Center Variability in Organ Offer Acceptance and Waitlist Mortality in Lung Transplantation

A. Y. Choi¹, M. S. Mulvihill², J. Weber³, H. Lee³, M. Cox², B. Yerokun², M. Kuchibhatla³, J. A. Klapper², M. G. Hartwig²

¹Duke University School of Medicine, Durham, NC, ²Department of Surgery, Duke University Medical Center, Durham, NC, ³Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC

Meeting: 2019 American Transplant Congress

Abstract number: 191

Keywords: Lung transplantation, Mortality, Outcome, Waiting lists

Session Information

Session Name: Concurrent Session: Setting the Table for Success after Lung Transplantation

Session Type: Concurrent Session

Date: Sunday, June 2, 2019

Session Time: 4:30pm-6:00pm

Presentation Time: 5:18pm-5:30pm

Location: Room 206

*Purpose: Lung transplantation (LTx) offers a survival benefit for patients with end-stage lung disease. When suitable donors are identified, centers must accept or decline the offer for a matched candidate on their waitlist. The purpose of the study was to evaluate the degree to which center-level variability in organ acceptance impacts candidate survival.

*Methods: We performed a retrospective cohort study of candidates aged ≥ 12 waitlisted for isolated LTx in the US using UNOS/OPTN data from 5/2007-5/2017. Centers that never had candidates ranked first on a match run >10 times in a year were excluded. Logistic regression was fit to assess the relationship of offer acceptance with donor-, candidate-, and geographic factors. Listing center was evaluated as a fixed effect to determine the adjusted per-center acceptance rate. Competing risks analysis employing the Fine-Gray model was undertaken to ascertain the relationship between the adjusted per-center acceptance rate and waitlist mortality.

*Results: Of 15,847 unique organ offers, 4,735 (29.9%) were accepted for the first-ranked patients. After adjustment for important covariates, transplant centers varied markedly in acceptance rate practices (9% to 67%). Higher cumulative incidence of 1-year waitlist mortality was associated with lower acceptance rate (Figure 1). For every 10% increase in adjusted center acceptance rate, the risk of waitlist mortality decreased by 36.3% (subdistribution hazard ratio 0.637; CI 0.592, 0.685). Importantly, high-acceptance centers that accepted ≥ 40% of their first-ranked offers had improved 1-year posttransplant survival compared to centers with adjusted organ acceptance rates <25% (88.7% vs. 82.7%, log-rank test p=0.003).

*Conclusions: Variability in center-level behavior potentially represents the largest modifiable risk factor for prolonged waitlist times and mortality in LTx. Further intervention is needed to standardize center-level organ offer acceptance practices and minimize waitlist mortality at the national level.

To cite this abstract in AMA style:

Choi AY, Mulvihill MS, Weber J, Lee H, Cox M, Yerokun B, Kuchibhatla M, Klapper JA, Hartwig MG. Center Variability in Organ Offer Acceptance and Waitlist Mortality in Lung Transplantation [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/center-variability-in-organ-offer-acceptance-and-waitlist-mortality-in-lung-transplantation/. Accessed May 9, 2025.

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