BACKGROUND Lung continuous distribution (CD), implemented on March 9, 2023, changed the calculation and relative importance of medical urgency and posttransplant survival in prioritizing candidates for transplant. We aimed to identify factors associated with waitlist clinical deterioration and change in expected posttransplant survival from listing to transplant in the current system. METHODS We used Organ Procurement and Transplantation Network (OPTN) data to conduct a retrospective study of 2,395 adult, lung-only transplant recipients added to the waiting list and transplanted between March 09, 2023, and March 08, 2024. We used multivariable linear regression to identify factors associated with change in waitlist area under the curve (WLAUC) and posttransplant area under the curve (PTAUC), representing expected survival (in days) without and with transplant, respectively. RESULTS In multivariable analysis, longer waiting time (β=-1.3 per 7 days; p<0.001), male birth sex (β=-11; p=0.006), diagnosis group D (β=-27; p<0.001), and blood type O (β=-13; p<0.001) were associated with greater clinical deterioration from listing to transplant. Older (β=3.2 per 10-year increase in age; p=0.023) and taller (β=3.0 per 5 cm increase in height; p=0.003) recipients were less likely to clinically deteriorate from listing to transplant. Diagnosis group D (β=-4.7, p=0.032) and blood type O (β=-4.2, p=0.025) recipients had lower expected posttransplant survival at transplant compared to listing. CONCLUSION Our findings suggest the need to further investigate and address factors associated with waitlist clinical deterioration under CD. Future analysis of the effect of waitlist clinical deterioration on posttransplant outcomes under CD is needed.

中文翻译：

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在连续分配系统下，与美国肺移植受者候补名单临床恶化相关的因素。


背景 2023 年 3 月 9 日实施的肺连续分布 （CD） 改变了医疗紧急性和移植后生存率在优先考虑移植候选人时的计算和相对重要性。我们旨在确定与当前系统中候补名单临床恶化和移植后预期生存率变化相关的因素。方法 我们使用器官获取和移植网络 （OPTN） 数据对 2023 年 3 月 9 日至 2024 年 3 月 8 日期间被添加到等待名单并移植的 2,395 名成年纯肺移植受者进行了回顾性研究。我们使用多变量线性回归来确定与等待名单曲线下面积 （WLAUC） 和移植后曲线下面积 （PTAUC） 变化相关的因素，分别代表未移植和移植后的预期生存期 （以天为单位）。结果 在多变量分析中，较长的等待时间 （β=-1.3/7 天;p<0.001）、男性出生性别 （β=-11;p=0.006）、诊断组 D （β=-27;p<0.001） 和 O 型 （β=-13;p<0.001） 与从上市到移植的更大临床恶化相关。年龄较大 （β=每 10 岁增加 3.2;p=0.023） 和高个子 （β=身高每 5 cm 增加 3.0;p=0.003） 接受者从列入名单到移植临床恶化的可能性较小。诊断组 D （β=-4.7，p=0.032） 和 O 型血 （β=-4.2，p=0.025） 受者与列表相比，移植时移植后预期生存率较低。结论 我们的研究结果表明，需要进一步调查和解决与 CD 下候补名单临床恶化相关的因素。需要进一步分析候补名单临床恶化对 CD 移植后结局的影响。