The lung allocation score (LAS) prioritizes patients based on predicted one-year waitlist and post-transplant mortality. However, for a given diagnosis, it is unclear whether LAS is actually associated with cumulative waitlist and post-transplant mortality and thus whether it is accurately prioritizing patients.

METHODS: Using SRTR, we studied adult lung transplant candidates listed for transplant from 5/1/2005 – 7/31/2015. Patients listed at multiple institutions were excluded. Cox regression was used to compare mortality across time-varying LAS categories for each of the major diagnoses, pulmonary hypertension (PH), cystic fibrosis (CF), COPD/emphysema, and idiopathic pulmonary fibrosis (IPF). There were n=310, 1531, 3699, and 5255 patients for each diagnosis, respectively, in the study. Donor and recipient traits were adjusted for. LAS categories were determined based on those commonly used in the literature but were adjusted in certain diagnoses due to sample size.

RESULTS: Higher LAS categories were associated with higher risk of waitlist mortality (p<0.001), but there was no statistically significant difference between lower LAS categories 24-30 vs 31-35 in COPD, 24-35 vs 36-46 in IPF, and 24-35 vs 36-46 among CF patients (Figure). LAS was not associated with post-transplant mortality in IPF, CF, and PH recipients. Risk of waitlist mortality is significantly higher relative to post-transplant mortality for all LAS categories across all diagnoses, as high as 151.4-fold among CF patients with LAS 61-100 (p<0.001).

CONCLUSIONS: Transplantation under the current allocation procedures was associated with reduced risk of mortality for all LAS groups relative to waitlist mortality. However, given LAS is not associated with cumulative post-transplant mortality in IPF, CF, and PH patients, important prognostic factors may need to be incorporated into or weighed differently in the formula for calculating LAS.

CITATION INFORMATION: Maredia H, Bowring M, Massie A, Oyetunji S, Merlo C, Higgins R, Segev D, Bush E. Is Lung Allocation Score Associated with Waitlist and Post-Transplant Survival? Am J Transplant. 2017;17 (suppl 3).

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