Gender Disparity in Lung Transplantation in the Pre- and Post-Composite Allocation Score System

Area of Science:

• Transplantation research
• Organ allocation policy
• Health equity

Background:

• Lung transplantation is a critical treatment for end-stage lung disease.
• Assessing organ access and outcomes by candidate demographics is essential for equitable healthcare.
• Recent changes to the Composite Allocation Score (CAS) system aimed to refine lung transplant allocation.

Purpose of the Study:

• To evaluate lung transplantation access and outcomes in male versus female candidates.
• To examine the impact of the updated Composite Allocation Score (CAS) system on gender-based disparities in lung transplantation.

Main Methods:

• Analysis of the United Network for Organ Sharing database for adult lung transplant candidates (March 2022-March 2024).
• Stratification of data into two eras based on CAS system implementation.
• Utilized multivariable competing risk regression and Kaplan-Meier methods to compare transplantation rates, waitlist mortality, and posttransplant survival by gender.

Main Results:

• A total of 6878 patients were analyzed, with increasing female representation in the second era.
• In both eras, female candidates had significantly lower lung transplant rates compared to males.
• Waitlist mortality and 6-month posttransplant survival were similar between genders in both eras.

Conclusions:

• The Composite Allocation Score (CAS) system demonstrated a positive impact on lung transplantation rates for female candidates.
• Despite improvements, significant gender-based disparities in accessing lung organs persist.
• Continuous evaluation and potential adjustments to organ allocation policies are recommended to address persistent inequities.