Clinical impact of a modified lung allocation score that mitigates selection bias
Section snippets
Methods
This study utilizes pre- and postlung transplant data from the United Network for Organ Sharing (UNOS). Our cohort consisted of all patients 18 years or older who were listed for single or bi-lateral lung transplantation in the United States between January 1, 2016 and December 31, 2017. This cohort is consistent with the testing cohort used in Schnellinger et al (2021),4 and ensures that enough follow-up time accrued among transplanted patients to evaluate 1-year posttransplant survival.
We
Observed analyses
Table 1 summarizes the demographic and clinical characteristics of the complete waiting list population as well as the subset of individuals who received transplant. In the full waitlist population, covariates were measured at the time of waitlist registration; among the subset of transplanted individuals, covariates are shown both at the time of waitlist registration and at the time of transplantation. In the full waitlist population, the median waiting time was 57 days (interquartile range,
Discussion
In this study, we used observed and simulated data to examine the clinical impact of a mLAS score designed to mitigate selection bias. We found that changes in prioritization were more pronounced for patients with certain demographic and clinical characteristics, such as diagnosis group (individuals with restrictive lung disease were more likely to receive better priority), 6-minute walk distance (individuals in the third quartile of walk distance had the highest probability of receiving better
Ethics approval and consent to participate
The study protocol was reviewed by University of Pennsylvania's Institutional Review Board (IRB Protocol #833089) and determined to not meet the definition of human subjects research.
Consent for publication
This manuscript has not been published and is not under consideration for publication elsewhere.
Availability of data and materials
The data that support the findings of this study are available from the United Network for Organ Sharing (UNOS). The authors do not have the authority to share UNOS data; researchers interested in accessing this data must submit a request to UNOS directly. All code is available upon request to the corresponding author, Ms. Erin M. Schnellinger.
Authors’ contributions
All authors contributed to the study's conception and design. Ms. Schnellinger carried out the statistical analyses, and drafted the initial manuscript and revised it based on the critical review and scientific input of Drs Cantu, Schaubel, Kimmel, and Stephens-Shields.
Disclosure statement
The authors have no conflicts of interest to declare.
The authors thank the Editors and Referees for their helpful feedback, which strengthened the manuscript.
This work was funded by the NIH F31HL194338 from the National Heart, Lung, and Blood Institute (NHLBI). DES was partly supported by NIH R01-DK070869 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The funder had no role in the design of the study or the collection, the analysis, and interpretation of the
References (18)
- et al.
Development of the new lung allocation system in the United States
Am J Transplant
(2006) - et al.
Organ distribution without geographic boundaries: a possible framework for organ allocation
Am J Transplant
(2018) - et al.
Impact of the lung allocation score on survival beyond 1 year
Am J Transplant
(2014) - et al.
Principles for allocation of scarce medical interventions
Lancet
(2009) - et al.
Impact of lung transplantation on recipient quality of life: a serial, prospective, multicenter analysis through the first posttransplant year
Chest
(2013) Organ Procurement and Transplantation Network (OPTN) Policies
(2020)A Guide to Calculating the Lung Allocation Score
(2015)- et al.
Mitigating selection bias in organ allocation models
BMC Med Res Methodol
(2021) - U.S. Department of Health & Human Services, O. P. T. N. Continuous Distribution, 2020, Accessed October 6, 2020....
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