Performance Changes Following the Revision of Organ Allocation System of Lung Transplant: Analysis of Korean Network for Organ Sharing Data

Abstract

Background There is currently a lack of data on the impact of the recent revision of the domestic lung allocation system on transplant performance. Methods We conducted a retrospective analysis of transplant candidates and transplant patients registered in Korean Network for Organ Sharing between July 2015 and July 2019. Study periods were classified according to the introduction of the revised lung allocation system as follows: period 1 from July 2015 to June 2017 and period 2 from August 2017 to July 2019. Results During the study period, a total of 627 patients were on the waiting list, of which 398 lung transplantations were performed. Total waiting list size increased by 98.6%, from 210 in period 1 to 417 in period 2. The number of transplant patients also increased by 32.7%, from 171 in period 1 to 227 in period 2. The number of donors decreased from 1,042 to 878, whereas the usage rate, i.e., the number of lung donors used for transplantation among the total number of reported lung donors, increased from 16.4% to 25.9%. The proportion of patients with high urgent status at transplantation increased from 45% to 60.4%, whereas those with urgent status decreased from 46.8% to 35.7% ( P = 0.006). The use of marginal donor lungs increased from 29.8% to 53.7% ( P < 0.001). To adjust urgency status and marginal donor usage between two groups, we conducted a propensity score matching analysis. No significant differences were detected in 1-year survival rates between the two periods after propensity score matching. As well, no significant difference was observed in mortality on the waiting list between the two periods. Conclusion The recent revision of the lung allocation system in Korea did not change the performance of lung transplant in terms of waiting list mortality and 1-year survival. The rapid increase in the volume of waiting list between the two periods increased the waiting time, transplantation of high-urgency patients, and use of marginal lung donors.

Successful lung transplantation after prone positioning in an ineligible donor: a case report

“…In the same context, other studies have shown that there was no difference in the utilization of the heart, liver, and kidney with the donor in the prone and supine positions [4,7]. The mortality on the waiting list has been high because of the imbalance between the number of available organs and potential recipients [3]. Therefore, it is necessary to increase the number of available lungs for transplantation through active lung management of marginal or unacceptable donors [8].…”

“…The mortality on the waiting list has been high because of the imbalance between the number of available organs and potential recipients [ 3 ]. Therefore, it is necessary to increase the number of available lungs for transplantation through active lung management of marginal or unacceptable donors [ 8 ].…”

“…The demand for lung transplantation has increased recently, and the shortage of lung donors is a critical issue [ 1 ]. Annually, approximately 20% of anticipatory lung transplant patients worldwide die on the waiting list [ 2 , 3 ]. Although the use of marginal donors has increased in response to this problem, several donor lungs are not used due to poor lung conditions [ 3 ].…”

“…Annually, approximately 20% of anticipatory lung transplant patients worldwide die on the waiting list [ 2 , 3 ]. Although the use of marginal donors has increased in response to this problem, several donor lungs are not used due to poor lung conditions [ 3 ]. One of the main reasons why donor’s lungs are not used is the low oxygen (PaO 2 )/fraction of inspired oxygen (FiO 2 ) ratio [ 4 ].…”

Allocation of Donor Lungs in Korea

“…Since then, efforts have been made to distribute and manage organs fairly and efficiently according to the Internal Organs Transplant Act [ 5 ]. The current donor lung allocation system is based mainly on urgency, with additional points allocated according to region, blood type, wait time, previous donation history, and age [ 6 ]. Transplant candidates are classified as 0–4 according to urgency; a lower status indicates a higher priority.…”