The impact of the lung allocation score on short-term transplantation outcomes: a multicenter study.
OBJECTIVE
The lung allocation score restructured the distribution of scarce donor lungs for transplantation. The algorithm ranks waiting list patients according to medical urgency and expected benefit after transplantation. The purpose of this study was to evaluate the impact of the lung allocation score on short-term outcomes after lung transplantation.


METHODS
A multicenter retrospective cohort study was performed with data from 5 academic medical centers. Results of patients undergoing transplantation on the basis of the lung allocation score (May 4, 2005 to May 3, 2006) were compared with those of patients receiving transplants the preceding year before the lung allocation score was implemented (May 4, 2004, to May 3, 2005).


RESULTS
The study reports on 341 patients (170 before the lung allocation score and 171 after). Waiting time decreased from 680.9 +/- 528.3 days to 445.6 +/- 516.9 days (P < .001). Recipient diagnoses changed with an increase in idiopathic pulmonary fibrosis and a decrease in emphysema and cystic fibrosis (P = .002). Postoperatively, primary graft dysfunction increased from 14.1% (24/170) to 22.9% (39/171) (P = .04) and intensive care unit length of stay increased from 5.7 +/- 6.7 days to 7.8 +/- 9.6 days (P = .04). Hospital mortality and 1-year survival were the same between groups (5.3% vs 5.3% and 90% vs 89%, respectively; P > .6)


CONCLUSIONS
This multicenter retrospective review of short-term outcomes supports the fact that the lung allocation score is achieving its objectives. The lung allocation score reduced waiting time and altered the distribution of lung diseases for which transplantation was done on the basis of medical necessity. After transplantation, recipients have significantly higher rates of primary graft dysfunction and intensive care unit lengths of stay. However, hospital mortality and 1-year survival have not been adversely affected.
Kozower
Benjamin D
BD
Department of Surgery, University of Virginia Health System, Charlottesville 22908-0679, USA. bdk8g@virginia.edu
Meyers
Bryan F
BF
Smith
Michael A
MA
De Oliveira
Nilto C
NC
Cassivi
Stephen D
SD
Guthrie
Tracey J
TJ
Wang
Honkung
H
Ryan
Beverly J
BJ
Shen
K Robert
KR
Daniel
Thomas M
TM
Jones
David R
DR
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D000465:Algorithms; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D008171:Lung Diseases / Q000401:mortality / Q000601:surgery*; D016040:Lung Transplantation / Q000401:mortality* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D018579:Patient Selection; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists