LUNG ALLOCATION SCORE SYSTEM UPDATE
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- Joella Allen
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1 LUNG ALLOCATION SCORE SYSTEM UPDATE
2 Current Lung Allocation System System was implemented on May 4, 25 The Lung Allocation Score (LAS) is based on a combination of Expected survival in next year without a transplant and Expected survival during 1 st year with a transplant Details of calculation and allocation can be found in Policy 3.7.6
3 Components Of Current Lung Allocation System: Diagnosis Groups Diagnosis group A B C D Diagnoses COPD/Emphysema; Alpha-1 Antitrypsin Deficiency; Bronchiectasis; LAM; Sarcoidosis with PA mean < 3; Primary Ciliary Dyskinesia PPH; Eisenmenger's; Scleroderma (primarily Pulmonary HTN) CF; Hypogammaglobulinemia IPF; Sarcoidosis with PA mean > 3; Lung retransplant; Obliterative Bronchiolitis (OB); Pulmonary Fibrosis (not IPF); Eosinophilic granuloma; Amyloidosis; Mixed Connective Tissue Disease; Scleroderma (primarily restrictive)
4 Lung and Heart-Lung Registrations Number Of Lung And Heart-lung Registrations By LAS Status Active Registrations 12+ Years LAS = LAS > /4 5/11 5/18 5/25 6/1 6/8 6/15 6/22 6/29 7/6 N=1667 N=1443
5 Active Lung And Heart-Lung Registrations (12+) On July 6, 25, By Region Lung and Heart-Lung Registrations Region
6 LAS for Active Lung And Heart-Lung Registrations (12+) With Nonzero Scores On July 6, 25, by Diagnosis Group Age Group Adult (18+) Pediatric (12-17) Diagnosis Median N Group Score ALL A (COPD) B (PPH) C (CF) D (IPF) ALL A (COPD) B (PPH) C (CF) D (IPF)
7 Percent Of Lung and Heart-Lung Transplants Pre- And Post- Policy Implementation By Diagnosis group Percent of Transplants A (COPD) B (PPH) C (CF) D (IPF) 5/5/24-7/5/4 5/5/25-7/5/25
8 Lung Utilization May 4, 24 June 3, 24 N % of donors May 4, 25 June 3, 25 N % of donors Deceased donors Deceased donor lungs Donors 66 Donors with at least 1 lung transplanted Lungs (2*donors) Lungs transplanted 82 N % of lungs N 16.8 % of lungs
9 Percent of Lungs Transplanted* May 4, 25 June 3, 25 1 Percent of Lungs Transplanted Region * Percent = # Lungs transplanted / donors*2
10 Evaluation of National Kidney Allocation Policy after the Elimination of HLA-B Matching Points
11 Background On May 7, 23, the kidney allocation system was modified so that: No points for HLA-B matches 2 points for zero HLA-DR mismatches 1 point for one HLA-DR mismatches. Previously: 7 points for zero HLA-BDR mismatch 5 points for one HLA-BDR mismatch
12 Data/Methods Deceased donor kidney alone transplants performed at 35 DSA s (with standard HLA points) between 5/7/2 and 5/6/4 were included. Pediatric recipients and recipients of expanded criteria donor (ECD) kidneys were excluded from the analysis.
13 Data/Methods Compare percentage of transplants by ethnicity, HLA MM level, PRA, wait time, and graft survival in two periods: Pre-policy period: 5/7/2-5/6/3 N = 3,236 Post-policy period: 5/7/3-5/6/4 N = 3,1
14 Non-Zero MM Transplants by Policy Period and Ethnicity Percent of Transplants P= White Black Hispanic Asian Other Pre-Policy Post-Policy
15 Non-Zero MM Transplants by Policy Period and HLA DR MM Percent of Transplants P< DR MM 1 DR MM 2 DR MM Pre-Policy Post-Policy
16 Non-Zero MM Transplants by Policy Period and HLA MM Percent of Transplants P< MM 2 MM 3 MM 4 MM 5 MM 6 MM Pre-Policy Post-Policy
17 Non-Zero MM Transplants by Policy Period and Peak PRA (%) Percent of Transplants P< Not Reported % - 2% 21% - 79% 8%+ Pre-Policy Post-Policy
18 Non-Zero MM Transplants by Policy Period and Wait Time Percent of Transplants P< <=1 yr 1-2 yrs 2-4 yrs >4 yrs Pre-Policy Post-Policy 1
19 Kaplan-Meier Graft Survival by Policy Period 1 9 P=.2 Survival (%) Pre-Policy Post-Policy
20 Summary Compared with pre-policy period: More minority candidates received a nonzero MM kidney transplant. More transplants with worse HLA DR MM. More transplants with PRA > 8%. More transplants with longer waiting times. Graft survival rates were similar.
21 Evaluation of National Liver Allocation Policy after the Implementation of Share 15 Policy
22 Background On January 12, 25, the liver allocation system was modified: Local Status 1A, Status 1B Regional Status 1A, Status 1B Local MELD/PELD > 15 Regional MELD/PELD > 15 Local MELD/PELD < 15 Regional MELD/PELD < 15 National Status 1A, Status 1B, MELD/PELD Previously: Local Status 1A, Status 1B Regional Status 1A, Status 1B Local MELD/PELD Regional MELD/PELD National Status 1A, Status 1B, MELD/PELD
23 Adult Deceased Donor Liver Transplants Pre-Policy Period: 1/12/4 5/11/4 3 Number of Transplants Region MELD < 15 MELD >= 15 Status 1
24 Adult Deceased Donor Liver Transplants Post-Policy Period: 1/12/5 5/11/5 3 Number of Transplants Region MELD < 15 MELD >= 15 Status 1
25 Adults Removed for Death/Too Sick from Liver Waiting List Pre-Policy Period: 1/12/4 5/11/4 12 Number of Candidates Region MELD < 15 MELD >= 15 Status 1
26 Adults Removed for Death/Too Sick from Liver Waiting List Post-Policy Period: 1/12/5 5/11/5 12 Number of Candidates Region MELD < 15 MELD >= 15 Status 1
27 Death Rates per 1 Patient Days Liver Candidates on the Waiting List During 9/12/4-5/11/5 By Age at Listing and Policy Period Death Rate per 1 patient days /12/4-1/11/5 1/12/5-5/11/5
28 Organs Transplanted Locally vs. Non-Locally What percentage of organs are transplanted outside the DSA? Some are offered and refused locally, but are ultimately transplanted outside the DSA Others are offered outside the DSA first (no local patients, Status 1 liver shares, MM kidneys, Statewide shares, etc.) How well do these organs function? UNet sm Utility for Recovering OPOs Overall survival rates shown here (adult donors, excluding repeat txs and multiorgan txs)
29 Number of Transplants Kidney Transplants from Adult Donors by Region of Recovery Region of Recovery Local Non-Local
30 Kidney Transplants from Adult Donors by Region of Recovery Number of Transplants Region of Recovery Local Non-Local, No Local Refusals Non-Local, Locally Refused
31 Number of Transplants Kidney Transplants from Adult Donors by Region of Recovery Region of Recovery Local No Local Refusal, Tx Out of Region Locally Refused, Tx Out of Region No Local Refusal, Tx in Region Locally Refused, Tx in Region
32 Kidney Transplant* Graft Survival Survival Rate (%) P< Months Post Transplant Local Non-Local, No Local Refusal Non-Local, Locally Refused * Adult donors only, excluding multiorgan and repeat transplants.
33 Number of Transplants Heart Transplants from Adult Donors by Region of Recovery Region of Recovery Local Non-Local
34 Heart Transplants from Adult Donors by Region of Recovery Number of Transplants Region of Recovery Local Non-Local, No Local Refusals Non-Local, Locally Refused
35 Number of Transplants Heart Transplants from Adult Donors by Region of Recovery Region of Recovery Local No Local Refusal, Tx Out of Region Locally Refused, Tx Out of Region No Local Refusal, Tx in Region Locally Refused, Tx in Region
36 Heart Transplant* Patient Survival Survival Rate (%) P= Months Post Transplant Local Non-Local, No Local Refusal Non-Local, Locally Refused * Adult donors only, excluding multiorgan and repeat transplants.
37 Liver Transplants from Adult Donors by Region of Recovery Number of Transplants Region of Recovery Local Non-Local
38 Number of Transplants Liver Transplants from Adult Donors by Region of Recovery Region Local Non-Local, No Local Refusals Non-Local, Locally Refused
39 Number of Transplants Liver Transplants from Adult Donors by Region of Recovery Region of Recovery Local No Local Refusal, Tx Out of Region Locally Refused, Tx Out of Region No Local Refusal, Tx in Region Locally Refused, Tx in Region
40 Liver Transplant* Graft Survival Survival Rate (%) P= Months Post Transplant Local Non-Local, No Local Refusal Non-Local, Locally Refused * Adult donors only, excluding multiorgan and repeat transplants.
41 Number of Transplants Lung Transplants from Adult Donors by Region of Recovery Region of Recovery Local Non-Local
42 Lung Transplants from Adult Donors by Region of Recovery Number of Transplants Region of Recovery Local Non-Local, No Local Refusals Non-Local, Locally Refused
43 Number of Transplants Lung Transplants from Adult Donors by Region of Recovery Region of Recovery Local No Local Refusal, Tx Out of Region Locally Refused, Tx Out of Region No Local Refusal, Tx in Region Locally Refused, Tx in Region
44 Lung Transplant* Patient Survival Survival Rate (%) P= Months Post Transplant Local Non-Local, No Local Refusal Non-Local, Locally Refused * Adult donors only, excluding multiorgan and repeat transplants.
45 HHS PART Goals Performance Assessment and Review Tool (PART) 1 year and annual programmatic goals Increase donors, transplants, life years gained for kidney tx, reduce costs per tx Very aggressive annual goals
46 7 Monthly National Donation Rates 65 Organ Donors Collaborative Starts Here 45 4 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
47 HRSA S PART Goals Increase the number of deceased donor organs transplanted Increase the number of non-dcd donors Increase the number of DCD donors Increase the average number of organs transplanted per non-dcd donor Increase the average number of organs transplanted per DCD donors
48 HRSA s PART GOALS Increase the number of deceased donor organs transplanted each year until 42,8 are transplanted in 213 Organs Txed Year Actual PART Goals
49 HRSA s PART GOALS Increase the number of non-dcd donors each year until 9251 is achieved in 213 # Non-DCD Year Actual PART Goals
50 HRSA s PART GOALS Increase the number of DCD donors each year until 218 is achieved in 213 # DCD Year Actual PART Goals
51 HRSA s PART GOALS Avg. Tx/Donor Increase the average number of organs transplanted per non-dcd donors each year by.8 to reach 4. in Year Actual PART Goals
52 HRSA s PART GOALS Increase the average number of organs transplanted per DCD donors each year by to reach 3. in 213 Avg. Tx/Donor Year Actual PART Goals
53 HRSA s PART GOALS Increase the total expected life-years gained for kidney transplant recipients in the first 5 years after transplant compared to what would be expected had they remained on the waiting list LY Gained % Increase Year
54 Avg LY Gained HRSA s PART GOALS Increase the average number of years of life gained in the first 5 years after the transplant for deceased kidney/kidney-pancreas transplanted by.3 life-years until the goal of.436 lifeyears gained per transplant is achieved in Year 8.7 % Increase
55 Number of Transplants Transplants from DCD Donors July, 24 June, Kidney Liver Kidney- Pancreas Lung Pancreas
56 14 DCD Kidney Transplants July, 23 June, 25 Number of Transplants Region 7/1/23-6/3/24 7/1/24-6/3/25
57 14 DCD Kidney-Pancreas Transplants July, 23 June, 25 Number of Transplants Region 7/1/23-6/3/24 7/1/24-6/3/25
58 Number of Transplants DCD Liver Transplants July, 23 June, Region 7/1/23-6/3/24 7/1/24-6/3/25
59 Number of Transplants DCD Lung Transplants July, 23 June, Region 7/1/23-6/3/24 7/1/24-6/3/25
60 Transplants from ECD Donors July, 24 June, 25 1,472 1, HL Heart Kidney KP Liver Lung Pancreas Number of Transplants
61 3 ECD Kidney Transplants July, 23 June, 25 Kidney Transplants Region 7/1/23-6/3/24 7/1/24-6/3/25
62 Kidney Transplant Graft Survival 2-23 U.S. 1 Survival Rate (%) Years Post Transplant SCD DCD ECD
63 1 Liver Transplant Graft Survival 2-23 U.S. Survival Rate (%) Years Post Transplant SCD DCD ECD
64 Mar5 May DCD Donors by Month 23 June, 25 Jul3 Sep3 Nov3 Jan4 Mar4 May4 Jul4 Sep4 Nov4 Jan5 Jan3 Mar3 May3 Number of Donors
65 Mar5 May5 Jan ECD Donors by Month 23 June, 25 Jul3 Sep3 Nov3 Jan4 Mar4 May4 Jul4 Sep4 Nov4 Jan3 Mar3 May3 Number of Donors
66 Organs Recovered Per Donor by Donor Type 1995 June, 25 Organs Recovered per Donor Standard ECD DCD
67 Organs Transplanted Per Donor by Donor Type 1995 June, 25 Organs Transplanted per Donor Standard ECD DCD
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