Early posttransplant survival after lung transplantation in the Continuous Allocation Era: Associations with changing...

Despite more complex procurement logistics under continuous distribution (CD), lung transplant outcomes appear better. The current analysis sought to investigate the potential contributors to these trends observed under the CD framework. This study compared lung transplant recipients from the Composite Allocation Score (CAS) era (March 9, 2023-March 31, 2025) and the Lung Allocation Score era (January 1, 2021-March 8, 2023; n = 12,287). Recipients in the CAS era were more often female, Black, and non-O blood type, with a higher proportion of obstructive lung disease and fewer restrictive or vascular diseases. Although pretransplant recipient profiles varied between the 2 eras, the CAS era involved greater use of older and extended criteria donors, longer procurement distances, and higher ischemic time. Cox regression demonstrated an independent association between transplantation during the Lung Allocation Score era and higher 1-year posttransplant mortality. Waitlist time did not affect 1-year mortality, and transplant center volumes were comparable between eras. Favorable 1-year survival during the CD era was observed across several exploratory subgroups, including recipients aged 56 to 63 years and those not hospitalized at the time of transplant. Overall, transplantation during the CD era was associated with improved early morbidity and 1-year posttransplant survival despite substantial changes in donor characteristics and procurement logistics.