OPTN/SRTR 2019 Annual Data Report: Lung

Abstract

The number of lung transplants performed continues to increase annually and reached an all-time high in 2019, with decreasing waitlist mortality. These trends are attributable to an increasing number of candidates listed for transplant each year and a continuing increase in the number of donors. Despite these favorable trends, 6.4% of lungs recovered for transplant were not transplanted in 2019, and strategies to optimize use of these available organs may reduce the number of waitlist even further. Time to transplant continued to decrease, as over 50% of candidates waited 3 months or less in 2019, yet regional heterogeneity remained despite policy changes intended to improve allocation equity. Small gains continued in posttransplant survival, with 1-year survival at 88.8%; 3 year, 74.4%; 5 year, 59.2%, and 10 year, 33.1%.

Introduction

In 2019, the highest ever number of new candidates, 3243, were added to the US lung transplant waiting list (Figure LU 1), and 2759 lung transplants were performed (Figure LU 51). The rate of increase in lung transplants performed outpaced the rate of new candidates added, but the demand for transplant was not fully met. More transplants were performed due to ongoing scientific and policy efforts to increase the number of deceased lung donors, leading to a remarkable 62% donor increase over the past decade (Figure LU 39). The number of lung transplants performed in 2019 increased by 197, a 7.6% increase compared with the year prior, and a 52.3% increase over the past decade (Figure LU 51). With these trends came a decreasing waitlist mortality rate of 14.6% in 2019 (Figure LU 25), an important accomplishment given the increasingly older and sicker candidate population (Figure LU 57, LU 8). However, 316 candidates became too sick to undergo transplant or died while waiting (Table LU 5). Some small gains occurred in posttransplant survival, with 5-year death rates decreasing from 46.4% among recipients in 2008 to 40.8% among recipients in 2014 (Figure LU 65). Survival after lung transplant, however, remained the lowest of all solid organ transplants.

The US allocation system is monitored and adjusted by the Organ Procurement and Transplantation Network (OPTN), which implements policies to ensure equitable and timely access for lung transplant candidates. Currently, candidates aged 12 years or older access lung transplant based on their calculated lung allocation score (LAS), age, geography, 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 calculates transplant benefit by estimating waitlist and posttransplant mortality. Waitlist mortality contributes two-thirds of the score, reflecting the preference to prioritize candidates at high risk of death while waiting over likelihood of posttransplant survival. To calculate the LAS, pulmonary diseases are categorized by survival probability and disease pathophysiology into four main groups: group A, obstructive lung disease; group B, pulmonary vascular disease; group C, cystic fibrosis and immunodeficiency disorders; and group D, restrictive lung diseases.

Some trends highlighted in this report may reflect changes to the US allocation system. The LAS was implemented in 2005, changing allocation from a time-based to an urgency-based system and resulting in an increasing number of transplants for sicker candidates (Figure LU 57). The LAS was revised in February 2015 to reflect an updated cohort and add new variables to improve characterization of disease severity for candidates in group B; thus, LAS values after this change are not comparable to values in periods prior. OPTN implemented a broader geographic sharing policy in March 2017 for child (age 0-11 years) and adolescent (age 12-17 years) candidates. Adolescents additionally receive preferential access to adult donor lungs in the LAS system. Finally, geographic allocation policy was adapted in 2017 to change the first unit of allocation from the donation service area to a 250-nautical-mile radius from the donor hospital to decrease geographic inequity and ensure organ availability for the sickest candidates. The lung transplant system is the first solid organ transplant system in the US to undergo OPTN review toward the continuous distribution framework.

In this report, all lung transplant candidates and recipients aged 18 years or older are included under Adult Lung Transplant, and those aged < 18 years are included under Pediatric Lung Transplant. This is a change from prior reports, in which the cut-point separating pediatric and adult candidates was age 12 years, to mirror allocation policy. This change allows for a more accurate comparison between US and international data. Heart-lung candidates and recipients are included in all tabulations.

Adult Lung Transplantation in the US

Waiting List

Characteristics of adult candidates waiting for lung transplant

In 2019, 3243 new candidates were added to the lung transplant waiting list (Figure LU 1). Each listing in this report is counted as a candidate; therefore, a minority of candidates listed at multiple centers may be counted more than once. The majority of lung transplant candidates on the waiting list were aged 50-64 years, followed by those aged 65 years or older and 35-49 years; fewer than 10% of candidates were aged 34 years or younger (Figure LU 3). The proportion of candidates aged 65 years or older increased by 35.4% from 2015 to 2019 (Figure LU 3). The proportions of male and female candidates were similar (Figure LU 4). Most lung transplant candidates were white (73.1%), with increasing proportions of Black (11.5%), Hispanic (11.5%), and Asian (3.2%) candidates (Figure LU 5). The proportion of candidates in group D continued to increase yearly and represented 56.9% of the lung transplant waiting list in 2019 (Figure LU 6). The proportion of candidates in group A decreased to 27.7% of the waiting list, a 26% relative decrease since 2010 (Figure LU 6). Candidates with a LAS below 35 comprised 32.8% of the waiting list; 35-<40, 27.3%; 40-<50, 21%; 50-<60, 6.2; and ≥ 60, 12.6% (Figure LU 8). Candidates with ABO blood type A or O comprised 36.3% and 48.9% of the waiting list, respectively (Figure LU 10).

Outcome of adult candidates listed for lung transplant

Over 75% of candidates waiting in 2019 had been on the list less than 90 days (Figure LU 7). Transplant rates remained highest for candidates aged 65 years or older (Figure LU 13). Rates were highest for group D (263 transplants per 100 waitlist-years), followed by group C (202 per 100 waitlist-years), group A (114 per 100 waitlist-years), and group B (104 per 100 waitlist-years) (Figure LU 15). Rates were highest for recipients with type AB blood (314 transplants per 100 waitlist-years), similar for type A (215 per 100 waitlist-years) and B (202 per 100 waitlist-years), and lowest for type O (159 per 100 waitlist-years) (Figure LU 16). Height continued to affect transplant rates, evidenced by decreasing rates with decreasing height; rates were lowest for recipients less than 150 cm tall (Figure LU 17).

Among those listed in 2016, 60% of candidates underwent transplant by 6 months, and by 1 year, 70% (Figure LU 19). An additional 6% of candidates underwent transplant between waitlist years 1 and 2, and an additional 2% between years 2 and 3 (Figure LU 19). Median waiting times differed by diagnosis group; times were shortest for group D (1.7 months), followed by group C (2.1 months), and group A (4.0 months); times were longest for group B (6.2 months) (Figure LU 20). Median waiting time across diagnoses was 2.3 months. Median waiting times varied by LAS; 0.7 months for candidates with an LAS of 50-100, 1.5 months for 40-<50, 3.1 months for 35-<40 and 4.4 months for <35 (Figure LU 21). Percentages of adults undergoing lung transplant differed by state, with ranges between 30%-100%; however, these values are likely affected by the denominator of patients listed by state (Figure LU 24). Overall waitlist mortality continued to improve, despite differences by age, diagnosis group, LAS, and blood type. Mortality rates were highest for candidates aged 65 or older (21.9 deaths per 100 waitlist-years), and increased with increasing age (Figure LU 26). Mortality rates were highest for candidates in group D (24.9 deaths per 100 waitlist-years) and lowest for candidates in group A (4.8 deaths per 100 waitlist-years) (Figure LU 29). Mortality rates differed considerably for candidates with an LAS of 60 or higher and those with an LAS below 60 (Figure LU 30). Mortality rates were highest for candidates in blood group AB in 2018 and 2019 compared with rates for other blood groups (43.4 vs. 12.3-14.8 deaths per 100 waitlist-years) (Figure LU 31). Waitlist mortality was slightly higher for candidates shorter than 150 cm, but this trend has varied by year (Figure LU 32). In 2019, 32.4% of candidates died within 6 months after removal from the waiting list; most deaths occurred in group D candidates and those aged 65 years or older (Figure LU 36, Figure LU 37, Figure LU 38).

Donors

Of the 2755 deceased lung donors in 2019, 196 (7.1%) were aged younger than 18 years, 869 (31.5%) 18-29 years, 644 (23.4%) 30-39 years, 716 (26.0%) 40-54 years, and 330 (12.0%) 55 years or older (Figure LU 40, Figure LU 41); 40% of donors were female (Figure LU 42), 16.5% Black, 16% Hispanic, and 3.7% Asian (Figure LU 43). Deceased donor counts increased in 2019, reflecting data on all donors whose lungs were recovered. In 2019, 6.4% of lungs recovered for transplant were not transplanted, most frequently from donors with anoxia as the cause of death (Figure LU 45, Figure LU 47). Discard rates were similar for increased-risk and standard-risk donors (Figure LU 48). The proportion of donors with a smoking history of 20 pack-years or longer remained stable at 8% (Figure LU 49). The proportion of transplants from donation after circulatory death donors increased in the past 5 years, from 2.3% in 2014 to 5.7% in 2019 (Table LU 8).

Transplant

Characteristics of adult lung transplant recipients

In 2019, 2759 total lung transplants were performed (including adults and pediatric populations), 75.5% bilateral, and only 3.3% were re-transplants (Figure LU 51, Figure LU 52, Table LU 8). By age, in decreasing order, numbers of transplants were: 50-64 years, 1177; 65 years or older, 963; 35-49 years, 337; 18-34 years, 230, and younger than 18 years, 52 (Figure LU 53). Male recipients underwent 1659 transplants (60%) and female recipients 1100 (40%) (Figure LU 54). Numbers of transplants continued to increase for group D candidates and remained stable for other diagnosis groups (Figure LU 56). In 2019, adult candidates in group A underwent 619 transplants; group B, 149; group C, 220; and group D, 1719 (Table LU 7). The number of transplants in candidates with an LAS of 60 or higher increased over time and in 2019 outpaced increases for candidates with lower LAS values (Figure LU 57). Median LAS differed by diagnosis group: 47.3 in group B, 46.3 in group D, 45.0 in group C, and 33.7 in group A (Figure LU 59). Candidates hospitalized in the intensive care unit (ICU) comprised 16.5% of transplant recipients; 10.3% were hospitalized but not in the ICU, trends that have remained stable over the past 5 years. Candidates continued to be bridged to transplant; 3.3% required mechanical ventilation and extracorporeal membrane oxygenation (ECMO), 2.3% mechanical ventilation only, and 4.0% ECMO only (Table LU 7). Transplant recipient payer services changed over the past 5 years; 51% had private insurance in 2014 and 41.4% in 2019 (Table LU 6). Nearly 50% of transplant recipients lived within 50 miles of their transplant center and only 10.8% 250 or more miles away (Table LU 6).

There are 64 adult lung transplant centers in the US (Figure LU 91). Median transplant center volume for 2019 was 31 lung transplants; the 75th and 95th percentiles were 47 and 118 transplants, respectively (Figure LU 63). Centers performing 101 or more transplants accounted for 22.8% of transplant volume; 41-100, 47.3%; 11-40, 28.2%; and 1-10 1.7% (Figure LU 64).

Outcomes of adult lung transplant recipients

Across all recipients, 1-year survival was 88.8%; 3 year, 74.4%; 5 year, 59.2%, and 10 year, 33.1% (Figure LU 65). Five-year survival differed by age, and was lowest for recipients aged 65 years or older, followed by those aged 18-34, 50-64, and 35-49 years (Figure LU 66). Survival also differed by race, and was lowest for Black recipients after the first year compared with other racial groups (Figure LU 67). Survival did not meaningfully differ by sex (Figure LU 71). Survival varied by LAS, a finding more pronounced with longer time from transplant; however, the difference was only 8.9% between those with the highest 5-year survival (LAS 35-<40) and those with the lowest (LAS 50-<60) (Figure LU 68). Survival was overall higher for recipients of bilateral than for recipients of single lung transplant, a finding likely affected by selection of candidates (Figure LU 69). Interestingly, survival rates were similar over the first 2 years but began to diverge between years 2 and 3. Survival differed by diagnosis group, and was lower for groups B and D than for groups A and C (Figure LU 70).

Induction agents were used commonly; 78% of recipients received induction therapy (Figure LU 60). Acute rejection occurred commonly, in 16% of recipients in the first year, with higher rates for recipients aged 18-49 years than for those aged 50 years or older (Figure LU 74). Incidence of acute rejection within 1 year was highest for recipients who received T-cell depleting agents (18.9%) compared with those who received no induction (17.8%); incidence was lowest for those who received IL2-receptor antagonists (15.1%) (Figure LU 75). This may reflect differences in the population driving the choice for induction agents. Posttransplant lymphoproliferative disorder (PTLD) occurred in 1.7% of recipients by 5 years; incidence was highest in recipients who were Epstein-Barre virus (EBV) negative at the time of transplant (7.6%) (Figure LU 76).

Bronchiolitis obliterans was common after transplant, with incidence of 7.1% at 1 year and 43% by 5 years. Chronic kidney disease with a creatinine above 2.5 mg/dl occurred in 4.3% of recipients by 1 year and in 13.4% by 5 years, but only 3.1% required maintenance dialysis. Malignancy occurred in 3.7% of recipients by 1 year, but is prevalent, occurring in 24.1% by 5 years. The majority of recipients reported unencumbered functional status and only 1.7% required total assistance (Table LU 9).

Pediatric Lung Transplant in the US

Waiting List

In 2019, 72 new pediatric candidates (aged < 18 years) were added to the lung transplant waiting list (Figure LU 77). The number of period-prevalent pediatric candidates (i.e., on the waiting list during a given year) steadily decreased from a peak of 295 in 2009 to 114 in 2019 (Figure LU 78). The largest age group of pediatric candidates on the waiting list in 2019 was 12-17 years (58.8%) followed by 1-5 years (16.7%), 6-11 years (14.9%), and younger than 1 year, 9.6% (Figure LU 79). Most pediatric lung transplant candidates were white (71.9%), followed by Hispanic (16.7%), and Black (8.8%) (Figure LU 80). The majority (74.6%) of pediatric candidates on the waiting list in 2019 had been on the list less than 90 days (Figure LU 82).

Of 84 candidates removed from the waiting list in 2019, 56 (66.7%) were removed due to undergoing transplant, 9 (10.7%) due to death, 5 (6.0%) due to improved condition, and 5 (6.0%) due to becoming too sick to undergo transplant (Table LU 13, Table LU 14). Among child lung transplant candidates listed in 2016, 60.3% underwent deceased donor transplant within 3 years, 16.1% died waiting, 21.4% were removed from the list for reasons other than transplant or death, and 2.2% were still waiting (Figure LU 83). The overall pediatric lung transplant rate rose dramatically in 2013 and increased to the highest rate of 150.3 transplants per 100 waitlist-years in 2019 (Figure LU 84). Transplant rates in 2019 varied with age and were highest for candidates aged 12-17 tears (232.7 per 100 waitlist years), followed by candidates aged less than 1 year (154.7 per 100 waitlist years, n=11), lowest for candidates aged 1-5 years (n = 19), 55.0 per 100 waitlist-years (Figure LU 85). Waitlist mortality increased over the past decade for all pediatric age groups, although the pattern for candidates aged younger than 1 year was unclear due to the small number of candidates (Figure LU 88). In 2019, the waitlist mortality rate ranged from 17.8 deaths per 100 waitlist-years among candidates aged 1-5 years to 34.3 among candidates aged younger than 1 year (Figure LU 88).

Transplant

Characteristics of pediatric lung transplant recipients

In 2019, a total of 52 lung transplants were performed in pediatric recipients aged 0-17 years, four in those aged younger than 1 year, five in those aged 1-5 years, five in those aged 6-10 years, and 38 in those aged 11-17 years (Figure LU 90). In 2019, seven programs were characterized as pediatric only, compared with 53 adult-only programs (Figure LU 91). Over the past decade, cystic fibrosis remained the leading indication for pediatric lung transplant (Table LU 16). More than half of pediatric lung transplant recipients in 2017-2019 were not hospitalized at the time of transplant (Figure LU 16). ECMO use increased to 8.8% in 2017-2019 from 1.2% a decade ago (Figure LU 16). Time to transplant became shorter; wait times for 40.1% of recipients in 2017-2019 were shorter than 31 days, compared with 18.7% in 2007-2009 (Table LU 17). Use of induction therapy changed over time, and 90.4% reported some induction use in 2019 (Figure LU 92). The most common initial immunosuppression regimen was tacrolimus, mycophenolate, and steroids, used in 86.5% of pediatric recipients (Figure LU 93). Among child lung transplant recipients in 2017-2019, the combination of a cytomegalovirus (CMV)-positive donor and CMV-negative recipient occurred in 35.8% of transplants; this combination for EBV occurred in 35.0% of transplants (Table LU 18).

Outcomes of pediatric lung transplant recipients

Across all pediatric recipients who underwent transplant in 2012-2014, overall 1-, 3-, and 5-year patient survival was 87.0%, 63.0%, and 55.2%, respectively (Figure LU 97). Incidence of death was 5.0% at 6 months and 12.5% at 1 year for transplants in 2018, 30.8% at 3 years for transplants in 2016, 47.1% at 5 years for transplants in 2014, and 64.6% at 10 years for transplants in 2009 (Figure LU 96). The incidence of PTLD among EBV-negative recipients who underwent transplant in 2007-2017 was 10.3% at 5 years posttransplant, compared with 1.1% among EBV-positive recipients (Figure LU 95). Complication rates in child lung transplant recipients increased with time posttransplant, including bronchiolitis obliterans syndrome (2.1% at 1 year and 32.0% at 5 years) (Table LU 19). For most surviving child lung transplant recipients (90.3%), functional status was reported as fully active at 5 years posttransplant.

Figure List

Waiting list

Figure LU 1. New candidates added to the lung transplant waiting list
Figure LU 2. All adult candidates on the lung transplant waiting list
Figure LU 3. Distribution of adults waiting for lung transplant by age
Figure LU 4. Distribution of adults waiting for lung transplant by sex
Figure LU 5. Distribution of adults waiting for lung transplant by race
Figure LU 6. Distribution of adults waiting for lung transplant by diagnosis
Figure LU 7. Distribution of adults waiting for lung transplant by waiting time
Figure LU 8. Distribution of adult candidates waiting for lung transplant by LAS
Figure LU 9. Distribution of adult candidates waiting for lung transplant by height
Figure LU 10. Distribution of adults waiting for lung transplant by blood type
Figure LU 11. Distribution of adults waiting for lung transplant by prior transplant status
Figure LU 12. Overall deceased donor lung transplant rates among adult waitlist candidates
Figure LU 13. Deceased donor lung transplant rates among adult waitlist candidates by age
Figure LU 14. Deceased donor lung transplant rates among adult waitlist candidates by race
Figure LU 15. Deceased donor lung transplant rates among adult waitlist candidates by diagnosis
Figure LU 16. Deceased donor lung transplant rates among adult waitlist candidates by blood type
Figure LU 17. Deceased donor lung transplant rates among adult waitlist candidates by height
Figure LU 18. Deceased donor lung transplant rates among adult waitlist candidates by metropolitan vs. non-metropolitan residence
Figure LU 19. Three-year outcomes for adults waiting for lung transplant, new listings in 2016
Figure LU 20. Median months to lung transplant for waitlisted adults
Figure LU 21. Median months to lung transplant for waitlisted adults by LAS at listing
Figure LU 22. Percentage of adults who underwent deceased donor lung transplant within a given time period of listing
Figure LU 23. Percentage of adults who underwent deceased donor lung transplant within 1 year of listing, 2018, by DSA
Figure LU 24. Percentage of adults who underwent deceased donor lung transplant within 1 year of listing, 2018, by state
Figure LU 25. Overall pretransplant mortality rates among adults waitlisted for lung transplant
Figure LU 26. Pretransplant mortality rates among adults waitlisted for lung transplant by age
Figure LU 27. Pretransplant mortality rates among adults waitlisted for lung transplant by race
Figure LU 28. Pretransplant mortality rates among adults waitlisted for lung transplant by sex
Figure LU 29. Pretransplant mortality rates among adults waitlisted for lung transplant by diagnosis
Figure LU 30. Pretransplant mortality rates among adults waitlisted for lung transplant by LAS
Figure LU 31. Pretransplant mortality rates among adults waitlisted for lung transplant by blood type
Figure LU 32. Pretransplant mortality rates among adults waitlisted for lung transplant by height
Figure LU 33. Pretransplant mortality rates among adults waitlisted for lung transplant by metropolitan vs. non-metropolitan residence
Figure LU 34. Pretransplant mortality rates among adults waitlisted for lung transplant, by active/inactive status
Figure LU 35. Pretransplant mortality rates among adults waitlisted for lung transplant in 2019 by DSA
Figure LU 36. Deaths within six months after removal among adult lung waitlist candidates, overall
Figure LU 37. Deaths within six months after removal among adult lung waitlist candidates, by diagnosis
Figure LU 38. Deaths within six months after removal among adult lung waitlist candidates, by age

Deceased donation

Figure LU 39. Overall deceased lung donor count
Figure LU 40. Deceased lung donor count by age
Figure LU 41. Distribution of deceased lung donors by age
Figure LU 42. Distribution of deceased lung donors by sex
Figure LU 43. Distribution of deceased lung donors by race
Figure LU 44. Percent of pediatric donor lungs allocated to adult recipients, by DSA of donor hospital, 2015-2019
Figure LU 45. Overall rates of lungs recovered for transplant and not transplanted
Figure LU 46. Rates of lungs recovered for transplant and not transplanted by donor age
Figure LU 47. Rates of lungs recovered for transplant and not transplanted by donor cause of death
Figure LU 48. Rates of lungs recovered for transplant and not transplanted, by donor risk of disease transmission
Figure LU 49. Lung donors with a smoking history of 20 pack-years or more
Figure LU 50. Cause of death among deceased lung donors

Transplant

Figure LU 51. Overall lung transplants
Figure LU 52. Total lung transplants by procedure type
Figure LU 53. Total lung transplants by age
Figure LU 54. Total lung transplants by sex
Figure LU 55. Total lung transplants by race
Figure LU 56. Total lung transplants by diagnosis
Figure LU 57. Total lung transplants by LAS
Figure LU 58. Percentiles of LAS at transplant
Figure LU 59. Median LAS at transplant by diagnosis group
Figure LU 60. Induction agent use in adult lung transplant recipients
Figure LU 61. Immunosuppression regimen use in adult lung transplant recipients
Figure LU 62. Total HLA A, B, and DR mismatches among deceased donor lung transplant recipients aged 18 years or older, 2015-2019
Figure LU 63. Annual adult lung transplant center volumes by percentile
Figure LU 64. Distribution of adult lung transplants by annual center volume

Outcomes

Figure LU 65. Patient death among adult lung transplant recipients
Figure LU 66. Patient survival among adult lung transplant recipients, 2012-2014, by age
Figure LU 67. Patient survival among adult lung transplant recipients, 2012-2014, by race
Figure LU 68. Patient survival among adult lung transplant recipients, 2012-2014, by LAS
Figure LU 69. Patient survival among adult lung transplant recipients, 2012-2014, by transplant type
Figure LU 70. Patient survival among adult lung transplant recipients, 2012-2014, by diagnosis group
Figure LU 71. Patient survival among adult lung transplant recipients, 2012-2014, by sex
Figure LU 72. Patient survival among adult lung transplant recipients, 2012-2014, by metropolitan vs. non-metropolitan recipient residence
Figure LU 73. Recipients alive with a functioning lung graft on June 30 of the year, by age at transplant
Figure LU 74. Incidence of acute rejection by 1 year posttransplant among adult lung transplant recipients by age, 2017-2018
Figure LU 75. Incidence of acute rejection by 1 year posttransplant among adult lung transplant recipients by induction agent, 2017-2018
Figure LU 76. Incidence of PTLD among adult lung transplant recipients by recipient EBV status at transplant, 2013-2017

Pediatric transplant

Figure LU 77. New pediatric candidates added to the lung transplant waiting list
Figure LU 78. All pediatric candidates on the lung transplant waiting list
Figure LU 79. Distribution of pediatric candidates waiting for lung transplant by age
Figure LU 80. Distribution of pediatric candidates waiting for lung transplant by race
Figure LU 81. Distribution of pediatric candidates waiting for lung transplant by sex
Figure LU 82. Distribution of pediatric candidates waiting for lung transplant by waiting time
Figure LU 83. Three-year outcomes for newly listed pediatric candidates waiting for lung transplant, 2016
Figure LU 84. Overall deceased donor lung transplant rates among pediatric waitlist candidates
Figure LU 85. Deceased donor lung transplant rates among pediatric waitlist candidates by age
Figure LU 86. Deceased donor lung transplant rates among pediatric waitlist candidates by race
Figure LU 87. Overall pretransplant mortality rates among pediatric candidates waitlisted for lung
Figure LU 88. Pretransplant mortality rates among pediatric candidates waitlisted for lung transplant by age
Figure LU 89. Overall pediatric lung transplants
Figure LU 90. Pediatric lung transplants by recipient age
Figure LU 91. Number of centers performing pediatric and adult lung transplants by center's age mix
Figure LU 92. Induction agent use in pediatric lung transplant recipients
Figure LU 93. Immunosuppression regimen use in pediatric lung transplant recipients
Figure LU 94. Total HLA A, B, and DR mismatches among pediatric deceased donor lung transplant recipients, 2015-2019
Figure LU 95. Incidence of PTLD among pediatric lung transplant recipients by recipient EBV status at transplant, 2007-2017
Figure LU 96. Patient death among pediatric lung transplant recipients
Figure LU 97. Overall patient survival among pediatric deceased donor lung transplant recipients, 2012-2014

Table List

Waiting list

Table LU 1. Demographic characteristics of adults on the lung transplant waiting list on December 31, 2014 and December 31, 2019
Table LU 2. Clinical characteristics of adults on the lung transplant waiting list on December 31, 2014 and December 31, 2019
Table LU 3. Listing characteristics of adults on the lung transplant waiting list on December 31, 2014 and December 31, 2019
Table LU 4. Lung transplant waitlist activity among adults
Table LU 5. Removal reason among lung transplant candidats aged 18 years or older

Transplant

Table LU 6. Demographic characteristics of adult lung transplant recipients, 2014 and 2019
Table LU 7. Clinical characteristics of adult lung transplant recipients, 2014 and 2019
Table LU 8. Transplant characteristics of adult lung transplant recipients, 2014 and 2019

Outcomes

Table LU 9. Posttransplant events among lung transplant recipients aged 18 years or older

Pediatric transplant

Table LU 10. Demographic characteristics of pediatric candidates on the lung transplant waiting list on December 31, 2009 and December 31, 2019
Table LU 11. Clinical characteristics of pediatric candidates on the lung transplant waiting list on December 31, 2009 and December 31, 2019
Table LU 12. Listing characteristics of pediatric candidates on the lung transplant waiting list on December 31, 2009 and December 31, 2019
Table LU 13. Lung transplant waitlist activity among pediatric candidates
Table LU 14. Removal reason among pediatric lung transplant candidates
Table LU 15. Demographic characteristics of pediatric lung transplant recipients, 2007-2009 and 2017-2019
Table LU 16. Clinical characteristics of pediatric lung transplant recipients, 2007-2009 and 2017-2019
Table LU 17. Transplant characteristics of pediatric lung transplant recipients, 2007-2009 and 2017-2019
Table LU 18. Pediatric lung donor-recipient serology matching, 2017-2019
Table LU 19. Posttransplant events among lung transplant recipients aged 0-17 years

Table LU 1. Demographic characteristics of adults on the lung transplant waiting list on December 31, 2014 and December 31, 2019
Candidates waiting for transplant on December 31 of the given year, regardless of first listing date. Distance is computed from candidate's home zip code to the transplant center.

Characteristic	2014, N	2014, Percent	2019, N	2019, Percent
Age: 18-34 years	183	10.9%	100	7.0%
Age: 35-49 years	270	16.0%	203	14.3%
Age: 50-64 years	869	51.6%	675	47.4%
Age: ≥ 65 years	361	21.4%	445	31.3%
Sex: Female	1007	59.8%	859	60.4%
Sex: Male	676	40.2%	564	39.6%
Race/ethnicity: White	1336	79.4%	987	69.4%
Race/ethnicity: Black	171	10.2%	186	13.1%
Race/ethnicity: Hispanic	116	6.9%	185	13.0%
Race/ethnicity: Asian	47	2.8%	51	3.6%
Race/ethnicity: Other/unknown	13	0.8%	14	1.0%
Geography: Metropolitan	1391	82.7%	1199	84.3%
Geography: Non-metro	292	17.3%	224	15.7%
Distance: < 50 miles	750	44.6%	763	53.6%
Distance: 50-<100 miles	330	19.6%	264	18.6%
Distance: 100-<150 miles	191	11.3%	128	9.0%
Distance: 150-<250 miles	205	12.2%	132	9.3%
Distance: ≥ 250 miles	198	11.8%	130	9.1%
Distance: Unknown	9	0.5%	6	0.4%
Height: < 150 cm	59	3.5%	58	4.1%
Height: 150-< 160 cm	378	22.5%	342	24.0%
Height: 160-< 170 cm	613	36.4%	485	34.1%
Height: 170-< 180 cm	461	27.4%	381	26.8%
Height: ≥ 180 cm	171	10.2%	155	10.9%
Height: Unknown	1	0.1%	2	0.1%
All candidates	1683	100.0%	1423	100.0%

Table LU 2. Clinical characteristics of adults on the lung transplant waiting list on December 31, 2014 and December 31, 2019
Candidates waiting for transplant on December 31 of the given year, regardless of first listing date. All candidates with unknown LAS in are inactive.

Characteristic	2014, N	2014, Percent	2019, N	2019, Percent
Diagnosis group: A	737	43.8%	532	37.4%
Diagnosis group: B	130	7.7%	158	11.1%
Diagnosis group: C	171	10.2%	102	7.2%
Diagnosis group: D	645	38.3%	631	44.3%
LAS: < 30	40	2.4%	61	4.3%
LAS: 30-< 35	796	47.3%	549	38.6%
LAS: 35-< 40	396	23.5%	421	29.6%
LAS: 40-< 50	275	16.3%	268	18.8%
LAS: 50-< 60	84	5.0%	53	3.7%
LAS: ≥ 60	76	4.5%	71	5.0%
LAS: Unknown	16	1.0%	0	0.0%
Blood type: A	671	39.9%	453	31.8%
Blood type: B	156	9.3%	143	10.0%
Blood type: AB	50	3.0%	31	2.2%
Blood type: O	806	47.9%	796	55.9%
All candidates	1683	100.0%	1423	100.0%

Table LU 3. Listing characteristics of adults on the lung transplant waiting list on December 31, 2014 and December 31, 2019
Candidates waiting for transplant on December 31 of the given year, regardless of first listing date.

Characteristic	2014, N	2014, Percent	2019, N	2019, Percent
Wait time: < 31 days	199	11.8%	189	13.3%
Wait time: 31-60 days	125	7.4%	150	10.5%
Wait time: 61-90 days	107	6.4%	121	8.5%
Wait time: 3-< 6 months	249	14.8%	247	17.4%
Wait time: 6-< 12 months	300	17.8%	261	18.3%
Wait time: 1-< 2 years	335	19.9%	271	19.0%
Wait time: 2-< 3 years	133	7.9%	84	5.9%
Wait time: ≥ 3 years	235	14.0%	100	7.0%
Waitlist status: Active	1370	81.4%	1137	79.9%
Waitlist status: Inactive	313	18.6%	256	18.0%
Waitlist status: Unknown	0	0.0%	30	2.1%
Transplant history: First	1639	97.4%	1392	97.8%
Transplant history: Retransplant	44	2.6%	31	2.2%
Tx type: Lung only	1614	95.9%	1324	93.0%
Tx type: Heart-lung	58	3.4%	74	5.2%
Tx type: Other	11	0.7%	25	1.8%
All candidates	1683	100.0%	1423	100.0%

Table LU 4. Lung transplant waitlist activity among adults
Candidates listed at more than one center are counted once per listing. 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	2017	2018	2019
Patients at start of year	1424	1382	1442
Patients added during year	2982	3200	3244
Patients removed during year	3017	3131	3263
Patients at end of year	1389	1451	1423

Table LU 5. Removal reason among lung transplant candidats aged 18 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	2017	2018	2019
Deceased donor transplant	2423	2515	2692
Living donor transplant	0	0	0
Patient died	228	236	173
Patient refused transplant	11	22	11
Improved, transplant not needed	42	48	41
Too sick for transplant	121	139	143
Other	192	171	203

Table LU 6. Demographic characteristics of adult lung transplant recipients, 2014 and 2019
Lung transplant recipients, including retransplants. Distance is computed from recipient's home zip code to the transplant center.

Characteristic	2014, N	2014, Percent	2019, N	2019, Percent
Age: 18-34 years	200	10.5%	230	8.5%
Age: 35-49 years	238	12.5%	337	12.4%
Age: 50-64 years	906	47.7%	1177	43.5%
Age: ≥ 65 years	554	29.2%	963	35.6%
Sex: Female	731	38.5%	1073	39.6%
Sex: Male	1167	61.5%	1634	60.4%
Race/ethnicity: White	1561	82.2%	2070	76.5%
Race/ethnicity: Black	156	8.2%	265	9.8%
Race/ethnicity: Hispanic	131	6.9%	286	10.6%
Race/ethnicity: Asian	41	2.2%	70	2.6%
Race/ethnicity: Other/unknown	9	0.5%	16	0.6%
Height: < 150 cm	38	2.0%	56	2.1%
Height: 150-< 160 cm	222	11.7%	382	14.1%
Height: 160-< 170 cm	578	30.5%	809	29.9%
Height: 170-< 180 cm	668	35.2%	949	35.1%
Height: ≥ 180 cm	387	20.4%	507	18.7%
Height: Unknown	5	0.3%	4	0.1%
Insurance: Private	968	51.0%	1120	41.4%
Insurance: Medicare	751	39.6%	1252	46.3%
Insurance: Other government	158	8.3%	290	10.7%
Insurance: Unknown	21	1.1%	45	1.7%
Geography: Metropolitan	1556	82.0%	2239	82.7%
Geography: Non-metro	342	18.0%	468	17.3%
Distance: < 50 miles	930	49.0%	1313	48.5%
Distance: 50-<100 miles	298	15.7%	502	18.5%
Distance: 100-<150 miles	196	10.3%	270	10.0%
Distance: 150-<250 miles	210	11.1%	287	10.6%
Distance: ≥ 250 miles	238	12.5%	292	10.8%
Distance: Unknown	26	1.4%	43	1.6%
All recipients	1898	100.0%	2707	100.0%

Table LU 7. Clinical characteristics of adult lung transplant recipients, 2014 and 2019
Lung transplant recipients, including retransplants. ECMO, extracorporeal membrane oxygenation.

Characteristic	2014, N	2014, Percent	2019, N	2019, Percent
Diagnosis group: A	458	24.1%	619	22.9%
Diagnosis group: B	53	2.8%	149	5.5%
Diagnosis group: C	202	10.6%	220	8.1%
Diagnosis group: D	1185	62.4%	1719	63.5%
Blood type: A	751	39.6%	1068	39.5%
Blood type: B	220	11.6%	324	12.0%
Blood type: AB	79	4.2%	105	3.9%
Blood type: O	848	44.7%	1210	44.7%
Medical condition: Hospitalized in ICU	303	16.0%	447	16.5%
Medical condition: Hospitalized, not ICU	196	10.3%	278	10.3%
Medical condition: Not hospitalized	1399	73.7%	1977	73.0%
Medical condition: Hospitalization unknown	0	0.0%	5	0.2%
LAS: < 30	4	0.2%	3	0.1%
LAS: 30-< 35	371	19.5%	582	21.5%
LAS: 35-< 40	336	17.7%	565	20.9%
LAS: 40-< 50	451	23.8%	629	23.2%
LAS: 50-< 60	236	12.4%	250	9.2%
LAS: ≥ 60	500	26.3%	678	25.0%
Vent/ECMO at transplant: Vent + ECMO	66	3.5%	88	3.3%
Vent/ECMO at transplant: Vent only	75	4.0%	63	2.3%
Vent/ECMO at transplant: ECMO only	44	2.3%	108	4.0%
Vent/ECMO at transplant: Neither	1713	90.3%	2448	90.4%
All recipients	1898	100.0%	2707	100.0%

Table LU 8. Transplant characteristics of adult lung transplant recipients, 2014 and 2019
Lung transplant recipients, including retransplants. DBD, donation after brain death; DCD, donation after circulatory death.

Characteristic	2014, N	2014, Percent	2019, N	2019, Percent
Wait time: < 31 days	647	34.1%	1106	40.9%
Wait time: 31-60 days	298	15.7%	419	15.5%
Wait time: 61-90 days	190	10.0%	259	9.6%
Wait time: 3-< 6 months	297	15.6%	373	13.8%
Wait time: 6-< 12 months	232	12.2%	290	10.7%
Wait time: ≥ 1 year	234	12.3%	260	9.6%
Procedure: Lobar	2	0.1%	0	0.0%
Procedure: Single	611	32.2%	676	25.0%
Procedure: Bilateral	1285	67.7%	2031	75.0%
Donor type: DBD	1855	97.7%	2552	94.3%
Donor type: DCD	43	2.3%	155	5.7%
Transplant history: First	1816	95.7%	2618	96.7%
Transplant history: Retransplant	82	4.3%	89	3.3%
Tx type: Lung only	1870	98.5%	2638	97.5%
Tx type: Heart-lung	17	0.9%	42	1.6%
Tx type: Other	11	0.6%	27	1.0%
All recipients	1898	100.0%	2707	100.0%

Table LU 9. Posttransplant events among lung transplant recipients aged 18 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 2016-2018 and 5-year events for recipients in 2012-2014. Recipients of more than one transplant are counted separately per transplant.

Event	One-year, N	One-year, Pct	Five-year, N	Five-year, Pct
BOS: None reported	5744	90.0%	1774	56.9%
BOS: Reported	456	7.1%	1342	43.0%
BOS: Unknown	185	2.9%	2	0.1%
Creatinine > 2.5 mg/dl	272	4.3%	418	13.4%
Chronic dialysis	113	1.8%	98	3.1%
Renal transplant	8	0.1%	24	0.8%
Diabetes	508	8.0%	467	15.0%
Malignancy	234	3.7%	752	24.1%
Re-hospitalization	3220	50.4%	2434	78.1%
Functional status: No assistance needed	5101	79.9%	2522	80.9%
Functional status: Some assistance needed	423	6.6%	205	6.6%
Functional status: Total assistance needed	128	2.0%	54	1.7%
Functional status: Unknown	733	11.5%	337	10.8%
All recipients	6385	100.0%	3118	100.0%

Table LU 10. Demographic characteristics of pediatric candidates on the lung transplant waiting list on December 31, 2009 and December 31, 2019
Candidates aged younger than 18 years waiting for transplant on December 31 of given year, regardless of first listing date. Age calculated at snapshot. Candidates listed as children who turned 18 before the cohort date are excluded. Distance is computed from candidate's home zip code to the transplant center.

Characteristic	2009, N	2009, Percent	2019, N	2019, Percent
Age: < 1 year	3	1.9%	1	3.3%
Age: 1-5 years	19	11.8%	5	16.7%
Age: 6-11 years	26	16.1%	7	23.3%
Age: ≥ 12 years	72	44.7%	12	40.0%
Age: Unknown	41	25.5%	5	16.7%
Sex: Female	85	52.8%	15	50.0%
Sex: Male	76	47.2%	15	50.0%
Race/ethnicity: White	125	77.6%	20	66.7%
Race/ethnicity: Black	14	8.7%	1	3.3%
Race/ethnicity: Hispanic	18	11.2%	7	23.3%
Race/ethnicity: Asian	2	1.2%	2	6.7%
Race/ethnicity: Other/unknown	2	1.2%	0	0.0%
Geography: Metropolitan	125	77.6%	22	73.3%
Geography: Non-metro	36	22.4%	8	26.7%
Distance: < 50 miles	33	20.5%	11	36.7%
Distance: 50-<100 miles	21	13.0%	1	3.3%
Distance: 100-<150 miles	18	11.2%	5	16.7%
Distance: 150-<250 miles	31	19.3%	9	30.0%
Distance: ≥ 250 miles	57	35.4%	4	13.3%
Distance: Unknown	1	0.6%	0	0.0%
Height: < 70 cm	8	5.0%	3	10.0%
Height: 70-< 90 cm	19	11.8%	3	10.0%
Height: 90-< 110 cm	13	8.1%	3	10.0%
Height: 110-< 130 cm	25	15.5%	5	16.7%
Height: ≥ 130 cm	95	59.0%	16	53.3%
Height: Unknown	1	0.6%	0	0.0%
All candidates	161	100.0%	30	100.0%

Table LU 11. Clinical characteristics of pediatric candidates on the lung transplant waiting list on December 31, 2009 and December 31, 2019
Candidates aged younger than 18 years waiting for transplant on December 31 of the given year, regardless of first listing date. Candidates listed as before age 18 who turned 18 before the cohort date are excluded.

Characteristic	2009, N	2009, Percent	2019, N	2019, Percent
Diagnosis: Cystic fibrosis	55	34.2%	13	43.3%
Diagnosis: Pulmonary hypertension	54	33.5%	2	6.7%
Diagnosis: Pulmonary fibrosis	12	7.5%	0	0.0%
Diagnosis: Other vascular	3	1.9%	6	20.0%
Diagnosis: Other/unknown	37	23.0%	9	30.0%
Blood type: A	57	35.4%	13	43.3%
Blood type: B	23	14.3%	5	16.7%
Blood type: AB	2	1.2%	1	3.3%
Blood type: O	79	49.1%	11	36.7%
All candidates	161	100.0%	30	100.0%

Table LU 12. Listing characteristics of pediatric candidates on the lung transplant waiting list on December 31, 2009 and December 31, 2019
Candidates aged younger than 18 years waiting for transplant on December 31 of the given year, regardless of first listing date. Candidates listed as before age 18 who turned 18 before the cohort date are excluded.

Characteristic	2009, N	2009, Percent	2019, N	2019, Percent
Wait time: < 31 days	10	6.2%	1	3.3%
Wait time: 31-60 days	5	3.1%	2	6.7%
Wait time: 61-90 days	7	4.3%	4	13.3%
Wait time: 3-< 6 months	14	8.7%	3	10.0%
Wait time: 6-< 12 months	21	13.0%	8	26.7%
Wait time: 1-< 2 years	12	7.5%	6	20.0%
Wait time: 2-< 3 years	13	8.1%	1	3.3%
Wait time: ≥ 3 years	79	49.1%	5	16.7%
Waitlist status: Active	64	39.8%	15	50.0%
Waitlist status: Inactive	97	60.2%	15	50.0%
Transplant history: First	161	100.0%	30	100.0%
Tx type: Lung only	142	88.2%	20	66.7%
Tx type: Heart-lung	16	9.9%	8	26.7%
Tx type: Other	3	1.9%	2	6.7%
All candidates	161	100.0%	30	100.0%

Table LU 13. Lung transplant waitlist activity among pediatric candidates
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	2017	2018	2019
Patients at start of year	39	40	42
Patients added during year	65	72	72
Patients removed during year	64	70	84
Patients at end of year	40	42	30

Table LU 14. Removal reason among pediatric lung transplant candidates
Removal reason as reported to the OPTN. Candidates with death dates that precede removal dates are assumed to have died waiting.

Removal reason	2017	2018	2019
Deceased donor transplant	47	42	56
Living donor transplant	0	0	0
Patient died	10	14	9
Patient refused transplant	0	1	0
Improved, transplant not needed	3	1	5
Too sick for transplant	1	1	5
Other	3	11	9

Table LU 15. Demographic characteristics of pediatric lung transplant recipients, 2007-2009 and 2017-2019
Pediatric lung transplant recipients, including retransplants. Distance is computed from recipient's home zip code to the transplant center.

Characteristic	2007-09, N	2007-09, Percent	2017-19, N	2017-19, Percent
Age: < 1 year	10	5.8%	10	7.3%
Age: 1-5 years	18	10.5%	11	8.0%
Age: 6-10 years	18	10.5%	17	12.4%
Age: 11-17 years	125	73.1%	99	72.3%
Sex: Female	105	61.4%	81	59.1%
Sex: Male	66	38.6%	56	40.9%
Race/ethnicity: White	129	75.4%	94	68.6%
Race/ethnicity: Black	8	4.7%	12	8.8%
Race/ethnicity: Hispanic	22	12.9%	27	19.7%
Race/ethnicity: Asian	8	4.7%	2	1.5%
Race/ethnicity: Other/unknown	4	2.3%	2	1.5%
Height: < 70 cm	11	6.4%	10	7.3%
Height: 70-< 90 cm	11	6.4%	7	5.1%
Height: 90-< 110 cm	8	4.7%	7	5.1%
Height: 110-< 130 cm	21	12.3%	17	12.4%
Height: ≥ 130 cm	120	70.2%	96	70.1%
Insurance: Private	89	52.0%	68	49.6%
Insurance: Medicaid	70	40.9%	59	43.1%
Insurance: Unknown	12	7.0%	10	7.3%
Geography: Metropolitan	132	77.2%	112	81.8%
Geography: Non-metro	39	22.8%	25	18.2%
Distance: < 50 miles	40	23.4%	41	29.9%
Distance: 50-<100 miles	24	14.0%	15	10.9%
Distance: 100-<150 miles	9	5.3%	11	8.0%
Distance: 150-<250 miles	28	16.4%	25	18.2%
Distance: ≥ 250 miles	66	38.6%	39	28.5%
Distance: Unknown	4	2.3%	6	4.4%
All recipients	171	100.0%	137	100.0%

Table LU 16. Clinical characteristics of pediatric lung transplant recipients, 2007-2009 and 2017-2019
Pediatric lung transplant recipients, including retransplants. Pediatric priority was reported in 2012 and later. ECMO, extracorporeal membrane oxygenation.

Characteristic	2007-09, N	2007-09, Percent	2017-19, N	2017-19, Percent
Diagnosis: Cystic fibrosis	93	54.4%	69	50.4%
Diagnosis: Pulmonary hypertension	22	12.9%	16	11.7%
Diagnosis: Pulmonary fibrosis	9	5.3%	5	3.6%
Diagnosis: Other vascular	2	1.2%	3	2.2%
Diagnosis: Other/unknown	45	26.3%	44	32.1%
Blood type: A	65	38.0%	52	38.0%
Blood type: B	20	11.7%	16	11.7%
Blood type: AB	14	8.2%	5	3.6%
Blood type: O	72	42.1%	64	46.7%
Medical condition: Hospitalized in ICU	36	21.1%	40	29.2%
Medical condition: Hospitalized, not ICU	43	25.1%	15	10.9%
Medical condition: Not hospitalized	92	53.8%	82	59.9%
Medical urgency: priority 1	0	0.0%	36	26.3%
Medical urgency: priority 2	0	0.0%	7	5.1%
Medical urgency: LAS <30	2	1.2%	1	0.7%
Medical urgency: LAS 30-<35	28	16.4%	26	19.0%
Medical urgency: LAS 35-<40	43	25.1%	29	21.2%
Medical urgency: LAS 40-<50	18	10.5%	17	12.4%
Medical urgency: LAS 50-<60	9	5.3%	4	2.9%
Medical urgency: LAS ≥60	17	9.9%	17	12.4%
Medical urgency: Unknown	54	31.6%	0	0.0%
Vent/ECMO at transplant: Vent + ECMO	0	0.0%	5	3.6%
Vent/ECMO at transplant: Vent only	33	19.3%	14	10.2%
Vent/ECMO at transplant: ECMO only	2	1.2%	12	8.8%
Vent/ECMO at transplant: Neither	136	79.5%	106	77.4%
All recipients	171	100.0%	137	100.0%

Table LU 17. Transplant characteristics of pediatric lung transplant recipients, 2007-2009 and 2017-2019
Pediatric lung transplant recipients, including retransplants.

Characteristic	2007-09, N	2007-09, Percent	2017-19, N	2017-19, Percent
Wait time: < 31 days	32	18.7%	55	40.1%
Wait time: 31-60 days	38	22.2%	23	16.8%
Wait time: 61-90 days	13	7.6%	17	12.4%
Wait time: 3-< 6 months	37	21.6%	16	11.7%
Wait time: 6-< 12 months	28	16.4%	15	10.9%
Wait time: ≥ 1 year	22	12.9%	11	8.0%
Wait time: Unknown	1	0.6%	0	0.0%
Unknown procedure	1	0.6%	0	0.0%
Bilateral procedure	170	99.4%	137	100.0%
Transplant history: First	156	91.2%	132	96.4%
Transplant history: Retransplant	15	8.8%	5	3.6%
Tx type: Lung only	157	91.8%	129	94.2%
Tx type: Heart-lung	12	7.0%	8	5.8%
Tx type: Other	2	1.2%	0	0.0%
All recipients	171	100.0%	137	100.0%

Table LU 18. Pediatric lung donor-recipient serology matching, 2017-2019
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. CMV, cytomegalovirus; EBV, Epstein-Barr virus.

Donor	Recipient	CMV	EBV
D-	R-	23.4%	12.4%
D-	R+	15.3%	8.8%
D-	R unk	0.0%	0.0%
D+	R-	35.8%	35.0%
D+	R+	21.9%	41.6%
D+	R unk	2.2%	2.2%
D unk	R-	0.7%	0.0%
D unk	R+	0.7%	0.0%
D unk	R unk	0.0%	0.0%

Table LU 19. Posttransplant events among lung transplant recipients aged 0-17 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 2015-2018 and 5-year events for recipients in 2011-2014. Recipients of more than one transplant are counted separately per transplant.

Event	One-year, N	One-year, Pct	Five-year, N	Five-year, Pct
BOS: None reported	132	93.0%	70	68.0%
BOS: Reported	3	2.1%	33	32.0%
BOS: Unknown	7	4.9%	0	0.0%
Diabetes	4	2.8%	11	10.7%
Malignancy	5	3.5%	8	7.8%
Re-hospitalization	70	49.3%	84	81.6%
Functional status: Fully active	131	92.3%	93	90.3%
Functional status: Min. active	3	2.1%	2	1.9%
Functional status: Bedbound	3	2.1%	2	1.9%
Functional status: Unknown	0	0.0%	6	5.8%
Functional status: Unknown	5	3.5%	0	0.0%
All recipients	142	100.0%	103	100.0%