Disparities in lung transplantation before and after introduction of the lung allocation score

Abstract

Background In May 2005 the lung allocation score (LAS) became the primary method for determining allocation of lungs for organ transplantation for those at least 12 years of age in the United States. During the pre-LAS period, black patients were more likely than white patients to become too sick or die while awaiting transplant. The association between gender and lung transplant outcomes has not been widely studied. Methods Black and white patients ≥18 years of age registered on the UNOS lung transplantation waiting list from January 1, 2000-May 3, 2005 (pre-LAS, n=8765) and May 4, 2005-September 13, 2010 (LAS, n=8806) were included; logistic regression analyses were based on smaller cohorts derived from patients listed in the first 2 years of each era (pre-LAS, n=2350, and LAS, n=2446) to allow for follow-up time. Lung transplantation was the primary outcome measure. Multivariable analyses were performed within each time period to determine the odds of dying or receiving a lung transplant within three years of listing. Results In the pre-LAS era, black patients were more likely than white to become too sick for transplantation or die within three years of wait list registration (43.8% vs. 30.8%; odds ratio [OR] 1.84; p<0.001). Race was not associated with death or becoming too sick while listed for transplantation in the LAS era (14.0% vs. 13.3%; OR 0.93; p=0.74). Black patients were less likely to undergo transplantation in the pre-LAS era (56.3% vs. 69.2%; OR 0.54; p<0.001) but not in the LAS era (86.0% vs. 86.7%; OR 1.07; p=0.74). Women were more likely than men to die or become too sick for transplantation within three years of listing in the LAS era (16.1% vs. 11.3%; OR 1.58; p<0.001), as compared to the pre-LAS era (33.4% vs. 30.7%; OR 1.19; p=0.08). Conclusion Racial disparities in lung transplantation have decreased with the implementation of LAS as the method of organ allocation; however, gender disparities may have actually increased in the LAS era.

Medication Nonadherence After Lung Transplantation in Adult Recipients

“…Predictor variables for analysis were determined a priori based on factors previously demonstrated in the literature to affect medication adherence [8, 16, 25, 27–29]. These variables included recipient age, sex, race, smoking history, insurance carrier, education level, cause of lung failure, comorbidities, year of transplantation, and transplantation center volume.…”

A decade of extended-criteria lung donors in a single center: was it justified?

“…There was no difference in time to extubation in lung recipients from ECDs (4 [2-7] days) versus SCDs (3 [2-6] days) (unadjusted P = 0.13 and adjusted P = 0.27). ECD recipients had longer ICU stay (ECD 7 [5][6][7][8][9][10][11][12][13] days versus SCD 6 [4-11] days; unadjusted P < 0.01 and adjusted analysis P = 0.074). Prevalence of respiratory infection (unadjusted P = 0.65; adjusted P = 0.58) and prevalence of AR (unadjusted < grade 2 P = 0.99; ≥ grade 2 P = 0.25; adjusted < grade 2 P = 0.59; ≥ grade 2 P = 0.82) as well as LB (unadjusted B1R P = 0.62; ≥ B2R P = 0.43; adjusted B1R P = 0.59; ≥ B2R P = 0.79) did not differ between groups during the entire follow-up period ( Table 2).…”

“…For the year 2012, of a total of 2106 donors in Eurotransplant, 1813 (86.1%) donated a kidney, 1642 (77.9%) a liver versus 670 (31.8%) a lung, and 607 (28.8%) a heart [4]. As a consequence, the scarcity of suitable donor lungs has become the major limitation for LTx, giving rise to longer waiting times and a substantial risk of death prior to LTx [5].…”

Short Stature and Access to Lung Transplantation in the United States. A Cohort Study

“…Priority-based lung allocation seems to have ameliorated racial differences in access to lung transplantation (7,8), but may have led to an unexplained difference by sex, with women facing lower transplant rates than men (7). We have anecdotally noted that short lung transplant candidates seem to have longer waiting times than taller candidates, perhaps related to the common practice of attempting to find donor lungs of similar size to the candidate.…”