{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:49:52Z","timestamp":1791362992093,"version":"4.3.1"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T00:00:00Z","timestamp":1698796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL153175"],"award-info":[{"award-number":["R01HL153175"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL153175"],"award-info":[{"award-number":["R01HL153175"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>U.S. lung transplant mortality risk models do not account for patients\u2019 disease progression as time accrues between mandated clinical parameter updates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the effects of accrued waitlist (WL) time on mortality in lung transplant candidates and recipients beyond those expressed by worsening clinical status and to present a new framework for conceptualizing mortality risk in end-stage lung disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using Scientific Registry of Transplant Recipients data (2015\u20132020, N\u2009=\u200912,616), we modeled transitions among multiple clinical states over time: WL, posttransplant, and death. Using cause-specific and ordinary Cox regression to estimate trajectories of composite 1-year mortality risk as a function of time from waitlisting to transplantation, we quantified the predictive accuracy of these estimates. We compared multistate model-derived candidate rankings against composite allocation score (CAS) rankings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>There were 11.5% of candidates whose predicted 1-year mortality risk increased by &amp;gt;10% by day 30 on the WL. The multistate model ascribed lower numerical rankings (i.e., higher priority) than CAS for those who died while on the WL (multistate mean; median [interquartile range] ranking at death, 227; 154 [57\u2013334]; CAS median [interquartile range] ranking at death, 329; 162 [11\u2013668]). Patients with interstitial lung disease were more likely to have increasing risk trajectories as a function of time accrued on the WL compared with other lung diagnoses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Incorporating the effects of time accrued on the WL for lung transplant candidates and recipients in donor lung allocation systems may improve the survival of patients with end-stage lung diseases on the individual and population levels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202306-0968oc","type":"journal-article","created":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T00:15:12Z","timestamp":1695946512000},"page":"983-989","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":14,"title":["Incorporating Effects of Time Accrued on the Waiting List into Lung Transplantation Survival Models"],"prefix":"10.1093","volume":"208","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8336-1212","authenticated-orcid":false,"given":"Jarrod E.","family":"Dalton","sequence":"first","affiliation":[{"name":"Center for Populations Health Research, Department of Quantitative Health Sciences and"},{"name":"Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6976-9094","authenticated-orcid":false,"given":"Paul R.","family":"Gunsalus","sequence":"additional","affiliation":[{"name":"Center for Populations Health Research, Department of Quantitative Health Sciences and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2846-2242","authenticated-orcid":false,"given":"Carli J.","family":"Lehr","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio"},{"name":"Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7458-9303","authenticated-orcid":false,"given":"Johnie","family":"Rose","sequence":"additional","affiliation":[{"name":"Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0707-9009","authenticated-orcid":false,"given":"Belinda L.","family":"Udeh","sequence":"additional","affiliation":[{"name":"Center for Populations Health Research, Department of Quantitative Health Sciences and"},{"name":"Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7454-0603","authenticated-orcid":false,"given":"Maryam","family":"Valapour","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,11,1]]},"reference":[{"key":"2026012204344102000_bib1","author":"Organ Procurement and Transplantation Network","year":"2023"},{"key":"2026012204344102000_bib2","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1016\/j.healun.2022.02.012","article-title":"Impact of incorporating long-term survival for calculating transplant benefit in the US lung transplant allocation system","volume":"41","author":"Lehr","year":"2022","journal-title":"J Heart Lung Transplant"},{"key":"2026012204344102000_bib3","author":"Gunsalus","year":"2022"},{"key":"2026012204344102000_bib4","author":"Gerds","year":"2023"},{"key":"2026012204344102000_bib5","first-page":"NP1","article-title":"Incorporating effects of delayed transplant in lung transplant mortality risk models. 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