Zhizhou Yang, Charles R Liu, Xucheng Wang, Ruirui Lan, Zhaogu Sun, Yan Yan, Su-Hsin Chang, Nikki Rossetti, Nahom Seyoum, Pimchanok Junnil, Tsuyoshi Takahashi, Chad A Witt, Rodrigo Vazquez Guillamet, Derek E Byers, Gary F Marklin, Ruben G Nava, Bryan F Meyers, Benjamin D Kozower, G Alexander Patterson, Daniel Kreisel, Ana A Baumann, Brendon Cummiskey, Matthew G Hartwig, Varun Puri
The availability and structure of donor care units (DCUs) at OPO level may influence lung utilization and transplant outcomes. Adult first-time lung transplant recipients and donors with lung disposition data from January 1, 2018, through August 31, 2025 were abstracted from Scientific Registry of Transplant Recipients database. Mixed-effects logistic regression and frailty-adjusted Cox models were performed to examine lung utilization and graft survival respectively across no DCU available (DCU-negative), hospital-based DCU available (DCU-hospital available), and independent DCU available (DCU-independent available) groups. An OPO performance visualization tool was developed (http://opolung2025.com/). Among 108,502 donors, lung utilization increased stepwise by available DCU structure. DBD donors recovered by OPOs with DCU-hospital available (OR=1.11, 95% CI 1.01-1.22) and DCU-independent available (OR=1.21, 95% CI 1.08-1.36) had higher odds of utilization than DBD donors recovered by DCU-negative OPOs, whereas no significant DCU association was observed among DCD donors. Among 18,271 lung transplant recipients, graft survival did not differ between DCU-positive and DCU-negative groups (HR= 1.03, 95% CI 0.96-1.11) or between DCU-independent available and DCU-hospital available groups within the DCU-positive cohort (HR=1.00, 95% CI 0.87-1.15). DCU availability was associated with higher DBD donor lung utilization but not recipient graft survival.