Use of a novel donor lung scoring system as a tool for increasing lung recovery for transplantation.

Autor:	Bai YZ; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo. Electronic address: y.bai@wustl.edu., Yan Y; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Mo., Chang SH; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Mo., Yang Z; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo; Department of Surgery, Massachusetts General Hospital, Boston, Mass., Delhi A; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo., Farahnak K; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo., Joseph K; Washington University School of Medicine, St. Louis, Mo., Hamilton C; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo., Baumann Walker AA; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Mo., Hachem RR; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Mo., Witt CA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Mo., Guillamet RV; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Mo., Byers DE; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Mo., Marklin GF; Mid-America Transplant, St. Louis, Mo., Hartwig MG; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC., Brandt WS; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo., Kreisel D; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo., Nava RG; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo., Patterson GA; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo., Kozower BD; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo., Meyers BF; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo., Heiden BT; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo., Puri V; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2024 Sep 01. Date of Electronic Publication: 2024 Sep 01.
DOI:	10.1016/j.jtcvs.2024.08.047
Abstrakt:	Background: There is a critical shortage of donor lungs for transplantation. We previously developed a parsimonious, highly discriminatory 9-variable Lung Donor (LUNDON) acceptability score. Here we assessed the utility of this score as a tool for improving lung recovery rates for transplantation. Methods: We examined all brain-dead donors between 2014 and 2020 from 3 US organ procurement organizations and validated the score's predictive performance. We examined the trajectory of donors with low (<40) and high (>60) initial LUNDON scores, their corresponding lung recovery rates, factors contributing to score improvement using multivariable regression models, and 1-year post-transplant recipient survival. Results: Overall lung recovery was 32.4% (1410 of 4351). Validation of the LUNDON score in our cohort revealed a C statistic of 0.904 and required intercept calibration. Low initial LUNDON donors that improved to a high final score had an increase in lung recovery rate from 29.3% (1100 of 3765) to 86.8% (441 of 508), associated with lower body mass index, management in a specialized donor care facility (SDCF), and more bronchoscopies. Donors with high initial and final LUNDON scores had a lung recovery rate of 85.2% (98 of 115), associated with shorter length of hospital stay. One-year survival was similar in recipients of low-to-high versus high-to-high LUNDON score donors (0.89 vs 0.84; P = .2). Conclusions: The LUNDON score performs well as a predictor of lung recovery in a contemporary cohort but may require organ procurement organization-specific calibration. SDCF care, increasing use of bronchoscopy, and decreasing the time from brain death to organ procurement may improve lung utilization. The LUNDON score can be used to guide donor management to expand the donor pool. Competing Interests: Conflict of Interest Statement The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. (Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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