High lung allocation score is associated with increased morbidity and mortality following transplantation

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

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)651-657
Number of pages7
JournalChest
Volume137
Issue number3
DOIs
StatePublished - Mar 1 2010

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Transplantation
Morbidity
Lung
Mortality
Survival
Transplants
Waiting Lists
Length of Stay
Graft Survival
Dialysis
Hospitalization
Infection

ASJC Scopus subject areas

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

Cite this

Russo, M. J., Iribarne, A., Hong, K. N., Davies, R. R., Xydas, S., Takayama, H., ... Sonett, J. R. (2010). High lung allocation score is associated with increased morbidity and mortality following transplantation. Chest, 137(3), 651-657. https://doi.org/10.1378/chest.09-0319

High lung allocation score is associated with increased morbidity and mortality following transplantation. / Russo, Mark J.; Iribarne, Alexander; Hong, Kimberly N.; Davies, Ryan R.; Xydas, Steve; Takayama, Hiroo; Ibrahimiye, Ali; Gelijns, Annetine C.; Bacchetta, Matthew D.; D'Ovidio, Frank; Arcasoy, Selim; Sonett, Joshua R.

In: Chest, Vol. 137, No. 3, 01.03.2010, p. 651-657.

Research output: Contribution to journalArticle

Russo, MJ, Iribarne, A, Hong, KN, Davies, RR, Xydas, S, Takayama, H, Ibrahimiye, A, Gelijns, AC, Bacchetta, MD, D'Ovidio, F, Arcasoy, S & Sonett, JR 2010, 'High lung allocation score is associated with increased morbidity and mortality following transplantation', Chest, vol. 137, no. 3, pp. 651-657. https://doi.org/10.1378/chest.09-0319
Russo, Mark J. ; Iribarne, Alexander ; Hong, Kimberly N. ; Davies, Ryan R. ; Xydas, Steve ; Takayama, Hiroo ; Ibrahimiye, Ali ; Gelijns, Annetine C. ; Bacchetta, Matthew D. ; D'Ovidio, Frank ; Arcasoy, Selim ; Sonett, Joshua R. / High lung allocation score is associated with increased morbidity and mortality following transplantation. In: Chest. 2010 ; Vol. 137, No. 3. pp. 651-657.
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abstract = "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.",
author = "Russo, {Mark J.} and Alexander Iribarne and Hong, {Kimberly N.} and Davies, {Ryan R.} and Steve Xydas and Hiroo Takayama and Ali Ibrahimiye and Gelijns, {Annetine C.} and Bacchetta, {Matthew D.} and Frank D'Ovidio and Selim Arcasoy and Sonett, {Joshua R.}",
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T1 - High lung allocation score is associated with increased morbidity and mortality following transplantation

AU - Russo, Mark J.

AU - Iribarne, Alexander

AU - Hong, Kimberly N.

AU - Davies, Ryan R.

AU - Xydas, Steve

AU - Takayama, Hiroo

AU - Ibrahimiye, Ali

AU - Gelijns, Annetine C.

AU - Bacchetta, Matthew D.

AU - D'Ovidio, Frank

AU - Arcasoy, Selim

AU - Sonett, Joshua R.

PY - 2010/3/1

Y1 - 2010/3/1

N2 - 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.

AB - 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.

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DO - 10.1378/chest.09-0319

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JF - Chest

SN - 0012-3692

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