Lung transplant for interstitial lung disease: outcomes before and after implementation of the united network for organ sharing lung allocation scoring system

• Published in: European journal of cardio-thoracic surgery 2012-03, Vol.41 (3), p.680-685
• Main Authors: De Oliveira, Nilto C., Osaki, Satoru, Maloney, James, Cornwell, Richard D., Meyer, Keith C.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Bronchoscopy - methods; Cardiology. Vascular system; Female; Follow-Up Studies; Forced Expiratory Volume - physiology; Hemodynamics; Humans; Kaplan-Meier Estimate; Lung Diseases, Interstitial - mortality; Lung Diseases, Interstitial - physiopathology; Lung Diseases, Interstitial - surgery; Lung Transplantation - mortality; Male; Medical sciences; Middle Aged; Organ Preservation - methods; Patient Selection; Perioperative Care - methods; Pneumology; Respiratory system : syndromes and miscellaneous diseases; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Tissue and Organ Procurement - organization & administration; Treatment Outcome; Vital Capacity - physiology; Waiting Lists; Wisconsin - epidemiology
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezr079

OBJECTIVES This study was undertaken to evaluate whether the adoption of the united network for organ sharing lung allocation score (LAS) was associated with significant changes in lung transplantation (LTX) outcomes for patients with interstitial lung disease (ILD) who underwent LTX at the University of Wisconsin Hospital and Clinics. METHODS Outcomes for 107 consecutive patients with various forms of ILD who underwent LTX between January 1993 and March 2009 were examined. Patients transplanted following the implementation of the LAS system (LAS, n = 56) were compared with those transplanted prior to LAS implementation (pre-LAS, n = 51) for whom LAS scores were calculated. RESULTS Patients with idiopathic pulmonary fibrosis (IPF) comprised the majority of patients with ILD. Recipients transplanted after the implementation of the LAS were significantly older (pre-LAS: 50.4 vs. LAS: 56.7 years, P < 0.01), required more supplemental oxygen (3 vs. 5 l/min, P < 0.01) and displayed lower cardiac index values (3.1 vs. 2.6 l/m2, P < 0.01). The estimated LAS was significantly increased from 38.3 (pre-LAS) to 43.3 (LAS), P < 0.01. However, waiting time decreased from 266 to 78 days (P < 0.01). The rate of bilateral vs. single LTX was lower (35 vs. 16%, P = 0.02) for the post-LAS group. Cold ischaemic time was shorter in the post-LAS group (434 vs. 299 min, P < 0.01), and the length of hospital stay decreased from 24 to 11 days (P < 0.01). Hospital mortality (11 vs. 7%, P = 0.51) and post-transplant survival did not differ between the groups. CONCLUSIONS Post-transplant outcomes for patients with ILD or the subset of recipients with IPF were not adversely affected by the implementation of the LAS.