Gries Cynthia J, Mulligan Michael S, Edelman Jeffrey D, Raghu Ganesh, Curtis J Randall, Goss Christopher H
Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA 98195, USA.
Chest. 2007 Dec;132(6):1954-61. doi: 10.1378/chest.07-1160.
Prior to implementation of the lung allocation score (LAS) system, allocation of donor lungs was based on accrued time on the waiting list and was potentially influenced by center-specific thresholds for listing. The impact of LAS implementation on patient characteristics and survival is unknown.
United Network of Organ Sharing data were obtained on all lung transplant candidates listed and all patients undergoing transplantation in region 6 between May 4, 2003, and May 4, 2006. Each data set was divided into two cohorts: 2 years before LAS implementation, and 1 year after LAS implementation. LAS was calculated and compared by cohort. Pre-LAS and post-LAS differences in patient characteristics were examined. Waiting list and posttransplant survival rates for each cohort were examined using Kaplan-Meier estimates and Cox regression.
After LAS implementation, the distribution of diagnoses in patients undergoing transplantation significantly changed (p = 0.02), while the distribution of diagnoses in those listed did not (p = 0.17). Characteristics of patients on the waiting list were similar, except that a higher proportion of nonwhite patients were listed (p = 0.04) and lower FVC (p < 0.001) was observed after LAS implementation. Similarly, characteristics of patients undergoing transplantation did not change, except that posttransplant hospital length of stay was shorter (p = 0.01) after LAS implementation. Calculated LAS was higher after LAS implementation (p = 0.006). After controlling for age and diagnosis, neither waiting list nor transplant survival was significantly different (p = 0.93 and p = 0.81, respectively).
After LAS implementation, the distribution of diagnoses in lung transplant recipients was significantly changed, while that of candidates was not. Posttransplant and waiting list survival were not affected by the LAS system, but power was limited. Larger and long-term survival studies are needed to determine if the LAS system improves overall allocation and survival for patients interested in lung transplantation.
在肺分配评分（LAS）系统实施之前，供体肺的分配基于在等待名单上的累计时间，并且可能受到各中心特定的列入标准的影响。LAS实施对患者特征和生存的影响尚不清楚。
获取了器官共享联合网络关于2003年5月4日至2006年5月4日期间在6区登记的所有肺移植候选者以及所有接受移植患者的数据。每个数据集被分为两个队列：LAS实施前2年和LAS实施后1年。按队列计算并比较LAS。检查LAS实施前后患者特征的差异。使用Kaplan-Meier估计和Cox回归检查每个队列的等待名单和移植后生存率。
LAS实施后，接受移植患者的诊断分布发生了显著变化（p = 0.02），而登记患者的诊断分布没有变化（p = 0.17）。等待名单上患者的特征相似，只是非白人患者列入的比例更高（p = 0.04），并且在LAS实施后观察到较低的用力肺活量（FVC）（p < 0.001）。同样，接受移植患者的特征没有变化，只是LAS实施后移植后住院时间更短（p = 0.01）。LAS实施后计算出的LAS更高（p = 0.006）。在控制年龄和诊断后，等待名单生存率和移植生存率均无显著差异（分别为p = 0.93和p = 0.81）。
LAS实施后，肺移植受者的诊断分布发生了显著变化，而候选者的诊断分布没有变化。移植后和等待名单生存率不受LAS系统影响，但检验效能有限。需要进行更大规模的长期生存研究，以确定LAS系统是否能改善对有肺移植意愿患者的总体分配和生存情况。
