Efforts are underway to transition the current lung allocation system to a continuous distribution framework whereby multiple factors are simultaneously combined into a Composite Allocation Score (CAS) to prioritize candidates for lung transplant. The purpose of this study was to compare discrete CAS scenarios with the current concentric circle–based allocation system to assess their potential effects on the US lung transplantation system using the Scientific Registry of Transplant Recipients' thoracic simulated allocation model. Six alternative CAS scenarios were compared over 10 simulation runs using data from individuals on the lung transplant waiting list from January 1, 2018, through December 31, 2019. Outcome measures were transplant rate, count, waitlist deaths, posttransplant deaths within 2 years, donor-to-recipient distance, and percentage of organs predicted to have flown. Across scenarios, waitlist deaths decreased by 36% to 47%, with larger decreases in deaths at lower placement efficiency weight and higher weighting of the waitlist outcomes. When waitlist outcomes were equally weighted to posttransplant outcomes, more transplants occurred in individuals with the highest expected posttransplant survival. All CAS scenarios led to improved overall measures of equity compared with the current Lung Allocation Score system, including reduced waitlist deaths, and resulted in similar posttransplant survival.

中文翻译：

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肺综合分配评分系统对美国肺移植的预期效果


目前正在努力将当前的肺分配系统转变为连续分配框架，将多个因素同时组合成综合分配评分（CAS），以优先考虑肺移植候选者。本研究的目的是将离散 CAS 场景与当前基于同心圆的分配系统进行比较，以使用移植受者科学登记处的胸腔模拟分配模型评估其对美国肺移植系统的潜在影响。使用 2018 年 1 月 1 日至 2019 年 12 月 31 日期间肺移植等待名单上的个体的数据，对六种替代 CAS 情景进行了 10 次模拟运行的比较。结果指标包括移植率、计数、候补死亡人数、2 年内移植后死亡人数、供者人数- 到接受者的距离，以及预计已飞出的器官的百分比。在各种情景中，候补名单死亡人数下降了 36% 至 47%，在安置效率权重较低和候补名单结果权重较高的情况下，死亡人数下降幅度更大。当候补名单结果与移植后结果同等权重时，预期移植后存活率最高的个体发生了更多的移植。与当前的肺分配评分系统相比，所有 CAS 方案都改善了总体公平性指标，包括减少了候补死亡人数，并实现了类似的移植后存活率。