0
Original Research: LUNG TRANSPLANTATION |

High Lung Allocation Score Is Associated With Increased Morbidity and Mortality Following Transplantation

Mark J. Russo, MD, MS; Alexander Iribarne, MD; Kimberly N. Hong, MHSA; Ryan R. Davies, MD; Steve Xydas, MD; Hiroo Takayama, MD; Ali Ibrahimiye, MD; Annetine C. Gelijns, PhD; Matthew D. Bacchetta, MD; Frank D’Ovidio, MD, PhD; Selim Arcasoy, MD, FCCP; Joshua R. Sonett, MD
Author and Funding Information

From the Division of Cardiothoracic Surgery, Department of Surgery, (Drs Russo, Iribarne, Davies, Xydas, Takayama, Ibrahimiye, Bacchetta, D’Ovidio, and Sonnett, and Ms Hong), and Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, (Dr Arcasoy), College of Physicians and Surgeons, Columbia University, New York, NY; and the International Center for Health Outcomes and Innovation Research (Dr Gelijns), Department of Health Policy, Mount Sinai School of Medicine, New York, NY.

Correspondence to: Joshua R. Sonett, MD, Division of Cardiothoracic Surgery, Columbia University Medical Center, PH Room 415, 14th Floor, 622 W 168th St, New York, NY 10032; e-mail: js2106@columbia.edu


Funding/Support: This work was supported in part by Health Resources and Services Administration [contract 231-00-0115] and National Institutes of Health Training [Grant 5T32HL007854-13].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(3):651-657. doi:10.1378/chest.09-0319
Text Size: A A A
Published online

Background:  The lung allocation score (LAS) was initiated in May 2005 to allocate lungs based on medical urgency and posttransplant survival. The purpose of this study was to determine if there is an association between an elevated LAS at the time of transplantation and increased postoperative morbidity and mortality.

Methods:  The United Network for Organ Sharing provided de-identified patient-level data. Analysis included lung transplant recipients aged ≥ 12 years who received transplants between April 5, 2006, and December 31, 2007 (n = 3,836). Recipients were stratified into three groups: LAS < 50 (n = 3,161, 83.87%), LAS 50 to 75 (n = 411, 10.9%), and LAS ≥ 75 (n = 197, 5.23%), referred to as low LAS (LLAS), intermediate LAS (ILAS), and high LAS (HLAS), respectively. The primary outcome was posttransplant graft survival at 1 year. Secondary outcomes included length of stay and in-hospital complications.

Results:  HLAS recipients had significantly worse actuarial survival at 90 days and 1 year compared with LLAS recipients. When transplant recipients were stratified by disease etiology, a trend of decreased survival with elevated LAS was observed across all major causes of lung transplant. HLAS recipients were more likely to require dialysis or to have infections compared with LLAS recipients (P < .001). In addition, length of stay was higher in the HLAS group when compared with the LLAS group (P < .001).

Conclusions:  HLAS is associated with decreased survival and increased complications during the transplant hospitalization. Whereas the LAS has improved organ allocation through decreased waiting list deaths and waiting list times, lower survival and higher morbidity among HLAS recipients suggests that continued review of LAS scoring is needed to ensure optimal long-term transplant survival.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543