Eighty-four percent more lung transplants in Canada over 10 years

As survival rates improve and transplant numbers increase, so do the number of patients waiting for new lungs

December 18, 2008—Since the world’s first successful lung transplant was performed in

Canada 25 years ago, the number of lung transplants performed annually has grown significantly. A new report released today by the Canadian Institute for Health Information (CIHI) shows that lung transplants in Canada increased from 93 in 1997, to 171 in 2006, rising at a faster rate than solid organ transplants in general (up 29% over the same period).

The report, Treatment of End-Stage Organ Failure in Canada, 1997 to 2006, draws on data from CIHI’s Canadian Organ Replacement Register (CORR) to examine dialysis, transplantation and organ donation characteristics and trends in Canada over a 10-year period. In total, 1,222 lung transplants were performed in this country between 1997 and 2006. Patients receiving double-lung transplants accounted for 75% of the procedures performed in 2006, a number that more than doubled since 1997 (from 52 to 129).

“The lung transplant landscape has evolved a great deal in a short span of time, offering a new lease on life to a growing number of Canadians with lung disease,” says Margaret Keresteci, CIHI’s manager of Clinical Registries. “Although these transplants are technically very difficult to perform, outcomes have improved significantly. Just a decade ago, the likelihood that a child with cystic fibrosis would live to see his or her 18th birthday was doubtful, but transplantation has changed this reality. While the numbers remain relatively small, lung transplants have increased at a rate greater than kidney, heart or liver transplants.”

Survival rates continue to improve

Over a similar time frame, the three-year survival rate for lung transplant recipients increased from 60% in 1997, to 80% in 2003.

“There are several reasons why outcomes for lung transplant recipients have continued to improve,” says Dr. Shaf Keshavjee, Director of the Toronto Lung Transplant Program at Toronto General Hospital. “In addition to advances in immunosuppression, better organ preservation techniques have been developed and there continue to be advancements in the management and monitoring of lung transplant recipients.”

Canada a world leader

The world’s first successful lung transplant was performed in Canada in 1983, followed by the first bilateral (or double-lung) transplant in 1986. Canada’s lung transplant experience is highly regarded internationally, and the country’s lung transplantation rate is 5.3 per million population (PMP), compared to 4.7 PMP in the United States and 2.9 PMP in France. Canada’s success in lung transplantation is in part due to the increase in living donors. Today in Canada, there are six lung transplant programs in five provinces, two of which perform living donations.

Canada has lower transplantation rates than both the United States and France for other types of organs, such as heart transplants (5.4 PMP in Canada, versus 7.3 in the U.S. and 5.8 in France) and liver transplants (14.2 PMP in Canada, versus 22.2 in the U.S. and 16.7 in France).

Waiting times for transplants grow

Advances in treatment opened up lung transplants as a possibility for more patients, which led to a corresponding growth in the number of people waiting for transplantation. Over 10 years, the number of people waiting for a lung transplant more than doubled, with 252 Canadians waiting to receive a transplant in 2006, compared to 119 in 1997. Between 1997 and 2006, 299 people died while waiting for a lung transplant in Canada.

“End-stage organ failure continues to present complex issues and challenges for Canadian clinicians, the health care system and patients,” says Keresteci. “Treatment options are evolving, but only through the systematic collection of data can sound information be produced. It is the intent of this report to provide such information in an effort to improve the health of Canadians with end-stage organ failure.”

Other highlights from Treatment of End-Stage Organ Failure in Canada, 1997 to 2006:

• The total number of solid organ transplants in Canada increased from 1,620 in 1997, to 2,087 in 2006.
• There were an estimated 33,832 people with end-stage renal disease (ESRD), or kidney failure, in Canada at the end of 2006, an increase of 70% since 1997. Of these, 20,465 were on dialysis and 13,367 were living with a functioning kidney transplant.
• Liver transplantation underwent tremendous innovation in technique that vaulted it to the forefront as the treatment of choice for end-stage liver disease in Canada. There were
• 466 liver transplants performed in Canada in 2006, a 33% increase compared to 1997. Advances in treatment increased demand for liver transplants, with the number of patients waiting for a liver up from 42 to 129 over 10 years.
• Between 1997 and 2006, 1,575 Canadians received a first heart transplant, and 58 were re-transplanted. On average, there were 163 heart transplants performed each year in Canada. In 2006, there were 87 Canadians waiting for a heart transplant, with 13 deaths occurring while people were on the waiting list. Between 1997 and 2006, the number of patients awaiting heart transplants decreased 10%, while the number of deaths on the waiting list decreased by more than half.
• There were 603 pancreatic transplants performed in Canada in the last decade, two-thirds of which were simultaneous pancreas–kidney transplants. The number of Canadians waiting for simultaneous transplants peaked in 2001 (172), and dipped to 113 in 2006. Since 1997, the number of individuals waiting for a single pancreas transplant increased from 8 to 63.
• Small intestine transplantation is an emerging and evolving field. Between 1988 and 2006, there were 45 procedures performed in Canada, with 53% of recipients younger than 18 years.

About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.

Media contacts

Leona Hollingsworth
416-481-2002 ext. 3251
Cell: 416-459-6855
lhollingsworth@cihi.ca

Jennie Hoekstra
613-241-7860 ext. 4331
Cell: 613-725-4097
jhoekstra@cihi.ca

Report

Information about: 2008 CORR Report - 2008 CORR Report—Treatment of End-Stage Organ Failure in Canada 1997 to 2006

Figures

• Table 1: Lung Transplants by Year, Age Group and Re-Transplants, Canada, 1997 to 2006 (Table 26 in the report)
• Table 2: Lung Transplants by Transplant Type, Canada, 1997 to 2006 (Table 27 in the report)
• Table 3: Lung Transplant Waiting List on December 31, Canada, 1997 to 2006 (Table 29 in the report)
• Figure 1: Lung Transplants, Canada and United States, 1997 to 2006, France 2002 to 2006 (Crude Rate per Million Population)