Impact of lung allocation policy change on Hispanic lung transplant outcomes: Addressing disparities and improving accessCentral MessagePerspective
Eric Klipsch, MD,
Jeffrey Rodgers, MS,
Kelly Sokevitz, BSN,
Jennie Kwon, MD,
Khaled Shorbaji, MD,
Ian Bostock, MD, MS,
Barry C. Gibney, DO,
Luca Paoletti, MD,
Timothy P.M. Whelan, MD,
Arman Kilic, MD,
Kathryn E. Engelhardt, MD, MS
Affiliations
Eric Klipsch, MD
Division of General Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
Jeffrey Rodgers, MS
Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
Kelly Sokevitz, BSN
Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
Jennie Kwon, MD
Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
Khaled Shorbaji, MD
Division of Biology and Biomedical Sciences, Washington University in St Louis, St Louis, Mo
Ian Bostock, MD, MS
Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
Barry C. Gibney, DO
Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
Luca Paoletti, MD
Division of Pulmonary and Critical Care, Department of Medicine, Medical University of South Carolina, Charleston, SC
Timothy P.M. Whelan, MD
Division of Pulmonary and Critical Care, Department of Medicine, Medical University of South Carolina, Charleston, SC
Arman Kilic, MD
Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
Kathryn E. Engelhardt, MD, MS
Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC; Address for reprints: Kathryn E. Engelhardt, MD, MS, Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, 30 Courtenay Dr, Ste BM 285, MSC 295, Charleston, SC 29425.
Objective: Racial disparities in organ allocation may result in differential survival for marginalized groups. This study aims to examine the impact of the November 2017 lung allocation policy change (LAPC) on trends and outcomes of Hispanic lung transplant (LT) recipients. Methods: The United Network for Organ Sharing database was used to identify adult (older than age 18 years) LT recipients between January 2010 and March 2023. Recipients were categorized into 3 self-identified racial groups (Hispanic, non-Hispanic White, and non-Hispanic other). The Mann-Kendall trend test was used to assess the trend in rates of Hispanic LT over 5 years pre- and 5 years post-LAPC. The primary outcome was 1-year mortality. Results: A total of 28,495 recipients from 80 centers were included, with 15,343 (53.8%) prepolicy change and 13,152 (46.2%) postpolicy change. The racial distribution of LT recipients was pre-LAPC: Hispanic: 1013 (6.6%), White: 12,601 (82.1%), Other: 1729 (11.3%) and post-LAPC: Hispanic: 1522 (11.6%), White: 9873 (75.0%), Other: 1757 (13.4%) (P < .001). Between 2013 and 2017, the proportion of Hispanic LT recipients increased from 6.0% to 7.6% (P = .221). Post-LAPC, the proportion increased from 8.5% in 2018 to 14.4% in 2022 (P < .027). Unadjusted 1-year survival rates were pre-LAPC: Hispanic: 88.8%, White: 87.6%, Other: 86.8% (log-rank P = .260) and post-LAPC: Hispanic: 90.6%, White: 88.2%, Other: 86.1% (log-rank P < .001). Conclusions: The LAPC has led to increased access to LT and improved 1-year survival rates among Hispanic patients. However, efforts should continue to address disparities among other racial groups and ensure equitable outcomes for all recipients of LT.
