title: Lung transplantation for high-risk patients with idiopathic pulmonary fibrosis.
abstract: BACKGROUND
  Survival for patients with idiopathic pulmonary fibrosis (IPF) and high lung allocation score (LAS) values may be significantly reduced in comparison to those with lower LAS values.
  
  
  OBJECTIVE
  To evaluate outcomes for high-risk IPF patients as defined by LAS values ≥46 (N=42) versus recipients with LAS values <46 (N=89).
  
  
  METHODS
  We retrospectively reviewed records of 131 consecutive patients with IPF who received lung transplants at our institution between 1999 and 2013.
  
  
  RESULTS
  The mean LAS was significantly higher (59.5, interquartile range 43.9-75.9 vs. 39.3, interquartile range 37.7-44.3; p<0.01) for the high-risk cohort. The higher LAS cohort had significantly lower percent predicted forced vital capacity (FVC) versus recipients with LAS <46 (41.3±14.1% vs. 53.2±16.2%; p<0.01) and required more supplemental oxygen (7±5 vs. 4±2 L/min, p<0.01) prior to transplant versus recipients with LAS <46. Although the incidence of early post-LTX pulmonary complications was increased for the higher LAS group versus recipients with LAS <46, 30-day mortality and actuarial survival did not differ between the two cohorts.
  
  
  CONCLUSIONS
  Although lung transplantation in patients with IPF and high LAS values is associated with increased risk of early post-transplant complications, long-term post-transplant survival for our high-LAS cohort was equivalent to that for the lower LAS recipients.
authors.affiliation: University of Wisconsin School of Medicine and Public Health. oliveira@surgery.wisc.edu.
authors.forename: Nilto C
authors.initials: NC
authors.lastname: De Oliveira
authors.forename: Walker
authors.initials: W
authors.lastname: Julliard
authors.forename: Satoru
authors.initials: S
authors.lastname: Osaki
authors.forename: James D
authors.initials: JD
authors.lastname: Maloney
authors.forename: Richard D
authors.initials: RD
authors.lastname: Cornwell
authors.forename: David A
authors.initials: DA
authors.lastname: Sonetti
authors.forename: Keith C
authors.initials: KC
authors.lastname: Meyer
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000503:physiopathology / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity; D014922:Wisconsin
keywords: Idiopathic pulmonary fibrosis; Lung allocation score; Lung transplantation