Alexis E Shafii1, David P Mason2, Chase R Brown3, Lucy Thuita4, Sudish C Murthy1, Marie M Budev5, Gösta B Pettersson1, Eugene H Blackstone6. 1. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Heart and Vascular Institute, Cleveland, Ohio. 2. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Heart and Vascular Institute, Cleveland, Ohio. Electronic address: david.mason@baylorhealth.edu. 3. Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio. 4. Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio. 5. Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio. 6. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Heart and Vascular Institute, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
Abstract
BACKGROUND: Recent studies using United Network for Organ Sharing data suggest that lung transplantation in patients with high lung allocation scores (LAS) may lead to organ and resource wastage. Therefore, to determine whether a LAS cutoff value should be considered, we evaluated the relation of LAS to waitlist and posttransplant mortality in our center to determine if it could identify patients for whom listing for transplantation may be futile. METHODS: From May 1, 2005 to July 1, 2010, 537 adults were listed and 426 underwent primary lung transplantation at our institution. Endpoints were mortality before and after lung transplantation. The relationships of LAS at listing to waitlist mortality and of pretransplant LAS to posttransplant mortality were both analyzed by multiphase hazard function methodology. RESULTS: Higher LAS was strongly associated with waitlist mortality (p<0.0001), with the highest quartile (LAS ranging from 47 to 95) experiencing 75% mortality within a year of listing. Although early (p=0.05), but not late (p=0.4), posttransplant survival was associated with higher LAS at transplantation, once other clinical characteristics predictive of early mortality were accounted for, neither waitlist nor pretransplant LAS was independently related to posttransplant mortality (p=0.12). CONCLUSIONS: Higher LAS strongly predicts higher mortality on the lung transplantation waitlist, underscoring the value of LAS in prioritizing patients with the highest scores for transplantation. Early posttransplant mortality is modestly higher with higher pretransplant LAS, but the data of our center do not suggest a value above which transplantation should be denied as futile. This suggests that donor organs and resources are not being wasted.
BACKGROUND: Recent studies using United Network for Organ Sharing data suggest that lung transplantation in patients with high lung allocation scores (LAS) may lead to organ and resource wastage. Therefore, to determine whether a LAS cutoff value should be considered, we evaluated the relation of LAS to waitlist and posttransplant mortality in our center to determine if it could identify patients for whom listing for transplantation may be futile. METHODS: From May 1, 2005 to July 1, 2010, 537 adults were listed and 426 underwent primary lung transplantation at our institution. Endpoints were mortality before and after lung transplantation. The relationships of LAS at listing to waitlist mortality and of pretransplant LAS to posttransplant mortality were both analyzed by multiphase hazard function methodology. RESULTS: Higher LAS was strongly associated with waitlist mortality (p<0.0001), with the highest quartile (LAS ranging from 47 to 95) experiencing 75% mortality within a year of listing. Although early (p=0.05), but not late (p=0.4), posttransplant survival was associated with higher LAS at transplantation, once other clinical characteristics predictive of early mortality were accounted for, neither waitlist nor pretransplant LAS was independently related to posttransplant mortality (p=0.12). CONCLUSIONS: Higher LAS strongly predicts higher mortality on the lung transplantation waitlist, underscoring the value of LAS in prioritizing patients with the highest scores for transplantation. Early posttransplant mortality is modestly higher with higher pretransplant LAS, but the data of our center do not suggest a value above which transplantation should be denied as futile. This suggests that donor organs and resources are not being wasted.
Authors: Jeremiah William Awori Hayanga; Heather K Hayanga; James H Fugett; Kelsey A Musgrove; Ghulam Abbas; Christopher R Ensor; Vinay Badhwar; Norihisa Shigemura Journal: Transpl Int Date: 2020-05-12 Impact factor: 3.782
Authors: Marco Schiavon; Giulio Faggi; Lorenzo Rosso; Luca Luzzi; Giovanni Maria Comacchio; Dario Gregori; Mario Nosotti; Francesco Damarco; Andrea Dell'Amore; David Bennet; Antonella Fossi; Piero Paladini; Luigi Santambrogio; Federico Rea Journal: J Thorac Dis Date: 2019-11 Impact factor: 2.895
Authors: Jeremiah A Hayanga; Alena Lira; Tedi Vlahu; Jingyan Yang; Jonathan K Aboagye; Heather K Hayanga; James D Luketich; Jonathan D'Cunha Journal: J Transplant Date: 2015-12-21