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Lung

OPTN/SRTR 2018 Annual Data Report: Lung

Abstract

The primary goal of US lung allocation policy is to ensure that candidates with the highest risk for mortality receive appropriate access to lung transplant. In 2018, 2562 lung transplants were performed in the US, reflecting a 31% increase over the past 5 years. More candidates are being listed for lung transplant, and the number of donors has increased substantially. Despite an increase of 84 lung transplants in 2018, 365 adult candidates died or became too sick to undergo transplant. In 2018, 24 new child (ages 0-11 years) candidates were added to the lung transplant waiting list. Fifteen lung transplants were performed in recipients aged 0-11 years, three in recipients aged younger than 1 year, two in recipients aged 1-5 years, and ten in recipients aged 6-11 years. Of 27 child candidates removed from the waiting list in 2018, 16 (59.3%) were removed due to undergoing transplant, six (22.2%) due to death, one (3.7%) due to improved condition, and one (3.7%) due to becoming too sick to undergo transplant.

Adult lung transplant

Introduction

In 2018, 2562 lung transplants were performed in the US, reflecting a 31% increase over the past 5 years (Figure LU 46). More lung transplants are being performed due to more candidates being listed for lung transplant (Figure LU 1) and a precipitous increase in numbers of donors (Figure LU 37). The number of candidates added to the waiting list increased by 233 in 2018 (Figure LU 1), and the number of donors increased by 80 (Figure LU 37). Despite an increase of 84 lung transplants in 2018, 365 candidates died or became too sick to undergo transplant (Table LU 5).

The primary goal of US lung allocation policy is to ensure that candidates with the highest risk for mortality receive appropriate access to lung transplant. The Organ Procurement and Transplantation Network (OPTN) monitors the status of transplant candidates and recipients and adjusts the system to meet this key objective. Candidates aged 12 years or older access lung transplant based on calculated lung allocation score (LAS), age, geography, and blood type (ABO) compatibility, and, if necessary, waiting time. Candidates aged younger than 12 years access transplant based on illness-based priority status, age, geography, blood type (ABO) compatibility, and waiting time.

The LAS considers waitlist mortality and posttransplant survival in its calculation, with more weight given to waitlist mortality to allow candidates at the highest risk of mortality increased access to transplant. Posttransplant survival is included in the model to minimize allocation of lungs to candidates with poor likelihood of posttransplant survival. In calculating the LAS, pulmonary diseases are categorized into four main groups based on similar survival probability and disease pathophysiology. These are group A, obstructive lung disease; group B, pulmonary vascular disease; group C, cystic fibrosis and immunodeficiency disorders; and group D, restrictive lung disease.

The LAS was implemented in 2005, resulting in candidates who were older and/or sicker being listed for transplant and ultimately undergoing transplant. The LAS was most recently updated in February 2015 with an updated cohort and new variables to more accurately reflect disease severity for the entire transplant population, and in particular group B candidates. Due to the changes in LAS calculation, scores prior to 2015 may not be directly comparable to those after. In March 2017, OPTN implemented a policy to improve transplant access for the pediatric population, with broader geographic sharing of organs for child (age 0-11 years) and adolescent (age 12-17 years) candidates. Additionally, adolescents and adults receive equal preference for adult donor lungs in the LAS system. Finally, in November 2017, a policy was implemented to eliminate donation service area as the first unit of allocation for donor lungs in favor of a more uniform 250-nautical-mile circle from the donor hospital. This policy has now been in effect for 1 year, and some of its impact is reflected in this year’s data report.

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.

Waiting list

Characteristics of US candidates waiting for a lung transplant

In 2018, 3134 candidates were added to the lung transplant waiting list, reflecting an 8.0% increase from 2017 (Figure LU 1), and a 42.2% increase over the past decade. Mostly keeping pace with the increasing demand, the number of lung transplants being performed continued to increase annually (Figure LU 46), although the number of candidates remaining on the waiting list at the end of 2018 increased for the first time since the end of 2014 (Figure LU 2).

The proportion of candidates aged 65 years or older continued to increase, comprising 32.0% of the waiting list in 2018 (Figure LU 3). Men outnumbered women and made up 52.7% of the waiting list (Figure LU 4). The percentage of white candidates decreased from 81.9% in 2013 to 75.9% in 2018 (Figure LU 5). The composition of the waiting list continued to change, with an increasing proportion of group D candidates and a decreasing proportion of group A candidates (Figure LU 6). Smaller changes occurred for groups B and C, but the waiting list included a larger proportion of group B candidates and a smaller proportion of group C candidates over the past 5 years. Candidates with type O blood comprised 49.2% of the waiting list, followed by types A, 36.1%; B, 11.1%; and AB, 3.7% (Figure LU 10). The percentage of candidates with lower LAS values at listing continued to decrease; 35.1% of candidates had a LAS of less than 35 at the time of listing, and the proportion of sicker candidates with of LAS 50 or higher continued to increase (Figure LU 8). In 2018, proportions of candidates by LAS values were: <30, 0.4%; 30-<35, 34.7%; 35-<40, 28.7%; 40-<50, 19.0%; and 50-100, 17.1% (Figure LU 8).

Outcome of US candidates listed for lung transplant

Overall lung transplant rates increased from 87.1 per 100 waitlist years in 2009 to 172.3 in 2018 (Figure LU 13). Transplant rates decreased for adolescents aged 12-17 years, although rates fluctuated widely in this age group due to the small number of candidates. From 2017 to 2018, transplant rates decreased slightly for candidates aged older than 50 years, remained similar for those aged 18-34 years, and increased for those aged 35-49 years (Figure LU 11). Candidate time on the waiting list remained stable in 2018; 53.4% of candidates had been listed for less than 90 days (Figure LU 7). The overall median time to transplant was 2.5 months, a decrease of 1.5 months compared with 2013 (Figure LU 19). Waiting time differed by diagnosis group, and was shortest for group D, 1.8 months; followed by group C, 2.7 months; group B, 2.8 months; and group A, 4.6 months (Figure LU 19). The greatest change occurred in group B, with a 41.3% improved waiting time over the past year, likely due to the 2015 LAS revision. As expected, time to transplant was related to LAS values, and was shortest for those with the highest LAS (Figure LU 20). However, waiting times have converged with time, with a 4-month difference in median waiting time between candidates with LAS below 35 and 50-100, due to the increasing transplant rates, allowing lower-LAS candidates to access transplant more readily (Figure LU 20).

Transplant rates differed by age, diagnosis, height, and blood type. By age, rates were highest for candidates aged 65 years or older, 220.1 transplants per 100 waitlist-years (Figure LU 11). By diagnosis, rates were highest for group D, 238.4 transplants per 100 waitlist-years, followed by groups C (205.6), A (109.1), and B (103.5) (Figure LU 13). By height, rates were highest for the tallest candidates, 302.4 transplants per 100 waitlist-years, and lowest for the shortest candidates, 102.7 (Figure LU 15). By blood type, rates were highest for candidates with type AB, 259.3 transplants per 100 waitlist-years, and lowest for candidates with type O, 152.1 (Figure LU 14). Generally, transplant rates did not differ based on distance between candidate residence and transplant program (Figure LU 17). Over the past 5 years, transplant rates for residents of metropolitan regions slowly outpaced rates for residents of non-metropolitan regions (Figure LU 16). Percentages of candidates who underwent lung transplant within one year of listing differed widely by state, from 33.3% to 100% (Figure LU 23).

Waitlist mortality rates generally continued to decrease but varied by age, diagnosis group, LAS, blood type, and sex. By age, waitlist mortality was highest for adolescents, 28.4 deaths per 100 waitlist-years, followed by ages 65 years or older (26.0), 35-49 years (18.2) 50-64 years (17.5), and 18-34 years (14.4) (Figure LU 24). By diagnosis, waitlist mortality was highest for group-D candidates, 29.7 deaths per 100 waitlist-years, and lowest for group-A candidates, 9.4 (Figure LU 27). By blood type, waitlist mortality was higher for candidates with type AB (Figure LU 29). By LAS, waitlist mortality was substantially higher for candidates with an LAS of 50 or higher (121.8 deaths per 100 waitlist-years), and ranged from 6.6 for candidates with LAS 30-<35 to 28.7 for candidates with LAS 40-<50 (Figure LU 28). Waitlist mortality was higher for men in this unadjusted analysis (Figure LU 26). Of candidates removed from the waiting list, 22.6% died within 6 months, but this varied by age and LAS (Figure LU 35, Figure LU 36).

Pretransplant use of extra-corporeal membrane oxygenation (ECMO) and mechanical ventilation continued, with 8% of candidates bridged using one or both of these modalities, although this population has decreased from 9.6% in 2013 (Table LU 7). A quarter of candidates were hospitalized prior to transplant, and 13.6% required an intensive care unit stay (Table LU 7).

Donors

Of 2407 deceased lung donors in 2018, 1.3% were aged younger than 12 years, 6.9% 12-17 years, 46.2% 18-34 years, 26.7% 35-49 years, and 18.9% 50 years or older (Figure LU 38); 39.2% of donors were female (Figure LU 39), 18.2% black, and 15.5% Hispanic (Figure LU 40). Discard rates differed by donor age; discard rates were highest for donors aged 35 years or older, but did not meaningfully differ between increased risk and standard infectious risk donors (Figure LU 42, Figure LU 43). The proportion of donors with a smoking history of 20 pack-years or longer decreased slightly over time and was 7.9% in 2018 (Figure LU 44). Use of organs from donation after circulatory death donors increased over the past 5 years, 4.8% in 2018 compared with 1.8% in 2013 (Table LU 8). The percentage of donors with anoxia as a cause of death increased over time from 10.8% in 2007 to 32.8% in 2018 (Figure LU 45). Head trauma and stroke continued to decline as causes of death among deceased lung donors.

Transplant

Characteristics of US lung transplant recipients

In 2018, 2562 lung transplants were performed, 75% bilateral (Figure LU 46); 97.4% were first lung transplants and only 2.6% were re-transplants (Table LU 8). Recipients aged 65 years or older underwent 886 transplants; 18-64 years, 1636 transplants; and younger than 18 years, 40 transplants (Figure LU 47). Men continued to undergo more transplants than women, and most recipients were of white race (Figure LU 48, Figure LU 49). Group D recipients underwent 60.0% of transplants, group A 23.8%, group C 10.3%, and group B 5.9% (Table LU 7). The median LAS at transplant was 42.3, an increase of two points from the previous year (Figure LU 53); LAS distribution was: 21.9%, <35; 21.3%, 35-<40; 23.0%, 40-<50; 10.3%, 50-<60; and 23.4%, 60-100 (Table LU 7). Notably, median LAS at transplant differed by primary diagnosis, and was highest for recipients in group B (49.0) and lowest for those in group A (33.6) (Figure LU 54).

In 2018, 67 programs in the US performed lung transplants in adults; a median of 27 transplants were performed at a program (Figure LU 59). Programs in the 25th percentile performed 2-17 transplants per year, and those in the 75th percentile 28-50 (Figure LU 59). The annual transplant volume for programs in the 95th percentile was 104, a value that ranged from 87 to 104 over the past 5 years (Figure LU 59); three programs accounted for nearly 20% of total volume of lung transplants performed in the US (Figure LU 60). Most lung transplants in the US were performed at programs performing 41-100 transplants per year (49.0%), followed by those performing 11-40 (30.5%), more than 100 (18.9%), and 1-10 (1.6%) (Figure LU 60).

In 2018, most transplant recipients lived in metropolitan regions, and only 15.2% in non-metropolitan regions (Table LU 6). Most recipients lived near their transplant programs, 51.3% within less than 50 miles and 16.7% within 50 to less than 100 miles (Table LU 6). The proportion of recipients with private insurance declined to 41.0%, compared with 50.6% in 2013, with a corresponding increase in the proportion with public insurance, likely due to increasing age of the lung transplant population (Table LU 6).

Outcomes of US lung transplant recipients

In 2018, over 15,000 individuals were living with a lung transplant, 426 who underwent transplant at age 17 or younger, 14,585 who underwent transplant as adults (Figure LU 70). Survival improved slightly at all time-points; 89.4% of recipients survived to 1 year, 73.5% to 3 years, and 59.4% to 5 years (Figure LU 69). Induction agents were used commonly; 68.9% of recipients received an IL-2 receptor antagonist and 9.1% T-cell depleting agents (Figure LU 56). Rates of acute rejection were only slightly lower (15.7%-15.9%) in recipients who received induction than in those who did not (18.0%) (Figure LU 72), and choice of induction did not seem to make a difference in incidence of rejection. Tacrolimus, mycophenolate, and steroids remained the most common immunosuppression regimen, used in 85.5% of transplant recipients (Figure LU 57). Half of recipients received a matched serology donor for cytomegalovirus (CMV) and 82.2% for Epstein Barr virus (EBV) (Table LU 9).

Infection and cardiovascular and cerebrovascular causes remained common causes of death in the first year posttransplant (Figure LU 75), with infection the most prevalent, and graft failure predominating by 3 years posttransplant (Figure LU 76). Programs reported development of bronchiolitis obliterans syndrome in 6.4% of recipients by 1 year and in 41.8% by 5 years (Table LU 10). Malignancy remained a common complication; 23.7% of recipients were diagnosed with malignancy by 5 years posttransplant (Table LU 10). Chronic kidney disease affected 12.9% of recipients by 5 years, with 2.7% requiring dialysis, but only 20 individuals underwent renal transplant within 5 years of lung transplant (Table LU 10). Despite these complications, nearly 81.4% of recipients were at normal functional status and did not require assistance to complete activities of daily living.

Lung transplant in children

Waiting list

In 2018, 24 new child (ages 0-11 years) candidates were added to the lung transplant waiting list; one was inactive at the time of listing (Figure LU 77). 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 107 in 2007 to 22 in 2018 (Figure LU 78). The largest age group of child candidates on the waiting list in 2018 was 6-11 years; these candidates made up 65.0%, followed by candidates aged 1-5 years, 22.5%, and younger than 1 year, 12.5% (Figure LU 79). Most child lung transplant candidates were white (57.5%), followed by Hispanic (20.0%), other or unknown race (12.5%), and black (10.0%) (Figure LU 80).

Of 27 candidates removed from the waiting list in 2018, 16 (59.3%) were removed due to undergoing transplant, six (22.2%) due to death, one (3.7%) due to improved condition, and one (3.7%) due to becoming too sick to undergo transplant (Table LU 14, Table LU 15). Regarding 3-year outcomes for child lung transplant candidates listed in 2015, 73.9% underwent deceased donor transplant, 8.7% died waiting, 13.0% were removed from the list for reasons other than transplant or death, and 4.4% were still waiting (Figure LU 83). The overall child lung transplant rate rose dramatically in 2013 and has remained steady since, with a rate of 68.3 per 100 waitlist-years in 2018 (Figure LU 84). In general, pretransplant mortality has increased over the decade; the rate was 31.1 deaths per 100 waitlist-years among candidates aged 0-11 years in 2017-2018, compared with 11.7 in 2007-2008 (Figure LU 86).

Transplant

In 2018, a total of 15 lung transplants were performed in recipients aged 0-11 years, three in recipients aged younger than 1 year, two in recipients aged 1-5 years, and ten in recipients aged 6-11 years (Figure LU 88). In 2018, seven programs were characterized as pediatric, compared with 55 adult-only programs (Figure LU 89). Cystic fibrosis and pulmonary hypertension were the leading known causes of disease, but almost 50% of causes were identified as other or unknown (Table LU 17). Half of child lung transplant recipients in 2016-2018 were not hospitalized at the time of transplant, with 77.3% as priority 1. Ventilator support and ECMO use remained stable over the past decade. In 2016-2018, lung-only transplants increased to 93.2% from 82.3% in 2006-2008 (Table LU 18).

Pediatric Immunosuppression and Outcomes

Induction therapy has changed over time, with increased use of T-cell-depleting agents to 60.0% of patients in 2017-2018 and continued decreased use of interleukin-2 receptor antagonists to 30.0% (Figure LU 90). The most common initial immunosuppression agent regimen was tacrolimus, mycophenolate, and steroids, used in 92.9% of child recipients (Figure LU 91). The incidence of posttransplant lymphoproliferative disorder among EBV-negative recipients who underwent transplant in 2006-2016 was 5.7% at 5 years posttransplant, compared with 1.1% among EBV-positive recipients (Figure LU 93). Incidence of death was 17.2% at 6 months and 24.1% at 1 year for transplants in 2016-2017, 41.7% at 3 years for transplants in 2014-2015, 33.3% at 5 years for transplants in 2012-2013, and 45.7% at 10 years for transplants in 2008-2009 (Figure LU 94). For children who underwent transplant in 2006-2013, overall 1-, 3-, and 5-year patient survival was 85.0%, 68.8%, and 60.6%, respectively (Figure LU 95). By age, patient survival rates were highest for recipients aged 6-11 years at all time-points. Among children, cystic fibrosis was associated with higher survival rates than pulmonary hypertension or other diagnoses (Figure LU 96). Leading causes of death at 1 year posttransplant were respiratory- and infection-related, and at 5 years graft failure and respiratory-related (Figure LU 97, Figure LU 98). The incidence of acute rejection among child lung transplant recipients in 2012-2017 was 7.1%.

Among child lung transplant recipients in 2016-2018, the combination of a CMV-positive donor and CMV-negative recipient occurred in 27.3% of transplants; this combination for EBV occurred in 43.2% of transplants (Table LU 19).

Complication rates in child lung transplant recipients increased with time posttransplant, including bronchiolitis obliterans syndrome (4.1% at 1 year and 26.0% at 5 years) (Table LU 20). For most surviving child lung transplant recipients (94.0%), 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 listed for lung transplant on December 31 of each year
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 sex
Figure LU 5. Distribution of candidates aged 12 years or older actively waiting for lung transplant by race
Figure LU 6. Distribution of candidates aged 12 years or older actively waiting for lung transplant by diagnosis group
Figure LU 7. Distribution of candidates aged 12 years or older actively waiting for lung transplant by waiting time
Figure LU 8. Distribution of candidates aged 12 years or older actively waiting for lung transplant by LAS at listing
Figure LU 9. Distribution of candidates aged 12 years or older actively waiting for lung transplant by height
Figure LU 10. Distribution of candidates aged 12 years or older actively waiting for lung transplant by blood type
Figure LU 11. Deceased donor lung transplant rates among waitlist candidates aged 12 years or older by age
Figure LU 12. Deceased donor lung transplant rates among waitlist candidates aged 12 years or older by race
Figure LU 13. Deceased donor lung transplant rates among waitlist candidates aged 12 years or older by diagnosis group
Figure LU 14. Deceased donor lung transplant rates among waitlist candidates aged 12 years or older by blood type
Figure LU 15. Deceased donor lung transplant rates among waitlist candidates aged 12 years or older by height
Figure LU 16. Deceased donor lung transplant rates among waitlist candidates aged 12 years or older by metropolitan vs. non-metropolitan residence
Figure LU 17. Deceased donor lung transplant rates among waitlist candidates aged 12 years or older by distance from listing center
Figure LU 18. Three-year outcomes for candidates aged 12 years or older waiting for lung transplant, new listings in 2015
Figure LU 19. Median months to lung transplant for waitlisted candidates aged 12 years or older, by diagnosis group
Figure LU 20. Median months to lung transplant for waitlisted candidates aged 12 years or older, by LAS at listing
Figure LU 21. Percentage of candidates aged 12 years or older who underwent deceased donor lung transplant within a given time period of listing
Figure LU 22. Percentage of candidates aged 12 years or older who underwent deceased donor lung transplant within 1 year of listing in 2017 by DSA
Figure LU 23. Percentage of candidates aged 12 years or older who underwent deceased donor lung transplant within 1 year of listing in 2017 by state
Figure LU 24. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by age
Figure LU 25. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by race
Figure LU 26. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by sex
Figure LU 27. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by diagnosis group
Figure LU 28. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by LAS
Figure LU 29. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by blood type
Figure LU 30. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by height
Figure LU 31. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by metropolitan vs. non-metropolitan residence
Figure LU 32. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant by distance from listing center
Figure LU 33. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung, by active/inactive status
Figure LU 34. Pretransplant mortality rates among candidates aged 12 years or older waitlisted for lung transplant in 2016-2018, by DSA
Figure LU 35. Deaths within six months after removal among lung waitlist candidates aged 12 years or older, by diagnosis
Figure LU 36. Deaths within six months after removal among lung waitlist candidates aged 12 years or older, by age at removal

Deceased donation

Figure LU 37. Deceased lung donor count by age
Figure LU 38. Distribution of deceased lung donors by age
Figure LU 39. Distribution of deceased lung donors by sex
Figure LU 40. Distribution of deceased lung donors by race
Figure LU 41. Percent of pediatric donor lungs allocated to adult recipients, by DSA of donor hospital, 2014-2018
Figure LU 42. Rates of lungs recovered for transplant and not transplanted by donor age
Figure LU 43. Rates of lungs recovered for transplant and not transplanted, by donor risk of disease transmission
Figure LU 44. Lung donors with a smoking history of 20 pack-years or more
Figure LU 45. Cause of death among deceased lung donors

Transplant

Figure LU 46. Total lung transplants
Figure LU 47. Total lung transplants by age
Figure LU 48. Total lung transplants by sex
Figure LU 49. Total lung transplants by race
Figure LU 50. Total lung transplants by diagnosis group
Figure LU 51. Total lung transplants by LAS
Figure LU 52. Total lung transplants by CPRA
Figure LU 53. Median LAS at transplant
Figure LU 54. Median LAS at transplant by diagnosis group
Figure LU 55. Percentage of transplants that were bilateral among lung recipients aged 12 years or older by diagnosis
Figure LU 56. Induction agent use in lung transplant recipients aged 12 years or older
Figure LU 57. Immunosuppression regimen use in transplant recipients aged 12 years or older
Figure LU 58. Total HLA A, B, and DR mismatches among deceased donor lung transplant recipients aged 12 years or older, 2014-2018
Figure LU 59. Annual adult lung transplant center volumes, by percentile
Figure LU 60. Distribution of adult lung transplants by annual center volume

Outcomes

Figure LU 61. Patient survival among lung transplant recipients aged 12 years or older, 2011-2013, by age
Figure LU 62. Patient survival among lung transplant recipients aged 12 years or older, 2011-2013, by race
Figure LU 63. Patient survival among lung transplant recipients aged 12 years or older, 2011-2013, by LAS
Figure LU 64. Patient survival among lung transplant recipients aged 12 years or older, 2011-2013, by transplant type
Figure LU 65. Patient survival among lung transplant recipients aged 12 years or older, 2011-2013, by diagnosis group
Figure LU 66. Patient survival among lung transplant recipients aged 12 years or older, 2011-2013, by diagnosis and transplant type
Figure LU 67. Patient survival among lung transplant recipients aged 12 years or older, 2011-2013, by metropolitan vs. non-metropolitan recipient residence
Figure LU 68. Patient survival among lung transplant recipients aged 12 years or older, 2011-2013, by recipients' distance from transplant center
Figure LU 69. Patient death among lung transplant recipients aged 12 years or older
Figure LU 70. Recipients alive with a functioning lung graft on June 30 of the year, by age at transplant
Figure LU 71. Incidence of acute rejection by 1 year posttransplant among lung transplant recipients aged 12 years or older by age, 2016-2017
Figure LU 72. Incidence of acute rejection by 1 year posttransplant among lung transplant recipients aged 12 years or older by induction agent 2016-2017
Figure LU 73. Incidence of acute rejection by 1 year posttransplant among lung transplant recipients aged 12 years or older by diagnosis group, 2016-2017
Figure LU 74. Incidence of PTLD among lung transplant recipients aged 12 years or older by recipient EBV status at transplant, 2012-2016
Figure LU 75. One-year cumulative incidence of death by cause among lung recipients aged 12 years or older, 2016-2017
Figure LU 76. Five-year cumulative incidence of death by cause among lung recipients aged 12 years or older, 2012-2013

Pediatric transplant

Figure LU 77. New candidates aged 0-11 years added to the lung transplant waiting list
Figure LU 78. Candidates aged 0-11 years waiting for lung transplant
Figure LU 79. Distribution of candidates aged 0-11 years actively waiting for lung transplant, by age
Figure LU 80. Distribution of candidates aged 0-11 years actively waiting for lung transplant by race
Figure LU 81. Distribution of candidates aged 0-11 years actively waiting for lung transplant by sex
Figure LU 82. Distribution of candidates aged 0-11 years actively waiting for lung transplant by waiting time
Figure LU 83. Three-year outcomes for newly listed candidates aged 0-11 years waiting for lung transplant, 2015
Figure LU 84. Deceased donor lung transplant rates among waitlist candidates aged 0-11 years, by age
Figure LU 85. Deceased donor lung transplant rates among waitlist candidates aged 0-11 years, by race
Figure LU 86. Pretransplant mortality rates among candidates aged 0-11 years waitlisted for lung transplant by age
Figure LU 87. Pretransplant mortality rates among candidates aged 0-11 years waitlisted for lung transplant by distance from listing center
Figure LU 88. Lung transplants, recipients aged 0-11 years by age
Figure LU 89. Number of centers performing pediatric and adult lung transplants by center's age mix
Figure LU 90. Induction agent use in lung transplant recipients aged 0-11 years
Figure LU 91. Immunosuppression regimen use in transplant recipients aged 0-11 years
Figure LU 92. Total HLA A, B, and DR mismatches among deceased donor lung transplant recipients aged 0-11 years, 2014-2018
Figure LU 93. Incidence of PTLD among lung transplant recipients aged 0-11 years by recipient EBV status at transplant, 2006-2016
Figure LU 94. Patient death among lung transplant recipients aged 0-11 years
Figure LU 95. Patient survival among lung transplant recipients aged 0-11 years, 2006-2013, by age
Figure LU 96. Patient survival among lung transplant recipients aged 0-11 years, 2006-2013, by diagnosis
Figure LU 97. One-year cumulative incidence of death by cause among lung transplant recipients aged 0-11 years, 2008-2017
Figure LU 98. Five-year cumulative incidence of death by cause among lung transplant recipients aged 0-11 years, 2008-2013

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, 2013, and December 31, 2018
Table LU 2. Clinical characteristics of candidates aged 12 years or older on the lung transplant waiting list on December 31, 2013, and December 31, 2018
Table LU 3. Listing characteristics of candidates aged 12 years or older on the lung transplant waiting list on December 31, 2013, and December 31, 2018
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, 2013 and 2018
Table LU 7. Clinical characteristics of lung transplant recipients aged 12 years or older, 2013 and 2018
Table LU 8. Transplant characteristics of lung transplant recipients aged 12 years or older, 2013 and 2018
Table LU 9. Donor-recipient serology matching among lung transplant recipients aged 12 years or older, 2016-2018

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, 2008 and December 31, 2018
Table LU 12. Clinical characteristics of candidates aged 0-11 years on the lung transplant waiting list on December 31, 2008 and December 31, 2018
Table LU 13. Listing characteristics of candidates aged 0-11 years on the lung transplant waiting list on December 31, 2008 and December 31, 2018
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, 2006-2008 and 2016-2018
Table LU 17. Clinical characteristics of lung transplant recipients aged 0-11 years, 2006-2008 and 2016-2018
Table LU 18. Transplant characteristics of lung transplant recipients aged 0-11 years, 2006-2008 and 2016-2018
Table LU 19. Donor-recipient serology matching among lung transplant recipients aged 0-11 years, 2016-2018
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 90.0% from 1611 candidates at 2007 to 3061 candidates at 2018; the inactive category decreases by 72.9% from 269 candidates at 2007 to 73 candidates at 2018; and the all category increases by 66.7% from 1880 candidates at 2007 to 3134 candidates at 2018.

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 listed for lung transplant on december 31 of each year; the active category increases by 21.3% from 994 candidates at 2007 to 1206 candidates at 2018; the inactive category decreases by 81.8% from 1173 candidates at 2007 to 213 candidates at 2018; and the all category decreases by 34.5% from 2167 candidates at 2007 to 1419 candidates at 2018.

Figure LU 2. Candidates aged 12 years or older listed for lung transplant on December 31 of each year
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 51.8% from 2.1 percent at 2007 to 1 percent at 2018; the 18 to 34 category decreases by 37.8% from 13.9 percent at 2007 to 8.7 percent at 2018; the 35 to 49 category decreases by 30.1% from 18.6 percent at 2007 to 13 percent at 2018; the 50 to 64 category decreases by 16.4% from 54.1 percent at 2007 to 45.2 percent at 2018; and the  greater than or equal to 65 category increases by 186.9% from 11.2 percent at 2007 to 32 percent at 2018.

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 sex; the male category is 48.4 percent at 2007 and remains relatively constant with a value of 52.7 percent at 2018; and the female category is 51.6 percent at 2007 and remains relatively constant with a value of 47.3 percent at 2018.

Figure LU 4. Distribution of candidates aged 12 years or older actively waiting for lung transplant by sex
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive patients 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 83.3 percent at 2007 and remains relatively constant with a value of 75.9 percent at 2018; the black category increases by 21.9% from 8.7 percent at 2007 to 10.6 percent at 2018; the hispanic category increases by 58.5% from 6.3 percent at 2007 to 9.9 percent at 2018; the asian category increases by 159.3% from 1.1 percent at 2007 to 2.8 percent at 2018; and the other/unknown category is 0.7 percent at 2007 and remains relatively constant with a value of 0.8 percent at 2018.

Figure LU 5. 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.