Impact of the New French Lung Allocation System on Geographic Disparities: The 3-month Results

Abstract

<h3>Purpose</h3> A new lung allocation system was introduced in France in September 2020 in order to reduce geographic disparities in lung allocation while maintaining proximity. The new system redistricted local allocation units (LAU) according to supply/demand ratio and replace regional by national sharing. The new system was designed to obtain a ratio of lungs recovered in the LAU to transplants performed in the paired center close to 0.5 in each center with a driving time between procurement (PC) and transplant centers (TC) of less than 2 hours. <h3>Methods</h3> The study compared specific end-points between the September 2020 to March 2021 post-implementation cohort of candidates (n=144) and recipients (n=98) and the September 2018 to March 2019 season-matched pre-implementation pre-pandemic cohort including 199 candidates and 122 recipients. The specific measures were graft travel distance between PC and TC, cold ischemia time, number of graft offers per candidate, 3-month cumulative incidence of death on the waiting list or delisting for worsening medical condition and 3-month posttransplant survival. Cumulative incidence of waitlist mortality was assessed with competing risk analysis and posttransplant survival was estimated with Kaplan-Meier method. Student t-test, Bartlett test, Levene test and z-test were used when appropriate. <h3>Results</h3> The new system was associated with a decrease in standard deviation of graft offers per candidate from 0.9 to 0.4 (p=0.01) whereas mean graft travel distance, mean cold ischemia time, 3-month waitlist mortality and 3-month posttransplant survival were similar in both cohorts. <h3>Conclusion</h3> The new supply/demand ratio-based French lung allocation system reduced geographic disparity in the number of grafts offered per candidate while maintaining proximity, without any adverse effect on patients' survival.