Evaluation of the lung allocation score in highly urgent and urgent lung transplant candidates in Eurotransplant

• Published in: The Journal of heart and lung transplantation Vol. 30; no. 1; pp. 22 - 28
• Main Authors: Smits, Jacqueline M., MD, PhD, Nossent, George D., MD, PhD, Vries, Erwin de, MSc, Rahmel, Axel, MD, Meiser, Bruno, MD, Strueber, Martin, MD, PhD, Gottlieb, Jens, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2011; Elsevier
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Critical Illness - mortality; Europe - epidemiology; Female; Follow-Up Studies; Health Care Rationing - methods; Humans; LAS; lung transplantation; Lung Transplantation - mortality; Male; Medical sciences; Middle Aged; organ allocation; overall mortality; Patient Selection; post-transplant mortality; Reproducibility of Results; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; waiting list mortality; Waiting Lists - mortality; Young Adult; Europe; lung transplantation; organ allocation; overall mortality; post-transplant mortality; waiting list mortality; LAS; Evaluation; Treatment; Surgery; Lung; Graft; Transplantation; Circulatory system; Cardiology; Homotransplantation; Phlebology
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2010.08.006

Background The purpose of the study was to investigate the impact of the lung allocation score (LAS) on mortality among highly urgent (HU) and urgent (U) lung transplant (LTx) candidates in Eurotransplant (ET) and to identify useful additional parameters (LAS plus ). Methods All adult LTx candidates for whom a first request for HU or U status was made in 2008 in ET were included ( N = 317). Patients were followed until LTx, death on the waiting list (WL), delisting, or closure date (i.e., January 10, 2010). The relationship between the LAS/LAS plus and waiting list, post-transplant, and overall mortality was assessed with a multivariate regression model. The LAS and LAS plus were decomposed into their basic waitlist and post-transplant components. Results Waiting list mortality rate was 22% and 1-year post-transplant mortality rate was 34%. The waitlist component of the LAS plus was significantly associated with waiting list mortality (hazard ratio [HR] 1.91, p = 0.021), whereas the LAS was not ( p = 0.063). The post-transplant components of both scores were significantly associated with 1-year post-transplant mortality (LAS: HR 2.69, p = 0.005; LAS plus: HR 2.55, p = 0.004). Both scores strongly predicted overall mortality (LAS: HR 1.65, p = 0.008; LAS plus: HR 1.72, p = 0.005). Conclusion LAS accurately predicts overall mortality in critically ill transplant candidates and should therefore be considered as the basis for a new lung allocation policy in ET. An adjustment of the original LAS may be indicated to accurately predict waiting list mortality.