4.5 Article

Geographic disparities in lung transplantation in the United States before and after the November 2017 allocation change

期刊

JOURNAL OF HEART AND LUNG TRANSPLANTATION
卷 41, 期 3, 页码 382-390

出版社

ELSEVIER SCIENCE INC
DOI: 10.1016/j.healun.2021.11.002

关键词

lung transplant; geographic disparities; lung allocation; donor allocation; ability Quartile

资金

  1. Boomer Esiason Foundation
  2. Cystic Fibrosis Foundation through the Cystic Fibrosis Lung Transplant Consortium
  3. National Institutes of Health [K23-HL150280]

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The expansion of the primary lung allocation unit improved disparities in waitlist outcomes, but significant differences remain due to geographic factors.
BACKGROUND: The primary lung allocation unit was expanded from the donation service area to a 250mile radius in 2017. Prior to the change, geographic disparities in donor lung availability impacted waitlist outcomes. We sought to determine if the new allocation system improved these disparities. METHODS: We conducted a retrospective cohort study comparing the 2-year period before and after the change. Donor lung availability was defined as the ratio of donor lungs to waitlist candidates in the primary allocation unit. Transplant centers were divided into quartiles by donor lung availability. Multivariable competing risk models were used to determine the association between lung availability and waitlist outcomes. Multivariable Cox proportional hazards models compared post-transplant survival. RESULTS: Prior to the allocation change, the unadjusted transplant rate at centers in the lowest and highest quartiles was 132 and 607 transplants per 100 waitlist years. Candidates in the lowest quartile of donor lung availability had a 61% adjusted lower transplantation rate compared to candidates in highest quartile (sub-hazard ratio [sHR]: 0.39, 95% confidence interval [CI]: 0.34-0.44). After the allocation change, the disparity decreased resulting in an unadjusted transplant rate of 141 and 309 among centers in the lowest and highest quartiles. Candidates in the lowest quartile had a 38% adjusted lower transplantation rate compared to those in the highest (sHR: 0.62, 95% CI: 0.57-0.68). There was no significant difference in 1-year post-transplant survival. CONCLUSIONS: Although the expansion of the primary allocation unit improved disparities in waitlist outcomes without any change in post-transplant survival, there still remain significant differences due to geography.

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