The Aggressive Phenotype: Center-Level Characteristics in the Use of Suboptimal Lungs
Johns Hopkins, Baltimore, MD.
Meeting: 2018 American Transplant Congress
Abstract number: C252
Keywords: Donors, High-risk, Ischemia, Lung transplantation, marginal
Session Information
Session Name: Poster Session C: Lung: All Topics
Session Type: Poster Session
Date: Monday, June 4, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
The disparity between organ supply and demand has led some centers to expand their criteria for donor selection. We explored utilization of suboptimal lungs to determine if an aggressive phenotype exists, and what center-level characteristics are associated with that phenotype.
Methods: We analyzed SRTR data for 17,484 adult lung transplants between 1/1/2006-12/31/2016. Based on available literature and clinical judgement, six categories of suboptimal lungs were selected. We assigned each center an aggressiveness score based on relative utilization of suboptimal lungs. We compared aggressive vs. nonaggressive centers to see if there were center-level characteristic differences. We explored potential phenotypes by a hierarchical agglomerative cluster analysis with Ward's linkage.
Results: There was no significant difference between aggressive and nonaggressive centers for UNOS region and median LAS at transplant. Median waitlist size was 11 for aggressive centers compared to 7.5 for nonaggressive (RR 1.691.902.13 p<0.001). Average annual transplant volume was 32.85 for aggressive compared to 17.34 for non-aggressive (RR 1.721.892.08 p<0.001). High waitlist disease severity represented by median number of patients reaching specified LAS cutpoints (LAS > 35, 40, 45) was significantly higher in aggressive centers (RR 1.87, 1.89, 1.93 p<0.001). Heat map and cluster analysis show that there is a difference in the use of suboptimal grafts by centers and that aggressive centers were, in general, aggressive with all categories of suboptimal lungs.
Conclusion: There are vast differences in center willingness to transplant suboptimal lungs. Centers which exhibit aggressive utilization of suboptimal lungs are associated with increased median waitlist size, average annual volume and high waitlist disease severity.
CITATION INFORMATION: Kosztowski M., Bush E., Luo X., Thomas A., Bowring M., Segev D., Garonzik Wang J. The Aggressive Phenotype: Center-Level Characteristics in the Use of Suboptimal Lungs Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Kosztowski M, Bush E, Luo X, Thomas A, Bowring M, Segev D, Wang JGaronzik. The Aggressive Phenotype: Center-Level Characteristics in the Use of Suboptimal Lungs [abstract]. https://atcmeetingabstracts.com/abstract/the-aggressive-phenotype-center-level-characteristics-in-the-use-of-suboptimal-lungs/. Accessed June 1, 2025.« Back to 2018 American Transplant Congress