title: Does lung allocation score maximize survival benefit from lung transplantation?
abstract: OBJECTIVE
  The lung allocation score was initiated in May 2005 to allocate lungs on the basis of medical urgency and posttransplant survival. However, the relationship between lung allocation score and candidate outcomes remains poorly characterized. The purpose of this study was (1) to describe outcomes by lung allocation score at the time of listing and (2) to estimate the net survival benefit of transplantation by lung allocation score.
  
  
  METHODS
  The United Network for Organ Sharing provided de-identified patient-level data. Analysis included lung transplant candidates aged 12 years or more and listed between May 4, 2005, and May 4, 2009 (n = 6082). Candidates were stratified according to lung allocation score at listing into 7 groups: lung allocation score less than 40, 40 to 49, 50 to 59, 60 to 69, 70 to 79, 80 to 89, and 90 or more. Outcomes of interest included the risk of death on the waiting list and likelihood of transplantation. The net survival benefit of transplantation was defined as actuarial median posttransplant graft survival minus actuarial median waiting list survival, where the outcome of interest was death on the waiting list or posttransplant; candidates were censored at the time of transplant or last follow-up.
  
  
  RESULTS
  In the lowest-priority strata (eg, <40 and 40-49), less than 4% of candidates died on the waiting list within 90 days of listing. The median net survival benefit was lowest in the lung allocation score less than 40 (-0.7 years) and lung allocation score 90+ group (1.95 years) and highest in the 50 to 59 (3.44 years), 60 to 69 (3.49 years), and 70 to 79 (2.81 years) groups.
  
  
  CONCLUSIONS
  The mid-priority groups (eg, 50-59, 60-69, 70-79) seem to achieve the greatest survival benefit from transplantation. Although low-priority candidates comprise the majority of transplant recipients, survival benefit in this group seems to be less than in other groups given the low risk of death on the waiting list. As expected, both the time to transplant and survival on the waitlist are lower in the higher-priority strata (eg, 80-89 and 90+). However, their net survival benefit was likewise relatively low as a result of their poor posttransplant survival.
authors.affiliation: Section of Cardiac and Thoracic Surgery, University of Chicago Medical Center, Chicago, Ill 60637, USA. mrusso@surgery.bsd.uchicago.edu
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Russo
authors.forename: Berhane
authors.initials: B
authors.lastname: Worku
authors.forename: Alexander
authors.initials: A
authors.lastname: Iribarne
authors.forename: Kimberly N
authors.initials: KN
authors.lastname: Hong
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Yang
authors.forename: Wickii
authors.initials: W
authors.lastname: Vigneswaran
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Sonett
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality*; D008875:Middle Aged; D018579:Patient Selection; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists / Q000401:mortality*