• Yun Zhu Bai, Yan Yan, Su-Hsin Chang, Zhizhou Yang, Anjana Delhi, Khashayar Farahnak, Karan Joseph, Christy Hamilton, Ana Amelia Baumann Walker, Ramsey R Hachem, Chad A Witt, GuillametRodrigo VazquezRVDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Mo., Derek E Byers, Gary F Marklin, Matthew G Hartwig, Whitney S Brandt, Daniel Kreisel, Ruben G Nava, G Alexander Patterson, Benjamin D Kozower, Bryan F Meyers, Brendan T Heiden, and Varun Puri.
• Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo. Electronic address: y.bai@wustl.edu.
• J. Thorac. Cardiovasc. Surg. 2024 Sep 1.

BackgroundThere is a critical shortage of donor lungs for transplantation. We previously developed a parsimonious, highly discriminatory 9-variable Lung Donor (LUNDON) acceptability score. Here we assessed the utility of this score as a tool for improving lung recovery rates for transplantation.MethodsWe examined all brain-dead donors between 2014 and 2020 from 3 US organ procurement organizations and validated the score's predictive performance. We examined the trajectory of donors with low (<40) and high (>60) initial LUNDON scores, their corresponding lung recovery rates, factors contributing to score improvement using multivariable regression models, and 1-year post-transplant recipient survival.ResultsOverall lung recovery was 32.4% (1410 of 4351). Validation of the LUNDON score in our cohort revealed a C statistic of 0.904 and required intercept calibration. Low initial LUNDON donors that improved to a high final score had an increase in lung recovery rate from 29.3% (1100 of 3765) to 86.8% (441 of 508), associated with lower body mass index, management in a specialized donor care facility (SDCF), and more bronchoscopies. Donors with high initial and final LUNDON scores had a lung recovery rate of 85.2% (98 of 115), associated with shorter length of hospital stay. One-year survival was similar in recipients of low-to-high versus high-to-high LUNDON score donors (0.89 vs 0.84; P = .2).ConclusionsThe LUNDON score performs well as a predictor of lung recovery in a contemporary cohort but may require organ procurement organization-specific calibration. SDCF care, increasing use of bronchoscopy, and decreasing the time from brain death to organ procurement may improve lung utilization. The LUNDON score can be used to guide donor management to expand the donor pool.Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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