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Lung CAS summary data updated

Lung CAS summary data updated
Below is information for lung transplant program physicians, surgeons, transplant coordinators, program directors and data coordinators on the distribution of scores for all lung candidates registered in the U.S. It is intended as a point-in-time reference to help transplant programs understand how their candidates’ scores compare to the national distribution of components of the lung Composite Allocation Score (lung CAS).

Members can also use this information as a guide when submitting CAS exception requests for lung candidates. See the Lung Review Board Operational Guidelines and Clinical Guidance for more information on submitting exception requests.

Recommendations for lung transplant candidates diagnosed with pulmonary hypertension (PH)
The guidance includes specific recommendations for lung transplant candidates diagnosed with pulmonary hypertension (PH). Such candidates who meet the following criteria may qualify for an increase in their Waitlist Survival and/or Post-Transplant Outcomes Scores:

  1. Patient is deteriorating on optimal therapy, and
  2. Patient has a right atrial pressure greater than 15 mm Hg or a cardiac index less than 1.8 L/min/m2

To request an increase in a PH candidate’s scores, transplant programs must submit an exception request to the Review Board; this request should include sufficient clinical detail to support that the patient meets the above criteria. If the transplant program believes that its patient has similar waiting list mortality and potential transplant benefit as a PH patient meeting the criteria listed above, then it should provide a detailed narrative on that assertion, referencing literature supporting the request for a higher score. Transplant programs may wish to submit to the Review Board exception requests for the candidate’s Waitlist Survival Score and Post-Transplant Outcomes Score to be at the national 90th percentile for each goal (see tables below).

The distribution of Medical Urgency points, Post-transplant Outcomes points, Biological Disadvantages points, CAS subscores for all active registrations waiting for lung transplants as of May 28, 2024 are as follows:

 

Please note: When submitting an exception request for one of the attributes, when prompted to enter the requested percentage of goal:

  • You first need to identify the percentile column that you are requesting in the corresponding table above
  • Then enter the value in the Percentage of Rating row that corresponds with that percentile

Summary of Medical Urgency Goal Points and Percentage of Goal

Medical UrgencyNumber Waiting25th percentileMedian75th percentile90th percentile95th percentile99th percentile
Number of Points9390.13750.37750.72751.40753.155020.4075
Percentage of Rating9390.5500%1.5100%2.9100%5.6300%12.6200%81.6300%

Summary of Post-Transplant Outcomes Goal and Percentage of Goal

Post-Transplant OutcomesNumber Waiting25th percentileMedian75th percentile90th percentile95th percentile99th percentile
Number of Points93918.442519.360020.112520.715021.042521.7700
Percentage of Rating93973.7700%77.4400%80.4500%82.8600%84.1700%87.0800%

Summary of Biological Disadvantages Goal Points and Percentage of Goal

Biological DisadvantagesBlood TypeNumber Waiting25th percentileMedian75th percentile90th percentile95th percentile99th percentile
Number of PointsAll Candidates9390.93525.02755.17955.49906.14208.5425
Percentage of RatingAll Candidates9396.2347%33.5167%34.5300%36.6600%40.9467%56.9500%
Number of PointsO5635.03355.10755.29355.71556.56459.1780
Percentage of RatingO56333.5567%34.0500%35.2900%38.1033%43.7633%61.1867%
Number of PointsA2730.33670.41070.64021.49074.53875.2272
Percentage of RatingA2732.2447%2.7380%4.2680%9.9380%30.2580%34.8480%
Number of PointsB952.27322.31122.66925.12626.96877.1712
Percentage of RatingB9515.1547%15.4080%17.7947%34.1747%46.4580%47.8080%
Number of PointsAB80.01550.29750.86154.54555.06605.0660
Percentage of RatingAB80.1033%1.9833%5.7433%30.3033%33.7733%33.7733%

 

Summary of CAS Subscore

Blood TypeNumber Waiting25th percentileMedian75th percentile90th percentile95th percentile99th percentile
All Candidates93921.548724.285725.652527.341234.154546.1669
O56324.260525.132026.016527.448530.920545.6910
A27319.426720.544221.535726.103738.516744.4492
B9522.026722.742223.555226.983739.617747.3666
AB820.761021.209722.134025.298026.211026.2110

a Does not include points for efficiency.

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