Modify lung TRF to improve post transplant lung function data

Proposal Overview

Status: Implemented

Sponsoring Committee: Lung Transplantation

Strategic Goal: Improve waitlisted patient, living donor, and transplant recipient outcomes

Board briefing paper (PDF - 364 K; 6/2018)

This proposal was originally sponsored by the Thoracic Transplantation Committee, which was dissolved July 1, 2020. The Lung Transplantation Committee will provide ongoing review and evaluation of this policy.

Read the full proposal (PDF – 914 K; 1/2018)

The current OPTN/UNOS adult and pediatric lung and heart-lung Transplant Recipient Follow-up form (TRF) collects lung graft function status limited to bronchiolitis obliterans syndrome (BOS). The Thoracic Organ Transplantation Committee (Committee) identified two issues with the way graft function data is collected on the TRF, which limits the utility of this data in the context of chronic lung rejection:

BOS data collection is outdated, incomplete, and inaccurate
Restrictive allograft syndrome (RAS) is not collected at all

Therefore, the limited data currently collected does not capture all the prognosis possibilities for declining graft function and may not accurately describe the type of rejection a patient is exhibiting. Chronic lung allograft dysfunction (CLAD) is a broader, more contemporary definition of post-transplant lung dysfunction, encompassing both obstructive and restrictive chronic lung rejection. This proposal will modify the adult and pediatric lung and heart-lung TRF forms to align with updated professional definitions. Refining the outcomes data the OPTN collects can better inform future policy.

This proposal aligns with the OPTN strategic goal of improving transplant recipient outcomes by collecting more granular data on lung dysfunction to help inform future policies for improving lung transplant outcomes. In addition, it will more accurately characterize longitudinal change in lung function following transplantation. Finally, examining outcomes other than strictly survival (in particular, quality-of-life measures such as pulmonary function) will be important for patients and for program assessment.

Specific questions

The Committee is proposing keeping the bronchial stricture question on the 6-month and 1-5 yearTRFs. Does the community feel this question is of value? If so, please provide input on how thequestion could be better asked to elicit more meaningful data regarding this short-termcomplication. If not, please articulate why.
The Committee welcomes feedback on how many time intervals should be collected for FEV1,FVC, and FEF25-75.
Members are asked to comment on both the immediate and long term budgetary impact ofresources that may be required if this proposal is approved. This information assists the Board inconsidering the proposal and its impact on the community.