Chest
Volume 132, Issue 6, December 2007, Pages 1954-1961
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Original Research
Lung Transplantation
Lung Allocation Score for Lung Transplantation: Impact on Disease Severity and Survival

https://doi.org/10.1378/chest.07-1160Get rights and content

Background

Prior to implementation of the lung allocation score (LAS) system, allocation of donor lungs was based on accrued time on the waiting list and was potentially influenced by center-specific thresholds for listing. The impact of LAS implementation on patient characteristics and survival is unknown.

Methods

United Network of Organ Sharing data were obtained on all lung transplant candidates listed and all patients undergoing transplantation in region 6 between May 4, 2003, and May 4, 2006. Each data set was divided into two cohorts: 2 years before LAS implementation, and 1 year after LAS implementation. LAS was calculated and compared by cohort. Pre-LAS and post-LAS differences in patient characteristics were examined. Waiting list and posttransplant survival rates for each cohort were examined using Kaplan-Meier estimates and Cox regression.

Results

After LAS implementation, the distribution of diagnoses in patients undergoing transplantation significantly changed (p = 0.02), while the distribution of diagnoses in those listed did not (p = 0.17). Characteristics of patients on the waiting list were similar, except that a higher proportion of nonwhite patients were listed (p = 0.04) and lower FVC (p < 0.001) was observed after LAS implementation. Similarly, characteristics of patients undergoing transplantation did not change, except that posttransplant hospital length of stay was shorter (p = 0.01) after LAS implementation. Calculated LAS was higher after LAS implementation (p = 0.006). After controlling for age and diagnosis, neither waiting list nor transplant survival was significantly different (p = 0.93 and p = 0.81, respectively).

Conclusions

After LAS implementation, the distribution of diagnoses in lung transplant recipients was significantly changed, while that of candidates was not. Posttransplant and waiting list survival were not affected by the LAS system, but power was limited. Larger and long-term survival studies are needed to determine if the LAS system improves overall allocation and survival for patients interested in lung transplantation.

Section snippets

Data Collection

Using data from the United Network of Organ Sharing (UNOS), we performed analyses on two different data sets available as of May 05, 2007: (1) 170 patients listed between May 4, 2003, and May 3, 2006, at University of Washington Medical Center; and (2) 127 lung transplant recipients who underwent transplantation in the same time period. Each data set was then divided into two cohorts: the pre-LAS cohort included patients who were listed (or underwent transplantation) 2 years prior to LAS

Waiting List Patients

A total of 170 patients (pre-LAS cohort, n = 102; post-LAS cohort, n = 68) were listed for lung transplantation in region 6 between May 4, 2003, and May 3, 2006 (Fig 1). No differences in patient characteristics were observed between LAS cohorts, except for the following: (1) proportionately fewer white patients were listed in the post-LAS cohort in comparison to the pre-LAS cohort (pre-LAS cohort, 94%; vs post-LAS cohort, 84%; p = 0.04); and (2) the patients listed after LAS had a lower mean

Discussion

Our findings suggest that the implementation of the LAS system led to significant differences in the diagnoses for patients who underwent transplantation; however, there was no significant change in diagnoses listed. Few clinically significant changes between pre-LAS and post-LAS cohorts were observed in patient characteristics overall and when stratified by disease in either the transplant-recipient or candidate data set. In addition, we also observed that transplant recipients in the pre-LAS

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This work was performed at the University of Washington, Seattle, WA.

This work was supported by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government.

The authors have no conflicts of interest to disclose.

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