The Registry of the International Society for Heart and Lung Transplantation: Thirty- second Official Adult Lung and Heart-Lung Transplantation Report—2015; Focus Theme: Early Graft Failure  Roger D. Yusen, MD, MPH, Leah B. Edwards, PhD, Anna Y. Kucheryavaya, MS, Christian Benden, MD, Anne I. Dipchand, MD, FRCPC, Samuel B. Goldfarb, MD, Bronwyn J. Levvey, RN, Lars H. Lund, MD, PhD, Bruno Meiser, MD, Joseph W. Rossano, MD, Josef Stehlik, MD, MPH  The Journal of Heart and Lung Transplantation  Volume 34, Issue 10, Pages 1264-1277 (October 2015) DOI: 10.1016/j.healun.2015.08.014 Copyright © 2015 Terms and Conditions

Figure 1 Number of reported adult lung transplants by year and procedure type (transplants: 1985–2013). The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 2 Number and percent of adult lung transplants by center volume and by center geographic location (transplants: January 2009–June 2014). The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 3 Number of adult lung retransplants and percent of all adult lung transplants by year and by center geographic location (retransplants: 1990–2013; Europe [N = 798], North America [N = 1,038], and other [N = 96]). The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 4 Number of adult lung transplants according to major indication and year of transplantation (transplants: 1990–2013). A1ATD, α1-anti-trypsin deficiency associated with chronic obstructive pulmonary disease; CF, cystic fibrosis–associated bronchiectasis; COPD, chronic obstructive pulmonary disease not associated with A1ATD; ILD, interstitial lung disease (includes idiopathic pulmonary fibrosis); IPAH, idiopathic pulmonary arterial hypertension; Retx, retransplant (includes those with a known previous lung or heart-lung transplant).2 The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 5 Adult lung transplant recipient Kaplan-Meier survival by transplant type (transplants: January 1990–June 2013). Conditional median survival is the time to 50% survival for the sub-set of recipients who were alive 1 year after transplantation. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 6 Primary adult lung transplant recipient Kaplan-Meier survival, stratified by procedure type (transplants: January 1990–June 2013). Conditional median survival is the time to 50% survival for the sub-set of recipients who were alive 1 year after transplantation. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 7 Adult lung transplant recipient Kaplan-Meier survival, stratified by era (transplants: January 1990–June 2013). All pair-wise log-rank test comparisons were significant at p < 0.05, except for primary transplants in 1999 to 2008 vs 2009 to June 2013. NA, not available. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 8 Adult lung transplant recipient Kaplan-Meier survival by transplant type and diagnosis (transplants: January 1990–June 2013). All pair-wise log rank test comparisons within diagnoses and between diagnoses for primary transplants were statistically significant (p < 0.05). No pair-wise comparisons between diagnoses for first Retx were statistically significant. CF, cystic fibrosis–associated bronchiectasis; COPD, chronic obstructive pulmonary disease not associated with α1-anti-trypsin deficiency; ILD, interstitial lung disease (includes idiopathic pulmonary fibrosis); Retx, first retransplant. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 9 Adult lung transplant recipient categoric risk factors for mortality within the first post-transplant year (transplants: January 2001–June 2013). ABO refers to blood type matching of donor and recipient; CI, confidence interval; CMV, cytomegalovirus; ICU, intensive care unit; ILD, interstitial lung disease (includes idiopathic pulmonary fibrosis); IPAH, idiopathic pulmonary arterial hypertension; LCL, lower confidence limit; UCL, upper confidence limit. *Retransplant includes those with a known previous lung or heart-lung transplant.2 **Other includes all diagnoses other than chronic obstructive pulmonary disease (COPD) with or without α1-anti-trypsin deficiency, ILD, bronchiectasis with or without cystic fibrosis, IPAH, sarcoidosis, retransplant, lymphangioleiomyomatosis, and connective tissue disease. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 10 Hazard ratio for mortality within the first post-transplant year for adult lung transplant recipient age and center volume (transplants: January 2001–June 2013). The dashed lines represent 95% confidence intervals. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 11 Adult lung transplant recipient categoric risk factors for mortality within the first 5 post-transplant years (transplants: January 2001–June 2009). All variables included in the model used pre-transplant data. CI, confidence interval; CF, cystic fibrosis–associated bronchiectasis; CMV, cytomegalovirus; COPD, chronic obstructive pulmonary disease not associated with α1-anti-trypsin deficiency; ICU, intensive care unit; LAM, lymphangioleiomyomatosis; LCL, lower confidence limit; UCL, upper confidence limit. *Retransplant includes those with a known previous lung or heart-lung transplant.2 The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 12 Adult lung transplant recipient categoric risk factors for mortality within the first 5 post-transplant years, conditional on survival in the first year (transplants: January 2001–June 2009). A1ATD, α1-anti-trypsin deficiency associated with chronic obstructive pulmonary disease; A mismatch, human leukocyte antigen A mismatch between donor and recipient; BOS, bronchiolitis obliterans syndrome; COPD, chronic obstructive pulmonary disease not associated with A1ATD; CF, cystic fibrosis–associated bronchiectasis; CMV, cytomegalovirus; ICU, intensive care unit; IL-2R, interleukin-2 receptor antagonist; IPAH, idiopathic pulmonary arterial hypertension; ILD, interstitial lung disease (includes idiopathic pulmonary fibrosis); LAM, lymphangioleiomyomatosis; LCL, lower confidence limit; UCL, upper confidence limit. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 13 Adult lung transplant recipient freedom from bronchiolitis obliterans syndrome, by transplant type, conditional on survival to 14 days (transplant follow-up: April 1994–June 2014). The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 14 Cumulative incidence of early graft failure (EGF) by transplant type (transplants: January 2005–December 2013). EGF defined by death or retransplant, associated with graft failure, within 30 days after transplant. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 15 Number and percentage of adult primary lung transplants with early graft failure (EGF) by EGF type and by year (for 27,438 transplants: January 2005–December 2013). EGF defined by death or retransplant, associated with graft failure, within 30 days after transplant. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 16 Number and percentage of first adult lung retransplants with early graft failure (EGF) by EGF type and by year (for 1,239 first retransplants: January 2005–December 2013). EGF defined by death or retransplant, associated with graft failure, within 30 days after transplant. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 17 Donor and recipient characteristics for adult primary lung transplants and percentage of patients with early graft failure (EGF) defined by death or retransplant, associated with graft failure, within 30 days after transplant (for 27,438 transplants: January 2005–December 2013). A1ATD, α1-anti-trypsin deficiency associated with chronic obstructive pulmonary disease; CF, cystic fibrosis–associated bronchiectasis; CI, confidence interval; COPD, chronic obstructive pulmonary disease not associated with A1ATD; ILD, interstitial lung disease (includes idiopathic pulmonary fibrosis); IPAH, idiopathic pulmonary arterial hypertension; LCL, lower confidence limit; UCL, upper confidence limit. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 18 Adult lung transplant recipient categoric risk factors for early graft failure (EGF), defined by death or retransplant, associated with graft failure, within 30 days after transplant (for 13,621 transplants: January 2005–December 2013). ABO, refers to blood type matching of donor and recipient; CF, cystic fibrosis–associated bronchiectasis; CI, confidence interval; COPD, chronic obstructive pulmonary disease not associated with α1-anti-trypsin deficiency; ICU, intensive care unit; ILD, interstitial lung disease (includes idiopathic pulmonary fibrosis); IPAH, idiopathic pulmonary arterial hypertension; LCL, lower confidence limit; UCL, upper confidence limit. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 19 Number of adult heart-lung transplants by year (transplants: 1982–2013). This figure includes only the adult heart-lung transplants that were reported to the International Society for Heart and Lung Transplantation Registry and does not represent the number of adult heart-lung transplants performed worldwide. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 20 Number and percent of adult heart-lung transplants by center volume and by geographic location (transplants: January 2009–June 2014). The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 21 Adult heart-lung transplantation according to major indication and year of transplantation (transplants: 1990–2012). A1ATD, α1-anti-trypsin deficiency associated with chronic obstructive pulmonary disease; COPD, chronic obstructive pulmonary disease not associated with A1ATD; IPAH, idiopathic pulmonary arterial hypertension. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 22 Adult heart-lung transplant diagnosis distribution by location (transplants: January 2004–June 2014). Excluded were 58 transplants with unknown diagnoses (Europe, 55; North America, 0; other, 3). IPAH, idiopathic pulmonary arterial hypertension; IPF, idiopathic pulmonary fibrosis. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 23 Adult heart-lung transplant recipient Kaplan-Meier survival by transplant type (transplants: January 1982–June 2013). Conditional median survival is the time to 50% survival for the sub-set of recipients who were alive 1 year after transplantation. NA, not available. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 24 Adult heart-lung transplant freedom from coronary artery vasculopathy (CAV) and bronchiolitis obliterans syndrome (BOS; adult heart-lung follow-up: April 1994–June 2014). The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 25 Cumulative incidence of early graft failure (EGF) in primary adult heart-lung transplant recipients (transplants: January 2005–December 2013). EGF defined by death or retransplant, associated with graft failure, within 30 days after transplant. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 26 Number and percent of adult primary heart-lung transplants with early graft failure (EGF) by EGF type and by year (for 687 primary transplants: January 2005–December 2013). EGF defined by death or retransplant, associated with graft failure, within 30 days after transplant. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions

Figure 27 Donor and recipient characteristics for adult primary heart-lung transplants with early graft failure (EGF) defined by death or retransplant, associated with graft failure, within 30 days after transplant (for 687 primary transplants: January 2005–December 2013). IPAH, idiopathic pulmonary arterial hypertension. The Journal of Heart and Lung Transplantation 2015 34, 1264-1277DOI: (10.1016/j.healun.2015.08.014) Copyright © 2015 Terms and Conditions