Andrew T Braun1, Elliott C Dasenbrook2, Ashish S Shah3, Jonathan B Orens4, Christian A Merlo4. 1. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: abraun1@jhmi.edu. 2. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and Cleveland, Ohio; Division of Pediatric Pulmonology and Allergy/Immunology, Department of Pediatrics, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio. 3. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. 4. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Abstract
BACKGROUND: The lung allocation score (LAS) has changed organ allocation for lung transplantation in the United States. Previous investigations of transplant recipients reported an association between high LAS and an increased risk of death after lung transplantation. We hypothesize that a high LAS predicts survival in lung transplant recipients with cystic fibrosis (CF) in the United Network for Organ Sharing Scientific Registry of Transplant Recipients database. METHODS: A cohort study was conducted of 1,437 U.S. adult lung transplant recipients with CF from May 1, 2005, through December 31, 2012. The cohort was divided into a high-risk group and a low-risk group based on LAS. Survival data were examined using Kaplan-Meier estimates and Cox proportional hazard models to compare survival. The primary outcome was adjusted survival at 1 year after lung transplantation. RESULTS: The high-risk group of 318 patients with a median LAS of 69.6 (interquartile range 56.3-87.2) was compared with a low-risk group of 1,119 patients with a median LAS of 38.8 (interquartile range 36.3-42.3). Patients in the high-risk group had a 41% increased relative risk of cumulative mortality at 1 year after transplantation compared with the low-risk group (16.1% vs 12.0%). After adjustment for known predictors of mortality, the risk of death at 1 year after transplantation remained elevated (hazard ratio = 1.41; 95% confidence interval = 1.00-2.01). The high-risk group had worse survival at 90 days and 2 years after lung transplantation. CONCLUSIONS: High LAS are associated with worse survival in lung transplant recipients with CF.
BACKGROUND: The lung allocation score (LAS) has changed organ allocation for lung transplantation in the United States. Previous investigations of transplant recipients reported an association between high LAS and an increased risk of death after lung transplantation. We hypothesize that a high LAS predicts survival in lung transplant recipients with cystic fibrosis (CF) in the United Network for Organ Sharing Scientific Registry of Transplant Recipients database. METHODS: A cohort study was conducted of 1,437 U.S. adult lung transplant recipients with CF from May 1, 2005, through December 31, 2012. The cohort was divided into a high-risk group and a low-risk group based on LAS. Survival data were examined using Kaplan-Meier estimates and Cox proportional hazard models to compare survival. The primary outcome was adjusted survival at 1 year after lung transplantation. RESULTS: The high-risk group of 318 patients with a median LAS of 69.6 (interquartile range 56.3-87.2) was compared with a low-risk group of 1,119 patients with a median LAS of 38.8 (interquartile range 36.3-42.3). Patients in the high-risk group had a 41% increased relative risk of cumulative mortality at 1 year after transplantation compared with the low-risk group (16.1% vs 12.0%). After adjustment for known predictors of mortality, the risk of death at 1 year after transplantation remained elevated (hazard ratio = 1.41; 95% confidence interval = 1.00-2.01). The high-risk group had worse survival at 90 days and 2 years after lung transplantation. CONCLUSIONS: High LAS are associated with worse survival in lung transplant recipients with CF.
Authors: Jonathan B Orens; Marc Estenne; Selim Arcasoy; John V Conte; Paul Corris; Jim J Egan; Thomas Egan; Shaf Keshavjee; Christiane Knoop; Robert Kotloff; Fernando J Martinez; Steven Nathan; Scott Palmer; Alec Patterson; Lianne Singer; Gregory Snell; Sean Studer; J L Vachiery; Allan R Glanville Journal: J Heart Lung Transplant Date: 2006-07 Impact factor: 10.247
Authors: T M Egan; F C Detterbeck; M R Mill; M S Bleiweis; R Aris; L Paradowski; G Retsch-Bogart; B S Mueller Journal: Eur J Cardiothorac Surg Date: 2002-10 Impact factor: 4.191
Authors: Eric S Weiss; Jeremiah G Allen; Monica N Modi; Christian A Merlo; John V Conte; Ashish S Shah Journal: J Heart Lung Transplant Date: 2009-02 Impact factor: 10.247
Authors: A J Duncan; J S Dummer; I L Paradis; J H Dauber; S A Yousem; M A Zenati; R L Kormos; B P Griffith Journal: J Heart Lung Transplant Date: 1991 Sep-Oct Impact factor: 10.247
Authors: Cynthia J Gries; Michael S Mulligan; Jeffrey D Edelman; Ganesh Raghu; J Randall Curtis; Christopher H Goss Journal: Chest Date: 2007-12 Impact factor: 9.410
Authors: Christian A Merlo; Eric S Weiss; Jonathan B Orens; Marvin C Borja; Marie Diener-West; John V Conte; Ashish S Shah Journal: J Heart Lung Transplant Date: 2009-08 Impact factor: 10.247
Authors: Benjamin D Kozower; Bryan F Meyers; Michael A Smith; Nilto C De Oliveira; Stephen D Cassivi; Tracey J Guthrie; Honkung Wang; Beverly J Ryan; K Robert Shen; Thomas M Daniel; David R Jones Journal: J Thorac Cardiovasc Surg Date: 2007-11-12 Impact factor: 5.209
Authors: Kathleen J Ramos; Patrick J Smith; Edward F McKone; Joseph M Pilewski; Amy Lucy; Sarah E Hempstead; Erin Tallarico; Albert Faro; Daniel B Rosenbluth; Alice L Gray; Jordan M Dunitz Journal: J Cyst Fibros Date: 2019-03-27 Impact factor: 5.482
Authors: Cesar A Keller; Thomas A Gonwa; Launia J White; March E Rucci; Sue L Visscher; Cassie C Kennedy; Richard C Daly; James M Naessens Journal: Transplantation Date: 2019-03 Impact factor: 4.939
Authors: Scott C Bell; Marcus A Mall; Hector Gutierrez; Milan Macek; Susan Madge; Jane C Davies; Pierre-Régis Burgel; Elizabeth Tullis; Claudio Castaños; Carlo Castellani; Catherine A Byrnes; Fiona Cathcart; Sanjay H Chotirmall; Rebecca Cosgriff; Irmgard Eichler; Isabelle Fajac; Christopher H Goss; Pavel Drevinek; Philip M Farrell; Anna M Gravelle; Trudy Havermans; Nicole Mayer-Hamblett; Nataliya Kashirskaya; Eitan Kerem; Joseph L Mathew; Edward F McKone; Lutz Naehrlich; Samya Z Nasr; Gabriela R Oates; Ciaran O'Neill; Ulrike Pypops; Karen S Raraigh; Steven M Rowe; Kevin W Southern; Sheila Sivam; Anne L Stephenson; Marco Zampoli; Felix Ratjen Journal: Lancet Respir Med Date: 2019-09-27 Impact factor: 30.700
Authors: Kathleen J Ramos; Ranjani Somayaji; Erika D Lease; Christopher H Goss; Moira L Aitken Journal: BMC Pulm Med Date: 2017-01-19 Impact factor: 3.317