Cleveland Clinic studies new method for ranking lung transplants

Experts at Cleveland Clinic are hoping to rework the scoring equation that ranks patients awaiting lung transplants and improve overall outcomes.

The equation — known as the Composite Allocation Score — ranks transplant candidates based on stability while awaiting the transplant and also chances of survival. However, the tests used to determine the score are only given to patients twice a year, meaning they go six months without re-evaluation. During that time, their health could change drastically, which prompted Cleveland Clinic experts to seek a solution that evaluates their transplant needs more efficiently. 

And while the number of patients on the lung transplant waitlist have gone down slightly in recent years, there is still a shortage of available organs in the U.S., according to a Sept. 29 Cleveland Clinic news release. Connecting the patients who are most in need of a transplant with a match quickly improves survival outcomes, they said.

"The problem with this method is that the scoring equations fail to consider how a patient's health status changes as they spend more time on the list," Maryam Valapour, MD, a lead author of the study and director of lung transplant outcomes at Cleveland Clinic stated in the news release. "The longer a patient lives with a severe lung disease, the more their risk of developing severe complications increases. This is something clinicians observe every day – that our patients' risk of developing complications changes over time. Therefore, some patients' scores may not reflect how urgently they need a transplant."

For the study — which was published Sept. 29 in The American Journal of Respiratory and Critical Care Medicine — researchers evaluated data from 12,000 U.S. adults on the transplant list and found that 11.5 percent of the individuals awaiting transplants had an increased of candidates already had an increased mortality risk after just 30 days on the waiting list.

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