Figure LU 22. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by LAS
Figure LU 23. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by blood type
Figure LU 24. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by height
Figure LU 25. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant in 2014-2016, by DSA
Figure LU 26. Deaths within six months after removal among lung waitlist candidates aged 12 years or older

Deceased donation

Figure LU 27. Deceased lung donors by age
Figure LU 28. Deceased lung donors by race
Figure LU 29. Deceased donor lung donation rates (per 1000 deaths) by state, 2013-2015
Figure LU 30. Rates of lungs recovered for transplant and not transplanted by age
Figure LU 31. Lung donors with a smoking history of 20 pack-years or more
Figure LU 32. Cause of death among deceased lung donors

Transplant

Figure LU 33. Total lung transplants
Figure LU 34. Total lung transplants by age
Figure LU 35. Total lung transplants by sex
Figure LU 36. Total lung transplants by race
Figure LU 37. Total lung transplants by diagnosis group
Figure LU 38. Total lung transplants by LAS
Figure LU 39. Total lung transplants by CPRA
Figure LU 40. Median LAS at transplant
Figure LU 41. Median LAS at transplant by diagnosis group
Figure LU 42. Bilateral transplants among lung recipients aged 12 years or older by diagnosis
Figure LU 43. Induction agent use in lung transplant recipients aged 12 years or older
Figure LU 44. Calcineurin inhibitor use in lung transplant recipients aged 12 years or older
Figure LU 45. Anti-metabolite use in lung transplant recipients aged 12 years or older
Figure LU 46. mTOR inhibitor use in lung transplant recipients aged 12 years or older
Figure LU 47. Steroid use in lung transplant recipients aged 12 years or older
Figure LU 48. Total HLA A, B, and DR mismatches among deceased donor lung transplant recipients aged 12 years or older, 2012-2016
Figure LU 49. Annual adult lung transplant center volumes, by percentile
Figure LU 50. Distribution of adult lung transplants by percentile of center volume

Outcomes

Figure LU 51. Patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by age
Figure LU 52. Patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by race
Figure LU 53. Patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by LAS
Figure LU 54. Patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by transplant type
Figure LU 55. Patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by diagnosis group
Figure LU 56. Patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by diagnosis and transplant type
Figure LU 57. Patient death among lung transplant recipients aged 12 years or older
Figure LU 58. Recipients alive with a functioning lung graft on June 30 of the year, by age at transplant
Figure LU 59. Incidence of acute rejection by 1 year posttransplant among lung transplant recipients aged 12 years or older by age
Figure LU 60. Incidence of PTLD among lung transplant recipients aged 12 years or older by recipient EBV status at transplant, 2010-2014
Figure LU 61. One-year cumulative incidence of death by cause among lung recipients aged 12 years or older, 2014-2015
Figure LU 62. Five-year cumulative incidence of death by cause among lung recipients aged 12 years or older, 2010-2011

Pediatric transplant

Figure LU 63. New candidates aged 0-11 years added to the lung transplant waiting list
Figure LU 64. Candidates aged 0-11 years waiting for lung transplant
Figure LU 65. Distribution of candidates aged 0-11 years actively waiting for lung transplant, by age
Figure LU 66. Distribution of candidates aged 0-11 years actively waiting for lung transplant by race
Figure LU 67. Distribution of candidates aged 0-11 years actively waiting for lung transplant by sex
Figure LU 68. Distribution of candidates aged 0-11 years actively waiting for lung transplant by waiting time
Figure LU 69. Three-year outcomes for newly listed candidates aged 0-11 years waiting for lung transplant, 2013
Figure LU 70. Lung transplant rates among active waitlist candidates listed when aged younger than 12 years
Figure LU 71. Pretransplant mortality rates among candidates aged 0-11 years waitlisted for lung transplant by age
Figure LU 72. Lung transplants, recipients aged 0-11 years by age
Figure LU 73. Number of centers performing pediatric and adult lung transplants by center's age mix
Figure LU 74. Induction agent use in lung transplant recipients aged 0-11 years
Figure LU 75. Calcineurin inhibitor use in lung transplant recipients aged 0-11 years
Figure LU 76. Anti-metabolite use in lung transplant recipients aged 0-11 years
Figure LU 77. Steroid use in lung transplant recipients aged 0-11 years
Figure LU 78. Total HLA A, B, and DR mismatches among deceased donor lung transplant recipients aged 0-11 years, 2012-2016
Figure LU 79. Incidence of PTLD among lung transplant recipients aged 0-11 years by recipient EBV status at transplant, 2004-2014
Figure LU 80. Patient death among lung transplant recipients aged 0-11 years
Figure LU 81. Patient survival among lung transplant recipients aged 0-11 years, 2004-2011, by age
Figure LU 82. Patient survival among lung transplant recipients aged 0-11 years, 2004-2011, by diagnosis
Figure LU 83. One-year cumulative incidence of death by cause among lung transplant recipients aged 0-11 years, 2005-2015
Figure LU 84. Five-year cumulative incidence of death by cause among lung transplant recipients aged 0-11 years, 2005-2011

Table List

Waiting list

Table LU 1. Demographic characteristics of candidates aged 12 years or older on the lung transplant waiting list on December 31, 2011, and December 31, 2016
Table LU 2. Clinical characteristics of candidates aged 12 years or older on the lung transplant waiting list on December 31, 2011, and December 31, 2016
Table LU 3. Listing characteristics of candidates aged 12 years or older on the lung transplant waiting list on December 31, 2011, and December 31, 2016
Table LU 4. Lung transplant waitlist activity among candidates aged 12 years or older
Table LU 5. Removal reason among lung transplant candidats aged 12 years or older

Transplant

Table LU 6. Demographic characteristics of lung transplant recipients aged 12 years or older, 2011 and 2016
Table LU 7. Clinical characteristics of lung transplant recipients aged 12 years or older, 2011 and 2016
Table LU 8. Transplant characteristics of lung transplant recipients aged 12 years or older, 2011 and 2016
Table LU 9. Donor-recipient serology matching among lung transplant recipients aged 12 years or older, 2012-2016

Outcomes

Table LU 10. Posttransplant events among lung transplant recipients aged 12 years or older

Pediatric transplant

Table LU 11. Demographic characteristics of candidates aged 0-11 years on the lung transplant waiting list on December 31, 2006, and December 31, 2016
Table LU 12. Clinical characteristics of candidates aged 0-11 years on the lung transplant waiting list on December 31, 2006, and December 31, 2016
Table LU 13. Listing characteristics of candidates aged 0-11 years on the lung transplant waiting list on December 31, 2006, and December 31, 2016
Table LU 14. Lung transplant waitlist activity among candidates aged 0-11 years
Table LU 15. Removal reason among lung transplant candidates aged 0-11 years
Table LU 16. Demographic characteristics of lung transplant recipients aged 0-11 years, 2004-2006 and 2014-2016
Table LU 17. Clinical characteristics of lung transplant recipients aged 0-11 years, 2004-2006 and 2014-2016
Table LU 18. Transplant haracteristics of lung transplant recipients aged 0-11 years, 2004-2006 and 2014-2016
Table LU 19. Donor-recipient serology matching among lung transplant recipients aged 0-11 years, 2012-2016
Table LU 20. Posttransplant events among lung transplant recipients aged 0-11 years

A line plot for new candidates aged 12 years or older added to the lung transplant waiting list; the active category increases by 94.3% from 1351 candidates at 2005 to 2625 candidates at 2016; the inactive category decreases by 48.9% from 131 candidates at 2005 to 67 candidates at 2016; and the all category increases by 81.6% from 1482 candidates at 2005 to 2692 candidates at 2016.

Figure LU 1. New candidates aged 12 years or older added to the lung transplant waiting list
A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Candidates concurrently listed at multiple centers are counted once. Active and inactive patients are included.


A line plot for candidates aged 12 years or older waiting for lung transplant; the active category is 1030 candidates at 2005 and remains relatively constant with a value of 1127 candidates at 2016; the inactive category decreases by 86.9% from 2047 candidates at 2005 to 268 candidates at 2016; and the all category decreases by 54.7% from 3077 candidates at 2005 to 1395 candidates at 2016.

Figure LU 2. Candidates aged 12 years or older waiting for lung transplant
Candidates concurrently listed at multiple centers are counted once. Those with concurrent listings and active at any program are considered active.


A line plot for distribution of candidates aged 12 years or older actively waiting for lung transplant by age; the 12 to 17 category decreases by 69.2% from 3.3 percent at 2005 to 1 percent at 2016; the 18 to 34 category decreases by 30.9% from 15.2 percent at 2005 to 10.5 percent at 2016; the 35 to 49 category decreases by 45.1% from 23.1 percent at 2005 to 12.7 percent at 2016; the 50 to 64 category is 53 percent at 2005 and remains relatively constant with a value of 49.2 percent at 2016; and the greater than or equal to 65 category increases by 392.9% from 5.4 percent at 2005 to 26.6 percent at 2016.

Figure LU 3. Distribution of candidates aged 12 years or older actively waiting for lung transplant by age
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Age is determined at the later of listing date or January 1 of the given year. Only candidates who were active for at least 1 day are included.


A line plot for distribution of candidates aged 12 years or older actively waiting for lung transplant by race; the white category is 83.7 percent at 2005 and remains relatively constant with a value of 79.5 percent at 2016; the black category is 9.3 percent at 2005 and remains relatively constant with a value of 9.7 percent at 2016; the hispanic category increases by 49.4% from 5 percent at 2005 to 7.4 percent at 2016; the asian category increases by 83.5% from 1.4 percent at 2005 to 2.6 percent at 2016; and the other/unknown category increases by 18.5% from 0.7 percent at 2005 to 0.8 percent at 2016.

Figure LU 4. Distribution of candidates aged 12 years or older actively waiting for lung transplant by race
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Only candidates who were active for at least 1 day are included.


A line plot for distribution of candidates aged 12 years or older actively waiting for lung transplant by diagnosis group; the a category decreases by 23.1% from 42.2 percent at 2005 to 32.5 percent at 2016; the b category decreases by 47.8% from 9.8 percent at 2005 to 5.1 percent at 2016; the c category decreases by 21.5% from 15.6 percent at 2005 to 12.3 percent at 2016; and the d category increases by 55.2% from 32.3 percent at 2005 to 50.1 percent at 2016.

Figure LU 5. Distribution of candidates aged 12 years or older actively waiting for lung transplant by diagnosis group
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Only candidates who were active for at least 1 day are included.


A line plot for distribution of candidates aged 12 years or older actively waiting for lung transplant by waiting time; the less than 31 days category increases by 185.9% from 10.2 percent at 2005 to 29.3 percent at 2016; the 31 to less than 90 days category increases by 78.5% from 11.5 percent at 2005 to 20.5 percent at 2016; the 3 to less than 6 months category increases by 40.1% from 10.9 percent at 2005 to 15.3 percent at 2016; the 6 to less than 12 months category is 16 percent at 2005 and remains relatively constant with a value of 14.6 percent at 2016; the 1 to less than 2 years category decreases by 57.4% from 26.3 percent at 2005 to 11.2 percent at 2016; and the greater than or equal to 2 years category decreases by 63.4% from 25.1 percent at 2005 to 9.2 percent at 2016.

Figure LU 6. Distribution of candidates aged 12 years or older actively waiting for lung transplant by waiting time
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Time on the waiting list is determined at the earlier of December 31 or removal from the waiting list. Only candidates who were active for at least 1 day are included.


A line plot for distribution of candidates aged 12 years or older actively waiting for lung transplant by las; the less than 30 category decreases by 98.7% from 3.8 percent at 2005 to 0 percent at 2016; the 30 to less than 35 category decreases by 21.2% from 36.9 percent at 2005 to 29.1 percent at 2016; the 35 to less than 40 category increases by 73.3% from 14.7 percent at 2005 to 25.4 percent at 2016; the 40 to less than 50 category increases by 123.6% from 9.1 percent at 2005 to 20.3 percent at 2016; the greater than or equal to 50 category increases by 331.9% from 5.7 percent at 2005 to 24.8 percent at 2016; and the no las category decreases by 99.1% from 29.7 percent at 2005 to 0.3 percent at 2016.

Figure LU 7. Distribution of candidates aged 12 years or older actively waiting for lung transplant by LAS
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Lung allocation score (LAS) is the most severe during the year. Only candidates who were active for at least 1 day are included.


A line plot for distribution of candidates aged 12 years or older actively waiting for lung transplant by height; the less than 160 cm category is 21 percent at 2005 and remains relatively constant with a value of 21.3 percent at 2016; the 160 to less than 168 category decreases by 11.6% from 35 percent at 2005 to 30.9 percent at 2016; the 168 to less than 175 category increases by 10.2% from 16.2 percent at 2005 to 17.9 percent at 2016; the 175 to less than 183 category is 21.8 percent at 2005 and remains relatively constant with a value of 23.5 percent at 2016; and the greater than or equal to 183 category is 5.9 percent at 2005 and remains relatively constant with a value of 6.4 percent at 2016.

Figure LU 8. Distribution of candidates aged 12 years or older actively waiting for lung transplant by height
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Only candidates who were active for at least 1 day are included.


A line plot for distribution of candidates aged 12 years or older actively waiting for lung transplant by blood type; the a category is 39.2 percent at 2005 and remains relatively constant with a value of 39.9 percent at 2016; the b category increases by 16.1% from 9.8 percent at 2005 to 11.4 percent at 2016; the ab category decreases by 10.4% from 3.5 percent at 2005 to 3.1 percent at 2016; and the o category is 47.6 percent at 2005 and remains relatively constant with a value of 45.6 percent at 2016.

Figure LU 9. Distribution of candidates aged 12 years or older actively waiting for lung transplant by blood type
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Only candidates who were active for at least 1 day are included.


A line plot for deceased donor lung transplant rates among active waitlist candidates aged 12 years or older by age; the 12 to 17 category increases by 263.3% from 56.6 transplants per 100 waitlist years at 2005 to 205.6 transplants per 100 waitlist years at 2016; the 18 to 34 category increases by 160.8% from 71.1 transplants per 100 waitlist years at 2005 to 185.4 transplants per 100 waitlist years at 2016; the 35 to 49 category increases by 116.4% from 67.6 transplants per 100 waitlist years at 2005 to 146.4 transplants per 100 waitlist years at 2016; the 50 to 64 category increases by 82.2% from 101.7 transplants per 100 waitlist years at 2005 to 185.4 transplants per 100 waitlist years at 2016; and the greater than or equal to 65 category increases by 27.3% from 187.1 transplants per 100 waitlist years at 2005 to 238.3 transplants per 100 waitlist years at 2016.

Figure LU 10. Deceased donor lung transplant rates among active waitlist candidates aged 12 years or older by age
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active wait time in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year. Rates with less than 10 patient-years of exposure are not shown.


A line plot for deceased donor lung transplant rates among active waitlist candidates aged 12 years or older by diagnosis group; the a category increases by 58.7% from 78.5 transplants per 100 waitlist years at 2005 to 124.6 transplants per 100 waitlist years at 2016; the b category increases by 151.4% from 42.2 transplants per 100 waitlist years at 2005 to 106 transplants per 100 waitlist years at 2016; the c category increases by 176.1% from 80.1 transplants per 100 waitlist years at 2005 to 221 transplants per 100 waitlist years at 2016; the d category increases by 103.3% from 132.2 transplants per 100 waitlist years at 2005 to 268.7 transplants per 100 waitlist years at 2016; and the all category increases by 112.8% from 90.2 transplants per 100 waitlist years at 2005 to 191.9 transplants per 100 waitlist years at 2016.

Figure LU 11. Deceased donor lung transplant rates among active waitlist candidates aged 12 years or older by diagnosis group
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active wait time in a given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for deceased donor lung transplant rates among active waitlist candidates aged 12 years or older by blood type; the a category increases by 118.0% from 98.5 transplants per 100 waitlist years at 2005 to 214.6 transplants per 100 waitlist years at 2016; the b category increases by 104.3% from 95.5 transplants per 100 waitlist years at 2005 to 195 transplants per 100 waitlist years at 2016; the ab category increases by 70.0% from 137.2 transplants per 100 waitlist years at 2005 to 233.3 transplants per 100 waitlist years at 2016; and the o category increases by 114.0% from 80.1 transplants per 100 waitlist years at 2005 to 171.5 transplants per 100 waitlist years at 2016.

Figure LU 12. Deceased donor lung transplant rates among active waitlist candidates aged 12 years or older by blood type
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active wait time in a given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for deceased donor lung transplant rates among active waitlist candidates aged 12 years or older by height; the less than 160 cm category increases by 100.5% from 55.2 transplants per 100 waitlist years at 2005 to 110.7 transplants per 100 waitlist years at 2016; the 160 to less than 168 category increases by 84.0% from 89 transplants per 100 waitlist years at 2005 to 163.9 transplants per 100 waitlist years at 2016; the 168 to less than 175 category increases by 130.4% from 102.3 transplants per 100 waitlist years at 2005 to 235.7 transplants per 100 waitlist years at 2016; the 175 to less than 183 category increases by 153.9% from 118.1 transplants per 100 waitlist years at 2005 to 299.8 transplants per 100 waitlist years at 2016; and the greater than or equal to 183 category increases by 179.0% from 114.8 transplants per 100 waitlist years at 2005 to 320.3 transplants per 100 waitlist years at 2016.

Figure LU 13. Deceased donor lung transplant rates among active waitlist candidates aged 12 years or older by height
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active wait time in a given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for three-year outcomes for candidates aged 12 years or older waiting for lung transplant, new listings in 2013; the still waiting category decreases by 95.8% from 99.9 percent at 0 Months postlisting to 4.2 percent at 36 Months postlisting; the removed from list category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting; the died category increases by 23300.0% from 0 percent at 0 Months postlisting to 9.8 percent at 36 Months postlisting; and the dd transplant category increases by 184800.0% from 0 percent at 0 Months postlisting to 77.3 percent at 36 Months postlisting.

Figure LU 14. Three-year outcomes for candidates aged 12 years or older waiting for lung transplant, new listings in 2013
Candidates aged 12 years or older waiting for lung transplant and first listed in 2013. Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. DD, deceased donor.


A line plot for median months to lung transplant for waitlisted candidates aged 12 years or older, by diagnosis group; the a category decreases by 35.9% from 6 months at 2006 to 3.8 months at 2016; the b category decreases by 83.2% from 20.7 months at 2006 to 3.5 months at 2016; the c category decreases by 55.5% from 5.1 months at 2006 to 2.3 months at 2016; the d category decreases by 30.6% from 2.8 months at 2006 to 1.9 months at 2016; and the all category decreases by 44.0% from 4.4 months at 2006 to 2.5 months at 2016.

Figure LU 15. Median months to lung transplant for waitlisted candidates aged 12 years or older, by diagnosis group
Observations censored on December 31, 2016; Kaplan-Meier competing risk methods used to estimate time to transplant. Analysis performed per candidate, not per listing. If an estimate is not plotted, 50% of the cohort listed in that year had not undergone transplant by the censoring date. Only the first transplant is counted.


A line plot for percentage of adults who underwent deceased donor lung transplant within a given time period of listing; the 3 to month category increases by 36.7% from 34.7 percent at 2005 to 47.4 percent at 2015; the 6 to month category increases by 26.1% from 47.9 percent at 2005 to 60.3 percent at 2015; the 1 to year category increases by 19.1% from 59.3 percent at 2005 to 70.6 percent at 2015; the 3 to year category increases by 10.6% from 67.8 percent at 2005 to 75 percent at 2013; the 5 to year category is 69.7 percent at 2005 and remains relatively constant with a value of 75.9 percent at 2011; and the 10 to year category is 70.1 percent at 2005 and remains relatively constant with a value of 75.1 percent at 2006.

Figure LU 16. Percentage of adults who underwent deceased donor lung transplant within a given time period of listing
Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal.


A map of percentage of candidates aged 12 years or older who underwent deceased donor lung transplant within 1 year of listing in 2015 by dsa, the values range from 28.85 to 100.00.

Figure LU 17. Percentage of candidates aged 12 years or older who underwent deceased donor lung transplant within 1 year of listing in 2015 by DSA
Candidates listed concurrently in a single DSA are counted once in that DSA, from the time of earliest listing to the time of latest removal; candidates listed in multiple DSAs are counted separately per DSA.


A line plot for pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by age; the 12 to 17 category increases by 84.9% from 15.8 deaths per 100 waitlist years at 2005-2006 to 29.1 deaths per 100 waitlist years at 2015-2016; the 18 to 34 category increases by 29.5% from 12.6 deaths per 100 waitlist years at 2005-2006 to 16.3 deaths per 100 waitlist years at 2015-2016; the 35 to 49 category increases by 49.3% from 9.1 deaths per 100 waitlist years at 2005-2006 to 13.5 deaths per 100 waitlist years at 2015-2016; the 50 to 64 category increases by 18.2% from 11.1 deaths per 100 waitlist years at 2005-2006 to 13.1 deaths per 100 waitlist years at 2015-2016; and the greater than or equal to 65 category increases by 30.9% from 15.1 deaths per 100 waitlist years at 2005-2006 to 19.8 deaths per 100 waitlist years at 2015-2016.

Figure LU 18. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by age
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown. Age is determined at the later of listing date or January 1 of the given year.


A line plot for pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by race; the white category increases by 41.2% from 10.2 deaths per 100 waitlist years at 2005-2006 to 14.4 deaths per 100 waitlist years at 2015-2016; the black category increases by 13.9% from 13.5 deaths per 100 waitlist years at 2005-2006 to 15.4 deaths per 100 waitlist years at 2015-2016; the hispanic category is 20.7 deaths per 100 waitlist years at 2005-2006 and remains relatively constant with a value of 19.2 deaths per 100 waitlist years at 2015-2016; the asian category increases by 124.3% from 11.3 deaths per 100 waitlist years at 2005-2006 to 25.4 deaths per 100 waitlist years at 2015-2016; and the all category increases by 35.9% from 11.1 deaths per 100 waitlist years at 2005-2006 to 15.1 deaths per 100 waitlist years at 2015-2016.

Figure LU 19. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by race
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by sex; the male category increases by 71.7% from 11 deaths per 100 waitlist years at 2005-2006 to 18.9 deaths per 100 waitlist years at 2015-2016; and the female category increases by 13.1% from 11.2 deaths per 100 waitlist years at 2005-2006 to 12.6 deaths per 100 waitlist years at 2015-2016.

Figure LU 20. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by sex
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by diagnosis group; the a category decreases by 35.9% from 7.4 deaths per 100 waitlist years at 2005-2006 to 4.7 deaths per 100 waitlist years at 2015-2016; the b category increases by 61.2% from 9.1 deaths per 100 waitlist years at 2005-2006 to 14.6 deaths per 100 waitlist years at 2015-2016; the c category increases by 57.2% from 11.4 deaths per 100 waitlist years at 2005-2006 to 17.9 deaths per 100 waitlist years at 2015-2016; and the d category increases by 46.5% from 17.4 deaths per 100 waitlist years at 2005-2006 to 25.5 deaths per 100 waitlist years at 2015-2016.

Figure LU 21. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by diagnosis group
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by las; the less than 30 category is NA deaths per 100 waitlist years at 2005-2006 and is deaths per 100 waitlist years at 2015-2016; the 30 to less than 35 category is NA deaths per 100 waitlist years at 2005-2006 and is deaths per 100 waitlist years at 2015-2016; the 35 to less than 40 category is NA deaths per 100 waitlist years at 2005-2006 and is deaths per 100 waitlist years at 2015-2016; the 40 to less than 50 category is NA deaths per 100 waitlist years at 2005-2006 and is deaths per 100 waitlist years at 2015-2016; and the greater than or equal to 50 category is NA deaths per 100 waitlist years at 2005-2006 and is deaths per 100 waitlist years at 2015-2016.

Figure LU 22. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by LAS
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by blood type; the a category increases by 52.6% from 10.1 deaths per 100 waitlist years at 2005-2006 to 15.4 deaths per 100 waitlist years at 2015-2016; the b category increases by 41.7% from 11.4 deaths per 100 waitlist years at 2005-2006 to 16.1 deaths per 100 waitlist years at 2015-2016; the ab category increases by 122.9% from 8.7 deaths per 100 waitlist years at 2005-2006 to 19.5 deaths per 100 waitlist years at 2015-2016; and the o category increases by 18.9% from 12 deaths per 100 waitlist years at 2005-2006 to 14.3 deaths per 100 waitlist years at 2015-2016.

Figure LU 23. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by blood type
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by height; the less than 160 cm category increases by 20.1% from 13 deaths per 100 waitlist years at 2005-2006 to 15.6 deaths per 100 waitlist years at 2015-2016; the 160 to less than 168 category increases by 29.7% from 10.7 deaths per 100 waitlist years at 2005-2006 to 13.9 deaths per 100 waitlist years at 2015-2016; the 168 to less than 175 category increases by 71.5% from 9.5 deaths per 100 waitlist years at 2005-2006 to 16.2 deaths per 100 waitlist years at 2015-2016; the 175 to less than 183 category increases by 31.0% from 11.5 deaths per 100 waitlist years at 2005-2006 to 15 deaths per 100 waitlist years at 2015-2016; and the greater than or equal to 183 category increases by 76.7% from 9.3 deaths per 100 waitlist years at 2005-2006 to 16.4 deaths per 100 waitlist years at 2015-2016.

Figure LU 24. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by height
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A map of pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant in 2014-2016, by dsa, the values range from 3.78 to 39.67.

Figure LU 25. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant in 2014-2016, by DSA
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Patients censored at waitlist removal. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for deaths within six months after removal among lung waitlist candidates aged 12 years or older; the all category increases by 164.1% from 13.9 percent at 2005 to 36.7 percent at 2016; the a category increases by 123.5% from 9.9 percent at 2005 to 22.2 percent at 2016; the b category increases by 125.0% from 11.1 percent at 2005 to 25 percent at 2016; the c category increases by 275.0% from 13.3 percent at 2005 to 50 percent at 2016; and the d category increases by 118.9% from 21.2 percent at 2005 to 46.4 percent at 2016.

Figure LU 26. Deaths within six months after removal among lung waitlist candidates aged 12 years or older
Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.


A line plot for deceased lung donors by age; the less than 12 category decreases by 52.1% from 2.7 percent at 2005 to 1.3 percent at 2016; the 12 to 17 category decreases by 39.4% from 12.3 percent at 2005 to 7.5 percent at 2016; the 18 to 34 category is 42.6 percent at 2005 and remains relatively constant with a value of 45.7 percent at 2016; the 35 to 49 category is 25 percent at 2005 and remains relatively constant with a value of 27 percent at 2016; and the greater than or equal to 50 category is 17.3 percent at 2005 and remains relatively constant with a value of 18.5 percent at 2016.

Figure LU 27. Deceased lung donors by age
Deceased donors with at least one lung recovered for transplant. Donors whose lungs were recovered en-bloc are counted once, and donors whose lungs were recovered separately are counted twice.


A line plot for deceased lung donors by race; the white category is 66 percent at 2005 and remains relatively constant with a value of 61.7 percent at 2016; the black category increases by 13.5% from 17.3 percent at 2005 to 19.6 percent at 2016; the hispanic category is 13.8 percent at 2005 and remains relatively constant with a value of 14.6 percent at 2016; and the other/unknown category increases by 38.6% from 3 percent at 2005 to 4.1 percent at 2016.

Figure LU 28. Deceased lung donors by race
Deceased donors with at least one lung recovered for transplant. Donors whose lungs were recovered en-bloc are counted once, and donors whose lungs were recovered separately are counted twice.


A map of deceased donor lung donation rates (per 1000 deaths) by state, 2013-2015, the values range from 0.71 to 5.71.

Figure LU 29. Deceased donor lung donation rates (per 1000 deaths) by state, 2013-2015
Numerator: Deceased donors aged < 70 years, by state of death, whose lungs were recovered for transplant from 2013 through 2015. Denominator: US deaths aged < 70 years, by state of death, from 2013 through 2015. State death data by age obtained through agreement with NAPHSIS (https://www.naphsis.org/research-requests). Donors whose lungs were recovered en-bloc are counted once, and donors whose lungs were recovered separately are counted twice.


A line plot for rates of lungs recovered for transplant and not transplanted by age; the 12 to 17 category is 6.5 percent at 2005-2006 and remains relatively constant with a value of 6.3 percent at 2015-2016; the 18 to 34 category increases by 49.1% from 4.2 percent at 2005-2006 to 6.3 percent at 2015-2016; the 35 to 49 category increases by 68.5% from 4.1 percent at 2005-2006 to 6.8 percent at 2015-2016; and the greater than or equal to 50 category increases by 49.4% from 4 percent at 2005-2006 to 6 percent at 2015-2016.

Figure LU 30. Rates of lungs recovered for transplant and not transplanted by age
Percentages of lungs not transplanted out of all lungs recovered for transplant. Lungs recovered en-bloc are counted once, and lungs recovered separately are counted twice.


A line plot for lung donors with a smoking history of 20 pack-years or more; the percent category decreases by 62.9% from 18.7 percent at 2005 to 7 percent at 2016.

Figure LU 31. Lung donors with a smoking history of 20 pack-years or more
All deceased donors whose lungs were transplanted in the given year.


A line plot for cause of death among deceased lung donors; the anoxia category increases by 217.6% from 8.4 percent at 2005 to 26.8 percent at 2016; the cva/stroke category decreases by 11.5% from 33.1 percent at 2005 to 29.3 percent at 2016; the head trauma category decreases by 25.1% from 54.9 percent at 2005 to 41.1 percent at 2016; the cns tumor category decreases by 79.6% from 1.3 percent at 2005 to 0.3 percent at 2016; and the other category increases by 13.4% from 2.3 percent at 2005 to 2.6 percent at 2016.

Figure LU 32. Cause of death among deceased lung donors
Deceased donors whose lungs were transplanted. Each donor is counted once. CNS, central nervous system; CVA, cerebrovascular accident.


A line plot for total lung transplants; the single category is 587 transplants at 2005 and remains relatively constant with a value of 588 transplants at 2016; the bilateral category increases by 105.7% from 854 transplants at 2005 to 1757 transplants at 2016; and the all category increases by 62.7% from 1441 transplants at 2005 to 2345 transplants at 2016.

Figure LU 33. Total lung transplants
All lung transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for total lung transplants by age; the less than 12 category decreases by 15.8% from 19 transplants at 2005 to 16 transplants at 2016; the 12 to 17 category decreases by 42.5% from 40 transplants at 2005 to 23 transplants at 2016; the 18 to 34 category increases by 45.3% from 170 transplants at 2005 to 247 transplants at 2016; the 35 to 49 category is 265 transplants at 2005 and remains relatively constant with a value of 267 transplants at 2016; the 50 to 64 category increases by 35.5% from 815 transplants at 2005 to 1104 transplants at 2016; and the greater than or equal to 65 category increases by 421.2% from 132 transplants at 2005 to 688 transplants at 2016.

Figure LU 34. Total lung transplants by age
All lung transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for total lung transplants by sex; the male category increases by 72.5% from 789 transplants at 2005 to 1361 transplants at 2016; and the female category increases by 50.9% from 652 transplants at 2005 to 984 transplants at 2016.

Figure LU 35. Total lung transplants by sex
All lung transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for total lung transplants by race; the white category increases by 52.4% from 1241 transplants at 2005 to 1891 transplants at 2016; the black category increases by 90.4% from 115 transplants at 2005 to 219 transplants at 2016; the hispanic category increases by 194.8% from 58 transplants at 2005 to 171 transplants at 2016; the asian category increases by 163.2% from 19 transplants at 2005 to 50 transplants at 2016; and the other/unknown category increases by 75.0% from 8 transplants at 2005 to 14 transplants at 2016.

Figure LU 36. Total lung transplants by race
All lung transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for total lung transplants by diagnosis group; the a category is 575 transplants at 2005 and remains relatively constant with a value of 627 transplants at 2016; the b category increases by 25.0% from 80 transplants at 2005 to 100 transplants at 2016; the c category increases by 47.7% from 193 transplants at 2005 to 285 transplants at 2016; the d category increases by 130.6% from 578 transplants at 2005 to 1333 transplants at 2016; and the other/unknown category decreases by 100.0% from 15 transplants at 2005 to 0 transplants at 2016.

Figure LU 37. Total lung transplants by diagnosis group
All lung transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for total lung transplants by las; the less than 35 category increases by 40.0% from 408 transplants at 2005 to 571 transplants at 2016; the 35 to less than 40 category increases by 133.6% from 247 transplants at 2005 to 577 transplants at 2016; the 40 to less than 50 category increases by 161.8% from 207 transplants at 2005 to 542 transplants at 2016; the 50 to less than 60 category increases by 344.7% from 47 transplants at 2005 to 209 transplants at 2016; and the 60 to 100 category increases by 491.7% from 72 transplants at 2005 to 426 transplants at 2016.

Figure LU 38. Total lung transplants by LAS
All lung transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for total lung transplants by cpra; the less than 1% category increases by 39.2% from 942 transplants at 2005 to 1311 transplants at 2016; the 1 to less than 20% category is 277 transplants at 2005 and remains relatively constant with a value of 274 transplants at 2016; the 20 to less than 80% category increases by 277.9% from 68 transplants at 2005 to 257 transplants at 2016; the 80 to 100% category increases by 437.5% from 8 transplants at 2005 to 43 transplants at 2016; and the unknown category increases by 215.1% from 146 transplants at 2005 to 460 transplants at 2016.

Figure LU 39. Total lung transplants by CPRA
All lung transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for median las at transplant; the 75th percentile category increases by 19.8% from 42.9 las at 2006 to 51.4 las at 2016; the median las category is 36.6 las at 2006 and remains relatively constant with a value of 40.2 las at 2016; and the 25th percentile category is 33.5 las at 2006 and remains relatively constant with a value of 35 las at 2016.

Figure LU 40. Median LAS at transplant
Recipients aged 12 years or older; last LAS before transplant.


A line plot for median las at transplant by diagnosis group; the a category is 33.1 las at 2006 and remains relatively constant with a value of 33.6 las at 2016; the b category increases by 30.6% from 35.9 las at 2006 to 46.9 las at 2016; the c category increases by 13.3% from 38.2 las at 2006 to 43.3 las at 2016; and the d category is 41.7 las at 2006 and remains relatively constant with a value of 43.9 las at 2016.

Figure LU 41. Median LAS at transplant by diagnosis group
Recipients aged 12 years or older; last LAS before transplant.


A line plot for bilateral transplants among lung recipients aged 12 years or older by diagnosis; the alpha to 1 category increases by 34.5% from 66.1 percent at 2005 to 88.9 percent at 2016; the copd category increases by 57.6% from 43.7 percent at 2005 to 68.8 percent at 2016; the ipf category increases by 45.1% from 43.3 percent at 2005 to 62.9 percent at 2016; and the other category is 82.2 percent at 2005 and remains relatively constant with a value of 85.8 percent at 2016.

Figure LU 42. Bilateral transplants among lung recipients aged 12 years or older by diagnosis
Heart-lung transplants are excluded. COPD, chronic obstructive pulmonary disease; IPF, idiopathic pulmonary fibrosis.


A line plot for induction agent use in lung transplant recipients aged 12 years or older; the il2 to ra category increases by 117.5% from 29.4 percent at 2005 to 64 percent at 2016; the t to cell depleting category decreases by 21.4% from 13.1 percent at 2005 to 10.3 percent at 2016; and the none category decreases by 54.6% from 57.8 percent at 2005 to 26.2 percent at 2016.

Figure LU 43. Induction agent use in lung transplant recipients aged 12 years or older
Immunosuppression at transplant reported to the OPTN. IL2-RA, interleukin-2 receptor antagonist.


A line plot for calcineurin inhibitor use in lung transplant recipients aged 12 years or older; the cyclosporine category decreases by 86.5% from 21.9 percent at 2005 to 3 percent at 2016; and the tacrolimus category increases by 29.3% from 73.7 percent at 2005 to 95.3 percent at 2016.

Figure LU 44. Calcineurin inhibitor use in lung transplant recipients aged 12 years or older
Immunosuppression at transplant reported to the OPTN.


A line plot for anti-metabolite use in lung transplant recipients aged 12 years or older; the azathioprine category decreases by 79.7% from 36.9 percent at 2005 to 7.5 percent at 2016; and the mycophenolate category increases by 66.9% from 52.9 percent at 2005 to 88.3 percent at 2016.

Figure LU 45. Anti-metabolite use in lung transplant recipients aged 12 years or older
Immunosuppression at transplant reported to the OPTN. Mycophenolate includes mycophenolate mofetil and mycophenolate sodium.


A line plot for mtor inhibitor use in lung transplant recipients aged 12 years or older; the at transplant category decreases by 76.1% from 0.7 percent at 2005 to 0.2 percent at 2016; and the 1 year posttransplant category decreases by 19.2% from 8 percent at 2005 to 6.5 percent at 2015.

Figure LU 46. mTOR inhibitor use in lung transplant recipients aged 12 years or older
Immunosuppression at transplant reported to the OPTN. One-year posttransplant data are limited to patients alive with graft function at 1 year posttransplant. mTOR, mammalian target of rapamycin.


A line plot for steroid use in lung transplant recipients aged 12 years or older; the at transplant category is 95.1 percent at 2005 and remains relatively constant with a value of 94.4 percent at 2016; and the 1 year posttransplant category is 98.9 percent at 2005 and remains relatively constant with a value of 97.8 percent at 2015.

Figure LU 47. Steroid use in lung transplant recipients aged 12 years or older
Immunosuppression at transplant reported to the OPTN. One-year posttransplant data are limited to patients alive with graft function at 1 year posttransplant.


A bar plot for total hla a, b, and dr mismatches among deceased donor lung transplant recipients aged 12 years or older, 2012-2016, the 0 group is 0.13 percent; the 1 group is 0.54 percent; the 2 group is 2.98 percent; the 3 group is 11.08 percent; the 4 group is 24.58 percent; the 5 group is 33.53 percent; the 6 group is 20.41 percent; and the unk. group is 6.76 percent.

Figure LU 48. Total HLA A, B, and DR mismatches among deceased donor lung transplant recipients aged 12 years or older, 2012-2016
Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2016.


A line plot for annual adult lung transplant center volumes, by percentile; the 5th category increases by 200.0% from 1 transplants per center at 2005 to 3 transplants per center at 2016; the 25th category increases by 75.0% from 8 transplants per center at 2005 to 14 transplants per center at 2016; the median category increases by 31.6% from 19 transplants per center at 2005 to 25 transplants per center at 2016; the 75th category increases by 25.0% from 36 transplants per center at 2005 to 45 transplants per center at 2016; and the 95th category increases by 60.0% from 65 transplants per center at 2005 to 104 transplants per center at 2016.

Figure LU 49. Annual adult lung transplant center volumes, by percentile
Annual volume data are limited to recipients aged 18 or older.


A line plot for distribution of adult lung transplants by percentile of center volume; the less than or equal to 25th category increases by 43.1% from 4.4 percent at 2005 to 6.3 percent at 2016; the greater than 25th to 75th category is 42.5 percent at 2005 and remains relatively constant with a value of 39.2 percent at 2016; the greater than 75th to 95th category is 41.6 percent at 2005 and remains relatively constant with a value of 40.2 percent at 2016; and the greater than 95th category increases by 24.4% from 11.5 percent at 2005 to 14.3 percent at 2016.

Figure LU 50. Distribution of adult lung transplants by percentile of center volume
Percentiles are based on annual volume data among recipients aged 18 or older.


A line plot for patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by age; the 12 to 17 category decreases by 52.1% from 100 percent at 0 Months posttransplant to 47.9 percent at 60 Months posttransplant; the 18 to 34 category decreases by 43.0% from 100 percent at 0 Months posttransplant to 57 percent at 60 Months posttransplant; the 35 to 49 category decreases by 32.3% from 100 percent at 0 Months posttransplant to 67.7 percent at 60 Months posttransplant; the 50 to 64 category decreases by 42.6% from 100 percent at 0 Months posttransplant to 57.4 percent at 60 Months posttransplant; the greater than or equal to 65 category decreases by 55.1% from 100 percent at 0 Months posttransplant to 44.9 percent at 60 Months posttransplant; and the all category decreases by 44.5% from 100 percent at 0 Months posttransplant to 55.5 percent at 60 Months posttransplant.

Figure LU 51. Patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by age
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.


A line plot for patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by race; the white category decreases by 45.4% from 100 percent at 0 Months posttransplant to 54.6 percent at 60 Months posttransplant; the black category decreases by 40.5% from 100 percent at 0 Months posttransplant to 59.5 percent at 60 Months posttransplant; the hispanic category decreases by 39.3% from 100 percent at 0 Months posttransplant to 60.7 percent at 60 Months posttransplant; the asian category decreases by 35.4% from 100 percent at 0 Months posttransplant to 64.6 percent at 60 Months posttransplant; and the other/unknown category decreases by 41.9% from 100 percent at 0 Months posttransplant to 58.1 percent at 60 Months posttransplant.

Figure LU 52. Patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by race
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.


A line plot for patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by las; the less than 35 category decreases by 41.8% from 100 percent at 0 Months posttransplant to 58.2 percent at 60 Months posttransplant; the 35 to less than 40 category decreases by 43.5% from 100 percent at 0 Months posttransplant to 56.5 percent at 60 Months posttransplant; the 40 to less than 50 category decreases by 44.7% from 100 percent at 0 Months posttransplant to 55.3 percent at 60 Months posttransplant; the 50 to less than 60 category decreases by 45.7% from 100 percent at 0 Months posttransplant to 54.3 percent at 60 Months posttransplant; and the 60 to 100 category decreases by 49.0% from 100 percent at 0 Months posttransplant to 51 percent at 60 Months posttransplant.

Figure LU 53. Patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by LAS
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.


A line plot for patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by transplant type; the single left category decreases by 52.5% from 100 percent at 0 Months posttransplant to 47.5 percent at 60 Months posttransplant; the single right category decreases by 51.4% from 100 percent at 0 Months posttransplant to 48.6 percent at 60 Months posttransplant; and the bilateral category decreases by 41.2% from 100 percent at 0 Months posttransplant to 58.8 percent at 60 Months posttransplant.

Figure LU 54. Patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by transplant type
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.


A line plot for patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by diagnosis group; the a category decreases by 42.4% from 100 percent at 0 Months posttransplant to 57.6 percent at 60 Months posttransplant; the b category decreases by 41.3% from 100 percent at 0 Months posttransplant to 58.7 percent at 60 Months posttransplant; the c category decreases by 39.4% from 100 percent at 0 Months posttransplant to 60.6 percent at 60 Months posttransplant; and the d category decreases by 47.4% from 100 percent at 0 Months posttransplant to 52.6 percent at 60 Months posttransplant.

Figure LU 55. Patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by diagnosis group
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.


A line plot for patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by diagnosis and transplant type; the alpha to 1 single category decreases by 47.8% from 100 percent at 0 Months posttransplant to 52.2 percent at 60 Months posttransplant; the alpha to 1 bilateral category decreases by 39.2% from 100 percent at 0 Months posttransplant to 60.8 percent at 60 Months posttransplant; the ipf single category decreases by 54.4% from 100 percent at 0 Months posttransplant to 45.6 percent at 60 Months posttransplant; the ipf bilateral category decreases by 42.6% from 100 percent at 0 Months posttransplant to 57.4 percent at 60 Months posttransplant; the copd single category decreases by 47.4% from 100 percent at 0 Months posttransplant to 52.6 percent at 60 Months posttransplant; and the copd bilateral category decreases by 40.5% from 100 percent at 0 Months posttransplant to 59.5 percent at 60 Months posttransplant.

Figure LU 56. Patient survival among lung transplant recipients aged 12 years or older, 2009-2011, by diagnosis and transplant type
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered. COPD, chronic obstructive pulmonary disease; IPF, idiopathic pulmonary fibrosis.


A line plot for patient death among lung transplant recipients aged 12 years or older; the 6 to month category decreases by 66.9% from 20 percent at 1998 to 6.6 percent at 2015; the 1 to year category decreases by 58.5% from 25.9 percent at 1998 to 10.8 percent at 2015; the 3 to year category decreases by 38.7% from 43.8 percent at 1998 to 26.9 percent at 2013; the 5 to year category decreases by 21.0% from 56.3 percent at 1998 to 44.4 percent at 2011; and the 10 to year category decreases by 10.7% from 75.6 percent at 1998 to 67.5 percent at 2006.

Figure LU 57. Patient death among lung transplant recipients aged 12 years or older
All recipients aged 12 years or older of deceased donor lungs, including multi-organ transplants. Patients are followed until the earlier of death or December 31, 2016. Estimates computed with Cox proportional hazards models adjusted for age, sex, and race.


A line plot for recipients alive with a functioning lung graft on june 30 of the year, by age at transplant; the less than 18 category increases by 32.1% from 0.3 patients (in thousands) at 2005 to 0.4 patients (in thousands) at 2016; the 18 to 49 category increases by 53.7% from 2.5 patients (in thousands) at 2005 to 3.9 patients (in thousands) at 2016; the greater than or equal to 50 category increases by 165.4% from 3.3 patients (in thousands) at 2005 to 8.8 patients (in thousands) at 2016; and the all category increases by 112.8% from 6.1 patients (in thousands) at 2005 to 13.1 patients (in thousands) at 2016.

Figure LU 58. Recipients alive with a functioning lung graft on June 30 of the year, by age at transplant
Recipients are assumed to be alive with function unless a death or graft failure is recorded. A recipient may experience a graft failure and be removed from the cohort, undergo retransplant, and re-enter the cohort.


A bar plot for incidence of acute rejection by 1 year posttransplant among lung transplant recipients aged 12 years or older by age, the 12 to 17 age group is 12.28 percent for 2010-11, 19.05 percent for 2012 to 13, and 15.25 percent for 2014 to 15; the 18 to 34 age group is 19.08 percent for 2010-11, 26.87 percent for 2012 to 13, and 16.91 percent for 2014 to 15; the 35 to 49 age group is 21.21 percent for 2010-11, 19.38 percent for 2012 to 13, and 21.63 percent for 2014 to 15; the 50 to 64 age group is 16.46 percent for 2010-11, 15.73 percent for 2012 to 13, and 16.54 percent for 2014 to 15; the greater than or equal to 65 age group is 19.02 percent for 2010-11, 14.91 percent for 2012 to 13, and 16.20 percent for 2014 to 15; and the all age group is 18.04 percent for 2010-11, 17.21 percent for 2012 to 13, and 17.09 percent for 2014 to 15.

Figure LU 59. Incidence of acute rejection by 1 year posttransplant among lung transplant recipients aged 12 years or older by age
Acute rejection is defined as a record of acute or hyperacute rejection, as reported on the OPTN Transplant Recipient Registration or Transplant Recipient Follow-up Form. Only the first rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier competing risk method.


A line plot for incidence of ptld among lung transplant recipients aged 12 years or older by recipient ebv status at transplant, 2010-2014; the ebv to category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; the ebv+ category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; the ebv unknown category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; and the all category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant.

Figure LU 60. Incidence of PTLD among lung transplant recipients aged 12 years or older by recipient EBV status at transplant, 2010-2014
Cumulative incidence is estimated using the Kaplan-Meier competing risk 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 disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.


A line plot for one-year cumulative incidence of death by cause among lung recipients aged 12 years or older, 2014-2015; the graft failure category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant; the infection category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant; the cardio/cerebrovascular category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant; the malignancy category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant; and the respiratory category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant.

Figure LU 61. One-year cumulative incidence of death by cause among lung recipients aged 12 years or older, 2014-2015
Primary cause of death is as reported on the OPTN Transplant Recipient Registration and Follow-up Forms. Other causes of death include hemorrhage, trauma, nonadherence, unspecified other, unknown, etc. Cumulative incidence is estimated using Kaplan-Meier competing risk methods.


A line plot for five-year cumulative incidence of death by cause among lung recipients aged 12 years or older, 2010-2011; the graft failure category is 0 percent at 0 and is percent at 5; the infection category is 0 percent at 0 and is percent at 5; the cardio/cerebrovascular category is 0 percent at 0 and is percent at 5; the malignancy category is 0 percent at 0 and is percent at 5; and the respiratory category is 0 percent at 0 and is percent at 5.

Figure LU 62. Five-year cumulative incidence of death by cause among lung recipients aged 12 years or older, 2010-2011
Primary cause of death is as reported on the OPTN Transplant Recipient Registration and Follow-up Forms. Other causes of death include hemorrhage, trauma, nonadherence, unspecified other, unknown, etc. Cumulative incidence is estimated using Kaplan-Meier competing risk methods.


A line plot for new candidates aged 0-11 years added to the lung transplant waiting list; the active category decreases by 57.5% from 40 candidates at 2005 to 17 candidates at 2016; the inactive category increases by 500.0% from 1 candidates at 2005 to 6 candidates at 2016; and the all category decreases by 43.9% from 41 candidates at 2005 to 23 candidates at 2016.

Figure LU 63. New candidates aged 0-11 years added to the lung transplant waiting list
Candidates concurrently listed at multiple centers are counted once. Candidates who are active at at least one program are considered active; otherwise they are inactive. A new patient is one who first joined the list during the given year without ever listing in a prior year, or one who listed and underwent transplant in a prior year and relisted in the given year. Patients on the list on December 31 were aged 0-11 years at listing.


A line plot for candidates aged 0-11 years waiting for lung transplant; the active category decreases by 81.7% from 60 candidates at 2005 to 11 candidates at 2016; the inactive category decreases by 84.1% from 63 candidates at 2005 to 10 candidates at 2016; and the all category decreases by 82.9% from 123 candidates at 2005 to 21 candidates at 2016.

Figure LU 64. Candidates aged 0-11 years waiting for lung transplant
Candidates concurrently listed at multiple centers are counted once. Those with concurrent listings and active at any program are considered active.


A line plot for distribution of candidates aged 0-11 years actively waiting for lung transplant, by age; the less than 1 category increases by 116.9% from 6.8 percent at 2005 to 14.7 percent at 2016; the 1 to 5 category increases by 19.7% from 24.6 percent at 2005 to 29.4 percent at 2016; and the 6 to 11 category decreases by 18.6% from 68.6 percent at 2005 to 55.9 percent at 2016.

Figure LU 65. Distribution of candidates aged 0-11 years actively waiting for lung transplant, by age
Candidates waiting for transplant any time in the given year. Candidates listed concurrently at multiple centers are counted once. Age is determined at the later of listing date or January 1 of the given year. Only candidates who were active for at least 1 day are included.


A line plot for distribution of candidates aged 0-11 years actively waiting for lung transplant by race; the white category decreases by 27.9% from 65.3 percent at 2005 to 47.1 percent at 2016; the black category increases by 98.3% from 5.9 percent at 2005 to 11.8 percent at 2016; the hispanic category increases by 52.7% from 21.2 percent at 2005 to 32.4 percent at 2016; the asian category increases by 48.7% from 5.9 percent at 2005 to 8.8 percent at 2016; and the other/unknown category decreases by 100.0% from 1.7 percent at 2005 to 0 percent at 2016.

Figure LU 66. Distribution of candidates aged 0-11 years actively waiting for lung transplant by race
Candidates waiting for transplant any time in the given year. Candidates listed concurrently at multiple centers are counted once. Only candidates who were active for at least 1 day are included.


A line plot for distribution of candidates aged 0-11 years actively waiting for lung transplant by sex; the male category increases by 30.1% from 40.7 percent at 2005 to 52.9 percent at 2016; and the female category decreases by 20.7% from 59.3 percent at 2005 to 47.1 percent at 2016.

Figure LU 67. Distribution of candidates aged 0-11 years actively waiting for lung transplant by sex
Candidates waiting for transplant any time in the given year. Candidates listed concurrently at multiple centers are counted once. Only candidates who were active for at least 1 day are included.


A line plot for distribution of candidates aged 0-11 years actively waiting for lung transplant by waiting time; the less than 31 days category increases by 89.3% from 9.3 percent at 2005 to 17.6 percent at 2016; the 31 to less than 90 days category increases by 177.6% from 8.5 percent at 2005 to 23.5 percent at 2016; the 3 to less than 6 months category is 13.6 percent at 2005 and remains relatively constant with a value of 14.7 percent at 2016; the 6 to less than 12 months category increases by 73.5% from 10.2 percent at 2005 to 17.6 percent at 2016; the 1 to less than 2 years category decreases by 28.2% from 24.6 percent at 2005 to 17.6 percent at 2016; and the greater than or equal to 2 years category decreases by 74.0% from 33.9 percent at 2005 to 8.8 percent at 2016.

Figure LU 68. Distribution of candidates aged 0-11 years actively waiting for lung transplant by waiting time
Candidates waiting for transplant any time in the given year. Candidates listed concurrently at multiple centers are counted once. Time on the waiting list is determined at the earlier of December 31 or removal from the waiting list. Only candidates who were active for at least 1 day are included.


A line plot for three-year outcomes for newly listed candidates aged 0-11 years waiting for lung transplant, 2013; the still waiting category decreases by 100.0% from 100 percent at 0 Months postlisting to 0 percent at 36 Months postlisting; the removed from list category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting; the died category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting; and the dd transplant category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting.

Figure LU 69. Three-year outcomes for newly listed candidates aged 0-11 years waiting for lung transplant, 2013
Candidates aged 0-11 who joined the waitlist in 2013. Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. DD, deceased donor.


A line plot for lung transplant rates among active waitlist candidates listed when aged younger than 12 years; the overall category increases by 249.2% from 40.5 transplants per 100 waitlist years at 2005 to 141.4 transplants per 100 waitlist years at 2016.

Figure LU 70. Lung transplant rates among active waitlist candidates listed when aged younger than 12 years
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active waiting in a given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for pretransplant mortality rates among candidates aged 0-11 years waitlisted for lung transplant by age; the overall category increases by 263.3% from 8.9 deaths per 100 waitlist years at 2005-2006 to 32.2 deaths per 100 waitlist years at 2015-2016; the less than 6 category increases by 304.6% from 16.7 deaths per 100 waitlist years at 2005-2006 to 67.4 deaths per 100 waitlist years at 2015-2016; and the 6 to 11 category increases by 169.7% from 6.7 deaths per 100 waitlist years at 2005-2006 to 18.1 deaths per 100 waitlist years at 2015-2016.

Figure LU 71. Pretransplant mortality rates among candidates aged 0-11 years waitlisted for lung transplant by age
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year. Rates with less than 10 patient-years of exposure are not shown.


A line plot for lung transplants, recipients aged 0-11 years by age; the less than 1 category is 3 transplants at 2005 and remains relatively constant with a value of 3 transplants at 2016; the 1 to 5 category decreases by 37.5% from 8 transplants at 2005 to 5 transplants at 2016; the 6 to 11 category is 8 transplants at 2005 and remains relatively constant with a value of 8 transplants at 2016; and the all category decreases by 15.8% from 19 transplants at 2005 to 16 transplants at 2016.

Figure LU 72. Lung transplants, recipients aged 0-11 years by age
All lung transplant recipients aged 0-11 years, including retransplant, and multi-organ recipients.


A line plot for number of centers performing pediatric and adult lung transplants by center

Figure LU 73. Number of centers performing pediatric and adult lung transplants by center's age mix
Adult centers transplanted only recipients aged 18 years or older. Functionally adult centers transplant 80% adults or more, and the remainder were children aged 15-17 years. Mixed included adults and children of any age groups. Child only centers transplanted recipeints aged 0-17 years, and small number of adults up to age 21 years.


A line plot for induction agent use in lung transplant recipients aged 0-11 years; the il2 to ra category decreases by 36.6% from 45.1 percent at 2005-2006 to 28.6 percent at 2015-2016; the t to cell depleting category increases by 191.4% from 17.6 percent at 2005-2006 to 51.4 percent at 2015-2016; and the none category decreases by 41.7% from 39.2 percent at 2005-2006 to 22.9 percent at 2015-2016.

Figure LU 74. Induction agent use in lung transplant recipients aged 0-11 years
Immunosuppression at transplant reported to the OPTN. IL2-RA, interleukin-2 receptor antagonist.


A line plot for calcineurin inhibitor use in lung transplant recipients aged 0-11 years; the cyclosporine category decreases by 100.0% from 39.2 percent at 2005-2006 to 0 percent at 2015-2016; and the tacrolimus category increases by 59.8% from 60.8 percent at 2005-2006 to 97.1 percent at 2015-2016.

Figure LU 75. Calcineurin inhibitor use in lung transplant recipients aged 0-11 years
Immunosuppression at transplant reported to the OPTN.


A line plot for anti-metabolite use in lung transplant recipients aged 0-11 years; the azathioprine category decreases by 100.0% from 23.5 percent at 2005-2006 to 0 percent at 2015-2016; and the mycophenolate category increases by 37.8% from 72.5 percent at 2005-2006 to 100 percent at 2015-2016.

Figure LU 76. Anti-metabolite use in lung transplant recipients aged 0-11 years
Immunosuppression at transplant reported to the OPTN. Mycophenolate includes mycophenolate mofetil and mycophenolate sodium.


A line plot for steroid use in lung transplant recipients aged 0-11 years; the at transplant category is 96.1 percent at 2005-2006 and remains relatively constant with a value of 100 percent at 2015-2016; and the 1 year posttransplant category decreases by 11.8% from 100 percent at 2005-2006 to 88.2 percent at 2015-2016.

Figure LU 77. Steroid use in lung transplant recipients aged 0-11 years
Immunosuppression at transplant reported to the OPTN. One-year posttransplant data are limited to patients alive with graft function at 1 year posttransplant.


A bar plot for total hla a, b, and dr mismatches among deceased donor lung transplant recipients aged 0-11 years, 2012-2016, the 0 group is 0.00 percent; the 1 group is 0.00 percent; the 2 group is 1.09 percent; the 3 group is 6.52 percent; the 4 group is 16.30 percent; the 5 group is 17.39 percent; the 6 group is 16.30 percent; and the unk. group is 42.39 percent.

Figure LU 78. Total HLA A, B, and DR mismatches among deceased donor lung transplant recipients aged 0-11 years, 2012-2016
Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2016.


A line plot for incidence of ptld among lung transplant recipients aged 0-11 years by recipient ebv status at transplant, 2004-2014; the ebv to category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; the ebv+ category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; and the all category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant.

Figure LU 79. Incidence of PTLD among lung transplant recipients aged 0-11 years by recipient EBV status at transplant, 2004-2014
Cumulative incidence is estimated using the Kaplan-Meier competing risk method. Posttransplant lymphoproliferative disorder (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 disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus.


A line plot for patient death among lung transplant recipients aged 0-11 years; the 6 to month category decreases by 40.7% from 23.3 percent at 1998-1999 to 13.8 percent at 2014-2015; the 1 to year category decreases by 32.1% from 28.8 percent at 1998-1999 to 19.6 percent at 2014-2015; the 3 to year category decreases by 58.0% from 52.2 percent at 1998-1999 to 22 percent at 2012-2013; the 5 to year category decreases by 46.0% from 54.5 percent at 1998-1999 to 29.5 percent at 2010-2011; and the 10 to year category decreases by 31.4% from 67.8 percent at 1998-1999 to 46.5 percent at 2004-2005.

Figure LU 80. Patient death among lung transplant recipients aged 0-11 years
All deceased donor lung recipients aged 0-11 years, including multi-organ transplants. Patients are followed until the earlier of death or December 31, 2016. Estimates computed with Cox proportional hazards models reporting, adjusted for age, sex, and race.


A line plot for patient survival among lung transplant recipients aged 0-11 years, 2004-2011, by age; the less than 1 category decreases by 54.3% from 100 percent at 0 Months post-transplant to 45.7 percent at 60 Months post-transplant; the 1 to 5 category decreases by 43.2% from 100 percent at 0 Months post-transplant to 56.8 percent at 60 Months post-transplant; the 6 to 11 category decreases by 35.5% from 100 percent at 0 Months post-transplant to 64.5 percent at 60 Months post-transplant; and the all category decreases by 41.9% from 100 percent at 0 Months post-transplant to 58.1 percent at 60 Months post-transplant.

Figure LU 81. Patient survival among lung transplant recipients aged 0-11 years, 2004-2011, by age
Recipient survival estimated using unadjusted Kaplan-Meier methods.


A line plot for patient survival among lung transplant recipients aged 0-11 years, 2004-2011, by diagnosis; the cystic fibrosis category decreases by 35.3% from 100 percent at 0 Months post-transplant to 64.7 percent at 60 Months post-transplant; the ph category decreases by 46.9% from 100 percent at 0 Months post-transplant to 53.1 percent at 60 Months post-transplant; and the other category decreases by 42.7% from 100 percent at 0 Months post-transplant to 57.3 percent at 60 Months post-transplant.

Figure LU 82. Patient survival among lung transplant recipients aged 0-11 years, 2004-2011, by diagnosis
Recipient survival estimated using unadjusted Kaplan-Meier methods. PH, pulmonary hypertension.


A line plot for one-year cumulative incidence of death by cause among lung transplant recipients aged 0-11 years, 2005-2015; the graft failure category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant; the infection category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant; the cardio/cerebrovascular category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant; the malignancy category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant; and the respiratory category is 0 percent at 0 Months since transplant and is percent at 12 Months since transplant.

Figure LU 83. One-year cumulative incidence of death by cause among lung transplant recipients aged 0-11 years, 2005-2015
Primary cause of death is as reported on the OPTN Transplant Recipient Registration and Follow-up Forms. Other causes of death include hemorrhage, trauma, nonadherence, unspecified other, unknown, etc. Cumulative incidence is estimated using Kaplan-Meier competing risk methods.


A line plot for five-year cumulative incidence of death by cause among lung transplant recipients aged 0-11 years, 2005-2011; the graft failure category is 0 percent at 0 and is percent at 5; the infection category is 0 percent at 0 and is percent at 5; the cardio/cerebrovascular category is 0 percent at 0 and is percent at 5; the malignancy category is 0 percent at 0 and is percent at 5; and the respiratory category is 0 percent at 0 and is percent at 5.

Figure LU 84. Five-year cumulative incidence of death by cause among lung transplant recipients aged 0-11 years, 2005-2011
Primary cause of death is as reported on the OPTN Transplant Recipient Registration and Follow-up Forms. Other causes of death include hemorrhage, trauma, nonadherence, unspecified other, unknown, etc. Cumulative incidence is estimated using Kaplan-Meier competing risk methods.


Table LU 1 Demographic characteristics of candidates aged 12 years or older on the lung transplant waiting list on December 31, 2011, and December 31, 2016
Candidates waiting for transplant on December 31, 2011, and 2016, regardless of first listing date; multiple listings are collapsed.
Characteristic 2011, N 2011, Percent 2016, N 2016, Percent
Age: 12-17 years 31 1.9% 11 0.8%
Age: 18-34 years 197 11.9% 136 9.7%
Age: 35-49 years 268 16.1% 208 14.9%
Age: 50-64 years 873 52.6% 707 50.7%
Age: ≥ 65 years 292 17.6% 333 23.9%
Sex: Female 991 59.7% 841 60.3%
Sex: Male 670 40.3% 554 39.7%
Race/ethnicity: White 1355 81.6% 1084 77.7%
Race/ethnicity: Black 168 10.1% 147 10.5%
Race/ethnicity: Hispanic 102 6.1% 106 7.6%
Race/ethnicity: Asian 27 1.6% 44 3.2%
Race/ethnicity: Other/unknown 9 0.5% 14 1.0%
Height: < 150 cm 80 4.8% 68 4.9%
Height: 150-< 160 cm 349 21.0% 313 22.4%
Height: 160-< 170 cm 604 36.4% 514 36.8%
Height: 170-< 180 cm 431 25.9% 346 24.8%
Height: ≥ 180 cm 193 11.6% 154 11.0%
Height: Unknown 4 0.2% 0 0.0%
All candidates 1661 100.0% 1395 100.0%



Table LU 2 Clinical characteristics of candidates aged 12 years or older on the lung transplant waiting list on December 31, 2011, and December 31, 2016
Candidates waiting for transplant on December 31, 2011, and 2016, regardless of first listing date; multiple listings are collapsed. All candidates with unknown LAS in are inactive.
Characteristic 2011, N 2011, Percent 2016, N 2016, Percent
Diagnosis group: A 797 48.0% 608 43.6%
Diagnosis group: B 144 8.7% 105 7.5%
Diagnosis group: C 192 11.6% 153 11.0%
Diagnosis group: D 528 31.8% 529 37.9%
LAS: < 30 39 2.3% 113 8.1%
LAS: 30-< 35 886 53.3% 627 44.9%
LAS: 35-< 40 362 21.8% 367 26.3%
LAS: 40-< 50 227 13.7% 199 14.3%
LAS: 50-< 60 61 3.7% 43 3.1%
LAS: ≥ 60 45 2.7% 46 3.3%
LAS: Unknown 41 2.5% 0 0.0%
Blood type: A 643 38.7% 517 37.1%
Blood type: B 157 9.5% 155 11.1%
Blood type: AB 37 2.2% 35 2.5%
Blood type: O 824 49.6% 688 49.3%
All candidates 1661 100.0% 1395 100.0%



Table LU 3 Listing characteristics of candidates aged 12 years or older on the lung transplant waiting list on December 31, 2011, and December 31, 2016
Candidates waiting for transplant on December 31, 2011, and 2016, regardless of first listing date; multiple listings are collapsed.
Characteristic 2011, N 2011, Percent 2016, N 2016, Percent
Wait time: < 31 days 149 9.0% 187 13.4%
Wait time: 31-60 days 114 6.9% 117 8.4%
Wait time: 61-90 days 107 6.4% 89 6.4%
Wait time: 3-< 6 months 228 13.7% 215 15.4%
Wait time: 6-< 12 months 284 17.1% 258 18.5%
Wait time: 1-< 2 years 351 21.1% 235 16.8%
Wait time: 2-< 3 years 149 9.0% 120 8.6%
Wait time: ≥ 3 years 279 16.8% 174 12.5%
Waitlist status: Active 1314 79.1% 1127 80.8%
Waitlist status: Inactive 347 20.9% 268 19.2%
Transplant history: First 1582 95.2% 1363 97.7%
Transplant history: Retransplant 79 4.8% 32 2.3%
Tx type: Lung only 1593 95.9% 1331 95.4%
Tx type: Heart-lung 55 3.3% 47 3.4%
Tx type: Other 13 0.8% 17 1.2%
All candidates 1661 100.0% 1395 100.0%



Table LU 4 Lung transplant waitlist activity among candidates aged 12 years or older
Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. Candidates who are listed, undergo transplant, and are relisted are counted more than once. Candidates are not considered to be on the list on the day they are removed; counts on January 1 may differ from counts on December 31 of the prior year. Candidates listed for multi-organ transplants are included.
Waiting list state 2014 2015 2016
Patients at start of year 1578 1636 1519
Patients added during year 2515 2490 2692
Patients removed during year 2454 2604 2816
Patients at end of year 1639 1522 1395



Table LU 5 Removal reason among lung transplant candidats aged 12 years or older
Removal reason as reported to the OPTN. Candidates with death dates that precede removal dates are assumed to have died waiting.
Removal reason 2014 2015 2016
Deceased donor transplant 1916 2048 2322
Living donor transplant 0 0 0
Patient died 272 242 201
Patient refused transplant 14 9 16
Improved, transplant not needed 38 42 29
Too sick for transplant 132 147 136
Other 82 116 112



Table LU 6 Demographic characteristics of lung transplant recipients aged 12 years or older, 2011 and 2016
Lung transplant recipients aged 12 years or older, including retransplants.
Characteristic 2011, N 2011, Percent 2016, N 2016, Percent
Age: 12-17 years 26 1.4% 23 1.0%
Age: 18-34 years 221 12.1% 247 10.6%
Age: 35-49 years 229 12.5% 267 11.5%
Age: 50-64 years 872 47.7% 1104 47.4%
Age: ≥ 65 years 482 26.3% 688 29.5%
Sex: Female 766 41.9% 975 41.9%
Sex: Male 1064 58.1% 1354 58.1%
Race/ethnicity: White 1544 84.4% 1884 80.9%
Race/ethnicity: Black 152 8.3% 218 9.4%
Race/ethnicity: Hispanic 93 5.1% 165 7.1%
Race/ethnicity: Asian 30 1.6% 48 2.1%
Race/ethnicity: Other/unknown 11 0.6% 14 0.6%
Height: < 150 cm 39 2.1% 45 1.9%
Height: 150-< 160 cm 247 13.5% 330 14.2%
Height: 160-< 170 cm 569 31.1% 710 30.5%
Height: 170-< 180 cm 632 34.5% 805 34.6%
Height: ≥ 180 cm 343 18.7% 437 18.8%
Height: Unknown 0 0.0% 2 0.1%
Insurance: Private 942 51.5% 1055 45.3%
Insurance: Medicare 707 38.6% 1017 43.7%
Insurance: Other government 170 9.3% 228 9.8%
Insurance: Unknown 11 0.6% 29 1.2%
All recipients 1830 100.0% 2329 100.0%



Table LU 7 Clinical characteristics of lung transplant recipients aged 12 years or older, 2011 and 2016
Lung transplant recipients aged 12 years or older, including retransplants. ECMO, extracorporeal membrane oxygenation.
Characteristic 2011, N 2011, Percent 2016, N 2016, Percent
Diagnosis group: A 541 29.6% 626 26.9%
Diagnosis group: B 75 4.1% 92 4.0%
Diagnosis group: C 241 13.2% 280 12.0%
Diagnosis group: D 973 53.2% 1331 57.1%
Blood type: A 752 41.1% 970 41.6%
Blood type: B 195 10.7% 260 11.2%
Blood type: AB 62 3.4% 80 3.4%
Blood type: O 821 44.9% 1019 43.8%
Medical condition: Hospitalized in ICU 199 10.9% 270 11.6%
Medical condition: Hospitalized, not ICU 164 9.0% 228 9.8%
Medical condition: Not hospitalized 1467 80.2% 1819 78.1%
Medical condition: Hospitalization unknown 0 0.0% 12 0.5%
LAS: < 30 2 0.1% 5 0.2%
LAS: 30-< 35 428 23.4% 570 24.5%
LAS: 35-< 40 413 22.6% 577 24.8%
LAS: 40-< 50 451 24.6% 542 23.3%
LAS: 50-< 60 203 11.1% 209 9.0%
LAS: ≥ 60 333 18.2% 426 18.3%
Vent/ECMO at transplant: Vent + ECMO 33 1.8% 74 3.2%
Vent/ECMO at transplant: Vent only 138 7.5% 53 2.3%
Vent/ECMO at transplant: ECMO only 10 0.5% 61 2.6%
Vent/ECMO at transplant: Neither 1649 90.1% 2141 91.9%
All recipients 1830 100.0% 2329 100.0%



Table LU 8 Transplant characteristics of lung transplant recipients aged 12 years or older, 2011 and 2016
Lung transplant recipients aged 12 years or older, including retransplants. DBD, donation after brain death; DCD, donation after circulatory death.
Characteristic 2011, N 2011, Percent 2016, N 2016, Percent
Wait time: < 31 days 633 34.6% 901 38.7%
Wait time: 31-60 days 262 14.3% 358 15.4%
Wait time: 61-90 days 156 8.5% 222 9.5%
Wait time: 3-< 6 months 294 16.1% 347 14.9%
Wait time: 6-< 12 months 249 13.6% 254 10.9%
Wait time: ≥ 1 year 236 12.9% 247 10.6%
Procedure: Lobar 3 0.2% 0 0.0%
Procedure: Single 546 29.8% 588 25.2%
Procedure: Bilateral 1281 70.0% 1741 74.8%
Donor type: DBD 1810 98.9% 2236 96.0%
Donor type: DCD 19 1.0% 93 4.0%
Donor type: Living 1 0.1% 0 0.0%
Transplant history: First 1761 96.2% 2253 96.7%
Transplant history: Retransplant 69 3.8% 76 3.3%
Tx type: Lung only 1793 98.0% 2299 98.7%
Tx type: Heart-lung 25 1.4% 18 0.8%
Tx type: Other 12 0.7% 12 0.5%
All recipients 1830 100.0% 2329 100.0%



Table LU 9 Donor-recipient serology matching among lung transplant recipients aged 12 years or older, 2012-2016
Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. If all fields are unknown, incomplete, or pending, the person is categorized as unknown for that serology; otherwise, serology is assumed negative. CMV, cytomegalovirus; EBV, Epstein-Barr virus.
Donor Recipient CMV EBV
D- R- 9.3% 0.6%
D- R+ 11.6% 6.0%
D- R unk 16.3% 0.2%
D+ R- 15.2% 8.6%
D+ R+ 21.0% 81.2%
D+ R unk 26.2% 3.2%
D unk R- 0.0% 0.0%
D unk R+ 0.1% 0.1%
D unk R unk 0.2% 0.0%



Table LU 10 Posttransplant events among lung transplant recipients aged 12 years or older
Posttransplant morbidities are recorded on the OPTN Transplant Recipient Follow-up Form and are included in the table if they were reported anytime on or before 1-year and 5-year follow-up. One-year events are reported for recipients in 2013-2015 and 5-year events for recipients in 2009-2011. Recipients of more than one transplant are counted separately per transplant. For bronchiolitis obliterans syndrome (BOS), the most severe complication recorded for each transplant is counted.
Event One-year, N One-year, Pct Five-year, N Five-year, Pct
BOS: None reported 4446 87.7% 1558 57.0%
BOS: Reported 351 6.9% 1173 42.9%
BOS: Unknown 271 5.3% 4 0.1%
Creatinine > 2.5 mg/dl 218 4.3% 351 12.8%
Chronic dialysis 67 1.3% 72 2.6%
Renal transplant 4 0.1% 26 1.0%
Diabetes 417 8.2% 665 24.3%
Malignancy 181 3.6% 635 23.2%
Re-hospitalization 2322 45.8% 2163 79.1%
Functional status: No assistance needed 4142 81.7% 2149 78.6%
Functional status: Some assistance needed 376 7.4% 200 7.3%
Functional status: Total assistance needed 109 2.2% 68 2.5%
Functional status: Unknown 441 8.7% 318 11.6%
All recipients 5068 100.0% 2735 100.0%



Table LU 11 Demographic characteristics of candidates aged 0-11 years on the lung transplant waiting list on December 31, 2006, and December 31, 2016
Candidates aged younger than 12 years waiting for transplant on December 31, 2006, and December 31, 2016, regardless of first listing date; multiple listings are collapsed. Age calculated at snapshot.
Characteristic 2006, N 2006, Percent 2016, N 2016, Percent
Age: < 1 year 0 0.0% 2 14.3%
Age: 1-5 years 10 17.9% 6 42.9%
Age: 6-11 years 46 82.1% 6 42.9%
Sex: Female 29 51.8% 7 50.0%
Sex: Male 27 48.2% 7 50.0%
Race/ethnicity: White 40 71.4% 11 78.6%
Race/ethnicity: Black 5 8.9% 2 14.3%
Race/ethnicity: Hispanic 9 16.1% 1 7.1%
Race/ethnicity: Asian 2 3.6% 0 0.0%
Height: < 70 cm 3 5.4% 5 35.7%
Height: 70-< 90 cm 15 26.8% 1 7.1%
Height: 90-< 110 cm 13 23.2% 4 28.6%
Height: 110-< 130 cm 19 33.9% 2 14.3%
Height: ≥ 130 cm 6 10.7% 2 14.3%
All candidates 56 100.0% 14 100.0%



Table LU 12 Clinical characteristics of candidates aged 0-11 years on the lung transplant waiting list on December 31, 2006, and December 31, 2016
Candidates aged younger than 12 years waiting for transplant on December 31, 2006, and December 31, 2016, regardless of first listing date; multiple listings are collapsed.
Characteristic 2006, N 2006, Percent 2016, N 2016, Percent
Diagnosis: Cystic fibrosis 10 17.9% 3 21.4%
Diagnosis: Pulmonary hypertension 21 37.5% 3 21.4%
Diagnosis: Pulmonary fibrosis 10 17.9% 0 0.0%
Diagnosis: Other vascular 1 1.8% 0 0.0%
Diagnosis: Other/unknown 14 25.0% 8 57.1%
Blood type: A 21 37.5% 6 42.9%
Blood type: B 8 14.3% 1 7.1%
Blood type: AB 2 3.6% 2 14.3%
Blood type: O 25 44.6% 5 35.7%
All candidates 56 100.0% 14 100.0%



Table LU 13 Listing characteristics of candidates aged 0-11 years on the lung transplant waiting list on December 31, 2006, and December 31, 2016
Candidates aged younger than 12 years waiting for transplant on December 31, 2006, and December 31, 2016, regardless of first listing date; multiple listings are collapsed.
Characteristic 2006, N 2006, Percent 2016, N 2016, Percent
Wait time: < 31 days 4 7.1% 1 7.1%
Wait time: 31-60 days 1 1.8% 2 14.3%
Wait time: 61-90 days 0 0.0% 3 21.4%
Wait time: 3-< 6 months 3 5.4% 1 7.1%
Wait time: 6-< 12 months 3 5.4% 2 14.3%
Wait time: 1-< 2 years 11 19.6% 2 14.3%
Wait time: 2-< 3 years 16 28.6% 0 0.0%
Wait time: ≥ 3 years 18 32.1% 3 21.4%
Waitlist status: Active 23 41.1% 8 57.1%
Waitlist status: Inactive 33 58.9% 6 42.9%
Transplant history: First 56 100.0% 13 92.9%
Transplant history: Retransplant 0 0.0% 1 7.1%
Tx type: Lung only 47 83.9% 13 92.9%
Tx type: Heart-lung 9 16.1% 1 7.1%
All candidates 56 100.0% 14 100.0%



Table LU 14 Lung transplant waitlist activity among candidates aged 0-11 years
Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. Candidates who are listed, undergo transplant, and are relisted are counted more than once. Candidates are not considered to be on the list on the day they are removed; counts on January 1 may differ from counts on December 31 of the prior year. Candidates listed for multi-organ transplants are included.
Waiting list state 2014 2015 2016
Patients at start of year 36 29 20
Patients added during year 36 23 23
Patients removed during year 43 32 22
Patients at end of year 29 20 21



Table LU 15 Removal reason among lung transplant candidates aged 0-11 years
Removal reason as reported to the OPTN. Candidates with death dates that precede removal dates are assumed to have died waiting.
Removal reason 2014 2015 2016
Deceased donor transplant 21 17 15
Living donor transplant 0 0 0
Patient died 11 8 4
Patient refused transplant 0 0 0
Improved, transplant not needed 7 2 2
Too sick for transplant 1 2 0
Other 3 3 1



Table LU 16 Demographic characteristics of lung transplant recipients aged 0-11 years, 2004-2006 and 2014-2016
Lung transplant recipients, including retransplants.
Characteristic 2004-06, N 2004-06, Percent 2014-16, N 2014-16, Percent
Age: < 1 year 14 20.9% 8 15.4%
Age: 1-5 years 18 26.9% 17 32.7%
Age: 6-11 years 35 52.2% 27 51.9%
Sex: Female 31 46.3% 26 50.0%
Sex: Male 36 53.7% 26 50.0%
Race/ethnicity: White 39 58.2% 30 57.7%
Race/ethnicity: Black 7 10.4% 5 9.6%
Race/ethnicity: Hispanic 14 20.9% 14 26.9%
Race/ethnicity: Asian 6 9.0% 3 5.8%
Race/ethnicity: Other/unknown 1 1.5% 0 0.0%
Height: < 70 cm 17 25.4% 12 23.1%
Height: 70-< 90 cm 7 10.4% 9 17.3%
Height: 90-< 110 cm 15 22.4% 7 13.5%
Height: 110-< 130 cm 23 34.3% 17 32.7%
Height: ≥ 130 cm 5 7.5% 7 13.5%
Insurance: Private 30 44.8% 21 40.4%
Insurance: Medicaid 34 50.7% 22 42.3%
Insurance: Unknown 3 4.5% 9 17.3%
All recipients 67 100.0% 52 100.0%



Table LU 17 Clinical characteristics of lung transplant recipients aged 0-11 years, 2004-2006 and 2014-2016
Lung transplant recipients, including retransplants. ECMO, extracorporeal membrane oxygenation.
Characteristic 2004-06, N 2004-06, Percent 2014-16, N 2014-16, Percent
Diagnosis: Cystic fibrosis 16 23.9% 11 21.2%
Diagnosis: Pulmonary hypertension 17 25.4% 14 26.9%
Diagnosis: Pulmonary fibrosis 5 7.5% 3 5.8%
Diagnosis: Other vascular 3 4.5% 4 7.7%
Diagnosis: Other/unknown 26 38.8% 20 38.5%
Blood type: A 21 31.3% 19 36.5%
Blood type: B 10 14.9% 9 17.3%
Blood type: AB 5 7.5% 1 1.9%
Blood type: O 31 46.3% 23 44.2%
Medical condition: Hospitalized in ICU 21 31.3% 18 34.6%
Medical condition: Hospitalized, not ICU 15 22.4% 12 23.1%
Medical condition: Not hospitalized 31 46.3% 22 42.3%
Medical urgency: priority 1 38 74.5%
Medical urgency: priority 2 13 25.5%
Vent/ECMO at transplant: Vent + ECMO 2 3.0% 3 5.8%
Vent/ECMO at transplant: Vent only 19 28.4% 11 21.2%
Vent/ECMO at transplant: ECMO only 0 0.0% 1 1.9%
Vent/ECMO at transplant: Neither 46 68.7% 37 71.2%
All recipients 67 100.0% 52 100.0%



Table LU 18 Transplant haracteristics of lung transplant recipients aged 0-11 years, 2004-2006 and 2014-2016
Lung transplant recipients, including retransplants.
Characteristic 2004-06, N 2004-06, Percent 2014-16, N 2014-16, Percent
Wait time: < 31 days 22 32.8% 11 21.2%
Wait time: 31-60 days 9 13.4% 10 19.2%
Wait time: 61-90 days 9 13.4% 10 19.2%
Wait time: 3-< 6 months 14 20.9% 11 21.2%
Wait time: 6-< 12 months 5 7.5% 7 13.5%
Wait time: ≥ 1 year 8 11.9% 3 5.8%
Bilateral procedure 67 100.0% 52 100.0%
Transplant history: First 64 95.5% 47 90.4%
Transplant history: Retransplant 3 4.5% 5 9.6%
Tx type: Lung only 57 85.1% 49 94.2%
Tx type: Heart-lung 8 11.9% 2 3.8%
Tx type: Other 2 3.0% 1 1.9%
All recipients 67 100.0% 52 100.0%



Table LU 19 Donor-recipient serology matching among lung transplant recipients aged 0-11 years, 2012-2016
Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. If all fields are unknown, incomplete, or pending, the person is categorized as unknown for that serology; otherwise, serology is assumed negative. CMV, cytomegalovirus; EBV, Epstein-Barr virus.
Donor Recipient CMV EBV
D- R- 30.4% 13.0%
D- R+ 7.6% 22.8%
D- R unk 16.3% 1.1%
D+ R- 16.3% 38.0%
D+ R+ 15.2% 23.9%
D+ R unk 14.1% 1.1%



Table LU 20 Posttransplant events among lung transplant recipients aged 0-11 years
Posttransplant morbidities are recorded on the OPTN Pediatric Transplant Recipient Follow-up Form and are included in the table if they were reported anytime on or before 1-year and 5-year follow-up. One-year events are reported for recipients in 2012-2015 and 5-year events for recipients in 2008-2011. Recipients of more than one transplant are counted separately per transplant. For bronchiolitis obliterans syndrome (BOS), the most severe complication recorded for each transplant is counted.
Event One-year, N One-year, Pct Five-year, N Five-year, Pct
BOS: None reported 59 92.2% 27 61.4%
BOS: Reported 3 4.7% 17 38.6%
BOS: Unknown 2 3.1% 0 0.0%
Diabetes 2 3.1% 2 4.5%
Malignancy 2 3.1% 1 2.3%
Re-hospitalization 32 50.0% 39 88.6%
Functional status: Fully active 60 93.8% 41 93.2%
Functional status: Min. active 1 1.6% 2 4.5%
Functional status: Bedbound 2 3.1% 0 0.0%
Functional status: Unknown 1 1.6% 1 2.3%
All recipients 64 100.0% 44 100.0%