Cho Peter D, White John P, Kim Samuel T, Zappacosta Hedwig, McKay Stephanie, Kim Ha-Jung, Abramov Alexey, Daniel Malini, Biniwale Reshma, Sayah David, Gjertson David, Ardehali Abbas
Department of Surgery, Drexel University College of Medicine, Philadelphia, Pa.
Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Calif.
J Thorac Cardiovasc Surg. 2025 May 3. doi: 10.1016/j.jtcvs.2025.04.014.
The Composite Allocation Score was introduced in March 2023 with the goal of improving organ allocation for potential lung transplant recipients. The purpose of this study is to characterize waitlist and post-transplant outcomes for adult lung transplant recipients under the Composite Allocation Score policy.
We included all adult candidates listed for isolated lung transplantation in the United States from May 2022 to December 2023. Candidates were categorized into 2 eras: Era 1 (pre-Composite Allocation Score, May 15, 2022 to March 8, 2023) and Era 2 (post--Composite Allocation Score, March 9, 2023 to December 31, 2023). Waitlist mortality and transplant rates within 9 months of listing were compared using competing risk regression. Post-transplant outcomes of the 2 groups were also compared. Kaplan-Meier was used to evaluate 9-month survival post-transplant.
A total of 5293 candidates were listed, with 2744 (51.8%) during Era 2. Lung transplant candidates in Era 2 experienced lower waitlist mortality (sub-hazard ratio, 0.79; 95% CI, 0.69-0.92, P = .002) and higher transplant rates (sub-hazard ratio, 1.22; 95% CI, 1.15-1.28, P < .001) compared with those in Era 1. Post-transplant extracorporeal membrane oxygenation rates at 72 hours (11.1% vs 9.9%, P = .25) and 30-day mortality (2.3% vs 2.4%, P = .96) were similar between Era 2 and Era 1. Nine-month survival after transplantation was not significantly different between Era 2 and Era 1 recipients (91.7% vs 90.9%, P = .47).
Lung transplant candidates in Era 2 had lower waitlist mortality and higher transplant rates compared with Era 1, with similar 9-month post-transplant survival. These findings suggest that the Composite Allocation Score policy has contributed to allocation improvement without compromising early post-transplant outcomes.
综合分配评分于2023年3月推出，旨在改善潜在肺移植受者的器官分配情况。本研究的目的是描述在综合分配评分政策下成年肺移植受者的等待名单和移植后结果。
我们纳入了2022年5月至2023年12月在美国登记进行单肺移植的所有成年候选者。候选者被分为两个时期：时期1（综合分配评分之前，2022年5月15日至2023年3月8日）和时期2（综合分配评分之后，2023年3月9日至2023年12月31日）。使用竞争风险回归比较等待名单死亡率和登记后9个月内的移植率。还比较了两组的移植后结果。采用Kaplan-Meier法评估移植后9个月的生存率。
共有5293名候选者登记，其中时期2有2744名（51.8%）。与时期1相比，时期2的肺移植候选者等待名单死亡率较低（亚风险比，0.79；95%可信区间，0.69 - 0.92，P = 0.002），移植率较高（亚风险比，1.22；95%可信区间，1.15 - 1.28，P < 0.001）。时期2和时期1之间，移植后72小时的体外膜肺氧合使用率（11.1%对9.9%，P = 0.25）和30天死亡率（2.3%对2.4%，P = 0.96）相似。时期2和时期1的受者移植后9个月生存率无显著差异（91.7%对90.9%，P = 0.47）。
与时期1相比，时期2的肺移植候选者等待名单死亡率较低，移植率较高，移植后9个月生存率相似。这些发现表明，综合分配评分政策有助于改善分配情况，且不影响移植后的早期结果。
