Transplantation |

Early Effects After the First Major Revision of the Lung Allocation Score (LAS) in the United States FREE TO VIEW

Kevin Chan, MD; Liz Robbins-Callahan, JD; Maryam Valapour, MD; Melissa Skeans, MS; Thomas Wozniak, MD; Leah Edwards, PhD
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University of Michigan Health Systems, Ann Arbor, MI

Chest. 2015;148(4_MeetingAbstracts):1079A. doi:10.1378/chest.2260216
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SESSION TITLE: Lung Transplantation

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 28, 2015 at 04:30 PM - 05:30 PM

PURPOSE: The US Lung Allocation Score (LAS) system was implemented in 2005 to allocate lungs for transplant (tx) based on calculated survival benefit. The LAS is based on the wait list (WL) urgency measure (# of days a candidate will live without a tx 1 year on the WL) and the tx survival measure (# of days a candidate will live in the 1st year after Tx). The Organ Procurement and Transplantation Network (OPTN) implemented the first major revision of the LAS in February 2015 to represent a more contemporary patient cohort (2005-2008). We describe the impact of this change on the LAS and rank order on the waiting list for lung tx candidates by diagnostic group (A = obstructive lung disease, B=pulmonary vascular disease, C=cystic fibrosis, D= restrictive lung disease).

METHODS: Our cohort included all WL patients on February 19, 2015 who were ≥ 12 years of age. The change in LAS, WL urgency measure, post-tx survival measure, and rank order relative to other candidates were computed overall and by diagnostic group.

RESULTS: There were 1518 patient registrations in the cohort. 54% of registrations experienced < a 2 point change in their LAS. 19% had a decrease and 20% had an increase of 2-10 points. 5% decreased & 2% increased by ≥ 10 points. The greatest increase in LAS was in group B (73% increased ≥2 points) while the greatest decrease was in group D (47% decreased ≥2 points). Overall, the predicted WL urgency measure changed minimally after implementation, except for group B, for whom it declined substantially. The predicted post-tx survival measure also changed minimally after implementation. Group A continues to occupy the lowest rank order with groups B and C moving to higher ranks. These changes led to redistribution of the highest 100 LAS scores pre-to 3 weeks post- LAS revision of group A from 4 to 5%, group B, 0 to 6%, group C, 2 to 11%, & group D, 94 to 78%.

CONCLUSIONS: Early results of the LAS revision indicate a decrease in WL urgency measure and increase in post- tx survival measure for group B patients, resulting in a significant increase in both LAS and rank order. The median relative ordering of Group D patients declined but they continue to occupy the highest rank order of all diagnostic groups. Continued evaluation is required to assess the predictive accuracy of the revised LAS system.

CLINICAL IMPLICATIONS: The revised LAS appears to more accurately reflect the severity of illness of Group B patients which should result in a greater opportunity to receive a lung transplant.

DISCLOSURE: The following authors have nothing to disclose: Kevin Chan, Liz Robbins-Callahan, Maryam Valapour, Melissa Skeans, Thomas Wozniak, Leah Edwards

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