title: The lung allocation score and survival in lung transplant candidates with chronic obstructive pulmonary disease.
abstract: The Lung Allocation Score (LAS), devised to prioritize candidates awaiting lung transplantation (LTX), is calculated using the predicted duration of survival on the wait list while also considering the recipient's likelihood of post-transplant survival. This score is generated based, in part, on the severity of the candidate's comorbid illnesses. The actual relationship between the LAS and survival is unknown. The current study was performed to evaluate the relationship between the LAS and both wait-list survival and post-transplant survival in candidates with COPD. The study was a retrospective analysis of 41 LTX candidates with chronic obstructive pulmonary disease (COPD) as well as a cohort of 17 candidates who survived to receive a graft. The study was conducted at a university hospital transplant center. Thirty-six of 41 candidates survived to transplant. The LAS of these survivors was 32.62 +/- 1.06 and was significantly lower than the score of 34.45 +/- 1.19 of the nonsurvivors (P < 0.01). The LAS also exhibited a negative association with survival to transplant (P < 0.05, beta = -1.39). A cohort of 17 LTX recipients was chosen for post-transplant analysis in which 13 survived at least 1 year. In this cohort the LAS did not exhibit significant association with 1-year post-transplant survival (P = 0.58, beta = -0.25). As might be anticipated by virtue of its calculation being based in part on the existence and severity of comorbid conditions, a lower LAS was associated with improved survival to transplantation in LTX candidates with COPD. However, the pretransplant calculation of the LAS was not associated with actual post-transplant survival.
authors.affiliation: The Ohio State University College of Medicine, Columbus, OH, USA. David.Nunley@osumc.edu
authors.forename: David R
authors.initials: DR
authors.lastname: Nunley
authors.forename: Gerene S
authors.initials: GS
authors.lastname: Bauldoff
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Holloman
authors.forename: Amy
authors.initials: A
authors.lastname: Pope-Harman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012907:Smoking; D016896:Treatment Outcome; D014850:Waiting Lists; D019896:alpha 1-Antitrypsin Deficiency / Q000150:complications / Q000473:pathology / Q000601:surgery