A Novel Donor Risk Scoring System for Better Organ Utilization in Lung Transplantation

项目摘要[摘要]： 在美国，等待肺移植患者的等待死亡率高得令人无法接受。另一方面， 我们只利用了提供给移植的供体肺的20%。这一数字明显低于 欧洲其他国家(高达50%)的移植后结果类似。这种低利用率归因于 美国各中心严格且不一致的捐赠者选择标准。至少有15种不同的 要考虑的施主变量，以及每个变量的重要性和变量之间的相互作用是 目前尚不清楚。与其他实体器官不同，例如肾脏，目前没有统一的捐赠者风险 肺移植的分层系统。此外，中心使用的许多标准都有单独的 受到挑战，利用大型国家和国际数据库，有证据表明，选择捐助者 在标准标准之外，对移植后的结果没有显著影响。此外，还有一些 欧洲和北美的中心在一个机构的扩展标准捐赠者身上取得了成功 但是，在国家一级还没有得到广泛的、全面的论证。 这个项目的目标是开发一个全面的捐赠者风险评分系统，以量化相关的风险。 不同捐赠者因素的组合。这将使捐赠者的选择标准化， 美国各地肺移植供者利用率的提高。捐赠者风险的积极影响 难配型患者的利用和移植评分系统已经在肾脏显示出来 移植。其次，我们的目标是确定利用不同供体和 收件人风险组合(虚拟匹配)。通过这次匹配，我们希望确定目前 未得到充分利用，并在现实和虚拟比赛中使用时显示出可接受的结果。 这有可能通过增加器官利用率来影响整个肺移植候选患者的结果 在受者变得不适合移植或变得不适合移植或 风险较高的接受者。

Project Summary [Abstract]: Waitlist mortality for patients awaiting lung transplantation is unacceptably high in the US. On the other hand, we are only utilizing 20% of the donor lungs being offered for transplantation. This is significantly lower than other countries in Europe (Up to 50%) with similar post-transplant outcomes. This low utilization is attributed to the stringent and inconsistent donor selection criteria across the centers in US. There are at least 15 different donor variables to consider, and the significance of each variable and the interplay between variables is currently unknown. Unlike other solid organs, kidney for example, there is currently no unified donor risk stratification system for lung transplantation. Additionally, many of the criteria used by centers have individually been challenged, utilizing large national and international databases, with evidence that selecting donors outside the standard criteria does not have a significant effect on post-transplant outcomes. Additionally, some European and North American centers have shown success with extended criteria donors at an institutional level; however it has not been widely demonstrated comprehensively at a national level. The goal of this project is to develop a comprehensive donor risk scoring system to quantify risk associated with combinations of various donor factors. This will enable standardization of donor selection and improvement in donor utilization for lung transplantation around the US. The positive impact of a donor risk score system on utilization and transplantation for difficult-to-match patients has already been shown in kidney transplantation. Secondly, we aim to determine outcomes of lung transplants utilizing various donor and recipient risk combinations (virtual match). With this match, we hope to identify donors that are currently underutilized and demonstrate acceptable outcomes when they were utilized in reality and in virtual match. This has a potential to impact overall lung transplant candidate outcomes by both increasing organ utilization rates and by transplanting recipients before they deteriorate and become either unsuitable for transplant or higher risk recipients.