Risk factors for lung transplant candidate waitlist removal in the era of the composite allocation score

Implementation of the composite allocation score (CAS) has improved, but not eliminated, waitlist mortality amongst lung transplant candidates. Identifying risk factors for clinical deterioration is important to stratify patients who may benefit from closer monitoring or increased support. We performed a UNOS registry-based study of lung transplant candidates listed between March 9, 2022 to March 8, 2024; analysis was stratified by listings before or after CAS implementation. Univariate and multivariate logistic regression analyses were performed to identify factors associated with waitlist removal for clinical decompensation or death. Traits associated with waitlist removal during the pre-CAS era were short stature, ECMO support at listing, and amount of supplemental oxygen. Following CAS implementation, ECMO support, low BMI, poor functional status, short stature, and ABO blood type O were significantly associated with waitlist removal. Close monitoring of patients with increased likelihood for waitlist removal, especially patients with multiple risk factors, may be appropriate.