title: Lung transplantation for patients with high lung allocation score: single-center experience.
abstract: BACKGROUND
  The lung allocation score (LAS) assigns organ allocation priority based on medical urgency and the likelihood of posttransplant survival. This study is a review of a single institutional experience for lung transplantation in the era of LAS.
  
  
  METHODS
  We performed a retrospective review of 527 consecutive patients, from May 2005 to February 2010, who underwent lung transplant at our institution, comprising a high LAS group (LAS≥50, n=108) and a low LAS group (LAS<50, n=419). Kaplan-Meier and univariate analyses were performed to assess postoperative mortality as a primary outcome, and length of ventilator support and intensive care unit stay as secondary outcomes. Risk factors, including demographics, pulmonary status, and surgical and donor variables, were compared. Predictors of mortality were determined using a Cox proportional hazard model.
  
  
  RESULTS
  Survivals after 30 days, 90 days, 1 year, and 3 years were 92.6%, 87.8%, 71.5%, and 52.0%, respectively, in the high LAS group, and 96.9%, 93.5%, 83.2%, and 73.9% in the low LAS group (p<0.001). The incidence of prolonged ventilator support and the need for tracheostomy were higher, and intensive care unit stay was longer in the high LAS group. In the high LAS group, ischemic time greater than 8 hours was an independent predictor for mortality (hazard ratio: 3.080; 95% confidence interval 1.101 to 8.161, p=0.032).
  
  
  CONCLUSIONS
  Lung transplant in patients with high a LAS is associated with significantly decreased survival and increased complications compared with patients with a low LAS. Ischemic time greater than 8 hours is a significant predictor of death in patients with a high LAS.
authors.affiliation: Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Horai
authors.forename: Norihisa
authors.initials: N
authors.lastname: Shigemura
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gries
authors.forename: Joseph
authors.initials: J
authors.lastname: Pilewski
authors.forename: Jay K
authors.initials: JK
authors.lastname: Bhama
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bermudez
authors.forename: Diana
authors.initials: D
authors.lastname: Zaldonis
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality; D004502:Education, Medical, Continuing; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000379:methods* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D011658:Pulmonary Fibrosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014463:Ultrasonography; D014850:Waiting Lists