Distribution of donor lungs in the United States: a case for broader geographic sharing. Issue 6 (15th April 2016)

• Record Type: Journal Article
• Authors: Iribarne, Alexander; Meltzer, David O.; Chauhan, Dhaval; Sonett, Joshua R.; Gibbons, Robert D.; Vigneswaran, Wickii; Russo, Mark J.
• Is Part Of: Clinical transplantation. Volume 30:Issue 6(2016)
• Page Start: 688
• Page End: 693
• Publication Date: 2016-04-15
• Subjects: donor lung -- geographical distribution -- lung allocation score -- lung transplant -- United States; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.12735
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: Objectives: To evaluate the association between allocation of donor lungs by geographic sharing type (GST) and lung allocation score (LAS). Methods: UNOS data included lung transplant recipients between 5/4/05 and 09/30/15 (n = 17 416) grouped by GST of donor lungs: local, regional, or national. Recipients were stratified by LAS <50, 50–75, and >75. Kaplan–Meier analysis was used to assess five‐yr survival. Results: The majority of lungs were shared locally (n = 9200; 52.8%) followed by nationally (n = 5356; 30.8%) and regionally (n = 2860; 16.4%). There was a significant difference in the mean LAS at transplant (local: 43.7 ± 15; regional: 49.5 ± 18.8; national 51 ± 19.4; p < 0.001). There was a significant association between GST and LAS (p < 0.001). The majority (n = 7431; 58.2%) of recipients with LAS <50 received local lungs. Recipients with LAS >75 received a majority of their organs from national (n = 881; 45.4%) and regional (n = 414; 21.6%) donors. Although statistically significant (p = 0.024), absolute decline in five‐yr survival by GST in the national GST was only 1.1% compared to the local GST. Conclusions: Nearly half of all lungs in the United States are allocated locally to recipients with an LAS <50. Additional studies should determine if organ sharing over broader geographies would improve waitlist outcomes.