BACKGROUND Potential lung transplantation (LTx) recipients are assigned a donor sequence number (DSN) based on their position on the match list. Since a higher DSN offer has already been declined for other recipients, some providers may assume that a high DSN connotates poorer allograft quality. This study evaluated the association between DSN and outcomes, the correlation between transplant program case volume and the utilization of higher DSN lungs, and whether LTx outcomes differ between lower- and higher-volume programs. METHODS Using the Scientific Registry of Transplant Recipients database, LTx cases from 2015-2021 were retrospectively reviewed. Recipients were categorized into low (<20), medium (21-50), high (51-100), and very high (>100) DSN groups. The primary outcome was LTx survival. For cases involving high or very high DSN donors, a subgroup analysis compared survival among programs with annual transplant volumes in the bottom, middle 2, and top quartiles. RESULTS Median survival was similar among the low (6.9 years), medium (6.1), high (5.9), and very high DSN (6.5) groups (log-rank p = 0.09). Higher DSN donors were more commonly accepted by higher-volume LTx centers. However, the annual case volume of the transplanting institution did not impact survival when high (log-rank p = 0.16) or very high DSN (log-rank p = 0.36) donors were used. CONCLUSIONS Higher DSN should not be considered an independent marker of low allograft quality. Additionally, lower-volume centers achieved similar post-transplant outcomes as higher-volume centers for recipients receiving higher DSN lungs. These findings underscore that surgeons must judge each donor offer independent of other programs' assessments.

中文翻译：

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无论移植中心病例量如何，供体序列号与较差的肺移植结局无关。


背景 潜在肺移植 （LTx） 受者根据他们在匹配列表中的位置分配一个供体序列号 （DSN）。由于其他受体已经拒绝了更高的 DSN 报价，因此一些提供商可能会认为高 DSN 意味着较差的同种异体移植物质量。本研究评估了 DSN 与结果之间的关联、移植计划病例量与较高 DSN 肺利用率之间的相关性，以及较低容量和较高容量计划之间的 LTx 结果是否不同。方法 使用移植受者科学登记数据库，回顾性回顾 2015-2021 年的 LTx 病例。受者分为低 （<20）、中 （21-50）、高 （51-100） 和非常高 （>100） DSN 组。主要结局是 LTx 生存率。对于涉及高或非常高 DSN 供体的病例，亚组分析比较了年移植量在底部、中间 2 和最高四分位数的项目之间的生存率。结果 低 （6.9 岁） 、中 （6.1） 、高 （5.9） 和非常高 （6.5） 组的中位生存期相似 （对数秩 p = 0.09）。较高的 DSN 供体更常被高容量的 LTx 中心接受。然而，当使用高 （log-rank p = 0.16） 或非常高的 DSN （log-rank p = 0.36） 供体时，移植机构的年病例量不会影响生存率。结论 较高的 DSN 不应被视为同种异体移植物质量低的独立标志物。此外，对于接受较高 DSN 肺的受者，低容量中心实现了与高容量中心相似的移植后结果。这些发现强调，外科医生必须独立于其他项目的评估来判断每个捐献者提供的捐献。