Original articleGeneral thoracicLung Transplantation for Patients With High Lung Allocation Score: Single-Center Experience
Section snippets
Patients and Study Design
This study was a retrospective review of the cardiothoracic transplantation database that is prospectively maintained at the University of Pittsburgh Medical Center (Institutional Review Board approval number: 0000421). The University of Pittsburgh Medical Center Lung and Heart-Lung Transplant Evaluation and Recipient Research Registry is approved by the University of Pittsburgh Institutional Review Board for use in patient management, quality assurance reports, and clinical research. A consent
Baseline Characteristics
Patient characteristics are displayed in Table 1. The LAS distribution was skewed (Fig 1). Mean LAS was 37.7 ± 5.1 in the low LAS group and 70.1 ± 15.0 in the high LAS group. The indication for lung transplant was notably different between the 2 groups. Chronic obstructive pulmonary disease (COPD) was the most frequent diagnosis in the low LAS group and accounted for 43.7% of lung transplants in that group. In contrast, in the high LAS group, idiopathic pulmonary fibrosis (IPF) accounted for
Comment
Lung transplant has become an increasingly viable option for patients with a variety of end-stage lung diseases; however, access to transplant remains limited by the availability of suitable donated organs. The LAS was developed to distribute organs in a manner that balances waiting list urgency with the probability of posttransplant survival [4]. There are several large national cohort studies, all of them using the UNOS database, demonstrating that an elevated LAS is associated with decreased
References (16)
- et al.
The registry of the International Society of the Heart and Lung Transplantation: twenty-sixth official adult lung and heart-lung transplantation report – 2009
J Heart Lung Transplant
(2009) - et al.
Disease-specific survival benefit of lung transplantation in adults: a national cohort study
Am J Transplant
(2009) - et al.
Analytical methods and database design: implications for transplant researchers, 2005
Am J Transplant
(2006) - et al.
Development of new lung allocation system in the United States
Am J Transplant
(2006) - et al.
The new lung allocation system and its impact on waiting list characteristics and post-transplant outcomes
Semin Thorac Cardiovasc Surg
(2008) - et al.
The impact of the lung allocation core on short-term transplantation outcomes: a multicenter study
J Thorac Cardiovasc Surg
(2008) - et al.
Lung allocation score predicts survival in lung transplantation patients with pulmonary fibrosis
Ann Thorac Surg Thorac
(2009) - et al.
High lung allocation score is associated with increased morbidity and mortality following transplantation
Chest
(2010)
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Commentary: Central defense on trial
2020, Journal of Thoracic and Cardiovascular SurgeryMechanical Ventilation and Extracorporeal Membrane Oxygenation as a Bridging Strategy to Lung Transplantation: Significant Gains in Survival
2018, American Journal of TransplantationECMO Support in Lung Transplantation: A Contemporary Analysis of Hospital Charges in the United States
2017, Annals of Thoracic SurgeryThe utility of 6-minute walk distance in predicting waitlist mortality for lung transplant candidates
2017, Journal of Heart and Lung TransplantationCitation Excerpt :Introduction of the LAS has re-distributed allografts such that waitlist mortality initially increased, and now varies significantly by age and diagnosis group.9–11 Furthermore, candidates with high LAS do not necessarily have the associated transplant benefit compared to candidates with a more moderate LAS, likely secondary to a stronger weighting of the LAS toward decreasing waitlist mortality over increasing post-transplant survival.8,12,17,34 Despite a built-in mechanism for the re-evaluation and addition of variables to the LAS over time, there have been few adjustments since 2005.8
Lung Transplant Mortality Is Improving in Recipients With a Lung Allocation Score in the Upper Quartile
2017, Annals of Thoracic SurgeryCitation Excerpt :These influential studies were the first to raise concern over the diminished returns seen in patients already demonstrating significant physiologic perturbations at the time of transplantation. Similar studies have demonstrated increased risk of mortality, higher rates of tracheostomy, and longer ICU length of stay in patients with a high LAS [14, 15]. In one study looking at net survival, accounting for both wait list and posttransplantation mortality, the lowest net survival benefit was observed in patients with an LAS below 40 or above 90 [16].
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2016, Journal of Heart and Lung Transplantation