Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina; University of Minnesota School of Public Health, Minneapolis, Minnesota; and College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York, New York.
Ann Intern Med. 2013 May 7;158(9):650-7. doi: 10.7326/0003-4819-158-9-201305070-00004.
Lung transplantation is an effective treatment for patients with advanced lung disease. In the United States, lungs are allocated on the basis of the lung allocation score (LAS), a composite measure of transplantation urgency and utility. Clinical deteriorations result in increases to the LAS; however, whether the trajectory of the LAS has prognostic significance is uncertain.
To determine whether an acute increase in the LAS before lung transplantation is associated with reduced posttransplant survival.
Retrospective cohort study of adult lung transplant recipients listed for at least 30 days between 4 May 2005 (LAS implementation) and 31 December 2010 in the United Network for Organ Sharing registry. An acute increase in the LAS was defined as an LAS change (LASΔ) greater than 5 units between the 30 days before and the time of transplantation. Multivariable Cox proportional hazard models were used to examine the relationship between an LASΔ >5 and posttransplant graft survival.
All U.S. lung transplantation centers.
5749 lung transplant recipients.
Survival time after lung transplantation.
702 (12.2%) patients experienced an LASΔ >5. These patients had significantly worse posttransplant survival (hazard ratio, 1.31 [95% CI, 1.11 to 1.54]; P = 0.001]) after adjustment for the LAS at transplantation (LAS-T) and other clinical covariates. The effect of an LASΔ >5 was independent of the LAS-T, underlying diagnosis, center volume, or donor characteristics.
Analysis was based on center-reported data.
An acute increase in LAS before transplantation is associated with posttransplant survival after adjustment for LAS-T. Further emphasis on serial assessment of the LAS could improve the ability to offer accurate prediction of survival after transplantation.
National Institutes of Health.
肺移植是治疗晚期肺病患者的有效方法。在美国，肺脏是根据肺分配评分（LAS）进行分配的，这是衡量移植紧迫性和实用性的综合指标。临床恶化会导致 LAS 增加；然而，LAS 的变化轨迹是否具有预后意义尚不确定。
确定肺移植前 LAS 的急性增加是否与移植后生存率降低有关。
回顾性队列研究，纳入了 2005 年 5 月 4 日（LAS 实施）至 2010 年 12 月 31 日期间在美国器官共享网络登记处至少登记 30 天的成人肺移植受者。LAS 的急性增加定义为在移植前 30 天内 LAS 变化（LASΔ）大于 5 个单位。多变量 Cox 比例风险模型用于检查 LASΔ>5 与移植后移植物存活率之间的关系。
所有美国肺移植中心。
5749 例肺移植受者。
肺移植后的生存时间。
702 例（12.2%）患者经历了 LASΔ>5。这些患者的移植后生存率明显较差（风险比，1.31 [95%CI，1.11 至 1.54]；P=0.001），在调整移植时的 LAS（LAS-T）和其他临床协变量后。LASΔ>5 的影响独立于 LAS-T、基础诊断、中心容量或供体特征。
分析基于中心报告的数据。
在调整 LAS-T 后，移植前 LAS 的急性增加与移植后生存率相关。进一步强调对 LAS 的连续评估可以提高提供移植后生存准确预测的能力。
美国国立卫生研究院。
