Journal article
Early outcomes of lung transplantation under the composite allocation score system
The Journal of thoracic and cardiovascular surgery, v 170(5), pp 1312-1321.e1
01 Nov 2025
PMID: 40324747
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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.
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Details
- Title
- Early outcomes of lung transplantation under the composite allocation score system
- Creators
- Peter D Cho - Drexel University, College of MedicineJohn P. White - University of California, Los AngelesSamuel T. Kim - University of California, Los AngelesHedwig Zappacosta - University of California, Los AngelesStephanie McKay - University of California, Los AngelesHa-Jung Kim - University of California, Los AngelesAlexey Abramov - University of California, Los AngelesMalini Daniel - University of California, Los AngelesReshma Biniwale - University of California, Los AngelesDavid Sayah - University of California, Los AngelesDavid Gjertson - University of California, Los AngelesAbbas Ardehali (Corresponding Author) - University of California, Los Angeles
- Publication Details
- The Journal of thoracic and cardiovascular surgery, v 170(5), pp 1312-1321.e1
- Publisher
- Elsevier
- Grant note
- Sam Malik Foundation
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:001611282700001
- Scopus ID
- 2-s2.0-105005437540
- Other Identifier
- 991022188672704721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Respiratory System
- Surgery