Organ Allocation in Lung Transplant

Davis, Steven Q.; Garrity, Edward R.

doi:10.1378/chest.07-0011

Cited by 93 publications

(47 citation statements)

References 10 publications

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“…16 A similar approach is currently used for liver allocation algorithms in the United States. 17,18 The only organ for which both transplant urgency and post-transplant survival are considered in assigning allocation priority is during the calculation of lung allocation score, 14,15 which analyzes transplant benefit at the individual level and seeks to avoid transplantation in patients at a very high risk of post-transplant mortality. Because this score gives the risk of wait-list mortality a higher weight than posttransplant survival, it is not surprising that recipients with higher lung allocation scores at transplant have higher posttransplant mortality compared with those with lower allocation scores.…”

Section: Discussionmentioning

confidence: 99%

Risk Stratification and Transplant Benefit in Children Listed for Heart Transplant in the United States

Singh

Almond

Piercey

2013

Circ: Heart Failure

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Background-The sickest children among those listed for heart transplant (HT) are also at higher risk of post-transplant mortality. We hypothesized that transplant benefit, defined as percentage reduction in risk of 1-year mortality on receiving HT, increases with higher risk of wait-list mortality. Methods and Results-We analyzed all children aged <18 years listed for first HT in the United States between July 2004 and December 2010. We developed a model for 90-day wait-list mortality (or removal because of deterioration) and stratified listed children into deciles based on their risk of wait-list mortality. Listed children were followed up for 1 year to assess cumulative 1-year wait-list mortality among the 10 risk groups. We developed a model for 1-year post-transplant mortality to estimate the risk of post-transplant mortality for children in each risk group. Of 2979 listed children, 15% reached the wait-list end point within 90 days and 18% within 1 year. Of 2034 HT recipients, 6.8% died within 90 days and 10.8% within 1 year. The risk of 90-day wait-list mortality increased progressively from 2.4% to 51.6% from the first to the tenth risk decile. Transplant benefit increased progressively across the wait-list risk groups (P<0.001 for trend). However, transplant benefit for children in the top 5% of risk (7.4%) was lower than that for children in the 91st to 95th percentile of risk (10.3%). Conclusions-Sicker children on the wait-list benefit more from HT unless the post-transplant mortality is predicted to be very high. Whether consideration of transplant benefit in allocation policy can improve overall survival among listed children requires further analysis. (Circ Heart Fail. 2013;6:800-808.)

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Section: Discussionmentioning

confidence: 99%

Risk Stratification and Transplant Benefit in Children Listed for Heart Transplant in the United States

Singh

Almond

Piercey

2013

Circ: Heart Failure

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“…13 Following the publication of the Final Rule by the Department of Health and Human services, 14 there were major changes in allocation of hearts, livers, and lungs, so that medical urgency became the predominant determinant of the new algorithms in the US. [15][16][17][18][19] Thus, patients listed for a HT have been considered in a new 3-tier system (versus a prior 2-tier system) of medical urgency since 1999. 1 It is important to note that allowing a broader sharing of donor hearts for 1A and 1B heart candidates is well within the scope of the First Rule (medical urgency first followed by firstcome first-served among those with equal medical urgency).…”

Section: Discussionmentioning

confidence: 99%

Decline in Heart Transplant Wait List Mortality in the United States Following Broader Regional Sharing of Donor Hearts

Singh

Almond²,

Taylor³

2012

Circ: Heart Failure

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Background— A change in allocation algorithm in July 2006 allowed broader regional sharing of donor hearts in the United States (US). We assessed if the allocation change has been associated with a decline in wait list mortality in the US. Methods and Results— We compared baseline characteristics and outcomes in patients ≥18 years old listed for a primary heart transplant in the US before (July 1, 2004–July 11, 2006, Era1) and after (July 12, 2006–June 30, 2009, Era 2) the change in allocation algorithm. Of 11 864 patients in the study, 4503 were listed during Era 1 and 7361 during Era 2. Patients listed during Era 2 were more likely to be listed status 1A, have an implantable cardioverter-defibrillator, and supported on a continuous flow assist device ( P <0.001 for distribution. Patients listed in Era 2 were at a 17% lower risk of dying on the wait list or becoming too sick to transplant (adjusted hazard ratio, 0.83, 95% CI 0.75, 0.93). Transplant recipients in Era 2 were more likely to be transplanted as status 1A (37% versus 48%, respectively, P <0.001). Post-transplant in-hospital mortality (6.3% versus 5.4%; adjusted odds ratio, 0.86 for Era 2, 95% CI 0.79, 1.06) and 1-year survival were similar. Conclusions— The risk of death on the wait list or becoming too sick to transplant has decreased by 17% in the US since the allocation algorithm allowing broader regional sharing was implemented in 2006. The shift in hearts to sicker candidates has not resulted in higher in-hospital or first year post-transplant mortality.

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“…Under the new system, each patient is now assigned a Lung Allocation Score (LAS) designed to estimate their survival benefit from a lung transplant (6). The LAS is calculated on the basis of clinical data collected for each patient, including information such as functional status, exercise capacity, lung function, hemodynamic data, and the need for oxygen or ventilatory support (7).…”

mentioning

confidence: 99%

Impact of the Lung Allocation Score on Lung Transplantation for Pulmonary Arterial Hypertension

Chen¹,

Shiboski²,

Golden³

et al. 2009

Am J Respir Crit Care Med

148

110

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Rationale: In 2005, lung allocation for transplantation in the United States changed from a system based on waiting time to a system based on the Lung Allocation Score (LAS). Objectives: To study the effect of the LAS on lung transplantation for idiopathic pulmonary arterial hypertension (IPAH) compared with other major diagnoses. Methods: We studied 7,952 adults listed for lung transplantation between 2002 and 2008. Analyses were restricted to patients with IPAH, idiopathic pulmonary fibrosis (IPF), chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF). Transplantation, waiting list mortality, and post-transplant mortality were compared between diagnoses for patients listed before and after implementation of the LAS. Measurements and Main Results: The likelihood of transplantation from the waiting list increased for all diagnoses after implementation of the LAS. Waiting list mortality decreased for every diagnosis, except for IPAH, which remained unchanged. Implementation of the LAS was not associated with changes in post-transplant mortality for any diagnosis. Under the LAS system, patients with IPAH were less likely to be transplanted than patients with IPF (hazard ratio [HR], 0.53; P , 0.001) or CF (HR, 0.49; P , 0.001) and at greater risk of death on the waiting list than patients with COPD (HR, 3.09; P , 0.001) or CF (HR, 1.83; P 5 0.025) after adjustment for demographics and transplant type. Post-transplant mortality for IPAH was not statistically different from that of other diagnoses. Conclusions: Implementation of the LAS has improved the likelihood of lung transplantation for listed patients with IPAH, but mortality on the waiting list remains high compared with other major diagnoses.

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Organ Allocation in Lung Transplant

Cited by 93 publications

References 10 publications

Risk Stratification and Transplant Benefit in Children Listed for Heart Transplant in the United States

Risk Stratification and Transplant Benefit in Children Listed for Heart Transplant in the United States

Decline in Heart Transplant Wait List Mortality in the United States Following Broader Regional Sharing of Donor Hearts

Impact of the Lung Allocation Score on Lung Transplantation for Pulmonary Arterial Hypertension

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