In March 2023, the lung allocation policy underwent major changes from a tiered structure to a composite allocation score (CAS). The goal was to improve allocation equity for disadvantaged groups by deprioritizing transplant distance. This study examines the effects of CAS on geographic trends and transportation efficiency. A retrospective cohort study was conducted using the United Network for Organ Sharing database, queried for adult lung transplants from September 1, 2022 to September 1, 2023. Outcomes were nautical distance of transplant, ischemic time, and flight required for transport (estimated as distance >100 miles). Perioperative complications and early survival were analyzed, with propensity matching to account for baseline differences. A total of 1,394 pre-CAS and 1,197 post-CAS patients were included in the study cohort. Post-CAS recipients were less likely to be ABO type O (39.2% vs 47.3%, p < 0.001) and were less likely to be an identical ABO match (82.7% vs 91.0%, p < 0.001). The CAS cohort traveled significantly further (354.0 miles [interquartile range (IQR): 139-657] vs 195.0 miles [IQR: 78-388], p < 0.001). CAS patients had longer ischemic times (6.8 hours [IQR: 5.3-8.9] vs 6.0 hours [IQR: 4.8-7.5], p < 0.001), and CAS procurements were more likely to require a flight for transport (n = 934, 78.0% vs n = 991, 71.1%, p < 0.001). However, waitlist time was shorter (28 days [IQR = 9-83] vs 33 days [IQR = 11-109]) as was the length of stay (24.21 ± 17.84 days vs 31.44 ± 30.19 days, p < 0.001) for CAS recipients, which remained true after propensity matching. The lung CAS policy change was intended to eliminate geographic boundaries for disadvantaged patients but has expanded transplant distances, with an expected increase in ischemic time and need for flights which affect transplant economics. Although efforts were made to improve transplant availability for the disadvantaged ABO type O group, early assessment of the recipient cohort showed that recipients with blood group type O were actually less likely to be transplanted under the new policy. Positive effects include an overall decrease in waitlist time, but further investigation is warranted to evaluate the effectiveness, equity, and economic sustainability of the new policy.

Background.: Liver transplantation (LT) is the standard treatment for liver failure secondary to alcohol-associated liver disease, but limited literature and best practices exist for post-LT treatment of alcohol use disorder (AUD). This study explores current AUD management practices and providers’ perceived barriers to effective post-LT AUD management. Methods.: A 45-item survey on post-LT AUD treatment practices was distributed to members of the American Society of Transplant Surgeons, the Association of Consult/Liaison Psychiatry Transplant Special Interest Group, and both the American Society of Transplantation’s Liver and Intestine Community of Practice and Psychosocial and Ethics Community of Practice discussion boards, between December 2021 and April 2022. Univariate analysis of categorical variables was performed using the chi-square test. Data were analyzed using center volume tertiles, country region, and provider professional activity. Results.: Two hundred thirty-two respondents from 70 LT centers across all 11 United Network for Organ Sharing regions completed the survey. Half of the them were attending physicians and 16.4% were nurse coordinators. Most centers (84%) aimed for alcohol abstinence for all post-LT patients. Perceived barriers to AUD treatment efficacy included ongoing desire to drink (18%), denial about alcohol misuse (14.9%), and lack of posttransplant support (14%). Additionally, 62.1% of centers had no policy for prescribing medication-assisted therapy to treat AUD, and 32.7% of centers reported no center-level changes in AUD care. Providers identified primary needs as hiring additional mental health professionals (30.8%), dedicating specific staff to AUD care (24.7%), and standardizing psychiatric/psychological care in transplant clinics (17.2%). Conclusions.: Despite the increasing volume of LT for alcohol-associated liver disease, significant perceived barriers to effective AUD treatment remain.

The current understanding of the safety of heart transplantation from COVID-19+ donors is uncertain. Preliminary studies suggest that heart transplants from these donors may be feasible. We analyzed 1-year outcomes in COVID-19+ donor heart recipients using 1:3 propensity matching. The OPTN database was queried for adult heart transplant recipients between 1 January 2020 and 30 September 2022. COVID-19+ donors were defined as those who tested positive on NATs or antigen tests within 21 days prior to procurement. Multiorgan transplants, retransplants, donors without COVID-19 testing, and recipients allocated under the old heart allocation system were excluded. A total of 7211 heart transplant recipients met the inclusion criteria, including 316 COVID-19+ donor heart recipients. Further, 290 COVID-19+ donor heart recipients were matched to 870 COVID-19− donor heart recipients. Survival was similar between the groups at 30 days (p = 0.46), 6 months (p = 0.17), and 1 year (p = 0.07). Recipients from COVID-19+ donors in the matched cohort were less likely to experience postoperative acute rejection prior to discharge (p = 0.01). National COVID-19+ donor heart usage varied by region: region 11 transplanted the most COVID-19+ hearts (15.8%), and region 6 transplanted the fewest (3.2%). Our findings indicate that COVID-19+ heart transplantation can be performed with safe early outcomes. Further analyses are needed to determine if long-term outcomes are equivalent between groups.