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Life Care Planning for Organ Transplantation
Published in Roger O. Weed, Debra E. Berens, Life Care Planning and Case Management Handbook, 2018
Allocation of lungs is based on a model called the Lung Allocation Scoring (LAS) system. Candidates aged 12 and older are prioritized for donated lung offers by LAS (UNOS Bylaws, 2008) and are calculated using the following: Wait-list urgency measure (expected number of days lived without a transplant during an additional year on the wait-list)Post-transplant survival measure (expected number of days lived during the first year post-transplant)Transplant benefit measure (post-transplant survival measure minus wait-list urgency measure)
Allocation of donor lungs
Published in Wickii T. Vigneswaran, Edward R. Garrity, John A. Odell, LUNG Transplantation, 2016
In May 2005, the lung allocation score (LAS) was implemented to allocate organs on the basis of medical urgency (and not strictly waiting time). The LAS, which is a normalized numerical score ranging from 0 to 100, is based on a multivariate model that is a weighted combination of the predicted risk of waiting list death and the predicted likelihood of survival during the first year after transplantation.10 Specifically, the LAS is calculated as perceived transplant benefit minus waiting list urgency. Transplant benefit is calculated by subtracting waiting list urgency from a post-transplant survival measure.3,7Transplant benefit measure = Posttransplant survival measure – Waiting list urgency measureRaw LAS = Transplant benefit measure - Waiting list urgency measure= Posttransplant survival measure - 2 × (Waiting list urgency measure)
US payer budget impact of a microarray assay with machine learning to evaluate kidney transplant rejection in for-cause biopsies
Published in Journal of Medical Economics, 2022
Lauren Fusfeld, Sreeranjani Menon, Gaurav Gupta, Christopher Lawrence, Salwa F. Masud, Thomas F. Goss
According to the Organ Procurement and Transplantation Network (OPTN), 22,817 kidney transplants were performed in the United States in 20201. Kidney transplantation has grown steadily by 20% in the last 5 years alone1. This increase is driven by the rise in eligible deceased-donor kidney transplants to over 77% of all kidney transplants from 40% in 20151. While greater opportunities for transplant benefit patients, deceased-donor transplants present an increased risk of rejection; approximately 60% of kidney graft failures in the US today are due to chronic or acute rejection2. Currently, 21% of deceased-donor kidney transplant recipients and 14% of living-donor kidney transplant recipients experience graft failure within 5 years of transplant.
Using Marginal Grafts for Liver Transplantation: The Balance of Risk
Published in Journal of Investigative Surgery, 2020
Marit Kalisvaart, M. Thamara P. R. Perera
The outcomes after liver transplantation do, however, not only depend on quality of the graft. Recipient age, Model for End Stage Liver Disease (MELD)-score and comorbidities and surgical issues during the transplant procedure also have an impact on recipient outcomes. This Balance of Risk concept follows the principle that a patient with limited risk can sustain the injury of marginal grafts, i.e. a young patient with a low MELD-score and hepatocellular carcinoma that needs urgent transplantation for oncological reasons might benefit from a DCD graft that is earlier available than a Donation after Brain Death (DBD) graft. On the contrary, a critically ill patient requiring organ support and renal replacement therapy can only receive the best DBD graft, to minimize the peri-transplant risk. Therefore, recent prediction models for graft loss or mortality after liver transplantation assess the cumulative risk of donor, graft and recipient factors. Examples include the BAR Score from Zürich, the SOFT Score from Columbia University and the UK DCD Risk Score for DCD grafts, developed by our team in Birmingham [4–6]. The ideal organ allocation system takes in to account all these aspects but such systems do not exist. In this context, a new allocation scheme has been introduced in the United Kingdom earlier this year called “Transplant Benefit Score” that combines a host of recipient and donor criteria and aims to match grafts and recipients in such a way that the graft is allocated to a recipient who will have the most benefit [7].
Hematopoietic stem cell transplant in adults with acute lymphoblastic leukemia: the present state
Published in Expert Review of Hematology, 2018
Salwa S. Saadeh, Mark R. Litzow
Reports in pediatric patients have demonstrated that treatment with imatinib plus intensive chemotherapy can result in substantially good outcome with no advantage for allo-HSCT [41,42], and less pediatric patients in current practice are receiving allo-HSCT in first remission. The role of transplant in first remission following induction with chemotherapy in combination with TKIs in adult patients is less defined. This has been retrospectively evaluated in patients enrolled in the Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL)-2005 trial [43]. In the whole cohort of 254 patients who achieved remission with induction therapy, those who received allo-HSCT (n = 161) had a significantly improved relapse-free survival (48.3%, HR 0.69, 95% CI 0.49–0.98, p = .036), and OS (56.7%, HR 0.64, 95% CI 0.44–0.93, p = .02) compared to patients who did not undergo allo-HSCT, consistent with previous reports. On analysis of transplant benefit according to pretransplant MRD status, however, patients in molecular remission did not seem to benefit from allo-HSCT in terms of relapse-free survival (p = .96), whereas patients with positive MRD status did (p = .034) [43], Figure 1.