Department of Anesthesiology, Ludwig-Maximilians-University Munich, Munich, Germany.
Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany.
Eur J Cardiothorac Surg. 2018 Aug 1;54(2):328-333. doi: 10.1093/ejcts/ezy035.
The Lung Allocation Score (LAS) was implemented in Germany on 10 December 2011 after demonstrating favourable outcomes in the USA since its introduction in 2005. There are only limited and short-term data on the effect of the LAS on lung transplantation programmes in Germany. The purpose of this study was to analyse our 5-year single-centre experience with the LAS within the influential area of the Eurotransplant Foundation (ET).
After implementation of the LAS until December 2016, 294 patients underwent a single-lung transplantation or a bilateral sequential lung transplantation for end-stage lung disease at our centre. Patients were divided into 4 groups according to their primary diagnosis. The Kaplan-Meier analyses of survival probabilities were performed to compare types of transplant procedures, underlying diagnoses and the LASs at the time of transplantation. Waitlist characteristics, transplant procedures and up to 5-year post-transplant outcomes were analysed.
The proportion of lung transplants performed for interstitial lung disease increased over time from 27% in 2012 to 54% in 2016 (P = 0.056). At the same time, the proportion of patients with chronic obstructive pulmonary disease undergoing lung transplantation declined over the 5-year period, i.e. from 29% in 2011 to 19% in 2016 (P = 0.029). Overall waiting times of transplanted patients were approximately 200 days and did not markedly change over time. There was an increasing proportion of chronic obstructive pulmonary disease patients on the waitlist from 41% in 2011 to 51% in 2016 (P = 0.51). Outcomes were independent of the underlying disease entity or the LAS. Bilateral sequential lung transplantation was associated with a better long-term survival probability when compared with a single-lung transplantation (P < 0.001).
Our centre-specific 5-year experience confirms previous findings demonstrating that the LAS is a well-established tool for the selection of lung transplant candidates, respecting urgency and prognostic transplant benefit in a disease-specific manner. However, the LAS did not shorten overall waiting times in transplanted patients. Further long-term and multicentre data with respect to differential transplant centre activities have to be gathered for further evaluation.
肺分配评分（LAS）于 2011 年 12 月 10 日在德国实施，此前自 2005 年引入以来，在美国取得了良好的效果。关于 LAS 对德国肺移植项目的影响，仅有有限的短期数据。本研究的目的是分析我们在欧洲器官移植基金会（ET）影响区域内使用 LAS 的 5 年单中心经验。
在 LAS 实施后（截至 2016 年 12 月），我们中心共有 294 名终末期肺病患者接受了单肺移植或双侧序贯肺移植。根据主要诊断，患者分为 4 组。采用 Kaplan-Meier 分析生存概率，比较移植类型、基础诊断和移植时的 LAS。分析候补者特征、移植程序以及移植后 5 年的结果。
间质性肺疾病患者进行肺移植的比例随着时间的推移逐渐增加，从 2012 年的 27%增加到 2016 年的 54%（P=0.056）。与此同时，5 年内慢性阻塞性肺疾病患者进行肺移植的比例下降，从 2011 年的 29%下降到 2016 年的 19%（P=0.029）。移植患者的总等待时间约为 200 天，且随时间变化不明显。候补者中慢性阻塞性肺疾病患者的比例从 2011 年的 41%增加到 2016 年的 51%（P=0.51）。结果与基础疾病实体或 LAS 无关。与单肺移植相比，双侧序贯肺移植具有更好的长期生存概率（P<0.001）。
我们中心的 5 年经验证实了先前的研究结果，即 LAS 是一种用于选择肺移植候选者的成熟工具，它以疾病特异性的方式尊重紧迫性和预后移植获益。然而，LAS 并未缩短移植患者的总等待时间。需要进一步收集有关不同移植中心活动的长期和多中心数据，以进行进一步评估。
