Lung Allocation Score Predicts Survival in Lung Transplantation Patients With Pulmonary Fibrosis
ABSTRACT Since 2005, the Organ Procurement and Transplantation Network has used the lung allocation score (LAS) to assign organ allocation priority in lung transplantation. This study was designed to determine whether LAS predicts short-term survival for patients with pulmonary fibrosis.
Organ Procurement and Transplantation Network data was retrospectively reviewed to identify 1,256 first-time adult lung transplantation recipients with pulmonary fibrosis since initiation of the LAS (May 2005 to December 2007). Patients were stratified by quartiles of LAS. Multivariable Cox proportional hazards regression predicted the risk of 30-day, 90-day, and 1-year mortality.
Lung allocation scores ranged from 31.1 to 94.1. Lung allocation score quartiles (Q) were as follows: Q1, 29.8 to 37.8, n = 315; Q2, 37.9 to 42.5, n = 313; Q3, 42.6 to 51.9, n = 314; and Q4, 52.0 to 94.1, n = 314. Lung allocation score correlated strongly with cumulative survival at 90 days and 1 year after lung transplantation. Patients in the highest LAS quartile (LAS Q4, 52.0 to 94.1) had a 10% lower cumulative survival at 1 year after transplantation when compared with patients in the lowest LAS quartile (p = 0.04). On Cox proportional hazards regression, patients in the highest LAS quartile (those above 52.0) had a significant increase in the risk of mortality at both 90 days and 1 year after transplantation (relative to reference Q1: hazard ratio, 2.09; 95% confidence interval, 1.16 to 3.80; p = 0.01 for 90 days; and hazard ratio, 1.59; 95% confidence interval, 1.04 to 2.44; p = 0.03 for 1 year).
An initial examination of survival for pulmonary fibrosis lung transplantation recipients in the post-LAS era was performed. Lung allocation score predicts short-term mortality in this cohort.
SourceAvailable from: Jeremiah A Hayanga[Show abstract] [Hide abstract]
ABSTRACT: Background. The relative paucity of donors heightens the debate and scrutiny surrounding retransplantation. To date, risk factors associated with retransplantation are poorly characterized in the literature. We sought to identify those risk factors that may independently serve to predict lung retransplantation. Methods. We performed a retrospective evaluation of the United Network for Organ Sharing data over 25 years from 1987 to 2012. Competing risk analysis was used to evaluate the cohort for cumulative incidence of retransplantation. Recipient-related, donor-related, and transplant-related characteristics were assessed using Cox regression to identify risk factors associated with lung retransplantation. Results. We identified 23,180 adult lung transplant recipients, of which 791 (3.4%) had also undergone retransplantation. Factors associated with lung retransplantation at 1 year included recipient age (hazard ratio [HR], 0.97; p = 0.005), admission to the intensive care unit (HR, 2.89; p = 0.002), donor age (HR, 1.02; p = 0.004), and bilateral lung transplantation (HR, 0.41; p < 0.001). Moreover, predictors of 5-year risk of retransplantation included recipient age (HR, 0.95; p < 0.001), intensive care unit hospitalization (HR, 1.87; p = 0.005), and bilateral lung transplant (HR, 0.46; p < 0.001), as well as recipient body mass index of 25 to 29 kg/m(2) (HR, 1.29; p = 0.04) and a diagnosis of chronic obstructive pulmonary disease (HR, 0.68; p = 0.008). Conclusions. We identified factors associated with retransplantation that may afford a better prediction of graft failure and need for retransplantation. These may further serve to better guide donor selection and assist in the development and validation of a risk-scoring model to further guide preoperative counseling. (C) 2014 by The Society of Thoracic SurgeonsThe Annals of Thoracic Surgery 09/2014; DOI:10.1016/j.athoracsur.2014.06.033 · 3.63 Impact Factor
Article: Update in Lung Transplantation 2013[Show abstract] [Hide abstract]
ABSTRACT: Research in pulmonary transplantation is actively evolving in quality and scope to meet the challenges of a growing population of lung allograft recipients. In 2013, research groups leveraged large publicly available datasets in addition to multicenter research networks and single-center studies to make significant contributions to our knowledge and clinical care in the areas of donor use, clinical transplant outcomes, mechanisms of rejection, infectious complications, and chronic allograft dysfunction.American Journal of Respiratory and Critical Care Medicine 07/2014; 190(1):19-24. DOI:10.1164/rccm.201402-0384UP · 11.99 Impact Factor
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ABSTRACT: Patients with end-stage lung disease complicated by cirrhosis are not expected to survive lung transplantation alone. Such patients are potential candidates for combined lung-liver transplantation (CLLT), however few reports document the indications and outcomes after CLLT. This is a review of a large single-center CLLT series. Eight consecutive CLLT performed during 2009-2012 were retrospectively reviewed. One patient received a third simultaneous heart transplant. Mean age was 42.5 +/- 11.5 years. Pulmonary indications included cystic fibrosis (CF) (n=3), idiopathic pulmonary fibrosis (n=2), 1-antitrypsin deficiency (AATD) (n=1) and pulmonary hypertension (n=2). Liver indications were CF (n=3), hepatitis C (n=2), AATD (n=1), cryptogenic (n=1), and cardiac/congestive (n=1). Urgency was reflected by median lung allocation score (LAS) of 41 (36.0-89.0) and median predicted FEV1 of 25.7%. Median donor age was 25 (20-58) years with median cold ischemia times of 147 minutes and 6.1 hours for lung and liver, respectively. Overall patient survival at 30 days, 90 days and 1 year was 87.5%, 75.0% and 71.4% respectively. One patient had evidence of acute lung rejection, and no patients had liver allograft rejection. Early postoperative mortalities (90 days) were caused by sepsis in 2 recipients who exhibited the highest LAS of 69.9 and 89.0. The remaining recipients had a median LAS of 39.5 and 100% survival at 1-year. Median length of stay was 25 days (7-181). Complications requiring operative intervention included bile duct ischemia (n=1) and bile leak (n=1), ischemia of the bronchial anastomosis (n=1), and necrotizing pancreatitis with duodenal perforation (n=1). This series reflects a large single-center CLLT experience. Sepsis is the most common cause of death. The procedure should be considered for candidates with LAS<50. (c) 2013 AASLD.Liver Transplantation 01/2014; 20(1). DOI:10.1002/lt.23770 · 3.79 Impact Factor