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University Hospital Gasthuisberg Leuven Belgium

Predictive factors for long-term survival after lung transplantation; a review in a single large-volume center. A. Demir, G.M. Verleden, L. Dupont, G. Van Helleputte, W. Coosemans, H. Decaluwé, P. De Leyn, Ph. Nafteux, T.Lerut , D. Van Raemdonck. University Hospital Gasthuisberg Leuven Belgium.

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University Hospital Gasthuisberg Leuven Belgium

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  1. Predictive factors for long-term survival after lung transplantation; a review in a single large-volume center A. Demir, G.M. Verleden, L. Dupont, G. Van Helleputte, W. Coosemans, H. Decaluwé, P. De Leyn, Ph. Nafteux, T.Lerut , D. Van Raemdonck University HospitalGasthuisberg Leuven Belgium

  2. AVERAGE CENTER VOLUMELung Transplants: January 1, 2000 - June 30, 2008 ISHLT 2009

  3. NUMBER OF LUNG TRANSPLANTS REPORTED BY YEAR AND PROCEDURE TYPE NOTE: This figure includes only the lung transplants that are reported to the ISHLT Transplant Registry. As such, this should not be construed as representing changes in the number of lung transplants performed worldwide. ISHLT 2009

  4. AGE DISTRIBUTION OF LUNG TRANSPLANT RECIPIENTS(1/1985-6/2008) ISHLT 2009

  5. DONOR AGE DISTRIBUTION FOR LUNG TRANSPLANTS (1/1985-6/2008) ISHLT 2009

  6. Aim • Long- term survival after lung transplantation (LTx) may vary between patients as a result of increased risk factors both in the donor and in the recipient. • The objective of this retrospective study was to analyze factors from a prospective database that are predictive for long-term survival in our lung transplant cohort.

  7. Patients and Methods • Donor variables (age, gender, smoking, cytomegalovirus, PaO2/FiO2, mechanical ventilation time, cause of death and cold ischemic time) • Recipient variables (age, gender, cytomegalovirus, underlying lung disorder and LTx type) • Analysed for long-term survival in a univariate and multivariate analysis

  8. Patients and Methods • Between July 1991 and December 2009 • 258 females and 203 males • Mean age:48 years [13-69 years]. • 461 consecutive LTx • Single (n=149) • Bilateral (n=312)

  9. Patients and Methods • Indications for LTx • emphysema (n=193) • pulmonary fıbrosis (n=85) • cystic fibrosis (n=68) • alfa-1-antitrypsin deficiency (n=33) • pulmonary hypertension (n=16) • others (n=66)

  10. ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis(Transplants: January 1990 – June 2007) Survival comparisons Alpha-1 vs. CF: p < 0.0001Alpha-1 vs. COPD: p < 0.0001 Alpha-1 vs. IPF: p < 0.0001Alpha-1 vs.Sarcoidosis: p = 0.0380 CF vs. COPD: p < 0.0001CF vs. IPF: p < 0.0001 CF vs. IPAH: p < 0.0001 CF vs. Sarcoidosis: p < 0.0001 IPAH vs. IPF: p = 0.0046 COPD vs. IPF: p < 0.0001 Note: Other comparisons are not statistically different. ISHLT 2009

  11. ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis(Transplants: January 1990 – June 2007) Survival comparisons Alpha-1 vs. CF: p < 0.0001 Alpha-1 vs. COPD: p < 0.0001 Alpha-1 vs. IPF: p < 0.0001 Alpha-1 vs.Sarcoidosis: p = 0.0380 CF vs. COPD: p < 0.0001 CF vs. IPF: p < 0.0001 CF vs. IPAH: p < 0.0001 CF vs. Sarcoidosis: p < 0.0001 IPAH vs. IPF: p = 0.0046 COPD vs. IPF: p < 0.0001 ISHLT 2009

  12. ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1994 - June 2007) ISHLT 2009

  13. ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Age Group(Transplants: January 1990 – June 2007) ISHLT 2009

  14. ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Gender(Transplants: January 1990 – June 2007) ISHLT 2009

  15. ADULT LUNG TRANSPLANTS(1/1995-6/2007)Diagnosis = IPFRisk Factors for 1 Year MortalityIschemia Time ISHLT 2009

  16. In a univariate analysis • Donor • Gender (p<0.05) • Cold ischemic time (p<0.0001) • Recipient • Age (p<0.05) • Gender (p<0.001) • Underlying lung disorder (p<0.01) • LTx type (p<0.000)

  17. In a multivariate analysis • The following recipient variables remained independent negative prognostic factors of survival: • Age <20 years (p<0.05) • Male gender (p<0.05) • Pulmonary hypertension (p<0.05) • Single LTx ( p<0.01).

  18. Conclusion • Patientsyounger than 20 years (H.R 0.3) andthose with pulmonary hypertensive disease(H.R 2.7)have an increased risk of inferior survival after LTx . • Female recipients (H.R 0.5) and bilateral lung recipients (H.R 2.5) experience better long-term survival

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