ASSOCIATION OF DONOR ALLOCATION SEQUENCE WITH OUTCOMES AFTER LUNG TRANSPLANTATION

Abstract

SESSION TITLE: Transplantation Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: There is limited data regarding the association of donor allocation sequence number with early complications such as primary graft dysfunction (PGD) and survival after lung transplantation (LT). METHODS: We included 152 consecutive patients who underwent LT over a two-year period (11/2014-12/2016; mean age 56.8±13.2 years; M:F 93:59). The data regarding the allocation characteristics as well as graft survival were obtained directly from the United Network for Organ Sharing (UNOS) database. This data was merged with the institutional recipient database. Recipient data included baseline characteristics, peri-operative and post-operative course, complications and hospital outcomes. Primary graft dysfunction was analyzed as the primary outcome variable whereas the hospital length of stay and survival at one, and three-year post transplant were secondary outcome variables. RESULTS: The most common diagnostic group was restrictive lung diseases (n=81, 52.2%) with a mean lung allocation score (LAS) of 44.8±15 and majority underwent bilateral LT (n=98). The median allocation sequence was 4.5 for the study group (IQR 2-13). The study group was divided into patients who were transplanted at sequence #1 (n=29) vs those transplanted with organs accepted at lower allocation sequence. Patients with higher mean LAS (56.4±19.5 vs 42.1±12.4, p<0.001), restrictive disorders as the transplant indication (72% vs 48.7%, p=0.03), hospitalized at the time of LT (28% vs 9%, p=0.06) and bridged to LT using ECMO (21% vs 3%, p=0.001) were significantly more likely to be transplanted at sequence #1. Despite being sicker, recipients of allocation sequence #1 had significantly lower incidence of PGD 2 or 3 at 0 hours (24%, vs 61%, p<0.001; mean PF ratio: 357±81 vs 273±107, p<0.001) and 72 hours (14% vs 28%, p=0.15 mean PF ratio: 303±147 vs 198±167, p=0.002). Although, the recipients of allocation at sequence #1 experienced equivalent hospital survival, their survival trended lower at one-year and three-year follow up (p=NS). CONCLUSIONS: While patients transplanted at allocation sequence #1 tend to be sicker, they have better oxygenation during the first 72 hours after LT and lower risk of PGD. Nonetheless, a higher donor allocation sequence is not associated with superior one-year or three-year survival. CLINICAL IMPLICATIONS: By virtue of being prioritized for LT, sicker recipients may be transplanted with better quality donor lungs. While this allocation strategy may be successful in reducing early complications, it fails to improve post-LT survival. DISCLOSURES: My spouse/partner as a Employee relationship with Abbott Labs Please note: $20001 - $100000 Added 06/05/2020 by Amit Banga, source=Web Response, value=Salary No relevant relationships by SRINIVAS Bollineni, source=Web Response No relevant relationships by John Joerns, source=Web Response No relevant relationships by Vaidehi Kaza, source=Web Response No relevant relationships by Adrian Lawrence, source=Admin input No relevant relationships by Manish Mohanka, source=Web Response No relevant relationships by John Murala, source=Web Response No relevant relationships by Matthias Peltz, source=Web Response No relevant relationships by Lauren Shaffer, source=Web Response No relevant relationships by Fernando Torres, source=Web Response No relevant relationships by Michael Wait, source=Web Response