Data summaries
Registry briefs
A running series of aggregate analyses of the UNOS STAR registry that trace one arc: a donor-lung supply that keeps growing yet is increasingly discarded; the blood-type, size, sensitization, and allocation filters that decide who gets an organ; and the graft outcomes and waitlist mortality that make every usable lung count. Together they map where objective, offer-time donor-lung assessment moves the needle. No PHI — each brief is self-contained and shareable.
The Long-Horizon Survival Landscape
Survival is the abundant, long-horizon outcome: 50,247 recipients (99.8%) have follow-up, with assessable survival for 46,254 at 1 year down to 32,237 at 10 years. Crude survival rose 77%->87% at 1 year from the pre-LAS to LAS era; SRTR death linkage recovers 988 deaths OPTN follow-up missed. Severe PGD@72h ~6x the 30-day mortality (7.1% vs 1.1%) with a gap that persists to 5 years. The label layer to anchor models.
Open reportThe CT Cohort Is a Transplanted-Lung Cohort
Selection audit of the DICOM→STAR crosswalk: donors with a linked chest CT were transplanted 91.5% of the time vs 15.2% without one, so the imaging set is almost all accepted lungs. The discard arm is just 790 donors — older, DCD-heavy, and declined mostly for physiologic 'poor function' — leaving only ~182 image-assessable declines. Scope companion to the Discarded-Lung CT Cohort brief.
Open reportThe Discarded-Lung CT Cohort
1,774 discarded lungs (1,029 donors, ~19% of all discards) carry a donor chest CT — a labeled validation set of declined organs. Discarded lungs had near-normal oxygenation (median P/F 400 vs 444 transplanted), ~1,500 declined for 'poor function' despite acceptable gas exchange: an objectively-questionable discard pool CT can adjudicate.
Open reportSevere PGD@72h Landscape
Severe primary graft dysfunction at 72 h — VitalMatch's model target — affects ~20% of bilateral lung recipients (ISHLT grade-3 proxy), rising over time and increasing with ischemic time (16→23%), DCD (25% vs 19%), and donor age. The drivers are all offer-time knowable.
Open reportPGD@72h Model — Performance Card
Candid status of the severe-PGD@72h classifier: clinical LR AUROC 0.68 (cross-seed median) on a small held-out set (251 cases, 22 events), beating published donor scores (~chance–0.64). RF looks higher but is unvalidated; imaging adds no value yet. Research use only — preliminary.
Open reportDonor Lung Utilization & Discard Trends
Registry-scale audit of U.S. donor-lung non-utilization: an 8.1% discard rate rising to 14.4% in 2025, concentrated in DCD and older donors, driven by subjective “poor organ function” calls.
Open reportDCD Share & the Lung Discard Trend
Decomposes the rising lung-discard rate: DCD donors climbed from 1% to 24% of the lung pool and carry a ~5× discard rate, so much of the headline trend is compositional, not a worsening of any single donor type.
Open reportCT Imaging Cohort Profile (Table 1)
Representativeness check: the ~9,300 donors with linked chest CT match the national lung-donor pool within a few points on sex, DCD, and smoking — establishing external validity for models trained on the cohort.
Open reportEx-Vivo Lung Perfusion — Uptake & Yield
Machine-perfusion adoption reached ~5% of lung donors by 2025; perfused donors skew marginal (mostly DCD) yet still convert to transplant — a rescue channel that pairs naturally with objective CT triage.
Open reportRegional Variation in Lung Discard
Lung discard varies 3.3× across the eleven OPTN regions (4.6% to 15.0%) — practice variation, beyond donor case-mix, that a consistent objective read could compress.
Open reportIschemic Time vs Lung Outcome
One-year graft failure is U-shaped in cold-ischemia time — lowest at 5–6 h, rising beyond 10 h and (via confounding) under 4 h. The long tail is the modifiable target for offer-time efficiency.
Open reportPost-Transplant Survival by Donor Tier
Lung-graft survival fans apart with time: youngest donors 85%→51% (1→5 yr), older donors trail by ~6 pts at 5 yr, and DCD grafts diverge late (40% vs 49%) — donor quality is a long-horizon cost the 72-hour window misses.
Open reportCAS-Era Allocation Shift
Since continuous distribution (Mar 2023), lung transplant volume rose ~30%, median cold ischemia climbed 5.8→8.9 h, lungs >8 h ischemia 17→57%, and DCD use 7→19% — broader sharing traded geography for time.
Open reportABO & Size-Matching Constraints
Two hard filters gate every lung offer before quality: 91% of transplants are ABO-identical (+9% compatible) and 72% within ±10 cm donor–recipient height — compounding constraints behind 'no recipient located' discards.
Open reportHLA Sensitization & Wait Time
Most lung recipients are unsensitized, but the cPRA 80–100% tail (~1%) waits ~1.8× longer (72→127 days median) — the minority where epitope-level (PIRCHE) matching would most widen the donor pool.
Open reportLung Waitlist Mortality & Wait Time
17% of lung candidates die on the waitlist or are removed too sick before transplant; type-O candidates wait longest (77 d median) and die most — the clinical counterweight to donor-lung discards.
Open report