High Lung Allocation Scores and Lung Transplantation

Meyer, Keith C.

doi:10.1016/j.chest.2019.02.330

Cited by 3 publications

(4 citation statements)

References 11 publications

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“…Prioritizing patients on the waiting list based on the calculated net-transplant benefit has indeed resulted in a significant decrease in the waiting time on the LTx list, along with a shift in the most common indication for LTx to become pulmonary fibrosis instead of obstructive lung disease. [2][3][4]9 The latter finding was evident in our cohort as well as the international experience. 6,10,11 Expectantly, recipients with higher LAS are sicker, older with multiple comorbidities, and increasingly bridged on mechanical ventilation or ECMO.…”

Section: Evolution In Recipient Characteristicssupporting

confidence: 81%

“…2 Indeed, implementation of the LAS has resulted in a decrease in waiting list mortality, yet impact on short-and long-term clinical outcomes is to be further characterized. [2][3][4][5] Clinically, we have been observing changes in the recipient characteristics with the LAS prioritizing sicker patients with older age, associated comorbidities, on mechanical ventilation, and bridged on mechanical circulatory support. In this study, we examined the accumulative experience of LTx over 30 y at our center, divided into 3 different eras following recent report design from the International Society for Heart and Lung Transplantation (ISHLT).…”

Section: Introductionmentioning

confidence: 99%

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Evolution of Recipient Characteristics Over 3 Decades and Impact on Survival After Lung Transplantation

et al. 2021

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Section: Evolution In Recipient Characteristicssupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Evolution of Recipient Characteristics Over 3 Decades and Impact on Survival After Lung Transplantation

et al. 2021

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“…The lung allocation score was implemented the United States in the year of 2005 and the idea behind it was to better understand the mortality between patients who are on the transplant waiting list and patient who survived posttransplant (14).…”

Section: Lung Transplant and Hepatitis Cmentioning

confidence: 99%

Ethical subjects in lung transplant and current era

Makdisi¹

2023

Curr Chall Thorac Surg

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General principals of biomedical ethicsLung transplantation has become a viable treatment option for many patients with terminal pulmonary disease, but the lack of available donors adds more constrains to already difficult and lengthy process. Sadly, many patients listed for lung transplant die while awaiting transplantation (1).Due to the fact that organs recovered from deceased donors offer substantial (and sometimes superior) benefits to potential recipients, with no risk to a healthy live donor, the efforts to maximize the use of organs from deceased donors must not be impeded by the development of live organ donation (2).Understanding the fundamental principles of biomedical ethics will help analyzing the complex medical situation that physicians often encounter such as organ transplantation.There are four principles: Beneficence which means "do good", non-maleficence "do no harm", autonomy which means making sure that the patients fully understand their options and that their decisions are respected, and Justice which means trying to advocate and invest the medical resources equally to all patients regardless of any factor including social economic status (3). Applying general biomedical ethical concepts in lung transplantIn lung transplant, Beneficence means that this ethical principal is clearly being met in all transplant patients as a group. In other words, the quality of life of some patients is

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“…The LAS is calculated on the basis of clinical data collected for each patient, including information such as functional status, exercise capacity, lung function, hemodynamic data, and the need for oxygen or ventilatory support [ 10 ]. If spirometry results are not available or updated in the prior 6 months, the lung function parameters included in LAS calculation will default to normal and the result will be a lower overall LAS score which may underestimate the disease severity and decrease the chance of timely transplantation [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Spirometry testing for extracorporeal membrane oxygenation (ECMO) bridge to transplant patients

Timofte

Diaz‐Abad

Alghanim

et al. 2022

Respiratory Medicine Case Reports

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Purpose ECMO can provide a bridge to transplantation and improve survival for patients with advanced lung disease. Although pulmonary function testing (PFT) is an important component of the lung allocation score (LAS), it is not always feasible on patients requiring ECMO. While generally safe, PFT testing has contraindications and is not recommended in unstable patients. Currently there are no recommendations regarding the performance of spirometry in ECMO patients. Study design and Methods: We reviewed data on five patients with advanced lung disease requiring ECMO-bridge to transplant. After careful consideration of the theoretical physiologic risks associated with forced expiratory maneuvers, bedside spirometry was performed in order to update the patients’ LAS. Results All patients successfully completed three forced expiratory maneuvers in the seated position with a bedside spirometer. Vital signs and ECMO flow were stable during testing and without complication. In 2 patients who had both a LAS pre and post spirometry, the LAS increased by 3–5 points. Conclusion Spirometry results are pivotal to organ allocation under current organ sharing protocols. This case series demonstrates that bedside spirometry testing may be performed safely in patients on ECMO awaiting lung transplantation without appreciable side effects, leading to a more accurate LAS score.

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High Lung Allocation Scores and Lung Transplantation

Cited by 3 publications

References 11 publications

Evolution of Recipient Characteristics Over 3 Decades and Impact on Survival After Lung Transplantation

Evolution of Recipient Characteristics Over 3 Decades and Impact on Survival After Lung Transplantation

Ethical subjects in lung transplant and current era

Spirometry testing for extracorporeal membrane oxygenation (ECMO) bridge to transplant patients

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