OPTN/SRTR 2016 Annual Data Report: Lung

Abstract

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

Use of Hepatitis C Positive Organs: Patient Attitudes in Urban Chicago

“…This survey analysis showed that more non-kidney transplant candidates (liver, heart, and lung) were willing to accept an HCV-positive organ compared to kidney transplant candidates, although this difference was not statistically significant (p = 0.05). This difference may indicate that the lack of a suitable alternative such as dialysis for the end-stage disease of these organs (although left ventricular assist devices are being used for heart failure) coupled with higher waitlist mortality rates may lead non-kidney transplant candidates toward pursuing HCV-positive organ transplantation more eagerly [2,3,31,32].…”

Frailty phenotypes and mortality after lung transplantation: A prospective cohort study

“…Despite stringent selection criteria and advances in surgical and medical therapies, mortality after lung transplantation is high and has not improved in the last 5 years (1). …”

“…While achieving its primary aim, a consequence of the Lung Allocation Score (LAS) system is that older and sicker candidates are prioritized for transplantation. As a result, older adults (age ≥65) are the fastest growing group of lung transplant candidates in the U.S., now accounting for nearly 30% of new transplant recipients compared to only 4% in 2002(1). After lung transplantation, those 65 years and older have a median survival of only 3.6 years, fully three years less than those 35–49 years old (3).…”

“…Absent better approaches, transplant programs have adopted admittedly arbitrary age cutoffs or “eyeball tests” of fitness to identify suitable candidates. Although known risk factors for death such as age, functional status, oxygen use, and others are already incorporated into LAS, increasing waitlist mortality rates and persistently high mortality after lung transplantation underscore the need to identify novel, ideally modifiable, risk factors for poor outcomes (1). Doing so will help to maximize the individual and societal benefit of a scarce resource such as lung transplantation (2).…”

Balancing fairness and efficacy in lung allocation for transplantation: unfinished business

“…While the field of lung transplantation has evolved considerably since the first lung transplant with long-term success was performed in 1983,1 the need for donated lungs to help patients with progressive end-stage lung diseases that do not respond to non-transplant therapies continues to outstrip the availability of lungs from organ donors 2. Many patients with certain types of lung disease or other characteristics such as short stature or ABO blood type O may be less likely to receive an organ offer than those with different profiles and are, therefore, more at risk to die while waitlisted and awaiting lung transplantation 3 4.…”