Variability in donor organ offer acceptance and lung transplantation survival
Section snippets
Data source
This study was approved by our institution's Institutional Review Board before study initiation. We performed a retrospective cohort analysis using United Network of Organ Sharing (UNOS) Standard Analysis and Research data. These data were subsequently linked with information from the Potential Transplant Recipient file, which provides match run information for every offer made for each candidate donor lung allograft that is ultimately employed for use in transplantation. Further discussion of
Study population
Across 65 listing centers, a total of 8,193 candidates received first-ranked offers from 15,847 unique donors after application of our inclusion criteria (Figure 1 for patient selection). The overall acceptance rate for the first-ranked offer was 29.9% (4,735/15,847). Complete demographic information for candidates and donors is reported in Table 1. Candidates who accepted the first-ranked offer tended to have a lower LAS at the time of match (median 47.5 for accept vs 50.5 for decline) and
Discussion
Cardiothoracic transplantation is appropriately one of the most closely scrutinized disciplines in medicine. The combination of a scarce resource and a medically comorbid patient population demands that outcomes at both the local and national levels be closely measured. In this retrospective analysis of US-based registry data, we find that organ offer acceptance patterns vary significantly by transplant center, a variation that contributes significantly to observed per-center differences in
Disclosure statement
The authors report no relevant conflicts of interests as described by ICMJE.
MSM is supported by the National Heart, Lung, and Blood Institute F32HL132460-02.
This work was supported by the NIH funded Cardiothoracic Surgery Trials Network (MLC), 5U01HL088953-05 and the National Institutes of Health TL-1 clinical and translational science award, UL1TR0025531 (NCATS).
References (28)
- et al.
OPTN/SRTR 2015 annual data report: lung
Am J Transplant
(2017) - et al.
Effect of lung transplantation on health-related quality of life in the era of the lung allocation score: a U.S. prospective cohort study
Am J Transplant
(2017) Lung allocation sequence: the system evolves
Am J Transplant
(2018)- et al.
Geographic disparities in donor lung supply and lung transplant waitlist outcomes: a cohort study
Am J Transplant
(2018) - et al.
Lung transplant mortality is improving in recipients with a lung allocation score in the upper quartile
Ann Thorac Surg
(2017) - et al.
A consensus document for the selection of lung transplant candidates: 2014—an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation
J Heart Lung Transplant
(2015) - et al.
Liver transplant center variability in accepting organ offers and its impact on patient survival
J Hepatol
(2016) - et al.
Heart and lung organ offer acceptance practices of transplant programs are associated with waitlist mortality and organ yield
Am J Transplant
(2018) - et al.
Big data in organ transplantation: registries and administrative claims
Am J Transplant
(2014) - et al.
Effect of the lung allocation score on lung transplantation in the United States
J Heart Lung Transplant
(2016)
Impact of U.S. Lung Allocation Score on survival after lung transplantation
J Heart Lung Transplant
Decline of increased risk donor offers on waitlist survival in heart transplantation
J Am Coll Cardiol
Implications of declining donor offers with increased risk of disease transmission on waiting list survival in lung transplantation
J Heart Lung Transplant
A novel patient-centered ”intention-to-treat” metric of U.S. lung transplant center performance
Am J Transplant
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2022, Seminars in Thoracic and Cardiovascular SurgeryCitation Excerpt :These findings are in line with a prior study using UNOS, which found that even among patients receiving first-ranked offers (those for which they are the first candidate to receive the donor offer and therefore supposedly the “best match”), the rejection rate is over 75%.14 The same study also reported the sobering fact that nearly half of patients for whom the first, first-ranked offer is declined will not receive another first-ranked offer, with 2% never receiving another offer at all and 25% subsequently dying while awaiting transplant.14 In the present analysis, the first acceptable offer (most often occurring as the first or second offer received) was declined for 78% of patients with LAS >80 and 88% of patients with LAS 61–80.