53: Changes in Adult Lung Transplantation: A UK Survey

Purpose: Lung transplant (LTx) activity is increasing. The UK Cardiothoracic Transplant Audit data was analysed to investigate changes in activity, procedures and outcomes. Methods and Materials: A cohort of first time single (SLTx) and bilateral (BLTx) LTx were grouped as: 07/95–03/99 (era1); 04/99– 03/03 (era2) and 04/03–03/07 (era3). Recipient and donor characteristics were compared using the 2 test (categorical data) or Kruskal Wallis test (continuous data). Survival was estimated using the Kaplan Meier method and compared by the log-rank test. Results: Total activity (n 1245) has increased: era1: n 367, 29%; era2: n 390, 31%; era3: n 488, 39% (p 0.01). BLTx increased over time (era1: 41%; era2: 57%; era3: 69%) with a corresponding decline in SLTx (p 0.01). BLTx was used with increasing frequency for chronic obstructive pulmonary disease (COPD) (era1: 27%; era2: 49%; era3: 59%, p 0.01). Median recipient age has remained unchanged (era1: 51y(IQR 41-56); era2: 51y(IQR 38-57); era3: 52y(IQR 38-57), p 0.18). Although the proportion of recipients with cystic fibrosis has increased (era1: 16%; era2: 22%; era3: 24%) and the proportions with COPD (era1: 37%; era2: 36%; era3: 31%) and interstitial lung disease (era1: 25%; era2: 23%; era3: 22%) have reduced, these changes were not significant (p 0.39). Median donor age has increased (era1: 36y (IQR 24-46); era2: 38y (IQR 26-50); era3: 42y (IQR 27-50), p 0.01) and female donors are used more frequently; (p 0.01). The percentage of traumatic death in donors has declined from 30% in era1 to 17% in era3, (p 0.01). 1-year survival following LTx (expressed as % survival and 95%CI) was superior in the two more recent eras. Conclusions: LTx activity has increased and outcomes have improved. BLTx is used more frequently and the choice of procedure for COPD has changed. Certain donor and recipient characteristics suggest a changing risk profile.