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Complications of Cardiac and Lung Transplantation
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Jay D. Pal, Daniel T. DeArmond, Hao Pan, Scott B. Johnson
All patients listed for lung transplant are given a lung allocation score (LAS) to determine their place on the transplant list based on the severity of their disease. Parameters considered in factoring the LAS score include predictors of waiting list mortality (spirometry assessment of forced vital capacity, pulmonary artery systolic pressure, supplemental oxygen requirements, age, body mass index, New York Heart Association status, diagnosis, 6-min walk distance, diabetes, need for ventilatory support) and predictors of posttransplant survival (mean pulmonary arterial pressure, serum creatinine). Contraindications to lung transplantation include recent malignancy (other than nonmelanoma skin cancer), infection with human immunodeficiency virus, infection with hepatitis B or C with histologic evidence of cirrhosis, active or recent cigarette smoking, drug or alcohol abuse, severe psychiatric illness, documented noncompliance with medical care, or absence of reliable social support network. Relative contraindications include age greater than 70 and body mass index greater than 30.
History of lung transplantation
Published in Wickii T. Vigneswaran, Edward R. Garrity, John A. Odell, LUNG Transplantation, 2016
Joel D. Cooper, Thomas M. Egan
By the late 1990s, organ allocation policies had become controversial. The shortage of brain-dead organ donors, and suitable lung donors in particular, led the lung transplant community to recommend strict listing guidelines.25 In 1998, the Department of Health and Human Services first released the “Final Rule” on organ allocation,26 which required the OPTN to emphasize broader sharing of organs, reduce the use of waiting time as an allocation criterion, and create equitable organ allocation systems focused on using objective medical criteria and medical urgency for allocation. A 1999 Institute of Medicine report stated that allocation should be based on measures of medical urgency while avoiding futile organ transplants, should minimize the effect of waiting time, and should use broader geographic sharing.27 In 1999, the Lung Allocation Subcommittee of the OPTN Thoracic Organ Transplantation Committee was created to evaluate the lung allocation system and make recommendations to comply with the Final Rule.* After years of analyses, the OPTN introduced a new system of lung allocation in May 2005. Now, lungs are allocated in the United States based on a lung allocation score (LAS) for each potential recipient that is based on two calculated predictions: waiting list survival for the next year without a transplant (a measure of urgency) and transplant benefit, which is based on predicted 1-year survival if a lung transplant were performed minus predicted survival if the recipient continued waiting. The intent of the LAS was to reduce deaths while on the waiting list and offer lungs to those most in need (those most likely to die without a transplant), thereby minimizing wasting of lungs.28
Limitations of the dichotomized 6-minute walk distance when computing lung allocation score for cystic fibrosis: a 16-year retrospective cohort study
Published in Disability and Rehabilitation, 2023
Simone Gambazza, Federica Carta, Federico Ambrogi, Giacomo Bassotti, Anna Brivio, Maria Russo, Carla Colombo
Lung Allocation Score (LAS) is a numerical value used for determining lung transplant recipient priority, introduced at first in United States in 2005. LAS uses a comprehensive set of patient- and disease variables (i.e., diagnosis code, type of assisted ventilation, presence of supplemental oxygen) to balance the degree of urgency for lung transplantation (LTx) with the probability of post-transplant survival. Specifically, LAS considers the estimated survival benefit offered LTx by 1 year after surgery and medical urgency. The 2010 version, currently adopted by Lombardia region (Italy) on a provisional basis [3], uses 6-min Walk Test (6MWT) distance as a dichotomous covariate of whether or not an individual can walk more than 150 ft or 45.7 m in 6 min. The 6MWT is a field test validated for assessing submaximal exercise tolerance in people with CF. [4] The distance obtained has proven useful in the prognostic evaluation and quantification of disease burden of individuals with CF, [5] positively correlating with the severity of lung disease based on Shwachman or Brasfield Score, [6] and negatively correlated with the Bhalla Score [6] and hospitalization rate. [7]
On survival comparisons between adult cystic fibrosis patients in Canada versus the United States: Twitter discussions from @respandsleepjc (#rsjc)
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2018
Preyanka Abhyankar, Anju Anand, Matthew B. Stanbrook
The study raised questions with regard to lung transplant allocation in the United States, in that the gap between Canada and the United States in median age of survival began to widen around 2005, coinciding with the implementation of the lung allocation score in the United States (but not in Canada) for assigning lung transplantation priority. The study team revealed that the results have led to efforts to rework transplant access in the United States.14,15,16 Newborn screening was also a point of interest; it was thought it may impact survival but not enough to account for differences seen in the study.17 Additionally, the different data collection practices between countries (the U.S. registry collected data on all clinic visits, the Canadian registry collected only the first stable visit in each year) were questioned, to which the study authors advised that Canada has now been collecting data from multiple visits since 2011.18,19
Recent advances in extracorporeal life support as a bridge to lung transplantation
Published in Expert Review of Respiratory Medicine, 2018
Efficient distribution of donor lungs remains crucial in optimizing donor use, reducing waitlist mortality and improving transplant outcomes [27]. Allocation criteria beyond blood group and body size matching are usually based on some pre-defined clinical concept of medical urgency (e.g. by audit process, individual decision, or objectively by a score system), combined in some regions with time on the wait list [28]. The lung allocation score (LAS) is a complex, calculated numerical value used to assign relative priority in distributing donated lungs. The LAS evaluates several parameters of candidate health status to facilitate donation toward patients deriving greatest benefit from lung transplantation, the latter being defined as the difference of the projected survival after transplantation and survival on the wait list. The LAS system was introduced in the US in May 2005 and subsequently adopted in Germany in December 2011 and in the Netherlands in April 2014. A revised LAS-version was introduced in the US in February 2015 with some new parameters and different weigh of others including oxygen demand.