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: Anne-Marie Russell[Show abstract] [Hide abstract]
ABSTRACT: Idiopathic pulmonary fibrosis (IPF) is a chronic progressive fatal disorder that remains difficult to treat. In this review, we examine non-pharmacological treatment modalities, including lung transplantation, pulmonary rehabilitation and palliation. Lung transplantation, the only therapeutic intervention that offers survival benefit, should be considered in all IPF patients with progressive disease who meet the International Society for Heart and Lung transplantation guidelines. Pulmonary rehabilitation improves exercise capacity, reduces dyspnoea and improves quality of life in IPF patients, and should be made available to patients. For those patients with advanced disease, palliative services offer symptom management, improved quality of life and psychological support for patients and their caregivers.12/2012; 1(4). DOI:10.1007/s13665-012-0031-z
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