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Who Is The High-risk Recipient? Predicting Mortality After Lung Transplant Using Pre-transplant Risk Factors
M. J. Russo, R. R. Davies, K. N. Hong, S. Kawut, M. Bacchetta, F. D'ovidio, A. Moskowitz, S. Arcasoy, A. Gelijns, J. Sonett*. New York Presbyterian/Columbia University, New York, NY,
BACKGROUND: The use of an alternative list for lung transplant may enable a more optimal distribution of donor organs. However, little consensus exists to identify which patients are at highest risk. We sought to devise a preoperative risk score based on recipient characteristics which could be used to predict mortality following lung transplantation in adults.
METHODS: UNOS provided de-identified patient-level data. The study population included 10,674 adult recipients (age >= 18 yo) undergoing lung transplantation between 1/1/87-12/31/06. Multivariate logistic regression (backward, p > 0.20) was performed to assess the simultaneous effect of multiple variables on post-operative mortality. Using the odds ratio for each identified variable, a risk factor score was devised.
RESULTS: The logistic regression model of postoperative mortality is shown in the Table. The risk score includes only pre-transplant recipient variables, and excluded donor and match variables. Patients with scores exceeding the 95th percentile (4.1) were considered high risk (n=366). In-hospital/30-day mortality was higher in high risk patients (27.1% vs. 8.7%, p < 0.0001). High-risk patients also had higher mortality at 1-year (37.7% vs. 17.7%, p < 0.0001) and over the long-term (Figure, p < 0.0001).
CONCLUSIONS: Pre-transplant recipient variables significantly influence both early and late survival following lung transplantation. Patients in the ICU or those with renal failure required only 1 other risk factor to exceed the high-risk threshold. Optimal allocation of donor organs should account for recipients with lower likelihood of long-term survival; patients with high pre-transplant scores should be considered for alternate listing.  
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