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Comparative Study
. 2010 Mar;137(3):651-7.
doi: 10.1378/chest.09-0319. Epub 2009 Oct 9.

High lung allocation score is associated with increased morbidity and mortality following transplantation

Mark J Russo  1 , Alexander Iribarne, Kimberly N Hong, Ryan R Davies, Steve Xydas, Hiroo Takayama, Ali Ibrahimiye, Annetine C Gelijns, Matthew D Bacchetta, Frank D'Ovidio, Selim Arcasoy, Joshua R Sonett
Affiliations
Comparative Study

High lung allocation score is associated with increased morbidity and mortality following transplantation

Mark J Russo et al. Chest. 2010 Mar.

Abstract

Background: The lung allocation score (LAS) was initiated in May 2005 to allocate lungs based on medical urgency and posttransplant survival. The purpose of this study was to determine if there is an association between an elevated LAS at the time of transplantation and increased postoperative morbidity and mortality.

Methods: The United Network for Organ Sharing provided de-identified patient-level data. Analysis included lung transplant recipients aged >or= 12 years who received transplants between April 5, 2006, and December 31, 2007 (n = 3,836). Recipients were stratified into three groups: LAS < 50 (n = 3,161, 83.87%), LAS 50 to 75 (n = 411, 10.9%), and LAS >or= 75 (n = 197, 5.23%), referred to as low LAS (LLAS), intermediate LAS (ILAS), and high LAS (HLAS), respectively. The primary outcome was posttransplant graft survival at 1 year. Secondary outcomes included length of stay and in-hospital complications.

Results: HLAS recipients had significantly worse actuarial survival at 90 days and 1 year compared with LLAS recipients. When transplant recipients were stratified by disease etiology, a trend of decreased survival with elevated LAS was observed across all major causes of lung transplant. HLAS recipients were more likely to require dialysis or to have infections compared with LLAS recipients (P < .001). In addition, length of stay was higher in the HLAS group when compared with the LLAS group (P < .001).

Conclusions: HLAS is associated with decreased survival and increased complications during the transplant hospitalization. Whereas the LAS has improved organ allocation through decreased waiting list deaths and waiting list times, lower survival and higher morbidity among HLAS recipients suggests that continued review of LAS scoring is needed to ensure optimal long-term transplant survival.

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Figures

Figure 1.
Figure 1.
Distribution of LAS in lung transplant recipients. LAS =lung allocation score.
Figure 2.
Figure 2.
Kaplan-Meier survival curve of patients transplanted by LAS. See Figure 1 legend for expansion of the abbreviation.
Figure 3.
Figure 3.
Incidence rate of death by LAS and posttransplant time interval. * = P < .05, compared with group that has LAS < 50. See Figure 1 legend for expansion of the abbreviation.
Figure 4.
Figure 4.
One-year survival by cause of disease. * = P < .05, compared with group that has LAS < 50. See Figure 1 for expansion of the abbreviation.
Figure 5.
Figure 5.
Incidence of in-hospital complication by LAS. Incidence reported per 100 patients, except infection per 1,000 patients. PGF30 = primary graft failure < 30 days posttransplant. See Figure 1 legend for expansion of other abbreviation.* = P < 0.05 compared with group that has LAS < 50.
Figure 6.
Figure 6.
Length of stay by LAS at the time of transplantation. See Figure 1 legend for expansion of the abbreviation.* = P < 0.05 compared with group that has LAS < 50.
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References

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