*Purpose: Lung transplantation (LTx) is an effective treatment for patients with end stage of respiratory disease. Two of the major candidates are patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). However, waiting list mortality is very high in ILD before suitable organs become available. In Jan 2015, Lung allocation score (LAS) was introduced in south China, replacing the previous waiting time-based system for allocating donor lungs. The aim of this study was to assess performance of the LAS in South China.

*Methods: This retrospective study analyzed the waitlist mortality, LTx activity and 6-month outcomes comparing pre and post-LAS introduction among patients with COPD and ILD. The LTx candidates registered in our center between Mar 2018 and Jan 2015 (pos-LAS period) as well as those registered between Dec 2014 and Jan 2005 (pre-LAS period) were included. Additionally, all LTx were followed up until Aug 2018, providing complete 6-month follow-up after LTx.

*Results: Chinese recipients have a much higher LAS when compared with the ones in Europe and America, especially in those with ILD pre-LAS. More patients with ILD (44% vs. 29%) and fewer with COPD (36% vs. 47%) underwent LTx, when compared to pre-LAS. The LAS among transplant recipients was (61.93±18.43) in ILD and (47.45±14.98) in COPD, respectively. Six-month survival increased (91.2% vs. 79.1%) in total patients.

*Conclusions: There is a significant reduction in waiting list mortality among patients with ILD with implementation of LAS in south China. As for the composition of transplant recipients, ILD recipients go up to the top one and COPD switch to the second. Prominent reductions in mortality among patients with ILD suggest that LAS is a good index to implement in China.

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