PMID- 38266712 OWN - NLM STAT- MEDLINE DCOM- 20240504 LR - 20240504 IS - 1600-6143 (Electronic) IS - 1600-6135 (Linking) VI - 24 IP - 5 DP - 2024 May TI - Scoring donor lungs for graft failure risk: The Lung Donor Risk Index (LDRI). PG - 839-849 LID - S1600-6135(24)00090-X [pii] LID - 10.1016/j.ajt.2024.01.022 [doi] AB - Lung transplantation lags behind other solid organ transplants in donor lung utilization due, in part, to uncertainty regarding donor quality. We sought to develop an easy-to-use donor risk metric that, unlike existing metrics, accounts for a rich set of donor factors. Our study population consisted of n = 26 549 adult lung transplant recipients abstracted from the United Network for Organ Sharing Standard Transplant Analysis and Research file. We used Cox regression to model graft failure (GF; earliest of death or retransplant) risk based on donor and transplant factors, adjusting for recipient factors. We then derived and validated a Lung Donor Risk Index (LDRI) and developed a pertinent online application (https://shiny.pmacs.upenn.edu/LDRI_Calculator/). We found 12 donor/transplant factors that were independently predictive of GF: age, race, insulin-dependent diabetes, the difference between donor and recipient height, smoking, cocaine use, cytomegalovirus seropositivity, creatinine, human leukocyte antigen (HLA) mismatch, ischemia time, and donation after circulatory death. Validation showed the LDRI to have GF risk discrimination that was reasonable (C = 0.61) and higher than any of its predecessors. The LDRI is intended for use by transplant centers, organ procurement organizations, and regulatory agencies and to benefit patients in decision-making. Unlike its predecessors, the proposed LDRI could gain wide acceptance because of its granularity and similarity to the Kidney Donor Risk Index. CI - Copyright (c) 2024. Published by Elsevier Inc. FAU - Cantu, Edward AU - Cantu E AD - Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Diamond, Joshua AU - Diamond J AD - Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Ganjoo, Nikhil AU - Ganjoo N AD - Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Nottigham, Ana AU - Nottigham A AD - Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Ramon, Christian Vivar AU - Ramon CV AD - Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. FAU - McCurry, Madeline AU - McCurry M AD - Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Friskey, Jacqueline AU - Friskey J AD - Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Jin, Dun AU - Jin D AD - Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Anderson, Michaela R AU - Anderson MR AD - Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Lisowski, Jessica AU - Lisowski J AD - Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Le Mahajan, Audrey AU - Le Mahajan A AD - Division of Infectious Disease, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Localio, A Russell AU - Localio AR AD - Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. FAU - Gallop, Robert AU - Gallop R AD - Department of Mathematics, West Chester University, West Chester, Pennsylvania, USA. FAU - Hsu, Jesse AU - Hsu J AD - Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. FAU - Christie, Jason AU - Christie J AD - Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA. FAU - Schaubel, Douglas E AU - Schaubel DE AD - Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: douglas.schaubel@pennmedicine.upenn.edu. LA - eng GR - R01 HL155821/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20240122 PL - United States TA - Am J Transplant JT - American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons JID - 100968638 SB - IM MH - Humans MH - *Lung Transplantation/adverse effects MH - Female MH - Male MH - *Tissue Donors/supply & distribution MH - Middle Aged MH - Risk Factors MH - Adult MH - *Tissue and Organ Procurement MH - *Graft Rejection/etiology MH - *Graft Survival MH - Follow-Up Studies MH - Prognosis MH - Risk Assessment OTO - NOTNLM OT - deceased-donor OT - graft failure OT - lung transplantation OT - risk prediction EDAT- 2024/01/25 00:42 MHDA- 2024/05/05 07:47 CRDT- 2024/01/24 19:13 PHST- 2023/06/15 00:00 [received] PHST- 2024/01/11 00:00 [revised] PHST- 2024/01/12 00:00 [accepted] PHST- 2024/05/05 07:47 [medline] PHST- 2024/01/25 00:42 [pubmed] PHST- 2024/01/24 19:13 [entrez] AID - S1600-6135(24)00090-X [pii] AID - 10.1016/j.ajt.2024.01.022 [doi] PST - ppublish SO - Am J Transplant. 2024 May;24(5):839-849. doi: 10.1016/j.ajt.2024.01.022. Epub 2024 Jan 22.