Alexander Iribarne1, David O Meltzer2,3, Dhaval Chauhan4, Joshua R Sonett5, Robert D Gibbons2, Wickii Vigneswaran6, Mark J Russo4,7. 1. Department of Cardiothoracic Surgery, Dartmouth Medical Center, Hanover, NH, USA. 2. Center for Health and the Social Sciences (CHESS), University of Chicago, Chicago, IL, USA. 3. Department of Medicine, University of Chicago, Chicago, IL, USA. 4. Department of Surgery, Rutgers - New Jersey Medical School, Newark, NJ, USA. 5. Division of Cardiac, Vascular and Thoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University, New York, NY, USA. 6. Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL, USA. 7. Newark Beth Israel Medical Center, Barnabas Heart Hospitals, Newark, NJ, USA.
Abstract
OBJECTIVES: To evaluate the association between allocation of donor lungs by geographic sharing type (GST) and lung allocation score (LAS). METHODS: UNOS data included lung transplant recipients between 5/4/05 and 09/30/15 (n = 17 416) grouped by GST of donor lungs: local, regional, or national. Recipients were stratified by LAS <50, 50-75, and >75. Kaplan-Meier analysis was used to assess five-yr survival. RESULTS: The majority of lungs were shared locally (n = 9200; 52.8%) followed by nationally (n = 5356; 30.8%) and regionally (n = 2860; 16.4%). There was a significant difference in the mean LAS at transplant (local: 43.7 ± 15; regional: 49.5 ± 18.8; national 51 ± 19.4; p < 0.001). There was a significant association between GST and LAS (p < 0.001). The majority (n = 7431; 58.2%) of recipients with LAS <50 received local lungs. Recipients with LAS >75 received a majority of their organs from national (n = 881; 45.4%) and regional (n = 414; 21.6%) donors. Although statistically significant (p = 0.024), absolute decline in five-yr survival by GST in the national GST was only 1.1% compared to the local GST. CONCLUSIONS: Nearly half of all lungs in the United States are allocated locally to recipients with an LAS <50. Additional studies should determine if organ sharing over broader geographies would improve waitlist outcomes.
OBJECTIVES: To evaluate the association between allocation of donor lungs by geographic sharing type (GST) and lung allocation score (LAS). METHODS: UNOS data included lung transplant recipients between 5/4/05 and 09/30/15 (n = 17 416) grouped by GST of donor lungs: local, regional, or national. Recipients were stratified by LAS <50, 50-75, and >75. Kaplan-Meier analysis was used to assess five-yr survival. RESULTS: The majority of lungs were shared locally (n = 9200; 52.8%) followed by nationally (n = 5356; 30.8%) and regionally (n = 2860; 16.4%). There was a significant difference in the mean LAS at transplant (local: 43.7 ± 15; regional: 49.5 ± 18.8; national 51 ± 19.4; p < 0.001). There was a significant association between GST and LAS (p < 0.001). The majority (n = 7431; 58.2%) of recipients with LAS <50 received local lungs. Recipients with LAS >75 received a majority of their organs from national (n = 881; 45.4%) and regional (n = 414; 21.6%) donors. Although statistically significant (p = 0.024), absolute decline in five-yr survival by GST in the national GST was only 1.1% compared to the local GST. CONCLUSIONS: Nearly half of all lungs in the United States are allocated locally to recipients with an LAS <50. Additional studies should determine if organ sharing over broader geographies would improve waitlist outcomes.
Authors: Martin Kosztowski; Sheng Zhou; Errol Bush; Robert S Higgins; Dorry L Segev; Sommer E Gentry Journal: Am J Transplant Date: 2018-12-15 Impact factor: 8.086
Authors: Luke J Benvenuto; Michaela R Anderson; Meghan Aversa; Mark E Snyder; Hilary Robbins; Lori Shah; Harpreet Singh Grewal; David Anderson; Joseph Costa; Brian P Stanifer; Philippe Lemaitre; Joshua R Sonett; Frank D'Ovidio; Selim M Arcasoy Journal: J Heart Lung Transplant Date: 2021-11-15 Impact factor: 13.569