OPTN/SRTR 2018 Annual Data Report: Lung

Abstract

The primary goal of US lung allocation policy is to ensure that candidates with the highest risk for mortality receive appropriate access to lung transplant. In 2018, 2562 lung transplants were performed in the US, reflecting a 31% increase over the past 5 years. More candidates are being listed for lung transplant, and the number of donors has increased substantially. Despite an increase of 84 lung transplants in 2018, 365 adult candidates died or became too sick to undergo transplant. In 2018, 24 new child (ages 0‐11 years) candidates were added to the lung transplant waiting list. Fifteen lung transplants were performed in recipients aged 0‐11 years, three in recipients aged younger than 1 year, two in recipients aged 1‐5 years, and ten in recipients aged 6‐11 years. Of 27 child candidates removed from the waiting list in 2018, 16 (59.3%) were removed due to undergoing transplant, six (22.2%) due to death, one (3.7%) due to improved condition, and one (3.7%) due to becoming too sick to undergo transplant.

Generation of vascular chimerism within donor organs

“…Those patients who do get an organ, must adhere to lifelong immunosuppressive therapy which expose them to increased risk of serious infection and cancer. In addition, organ transplants may still fail due to chronic rejection, leading to 5-year graft survival rate of around 80% (for kidneys) 26 and 50% (for lungs) 27 .…”

Bioengineering of Pulmonary Epithelium With Preservation of the Vascular Niche

“…Nearly 25 million people suffer from end-stage lung disease in the United States alone, with a staggering ∼400,000 patients dying each year. Lung transplantation, the only definitive treatment for these patients, remains constrained by the severe shortage of donor organs, as only one out of five donor lungs meets the historical criteria for transplant proposed in the 1980s (including: donor age between 20 and 45 years, arterial partial pressure of oxygen (PaO 2 )/fraction of inspired O 2 (FiO 2 ) >350, no smoking history, clear chest X-ray, less than five ventilation days, clear bronchoscopy, negative gram stain of tracheal secretions, ischemic time < 4 h) (Bhorade et al, 2000;Ware et al, 2002;Filosso et al, 2006;Botha et al, 2008;Kotloff and Thabut, 2011;Valapour et al, 2020). The indications for lung transplantation have broadened over time and now include a diverse spectrum of pulmonary diseases of the airway, parenchyma, and vasculature.…”

“…The indications for lung transplantation have broadened over time and now include a diverse spectrum of pulmonary diseases of the airway, parenchyma, and vasculature. Chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and cystic fibrosis (CF) are still the major indications for transplantation, whereas vascular disease such as idiopathic pulmonary arterial hypertension (IPAH) has become a lower indication (Kotloff and Thabut, 2011;Valapour et al, 2020). However, the need for lung transplant continues to exceed the availability of donor organs.…”

“…However, the need for lung transplant continues to exceed the availability of donor organs. Each year approximately 25% of listed patients either die or are too sick to undergo transplant and are removed from the waiting list (Keeshan et al, 2015;Valapour et al, 2020). Unfortunately the graft shortage persists and it is becoming clear that empirical criteria for donor selection are too stringent.…”

Effects of the duration of bridge to lung transplantation with extracorporeal membrane oxygenation

“…However, the shortage of available donor lungs continues to be a huge problem. Waiting list mortality rates are as high as 121.8 deaths per 100 waitlist-years, with mortality rates being particularly high in patients with high severity indices [2]. These findings suggest that a conventional bridging strategy, consisting of invasive mechanical ventilation alone, may be suboptimal in severely ill patients.…”