Impact of the Lung Allocation Score on Lung Transplantation for Pulmonary Arterial Hypertension

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 5 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.

Update on Pulmonary Hypertension 2009

“…Chen and colleagues reviewed the effects of changes to the lung allocation system in 2005 on the likelihood of patients with PAH receiving a lung while on the waiting list (27). In 2005, the system was changed to direct organs to patients with a high Lung Allocation Sore (LAS) rather than being based on the time a patient was listed.…”

Successful Lung Transplant From Donor After Cardiac Death: A Potential Solution to Shortage of Thoracic Organs

“…4 Generalized acceptance and adoption of DCD have been slow and gradual, 6,7 primarily because of concerns of both the logistics of the procurement procedure and an overriding ethical dilemma regarding appropriate donor selection. Placed in proper perspective, DCD organ procurement has brought the ethics of organ transplant full circle be- cause the earliest organ donations were from deceased donors after cardiac death, 5,6 with consensus criteria for brain death organ donation having been established later. The critical shortage of organs has brought about renewed interest in DCD organ procurement and rekindled the ethical dialogue.…”

“…3,4 Despite progress, waiting-list mortality remains unacceptably high. 5 Organ donation after cardiac death (DCD), also known as non-heart-beating donors, is one proposed solution to increase the supply of transplant organs. We report our institution's initial experience with DCD, lung procurement, and transplant.…”

Advanced pulmonary arterial hypertension: mechanical support and lung transplantation

“…In the USA and Germany, the introduction of the LAS has shortened the time to transplantation and decreased the risk of waiting list mortality for many diseases [23,24], including IPAH [25,26]. Despite this observation, the LAS may not fully reflect disease severity in patients with IPAH [14,27].…”