Abstract

Background The United Network for Organ Sharing (UNOS) Lung Allocation Score (LAS) adopted in April 2005 to prioritize lung transplantation for patients at high risk of dying without a transplant may adversely affect outcomes for patients transplanted for Chronic Obstructive Pulmonary Disease (COPD). Methods We reviewed the records for 141 consecutive recipients with COPD (all without alpha-1-antitrypsin deficiency) who received lung transplants at our center between January 1993 and March 2013 and compared outcomes for patients transplanted using the LAS (LAS, n = 71) to those transplanted prior to introduction of the LAS (pre-LAS, n = 70). Results The cohort of patients transplanted after LAS implementation had lower FVC% predicted (pre-LAS: 52 vs. LAS 46%, p < 0.05), lower FEV1% predicted (20 vs. 18%, p < 0.05), and a higher prevalence of diabetes (7 vs. 21%, p < 0.01). Median estimated LAS values increased significantly (P < 0.01) from 33.0 (pre-LAS) to 35.4 (LAS). Length of hospital stay and hospital mortality did not significantly change, and ICU length of stay decreased from 13 (pre-LAS) to 4 days (post-LAS, p < 0.01). However, long-term survival was significantly decreased in the LAS group with a 5-year survival of 74.2% in the pre-LAS group versus 65.0% in the LAS group (p < 0.05). Conclusions Although the mean calculated LAS value was higher for COPD patients transplanted after LAS implementation versus pre-LAS recipients, early post-transplant outcomes were not affected. However, longer term survival was decreased for LAS recipients who received Single Lung Transplants (SLT) versus the pre-LAS SLT cohort and Bilateral Lung Transplant (BLT) recipients.

Authors and Affiliations