Evolving trends in underlying etiologies for lung transplantation in Europe and outcomes

<bold>Background:</bold> Referring diagnosis to lung transplantation (LTx) impact outcomes concerning overall survival and freedom from chronic lung allograft dysfunction - bronchiolitis obliterans syndrome (CLAD-BOS). This analysis describes trends in aetiologies and outcomes in Europe. Methodology Reports from ISHLT and France and Spain were screened for trends in referring diagnoses LTx and outcomes after LTx. Publications addressing such trends were identified in a PubMed search. <bold>Results:</bold> Primary diagnoses for LTx evolved over the last two decades. COPD accounts for 33% in both periods, IIP-ILD grew from 21% to 26% and CF decreased from 20% to 18%. Reports from France and Spain support these findings. Survival varies depending on the diagnosis. Global ISHLT data shows median post-Tx survival of 9.9 years in CF, 7.1 in A1ATD, 7.0 in iPAH, 6.7 in non-IPF ILD, 6.0 in COPD and 5.2 in IIP. 5-year freedom from CLAD-BOS shows some differences amongst disease states ranging from 49% in COPD to 54% in CF per ISHLT data, and per French data 5-year CLAD-freedom varies more: 69%, 50% and 37% in CF, COPD and IPF, respectively. <bold>Conclusion:</bold> Underlying diagnosis for LTx has evolved over the past decades. 5-year freedom from CLAD-BOS is poor for all aetiologies, ranging from 37% to 69%. Those associated with higher CLAD-BOS rates are growing, like IIP-ILD. This emphasizes the urgent need for new treatment approaches for this frequent post-Tx complication. <fig><object-id>erj;64/suppl_68/PA4984/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>