The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-eighth adult lung transplantation report — 2021; Focus on recipient characteristics

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For over 30 years, the International Society for Heart and Lung Transplantation (ISHLT) International Thoracic Organ Transplant (TTX) Registry has gathered data regarding transplant procedures, donor and recipient characteristics, and outcomes from a global community of transplant centers. Almost 70,000 adult lung transplant procedures have been reported to the Registry since its inception, each one providing an opportunity for a recipient with end-stage lung disease to regain quality of life and longevity. With each year's report, we provide more detailed analyses on a particular focus theme important to recipient outcomes. Since 2013, these have been donor and recipient age; retransplantation; early graft failure; indication for transplant; allograft ischemic time; multiorgan transplantation; and donor and recipient size matching.1, 2, 3, 4, 5, 6, 7 In response to a changing regulatory environment, the ISHLT TTX Registry is undergoing an update in data acquisition, and the patient cohort examined in this report is therefore derived from the same data source or datasets as that examined in the 2019 annual reports.2,8, 9, 10 We refer the reader to the 2019 and prior reports for a detailed description of the baseline characteristics of the cohort, and additional core analyses not directly related to the focus explored in this year's report. To complement the 2020 report which focussed on donor characteristics, the goal of this year's report was to focus entirely on changes in recipient factors over the past 3 decades and to identify important recipient characteristics and transplant processes that may influence post-transplant outcomes. Due to small numbers, heart-lung transplant recipient characteristics and transplant outcomes have not been included. This 38th annual adult lung transplant report is hence based on data submitted to the ISHLT TTX Registry on 67,493 adult recipients of deceased recipient transplants between January 1, 1992 and June 30, 2018.

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Data collection, conventions and statistical methods

National and multinational transplant collectives and individual transplant centers submitted data to the ISHLT International TTX Registry. Since the Registry's inception, 481 heart transplant centers, 260 lung transplant centers, and 184 centers that perform combined heart–lung transplants have reported data to the ISHLT TTX Registry.2, 8, 9, 10 This report references specific online e-slides when particular data are discussed but not shown due to space limitations; e-slide numbers refer to

Conclusions

In this 2021 ISHLT TTX Registry Report, we focused on recipient trends over time. We observed many important changes over the years, reflecting changing practice, and demographics worldwide. Lung transplant recipients are ageing, are more likely to be transplanted for fibrosing lung disease, have an increasing BMI, are much more likely to have a history of diabetes mellitus, are more likely to be sensitized, less likely to be CMV seropositive, and more likely to have a history of malignancy.

Disclosure statement

Daniel C. Chambers received travel support from Astellas Pharma, Inc, and served as a consultant and speaker for Roche Ltd; Kiran K. Khush serves as a consultant and speaker for CareDx, Inc; Josef Stehlik serves as a consultant for Medtronic, receives research funding from Natera and receives funding from ISHLT; Michael Perch receives research funding from Roche, travel support from Boeringer-Ingelheim, and is a speaker for Mallinckrodt, Glaxo Smith Kline, and Astra-Zeneca; Wida S. Cherikh,

Acknowledgments

The authors wish to thank Ms. Lyna Cherikh, United Network of Organ Sharing Research Summer Intern, for her assistance with preparing the figures/table for the manuscript, and for reviewing the manuscript.

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