2002/N 20/12/02 9:57 am Page 1 Factsheet 2002/2 Lung and heart-lung transplantation Public Health Sciences Dept., St George’s Hospital Medical School, Cranmer Terrace, London SW17 0RE email@example.com http://www.sghms.ac.uk/depts/laia/laia.htm Lung and heart-lung transplants were first successfully Figure 1: Numbers of heart-lung and lung completed two decades ago. Since then they have been transplants in UK and Ireland, 1991- 2001 increasingly considered for patients with certain lung diseases where no other treatment is available, in order to improve very limited life expectancy or very poor quality of 180 Lung Heart-lung life. 160 52 57 53 This factsheet presents data from the National Transplant 140 44 50 120 Database on heart-lung and lung transplants in the UK and 78 52 35 52 33 32 100 the Republic of Ireland since 1991, published by UK 80 Transplant (see footnote). 116 60 115 112 95 103 110 98 91 Trends 40 73 88 93 20 Heart-lung transplants were the first to be implemented, 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 initially in cases where there was pulmonary vascular Year disease and later for those with certain other lung diseases and complex heart defects. In the UK they are often used for patients with cystic fibrosis. Over time there have been more lung only transplants, both single and double. Very occasionally lobes from lung donors have been Figure 2: Trend in cause of death in lung donors in transplanted. UK and Ireland, 1989-2001 There were 1632 heart-lung and lung transplants from 1991 to 2001, of which two-thirds were lung transplants (figure 1000 N = 944 (100%) N = 868 1). There has been no clear trend over the period with 900 20% (100%) Other between 125 and 169 transplants being carried out each 800 23% Road Traffic Accidents Intracranial causes year. 700 600 33% 21% The highest number of heart-lung transplants during this 500 period was 78 in 1991. Over recent years the number has 400 been about 50 per year. 300 46% 56% 200 In contrast, the number of lung transplants increased from 100 73 in 1991 to a peak of 116 in 1996. Since then numbers 0 1996-2001 have been stable at around 100 per year. 1989-1995 Period Cause of death of donor Eighteen percent of all donors' lungs were utilised for lung transplantation in the period 1996-2001. The main cause of Figure 3: Recipient and donor ages in heart-lung death of donors for whom lungs have been retrieved was and lung transplants, 1997-2001 UK and Ireland intracranial causes (which includes intracranial bleeding) though patterns have changed over time. As Road Traffic Accidents (RTA) have fallen due to improvements in safety, 50 so too have the number of lungs retrieved from RTAs. These 45 Heart-lung Lung fell from 316 in the period 1989-95 (a third of lungs 40 35 retrieved) to 182 in 1996-2001 (a fifth). At the same time 30 lungs retrieved from deaths due to intracranial causes rose 25 moderately increasing the proportion of these deaths from 20 46% to 56% while the number (and proportion) of deaths 15 for other causes has remained stable. 10 Age 5 0 0-5 6-11 12-1718-3435-49 50-59 60-64 65+ 0-5 6-11 12-1718-3435-4950-59 60-64 65+ Heart-lung transplants were carried out in people aged up to Recipients Donors 55 years (figure 3). Fifteen percent of heart-lung transplants and four percent of lung transplants in recent years were in Supported by: • British Lung Foundation • National Asthma Campaign • British Thoracic Society 020 7831 5831 020 7226 2260 020 7831 8778 2002/N 20/12/02 9:58 am Page 2 the under 18s. Single / double lung transplants were carried Figure 4: Primary disease of heart / lung recipient out in an older range of patients from teenagers to the over UK & Ireland, 1997-2001 65s. Congenital heart Emphysema disease 4% 2% Other heart disease Donors were younger than recipients with the under 18s Unknown/not 1% providing 28% of heart-lung and 11% of lung transplant reported 4% donors. Twenty-three percent of heart-lung and fifteen Fibrosing lung disease 5% Cystic fibrosis percent of lung transplants were from donors from an older 45% age band (not shown). Other 8% Primary disease of recipient Between 1997 and 2001 heart-lung transplants were most often carried out in those with cystic fibrosis (45%) and Eisenmengers 10% primary pulmonary hypertension (21%) (figure 4). Ten percent of recipients suffered from Eisenmenger's Primary pulmonary syndrome, a congenital heart problem that leads to hypertension pulmonary hypertension. Recipients of lung transplants in 21% the same period included those with emphysema (33%), a fibrosing lung disease (23%), cystic fibrosis (19%) or a congenital heart/lung disease (15%) (figure 5). Figure 5: Primary disease of lung only recipient Survival UK & Ireland 1997 - 2001 From the time of the operation and for the rest of their lives Primary pulmonary Other congenital heart/lung hypertension patients must take immunosuppressive medications to try to 1% disease 2% suppress rejection of the transplanted graft. Graft rejection Cystic fibrosis Other is common within the first 3-6 months post transplantation. 19% 19% During this period immunosuppressive therapy is intense leading to increased risks of serious infections. After the Unknown/not reported 2% first year the main causes of death are infection and bronchiolitis obliterans, an obstructive lung disease. Unlike other organ transplants, the lungs are constantly exposed to inhaled environmental pathogens. Lung and heart-lung transplants have lower survival rates than heart or liver Fibrosing lung disease 23% Emphysema transplants. The 1, 3 and 5 year survival rate estimates for 34% heart-lung transplants were 69%, 59% and 47% respectively (figure 6). Survival estimates for lung transplantation were comparable at 76%, 57% and 42%. Summary Figure 6: Estimates of percentage surviving after 1, 3 and 5 years for heart-lung and lung only • During 1991-2001 there were 538 heart-lung and transplants, with 95% confidence intervals, UK & 1094 lung transplants in the UK and the Ireland 2000 Republic of Ireland. 100 • In 1989 to 1995, 33% of lung donors were from 90 Road Traffic Accidents compared to 21% in 80 1996 –2001. 70 60 • Heart-lung transplants were most commonly 50 carried out in those with cystic fibrosis and 40 30 pulmonary hypertension. 20 • The most common reasons for a lung only 10 0 transplant were emphysema, fibrosing lung 1 year 3 year 5 year 1 year 3 year 5 year disease and cystic fibrosis. Heart & Lung Lung • The 5 year survival rate was 47% for heart-lung transplants and 42% for lung transplantation in 1994/1995. Statistics were prepared by UK Transplant from the National Transplant Database maintained on behalf of transplant services in the UK and Republic of Ireland. UK Transplant is a Special Health Authority established in 1991. See their web site for more details: www.uktransplant.org.uk. Our thanks to UK Transplant for permission to use their data.
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