Kozower Benjamin D, Meyers Bryan F, Smith Michael A, De Oliveira Nilto C, Cassivi Stephen D, Guthrie Tracey J, Wang Honkung, Ryan Beverly J, Shen K Robert, Daniel Thomas M, Jones David R
Department of Surgery, University of Virginia Health System, Charlottesville 22908-0679, USA.
J Thorac Cardiovasc Surg. 2008 Jan;135(1):166-71. doi: 10.1016/j.jtcvs.2007.08.044. Epub 2007 Nov 12.
The lung allocation score restructured the distribution of scarce donor lungs for transplantation. The algorithm ranks waiting list patients according to medical urgency and expected benefit after transplantation. The purpose of this study was to evaluate the impact of the lung allocation score on short-term outcomes after lung transplantation.
A multicenter retrospective cohort study was performed with data from 5 academic medical centers. Results of patients undergoing transplantation on the basis of the lung allocation score (May 4, 2005 to May 3, 2006) were compared with those of patients receiving transplants the preceding year before the lung allocation score was implemented (May 4, 2004, to May 3, 2005).
The study reports on 341 patients (170 before the lung allocation score and 171 after). Waiting time decreased from 680.9 +/- 528.3 days to 445.6 +/- 516.9 days (P < .001). Recipient diagnoses changed with an increase in idiopathic pulmonary fibrosis and a decrease in emphysema and cystic fibrosis (P = .002). Postoperatively, primary graft dysfunction increased from 14.1% (24/170) to 22.9% (39/171) (P = .04) and intensive care unit length of stay increased from 5.7 +/- 6.7 days to 7.8 +/- 9.6 days (P = .04). Hospital mortality and 1-year survival were the same between groups (5.3% vs 5.3% and 90% vs 89%, respectively; P > .6)
This multicenter retrospective review of short-term outcomes supports the fact that the lung allocation score is achieving its objectives. The lung allocation score reduced waiting time and altered the distribution of lung diseases for which transplantation was done on the basis of medical necessity. After transplantation, recipients have significantly higher rates of primary graft dysfunction and intensive care unit lengths of stay. However, hospital mortality and 1-year survival have not been adversely affected.
肺分配评分系统重新调整了稀缺供肺用于移植的分配方式。该算法根据医疗紧迫性和移植后的预期获益对等待名单上的患者进行排名。本研究的目的是评估肺分配评分对肺移植术后短期结局的影响。
利用来自5家学术医疗中心的数据进行了一项多中心回顾性队列研究。将基于肺分配评分进行移植的患者（2005年5月4日至2006年5月3日）的结果与在肺分配评分实施前一年接受移植的患者（2004年5月4日至2005年5月3日）的结果进行比较。
该研究报告了341例患者（肺分配评分实施前170例，实施后171例）。等待时间从680.9±528.3天降至445.6±516.9天（P<.001）。受者诊断情况发生了变化，特发性肺纤维化患者增加，肺气肿和囊性纤维化患者减少（P=.002）。术后，原发性移植物功能障碍从14.1%（24/170）增至22.9%（39/171）（P=.04），重症监护病房住院时间从5.7±6.7天增至7.8±9.6天（P=.04）。两组间医院死亡率和1年生存率相同（分别为5.3%对5.3%和90%对89%；P>.6）
这项关于短期结局的多中心回顾性研究支持了肺分配评分系统正在实现其目标这一事实。肺分配评分缩短了等待时间，并改变了基于医疗必要性进行移植的肺部疾病分布。移植后，受者原发性移植物功能障碍发生率和重症监护病房住院时间显著更高。然而，医院死亡率和1年生存率并未受到不利影响。
