Comparison of donor scores in bilateral lung transplantation – a large single‐center analysis

Objectifying donor lung quality is difficult and currently there is no consensus. Several donor scoring systems have been proposed in recent years. They all lack large-scale external validation and widespread acceptance. A retrospective evaluation of 2201 donor lungs offered to the lung transplant program at the Medical University of Vienna between January 2010 and June 2018 was performed. Five different lung donor scores were calculated for each offer (Oto, ET, MALT, UMN-DLQI and ODSS). Prediction of organ utilization, 1y-graft-survival and long-term outcome was analyzed for each score. 1049 organs were rejected at the initial offer (group I), 209 lungs declined after procurement (group II) and 841 lungs accepted and transplanted (group III). The Oto score was superior in predicting acceptance of the initial offer (AUC:0.795;CI:0.776-0.815) and actual donor utilization (AUC:0.660;CI:0.618-0.701). Prediction of 1y-graft-survival was best using the MALT-score, Oto score and UMN-DLQI. Stratification of early outcome by MALT was significant for length of mechanical ventilation, PGD3 rates, ICU-stay and hospital-stay, and in-hospital-mortality, respectively. To the best of our knowledge, this study is the largest validation analysis comparing currently available donor scores. The Oto score was superior in predicting organ utilization, MALT-score and UMN-DLQI for predicting outcome after lung transplantation.