First name
Edward
Last name
Cantu

Title

A Conceptual Model for Sources of Differential Selection in Lung Transplant Allocation.

Year of Publication

2023

Number of Pages

226-235

Date Published

02/2023

ISSN Number

2325-6621

Abstract

In the United States, donor lungs are allocated to transplant candidates on the basis of lung allocation scores (LAS). However, additional factors beyond the LAS can impact who is transplanted, including listing and donor-organ acceptance practices. These factors can result in differential selection, undermining the objectivity of lung allocation. Yet their impact on the lung transplant pathway has been underexplored. We sought to systematically examine sources of differential selection in lung transplantation via qualitative methods. We conducted semistructured qualitative interviews with lung transplant surgeons and pulmonologists in the United States between June 2019 and June 2020 to understand clinician perspectives on differential selection in lung transplantation and the LAS. A total of 51 respondents (30 surgeons and 21 pulmonologists) identified many sources of differential selection arising throughout the pathway from referral to transplantation. We synthesized these sources into a conceptual model with five themes: ) transplant center's degree of risk tolerance and accountability; ) successfulness and fairness of the LAS; ) donor-organ availability and regional competition; ) patient health versus program health; and ) access to care versus responsible stewardship of organs. Our conceptual model demonstrates how differential selection can arise throughout lung transplantation and facilitates the further study of such selection. As new organ allocation models are developed, differential selection should be considered carefully to ensure that these models are more equitable.

DOI

10.1513/AnnalsATS.202202-105OC

Alternate Title

Ann Am Thorac Soc

PMID

36044711
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Title

Oxidant stress regulatory genetic variation in recipients and donors contributes to risk of primary graft dysfunction after lung transplantation.

Year of Publication

2015

Number of Pages

596-602

Date Published

02/2015

ISSN Number

1097-685X

Abstract

<p><strong>OBJECTIVE: </strong>Oxidant stress pathway activation during ischemia reperfusion injury may contribute to the development of primary graft dysfunction (PGD) after lung transplantation. We hypothesized that oxidant stress gene variation in recipients and donors is associated with PGD.</p>

<p><strong>METHODS: </strong>Donors and recipients from the Lung Transplant Outcomes Group (LTOG) cohort were genotyped using the Illumina IBC chip filtered for oxidant stress pathway genes. Single nucleotide polymorphisms (SNPs) grouped into SNP sets based on haplotype blocks within 49 oxidant stress genes selected from gene ontology pathways and literature review were tested for PGD association using a sequencing kernel association test. Analyses were adjusted for clinical confounding variables and population stratification.</p>

<p><strong>RESULTS: </strong>Three hundred ninety-two donors and 1038 recipients met genetic quality control standards. Thirty percent of patients developed grade 3 PGD within 72 hours. Donor NADPH oxidase 3 (NOX3) was associated with PGD (P = .01) with 5 individual significant loci (P values between .006 and .03). In recipients, variation in glutathione peroxidase (GPX1) and NRF-2 (NFE2L2) was significantly associated with PGD (P = .01 for both). The GPX1 association included 3 individual loci (P values between .006 and .049) and the NFE2L2 association included 2 loci (P = .03 and .05). Significant epistatic effects influencing PGD susceptibility were evident between 3 different donor blocks of NOX3 and recipient NFE2L2 (P = .026, P = .017, and P = .031).</p>

<p><strong>CONCLUSIONS: </strong>Our study has prioritized GPX1, NOX3, and NFE2L2 genes for future research in PGD pathogenesis, and highlights a donor-recipient interaction of NOX3 and NFE2L2 that increases the risk of PGD.</p>

DOI

10.1016/j.jtcvs.2014.09.077

Alternate Title

J. Thorac. Cardiovasc. Surg.

PMID

25439478
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