Michael O Harhay1,2, Raphaël Porcher3,4,5, Gabriel Thabut6, Michael J Crowther7, Thomas DiSanto8, Samantha Rubin8, Zachary Penfil8, Zhou Bing9, Jason D Christie2,10, Joshua M Diamond10, Edward Cantu8. 1. 1 Palliative and Advanced Illness Research Center. 2. 2 Department of Biostatistics, Epidemiology and Informatics. 3. 3 Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France. 4. 4 Team METHODS, Centre de Recherche Epidémiologie et Statistiques Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale U1153, Paris, France. 5. 5 Paris Descartes University, Paris, France. 6. 6 Service de Pneumologie et Transplantation Pulmonaire, Hôpital Bichat, Paris, France. 7. 7 Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, United Kingdom; and. 8. 8 Division of Cardiovascular Surgery and. 9. 9 Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China. 10. 10 Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Abstract
RATIONALE: In the United States, an algorithm known as the "match-run" creates an ordered ranking of potential recipients for available lung allografts. A potential recipient's match-run position, or "sequence number," is available to the transplant center when contacted with a lung offer. Lung offers with higher sequence numbers may be interpreted as a crowd-sourced evaluation of poor organ quality, though the association between the sequence number at which a lung is accepted and its recipient's post-transplant outcomes is unclear. OBJECTIVES: We sought to evaluate the primary reasons provided when a lung offer was refused by a transplant center, transplant center and donor/organ factors associated with a higher sequence number at acceptance, and the association of the sequence number at acceptance with post-transplant mortality and graft failure. METHODS: Match-run outcomes for lung offers that occurred in the United States from May 2007 through June 2014 were merged with recipient follow-up data through December 2017. Associations between the sequence number at the time of acceptance and selected transplant center and donor characteristics were estimated using multivariable logistic and multinomial regression models. The associations between the final sequence number and recipient survival and graft survival were estimated using multivariable time-to-event models. RESULTS: Of 10,981 lung offer acceptances, nearly 70% were accepted by one of the top 10 ranked candidates. Higher median annual center volume and potential indicators of organ quality (e.g., abnormal chest radiograph or bronchoscopy) were associated with a higher sequence number at acceptance. There was weak evidence for a small positive relationship between the sequence number at acceptance and both mortality and graft failure. For example, the unadjusted and adjusted hazard ratios for death associated with the log-sequence number at acceptance were 1.019 (95% confidence interval, 1.001-1.038) and 1.011 (95% confidence interval, 0.989-1.033), respectively. On the absolute scale, using the multivariable model, a 10-fold increase in the sequence number translated into a 0.8% absolute decline in the predicted 5-year survival. CONCLUSIONS: Acceptance of a donor lung offer at a later point in the match-run was associated with measurable indicators of organ quality, but not with clinically meaningful differences in post-transplant mortality or graft failure.
RATIONALE: In the United States, an algorithm known as the "match-run" creates an ordered ranking of potential recipients for available lung allografts. A potential recipient's match-run position, or "sequence number," is available to the transplant center when contacted with a lung offer. Lung offers with higher sequence numbers may be interpreted as a crowd-sourced evaluation of poor organ quality, though the association between the sequence number at which a lung is accepted and its recipient's post-transplant outcomes is unclear. OBJECTIVES: We sought to evaluate the primary reasons provided when a lung offer was refused by a transplant center, transplant center and donor/organ factors associated with a higher sequence number at acceptance, and the association of the sequence number at acceptance with post-transplant mortality and graft failure. METHODS: Match-run outcomes for lung offers that occurred in the United States from May 2007 through June 2014 were merged with recipient follow-up data through December 2017. Associations between the sequence number at the time of acceptance and selected transplant center and donor characteristics were estimated using multivariable logistic and multinomial regression models. The associations between the final sequence number and recipient survival and graft survival were estimated using multivariable time-to-event models. RESULTS: Of 10,981 lung offer acceptances, nearly 70% were accepted by one of the top 10 ranked candidates. Higher median annual center volume and potential indicators of organ quality (e.g., abnormal chest radiograph or bronchoscopy) were associated with a higher sequence number at acceptance. There was weak evidence for a small positive relationship between the sequence number at acceptance and both mortality and graft failure. For example, the unadjusted and adjusted hazard ratios for death associated with the log-sequence number at acceptance were 1.019 (95% confidence interval, 1.001-1.038) and 1.011 (95% confidence interval, 0.989-1.033), respectively. On the absolute scale, using the multivariable model, a 10-fold increase in the sequence number translated into a 0.8% absolute decline in the predicted 5-year survival. CONCLUSIONS: Acceptance of a donor lung offer at a later point in the match-run was associated with measurable indicators of organ quality, but not with clinically meaningful differences in post-transplant mortality or graft failure.
Authors: Michael O Harhay; Raphaël Porcher; Edward Cantu; Michael J Crowther; Jason D Christie; Gabriel Thabut; Gavin C Donaldson Journal: Am J Respir Crit Care Med Date: 2018-09-01 Impact factor: 21.405
Authors: David S Goldberg; Benjamin French; James D Lewis; Frank I Scott; Ronac Mamtani; Richard Gilroy; Scott D Halpern; Peter L Abt Journal: J Hepatol Date: 2015-11-25 Impact factor: 25.083