Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2009 Sep 1;180(5):468-74.
doi: 10.1164/rccm.200810-1603OC. Epub 2009 Jun 11.

Impact of the lung allocation score on lung transplantation for pulmonary arterial hypertension

Hubert Chen  1 , Stephen C Shiboski, Jeffrey A Golden, Michael K Gould, Steven R Hays, Charles W Hoopes, Teresa De Marco
Affiliations
Comparative Study

Impact of the lung allocation score on lung transplantation for pulmonary arterial hypertension

Hubert Chen et al. Am J Respir Crit Care Med. .

Abstract

Rationale: In 2005, lung allocation for transplantation in the United States changed from a system based on waiting time to a system based on the Lung Allocation Score (LAS).

Objectives: To study the effect of the LAS on lung transplantation for idiopathic pulmonary arterial hypertension (IPAH) compared with other major diagnoses.

Methods: We studied 7,952 adults listed for lung transplantation between 2002 and 2008. Analyses were restricted to patients with IPAH, idiopathic pulmonary fibrosis (IPF), chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF). Transplantation, waiting list mortality, and post-transplant mortality were compared between diagnoses for patients listed before and after implementation of the LAS.

Measurements and main results: The likelihood of transplantation from the waiting list increased for all diagnoses after implementation of the LAS. Waiting list mortality decreased for every diagnosis, except for IPAH, which remained unchanged. Implementation of the LAS was not associated with changes in post-transplant mortality for any diagnosis. Under the LAS system, patients with IPAH were less likely to be transplanted than patients with IPF (hazard ratio [HR], 0.53; P < 0.001) or CF (HR, 0.49; P < 0.001) and at greater risk of death on the waiting list than patients with COPD (HR, 3.09; P < 0.001) or CF (HR, 1.83; P = 0.025) after adjustment for demographics and transplant type. Post-transplant mortality for IPAH was not statistically different from that of other diagnoses.

Conclusions: Implementation of the LAS has improved the likelihood of lung transplantation for listed patients with IPAH, but mortality on the waiting list remains high compared with other major diagnoses.

PubMed Disclaimer

Figures

<b>Figure 1.</b>
Figure 1.
Cumulative incidence curves comparing transplantation and death on the waiting list before and after implementation of the Lung Allocation Score (LAS) for idiopathic pulmonary arterial hypertension, idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease, and cystic fibrosis combined. Dashed line = pre-LAS; solid line = post-LAS.
<b>Figure 2.</b>
Figure 2.
Cumulative incidence curves comparing transplantation and death on the waiting list between diagnoses before and after implementation of the Lung Allocation Score (LAS). Idiopathic pulmonary arterial hypertension (solid line). Idiopathic pulmonary fibrosis (dashed line). Chronic obstructive pulmonary disease (gray line). Cystic fibrosis (dotted line).
<b>Figure 3.</b>
Figure 3.
Cumulative incidence curves comparing post-transplant mortality before and after implementation of the Lung Allocation Score (LAS) for idiopathic pulmonary arterial hypertension, idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease, and cystic fibrosis combined. Dashed line = pre-LAS; solid line = post-LAS.
<b>Figure 4.</b>
Figure 4.
Cumulative incidence curves comparing post-transplant mortality between diagnoses before and after implementation of the Lung Allocation Score (LAS). Idiopathic pulmonary arterial hypertension (solid line). Idiopathic pulmonary fibrosis (dashed line). Chronic obstructive pulmonary disease (gray line). Cystic fibrosis (dotted line).
See this image and copyright information in PMC

Comment in

References

    1. D'Alonzo GE, Barst RJ, Ayres SM, Bergofsky EH, Brundage BH, Detre KM, Fishman AP, Goldring RM, Groves BM, Kernis JT, et al. Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med 1991;115:343–349. - PubMed
    1. McLaughlin VV, Shillington A, Rich S. Survival in primary pulmonary hypertension: the impact of epoprostenol therapy. Circulation 2002;106:1477–1482. - PubMed
    1. Sitbon O, Humbert M, Nunes H, Parent F, Garcia G, Herve P, Rainisio M, Simonneau G. Long-term intravenous epoprostenol infusion in primary pulmonary hypertension: prognostic factors and survival. J Am Coll Cardiol 2002;40:780–788. - PubMed
    1. Barr ML, Bourge RC, Orens JB, McCurry KR, Ring WS, Hulbert-Shearon TE, Merion RM. Thoracic organ transplantation in the United States, 1994–2003. Am J Transplant 2005;5:934–949. - PubMed
    1. Orens JB, Shearon TH, Freudenberger RS, Conte JV, Bhorade SM, Ardehali A. Thoracic organ transplantation in the United States, 1995–2004. Am J Transplant 2006;6:1188–1197. - PubMed

Publication types

MeSH terms