title: An acute change in lung allocation score and survival after lung transplantation: a cohort study.
abstract: BACKGROUND
  Lung transplantation is an effective treatment for patients with advanced lung disease. In the United States, lungs are allocated on the basis of the lung allocation score (LAS), a composite measure of transplantation urgency and utility. Clinical deteriorations result in increases to the LAS; however, whether the trajectory of the LAS has prognostic significance is uncertain.
  
  
  OBJECTIVE
  To determine whether an acute increase in the LAS before lung transplantation is associated with reduced posttransplant survival.
  
  
  METHODS
  Retrospective cohort study of adult lung transplant recipients listed for at least 30 days between 4 May 2005 (LAS implementation) and 31 December 2010 in the United Network for Organ Sharing registry. An acute increase in the LAS was defined as an LAS change (LASΔ) greater than 5 units between the 30 days before and the time of transplantation. Multivariable Cox proportional hazard models were used to examine the relationship between an LASΔ >5 and posttransplant graft survival.
  
  
  METHODS
  All U.S. lung transplantation centers.
  
  
  METHODS
  5749 lung transplant recipients.
  
  
  METHODS
  Survival time after lung transplantation.
  
  
  RESULTS
  702 (12.2%) patients experienced an LASΔ >5. These patients had significantly worse posttransplant survival (hazard ratio, 1.31 [95% CI, 1.11 to 1.54]; P = 0.001]) after adjustment for the LAS at transplantation (LAS-T) and other clinical covariates. The effect of an LASΔ >5 was independent of the LAS-T, underlying diagnosis, center volume, or donor characteristics.
  
  
  CONCLUSIONS
  Analysis was based on center-reported data.
  
  
  CONCLUSIONS
  An acute increase in LAS before transplantation is associated with posttransplant survival after adjustment for LAS-T. Further emphasis on serial assessment of the LAS could improve the ability to offer accurate prediction of survival after transplantation.
  
  
  BACKGROUND
  National Institutes of Health.
authors: Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina; University of Minnesota School of Public Health, Minneapolis, Minnesota; and College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York, New York.
authors: Wayne M
authors: WM
authors: Tsuang
authors: Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina; University of Minnesota School of Public Health, Minneapolis, Minnesota; and College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York, New York.
authors: David M
authors: DM
authors: Vock
authors: Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina; University of Minnesota School of Public Health, Minneapolis, Minnesota; and College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York, New York.
authors: C Ashley Finlen
authors: CAF
authors: Copeland
authors: Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina; University of Minnesota School of Public Health, Minneapolis, Minnesota; and College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York, New York.
authors: David J
authors: DJ
authors: Lederer
authors: Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina; University of Minnesota School of Public Health, Minneapolis, Minnesota; and College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York, New York.
authors: Scott M
authors: SM
authors: Palmer
mesh_terms: D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States; D014850:Waiting Lists
references: Am J Transplant. 2010 Apr;10(4 Pt 2):1047-68
references: 20420652
references: J Heart Lung Transplant. 2010 Oct;29(10):1104-18
references: 20870165
references: Am J Transplant. 2010 Apr;10(4):915-920
references: 20121747
references: Lung. 2009 Nov-Dec;187(6):383-7
references: 19806401
references: Rev Mal Respir. 2011 Jun;28(6):e1-6
references: 21742227
references: Ann Intern Med. 2001 Jul 17;135(2):112-23
references: 11453711
references: Epidemiology. 2008 Nov;19(6):766-79
references: 18854702
references: Chest. 2009 Apr;135(4):923-928
references: 19017874
references: Am J Transplant. 2006;6(5 Pt 2):1212-27
references: 16613597
references: Liver Transpl. 2003 Jan;9(1):12-8
references: 12514767
references: Am J Respir Crit Care Med. 2009 Sep 1;180(5):468-74
references: 19520906
references: Ann Thorac Surg. 2009 Dec;88(6):1757-64
references: 19932231
references: Chest. 2007 Dec;132(6):1954-61
references: 18079228
references: Clin Liver Dis. 2011 Nov;15(4):685-98
references: 22032523
references: Stat Med. 2009 May 30;28(12):1725-38
references: 19347843
references: Stat Med. 2010 Nov 20;29(26):2757-68
references: 20803557
references: Biometrics. 2013 Dec;69(4):820-9
references: 24128090
references: Chest. 2007 Apr;131(4):1224-31
references: 17426231
references: J Thorac Cardiovasc Surg. 2011 May;141(5):1270-7
references: 21497235
references: N Engl J Med. 1999 Apr 8;340(14):1081-91
references: 10194239
references: Biometrics. 2005 Sep;61(3):721-8
references: 16135023
references: J Heart Lung Transplant. 2009 Aug;28(8):769-75
references: 19632571
references: J Thorac Cardiovasc Surg. 2008 Jan;135(1):166-71
references: 18179935
references: Am J Respir Crit Care Med. 2011 Jul 15;184(2):159-71
references: 21471083
references: Biometrics. 2006 Sep;62(3):910-7
references: 16984335
references: JAMA. 2010 Jul 7;304(1):53-60
references: 20606149
references: Am J Transplant. 2004 Nov;4(11):1798-804
references: 15476479
references: Transplantation. 2008 Sep 15;86(5):636-7
references: 18791441
references: Chest. 2010 Mar;137(3):651-7
references: 19820072