The international lung transplant database: Demographics and outcomes in 826 lung transplant recipients

The international lung transplant database: Demographics and outcomes in 826 lung transplant recipients

86 Abstracts The Journal of Heart and Lung Transplantation January 1999 calculate mean survival post-LT for CF pts (KaplarMeier). For each active pt...

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86

Abstracts

The Journal of Heart and Lung Transplantation January 1999 calculate mean survival post-LT for CF pts (KaplarMeier). For each active pt in the CFFPR with > 5yr of data by 1996, we optimized LT timing by maximizing expected survival over all possible LT dates, using survival based on pro)ectad FEVl%. arid assuming a mean p< survival of 4.lyr. We chose pts &Oyr of age, without B. cepacia whose projected LT date would be within 5yr.

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RESULTS: In 1996,969l active CF pts had &yr of data in the CFFPR. Using our model. 939 I9891 (9.5%) pts derived some survival benefit fmm LT. However, only 269 I939 (2%) of these pts gained rlyr addttlnal life wtth LT (x=1.4yr, rage 1.0.2.2yr) beyond their predicted death date without LT. Most of these pts had a rapid decline in FEVl% over time (x=3.7% I yr, range 1.7.8.1% / yr) compared to the CF population as a whole. Some of these pts were selected on the basis of their FEVl% atone. The FEVl% varied widely (x = 21%, range lo-40%). CONCLUSIONS: Using powerful mathematical and statistical tools, survival for individual CF pts and optimal timing of LT can be accurately predicted. Our model suggests that the mabrity of CF pts meeting the criteria for LT will not derive a e&n&ant suwival benefi~ fmm LT. However, CF pts with a rapid decline in FEV1% over time are a clinically identifiable subgroup likely to benefit from LT.

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was 5.5 (range O-15) and varied greatli by &.ntcr. Ioimutiosuppressive’ regimens post-TX nearly all included steroid and the majority combmed steroids with cyclosporine and azathioprinc for long-term maintenance. v: Initial findings of the database are in agreement with previously reported data on LTx patient demographics and outcomes. Data are reflective of 12 international centers’

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PULMONARY VOLUME INCREASES WITH LINEAR GROWTH IN PEDIATRIC LIVING DONOR LOBAR LUNG TRANSPLANT RECIPIENTS. MS Woo, EF MacLaogblin, MV Horn, VA Starnes. Cardiitbomcic Transplant Team. Childrens Hospital Los Angeles. University of Southern California School of Medicine. Los Angeles, California. USA.

MAXIMIZING THORACIC ORGAN TRANSPLANT (TOTX) OPPORTUNITIESTHE IMPORTANCE OF EFFICIENT CO-ORDINATION. AP Crifitbs, LM Macfarlane, E Gabbay, T Shirashi, TJ Williams, DS Bsmorc & GI Snell. Heart&Lung Transplant Service, Alfred Hospital, Prahran, Australia. In Australia, despite large distances and one of the world’s lowest donor rates (ll.S/million pop/year), the TOTx rate of IO/million population/year is the second highest in published literature. To achieve this, a system of transplant co-ordination and organ allocation has evolved at the Al&cd Hospital that has seen increasuJ efliciency in thoracic organ utilisation. Method. In Australia, organs are assigned locally, or between the 4 states with TOTx units on rotation. Unlike UNOS, the recipient team then selects appropriate recipients. matching by blood group, size, CMV status, and prospective cross matching. An experienced recipient coordinator takes responsibility for organisation of the retrieval and transplant process, including all operating room staIT(up to 3 OR’s), all medical personnel, and transport for the donor team and the potential TOTx recipients (up to 2,000 mites away). Results Between February 1989 and December 1997, 276 heart (19 dominoes), 48 heart/lung, 95 single and 98 bilateral lung transplanrs were performed from 723 donor offers of which 4 11 were accepied (48% beyond 500miles). This represents 1.9 organs transptanted&horaci donor and campares favourably to UNOS and European figures. The increase of TOTx /donor since 1992 has been achieved via an enlarged TOTx team and the optimising of donor criteria and co-ordination logistics. 80

Transplanting adult lobes into children with end-stage lung disease is an alternative to cadaveric lung procedures. Do transplanted mature lobes increase in size as the pediatric recipient grows? To help answer this question, we compared the changes in linear growth and lung volumes in I4 pts (7 males: 7 females) who had bilateral living donor lobar long transplantation (LD) and compared them to 9 pts (4 males: 5 females, p>O.5, ns) who received whole cadaver& lungs (CL). Data collected included demographics and total lung capacity (TLC) from the time of fust pulmonary function test aflex transplantation to 1.5-4.5 yrs after the transplant surgery. Results were compared between the groups using unpaired Student’s t-test. LD mean age was 13.8 f 3.8 ym [SD] and CL age was 12.2 f 3.0 ym (p=O.30, ns). During the study period, LD pts grew 5.013.8 cm and CL pts grew 5.0+ 3.2 cm (p=O.83, ns). The change in TLC was 0.98+ 0.65 liters for the LD pts and 0.22+ 0.55 liters for the CL group @Co.0 I, significant). We conclude that pediaeic LD pts have significantly greater increase in lung volume during linear growth as compared to CL recipients. This increase in total lung capacity occurs despite LD pts receiving mature lobes rather than whole lungs. We speculate that the significantly increased lung volumes during linear growth may be due to decreased incidence of bronchiolitis obliterans, pulmonary hyperplasia, or new long growthlalveolariuction.

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OPTIMAL TIMING OF LUNG TRANSPLANTATION IN CYSTIC FIBROSIS PATIENTS. BC Cahill’, TG L&I’, BC Marshall’, S FihSimmuns’, JR Hodal’, FR Adler’. Deparlments. 01 ‘Internal Medicine, ‘Math, and ‘Biology, University of Utah. +Cystic Fibrosis Foundation, Bethesda, MD. BACKGROUND: The use of lung transplantation (LT) as therapeutic modality for cystic fibrosis patients (CF pts) is highly constrained by limtted organ availability and uncertainty in the optimal timing of the procedure. Longitudinal data on CF morbidity and survival, as well as survival afler LT is avaibble to address the timing question. METHODS: We developed models of survival for CF pts with and without LT. We used the CF Foundation Patiint Registry (CFFPR) to model FEVl% decline (linear mixed effects models, Ime function in Spkrs) and survival (life table analysis). We used UNOS data to

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Conclusion The Australian TOTn model has enabled high transplant rates by efficiently using the available donor organs. A key to this is the necessity for expxienced staff to enable the co-ordination of multiple thoracic procedures simultaneously.

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COOPERATIVE PROCUREMENT FOR LUNG TRANSPLANTATION IMPROVES ORGAN UTILIZATION WITHOUT INCREASING COMPLICATIONS. Mark D. Iannettoni; M S Mulligan; L M Zaremba; J A Edwards, M B Orringer; Thoracic Sorgmy, University of Michigan, Arm Arbor, MI, USA PURPOSE: To determine if there is a di&mnce in acute survival for lungs procured by thoracic pmcorement teams not involved with the transplanting institution compared to that of the transplanting instihltion compared to that of the !mnsplanting institutions own procurement team. Fifteen lungs harvested over a one year period by cooperative METHODS: instihltions (CI) without support staff from UMI were compared with 10 consecutive organs harvested by oar (UMI) procurement teams. Procured lungs were evaluated for ischemic time, length of intabatlon, postoperative complications, and length of stay. RESULTS: There were no significant differences in any of the measured parameters for lungs procured by CI compared to lungs procured by UMI. Ischemic times were 236 minutes vs. 214 minutes for CT and UMI respectively. There were 2 episodes of reper&sion injury one in each group, requiring prolonged intobation. With exception to these 2 cases