The demand for organs for lung transplantation (LTx) continues to outweigh supply.
However, nearly 75% of donor lungs are never transplanted. LTx offer acceptance practices
and the effects on waitlist/post-transplant outcomes by candidate clinical acuity
are understudied. UNOS was used to identify all LTx candidates, donors, and offers
from 2005 to 2019. Candidates were grouped by Lung Allocation Score (LAS; applicable
post-2005, ages ≥12 years): LAS<40, 40–60, 61–80, and >80. Offer acceptance patterns,
waitlist death/decompensation, and post-transplant survival (PTS) were compared. “Acceptable
organ offers” were those from donors whose organs were accepted for transplantation.
Approximately 3 million offers to 34,531 candidates were reviewed. Median waitlist
durations were: 9 days-(LAS>80), 17 days-(LAS 61–80), 42 days-(LAS 40–60), 125 days-(LAS<40)
(P < 0.001 between all). Per waitlist-day, offer rates were: total offers – 0.8/day-(LAS>80), 0.7/day-(LAS 61–80), 0.6/day-(LAS 40–60), 0.4/day-(LAS<40); acceptable offers – 0.34/day-(LAS>80), 0.32/day-(LAS 61–80), 0.24/day-(LAS 40–60), 0.15/day-(LAS<40)
(both P < 0.001 between all LAS). Among patients who experienced waitlist mortality/decompensation,
≥1 acceptable offer was declined in 92% (3939/4270) of patients – 78% for LAS >80,
88% for LAS 61–80, 93% for LAS 40–60, and 96% for LAS <40. Thirty-day waitlist mortality/decompensation
rates were: 46%-(LAS>80), 24%-(LAS 61–80), 5%-(LAS 40–60), <1%-(LAS<40) (P < 0.001 between all). PTS was equivalent between patients for whom the first/second
offer vs later offers were accepted (all LAS P > 0.4). The first offers that LTx candidates receive (including acceptable organs)
are declined for nearly all candidates. Healthier candidates can afford offer selectivity
but more ill patients (LAS>60) cannot, experiencing exceedingly high 30-day waitlist
mortality.
Graphical Abstract
Graphical Abstract
Keywords
Abbreviations:
COPD (chronic obstructive pulmonary disease), IQR (interquartile range), LAS (lung allocation score), LVEF (left ventricular ejection fraction), PTR (Potential Transplant Recipient), UNOS (United Network for Organ Sharing)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 07, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: National Institutes of Health, R01HL147957: “Novel Methods to Grow the Impact of Pediatric Thoracic Transplantation;” Principal investigators: David L. S. Morales, MD, Farhan Zafar, MD, MS.
Conflict of interest: The authors declare no conflicts of interest.
Read at the 48th Annual Meeting of the Western Thoracic Surgical Association, June 22 - 25, 2022, Koloa, Hawaii.
Meeting Presentation: Presentation at the podium at the Western Thoracic Surgical Association 48th Annual Meeting, June 25th, 2022, Koloa, HI, USA.
IRB: #2018-6837; date of approval: 10/29/2018
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