Impact of the lung allocation score on survival beyond 1 year

B. G. Maxwell, J. E. Levitt, B. A. Goldstein, J. J. Mooney, M. R. Nicolls, M. Zamora, V. Valentine, D. Weill, G. S. Dhillon

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Implementation of the lung allocation score (LAS) in 2005 led to transplantation of older and sicker patients without altering 1-year survival. However, long-term survival has not been assessed and emphasizing the 1-year survival metric may actually sustain 1-year survival while not reflecting worsening longer-term survival. Therefore, we assessed overall and conditional 1-year survival; and the effect of crossing the 1-year threshold on hazard of death in three temporal cohorts: historical (1995-2000), pre-LAS (2001-2005) and post-LAS (2005-2010). One-year survival post-LAS remained similar to pre-LAS (83.1% vs. 82.1%) and better than historical controls (75%). Overall survival in the pre-and post-LAS cohorts was also similar. However, long-term survival among patients surviving beyond 1 year was worse than pre-LAS and similar to historical controls. Also, the hazard of death increased significantly in months 13 (1.44, 95% CI 1.10-1.87) and 14 (1.43, 95% CI 1.09-1.87) post-LAS but not in the other cohorts. While implementation of the LAS has not reduced overall survival, decreased survival among patients surviving beyond 1 year in the post-LAS cohort and the increased mortality occurring immediately after 1 year suggest a potential negative long-term effect of the LAS and an unintended consequence of increased emphasis on the 1-year survival metric.

Original languageEnglish (US)
Pages (from-to)2288-2294
Number of pages7
JournalAmerican Journal of Transplantation
Volume14
Issue number10
DOIs
StatePublished - Oct 1 2014

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Lung
Survival
Transplantation
Mortality

Keywords

  • Clinical research
  • ethics
  • health services and outcomes research
  • lung transplantation
  • organ allocation
  • organ transplantation in general
  • patient survival
  • practice
  • pulmonology
  • risk assessment
  • risk stratification
  • Scientific Registry for Transplant Recipients (SRTR)
  • social sciences

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Maxwell, B. G., Levitt, J. E., Goldstein, B. A., Mooney, J. J., Nicolls, M. R., Zamora, M., ... Dhillon, G. S. (2014). Impact of the lung allocation score on survival beyond 1 year. American Journal of Transplantation, 14(10), 2288-2294. https://doi.org/10.1111/ajt.12903

Impact of the lung allocation score on survival beyond 1 year. / Maxwell, B. G.; Levitt, J. E.; Goldstein, B. A.; Mooney, J. J.; Nicolls, M. R.; Zamora, M.; Valentine, V.; Weill, D.; Dhillon, G. S.

In: American Journal of Transplantation, Vol. 14, No. 10, 01.10.2014, p. 2288-2294.

Research output: Contribution to journalArticle

Maxwell, BG, Levitt, JE, Goldstein, BA, Mooney, JJ, Nicolls, MR, Zamora, M, Valentine, V, Weill, D & Dhillon, GS 2014, 'Impact of the lung allocation score on survival beyond 1 year', American Journal of Transplantation, vol. 14, no. 10, pp. 2288-2294. https://doi.org/10.1111/ajt.12903
Maxwell BG, Levitt JE, Goldstein BA, Mooney JJ, Nicolls MR, Zamora M et al. Impact of the lung allocation score on survival beyond 1 year. American Journal of Transplantation. 2014 Oct 1;14(10):2288-2294. https://doi.org/10.1111/ajt.12903
Maxwell, B. G. ; Levitt, J. E. ; Goldstein, B. A. ; Mooney, J. J. ; Nicolls, M. R. ; Zamora, M. ; Valentine, V. ; Weill, D. ; Dhillon, G. S. / Impact of the lung allocation score on survival beyond 1 year. In: American Journal of Transplantation. 2014 ; Vol. 14, No. 10. pp. 2288-2294.
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AU - Nicolls, M. R.

AU - Zamora, M.

AU - Valentine, V.

AU - Weill, D.

AU - Dhillon, G. S.

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