Appendix C — Appendix C. International Comparison Quick Reference

References: wiki/ center articles, data/ CSV datasets Version: v1.2

C.1 C.1 Four Major Centers Comparison Summary

Item Vienna AKH UTokyo KU Leuven TSGH
Annual volume ~170 (2023-2024) [Vienna-Aigner-2025] ~25 (2024: nationwide Japan 148 cases) ~80 📋 TBD
Cumulative volume 2,672 (1989-2024) [Vienna-Aigner-2025] 256 (through August 2025) >900 📋 TBD
Intraoperative ECMO All (routine VA) Selective (CPB/ECMO) Selective ⚠️ TBD
Induction ATG / Basiliximab (selected) Not routine Basiliximab ⚠️ TBD
CNI Tacrolimus Tacrolimus Tacrolimus Tacrolimus
Tac initiation Oral IV 0.03 mg/kg/h x 10d Oral ⚠️ TBD
Steroid (intraoperative) 1000 mg 500 mg 500 mg ⚠️ TBD
Steroid maintenance 5 mg/day 5 mg/day 5 mg/day 5 mg/day
PGD3 @ 72h 1.3% — ~5% 📋 TBD
1-year survival 85% (2019-2024) [Vienna-Aigner-2025] ~80% ~90% 📋 TBD
5-year survival 73% (2019-2024) [Vienna-Aigner-2025] ~65% ~70% 📋 TBD
Surveillance TBBx Routine Not routine Routine ⚠️ TBD

C.2 C.2 Organ Procurement Comparison

Item Vienna UTokyo Leuven TSGH
Preservation solution Perfadex Perfadex Perfadex ⚠️
Perfusion temperature 10°C (optimal) Cold Cold ⚠️
Retrograde flush ✅ ✅ ✅ ⚠️
Inflation preservation 50% O₂ — — ⚠️
Ex-vivo perfusion EVLP (research) EVLP (research) EVLP (research) OCS Lung ✅ (first in Taiwan)

C.3 C.3 ECMO Strategy Comparison

Item Vienna UTokyo Leuven
Intraoperative ECMO All BLTx (routine) Selective Selective
Mode Central VA-ECMO CPB or VA-ECMO CPB or VA-ECMO
Flow 40-50% CO Full support Variable
Prolongation criteria P/F <100, mPAP/mABP >2/3 Case-by-case Case-by-case
Prolongation rate 77% Low Low
Mean prolongation 30±12 hours — —
Anticoagulation Enoxaparin 0.5 mg/kg BID UFH Variable

C.4 C.4 Immunosuppression Comparison

C.4.1 Induction

Center Drug Notes
Vienna ATG / Basiliximab Selected patients
UTokyo None Not routine
Toronto None Not routine
Leuven Basiliximab Routine
BWH Basiliximab Routine
UNC ATG Routine

C.4.2 Tacrolimus Target (0-3 months)

Center Trough Target
UTokyo 15-20 ng/mL (IV phase) → 9-12 (oral phase)
Vienna 10-15 ng/mL
Leuven 10-15 ng/mL
BWH 10-12 ng/mL
UNC 8-12 ng/mL

C.5 C.5 Infection Prevention Comparison

Item Vienna UTokyo BWH UNC
CMV prevention Valganciclovir 6-12m Ganciclovir IV → Valganciclovir Valganciclovir 6-12m Valganciclovir 12m
PCP prevention TMP-SMX (lifelong) TMP-SMX (lifelong) TMP-SMX (lifelong) TMP-SMX (lifelong)
Fungal prevention Inhaled Amphotericin Itraconazole Inhaled Amphotericin Voriconazole

C.6 C.6 Global Statistics Quick Overview (full data in data/ CSV)

C.6.1 C.6.1 Global Lung Transplant Statistics Across 21 Countries (2024)

Data sources: IRODaT 2024, Eurotransplant 2024, respective national transplant organizations

Rank Country Annual Volume pmp Total Deceased Donors DCD Donors Allocation Organization
1 United States 3,340 9.05 16,336 5,895 UNOS/OPTN
2 Spain 623 13.11 2,278 1,149 ONT
3 Canada 416 10.64 894 321 CBS
4 France 332 5.12 1,856 312 ABM
5 Germany 311 3.73 953 0 Eurotransplant
6 India 228 0.16 1,128 2 NOTTO
7 South Korea 185 3.75 397 — KONOS
8 Italy 174 2.96 1,795 306 CNT
9 Japan 148 1.21 138 8 JOT
10 Australia 137 5.13 527 192 DonateLife
11 United Kingdom 130 1.91 1,385 686 NHSBT
12 Netherlands 123 6.95 373 247 Eurotransplant
13 Belgium 108 — — — Eurotransplant
14 Austria 106 11.78 166 30 Eurotransplant
15 Brazil 93 0.43 3,711 0 SNT
16 Switzerland 63 7.08 187 98 Swisstransplant
17 Sweden 58 5.42 243 60 Scandiatransplant
18 Taiwan 20-30 ~1.0 — — TORSC
19 Hungary 18 — — — Eurotransplant
20 Slovenia 11 — — — Eurotransplant
21 Croatia 6 — — — Eurotransplant

Taiwan pmp ~1.0, similar to Japan (1.21), far below Spain (13.11) and the United States (9.05). Improving organ donation rates is key to expanding lung transplantation. Spain has the highest pmp (13.11), attributed to the ONT three-tier coordinator system. Japan pmp only 1.21 (among the lowest globally), limited by brain death determination regulations.

C.6.2 C.6.2 Top 21 US Lung Transplant Centers

Data sources: SRTR, OPTN, center announcements 2024-2025

Center City Annual Volume SRTR Tier Distinguishing Features
Cleveland Clinic Cleveland, OH ~451 — Highest cumulative in the US (>2,500)
Stanford Hospital Palo Alto, CA ~295 — Heart-lung transplant pioneer (Shumway)
UT Southwestern Dallas, TX ~227 — Largest in Texas
Vanderbilt Nashville, TN 149 — Hoetzenecker (Vienna-trained) as surgical director
Northwestern Chicago, IL 148 — Bharat; OCS/robotic LTx; COVID pioneer; median wait 4 days
UPMC Pittsburgh, PA ~110 — SRTR high survival
Norton Thoracic Phoenix, AZ 103 Tier 5 Largest in western US
UCSF San Francisco, CA 100+ — 13 consecutive years significantly better than expected; 1-year survival 95%
Toronto General Toronto, Canada 100+ — World’s first successful LTx (1983); EVLP pioneer; >1000 EVLP
UCLA Los Angeles, CA 95 Tier 4 Major west coast center
Cedars-Sinai Los Angeles, CA 88 — Major LA center
NYU Langone New York, NY ~80 Tier 4 SRTR highest quality rating nationwide
Mayo - Jacksonville Jacksonville, FL 74 Tier 5 Mayo Florida
UF Health Shands Gainesville, FL 67 Tier 5
Corewell Health Grand Rapids, MI 55 Tier 5
Duke Durham, NC — — Shortest wait time nationwide; major research center
Mayo - Rochester Rochester, MN — — Mayo main campus
U of Michigan Ann Arbor, MI — — Major academic center
IU Health Methodist Indianapolis, IN 39 Tier 5
U of Alabama Birmingham, AL 26 Tier 4
U of Iowa Iowa City, IA 15 Tier 5

C.6.3 C.6.3 Major European Lung Transplant Centers

Data sources: Eurotransplant, NHSBT, Council of Europe 2024

Center City/Country Annual Volume Allocation System Distinguishing Features
Vienna AKH Vienna/Austria ~170 Eurotransplant Largest in Europe; routine ECMO; 8-country hub
Hannover MHH Hannover/Germany 103-110 Eurotransplant Highest Eurotransplant volume; preservation pioneer
KU Leuven Leuven/Belgium ~80 Eurotransplant LUNGguard; EVLP RCT
Royal Papworth Cambridge/UK 40-50 NHSBT Highest survival in Europe; EVLP
Pitie-Salpetriere Paris/France — ABM Largest in France
Henri-Mondor Creteil/France — ABM Major French center
UH Zurich Zurich/Switzerland — Swisstransplant Multicenter EVLP RCT
Sahlgrenska Gothenburg/Sweden — Scandiatransplant Largest in Scandinavia
Puerta de Hierro Madrid/Spain — ONT Major Spanish center; EVLP
Policlinico Milano Milan/Italy — CNT

C.6.4 C.6.4 Asian Lung Transplant Centers

Data sources: JOT, TORSC, KONOS, center publications

Japan (9 certified centers, 148 nationwide cases in 2024):

Center City Cumulative Volume Distinguishing Features
Kyoto University Kyoto 368 Highest cumulative in Japan; Prof. Date pioneered living-donor transplant
University of Tokyo Tokyo 256 Sato lab; living-donor + VATS; since 2014
Okayama University Okayama — World’s first living-donor lobar transplant (1998)
Tohoku University Sendai — Certified center
Dokkyo Medical University Tochigi — Certified center
Chiba University Chiba — Certified center
Osaka University Osaka — Certified center
Fukuoka University Fukuoka — Certified center
Nagasaki University Nagasaki — Certified center

Taiwan (6 certified centers):

Center City Distinguishing Features
National Taiwan University Hospital (NTUH) Taipei Largest in Taiwan; first SLTx/BLTx in Asia; 3-year survival ~51%
Chang Gung Memorial Hospital, Linkou Taoyuan Second largest in Taiwan; >20/year since 2019
Tri-Service General Hospital (TSGH) Taipei First OCS Lung in Taiwan; comprehensive SOP; military medical center
China Medical University Hospital Taichung Under development; fellow trained in Vienna (Dr. Chen Chien-Hsun)
Far Eastern Memorial Hospital New Taipei City Certified center
National Cheng Kung University Hospital Tainan Certified center

South Korea (3 major centers, 185 nationwide cases in 2024):

Center City Distinguishing Features
Asan Medical Center Seoul Major Korean transplant center
Samsung Medical Center Seoul Major Korean center
Severance Hospital (Yonsei University) Seoul Major Korean center

Other Asia-Pacific:

Center Country Annual Volume
NUH Singapore 20-40

📋 Annual volumes for each Taiwan center need to be obtained from the Ministry of Health and Welfare Organ Donation Registry Center

C.7 C.7 Decision Quick Reference

C.7.1 “What Should TSGH Do?” Decision Aid

Issue Considerations
Intraoperative ECMO Vienna routine VA yields best results (PGD3 1.3%), but requires team experience and equipment
Induction Japan/Toronto achieve good outcomes without induction, but most Western centers favor its use
Surveillance TBBx UTokyo approach without TBBx is feasible (clinical + imaging assessment), with pros and cons
Tac initiation UTokyo IV start provides stable levels but requires ICU monitoring
CMV prophylaxis duration D+/R- at least 12 months; others 6-12 months
Ex-vivo perfusion TSGH already has OCS Lung; initiation criteria and operational SOP need to be established

⚠️ All decisions require final determination by the clinical team based on TSGH’s actual conditions and experience.

C.8 C.8 Latest Center Updates (v1.2 Update)

C.8.1 Vienna AKH Update [Vienna-Aigner-2025]

Item Data
2024 referral volume 302 patients, median age 60.4 years
Surgical approach shift Thoracotomy 66.5% vs Clamshell 33.5% (n=170); wound infection rate 9.7% vs 22.8% (p=0.031)
Median ventilation time 1-2 days (2021-2023)
Median ICU stay 7 days (2021-2023)
ECP for rejection prevention Prospective RCT showed ECP reduces ACR and DSA formation (Alemanno et al., 2025)
10°C preservation technique Multicenter RCT underway (Vienna, Toronto, Duke, etc.)
Emerging directions LifeLUNG preservation platform, AI-assisted EVLP assessment, xenotransplantation research, MIS/robotic-assisted exploration

C.8.2 UTokyo Update

Item Data
Japan 2024 annual volume 148 nationwide cases (first time exceeding 100)
Living-donor proportion 23.7% (approximately 24 bilateral living-donor cases)
Median wait time 930 days (approximately 2.5 years)
Waitlist mortality 40%
Donor utilization rate Approximately 15%
Allocation system First come, first serve
Unique contraindications HTLV-1 infection (endemic in Japan), vCJD

C.9 References

  1. wiki/ all center articles
  2. data/ global center CSV datasets
  3. ISHLT Registry Reports
  4. SRTR Annual Data Reports
  5. Center-specific publications