Episode highlights
0:16 Intro
2:28 Recent modifications to the lung allocation score
5:11 Monitoring chronic graft rejection
9:23 The rising use of ex vivo lung perfusion
16:17 The presence of post-COVID patients on the lung transplant waitlist
21:01 Impact of long Covid on transplant rehabilitation
22:51 Double lung transplant in bilateral lung cancer—what’s the future?
26:52 Effect of LAS on lung transplant survival racial disparity
31:05 What lies ahead in the practice of lung transplantation
35:00 Outro
Lung allocation has been subject to a couple of major changes in the last 20 years. Since the implementation of the Lung Allocation Score (LAS) as the leading determinant of donor lung allocation in 2005, waitlist deaths decreased by approximately 40%, while annual increases in successful lung transplants doubled versus pre-LAS rates—despite there not being an increase in lung donors.1
Then, in 2017, the primary lung allocation unit was expanded to a 250-mile radius from the donation service area—significantly impacting well-evidenced geographic disparities in donor lung allocation in the US. With this change, investigators observed a 23 percent-point improvement in transplantation disparities between the highest and lower quartile of candidates based on their area’s donor lung availabilities.2
For all the national-scale benefit these alterations have made on lung allocation, there is still much effort ongoing to improve the clinical efficiency and non-disparate process of US lung transplantation.
In this latest episode of Lungcast, a member of the Cleveland Clinic Lung Transplant Team returns to this show with a colleague to catch up on the more recent developments in lung allocation strategy.
Maryam Valapour, MD, MPP, director of lung transplant outcomes at the Cleveland Clinic Respiratory Institute, makes her second appearance on Lungcast after joining the show to talk lung transplant trends in April 2021.3 She is joined by Kenneth McCurry, MD, cardiothoracic surgeon at the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute at the Cleveland Clinic, for a panel discussion on the underlying current of lung transplant practice improvements occurring in their practice and beyond.
Lungcast is a monthly respiratory news podcast series hosted by Al Rizzo, MD, chief medical officer of the ALA, and produced by HCPLive.
The panel discussion episode considers a number of topics greatly influencing the progress of lung allocation and successful transplants in the US, including further LAS modifications; ex vivo lung perfusion; long Covid’s potential effect on post-transplant rehabilitation; double lung transplants to combat bilateral lung cancer; and more.
Subscribe to Lungcast on Spotify here, or listen to the episode below.
References
- Egan TM, Edwards LB. Effect of the lung allocation score on lung transplantation in the United States. J Heart Lung Transplant. 2016;35(4):433-439. doi:10.1016/j.healun.2016.01.010
- Benvenuto LJ, Anderson MR, Aversa M, et al. Geographic disparities in lung transplantation in the United States before and after the November 2017 allocation change. J Heart Lung Transplant. 2022;41(3):382-390. doi:10.1016/j.healun.2021.11.002
- Kunzmann K. Advancements in Lung Transplants with the Cleveland Clinic Team. HCPLive. Published April 19, 2021. https://www.hcplive.com/view/advancements-lung-transplants-cleveland-clinic-team
