Risk factors for lung transplant candidate waitlist removal in the era of the composite allocation score

JHLT Open Pub Date : 2025-08-07 DOI:10.1016/j.jhlto.2025.100368

AH Toporek , E. Adjei , WD Gannon , JW Stokes , CT Demarest , M. Bacchetta , K. Hoetzenecker , AJ Trindade

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引用次数: 0

Abstract

Implementation of the composite allocation score (CAS) has improved, but not eliminated, waitlist mortality amongst lung transplant candidates. Identifying risk factors for clinical deterioration is important to stratify patients who may benefit from closer monitoring or increased support.

We performed a UNOS registry-based study of lung transplant candidates listed between March 9, 2022 to March 8, 2024; analysis was stratified by listings before or after CAS implementation. Univariate and multivariate logistic regression analyses were performed to identify factors associated with waitlist removal for clinical decompensation or death.

Traits associated with waitlist removal during the pre-CAS era were short stature, ECMO support at listing, and amount of supplemental oxygen. Following CAS implementation, ECMO support, low BMI, poor functional status, short stature, and ABO blood type O were significantly associated with waitlist removal.

Close monitoring of patients with increased likelihood for waitlist removal, especially patients with multiple risk factors, may be appropriate.

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复合分配评分时代肺移植候选候补名单移除的危险因素

复合分配评分（CAS）的实施改善了，但没有消除肺移植候选者的等待名单死亡率。确定临床恶化的危险因素对于对患者进行分层是很重要的，这些患者可能从更密切的监测或增加的支持中受益。我们对2022年3月9日至2024年3月8日期间列出的肺移植候选人进行了一项基于UNOS注册的研究；通过实施CAS前后的清单进行分层分析。进行单因素和多因素logistic回归分析，以确定与临床失代偿或死亡的候补名单移除相关的因素。在前cas时代，与候补名单移除相关的特征是身材矮小，在名单时ECMO支持和补充氧气量。在实施CAS后，ECMO支持、低BMI、功能状态差、身材矮小和ABO O型血与等待名单移除显著相关。密切监测排除候补名单可能性增加的患者，特别是有多种危险因素的患者，可能是适当的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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JHLT Open

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