David Geffen School of Medicine, UCLA Medical Center, Los Angeles, CA, USA.
Division of Cardiac Surgery, UCLA Medical Center, Los Angeles, CA, USA.
Clin Transplant. 2018 Aug;32(8):e13298. doi: 10.1111/ctr.13298. Epub 2018 Jun 15.
In 2005, the Lung Allocation Score (LAS) was implemented as the allocation system for lungs in the US. We sought to compare 5-year lung transplant outcomes before and after the institution of the LAS. Between 2000 and 2011, 501 adult patients were identified, with 132 from January 2000 to April 2005 (Pre-LAS era) and 369 from May 2005 to December 2011 (Post-LAS era). Kruskal-Wallis or chi-squared test was used to determine significance between groups. Survival was censored at 5 years. Overall, the post-LAS era was associated with more restrictive lung disease, higher LAS scores, shorter wait-list times, more preoperative immunosuppression, and more single lung transplantation. In addition, post-LAS patients had higher O requirements with greater preoperative pulmonary impairment. Postoperatively, 30-day mortality improved in post-LAS era (1.6% vs 5.3%, P = .048). During the pre- and post-LAS eras, 5-year survival was 52.3% and 55.3%, respectively (P = .414). The adjusted risk of mortality was not different in the post-LAS era (P = .139). Freedom from chronic lung allograft dysfunction was significantly higher in the post-LAS era (P = .002). In this single-center report, implementation of the LAS score has led to allocation to sicker patients without decrement in short- or medium-term outcomes. Freedom from CLAD at 5 years is improving after LAS implementation.
2005 年，美国实施了肺分配评分（LAS）作为肺分配系统。我们旨在比较 LAS 实施前后 5 年的肺移植结果。2000 年至 2011 年间，共确定了 501 例成人患者，其中 132 例来自 2000 年 1 月至 2005 年 4 月（LAS 前时代），369 例来自 2005 年 5 月至 2011 年 12 月（LAS 后时代）。Kruskal-Wallis 或卡方检验用于确定组间的显著性。生存截止到 5 年。总体而言，LAS 后时代与更具限制性的肺部疾病、更高的 LAS 评分、更短的等待时间、更多的术前免疫抑制和更多的单肺移植有关。此外，LAS 后时代的患者术前肺功能障碍更大，需要更高的 O 需求。术后，LAS 后时代的 30 天死亡率有所改善（1.6%对 5.3%，P=0.048）。在 LAS 前和 LAS 后时代，5 年生存率分别为 52.3%和 55.3%（P=0.414）。LAS 后时代的死亡率调整风险无差异（P=0.139）。LAS 后时代慢性肺移植物功能障碍的无复发率明显更高（P=0.002）。在这项单中心报告中，LAS 评分的实施导致分配给病情更严重的患者，但并未降低短期或中期结果。LAS 实施后，5 年无 CLAD 的自由正在改善。
