The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult lung and heart–lung transplantation Report—2019; Focus theme: Donor and recipient size match

Abstract

This 36 th adult lung and heart-lung transplant report summarizes data from 69,200 adult lung and 4,128 adult heart-lung transplants performed through June 30, 2018 and reported to the International Thoracic Organ Transplant Registry. With each year's report, we now provide more detailed analyses on a particular focus theme important to patient outcomes. Since 2013, these have been donor and recipient age; retransplantation; early graft failure; indication for transplant; allograft ischemic time; and multiorgan transplantation. Although widely accepted as critical to decision making at the time of receipt of an organ donor offer, there is surprisingly little literature outlining current practice and the impact of size (mis-)matching on outcomes. Hence, this year's report focuses on an overall theme of donor and recipient size matching. In addition to reporting donor and recipient height and weight difference for all adult lung and heart-lung transplant recipients stratified by transplant type (bilateral or single) and indication, we report historical trends and associations between size match and survival. The Registry's online slide sets include results from additional analyses and complementary information not included in this publication (see https:// ishltregistries.org/registries/slides.asp).

Relaxin Positively Influences Ischemia—Reperfusion Injury in Solid Organ Transplantation: A Comprehensive Review

“…First successful LuTx was performed by James Hardy in 1963 [48]. Since then, more than 69,000 procedures have been performed worldwide with the median survival reaching 6.7 years [49]. Although the survival almost doubled in the last 30 years, efforts are necessary to further improve outcome as the rate of primary graft dysfunction after LuTx can reach 30% [50].…”

Chronic Obstructive Pulmonary Disease and Lung Transplantation

“…ISHLT registry data reveal relative consistent maintenance immunosuppression policies across all jurisdictions, generally comprising prednisolone, a calcineurin inhibitor (CNI), and a cell cycle inhibitor. 1 Due to perceived superiority in preventing acute cellular rejection, 32 tacrolimus has emerged as the CNI of choice in over 90% of LTx recipients, usually combined with either mycophenolate mofetil or azathioprine. 1 CNIs have a relatively narrow therapeutic index, with toxicity being particularly problematic.…”

“…1 Due to perceived superiority in preventing acute cellular rejection, 32 tacrolimus has emerged as the CNI of choice in over 90% of LTx recipients, usually combined with either mycophenolate mofetil or azathioprine. 1 CNIs have a relatively narrow therapeutic index, with toxicity being particularly problematic. 33 This is a complex issue, beyond the scope of this review, but demands a comprehensive understanding of the complex interactions with other common medications by the treating physician and rigorous treatment adherence on behalf of the patient.…”

“…Survival after LTx lags behind most other forms of solid-organ transplantation, with median survival for COPD recipients being a sobering 6.0 years. 1 In the first year, infection and graft failure are the leading causes of death. Beyond this chronic graft rejectioncurrently referred to as chronic lung allograft dysfunction (CLAD)-represents the leading cause of death at all time points, with infection and over time malignancy also limiting survival.…”

“…CLAD is itself a complex entity of considerable heterogeneity, classified according to a combination of physiological and radiological criteria into one of four phenotypes. 2 It is present in 50% of LTx recipients at 5 years, 1 with median survival ranging from 6 to 40 months after onset dependent on form and timing of onset post-LTx. 3 Given this, it is always prudent to consider the natural course of COPD in determining both the necessity and timing of LTx.…”