TY - JOUR
T1 - Use of a novel donor lung scoring system as a tool for increasing lung recovery for transplantation
AU - Bai, Yun Zhu
AU - Yan, Yan
AU - Chang, Su Hsin
AU - Yang, Zhizhou
AU - Delhi, Anjana
AU - Farahnak, Khashayar
AU - Joseph, Karan
AU - Hamilton, Christy
AU - Baumann Walker, Ana Amelia
AU - Hachem, Ramsey R.
AU - Witt, Chad A.
AU - Guillamet, Rodrigo Vazquez
AU - Byers, Derek E.
AU - Marklin, Gary F.
AU - Hartwig, Matthew G.
AU - Brandt, Whitney S.
AU - Kreisel, Daniel
AU - Nava, Ruben G.
AU - Patterson, G. Alexander
AU - Kozower, Benjamin D.
AU - Meyers, Bryan F.
AU - Heiden, Brendan T.
AU - Puri, Varun
N1 - Publisher Copyright:
© 2024 The American Association for Thoracic Surgery
PY - 2024
Y1 - 2024
N2 - Background: There is a critical shortage of donor lungs for transplantation. We previously developed a parsimonious, highly discriminatory 9-variable Lung Donor (LUNDON) acceptability score. Here we assessed the utility of this score as a tool for improving lung recovery rates for transplantation. Methods: We examined all brain-dead donors between 2014 and 2020 from 3 US organ procurement organizations and validated the score's predictive performance. We examined the trajectory of donors with low (<40) and high (>60) initial LUNDON scores, their corresponding lung recovery rates, factors contributing to score improvement using multivariable regression models, and 1-year post-transplant recipient survival. Results: Overall lung recovery was 32.4% (1410 of 4351). Validation of the LUNDON score in our cohort revealed a C statistic of 0.904 and required intercept calibration. Low initial LUNDON donors that improved to a high final score had an increase in lung recovery rate from 29.3% (1100 of 3765) to 86.8% (441 of 508), associated with lower body mass index, management in a specialized donor care facility (SDCF), and more bronchoscopies. Donors with high initial and final LUNDON scores had a lung recovery rate of 85.2% (98 of 115), associated with shorter length of hospital stay. One-year survival was similar in recipients of low-to-high versus high-to-high LUNDON score donors (0.89 vs 0.84; P = .2). Conclusions: The LUNDON score performs well as a predictor of lung recovery in a contemporary cohort but may require organ procurement organization–specific calibration. SDCF care, increasing use of bronchoscopy, and decreasing the time from brain death to organ procurement may improve lung utilization. The LUNDON score can be used to guide donor management to expand the donor pool.
AB - Background: There is a critical shortage of donor lungs for transplantation. We previously developed a parsimonious, highly discriminatory 9-variable Lung Donor (LUNDON) acceptability score. Here we assessed the utility of this score as a tool for improving lung recovery rates for transplantation. Methods: We examined all brain-dead donors between 2014 and 2020 from 3 US organ procurement organizations and validated the score's predictive performance. We examined the trajectory of donors with low (<40) and high (>60) initial LUNDON scores, their corresponding lung recovery rates, factors contributing to score improvement using multivariable regression models, and 1-year post-transplant recipient survival. Results: Overall lung recovery was 32.4% (1410 of 4351). Validation of the LUNDON score in our cohort revealed a C statistic of 0.904 and required intercept calibration. Low initial LUNDON donors that improved to a high final score had an increase in lung recovery rate from 29.3% (1100 of 3765) to 86.8% (441 of 508), associated with lower body mass index, management in a specialized donor care facility (SDCF), and more bronchoscopies. Donors with high initial and final LUNDON scores had a lung recovery rate of 85.2% (98 of 115), associated with shorter length of hospital stay. One-year survival was similar in recipients of low-to-high versus high-to-high LUNDON score donors (0.89 vs 0.84; P = .2). Conclusions: The LUNDON score performs well as a predictor of lung recovery in a contemporary cohort but may require organ procurement organization–specific calibration. SDCF care, increasing use of bronchoscopy, and decreasing the time from brain death to organ procurement may improve lung utilization. The LUNDON score can be used to guide donor management to expand the donor pool.
KW - brain-dead donor
KW - donor acceptability score
KW - lung recovery
KW - lung transplantation
KW - organ utilization
UR - http://www.scopus.com/inward/record.url?scp=85205141001&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2024.08.047
DO - 10.1016/j.jtcvs.2024.08.047
M3 - Article
C2 - 39226995
AN - SCOPUS:85205141001
SN - 0022-5223
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
ER -