Pediatric Lung Waitlist Score (PLWS): A Score to Predict Waitlist Time for Pediatric Lung Transplant Candidates

In pediatric lung transplantation, the ability to estimate the projected waiting time could be particularly helpful for candidates and physicians. A score to predict waiting time has yet to be developed in this field. The purpose of this study was to create a score that predicts waitlist time for pediatric patients who are listed for lung transplantation.

A retrospective analysis was performed with publicly available de-identified OPTN lung transplant data from March 8, 2019, to March 8, 2025. After applying our exclusionary criteria, the sample included 218 pediatric patients, whom we divided into training and testing groups based on the implementation of the CAS. Univariable and multivariable analyses on the training group of pediatric patients identified independent recipient risk factors for the time spent on the waitlist. This model was used to make our score, the pediatric lung waitlist score (PLWS), which was then applied to the testing group to examine its validity.

Five recipient factors were independently associated with time to transplant: adolescence, ECMO support, residence in OPTN Region 4, residence in Region 8, and very high oxygen supplementation (>15 LPM). The resulting score demonstrated a c-statistic of 0.71 in the training cohort and 0.73 in the testing cohort.

We identified five recipient characteristics that significantly predict pediatric lung transplant waitlist duration and incorporated them into a prognostic score, the PLWS, derived from a Cox proportional hazards model.