title: Improved waitlist and transplant outcomes for pediatric lung transplantation after implementation of the lung allocation score.
abstract: BACKGROUND
  Although the lung allocation score (LAS) has not been considered valid for lung allocation to children, several additional policy changes for pediatric lung allocation have been adopted since its implementation. We compared changes in waitlist and transplant outcomes for pediatric and adult lung transplant candidates since LAS implementation.
  
  
  METHODS
  The United Network for Organ Sharing database was reviewed for all lung transplant listings during the period 1995 to June 2014. Outcomes were analyzed based on date of listing (pre-LAS vs post-LAS) and candidate age at listing (adults >18 years, adolescents 12 to 17 years, children 0 to 11 years).
  
  
  RESULTS
  Of the 39,962 total listings, 2,096 (5%) were for pediatric candidates. Median waiting time decreased after LAS implementation for all age groups (adults: 379 vs 83 days; adolescents: 414 vs 104 days; children: 211 vs 109 days; p < 0.001). The proportion of candidates reaching transplant increased after LAS (adults: 52.6% vs 71.6%, p < 0.001; adolescents: 40.3% vs 61.6%, p < 0.001; children: 42.4% vs 50.9%, p = 0.014), whereas deaths on the waitlist decreased (adults: 28.0% vs 14.4%, p < 0.001; adolescents: 33.1% vs 20.9%, p < 0.001; children: 32.2% vs 25.0%; p = 0.025), despite more critically ill candidates in all groups. Median recipient survival increased after LAS for adults and children (adults: 5.1 vs 5.5 years, p < 0.001; children: 6.5 vs 7.6 years, p = 0.047), but not for adolescents (3.6 vs 4.3 years, p = 0.295).
  
  
  CONCLUSIONS
  Improvements in waiting time, mortality and post-transplant survival have occurred in children after LAS implementation. Continued refinement of urgency-based allocation to children and broader sharing of pediatric donor lungs may help to maximize these benefits.
authors.affiliation: Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Lancaster
authors.affiliation: Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA.
authors.forename: Jacob R
authors.initials: JR
authors.lastname: Miller
authors.affiliation: Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA.
authors.forename: Deirdre J
authors.initials: DJ
authors.lastname: Epstein
authors.affiliation: Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA.
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: DuPont
authors.affiliation: Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA.
authors.forename: Stuart C
authors.initials: SC
authors.lastname: Sweet
authors.affiliation: Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA. Electronic address: eghtesadyp@wudosis.wustl.edu.
authors.forename: Pirooz
authors.initials: P
authors.lastname: Eghtesady
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010372:Pediatrics; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000331:legislation & jurisprudence*; D014481:United States; D014850:Waiting Lists; D055815:Young Adult
keywords: children; lung allocation score; lung transplantation; outcomes; pediatric