OBJECTIVE: The lung allocation score was initiated in May 2005 to allocate lungs on the basis of medical urgency and posttransplant survival. However, the relationship between lung allocation score and candidate outcomes remains poorly characterized. The purpose of this study was (1) to describe outcomes by lung allocation score at the time of listing and (2) to estimate the net survival benefit of transplantation by lung allocation score. METHODS: The United Network for Organ Sharing provided de-identified patient-level data. Analysis included lung transplant candidates aged 12 years or more and listed between May 4, 2005, and May 4, 2009 (n = 6082). Candidates were stratified according to lung allocation score at listing into 7 groups: lung allocation score less than 40, 40 to 49, 50 to 59, 60 to 69, 70 to 79, 80 to 89, and 90 or more. Outcomes of interest included the risk of death on the waiting list and likelihood of transplantation. The net survival benefit of transplantation was defined as actuarial median posttransplant graft survival minus actuarial median waiting list survival, where the outcome of interest was death on the waiting list or posttransplant; candidates were censored at the time of transplant or last follow-up. RESULTS: In the lowest-priority strata (eg, <40 and 40-49), less than 4% of candidates died on the waiting list within 90 days of listing. The median net survival benefit was lowest in the lung allocation score less than 40 (-0.7 years) and lung allocation score 90+ group (1.95 years) and highest in the 50 to 59 (3.44 years), 60 to 69 (3.49 years), and 70 to 79 (2.81 years) groups. CONCLUSIONS: The mid-priority groups (eg, 50-59, 60-69, 70-79) seem to achieve the greatest survival benefit from transplantation. Although low-priority candidates comprise the majority of transplant recipients, survival benefit in this group seems to be less than in other groups given the low risk of death on the waiting list. As expected, both the time to transplant and survival on the waitlist are lower in the higher-priority strata (eg, 80-89 and 90+). However, their net survival benefit was likewise relatively low as a result of their poor posttransplant survival.
OBJECTIVE: The lung allocation score was initiated in May 2005 to allocate lungs on the basis of medical urgency and posttransplant survival. However, the relationship between lung allocation score and candidate outcomes remains poorly characterized. The purpose of this study was (1) to describe outcomes by lung allocation score at the time of listing and (2) to estimate the net survival benefit of transplantation by lung allocation score. METHODS: The United Network for Organ Sharing provided de-identified patient-level data. Analysis included lung transplant candidates aged 12 years or more and listed between May 4, 2005, and May 4, 2009 (n = 6082). Candidates were stratified according to lung allocation score at listing into 7 groups: lung allocation score less than 40, 40 to 49, 50 to 59, 60 to 69, 70 to 79, 80 to 89, and 90 or more. Outcomes of interest included the risk of death on the waiting list and likelihood of transplantation. The net survival benefit of transplantation was defined as actuarial median posttransplant graft survival minus actuarial median waiting list survival, where the outcome of interest was death on the waiting list or posttransplant; candidates were censored at the time of transplant or last follow-up. RESULTS: In the lowest-priority strata (eg, <40 and 40-49), less than 4% of candidates died on the waiting list within 90 days of listing. The median net survival benefit was lowest in the lung allocation score less than 40 (-0.7 years) and lung allocation score 90+ group (1.95 years) and highest in the 50 to 59 (3.44 years), 60 to 69 (3.49 years), and 70 to 79 (2.81 years) groups. CONCLUSIONS: The mid-priority groups (eg, 50-59, 60-69, 70-79) seem to achieve the greatest survival benefit from transplantation. Although low-priority candidates comprise the majority of transplant recipients, survival benefit in this group seems to be less than in other groups given the low risk of death on the waiting list. As expected, both the time to transplant and survival on the waitlist are lower in the higher-priority strata (eg, 80-89 and 90+). However, their net survival benefit was likewise relatively low as a result of their poor posttransplant survival.
Authors: Bryan G Maxwell; Joshua J Mooney; Peter H U Lee; Joseph E Levitt; Laveena Chhatwani; Mark R Nicolls; Martin R Zamora; Vincent Valentine; David Weill; Gundeep S Dhillon Journal: Am J Respir Crit Care Med Date: 2015-02-01 Impact factor: 21.405
Authors: Anthony Castleberry; Michael S Mulvihill; Babatunde A Yerokun; Brian C Gulack; Brian Englum; Laurie Snyder; Mathias Worni; Asishana Osho; Scott Palmer; R Duane Davis; Matthew G Hartwig Journal: J Heart Lung Transplant Date: 2016-12-30 Impact factor: 10.247
Authors: Wayne M Tsuang; David M Vock; C Ashley Finlen Copeland; David J Lederer; Scott M Palmer Journal: Ann Intern Med Date: 2013-05-07 Impact factor: 25.391