A new method for classifying prognostic risk factors in lung transplant candidates.

backgroundPredicting risk of waitlist mortality and subsequent classification of lung transplant candidates has been difficult due to inter-relatedness of risk factors, differential risk across populations, and changes in relationships over time. We developed a clinically intuitive indexing system to simplify mortality risk assessment.

methodsScientific Registry of Transplant Recipients data from February 19, 2015, to May 26, 2020 (n = 13,726) were used to estimate 3 constructs. Airway and oxygen function indices were estimated using confirmatory factor analysis and hierarchical clustering was used to derive respiratory support clusters. Cox proportional hazards regression was used to characterize event-free waitlist survival by constructs (3), age, sex, and diagnosis group. Model performance was compared to the Lung Allocation Score/Composite Allocation Score (LAS/CAS).

resultsAirway and oxygen function indices were created with substantive factor loadings forced expiratory volume (0.86), forced vital capacity (0.64), partial pressure of carbon dioxide (0.56) and PO

conclusionsReducing the dimensionality of waitlist mortality risk offers an opportunity to identify clinical phenotypes that are more nuanced and thus more interpretable than current risk assessment provided by the LAS/CAS models.