Risk Stratification of Lung Transplant Candidates: Implications for Organ Allocation
Authors: Robert M. Kotloff
Journal: Annals of Internal Medicine (2013)

Editorials7 May 2013Risk Stratification of Lung Transplant Candidates: Implications for Organ AllocationRobert M. Kotloff, MDRobert M. Kotloff, MDFrom University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-9-201305070-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In response to perceived inequities of the existing time-based system, and under mandate of the federal government, a new lung allocation system was introduced in the United States in 2005. This system allocates organs on the basis of medical urgency (risk for death without transplantation) and “net transplant benefit” (the extent to which survival is increased with, as opposed to without, transplantation). It uses predictive models, incorporating more than a dozen variables, to generate predictions of 1-year survival with and without transplantation for a given patient (1). A raw lung allocation score (LAS) is calculated on the basis of these ...References1. Egan TM, Murray S, Bustami RT, Shearon TH, McCullough KP, Edwards LB, et al. Development of the new lung allocation system in the United States. Am J Transplant. 2006;6:1212-27. [PMID: 16613597] CrossrefMedlineGoogle Scholar2. Yusen RD, Shearon TH, Qian Y, Kotloff R, Barr ML, Sweet S, et al. Lung transplantation in the United States, 1999-2008. Am J Transplant. 2010;10:1047-68. [PMID: 20420652] CrossrefMedlineGoogle Scholar3. Gries CJ, Rue TC, Heagerty PJ, Edelman JD, Mulligan MS, Goss CH, et al. Development of a predictive model for long-term survival after lung transplantation and implications for the lung allocation score. J Heart Lung Transplant. 2010;29:731-8. [PMID: 20382034] CrossrefMedlineGoogle Scholar4. Chen H, Shiboski SC, Golden JA, Gould MK, Hays SR, Hoopes CW, et al. Impact of the lung allocation score on lung transplantation for pulmonary arterial hypertension. Am J Respir Crit Care Med. 2009;180:468-74. [PMID: 19520906] CrossrefMedlineGoogle Scholar5. Tsuang WM, Vock DM, Finlen Copeland CA, Lederer DJ, Palmer SM. An acute change in lung allocation score and survival after lung transplantation. A cohort study. Ann Intern Med. 2013;158:650-7. LinkGoogle Scholar6. Liu V, Zamora MR, Dhillon GS, Weill D. Increasing lung allocation scores predict worsened survival among lung transplant recipients. Am J Transplant. 2010;10:915-20. [PMID: 20121747] CrossrefMedlineGoogle Scholar7. Russo MJ, Iribarne A, Hong KN, Davies RR, Xydas S, Takayama H, et al. High lung allocation score is associated with increased morbidity and mortality following transplantation. Chest. 2010;137::651-7. [PMID: 19820072] CrossrefMedlineGoogle Scholar8. Russo MJ, Worku B, Iribarne A, Hong KN, Yang JA, Vigneswaran W, et al. Does lung allocation score maximize survival benefit from lung transplantation? J Thorac Cardiovasc Surg. 2011;141:1270-7. [PMID: 21497235] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-0666.Corresponding Author: Robert M. Kotloff, MD, 838 West Gates Building, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104; e-mail, [email protected]upenn.edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAn Acute Change in Lung Allocation Score and Survival After Lung Transplantation Wayne M. Tsuang , David M. Vock , C. Ashley Finlen Copeland , David J. Lederer , and Scott M. Palmer Metrics Cited ByInput and output in distributive theoryAdvances in pulmonary therapy and drug development: Lung tissue engineering to lung-on-a-chipBeyond “The LAS Is Broken”. Ways to Improve Lung Allocation 7 May 2013Volume 158, Issue 9Page: 699-700KeywordsLung transplantationLungsMotivationNatural history of diseaseOrgan transplantationPatient advocacyProgressive diseasesPulmonary hypertensionTransplantation ePublished: 7 May 2013 Issue Published: 7 May 2013 CopyrightCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...