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Use of Composite Allocation Score for Lung Transplant Wait List Improves Outcomes

Medically reviewed by Drugs.com.

By Lori Solomon HealthDay Reporter

MONDAY, May 19, 2025 -- Wait-list outcomes for lung transplants have substantially improved in the composite allocation score (CAS) era, according to a study presented at the American Thoracic Society 2025 International Conference, held from May 18 to 21 in San Francisco.

Mary Raddawi, M.D., from the Columbia University Irving Medical Center in New York City, and colleagues conducted a retrospective cohort study using the United Network for Organ Sharing registry to evaluate the impact of transplant era on wait-list outcomes (composite outcome of death or delisting for deterioration and transplantation). The three cohorts evaluated were the pre-November 2017 era, the post-November 2017 era (November 2017 to March 2023), and the CAS era (March 2023 to March 2024).

The researchers found that in the pre-November 2017 era, 11.2 percent of patients on the wait list died/delisted versus 8.4 percent in the post-November 2017 era and 4.1 percent in the CAS era. In patients with the top 5 percent of wait-list urgency (WLU) scores at listing, 34.5 percent of patients died/delisted in the pre-November 2017 era versus 22.2 percent in the post-November 2017 era and 6.5 percent in the CAS era. The pre- and post-November 2017 eras were associated with 3.3-fold and 2.1-fold higher risks for death/delisting, respectively, versus the CAS era. The pre- and post-November 2017 eras were associated with 8.0-fold and 4.8-fold higher risks for death/delisting, respectively, for patients in the top 5 percent of WLU at listing compared with the CAS era. Compared with the CAS era, patients on a high-flow nasal-cannula at listing also had a much greater increased risk for death/delisting in the prior eras (7.7-fold and 5.3-fold higher, respectively).

"We always want to make sure that any time we make a change to the allocation system that we're improving outcomes, especially for our sickest patients," Raddawi said in a statement. "This provides confirmation that we're on the right track."

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Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.

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Posted May 2025

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