Demographic, Clinical, and Allocation Shifts in the US Lung Transplant Waitlist: A National SRTR Study (2012-2023).

Publication date: Aug 24, 2026

The US lung transplant system has undergone major demographic, clinical, and policy shifts over the past decade, including implementation of the Lung Allocation Score (LAS), the COVID-19 pandemic, and the 2023 transition to a continuous distribution (“post-LAS”) framework. Contemporary longitudinal analyses integrating these transitions remain limited. We performed a retrospective national time-series analysis of SRTR/OPTN adult lung transplant candidates from 2012 to 2023. Annual trends were examined across waitlist volume, age, sex, race/ethnicity, disease etiology, waiting time, allocation severity, height, blood type, and prior transplant status. Segmented (interrupted) time-series regression was used to assess inflection points associated with COVID-19 (2020) and the post-LAS transition. From 2012 to 2023, new candidates increased from 2324 to 3385 (+45. 7%), while total waitlist size rose from 3992 to 4365 (+9. 3%). Candidates aged ≥65 years increased from 23. 8% to 38. 3%, whereas those aged 18 to 34 declined from 12. 0% to 5. 5%. Male predominance emerged (49. 9% to 53. 4%). White representation declined from 81. 6% to 69. 7%, with corresponding increases in Hispanic (6. 3% to 14. 1%) and Asian (1. 7% to 3. 5%) candidates. Restrictive lung disease increased from 47. 2% to 67. 9%, while cystic fibrosis declined from 10. 7% to 2. 0%. Waiting times compressed markedly, with candidates listed