(1171) Between-Center Disparities in Access to Lung Transplantation: Contribution of Candidate and Center Factors

Purpose The new lung allocation system introduced in France in September 2020 aimed to reduce geographic disparities in access to lung transplantation (LT) by redistricting local allocation according to supply/demand ratio. This study aimed to assess persistent between-center disparities. Methods All adult candidates newly listed on the national waiting list between September 2020 and July 2021 were included in the study. Cox frailty models with random center effects were used to identify candidate and center characteristics associated with 1-year access to LT. Center factors comprised number of candidates, percentage of candidates with high-urgency status, graft decline rate, percentage of LT from circulatory death donors (CDD) or with ex vivo lung perfusion (EVLP) treated lungs, percentage of transplants after national allocation and percentage of candidates living outside of center's region. Random center effects and Median Hazard Ratio (MHR) were reported to evaluate between-center heterogeneity. Results Of the 326 candidates (mean age 53 y, 142 females) 264 were transplanted at 1 year. Candidate's sex, immunization, blood type, in-hospital and intensive care stay as well as percentage of LT from CDD or with EVLP treated lungs and center's decline rate were associated with access to LT. MHRs for the null model, the model including candidate factors (Figure 1) and the model including candidate and center factors (Figure 2) were 1.71, 1.64 and 1.19, respectively. Conclusion Center factors more than candidate factors account for persistent variability in access to LT.