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Benjamin D. Kozower
Bryan F. Meyers
Michael A. Smith
Nilto C. De Oliveira
Stephen D. Cassivi
Tracey J. Guthrie
Thomas M. Daniel
David R. Jones
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J Thorac Cardiovasc Surg 2008;135:166-171
© 2008 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

The impact of the lung allocation score on short-term transplantation outcomes: A multicenter study

Benjamin D. Kozower, MDa,*, Bryan F. Meyers, MDb, Michael A. Smith, MDc, Nilto C. De Oliveira, MDd, Stephen D. Cassivi, MDe, Tracey J. Guthrie, RNb, Honkung Wang, PhDf, Beverly J. Ryan, ACNPa, K. Robert Shen, MDa, Thomas M. Daniel, MDa, David R. Jones, MDa

a Department of Surgery, University of Virginia Health System, Charlottesville, Va
b Department of Surgery, Washington University School of Medicine, St Louis, Mo
c Department of Cardiothoracic Surgery, University of Southern California, Los Angeles, Calif
d Department of Surgery, University of Wisconsin, Madison, Wis
e Department of Surgery, Mayo Clinic, Rochester, Minn
f Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Va

Read at the Eighty-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, DC, May 5–9, 2007.

Received for publication May 3, 2007; revisions received August 13, 2007; accepted for publication August 15, 2007.

* Address for reprints: Benjamin D. Kozower, MD, University of Virginia Health System, General Thoracic Surgery, PO Box 800679, Charlottesville, VA 22908-0679. (Email: bdk8g{at}virginia.edu).

Objective: The lung allocation score restructured the distribution of scarce donor lungs for transplantation. The algorithm ranks waiting list patients according to medical urgency and expected benefit after transplantation. The purpose of this study was to evaluate the impact of the lung allocation score on short-term outcomes after lung transplantation.

Methods: A multicenter retrospective cohort study was performed with data from 5 academic medical centers. Results of patients undergoing transplantation on the basis of the lung allocation score (May 4, 2005 to May 3, 2006) were compared with those of patients receiving transplants the preceding year before the lung allocation score was implemented (May 4, 2004, to May 3, 2005).

Results: The study reports on 341 patients (170 before the lung allocation score and 171 after). Waiting time decreased from 680.9 ± 528.3 days to 445.6 ± 516.9 days (P < .001). Recipient diagnoses changed with an increase in idiopathic pulmonary fibrosis and a decrease in emphysema and cystic fibrosis (P = .002). Postoperatively, primary graft dysfunction increased from 14.1% (24/170) to 22.9% (39/171) (P = .04) and intensive care unit length of stay increased from 5.7 ± 6.7 days to 7.8 ± 9.6 days (P = .04). Hospital mortality and 1-year survival were the same between groups (5.3% vs 5.3% and 90% vs 89%, respectively; P > .6)

Conclusions: This multicenter retrospective review of short-term outcomes supports the fact that the lung allocation score is achieving its objectives. The lung allocation score reduced waiting time and altered the distribution of lung diseases for which transplantation was done on the basis of medical necessity. After transplantation, recipients have significantly higher rates of primary graft dysfunction and intensive care unit lengths of stay. However, hospital mortality and 1-year survival have not been adversely affected.

Abbreviations and Acronyms ICU = intensive care unit; LAS = lung allocation score; OPTN = Organ Procurement and Transplantation Network


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Discussion
J. Thorac. Cardiovasc. Surg. 2008 135: 170-171. [Extract] [Full Text] [PDF]



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