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a Division of Cardiac Surgery, The Johns Hopkins Medical Institution, Baltimore, Maryland
b Division of Pulmonary and Critical Care Medicine, The Johns Hopkins Medical Institution, Baltimore, Maryland
c Bloomberg School of Public Health, The Johns Hopkins Medical Institution, Baltimore, Maryland
Accepted for publication July 2, 2009.
* Address correspondence to Dr Shah, Department of Surgery, Division of Cardiac Surgery, The Johns Hopkins Hospital, Blalock 618, 600 N Wolfe St, Baltimore, MD 21287 (Email: ashah29{at}jhmi.edu).
Presented at the Poster Session of the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.
Background: 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.
Methods: 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.
Results: 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).
Conclusions: 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.
This article has been cited by other articles:
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  N. C. De Oliveira, S. Osaki, J. Maloney, R. D. Cornwell, and K. C. Meyer Lung transplant for interstitial lung disease: outcomes for single versus bilateral lung transplantation Interact CardioVasc Thorac Surg, December 16, 2011; (2011) ivr085v1. [Abstract] [Full Text] [PDF]
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 N. C. De Oliveira, S. Osaki, J. Maloney, R. D. Cornwell, and K. C. Meyer Lung transplant for interstitial lung disease: outcomes before and after implementation of the united network for organ sharing lung allocation scoring system Eur J Cardiothorac Surg, December 14, 2011; (2011) ezr079v1. [Abstract] [Full Text] [PDF]
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 T. J. George, G. J. Arnaoutakis, and A. S. Shah Lung Transplant in Idiopathic Pulmonary Fibrosis Arch Surg, October 1, 2011; 146(10): 1204 - 1209. [Abstract] [Full Text] [PDF]
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