362: Effect of lung allocation score (LAS) on actual post-transplant survival: Early 1-year results

Hadjiliadis, Denis; Mendez, James D.; Blumenthal, Nancy P.; Isaia, D.; Carney, K.; Ahya, Vivek N.; Kotloff, Robert M.; Woo, Joseph; Sager, J.S.; Christie, Jason D.; Pochettino, Alberto

doi:10.1016/j.healun.2006.11.383

Cited by 3 publications

(3 citation statements)

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“…This is consistent with several single-center studies that demonstrated an increase in the proportion of patients transplanted for IPF. [15][16][17][18][19] The LAS was designed to maximize utility based on a combination of wait-list urgency and post-transplant survival and, as a result, sicker patients are often given higher priority. Clearly, patients with IPF represent an ill group with high wait-list mortality, and therefore the increase in the proportion of patients transplanted with IPF is not very surprising.…”

Section: Discussionmentioning

confidence: 99%

Impact of U.S. Lung Allocation Score on Survival After Lung Transplantation

Merlo

Weiss

Orens

et al. 2009

The Journal of Heart and Lung Transplantation

140

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Section: Discussionmentioning

confidence: 99%

Impact of U.S. Lung Allocation Score on Survival After Lung Transplantation

Merlo

Weiss

Orens

et al. 2009

The Journal of Heart and Lung Transplantation

140

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“…As can be seen in Figure 3, there was a small but statistically significant trend towards increased mortality in the postLAS group, with a P value of 0.043. 19 The actual percentage difference in mortality at 1 year was not much different, even though it reached a significant P value, with 83.5% survival preLAS and 82.2% postLAS.…”

Section: Review Of the Early Datamentioning

confidence: 84%

The New Lung Allocation Score for Lung Transplantation

Stephen¹,

Hadjiliadis²

2009

Clinical Pulmonary Medicine

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The new lung allocation score for lung transplantation went into effect in May 2005. This article presents a review of the history of lung transplantation, indications for transplantation, and selection criteria. The article also analyzes the need for a new lung allocation system and presents the process by which the new scoring system was designed and implemented. The early data on its effects on candidates, waiting time, waiting list size, and morbidity and mortality are presented.Key Words: lung transplant, lung allocation score, waiting list, referral for lung transplant (Clin Pulm Med 2009;16: 45-50) O ver the past 2 decades, lung transplantation has become an accepted treatment for end-stage lung disease. One of the ethical issues associated with lung transplantation is the scarcity of organs relative to potential recipients. How this scarce resource can best be allocated has been the subject of debate and continues to evolve as a conversation. Changes to the longstanding lung allocation system were prompted by the perceived notion that a lung allocation system based almost entirely on accrued time on a waiting list was unjust. The new ranking system on the active transplant waiting list for donor lungs is called the lung allocation score (LAS); in this system, the likelihood of survival on the list and the likelihood of survival after transplant are melded into a single score. This system of priority-based allocation has been likened to a surgeon operating on the sickest and most life-threatened patient first. 1 The new ranking system aims to minimize deaths on the waiting list and increase benefit to the sickest patients, while at the same time ensuring that futile transplants are not undertaken. Analysis of the early data shows that the new system is achieving most of its goals. It is unclear whether the system's goals are rendering just results in application and whether the results will be durable, given the persistent scarcity of lung donors. It is also questionable whether the calculation of the LAS score accurately measures what it is intended to measure. The following analysis of the controversies related to the LAS scoring system, and the review of the data gathered since the system's implementation in May of 2005, will help to clarify the nature of the debate and show what future questions should be answered to assist in the equitable distribution of this scarce resource.

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“…Similar to the national data, multiple centers have reported increasing numbers of IPF patients receiving transplants while COPD candidates are receiving fewer donor organs [9,10]. Some single-center studies have suggested worsened outcomes with the new allocation system, although this has not been borne out across all centers [11][12][13]. A single multicenter study did demonstrate greater primary graft dysfunction, as well as longer postoperative intensive care unit stays, although hospital mortality and 1-year survival were not adversely affected by the new allocation system [14].…”

Section: Box 2 Diagnostic Group Categoriesmentioning

confidence: 92%

Lung transplantation: the new lung-allocation system

Stern

Bhorade

2008

Expert Review of Respiratory Medicine

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Lung transplantation has evolved over the past two decades as a well-recognized therapy for patients with end-stage lung diseases. However, lung transplantation has been limited, in part, due to the scarcity of donor lung organs. Previously, donor lung organs were allocated based on a potential recipient's waiting list time. However, in 2005, under the mandate of the US Government, through the Department of Health and Human Services, the lung-allocation system was changed to incorporate medical urgency and utility in order to optimize patient outcomes. Clinical factors that predicted pretransplant and 1-year post-transplant survival for each potential recipient were incorporated into a Lung Allocation Score. Early 1-year results have shown a decrease in the number of candidates on the waiting list, a decrease in the waiting time and a decrease in waiting list mortality. Outcomes after lung transplantation have been conflicting, with some centers suggesting worse outcomes and others suggesting an increased morbidity but not increased 1-year mortality. Longer follow-up of these patients will be useful to determine the utility of the Lung Allocation Score system in lung transplantation.

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362: Effect of lung allocation score (LAS) on actual post-transplant survival: Early 1-year results

Cited by 3 publications

References 0 publications

Impact of U.S. Lung Allocation Score on Survival After Lung Transplantation

Impact of U.S. Lung Allocation Score on Survival After Lung Transplantation

The New Lung Allocation Score for Lung Transplantation

Lung transplantation: the new lung-allocation system

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