title: Disparities in lung transplantation before and after introduction of the lung allocation score.
abstract: BACKGROUND
  In May 2005, the Lung Allocation Score (LAS) became the primary method for determining allocation of lungs for organ transplantation for those at least 12 years of age in the United States. During the pre-LAS period, black patients were more likely than white patients to become too sick or die while awaiting transplant. The association between gender and lung transplant outcomes has not been widely studied.
  
  
  METHODS
  Black and white patients aged ≥ 18 years registered on the United Network for Organ Sharing (UNOS) lung transplantation waiting list from January 1, 2000, to May 3, 2005 (pre-LAS, n = 8,765), and from May 4, 2005, to September 4, 2010 (LAS, n = 8,806), were included. Logistic regression analyses were based on smaller cohorts derived from patients listed in the first 2 years of each era (2,350 pre-LAS, and 2,446 LAS) to allow for follow-up time. Lung transplantation was the primary outcome measure. Multivariable analyses were performed within each interval to determine the odds that a patient would die or receive a lung transplant within 3 years of listing.
  
  
  RESULTS
  In the pre-LAS era, black patients were more likely than white patients to become too sick for transplantation or die within 3 years of waiting list registration (43.8% vs 30.8%; odds ratio [OR], 1.84; p < 0.001). Race was not associated with death or becoming too sick while listed for transplantation in the LAS era (14.0% vs 13.3%; OR, 0.93; p = 0.74). Black patients were less likely to undergo transplantation in the pre-LAS era (56.3% vs 69.2%; OR, 0.54; p < 0.001) but not in the LAS era (86.0% vs 86.7%; OR, 1.07; p = 0.74). Women were more likely than men to die or become too sick for transplantation within 3 years of listing in the LAS era (16.1% vs 11.3%; OR, 1.58; p < 0.001) compared with the pre-LAS era (33.4% vs 30.7%; OR, 1.19; p = 0.08).
  
  
  CONCLUSIONS
  Racial disparities in lung transplantation have decreased with the implementation of LAS as the method of organ allocation; however, gender disparities may have actually increased in the LAS era.
authors.affiliation: Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. wille@uab.edu
authors.forename: Keith M
authors.initials: KM
authors.lastname: Wille
authors.forename: Kathy F
authors.initials: KF
authors.lastname: Harrington
authors.forename: Joao A
authors.initials: JA
authors.lastname: deAndrade
authors.forename: Sonia
authors.initials: S
authors.lastname: Vishin
authors.forename: Robert A
authors.initials: RA
authors.lastname: Oster
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kaslow
mesh_terms: D044383:Black People; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016040:Lung Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009927:Tissue and Organ Procurement / Q000592:standards* / Q000706:statistics & numerical data*; D044465:White People