Validation of a novel donor lung scoring system based on the updated lung Composite Allocation Score

Zhizhou Yang ¹, Yun Zhu Bai ², Yan Yan ³

⁰Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons +

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March 26, 2024

View abstract on PubMed

Summary

Lung transplantation outcomes improve with careful donor and recipient matching. Using the Lung Donor (LUNDON) score with the Composite Allocation Score (CAS) can guide decisions to optimize lung transplant survival.

Area Of Science

Transplantation immunology
Thoracic surgery
Organ allocation systems

Background

Lung transplantation (LTx) faces challenges with lower long-term graft survival and underutilization of donor lungs.
High waitlist mortality necessitates improved strategies for lung donor utilization and recipient selection.

Purpose Of The Study

To evaluate the combined impact of the novel Lung Donor (LUNDON) acceptability score and the Composite Allocation Score (CAS) on lung transplant outcomes.
To identify optimal donor-recipient matching strategies using LUNDON and CAS to improve graft survival.

Main Methods

Retrospective analysis of nearly 18,000 adult primary lung transplants in the US (2015-2022).
Retroactive calculation of Composite Allocation Score (CAS) for all recipients.
Evaluation of survival rates based on LUNDON and CAS score combinations.

Main Results

The medium-CAS group (29.6-34.5) demonstrated superior 1-year posttransplant survival.
High-CAS recipients paired with low LUNDON score donors exhibited the poorest 1-year survival.
A predictive model for 1- and 3-year survival was developed using LUNDON and CAS values.

Conclusions

Caution is advised when transplanting marginally acceptable donor lungs into high-priority recipients.
Integrating LUNDON and CAS scores can guide clinical decisions for optimizing donor-recipient matching in lung transplantation.
Improved donor-recipient matching strategies are crucial for enhancing long-term lung graft survival.

Keywords:

lung Composite Allocation Score lung allocation score lung transplantation organ donor