Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), member of the German Center for Lung Research; Eurotransplant International Foundation, Leiden, Niederlande; Department of Cardiac Surgery, Ludwig-Maximilians-Universität München; Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar; Department of Internal Medicine III (Hematology, Oncology, Pneumology), University Medical Center, Johannes Gutenberg University Mainz; Department of Pneumonology and Immunology, Charité-Universitätsmedizin Berlin; Richard DeVos Heart & Lung Transplant Program, Grand Rapids/Michigan, USA; Department of Cardiovascular Surgery, University Heart Center Hamburg.
Dtsch Arztebl Int. 2017 Mar 17;114(11):179-185. doi: 10.3238/arztebl.2017.0179.
The allocation of donor lungs for transplantation in Germany was changed on 10 December 2011 to a system based on the Lung Allocation Score (LAS). The aim of the present study is to determine whether this change has prolonged the survival of patients on the transplant waiting list and of those who have undergone lung transplantation (LTx).
We retrospectively compared data from the three-year periods before and after the change to an LAS-based allocation system (2009-2011 vs. 2012-2014).
The number of patients on the active waiting list declined from 606 on 12/31/2011 to 432 on 12/31/2014, a 29% decrease. The number of patients who died while on the waiting list fell from 306 in 2009-2011 to 226 in 2012-2014 (-26%, p = 0.04). Waiting-list mortality declined across all disease groups. Meanwhile, the number of lung transplantation procedures per year increased by 21% over the period of observation, from 865 to 1045. During the period in which the LAS was used, the proportion of transplant recipients with restrictive lung disease (46% vs. 31%; p<0.001) surpassed the proportion of those with a diagnosis of obstructive lung disease (33% vs. 40%; p = 0.003). The percentage of transplantations in patients treated with mechanical ventilation or extracorporeal respiratory support before transplantation rose from 9% to 13%. The one-year survival rate after lung transplantation was 76% in 2009-2011 and 81% in 2012-2014.
The introduction of the LAS in Germany was associated with a decrease in the number of patients on the waiting list, and also in the number of deaths among patients on the waiting list. The distribution of primary diagnoses among transplant recipients shifted away from obstructive and toward restrictive lung diseases. In the future, additional parameters of patients on the waiting list should be considered to enable further improvement of the allocation model.
2011 年 12 月 10 日，德国对供体肺移植的分配进行了改革，采用肺分配评分（LAS）系统。本研究旨在确定这一改变是否延长了移植等待名单上患者和已接受肺移植（LTx）患者的生存时间。
我们回顾性比较了 LAS 分配系统改变前后三年的数据（2009-2011 年与 2012-2014 年）。
活跃等待名单上的患者人数从 2011 年 12 月 31 日的 606 人减少到 2014 年 12 月 31 日的 432 人，减少了 29%。等待名单上死亡的患者人数从 2009-2011 年的 306 人减少到 2012-2014 年的 226 人（-26%，p=0.04）。所有疾病组的等待名单死亡率均下降。同时，每年的肺移植手术数量增加了 21%，从 865 例增加到 1045 例。在使用 LAS 的期间，患有限制性肺疾病的移植受者比例（46%比 31%；p<0.001）超过了阻塞性肺疾病的比例（33%比 40%；p=0.003）。在移植前接受机械通气或体外呼吸支持治疗的患者的移植比例从 9%增加到 13%。肺移植后 1 年的生存率在 2009-2011 年为 76%，在 2012-2014 年为 81%。
德国引入 LAS 与等待名单上患者人数减少以及等待名单上患者死亡人数减少有关。移植受者的主要诊断分布从阻塞性向限制性肺疾病转移。今后，应考虑等待名单上患者的其他参数，以进一步改进分配模型。
