Benjamin D. Kozower1, Bryan F. Meyers2, Michael A. Smith3, Nilto C. De Oliveira4, Stephen D. Cassivi5, Tracey J. Guthrie2, Mark R. Conaway1, Beverly J. Ryan1, K. Robert Shen1, David R. Jones1; 1Surgery, University of Virginia, Charlottesville, VA; 2Washington University in St. Louis, St. Louis, MO; 3University of Southern California, Los Angeles, CA; 4University of Wisconsin, Madison, WI; 5Mayo Clinic, Rochester, MN
Objective: The lung allocation score (LAS) was implemented in May of 2005 to restructure the distribution of scarce donor lungs for transplantation. It is an algorithm that ranks patients on the waiting list according to medical urgency and the expected benefit following transplantation. The purpose of this study was to evaluate the impact of the LAS on short-term outcomes following lung transplantation.Methods: A multicenter retrospective cohort study was performed with data from 5 academic medical centers. The 2 cohorts were patients transplanted using the LAS (May 4, 2005-May 3, 2006) and patients transplanted the preceding year prior to the LAS (May 4, 2004-May 3, 2005). Indications for transplant and short-term outcomes were compared between the two cohorts.
Results: The study reports on 341 patients (170 Pre-LAS and 171 LAS). Data are presented in Table 1.
Conclusion: This multicenter retrospective review supports that the LAS is achieving its objectives. The LAS has dramatically reduced waiting time and altered the distribution of lung diseases being transplanted based on medical necessity. Following transplantation, recipients have significantly higher rates of primary graft dysfunction and intensive care unit length of stays. These data suggest that the LAS increases the utilization of hospital resources during postoperative recovery due to the greater postoperative morbidity seen in these patients. However, hospital mortality and 1-year survival have not been adversely affected.
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