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Center-level Variation in Clinical Data Updates for US Lung Transplant Candidates.

Johnie Rose1, Samantha L Baker2, Paul R Gunsalus2

  • 1Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH.

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|July 8, 2026
PubMed
Summary

Lung transplant candidate data updates vary significantly across US centers, impacting allocation priority. Most of this variation in Composite Allocation Score (CAS) data updates remains unexplained by center or patient factors.

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Area of Science:

  • Transplantation Science
  • Health Services Research
  • Organ Allocation Policy

Background:

  • Lung transplant candidate priority in the US relies on clinical data for the Composite Allocation Score (CAS).
  • Transplant centers have discretion over the frequency of candidate data updates, despite minimum policy requirements.
  • Understanding this variation is crucial for equitable organ allocation.

Purpose of the Study:

  • To examine the variation in data update frequency across US lung transplant centers.
  • To determine if center or candidate characteristics explain the observed variation in update rates.
  • To assess the potential impact of update practices on allocation priority.

Main Methods:

  • Analysis of Scientific Registry of Transplant Recipients data for adult lung transplant candidates listed between March 2023 and November 2024.
  • Comparison of update rates for CAS-related variables within 6 months of listing.
  • Use of mixed-effects Poisson rate regression to model variation explained by center and candidate factors.

Main Results:

  • Over half of 5821 candidates received at least one update within 6 months; update frequency varied five-fold across centers.
  • Candidates with higher medical urgency received fewer updates, correlating with shorter waiting times.
  • A significant portion (70.9%) of update rate heterogeneity was unexplained by measured factors.

Conclusions:

  • Significant variation exists in the frequency of candidate data updates among US lung transplant centers.
  • The unexplained variation suggests that updating practices may influence how candidate clinical status translates to allocation priority.
  • Further investigation into center-specific practices is warranted to ensure fair allocation.