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The impact of the lung allocation scoring system at the single national Veterans Affairs Hospital lung transplantation program

^a Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
^b Section of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States

Received 30 June 2008; received in revised form 24 February 2009; accepted 3 March 2009.

^_* Corresponding author. Address: 600 Highland Avenue, H4/348 Clinical Science Center, Madison, WI 53792-3236, United States. Tel.: +1 608 263 6311; fax: +1 608 263 0547. (Email: DEOLIVEIRA{at}surgery.wisc.edu).

Objective: The lung allocation score (LAS) has changed the distribution of donor lungs for transplantation. This study was undertaken to evaluate the impact of the LAS on a unique patient population undergoing lung transplantation (LTX) at the single national Veterans Affairs (VA) LT center. Methods: One hundred and ten consecutive VA patients underwent LTX between 1994 and 2007. Patients transplanted using the LAS (LAS, n = 26) were compared to patients transplanted prior to introduction of the LAS (pre-LAS, n = 84). Results: Waiting time decreased from 353.8 ± 254.7 (pre-LAS) to 238.0 ± 306.6 (LAS) days (p < 0.01). Recipient diagnoses have changed with an increase in idiopathic pulmonary fibrosis [11% (9/84) pre-LAS vs 46% (12/26) LAS, p < 0.01] and a decrease in emphysema [57% (48/84) pre-LAS vs 35% (9/26) LAS, p < 0.01]. Mean LAS calculation was 33.1 ± 2.9 for pre-LAS versus 41.9 ± 9.8 for the LAS (p < 0.01). Postoperative complications did not differ between the groups. Length of hospital stay decreased from 44.3 ± 42.9 (pre-LAS) to 18.1 ± 12.3 (LAS) days (p < 0.01). Hospital mortality and 1-year survival did not differ between the pre-LAS and LAS groups (7% vs 8%; p = 0.72 and 92% [95% confidence interval (CI) 86–98] vs 92% [CI 82–100]; p = 0.23, respectively). Conclusions: The LAS appears to be achieving its objectives by reducing waitlist time and altering the distribution of lung disease being transplanted on the basis of medical necessity in the U.S. VA population. In addition, the LAS does not appear to have adversely affected short-term post-transplant outcomes in our recipient cohort.

Key Words: Organ donor management • Transplantation • Lung