A Simple Prioritization Change to Lung Transplant Allocation May Result in Improved Outcomes.

The Annals of Thoracic Surgery
Stephanie H ChangZachary N Kon

Abstract

The lung allocation score (LAS) significantly improved outcomes and wait list mortality in lung transplantation. However, mortality remains high for the sickest wait list candidates despite additional changes to allocation distance. Regulatory considerations of overhauling the current lung allocation system have met significant resistance, and changes would require years to implement. This study evaluates whether a modest change to the current system by prioritization of only high-LAS lung transplant candidates would result in lowered wait list mortality. The Thoracic Simulated Allocation Model was used to evaluate all lung transplant candidates and donor lungs recovered between July 1, 2009 and June 30, 2011. Current lung allocation rules (initial offer within a 250-nautical mile radius for ABO-identical then compatible offers) were run. Allocation was then changed for only patients with an LAS of50 or higher (high-LAS) to be prioritized within a 500-nautical mile radius with no stratification between ABO-identical and compatible offers. Ten iterations of each model were run. Primary end points were wait list mortality and posttransplant 1-year survival. A total of 6538 wait list candidates and transplant recipients were evalu...Continue Reading

References

Jun 2, 2014·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Sharven TaghaviYoshiya Toyoda
Aug 12, 2014·The Annals of Thoracic Surgery·Sharven TaghaviYoshiya Toyoda
Feb 29, 2016·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Thomas M Egan, Leah B Edwards
Feb 23, 2017·The Annals of Thoracic Surgery·Todd C CrawfordChristian A Merlo
Jun 28, 2018·Progress in Transplantation : Official Publication, North American Transplant Coordinators Organization ... [et Al.]·Wayne M TsuangJesse D Schold
Oct 23, 2018·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Joshua J MooneyGundeep S Dhillon
Jul 30, 2019·American Journal of Respiratory and Critical Care Medicine·Eric P Nolley, Joseph M Pilewski
Jan 4, 2020·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·M ValapourB L Kasiske

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