Comparison of donor scores in bilateral lung transplantation-A large single-center analysis

Abstract

Objectifying donor lung quality is difficult and currently there is no consensus. Several donor scoring systems have been proposed in recent years. They all lack large-scale external validation and widespread acceptance. A retrospective evaluation of 2201 donor lungs offered to the lung transplant program at the Medical University of Vienna between January 2010 and June 2018 was performed. Five different lung donor scores were calculated for each offer (Oto, ET, MALT, UMN-DLQI, and ODSS). Prediction of organ utilization, 1-year graft survival, and long-term outcome were analyzed for each score. 1049 organs were rejected at the initial offer (group I), 209 lungs declined after procurement (group II), and 841 lungs accepted and transplanted (group III). The Oto score was superior in predicting acceptance of the initial offer (AUC: 0.795; CI: 0.776-0.815) and actual donor utilization (AUC: 0.660; CI: 0.618-0.701). Prediction of 1-year graft survival was best using the MALT score, Oto score, and UMN-DLQI. Stratification of early outcome by MALT was significant for length of mechanical ventilation (LMV), PGD3 rates, ICU stay and hospital stay, and in-hospital-mortality, respectively. To the best of our knowledge, this study is the largest validation analysis comparing currently available donor scores. The Oto score was superior in predicting organ utilization, and MALT score and UMN-DLQI for predicting outcome after lung transplantation.

Keywords: clinical research / practice; donors and donation; donors and donation: donor evaluation; lung transplantation / pulmonology; organ procurement and allocation; organ transplantation in general.

Figure 1

Donors were assigned to three groups: declined at offer (group I), rejected after procurement (group II), and transplanted (group III). A total of 102 donors were excluded from the analysis. EVLP, ex vivo lung perfusion; DCD, donation after cardiac death

Figure 2

Distribution of scores in group I (organs rejected at offer), group II (organs rejected after procurement), and group III (transplanted organs). Scores using only donor factors are depicted in panel (A), and scores combining donor and recipient factors are shown in panel (B). Dotted lines signify 25%, 50% (median), and 75% quartiles [Color figure can be viewed at wileyonlinelibrary.com]

Figure 3

(A) The predictive value of accepting an organ offer was best for the Oto score, followed by the ET and the ODSS score. (B) The Oto score also predicted if the procured lung was ultimately transplanted most accurately, followed by the ODSS and the ET score. (C) For all successfully transplanted patients, the MALT, Oto, and ODSS scores were superior in predicting 1‐year graft survival among the scores using only donor factors. (D) Both scores based on a combination of donor and recipient factors (MALT and UMN‐DLQI) predicted 1‐year graft survival well. Level of statistical significance is indicated as follows: *p ≤ .05; **p ≤ .01; ***p ≤ .001 [Color figure can be viewed at wileyonlinelibrary.com]

Figure 4

Kaplan‐Meier curves of graft survival were produced for scores using only donor parameters (A) and scores combining donor and recipient parameters (B) and their respective donor organ quality categories [Color figure can be viewed at wileyonlinelibrary.com]