The Impact of the Lung Allocation Score

ABSTRACT

The lung allocation score (LAS) was developed in an effort to facilitate lung transplantation to more urgent and ill patients, to decrease wait time, and to change the allocation process to a more merit-based system. Four years after the implementation of the LAS, we now evaluate the impact and outcomes of this system. We have found that registrations on the wait list as well as wait time have decreased. Mortality on the wait list has decreased. There has been significant change in the distribution of diagnoses receiving transplantation with no significant difference in survival in most areas. Patients with higher LAS scores have increased short-term mortality. The LAS has affected the allocation process as well as significant outcomes in the transplant patient population.

KEYWORDS

Lung transplantation - lung allocation score

REFERENCES

• 1 Egan T M, Kotloff R M. Pro/Con debate: lung allocation should be based on medical urgency and transplant survival and not on waiting time.  Chest. 2005;  128 407-415
• 2 Garrity E R, Moore J, Mulligan M S, Shearon T H, Zucker M J, Murray S. Heart and lung transplantation in the United States, 1996–2005.  Am J Transplant. 2007;  7 1390-1403
• 3 Arcasoy S M, Kotloff R M. Lung transplantation.  N Engl J Med. 1999;  340 1081-1091
• 4 Egan T M, Murray S, Bustami R T et al.. Development of the new lung allocation system in the United States.  Am J Transplant. 2006;  6 1212-1227
• 5 Davis S Q, Garrity Jr E R. Organ allocation in lung transplant.  Chest. 2007;  132 1646-1651
• 6 Orens J B, Garrity Jr E R. General overview of lung transplantation and review of organ allocation.  Proc Am Thorac Soc. 2009;  6 13-19
• 7 McCurry K R, Shearon T H, Edwards L B et al.. Lung transplantation in the United States, 1998–2007.  Am J Transplant. 2009;  9 942-958
• 8 Kozower B D, Meyers B F, Smith M A et al.. The impact of the lung allocation score on short-term transplantation outcomes: a multicenter study.  J Thorac Cardiovasc Surg. 2008;  135 166-171
• 9 The Organ Procurement and Transplantation Network .2008 OPTN/SRTR Annual Report. Available at: http://optn.transplant.hrsa.gov
• 10 Gries C J, Mulligan M S, Edelman J D, Raghu G, Curtis J R, Goss C H. Lung allocation score for lung transplantation: impact on disease severity and survival.  Chest. 2007;  132 1954-1961
• 11 Lingaraju R, Blumenthal N P, Kotloff R M et al.. Effects of lung allocation score on waiting list rankings and transplant procedures.  J Heart Lung Transplant. 2006;  25 1167-1170
• 12 McCue J D, Mooney J, Quail J, Arrington A, Herrington C, Dahlberg P S. Ninety-day mortality and major complications are not affected by use of lung allocation score.  J Heart Lung Transplant. 2008;  27 192-196
• 13 Merlo C A, Weiss E S, Orens J B et al.. Impact of U.S. lung allocation score on survival after lung transplantation.  J Heart Lung Transplant. 2009;  28 769-775
• 14 Chen H, Shiboski S C, Golden J A et al.. Impact of the lung allocation score on lung transplantation for pulmonary arterial hypertension.  Am J Respir Crit Care Med. 2009;  180 468-474
• 15 Yusen R D. Technology and outcomes assessment in lung transplantation.  Proc Am Thorac Soc. 2009;  6 128-136
• 16 Lama V N. Update in lung transplantation 2008.  Am J Respir Crit Care Med. 2009;  179 759-764
• 17 Singer L G, Gould M K, Glidden D V, Theodore J. Effect of lung transplantation on quality-adjusted survival in emphysema [abstract].  J Heart Lung Transplant. 2002;  23 154
• 18 Yusen R D, Littenberg B. Integrating survival and quality of life data in clinical trials of lung disease: the case of lung volume reduction surgery.  Chest. 2005;  127 1094-1096