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An acute change in lung allocation score and survival after lung transplantation: a cohort study.

Publication ,  Journal Article
Tsuang, WM; Vock, DM; Copeland, CAF; Lederer, DJ; Palmer, SM
Published in: Ann Intern Med
May 7, 2013

BACKGROUND: Lung transplantation is an effective treatment for patients with advanced lung disease. In the United States, lungs are allocated on the basis of the lung allocation score (LAS), a composite measure of transplantation urgency and utility. Clinical deteriorations result in increases to the LAS; however, whether the trajectory of the LAS has prognostic significance is uncertain. OBJECTIVE: To determine whether an acute increase in the LAS before lung transplantation is associated with reduced posttransplant survival. DESIGN: Retrospective cohort study of adult lung transplant recipients listed for at least 30 days between 4 May 2005 (LAS implementation) and 31 December 2010 in the United Network for Organ Sharing registry. An acute increase in the LAS was defined as an LAS change (LASΔ) greater than 5 units between the 30 days before and the time of transplantation. Multivariable Cox proportional hazard models were used to examine the relationship between an LASΔ >5 and posttransplant graft survival. SETTING: All U.S. lung transplantation centers. PATIENTS: 5749 lung transplant recipients. MEASUREMENTS: Survival time after lung transplantation. RESULTS: 702 (12.2%) patients experienced an LASΔ >5. These patients had significantly worse posttransplant survival (hazard ratio, 1.31 [95% CI, 1.11 to 1.54]; P = 0.001]) after adjustment for the LAS at transplantation (LAS-T) and other clinical covariates. The effect of an LASΔ >5 was independent of the LAS-T, underlying diagnosis, center volume, or donor characteristics. LIMITATION: Analysis was based on center-reported data. CONCLUSION: An acute increase in LAS before transplantation is associated with posttransplant survival after adjustment for LAS-T. Further emphasis on serial assessment of the LAS could improve the ability to offer accurate prediction of survival after transplantation. PRIMARY FUNDING SOURCE: National Institutes of Health.

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Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

May 7, 2013

Volume

158

Issue

9

Start / End Page

650 / 657

Location

United States

Related Subject Headings

  • Waiting Lists
  • United States
  • Severity of Illness Index
  • Retrospective Studies
  • Registries
  • Proportional Hazards Models
  • Prognosis
  • Patient Selection
  • Middle Aged
  • Male
 

Citation

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Tsuang, W. M., Vock, D. M., Copeland, C. A. F., Lederer, D. J., & Palmer, S. M. (2013). An acute change in lung allocation score and survival after lung transplantation: a cohort study. Ann Intern Med, 158(9), 650–657. https://doi.org/10.7326/0003-4819-158-9-201305070-00004
Tsuang, Wayne M., David M. Vock, C Ashley Finlen Copeland, David J. Lederer, and Scott M. Palmer. “An acute change in lung allocation score and survival after lung transplantation: a cohort study.Ann Intern Med 158, no. 9 (May 7, 2013): 650–57. https://doi.org/10.7326/0003-4819-158-9-201305070-00004.
Tsuang WM, Vock DM, Copeland CAF, Lederer DJ, Palmer SM. An acute change in lung allocation score and survival after lung transplantation: a cohort study. Ann Intern Med. 2013 May 7;158(9):650–7.
Tsuang, Wayne M., et al. “An acute change in lung allocation score and survival after lung transplantation: a cohort study.Ann Intern Med, vol. 158, no. 9, May 2013, pp. 650–57. Pubmed, doi:10.7326/0003-4819-158-9-201305070-00004.
Tsuang WM, Vock DM, Copeland CAF, Lederer DJ, Palmer SM. An acute change in lung allocation score and survival after lung transplantation: a cohort study. Ann Intern Med. 2013 May 7;158(9):650–657.

Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

May 7, 2013

Volume

158

Issue

9

Start / End Page

650 / 657

Location

United States

Related Subject Headings

  • Waiting Lists
  • United States
  • Severity of Illness Index
  • Retrospective Studies
  • Registries
  • Proportional Hazards Models
  • Prognosis
  • Patient Selection
  • Middle Aged
  • Male