Development and validation of the lung donor (LUNDON) acceptability score for pulmonary transplantation

Abstract

There is a chronic shortage of donor lungs for pulmonary transplantation due, in part, to low lung utilization rates in the United States. We performed a retrospective cohort study using data from the Scientific Registry of Transplant Recipients database (2006-2019) and developed the lung donor (LUNDON) acceptability score. A total of 83 219 brain-dead donors were included and were randomly divided into derivation (n = 58 314, 70%) and validation (n = 24 905, 30%) cohorts. The overall lung acceptance was 27.3% (n = 22 767). Donor factors associated with the lung acceptance were age, maximum creatinine, ratio of arterial partial pressure of oxygen to fraction of inspired oxygen, mechanism of death by asphyxiation or drowning, history of cigarette use (≥20 pack-years), history of myocardial infarction, chest x-ray appearance, bloodstream infection, and the occurrence of cardiac arrest after brain death. The prediction model had high discriminatory power (C statistic, 0.891; 95% confidence interval, 0.886-0.895) in the validation cohort. We developed a web-based, user-friendly tool (available at https://sites.wustl.edu/lundon) that provides the predicted probability of donor lung acceptance. LUNDON score was also associated with recipient survival in patients with high lung allocation scores. In conclusion, the multivariable LUNDON score uses readily available donor characteristics to reliably predict lung acceptability. Widespread adoption of this model may standardize lung donor evaluation and improve lung utilization rates.

Keywords: clinical research/practice; donor selection; donors and donation; health services and outcomes research; lung transplant; lung transplantation/pulmonology; organ procurement; organ procurement and allocation.

Figure 1.

Formation of the derivation and internal validation cohorts Consort diagram displaying exclusion criteria for the study cohort, which was randomly split (70:30) into derivation and internal validation cohorts.

Figure 2.

Integer-based score for predicting donor lung acceptability Integer-based score for the acceptability of donor lungs. Higher scores represent donor lungs with higher probability of acceptance.

Figure 3.

Proportion of low, intermediate, and high LUNDON score from 2006 to 2018. Relative changes in LUNDON scores (grouped as low, intermediate, high scores) based on year of transplantation.

Figure 4.

Kaplan-Meier curves for five-year graft survival in the overall cohort stratified by LUNDON score. Overall survival among recipients stratified by donor LUNDON score (p=0.027).