Impact Of Lung Allocation Score On Survival In Cystic Fibrosis Lung Transplant Recipients

Abstract

Background-The Lung Allocation Score (LAS) has changed organ allocation for lung transplantation in the United States. Previous investigations of transplant recipients have reported an association between high LAS scores and an increased risk of death after lung transplantation. We hypothesize that a high LAS predicts survival in cystic fibrosis (CF) lung transplant recipients in the United Network for Organ Sharing (UNOS) Scientific Registry of Transplant Recipients (SRTR) database.

National Healthcare Delivery Systems Influence Lung Transplant Outcomes for Cystic Fibrosis

“…This observation may be unique to CF LTx recipients. Though medication adherence data are not available in the UK registry, we speculate this finding may reflect better medication compliance among older CF patients, which we have identified to be associated with LTx outcomes . It also may represent less aggressive clinical manifestations of the disease among patients who tend to be older before coming to transplantation.…”

Changing demographics and outcomes of lung transplantation recipients with cystic fibrosis

“…Because more patients with CF undergoing LTx are out of their teenage years, better patient compliance to treatment secondary to behavioral independence and emotional maturation may help explain the improved survival in the post-LAS era. 7 The LAS has dramatically affected LTx strategies. The interaction between the LAS and LTx outcomes is significant; higher LAS is typically associated with increased survival benefit of LTx.…”

“…The interaction between the LAS and LTx outcomes is significant; higher LAS is typically associated with increased survival benefit of LTx. 9 However, some authors have warned that very high LAS (approximately Z50) was associated with worse survival in LTx recipients with CF 7,8 and that the LAS should be considered an important tool for judging the appropriateness of patient candidacy. 7 Pre-transplant ventilator use is strongly associated with high LAS; our results showed higher mean LAS (42.9 vs 49.0) and higher pre-transplant ventilator use (5% vs 11%) in the current era, although graft survival was similar in the post-LAS era.…”

“…9 However, some authors have warned that very high LAS (approximately Z50) was associated with worse survival in LTx recipients with CF 7,8 and that the LAS should be considered an important tool for judging the appropriateness of patient candidacy. 7 Pre-transplant ventilator use is strongly associated with high LAS; our results showed higher mean LAS (42.9 vs 49.0) and higher pre-transplant ventilator use (5% vs 11%) in the current era, although graft survival was similar in the post-LAS era. This observation may support the current timing of placing patients with CF on waitlists even though they are more ill than in the earlier eras; we must consider that perhaps patients with CF were placed on the list too early in the past.…”

“…In May 2005, the Organ Procurement and Transplant Network (OPTN) modified the policy of lung allocation for transplantation in the United States from a system that allocated donor lungs based primarily on waiting time to a system based primarily on a new lung allocation score (LAS) that reflected not only disease severity 5,6 but also post-LTx outcomes. 7,8 A higher LAS is typically associated with increased survival benefit of LTx. 9 Since implementation of the LAS-based donor allocation system, decreased number of patients on the active waiting list, waiting times for LTx, and waitlist mortality have been reported.…”