OPTN/SRTR 2020 Annual Data Report: Lung

Abstract

For the first time in a decade, both the number of candidates added to the waiting list and the number of lung transplants performed decreased from the year prior; the number of lung donors also declined. This slowing of transplant activities in 2020 was associated with a modest increase in waitlist mortality. The year 2020 was notable for the global outbreak of the COVID-19 pandemic, which undoubtedly influenced all trends noted in lung transplantation. Time to transplant continued to decrease, with a median time to transplant of 1.4 months across all waitlist candidates. Posttransplant survival remained stable, with 89.4% of transplant recipients surviving to 1 year, 74.8% to 3 years, and 61.2% to 5 years.

Introduction

The year 2020 was remarkable for lung transplantation in many ways. The COVID-19 pandemic was declared in 2020, affecting every aspect of society worldwide, including the US transplant system. COVID-19-related restrictions and the health risks the virus posed to transplant candidates and recipients resulted in changes in center listing and transplant practices, and in time a COVID-19-related indication for lung transplant emerged. Compared with 2019, transplant activity declined. Fewer candidates were added to the lung transplant waiting list in 2020, with 2696 new candidates (Figure LU 1) and 2597 lung transplants performed (Figure LU 50).

In 2020, the impact of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy on cystic fibrosis patients came into focus, with potential transplant candidates experiencing stabilization and even improvement in their lung function, and so followed a precipitous decline in number of cystic fibrosis patients requiring a transplant. A lower proportion of candidates with cystic fibrosis was on the lung transplant waiting list, waitlist mortality rates decreased and, ultimately, fewer cystic fibrosis patients underwent lung transplant. Because long-term trends have yet to be observed, it is not known if these changes will persist or what we are witnessing is simply a delay in the need for transplant. Notably, some trends seen in the 2020 data may be impacted by changes in center listing or transplant practices amid the COVID-19 pandemic.

Last, work began to change the US lung transplant allocation system to the continuous distribution framework, in which the bounds of geography will become more flexible in relation to clinical factors that impact waitlist and posttransplant survival. Currently, candidates 12 years or older access lung transplant based on their calculated lung allocation score (LAS), age, geography, blood type compatibility and, if necessary, waiting time. Candidates younger than 12 years access transplant based on illness-based priority status, age, geography, blood type compatibility, and waiting time. The LAS calculates transplant benefit by estimating waitlist and posttransplant mortality. Currently, waitlist survival accounts for two-thirds and posttransplant survival accounts for one-third of the LAS, reflecting the preference for prioritizing waitlist mortality over posttransplant survival. Pulmonary diseases are categorized into four main diagnosis groups: group A, obstructive lung disease; group B, pulmonary vascular disease; group C, cystic fibrosis and immunodeficiency disorders; and group D, restrictive lung diseases. These groupings represent similar survival probability and disease pathophysiology. Notable changes to the LAS system that may impact interpretation of the data presented in this report include: (1) the 2015 update with a more contemporary cohort and addition of new variables to characterize disease severity for candidates in diagnosis group B; and (2) the 2017 replacement of donation service area with 250 nautical-mile radius from the donor hospital as the first unit of allocation, as a first step toward addressing geographic disparities in access to transplant.

In this report, all lung transplant candidates and recipients 18 years or older are included under Adult Lung Transplant, and those <18 years are included under Pediatric Lung Transplant. Heart-lung candidates and recipients are included in all tabulations. The data presented cover January 1 to December 31, 2020, except for the COVID-19 data, in which the latest available data is presented to July 31, 2021. The data presented here generally cover January 1, 2009, to December 31, 2020, with the addition of a few COVID-19 data points through July 31, 2021.

Adult Lung Transplantation in the US

Impact of COVID-19

The US declared a national emergency due to the COVID-19 pandemic on March 13, 2020; however, COVID-19 diagnosis codes were added to the Organ Procurement and Transplantation Network (OPTN) system on October 28, 2020, providing at least a 7-month lag in the collection of standardized data for this diagnosis. Transplant centers had the option to retrospectively change diagnoses for candidates with COVID-19 for this period once the diagnosis codes became available. In 2020, 21 candidates were listed for transplant with a COVID-19 diagnosis; of those, 17 (81%) underwent transplant, 2 (9.5%) died waiting, 1 (4.8%) died during the transplant procedure, and 1 (4.8%) was removed due to deteriorating health. An additional 5 patients received a transplant for this diagnosis who were not recorded to have COVID-19 at listing because diagnoses can be updated between listing and transplant, resulting in a total count of 22 lung transplant recipients in 2020.

From January 1 to July 31, 2021, 197 candidates with a COVID-19 diagnosis were added to the waiting list. Of these, 165 (84%) underwent transplant, 7 (3.6%) died waiting, 6 (3.1%) were removed for improved condition, 9 (4.6%) deteriorated, 1 was removed for other reasons, and 9 (4.6%) remain on the list. For the same reasons cited above, an additional 3 patients were reported with a COVID-19 diagnosis at transplant, resulting in a total of 168 lung transplant recipients in the first 7 months of 2021. In 2021, six transplant recipients died shortly posttransplant (three died within two weeks, two within 2 months posttransplant, and two within 6 months). The follow-up period for COVID-19 transplant recipients in 2021 is short and incomplete; however, it is being reported due to the novelty of this diagnosis and the transplant community’s interest in this population.

Waiting List

Characteristics of adult candidates listed for lung transplant

In 2020, 2696 new candidates were added to the lung transplant waiting list (Figure LU 1), a 17% decline from 2019. Adults aged 50-64 comprised 47% of the US lung transplant waiting list, although the percentage of candidates 65 years or older continued to increase, while the percentage of individuals 49 years or younger decreased (Figure LU 3). Since 2011, the proportion of candidates on the waiting list 65 years or older has nearly doubled, from 18.6% to 33.0% in 2020. There continues to be a higher percentage of men than women waiting for a lung transplant (Figure LU 4). The proportion of non-White candidates continues to increase, with Black, Asian, Hispanic, and “other” races comprising 28.2% of the waiting list (Figure LU 5). Lung transplant candidates in diagnosis group D continue to increase and represented 60.2% of the lung transplant waiting list. Diagnosis group A candidates decreased to 26.5% of the waiting list, and diagnosis group C candidates decreased from 7.4% in 2019 to 4.1% of candidates in 2020 (Figure LU 6). About one-third of candidates fall into the lowest LAS category, <35, 28.0% have LAS 35-<40, 21.6% have LAS 40-<50, and 6.2% have LAS 50-<60 (Figure LU 8). Candidates in the highest LAS category, 60 and above, continue to comprise 12.3% of the waitlist population. Most adults awaiting transplant are 150 to 180 cm (5 foot 2 to 5 foot 11 inches) tall, while 3.0% are under 150 cm, and 15.0% are over 180 cm (Figure LU 9). The proportion of candidates by blood type are like the general population, with type O blood comprising 50% of the waiting list, type A comprising 35.8%, type B comprising 11.1%, and type AB comprising 3.1%, respectively (Figure LU 10). The percentage of candidates with a prior lung transplant is 3.6%, a trend that has remained stable over time (Figure LU 11).

Outcome of adult candidates listed for lung transplant

Seventy-six percent of lung transplant candidates in 2020 were on the waiting list fewer than 90 days (Figure LU 7). Deceased donor lung transplant rates were the highest ever in 2020 at 218.6 transplants per 100 waitlist years (Figure LU 12). At the same time, waitlist mortality increased slightly from 14.7 deaths per 100 waitlist years in 2019 to 16.1 in 2020 (Figure LU 25). Transplant rates increased markedly for candidates 65 years or older, from 238.9 transplants per 100 waitlist years in 2019 to 302.1 in 2020 (Figure LU 13); candidates 50 to 64 years also experienced an increase in transplant rates from 172.4 to 209.1 transplants per 100 waitlist years. This mirrored an increase in transplant rates for candidates in diagnosis group D, which increased from 263.0 transplants per 100 waitlist years in 2019 to 308.7 in 2020 (Figure LU 15). Transplant rates declined sharply for diagnosis group C candidates, from 201.9 transplants per 100 waitlist years in 2019 to 92.7 in 2020 (Figure LU 15). Overall median waiting time for candidates in the US was 42 days in 2020, with the shortest waiting time for diagnosis group D candidates at 36 days, followed by diagnosis group C at 55 days, diagnosis group A at 68 days, and diagnosis group B at 78 days (Figure LU 20). As expected, median waiting time was inversely related to LAS, with those in the highest LAS range of 50-100 experiencing the shortest median waiting time of 17 days and those in the lowest LAS range of less than 35 with the longest median waiting time of 80 days (Figure LU 21). Transplant rates were highest for White candidates, followed by “other,” Asian, Hispanic, and Black candidates (Figure LU 14). Candidates with blood type AB experienced the highest transplant rates, followed by type A, B, and O, respectively (Figure LU 16). Candidates taller than 180 cm experienced the highest transplant rates, with declining rates as candidate height decreased (Figure LU 17). There was geographic variability in the percent of candidates who were transplanted within a year, by the state where the candidate lived, from 50%-100% (Figure LU 24). Differences were likely influenced by both the number of candidates per state and the number of transplant centers within a state (Figure LU 24). Transplant rates did not differ between residents of metropolitan or non-metropolitan areas (Figure LU 18).

While pretransplant mortality increased slightly over the last year, it has been declining since 2014, when 22.1 deaths per 100 waitlist years occurred, compared with 16.1 in 2020 (Figure LU 25). Candidates 65 years and older experienced the greatest pretransplant mortality rate of all age categories, a trend that remains largely unchanged over the past 5 years (Figure LU 26). Pretransplant mortality was greater for men, with 21.3 deaths per 100 waitlist years, compared with 12.6 for women, and varies annually by race, which may be influenced by small subgroups (Figure LU 28 and Figure LU 27, respectively). Pretransplant mortality varied by diagnosis group, with the highest mortality rate in group D, followed by group B, group A, and group C, respectively (Figure LU 29). Pretransplant mortality continued to decline for candidates with an LAS of 60 or above (Figure LU 30). Biological factors influenced access to transplant. Candidates <150 cm in height experienced the greatest pretransplant mortality, likely due to a smaller supply of appropriately sized donor organs (Figure LU 32). A clear trend for impact of blood type on access to transplant is not evident, likely because the lung allocation policy of prioritizing blood type identical over compatible donor-recipient matching allows blood type O candidates access to these universally compatible organs (Figure LU 31). Data about degree of immunological sensitization of candidates are not shown because the data are missing in a nonrandom fashion and may be misleading. Of candidates removed from the waiting list for reasons other than transplant or death, 18.8% died within 6 months of removal (Figure LU 35). Higher percentages of post-removal deaths occurred among those 65 years or older (Figure LU 37) and those in diagnosis group D (Figure LU 36).

Donors

There were 2578 deceased lung donors in 2020, compared with 2755 in 2019 (Figure LU 38); this unusually large decline in recovered donor lungs may be due to the impact of the COVID-19 pandemic on considerations such as determining donor eligibility and travel restrictions faced by organ procurement teams. Of the donors, 185 (7.2%) were younger than 18 years, 2125 (82.4%) 18-54 years, and 268 (10.4%) 55 years or older (Figure LU 39, Figure LU 40); 39.4% of donors were women (Figure LU 41), 19.0% Black, 18.0% Hispanic, and 3.4% Asian (Figure LU 42). In 2020, 5.4% lungs were recovered for transplant and not transplanted, with the highest proportion occurring in donors 55 years or older and those with a cause of death of anoxia (Figure LU 44, Figure LU 45, Figure LU 46). Utilization of increased risk donors continues to improve, with 95% of lungs recovered for transplant ultimately used for transplant (Figure LU 47). A minority of donors, 7.4%, had a smoking history of 20 pack-years or more (Figure LU 48). The most common causes of donor death were anoxia and head trauma (37% each), followed by cardiovascular accidents/stroke (Figure LU 49). In 2020, 7.4% of transplants used “donation after circulatory death” donors, which has increased from 3.1% in 2015 (Table LU 8).

Transplant

Characteristics of adult lung transplant recipients

In 2020, in line with a decreased number of donor lungs, 2597 lung transplants were performed, compared with 2759 the year prior, a 5.9% decline (Figure LU 50). Bilateral lung transplants accounted for 78% of procedures (Figure LU 51). There were 93 (3.6%) re-transplants and 53 (2.1%) heart-lung transplants performed (Table LU 8). By age, in decreasing order, the number of lung transplants performed were: 50-64 years, 1175; 65 years or older, 982; 35-49 years, 262; 18-34 years, 142; and younger than 18 years, 36 (Figure LU 52). Male recipients outnumbered women, at 1518 transplants (58%) versus 1100 (42%) (Figure LU 53). The number of transplants was greatest for diagnosis group D, at 1708, followed by group A (608), group B (205), and group C (76) (Figure LU 55). Notably, the number of transplants for group C decreased by 68.9% from 2019 to 2020. The overall median LAS at transplant was 40.7, and 543 transplants occurred in recipients with an LAS of >60, 216 with an LAS of 50-<60, 614 with an LAS of 40-<50, 605 with an LAS of 30-<40, and 605 with an LAS of <35 (Figure LU 57, Figure LU 56). Median LAS differed by diagnosis group, with the highest median LAS of 46.6 in group B, followed by 44.2 in group D, 43.8 in group C, and 33.7 in group A (Figure LU 58).

Sixty-eight centers performed lung transplants last year (Figure LU 90). The median number of transplants performed by centers was 34, with a 25th-75th percentile of 20-55 (Figure LU 62). Twenty percent of transplants were performed at centers with an annual transplant volume >100, 45.5% at centers performing 41-100 transplants, and 33.4% at centers performing 11-40 transplants, with less than 1% occurring at centers performing 10 or fewer transplants annually (Figure LU 63).

Outcomes of adult lung transplant recipients

Posttransplant survival trends remained stable, with 89.4% of recipients in 2019 surviving to one year, 61.2% in 2015 to five years, and 33.1% in 2010 to 10 years (Figure LU 64). Five-year posttransplant survival was lowest for recipients aged 65 and older, followed by those aged 18-34, 50-64, and 35-49, respectively (Figure LU 65). Five-year survival varied by race; by five years posttransplant, Black recipients had a survival of 54.5%, followed by White recipients (60.2%), Asian recipients (62.4%), and Hispanic recipients (64.1%) (Figure LU 66). By five years posttransplant, those with LAS values of =50 had the lowest survival, and those with LAS values of <40 had the highest survival (Figure LU 67). Recipients of bilateral transplants had better five-year survival (63.1%) than single-lung recipients (53.3%) (Figure LU 68). This is likely confounded by pretransplant characteristics informing decisions on procedure type. Diagnosis group C recipients had the best five-year survival (66.6%), followed by group A (62.4%), group B (59.5%), and group D (57.8%) (Figure LU 69).

Posttransplant outcomes, other than survival data reported above, has varying degrees of missingness particularly as time from transplant increases and should be interpreted with caution. Induction agents were used commonly at transplant; induction therapy was reported for 80.9% of recipients, and 81.5% reported the most common immunosuppression regimen of tacrolimus, mycophenolate mofetil, and prednisone (Figure LU 59, Figure LU 60). In the first posttransplant year, an episode of acute rejection was reported in 14.6% of lung transplant recipients, which varied slightly by age (12.5%-18.18%) (Figure LU 73). Episodes of acute rejection in the first year were most commonly reported in recipients with no induction therapy reported (19.6%), followed by those reporting T-cell-depleting agents (18.4%) and IL-2 receptor antagonists (13.0%) (Figure LU 74). Posttransplant lymphoproliferative disorder was most commonly reported among recipients who were Epstein-Barr virus-negative (7.6%) compared with 1.1% in those who were Epstein-Barr virus-positive (Figure LU 75). By 1 year, 5.7% of recipients had bronchiolitis obliterans syndrome (BOS) reported, and by year 5, 40.2% did. Creatinine of >2.5 mg/dl was reported in 4.8% of recipients by 1 year and 12.5% by 5 years, and 1.9% reported chronic dialysis by year 1 and 3.3% by year 5. Malignancy was reported in 24.0% of recipients by 5 years posttransplant. Most recipients (80%) had a functional status of no assistance needed at both 1 and 5 years posttransplant (Table LU 10).

Pediatric Lung Transplant in the US

Waiting List

Characteristics of pediatric candidates listed for lung transplant

In 2020, 58 new pediatric candidates (aged <18 years) were added to the lung transplant waiting list (Figure LU 76), and 88 candidates were on the list at some point during the year (Figure LU 77). The number of pediatric waitlist candidates decreased from 249 in 2010 to 88 in 2020 (Figure LU 77). The largest age-group of pediatric candidates on the waiting list in 2020 was 12-17 years (51.1%,) followed by 1-5 years (23.9%), younger than 1 year (15.9%), and 6-11 years (9.1%) (Figure LU 78). Most pediatric lung transplant candidates were White (62.5%), followed by Hispanic (19.3%), Black (9.1%), and Asian (3.4%) (Figure LU 79). Most (73.9%) pediatric candidates on the waiting list in 2020 had been on the list fewer than 90 days (Figure LU 81).

Outcomes of pediatric candidates listed for lung transplant

Of 66 candidates removed from the waiting list in 2020, 36 (54.6%) were removed after undergoing transplant, 8 (12.1%) after death, 8 (12.1%) due to improved condition, and 4 (6.0%) due to becoming too sick to undergo transplant (Table LU 14, Table LU 15). Among pediatric lung transplant candidates listed in 2017, 66.2% underwent deceased donor transplant within 3 years, 14.7% died waiting, 16.7% were removed from the list for reasons other than transplant or death, and 2.5% were still waiting (Figure LU 82). The overall pediatric lung transplant rate has generally increased since 2012, from 39.5 transplants per 100 waitlist-years to 131.3 in 2020 (Figure LU 83). Transplant rates varied with age and were highest for candidates aged 12-17 years (244.7 per 100 waitlist years), followed by candidates younger than 1 year (203.3 per 100 waitlist years), 6-11 years (111.6 per 100 waitlist years), and 1-5 years (26.3 per 100 waitlist-years) (Figure LU 84). Transplant rates also varied by race, with the highest rates among Black candidates (632 per 100 waitlist years), followed by Hispanic candidates (278.6 per 100 waitlist years) and White candidates (84.2 per 100 waitlist years) (Figure LU 85). Pretransplant mortality decreased from a peak of 42.9 deaths per 100 waitlist years in 2015 to 27.1 in 2020 (Figure LU 86). Pretransplant mortality varied by age, ranging from 24.2 deaths per 100 waitlist years among candidates aged 6-11 years to 58.1 among candidates younger than 1 year (Figure LU 87).

Transplant

Characteristics of pediatric lung transplant recipients

In 2020, 36 lung transplants were performed in pediatric recipients 0-17 years (Figure LU 88), seven in those younger than 1 year, three in those 1-5 years, four in those 6-11 years, and 22 in those 12-17 years (Figure LU 89). In 2020, 10 programs were characterized as providing pediatric transplant, compared with 61 programs that offered transplants for adults (Figure LU 90). Since 2008, cystic fibrosis remained the leading indication for pediatric lung transplant (Table LU 17). More than half of pediatric lung transplant recipients in 2018-2020 were not hospitalized at the time of transplant (Table LU 17). An increasing proportion of candidates were bridged to transplant; 7.0% required mechanical ventilation and extracorporeal membrane oxygenation (ECMO), 10.2% mechanical ventilation only, and 12.5% ECMO only (Table LU 17). Time to transplant has decreased over the past decade, with 46.9% of recipients in 2018-2020 with wait times shorter than 31 days, compared with 21.4% in 2008-2010 (Table LU 18). Induction therapy was reported in 86.1% of pediatric lung transplant recipients in 2020 (Figure LU 91). The most common initial immunosuppression regimen was tacrolimus, mycophenolate, and steroids, reported in 91.7% of pediatric lung recipients (Figure LU 92). Among pediatric lung transplant recipients in 2018-2020, the combination of a cytomegalovirus (CMV)-positive donor and CMV-negative recipient occurred in 35.2% of transplants; this combination for Epstein-Barr was used in 33.6% of transplants (Table LU 19).

Outcomes of pediatric lung transplant recipients

Across all pediatric recipients who underwent lung transplant in 2013-2015, 1-, 3-, and 5-year patient survival was 85.4%, 62.2%, and 53.7%, respectively (Figure LU 96). Incidence of death was 3.8% at 6 months and 7.7% at 1 year for transplants in 2019, 37.8% at 3 years for transplants in 2017, 47.7% at 5 years for transplants in 2015, and 59.6% at 10 years for transplants in 2010 (Figure LU 95). The incidence of post-transplant lymphoproliferative disorder among Epstein-Barr-negative recipients who underwent transplant in 2008-2018 was 9.9% at 5 years posttransplant, compared with 1.1% among Epstein-Barr-positive recipients (Figure LU 94). Complication rates in pediatric lung transplant recipients increased with time posttransplant, including bronchiolitis obliterans syndrome (1.9% at 1 year, 30.3% at 5 years) (Table LU 20). For most surviving pediatric lung transplant recipients (89.9%), 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 group
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 group
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 2015-2017
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, 2019, by DSA
Figure LU 24. Percentage of adults who underwent deceased donor lung transplant within 1 year of listing, 2019, 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 in 2020 by DSA
Figure LU 35. Deaths within six months after removal among adult lung waitlist candidates, overall
Figure LU 36. Deaths within six months after removal among adult lung waitlist candidates, by diagnosis
Figure LU 37. Deaths within six months after removal among adult lung waitlist candidates, by age

Deceased donation

Figure LU 38. Overall deceased lung donor count
Figure LU 39. Deceased lung donor count by age
Figure LU 40. Distribution of deceased lung donors by age
Figure LU 41. Distribution of deceased lung donors by sex
Figure LU 42. Distribution of deceased lung donors by race
Figure LU 43. Percent of pediatric donor lungs allocated to adult recipients, by DSA of donor hospital, 2016-2020
Figure LU 44. Overall percent of lungs recovered for transplant and not transplanted
Figure LU 45. Percent of lungs recovered for transplant and not transplanted by donor age
Figure LU 46. Percent of lungs recovered for transplant and not transplanted by donor cause of death
Figure LU 47. Percent of lungs recovered for transplant and not transplanted, by donor risk of disease transmission
Figure LU 48. Lung donors with a smoking history of 20 pack-years or more
Figure LU 49. Cause of death among deceased lung donors

Transplant

Figure LU 50. Overall lung transplants
Figure LU 51. Total lung transplants by procedure type
Figure LU 52. Total lung transplants by age
Figure LU 53. Total lung transplants by sex
Figure LU 54. Total lung transplants by race
Figure LU 55. Total lung transplants by diagnosis
Figure LU 56. Total lung transplants by LAS
Figure LU 57. Percentiles of LAS at transplant
Figure LU 58. Median LAS at transplant by diagnosis group
Figure LU 59. Induction agent use in adult lung transplant recipients
Figure LU 60. Immunosuppression regimen use in adult lung transplant recipients
Figure LU 61. Total HLA A, B, and DR mismatches among deceased donor lung transplant recipients aged 18 years or older, 2016-2020
Figure LU 62. Annual adult lung transplant center volumes by percentile
Figure LU 63. Distribution of adult lung transplants by annual center volume

Outcomes

Figure LU 64. Patient death among adult lung transplant recipients
Figure LU 65. Patient survival among adult lung transplant recipients, 2013-2015, by age
Figure LU 66. Patient survival among adult lung transplant recipients, 2013-2015, by race
Figure LU 67. Patient survival among adult lung transplant recipients, 2013-2015, by LAS
Figure LU 68. Patient survival among adult lung transplant recipients, 2013-2015, by transplant type
Figure LU 69. Patient survival among adult lung transplant recipients, 2013-2015, by diagnosis group
Figure LU 70. Patient survival among adult lung transplant recipients, 2013-2015, by sex
Figure LU 71. Patient survival among adult lung transplant recipients, 2013-2015, by metropolitan vs. non-metropolitan recipient residence
Figure LU 72. Recipients alive with a functioning lung graft on June 30 of the year, by age at transplant
Figure LU 73. Incidence of acute rejection by 1 year posttransplant among adult lung transplant recipients by age, 2018-2019
Figure LU 74. Incidence of acute rejection by 1 year posttransplant among adult lung transplant recipients by induction agent, 2018-2019
Figure LU 75. Incidence of PTLD among adult lung transplant recipients by recipient EBV status at transplant, 2014-2018

Pediatric transplant

Figure LU 76. New pediatric candidates added to the lung transplant waiting list
Figure LU 77. All pediatric candidates on the lung transplant waiting list
Figure LU 78. Distribution of pediatric candidates waiting for lung transplant by age
Figure LU 79. Distribution of pediatric candidates waiting for lung transplant by race
Figure LU 80. Distribution of pediatric candidates waiting for lung transplant by sex
Figure LU 81. Distribution of pediatric candidates waiting for lung transplant by waiting time
Figure LU 82. Three-year outcomes for newly listed pediatric candidates waiting for lung transplant, 2015-2017
Figure LU 83. Overall deceased donor lung transplant rates among pediatric waitlist candidates
Figure LU 84. Deceased donor lung transplant rates among pediatric waitlist candidates by age
Figure LU 85. Deceased donor lung transplant rates among pediatric waitlist candidates by race
Figure LU 86. Overall pretransplant mortality rates among pediatric candidates waitlisted for lung
Figure LU 87. Pretransplant mortality rates among pediatric candidates waitlisted for lung transplant by age
Figure LU 88. Overall pediatric lung transplants
Figure LU 89. Pediatric lung transplants by recipient age
Figure LU 90. Number of centers performing pediatric and adult lung transplants by center's age mix
Figure LU 91. Induction agent use in pediatric lung transplant recipients
Figure LU 92. Immunosuppression regimen use in pediatric lung transplant recipients
Figure LU 93. Total HLA A, B, and DR mismatches among pediatric deceased donor lung transplant recipients, 2016-2020
Figure LU 94. Incidence of PTLD among pediatric lung transplant recipients by recipient EBV status at transplant, 2008-2018
Figure LU 95. Patient death among pediatric lung transplant recipients
Figure LU 96. Overall patient survival among pediatric deceased donor lung transplant recipients, 2013-2015

Table List

Waiting list

Table LU 1. Demographic characteristics of adults on the lung transplant waiting list on December 31, 2015 and December 31, 2020
Table LU 2. Clinical characteristics of adults on the lung transplant waiting list on December 31, 2015 and December 31, 2020
Table LU 3. Listing characteristics of adults on the lung transplant waiting list on December 31, 2015 and December 31, 2020
Table LU 4. Lung transplant waitlist activity among adults
Table LU 5. Removal reason among adult lung transplant candidates

Transplant

Table LU 6. Demographic characteristics of adult lung transplant recipients, 2015 and 2020
Table LU 7. Clinical characteristics of adult lung transplant recipients, 2015 and 2020
Table LU 8. Transplant characteristics of adult lung transplant recipients, 2015 and 2020
Table LU 9. Adult lung donor-recipient serology matching, 2018-2020

Outcomes

Table LU 10. Posttransplant events among lung transplant recipients aged 18 years or older

Pediatric transplant

Table LU 11. Demographic characteristics of pediatric candidates on the lung transplant waiting list on December 31, 2010 and December 31, 2020
Table LU 12. Clinical characteristics of pediatric candidates on the lung transplant waiting list on December 31, 2010 and December 31, 2020
Table LU 13. Listing characteristics of pediatric candidates on the lung transplant waiting list on December 31, 2010 and December 31, 2020
Table LU 14. Lung transplant waitlist activity among pediatric candidates
Table LU 15. Removal reason among pediatric lung transplant candidates
Table LU 16. Demographic characteristics of pediatric lung transplant recipients, 2008-2010 and 2018-2020
Table LU 17. Clinical characteristics of pediatric lung transplant recipients, 2008-2010 and 2018-2020
Table LU 18. Transplant characteristics of pediatric lung transplant recipients, 2008-2010 and 2018-2020
Table LU 19. Pediatric lung donor-recipient serology matching, 2018-2020
Table LU 20. 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, 2015 and December 31, 2020
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	2015, N	2015, Percent	2020, N	2020, Percent
Age: 18-34 years	155	10.0%	86	8.6%
Age: 35-49 years	251	16.2%	143	14.2%
Age: 50-64 years	778	50.1%	463	46.1%
Age: ≥ 65 years	368	23.7%	313	31.1%
Sex: Female	946	61.0%	581	57.8%
Sex: Male	606	39.0%	424	42.2%
Race/ethnicity: White	1216	78.4%	656	65.3%
Race/ethnicity: Black	169	10.9%	141	14.0%
Race/ethnicity: Hispanic	104	6.7%	160	15.9%
Race/ethnicity: Asian	51	3.3%	38	3.8%
Race/ethnicity: Other/unknown	12	0.8%	10	1.0%
Geography: Metropolitan	1293	83.3%	852	84.8%
Geography: Non-metro	259	16.7%	153	15.2%
Distance: < 50 miles	720	46.4%	540	53.7%
Distance: 50-<100 miles	269	17.3%	190	18.9%
Distance: 100-<150 miles	197	12.7%	85	8.5%
Distance: 150-<250 miles	184	11.9%	95	9.5%
Distance: ≥ 250 miles	167	10.8%	90	9.0%
Distance: Unknown	15	1.0%	5	0.5%
Height: < 150 cm	51	3.3%	53	5.3%
Height: 150-< 160 cm	355	22.9%	240	23.9%
Height: 160-< 170 cm	591	38.1%	349	34.7%
Height: 170-< 180 cm	370	23.8%	245	24.4%
Height: ≥ 180 cm	184	11.9%	117	11.6%
Height: Unknown	1	0.1%	1	0.1%
All candidates	1552	100.0%	1005	100.0%

Table LU 2. Clinical characteristics of adults on the lung transplant waiting list on December 31, 2015 and December 31, 2020
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	2015, N	2015, Percent	2020, N	2020, Percent
Diagnosis group: A	661	42.6%	338	33.6%
Diagnosis group: B	129	8.3%	104	10.3%
Diagnosis group: C	152	9.8%	51	5.1%
Diagnosis group: D	610	39.3%	512	50.9%
LAS: < 30	126	8.1%	81	8.1%
LAS: 30-< 35	622	40.1%	348	34.6%
LAS: 35-< 40	422	27.2%	257	25.6%
LAS: 40-< 50	272	17.5%	221	22.0%
LAS: 50-< 60	62	4.0%	43	4.3%
LAS: ≥ 60	48	3.1%	55	5.5%
Blood type: A	582	37.5%	290	28.9%
Blood type: B	185	11.9%	97	9.7%
Blood type: AB	47	3.0%	18	1.8%
Blood type: O	738	47.6%	600	59.7%
All candidates	1552	100.0%	1005	100.0%

Table LU 3. Listing characteristics of adults on the lung transplant waiting list on December 31, 2015 and December 31, 2020
Candidates waiting for transplant on December 31 of the given year, regardless of first listing date.

Characteristic	2015, N	2015, Percent	2020, N	2020, Percent
Wait time: < 31 days	190	12.2%	170	16.9%
Wait time: 31-60 days	131	8.4%	107	10.6%
Wait time: 61-90 days	110	7.1%	75	7.5%
Wait time: 3-< 6 months	248	16.0%	126	12.5%
Wait time: 6-< 12 months	249	16.0%	145	14.4%
Wait time: 1-< 2 years	289	18.6%	208	20.7%
Wait time: 2-< 3 years	146	9.4%	98	9.8%
Wait time: ≥ 3 years	189	12.2%	76	7.6%
Waitlist status: Active	1240	79.9%	747	74.3%
Waitlist status: Inactive	312	20.1%	232	23.1%
Waitlist status: Unknown	0	0.0%	26	2.6%
Transplant history: First	1517	97.7%	974	96.9%
Transplant history: Retransplant	35	2.3%	31	3.1%
Tx type: Lung only	1468	94.6%	918	91.3%
Tx type: Heart-lung	76	4.9%	68	6.8%
Tx type: Other	8	0.5%	19	1.9%
All candidates	1552	100.0%	1005	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	2018	2019	2020
Patients at start of year	1382	1442	1413
Patients added during year	3200	3244	2697
Patients removed during year	3131	3263	3105
Patients at end of year	1451	1423	1005

Table LU 5. Removal reason among adult 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	2018	2019	2020
Deceased donor transplant	2515	2692	2551
Living donor transplant	0	0	0
Patient died	237	173	168
Patient refused transplant	22	11	13
Improved, transplant not needed	48	41	65
Too sick for transplant	135	143	115
Other	174	203	193

Table LU 6. Demographic characteristics of adult lung transplant recipients, 2015 and 2020
Lung transplant recipients, including retransplants. Distance is computed from recipient's home zip code to the transplant center.

Characteristic	2015, N	2015, Percent	2020, N	2020, Percent
Age: 18-34 years	208	10.3%	142	5.5%
Age: 35-49 years	252	12.4%	262	10.2%
Age: 50-64 years	974	48.0%	1175	45.9%
Age: ≥ 65 years	594	29.3%	982	38.3%
Sex: Female	821	40.5%	1058	41.3%
Sex: Male	1207	59.5%	1503	58.7%
Race/ethnicity: White	1635	80.6%	1922	75.0%
Race/ethnicity: Black	187	9.2%	264	10.3%
Race/ethnicity: Hispanic	152	7.5%	277	10.8%
Race/ethnicity: Asian	41	2.0%	79	3.1%
Race/ethnicity: Other/unknown	13	0.6%	19	0.7%
Height: < 150 cm	32	1.6%	40	1.6%
Height: 150-< 160 cm	262	12.9%	402	15.7%
Height: 160-< 170 cm	622	30.7%	771	30.1%
Height: 170-< 180 cm	745	36.7%	910	35.5%
Height: ≥ 180 cm	367	18.1%	430	16.8%
Height: Unknown	0	0.0%	8	0.3%
Insurance: Private	974	48.0%	1010	39.4%
Insurance: Medicare	840	41.4%	1275	49.8%
Insurance: Other government	194	9.6%	251	9.8%
Insurance: Unknown	20	1.0%	25	1.0%
Geography: Metropolitan	1691	83.4%	2162	84.4%
Geography: Non-metro	337	16.6%	399	15.6%
Distance: < 50 miles	1004	49.5%	1285	50.2%
Distance: 50-<100 miles	401	19.8%	497	19.4%
Distance: 100-<150 miles	180	8.9%	278	10.9%
Distance: 150-<250 miles	197	9.7%	247	9.6%
Distance: ≥ 250 miles	224	11.0%	231	9.0%
Distance: Unknown	22	1.1%	23	0.9%
All recipients	2028	100.0%	2561	100.0%

Table LU 7. Clinical characteristics of adult lung transplant recipients, 2015 and 2020
Lung transplant recipients, including retransplants. ECMO, extracorporeal membrane oxygenation.

Characteristic	2015, N	2015, Percent	2020, N	2020, Percent
Diagnosis group: A	565	27.9%	606	23.7%
Diagnosis group: B	68	3.4%	191	7.5%
Diagnosis group: C	212	10.5%	71	2.8%
Diagnosis group: D	1183	58.3%	1693	66.1%
Blood type: A	807	39.8%	1013	39.6%
Blood type: B	229	11.3%	281	11.0%
Blood type: AB	78	3.8%	97	3.8%
Blood type: O	914	45.1%	1170	45.7%
Medical condition: Hospitalized in ICU	274	13.5%	354	13.8%
Medical condition: Hospitalized, not ICU	243	12.0%	236	9.2%
Medical condition: Not hospitalized	1511	74.5%	1965	76.7%
Medical condition: Hospitalization unknown	0	0.0%	6	0.2%
LAS: < 30	3	0.1%	5	0.2%
LAS: 30-< 35	470	23.2%	596	23.3%
LAS: 35-< 40	438	21.6%	600	23.4%
LAS: 40-< 50	479	23.6%	608	23.7%
LAS: 50-< 60	216	10.7%	215	8.4%
LAS: ≥ 60	422	20.8%	537	21.0%
Vent/ECMO at transplant: Vent + ECMO	65	3.2%	91	3.6%
Vent/ECMO at transplant: Vent only	64	3.2%	46	1.8%
Vent/ECMO at transplant: ECMO only	30	1.5%	79	3.1%
Vent/ECMO at transplant: Neither	1869	92.2%	2345	91.6%
All recipients	2028	100.0%	2561	100.0%

Table LU 8. Transplant characteristics of adult lung transplant recipients, 2015 and 2020
Lung transplant recipients, including retransplants. DBD, donation after brain death; DCD, donation after circulatory death.

Characteristic	2015, N	2015, Percent	2020, N	2020, Percent
Wait time: < 31 days	691	34.1%	1159	45.3%
Wait time: 31-60 days	311	15.3%	355	13.9%
Wait time: 61-90 days	184	9.1%	225	8.8%
Wait time: 3-< 6 months	308	15.2%	316	12.3%
Wait time: 6-< 12 months	264	13.0%	267	10.4%
Wait time: ≥ 1 year	270	13.3%	239	9.3%
Procedure: Lobar	0	0.0%	3	0.1%
Procedure: Single	597	29.4%	566	22.1%
Procedure: Bilateral	1431	70.6%	1992	77.8%
Donor type: DBD	1966	96.9%	2371	92.6%
Donor type: DCD	62	3.1%	190	7.4%
Transplant history: First	1962	96.7%	2468	96.4%
Transplant history: Retransplant	66	3.3%	93	3.6%
Tx type: Lung only	2005	98.9%	2475	96.6%
Tx type: Heart-lung	12	0.6%	53	2.1%
Tx type: Other	11	0.5%	33	1.3%
All recipients	2028	100.0%	2561	100.0%

Table LU 9. Adult lung donor-recipient serology matching, 2018-2020
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-	16.9%	0.7%
D-	R+	20.6%	7.7%
D-	R unk	0.1%	0.1%
D+	R-	25.8%	6.9%
D+	R+	36.0%	82.8%
D+	R unk	0.1%	1.6%
D unk	R-	0.2%	0.0%
D unk	R+	0.3%	0.2%
D unk	R unk	0.0%	0.0%

Table LU 10. 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 2017-2019 and 5-year events for recipients in 2013-2015. Recipients of more than one transplant are counted separately per transplant. Bronchiolitis obliterans syndrome (BOS) ceased to be reported after June, 2020.

Event	One-year, N	One-year, Pct	Five-year, N	Five-year, Pct
BOS: None reported	4679	71.2%	1954	59.7%
BOS: Reported	378	5.7%	1315	40.2%
BOS: Unknown	1519	23.1%	2	0.1%
Creatinine > 2.5 mg/dl	315	4.8%	410	12.5%
Chronic dialysis	127	1.9%	108	3.3%
Renal transplant	5	0.1%	26	0.8%
Diabetes	450	6.8%	436	13.3%
Malignancy	234	3.6%	784	24.0%
Re-hospitalization	3327	50.6%	2544	77.8%
Functional status: No assistance needed	5278	80.3%	2624	80.2%
Functional status: Some assistance needed	373	5.7%	195	6.0%
Functional status: Total assistance needed	127	1.9%	45	1.4%
Functional status: Unknown	798	12.1%	407	12.4%
All recipients	6576	100.0%	3271	100.0%

Table LU 11. Demographic characteristics of pediatric candidates on the lung transplant waiting list on December 31, 2010 and December 31, 2020
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	2010, N	2010, Percent	2020, N	2020, Percent
Age: < 1 year	0	0.0%	2	9.1%
Age: 1-5 years	14	10.9%	13	59.1%
Age: 6-11 years	30	23.4%	2	9.1%
Age: ≥ 12 years	57	44.5%	4	18.2%
Age: Unknown	27	21.1%	1	4.5%
Sex: Female	68	53.1%	15	68.2%
Sex: Male	60	46.9%	7	31.8%
Race/ethnicity: White	98	76.6%	15	68.2%
Race/ethnicity: Black	10	7.8%	2	9.1%
Race/ethnicity: Hispanic	17	13.3%	2	9.1%
Race/ethnicity: Asian	3	2.3%	1	4.5%
Race/ethnicity: Other/unknown	0	0.0%	2	9.1%
Geography: Metropolitan	100	78.1%	18	81.8%
Geography: Non-metro	28	21.9%	4	18.2%
Distance: < 50 miles	23	18.0%	9	40.9%
Distance: 50-<100 miles	18	14.1%	1	4.5%
Distance: 100-<150 miles	13	10.2%	0	0.0%
Distance: 150-<250 miles	24	18.8%	4	18.2%
Distance: ≥ 250 miles	50	39.1%	7	31.8%
Distance: Unknown	0	0.0%	1	4.5%
Height: < 70 cm	3	2.3%	6	27.3%
Height: 70-< 90 cm	17	13.3%	6	27.3%
Height: 90-< 110 cm	13	10.2%	4	18.2%
Height: 110-< 130 cm	26	20.3%	1	4.5%
Height: ≥ 130 cm	68	53.1%	5	22.7%
Height: Unknown	1	0.8%	0	0.0%
All candidates	128	100.0%	22	100.0%

Table LU 12. Clinical characteristics of pediatric candidates on the lung transplant waiting list on December 31, 2010 and December 31, 2020
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	2010, N	2010, Percent	2020, N	2020, Percent
Diagnosis: Cystic fibrosis	43	33.6%	2	9.1%
Diagnosis: Pulmonary hypertension	41	32.0%	6	27.3%
Diagnosis: Pulmonary fibrosis	11	8.6%	0	0.0%
Diagnosis: Other vascular	5	3.9%	2	9.1%
Diagnosis: Other/unknown	28	21.9%	12	54.5%
Blood type: A	41	32.0%	5	22.7%
Blood type: B	13	10.2%	0	0.0%
Blood type: AB	4	3.1%	2	9.1%
Blood type: O	70	54.7%	15	68.2%
All candidates	128	100.0%	22	100.0%

Table LU 13. Listing characteristics of pediatric candidates on the lung transplant waiting list on December 31, 2010 and December 31, 2020
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	2010, N	2010, Percent	2020, N	2020, Percent
Wait time: < 31 days	5	3.9%	4	18.2%
Wait time: 31-60 days	6	4.7%	1	4.5%
Wait time: 61-90 days	2	1.6%	3	13.6%
Wait time: 3-< 6 months	12	9.4%	2	9.1%
Wait time: 6-< 12 months	19	14.8%	5	22.7%
Wait time: 1-< 2 years	18	14.1%	3	13.6%
Wait time: 2-< 3 years	6	4.7%	0	0.0%
Wait time: ≥ 3 years	60	46.9%	4	18.2%
Waitlist status: Active	54	42.2%	14	63.6%
Waitlist status: Inactive	74	57.8%	8	36.4%
Transplant history: First	126	98.4%	22	100.0%
Transplant history: Retransplant	2	1.6%	0	0.0%
Tx type: Lung only	105	82.0%	15	68.2%
Tx type: Heart-lung	19	14.8%	7	31.8%
Tx type: Other	4	3.1%	0	0.0%
All candidates	128	100.0%	22	100.0%

Table LU 14. 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	2018	2019	2020
Patients at start of year	40	42	30
Patients added during year	72	72	58
Patients removed during year	70	84	66
Patients at end of year	42	30	22

Table LU 15. 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	2018	2019	2020
Deceased donor transplant	42	56	36
Living donor transplant	0	0	0
Patient died	14	9	8
Patient refused transplant	1	0	0
Improved, transplant not needed	1	5	8
Too sick for transplant	1	5	4
Other	11	9	10

Table LU 16. Demographic characteristics of pediatric lung transplant recipients, 2008-2010 and 2018-2020
Pediatric lung transplant recipients, including retransplants. Distance is computed from recipient's home zip code to the transplant center.

Characteristic	2008-10, N	2008-10, Percent	2018-20, N	2018-20, Percent
Age: < 1 year	13	7.5%	14	10.9%
Age: 1-5 years	19	11.0%	10	7.8%
Age: 6-10 years	22	12.7%	15	11.7%
Age: 11-17 years	119	68.8%	89	69.5%
Sex: Female	101	58.4%	74	57.8%
Sex: Male	72	41.6%	54	42.2%
Race/ethnicity: White	130	75.1%	84	65.6%
Race/ethnicity: Black	10	5.8%	14	10.9%
Race/ethnicity: Hispanic	23	13.3%	23	18.0%
Race/ethnicity: Asian	7	4.0%	2	1.6%
Race/ethnicity: Other/unknown	3	1.7%	5	3.9%
Height: < 70 cm	16	9.2%	13	10.2%
Height: 70-< 90 cm	10	5.8%	6	4.7%
Height: 90-< 110 cm	8	4.6%	7	5.5%
Height: 110-< 130 cm	26	15.0%	16	12.5%
Height: ≥ 130 cm	113	65.3%	86	67.2%
Insurance: Private	82	47.4%	66	51.6%
Insurance: Medicaid	74	42.8%	51	39.8%
Insurance: Unknown	17	9.8%	11	8.6%
Geography: Metropolitan	131	75.7%	101	78.9%
Geography: Non-metro	42	24.3%	27	21.1%
Distance: < 50 miles	43	24.9%	41	32.0%
Distance: 50-<100 miles	26	15.0%	9	7.0%
Distance: 100-<150 miles	8	4.6%	10	7.8%
Distance: 150-<250 miles	27	15.6%	30	23.4%
Distance: ≥ 250 miles	64	37.0%	32	25.0%
Distance: Unknown	5	2.9%	6	4.7%
All recipients	173	100.0%	128	100.0%

Table LU 17. Clinical characteristics of pediatric lung transplant recipients, 2008-2010 and 2018-2020
Pediatric lung transplant recipients, including retransplants. Pediatric priority was reported in 2010 and later. ECMO, extracorporeal membrane oxygenation.

Characteristic	2008-10, N	2008-10, Percent	2018-20, N	2018-20, Percent
Diagnosis: Cystic fibrosis	89	51.4%	49	38.3%
Diagnosis: Pulmonary hypertension	23	13.3%	21	16.4%
Diagnosis: Pulmonary fibrosis	14	8.1%	6	4.7%
Diagnosis: Other vascular	6	3.5%	3	2.3%
Diagnosis: Other/unknown	41	23.7%	49	38.3%
Blood type: A	64	37.0%	47	36.7%
Blood type: B	21	12.1%	16	12.5%
Blood type: AB	13	7.5%	4	3.1%
Blood type: O	75	43.4%	61	47.7%
Medical condition: Hospitalized in ICU	37	21.4%	49	38.3%
Medical condition: Hospitalized, not ICU	44	25.4%	10	7.8%
Medical condition: Not hospitalized	92	53.2%	69	53.9%
Medical urgency: priority 1			39	30.5%
Medical urgency: priority 2			5	3.9%
Medical urgency: LAS <30	2	1.2%	2	1.6%
Medical urgency: LAS 30-<35	27	15.6%	20	15.6%
Medical urgency: LAS 35-<40	39	22.5%	26	20.3%
Medical urgency: LAS 40-<50	14	8.1%	13	10.2%
Medical urgency: LAS 50-<60	8	4.6%	5	3.9%
Medical urgency: LAS ≥60	21	12.1%	18	14.1%
Medical urgency: Unknown	56	32.4%	0	0.0%
Vent/ECMO at transplant: Vent + ECMO	3	1.7%	9	7.0%
Vent/ECMO at transplant: Vent only	32	18.5%	13	10.2%
Vent/ECMO at transplant: ECMO only	2	1.2%	16	12.5%
Vent/ECMO at transplant: Neither	136	78.6%	90	70.3%
All recipients	173	100.0%	128	100.0%

Table LU 18. Transplant characteristics of pediatric lung transplant recipients, 2008-2010 and 2018-2020
Pediatric lung transplant recipients, including retransplants.

Characteristic	2008-10, N	2008-10, Percent	2018-20, N	2018-20, Percent
Wait time: < 31 days	37	21.4%	60	46.9%
Wait time: 31-60 days	36	20.8%	23	18.0%
Wait time: 61-90 days	18	10.4%	13	10.2%
Wait time: 3-< 6 months	36	20.8%	13	10.2%
Wait time: 6-< 12 months	24	13.9%	12	9.4%
Wait time: ≥ 1 year	22	12.7%	7	5.5%
Unknown procedure	2	1.2%	0	0.0%
Bilateral procedure	171	98.8%	128	100.0%
Transplant history: First	157	90.8%	123	96.1%
Transplant history: Retransplant	16	9.2%	5	3.9%
Tx type: Lung only	160	92.5%	116	90.6%
Tx type: Heart-lung	10	5.8%	11	8.6%
Tx type: Other	3	1.7%	1	0.8%
All recipients	173	100.0%	128	100.0%

Table LU 19. Pediatric lung donor-recipient serology matching, 2018-2020
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-	25.0%	13.3%
D-	R+	18.8%	11.7%
D-	R unk	0.0%	0.0%
D+	R-	35.2%	33.6%
D+	R+	19.5%	39.1%
D+	R unk	0.8%	2.3%
D unk	R-	0.8%	0.0%
D unk	R+	0.0%	0.0%
D unk	R unk	0.0%	0.0%

Table LU 20. 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 2016-2019 and 5-year events for recipients in 2012-2015. Recipients of more than one transplant are counted separately per transplant. Bronchiolitis obliterans syndrome (BOS) ceased to be reported after June, 2020.

Event	One-year, N	One-year, Pct	Five-year, N	Five-year, Pct
BOS: None reported	117	75.5%	69	69.7%
BOS: Reported	3	1.9%	30	30.3%
BOS: Unknown	35	22.6%	0	0.0%
Diabetes	6	3.9%	9	9.1%
Malignancy	5	3.2%	8	8.1%
Re-hospitalization	73	47.1%	73	73.7%
Functional status: Fully active	145	93.5%	89	89.9%
Functional status: Min. active	3	1.9%	1	1.0%
Functional status: Bedbound	3	1.9%	2	2.0%
Functional status: Unknown	0	0.0%	7	7.1%
Functional status: Unknown	4	2.6%	0	0.0%
All recipients	155	100.0%	99	100.0%