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，在一项研究中， 我们只利用了20%的供肺进行移植。这明显低于 欧洲其他国家（高达50%）移植后结局相似。这种低利用率是由于 美国各中心严格且不一致的供体选择标准。至少有15种不同的 捐助者的变量要考虑，每个变量的意义和变量之间的相互作用是 目前未知。与其他实体器官不同，例如肾脏，目前没有统一的供体风险 肺移植分层系统。此外，各中心使用的许多标准 受到挑战，利用大型国家和国际数据库，有证据表明， 在标准标准之外，对移植后结果没有显著影响。此外，一些 欧洲和北美的中心已经在一个机构的扩展标准捐助者方面取得了成功。 然而，它并没有在国家一级得到广泛的全面展示。 该项目的目标是开发一个全面的捐助者风险评分系统， 与各种供体因素的组合。这将使捐助者的选择标准化， 改善了美国各地肺移植的供体利用率。捐助者风险的积极影响 对于难以匹配的患者，已经显示了肾脏利用和移植的评分系统 移植其次，我们的目标是确定使用各种供体和 接收方风险组合（虚拟匹配）。通过这场比赛，我们希望找到目前 在现实和虚拟比赛中使用时，未得到充分利用并表现出可接受的结果。 这有可能影响整体肺移植候选人的结果， 率和移植受体之前，他们恶化，变得不适合移植， 高风险的接受者。

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.