Lung allocation score: the Eurotransplant model versus the revised US model - a cross-sectional study

Smits, Jacqueline M.; Nossent, George; Evrard, Patrick; György, Lang; Knoop, Christiane; Erp, Johanna J.M. Kwakkel-van; Langer, Frank; Schramm, René; Graaf, Ed van de; Vos, Robin; Verleden, Geert M.; Rondelet, Benoît; Hoefer, Daniel; Hoek, Rogier A.S.; Höetzenecker, Konrad; Deuse, T.; Strēlniece, Agita; Green, Dave; Vries, Erwin de; Samuel, Undine; Laufer, Guenther; Buhl, Roland; Witt, Christian; Gottlieb, Jens

doi:10.1111/tri.13262

Cited by 27 publications

(22 citation statements)

References 21 publications

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“…Germany was the first country to utilize the LAS in December 2011. 1,25 Three years following the German implementation of the LAS, waiting list mortality and median wait time decreased, the volume of lung transplants increased, a shift in transplants to more candidates with restrictive lung disease from obstructive disease was observed, and 1 year posttransplant survival improved. 26 Many of these outcomes aligned with those seen in the United States following the conversion to a LAS-based system.…”

Section: Lung Allocation Score Utilization Abroadmentioning

confidence: 99%

“…Germany has historically been a member of Eurotransplant which up until December 2011, shared deceased donor lungs between countries for "high urgency" (HU) candidates. 25 Following Germany's adoption of the LAS, Eurotransplant agreed to collect the data needed to calculate the LAS for all HU candidates. The new system shares lungs across country borders for candidates with a LAS !…”

Section: Lung Allocation Score Utilization Abroadmentioning

confidence: 99%

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The Lung Allocation Score and Its Relevance

Lyu

Goff²,

Chan

2021

Semin Respir Crit Care Med

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Lung transplantation in the United States, under oversight by the Organ Procurement Transplantation Network (OPTN) in the 1990s, operated under a system of allocation based on location within geographic donor service areas, wait time of potential recipients, and ABO compatibility. On May 4, 2005, the lung allocation score (LAS) was implemented by the OPTN Thoracic Organ Transplantation Committee to prioritize patients on the wait list based on a balance of wait list mortality and posttransplant survival, thus eliminating time on the wait list as a factor of prioritization. Patients were categorized into four main disease categories labeled group A (obstructive lung disease), B (pulmonary hypertension), C (cystic fibrosis), and D (restrictive lung disease/interstitial lung disease) with variables within each group impacting the calculation of the LAS. Implementation of the LAS led to a decrease in the number of wait list deaths without an increase in 1-year posttransplant survival. LAS adjustments through the addition, modification or elimination of covariates to improve the estimates of patient severity of illness, have since been made in addition to establishing criteria for LAS value exceptions for pulmonary hypertension patients. Despite the success of the LAS, concerns about the prioritization, and transplantation of older, sicker individuals have made some aspects of the LAS controversial. Future changes in US lung allocation are anticipated with the current development of a continuous distribution model that incorporates the LAS, geographic distribution, and unaccounted aspects of organ allocation into an integrated score.

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Section: Lung Allocation Score Utilization Abroadmentioning

confidence: 99%

Section: Lung Allocation Score Utilization Abroadmentioning

confidence: 99%

The Lung Allocation Score and Its Relevance

Lyu

Goff²,

Chan

2021

Semin Respir Crit Care Med

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“…In den USA wurde im Februar 2015 eine Weiterentwicklung des LAS-Modells eingeführt. Erste Vergleichsuntersuchungen von "ET"-LAS und US-LAS sind kürzlich veröffentlicht worden [38].…”

Section: Ausblickunclassified

Wartelistenführung und Organvermittlung zur Lungentransplantation 2018 – Aktuelles für den Pneumologen

et al. 2018

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ZusammenfassungDie gesetzliche Grundlage der Allokation und Wartelistenführung zur Lungentransplantation wurde 2017 novelliert. Durch die aktuelle Richtlinie ergeben sich für die Transplantationszentren wichtige Änderungen. Wesentliche Neuerungen der Richtlinie betreffen die Transplantationskonferenz, die Indikationen zum Verfahren und die Führung der Warteliste zur Organtransplantation. In bestimmten klinischen Konstellationen ist die Aufnahme von Patienten nun beschränkt, und es gibt neue Regeln zur Größenkompatibilität von Spenderlunge und Empfänger. Zudem wird im Detail beschrieben, wie die Parameter, die dem Lung Allocation Score (LAS) zugrunde liegen, definiert sind inkl. der Durchführung der hierfür notwendigen Untersuchungen. Darüber hinaus gibt der vorliegende Artikel einen Überblick über die Organzuteilung durch die Vermittlungsstelle.

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“…7,8 No longer is the question ‘What excludes this patient from LTx?’, rather ‘How can we fit this patient for LTx and achieve a meaningful individual improvement in duration and quality of life?’ The iconoclastic change from a ‘time accrued’ system on the active waiting list, which saw many patients perish while waiting, to a more nuanced lung allocation score (LAS), initially in the USA but subsequently also in Europe, has made a dramatic change in both the composition of indications for LTx and the acuity of patients transplanted. 9–11 Despite these worthwhile changes, the recent Organ Procurement and Transplantation Network (OPTN)/Scientific Registry of Transplant Recipients (SRTR) report documents, in the USA, the need for organs continues to outpace available donors. 12 Despite an increase of 126 donors in 2017, 1360 candidates remained on the waiting list at the end of the year, and 326 patients died or became too sick to undergo LTx.…”

Section: Introductionmentioning

confidence: 99%

Lung transplantation: a review of the optimal strategies for referral and patient selection

Mitchell

Glanville

2019

Ther Adv Respir Dis

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One of the great challenges of lung transplantation is to bridge the dichotomy between supply and demand of donor organs so that the maximum number of potential recipients achieve a meaningful benefit in improvements in survival and quality of life. To achieve this laudable goal is predicated on choosing candidates who are sufficiently unwell, in fact possessing a terminal respiratory illness, but otherwise fit and able to undergo major surgery and a prolonged recuperation and rehabilitation stage combined with ongoing adherence to complex medical therapies. The choice of potential candidate and the timing of that referral is at times perhaps more art than science, but there are a number of solid guidelines for specific illnesses to assist the interested clinician. In this regard, the relationship between the referring clinician and the lung transplant unit is a critical one. It is an ongoing and dynamic process of education and two way communication, which is a marker of the professionalism of a highly performing unit. Lung transplantation is ultimately a team effort where the recipient is the key player. That principle has been enshrined in the three consensus position statements regarding selection criteria for lung and heart-lung transplantation promulgated by the International Society for Heart and Lung Transplantation over the last two decades. During this period, the number of indications for lung transplantation have broadened and the number of contraindications reduced. Risk management is paramount in the pre- and perioperative period to effect early successful outcomes. While it is not the province of this review to reiterate the detailed listing of those factors, an overview position will be developed that describes the rationale and evidence for selected criteria where that exists. Importantly, the authors will attempt to provide an historical and experiential basis for making these important and life-determining decisions. The reviews of this paper are available via the supplementary material section.

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Lung allocation score: the Eurotransplant model versus the revised US model - a cross-sectional study

Cited by 27 publications

References 21 publications

The Lung Allocation Score and Its Relevance

The Lung Allocation Score and Its Relevance

Wartelistenführung und Organvermittlung zur Lungentransplantation 2018 – Aktuelles für den Pneumologen

Lung transplantation: a review of the optimal strategies for referral and patient selection

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