Development and validation of the lung donor (LUNDON) acceptability score for pulmonary transplantation.

Abstract

There is a chronic shortage of donor lungs for pulmonary transplantation due, in part, to low lung utilization rates in the United States. We performed a retrospective cohort study using data from the Scientific Registry of Transplant Recipients database (2006-2019) and developed the lung donor (LUNDON) acceptability score. A total of 83 219 brain-dead donors were included and were randomly divided into derivation (n = 58 314, 70%) and validation (n = 24 905, 30%) cohorts. The overall lung acceptance was 27.3% (n = 22 767). Donor factors associated with the lung acceptance were age, maximum creatinine, ratio of arterial partial pressure of oxygen to fraction of inspired oxygen, mechanism of death by asphyxiation or drowning, history of cigarette use (≥20 pack-years), history of myocardial infarction, chest x-ray appearance, bloodstream infection, and the occurrence of cardiac arrest after brain death. The prediction model had high discriminatory power (C statistic, 0.891; 95% confidence interval, 0.886-0.895) in the validation cohort. We developed a web-based, user-friendly tool (available at https://sites.wustl.edu/lundon) that provides the predicted probability of donor lung acceptance. LUNDON score was also associated with recipient survival in patients with high lung allocation scores. In conclusion, the multivariable LUNDON score uses readily available donor characteristics to reliably predict lung acceptability. Widespread adoption of this model may standardize lung donor evaluation and improve lung utilization rates.

• Authors: Brendan T Heiden, Zhizhou Yang, Yun Zhu Bai, Yan Yan, Su-Hsin Chang, Yikyung Park, Graham A Colditz, Hank Dart, Ramsey R Hachem, Chad A Witt, Rodrigo Vazquez Guillamet, Derek E Byers, Gary F Marklin, Michael K Pasque, Daniel Kreisel, Ruben G Nava, Bryan F Meyers, Benjamin D Kozower, Varun Puri
• Journal: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons (Am J Transplant) Vol. 23 Issue 4 Pg. 540-548 (04 2023) ISSN: 1600-6143 [Electronic] United States
• PMID: 36764887 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2023 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Humans
• Young Adult
• Adult
• Tissue and Organ Procurement
• Retrospective Studies
• Lung Transplantation
• Tissue Donors
• Lung
• Brain Death