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

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38 Scopus citations

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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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., Valentine, V., Weill, D., & 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