Despite decreased wait-list times for lung transplantation, lung allocation scores continue to increase

Alexander Iribarne, Mark J. Russo, Ryan R Davies, Kimberly N. Hong, Annetine C. Gelijns, Matthew D. Bacchetta, Frank D'Ovidio, Selim Arcasoy, Joshua R. Sonett

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Background: In May 2005, the lung allocation score (LAS) was introduced as a means of allocating donor lungs in order to decrease wait-list mortality and prioritize candidates based on medical urgency and posttransplant survival. The purpose of this study was to assess changes in recipient wait-list times and mean LAS since the introduction of the LAS model. Methods: The United Network for Organ Sharing provided de-identified patient-level data. The study population consisted of all patients in the United States with a reported LAS (n = 3529) undergoing lung transplantation between May 7, 2005 and November 7, 2007. The study period was divided into 6-month intervals. The Kruskal-Wallis test was used to assess differences in variables with nonparametric distributions. The nonparametric trends test was used to determine significance of trends over time. Results: There was a significant decrease in wait-list time during the study period, while LAS among transplant recipients increased (p < 0.001). There was no significant change in FVC (49.3 ± 17.5%, p = 0.48) or pulmonary capillary wedge pressure (11.1 ± 5.8 mm Hg, p = 0.23); however, there was a significant increase in age (51.5 ± 13.9 years, p < 0.001) during the study period. When stratified by etiology, the LAS increased for both interstitial pulmonary fibrosis and COPD patients (p < 0.001). Moreover, the overall number of patients listed for transplantation as well as the LAS among transplant candidates increased (p <0.001). Conclusions: Two years after initiation of the LAS model, wait-list times continue to decrease while mean LAS continued to increase. This increase in LAS among transplant recipients was observed most notably in patients with interstitial pulmonary fibrosis and COPD, and reflected in an increased mean LAS at the time of listing.

Original languageEnglish (US)
Pages (from-to)923-928
Number of pages6
JournalChest
Volume135
Issue number4
DOIs
StatePublished - Apr 1 2009

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Lung Transplantation
Lung
Pulmonary Fibrosis
Chronic Obstructive Pulmonary Disease
Pulmonary Wedge Pressure
Transplantation
Tissue Donors

Keywords

  • Lung allocation score
  • Lung transplantation
  • Organ allocation
  • Wait-list time

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Iribarne, A., Russo, M. J., Davies, R. R., Hong, K. N., Gelijns, A. C., Bacchetta, M. D., ... Sonett, J. R. (2009). Despite decreased wait-list times for lung transplantation, lung allocation scores continue to increase. Chest, 135(4), 923-928. https://doi.org/10.1378/chest.08-2052

Despite decreased wait-list times for lung transplantation, lung allocation scores continue to increase. / Iribarne, Alexander; Russo, Mark J.; Davies, Ryan R; Hong, Kimberly N.; Gelijns, Annetine C.; Bacchetta, Matthew D.; D'Ovidio, Frank; Arcasoy, Selim; Sonett, Joshua R.

In: Chest, Vol. 135, No. 4, 01.04.2009, p. 923-928.

Research output: Contribution to journalArticle

Iribarne, A, Russo, MJ, Davies, RR, Hong, KN, Gelijns, AC, Bacchetta, MD, D'Ovidio, F, Arcasoy, S & Sonett, JR 2009, 'Despite decreased wait-list times for lung transplantation, lung allocation scores continue to increase', Chest, vol. 135, no. 4, pp. 923-928. https://doi.org/10.1378/chest.08-2052
Iribarne, Alexander ; Russo, Mark J. ; Davies, Ryan R ; Hong, Kimberly N. ; Gelijns, Annetine C. ; Bacchetta, Matthew D. ; D'Ovidio, Frank ; Arcasoy, Selim ; Sonett, Joshua R. / Despite decreased wait-list times for lung transplantation, lung allocation scores continue to increase. In: Chest. 2009 ; Vol. 135, No. 4. pp. 923-928.
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abstract = "Background: In May 2005, the lung allocation score (LAS) was introduced as a means of allocating donor lungs in order to decrease wait-list mortality and prioritize candidates based on medical urgency and posttransplant survival. The purpose of this study was to assess changes in recipient wait-list times and mean LAS since the introduction of the LAS model. Methods: The United Network for Organ Sharing provided de-identified patient-level data. The study population consisted of all patients in the United States with a reported LAS (n = 3529) undergoing lung transplantation between May 7, 2005 and November 7, 2007. The study period was divided into 6-month intervals. The Kruskal-Wallis test was used to assess differences in variables with nonparametric distributions. The nonparametric trends test was used to determine significance of trends over time. Results: There was a significant decrease in wait-list time during the study period, while LAS among transplant recipients increased (p < 0.001). There was no significant change in FVC (49.3 ± 17.5{\%}, p = 0.48) or pulmonary capillary wedge pressure (11.1 ± 5.8 mm Hg, p = 0.23); however, there was a significant increase in age (51.5 ± 13.9 years, p < 0.001) during the study period. When stratified by etiology, the LAS increased for both interstitial pulmonary fibrosis and COPD patients (p < 0.001). Moreover, the overall number of patients listed for transplantation as well as the LAS among transplant candidates increased (p <0.001). Conclusions: Two years after initiation of the LAS model, wait-list times continue to decrease while mean LAS continued to increase. This increase in LAS among transplant recipients was observed most notably in patients with interstitial pulmonary fibrosis and COPD, and reflected in an increased mean LAS at the time of listing.",
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T1 - Despite decreased wait-list times for lung transplantation, lung allocation scores continue to increase

AU - Iribarne, Alexander

AU - Russo, Mark J.

AU - Davies, Ryan R

AU - Hong, Kimberly N.

AU - Gelijns, Annetine C.

AU - Bacchetta, Matthew D.

AU - D'Ovidio, Frank

AU - Arcasoy, Selim

AU - Sonett, Joshua R.

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Y1 - 2009/4/1

N2 - Background: In May 2005, the lung allocation score (LAS) was introduced as a means of allocating donor lungs in order to decrease wait-list mortality and prioritize candidates based on medical urgency and posttransplant survival. The purpose of this study was to assess changes in recipient wait-list times and mean LAS since the introduction of the LAS model. Methods: The United Network for Organ Sharing provided de-identified patient-level data. The study population consisted of all patients in the United States with a reported LAS (n = 3529) undergoing lung transplantation between May 7, 2005 and November 7, 2007. The study period was divided into 6-month intervals. The Kruskal-Wallis test was used to assess differences in variables with nonparametric distributions. The nonparametric trends test was used to determine significance of trends over time. Results: There was a significant decrease in wait-list time during the study period, while LAS among transplant recipients increased (p < 0.001). There was no significant change in FVC (49.3 ± 17.5%, p = 0.48) or pulmonary capillary wedge pressure (11.1 ± 5.8 mm Hg, p = 0.23); however, there was a significant increase in age (51.5 ± 13.9 years, p < 0.001) during the study period. When stratified by etiology, the LAS increased for both interstitial pulmonary fibrosis and COPD patients (p < 0.001). Moreover, the overall number of patients listed for transplantation as well as the LAS among transplant candidates increased (p <0.001). Conclusions: Two years after initiation of the LAS model, wait-list times continue to decrease while mean LAS continued to increase. This increase in LAS among transplant recipients was observed most notably in patients with interstitial pulmonary fibrosis and COPD, and reflected in an increased mean LAS at the time of listing.

AB - Background: In May 2005, the lung allocation score (LAS) was introduced as a means of allocating donor lungs in order to decrease wait-list mortality and prioritize candidates based on medical urgency and posttransplant survival. The purpose of this study was to assess changes in recipient wait-list times and mean LAS since the introduction of the LAS model. Methods: The United Network for Organ Sharing provided de-identified patient-level data. The study population consisted of all patients in the United States with a reported LAS (n = 3529) undergoing lung transplantation between May 7, 2005 and November 7, 2007. The study period was divided into 6-month intervals. The Kruskal-Wallis test was used to assess differences in variables with nonparametric distributions. The nonparametric trends test was used to determine significance of trends over time. Results: There was a significant decrease in wait-list time during the study period, while LAS among transplant recipients increased (p < 0.001). There was no significant change in FVC (49.3 ± 17.5%, p = 0.48) or pulmonary capillary wedge pressure (11.1 ± 5.8 mm Hg, p = 0.23); however, there was a significant increase in age (51.5 ± 13.9 years, p < 0.001) during the study period. When stratified by etiology, the LAS increased for both interstitial pulmonary fibrosis and COPD patients (p < 0.001). Moreover, the overall number of patients listed for transplantation as well as the LAS among transplant candidates increased (p <0.001). Conclusions: Two years after initiation of the LAS model, wait-list times continue to decrease while mean LAS continued to increase. This increase in LAS among transplant recipients was observed most notably in patients with interstitial pulmonary fibrosis and COPD, and reflected in an increased mean LAS at the time of listing.

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KW - Organ allocation

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