Expected effect of the lung Composite Allocation Score system on US lung transplantation
Expected effect of the lung Composite Allocation Score system on US lung transplantation
复制标题
肺综合分配评分系统对美国肺移植的预期效果
DOI：
10.1111/ajt.17160
复制
发表时间：
2022
影响因子：
8.8
通讯作者：
E. Lease
中科院分区：
文献类型：
--
作者：
M. Valapour;C. Lehr;A. Wey;M. Skeans;Jonathan M. Miller;E. Lease
目前正在努力将当前的肺分配系统转变为一个连续的分配框架，在这个框架中，多个因素同时结合到一个复合分配评分（CAS）中，以优先考虑肺移植候选人。本研究的目的是比较离散CAS方案与当前基于同心圆的分配系统，以评估其对美国肺移植系统的潜在影响，使用移植受者科学登记的胸部模拟分配模型。使用2018年1月1日至2019年12月31日肺移植等待名单上的个人的数据，在10次模拟运行中比较了6种备选CAS方案。结果测量包括移植率、数量、等候名单死亡人数、移植后2年内死亡人数、供体与受体之间的距离以及预计移植器官的百分比。在各种情况下，等候名单死亡率下降了36%至47%，在较低的安置效率权重和较高的等候名单结果权重下，死亡率下降幅度较大。当等待名单结果与移植后结果同等加权时，更多的移植发生在移植后存活率最高的个体中。与目前的肺分配评分系统相比，所有CAS方案都改善了公平的总体衡量标准，包括减少了等待名单上的死亡，并导致了相似的移植后生存。
Efforts are underway to transition the current lung allocation system to a continuous distribution framework whereby multiple factors are simultaneously combined into a Composite Allocation Score (CAS) to prioritize candidates for lung transplant. The purpose of this study was to compare discrete CAS scenarios with the current concentric circle–based allocation system to assess their potential effects on the US lung transplantation system using the Scientific Registry of Transplant Recipients' thoracic simulated allocation model. Six alternative CAS scenarios were compared over 10 simulation runs using data from individuals on the lung transplant waiting list from January 1, 2018, through December 31, 2019. Outcome measures were transplant rate, count, waitlist deaths, posttransplant deaths within 2 years, donor‐to‐recipient distance, and percentage of organs predicted to have flown. Across scenarios, waitlist deaths decreased by 36% to 47%, with larger decreases in deaths at lower placement efficiency weight and higher weighting of the waitlist outcomes. When waitlist outcomes were equally weighted to posttransplant outcomes, more transplants occurred in individuals with the highest expected posttransplant survival. All CAS scenarios led to improved overall measures of equity compared with the current Lung Allocation Score system, including reduced waitlist deaths, and resulted in similar posttransplant survival.