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

US lung transplant candidates' allocation priority is influenced by clinical data reported to the Organ Procurement and Transplantation Network and used to calculate the Composite Allocation Score (CAS). Although policy specifies minimum update requirements, transplant centers have discretion in how frequently candidate data are updated. We examined variation in updating frequency across centers and the extent to which this variation is explained by characteristics of centers and their candidates.

Using Scientific Registry of Transplant Recipients data for adult candidates listed March 9, 2023, through November 1, 2024, we compared rates at which CAS-related variables were updated within 6 mo of listing. Mixed-effects Poisson rate regression with center-level random effects was used to examine how much variation was explained by center and candidate characteristics.

Among 5821 candidates across 64 transplant centers, 3010 (51.7%) had at least 1 update within 6 mo (median [IQR] 2 [1-3]). Update frequency varied approximately 5-fold across centers. Candidates with the highest medical urgency received fewer updates, reflecting shorter waiting times. After adjustment, 70.9% of update rate heterogeneity remained unexplained by measured center or candidate characteristics.

Substantial variation exists across US lung transplant centers in the frequency of candidate data updates used to calculate the CAS. Most of this variation is not explained by measured center or candidate factors, suggesting that differences in updating practices may influence how candidate clinical status is translated into allocation priority.