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Broader Geographic Sharing of Pediatric Donor Lungs Improves Pediatric Access to Transplant
W M Tsuang1, K M Chan2, M A Skeans3
1Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
Insights
Expanding geographic sharing of donor lungs for children and adolescents significantly increases lung transplant access for pediatric candidates. This approach improves transplant rates without negatively impacting adult recipients or post-transplant outcomes.
Area of Science:
- Organ transplantation
- Pediatric pulmonology
- Transplant allocation systems
Background:
- Pediatric lung transplant candidates face limited donor availability due to restricted geographic sharing.
- Current lung allocation systems may not adequately serve the needs of pediatric patients.
- Broader organ sharing is a potential strategy to improve access for pediatric recipients.
Purpose of the Study:
- To evaluate the impact of expanded geographic sharing of pediatric donor lungs on lung transplant access for pediatric candidates.
- To assess whether wider sharing of adolescent and child donor lungs improves transplant rates for pediatric recipients.
- To determine if expanded sharing affects adult transplant rates or post-transplant outcomes.
Main Methods:
- Utilized the thoracic simulated allocation model to simulate different lung sharing scenarios.
- Compared current lung allocation rules with strategies involving broader geographic sharing of pediatric donor lungs.
- Simulated scenarios included sharing adolescent lungs with adolescents, child lungs with adolescents, and prioritized sharing for children.
Main Results:
- Expanded sharing of adolescent donor lungs to adolescents (Simulation 4) increased transplant rates to 461 per 100 patient-years, compared to 206 under current rules.
- Prioritizing adolescent donor lungs for children (Simulation 5) resulted in 388 transplants per 100 patient-years and likely improved pediatric transplant rates.
- Expanded sharing did not adversely affect adult transplant rates, waitlist mortality, or 1-year posttransplant mortality.
Conclusions:
- Broader geographic sharing of pediatric donor lungs can significantly enhance lung transplant access for pediatric candidates.
- Current allocation boundaries limit opportunities for pediatric lung transplantation.
- Implementing wider sharing policies for pediatric donor lungs may improve outcomes for children and adolescents awaiting transplants.
Abstract:
US pediatric transplant candidates have limited access to lung transplant due to the small number of donors within current geographic boundaries, leading to assertions that the current lung allocation system does not adequately serve pediatric patients. We hypothesized that broader geographic sharing of pediatric (adolescent, 12-17 years; child, <12 years) donor lungs would increase pediatric candidate access to transplant. We used the thoracic simulated allocation model to simulate broader geographic sharing. Simulation 1 used current allocation rules. Simulation 2 offered adolescent donor lungs across a wider geographic area to adolescents. Simulation 3 offered child donor lungs across a wider geographic area to adolescents. Simulation 4 combined simulations 2 and 3. Simulation 5 prioritized adolescent donor lungs to children across a wider geographic area. Simulation 4 resulted in 461 adolescent transplants per 100 patient-years on the waiting list (range 417-542), compared with 206 (range 180-228) under current rules. Simulation 5 resulted in 388 adolescent transplants per 100 patient-years on the waiting list (range 348-418) and likely increased transplant rates for children. Adult transplant rates, waitlist mortality, and 1-year posttransplant mortality were not adversely affected. Broader geographic sharing of pediatric donor lungs may increase pediatric candidate access to lung transplant.
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