The Lung Allocation Score Remains Inequitable for Patients with Pulmonary Arterial Hypertension, Even after the 2015 Revision.
The Lung Allocation Score Remains Inequitable for Patients with Pulmonary Arterial Hypertension, Even after the 2015 Revision.
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即使在 2015 年修订之后，肺动脉高压患者的肺部分配评分仍然不公平。
DOI：
10.1164/rccm.202201-0217oc
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发表时间：
2023
影响因子：
24.7
通讯作者：
DeMarco,Teresa
中科院分区：
文献类型：
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作者：
Kolaitis,NicholasA;Chen,Hubert;Calabrese,DanielR;Kumar,Kerry;Obata,Jill;Bach,Carrie;Golden,JeffreyA;Simon,MarcA;Kukreja,Jasleen;Hays,StevenR;Leard,LorrianaE;Singer,JonathanP;DeMarco,Teresa
理由：肺分配评分 (LAS) 于 2015 年进行了修订，以提高肺动脉高压 (PAH) 患者的等候名单死亡率和移植率。目的：我们试图确定 2015 年修订是否达到了预期目标。方法：使用标准移植分析和研究文件，我们通过比较修订前后的时代来评估 2015 年 LAS 修订的影响。注册者被分为 LAS 诊断类别：A 组——慢性阻塞性肺疾病； B组——肺动脉高压； C组——囊性纤维化；和D组——间质性肺疾病。竞争风险回归用于评估等待名单死亡和移植这两种相互排斥的竞争风险。创建累积发生率图以目视检查风险。测量和主要结果：2015 年 LAS 修订后，PAH 登记者的器官匹配 LAS 增加了 14.2 分，是诊断类别中增幅最大的（其他 LAS 类别：Δ，-0.9 至 +2.8 分）。修订之前，肺动脉高压患者的死亡风险最高，移植可能性最低。 2015 年修订后，PAH 登记者的死亡风险仍然最高，现在与间质性肺疾病患者相似，移植率最低，现在与慢性阻塞性肺疾病患者相似。结论：尽管 2015 年 LAS 修订改善了 PAH 患者获得移植的机会并降低了等待名单死亡的风险，但还远远不够。候补死亡率和移植可能性之间仍然存在显着差异。
Rationale:The lung allocation score (LAS) was revised in 2015 to improve waiting list mortality and rate of transplant for patients with pulmonary arterial hypertension (PAH).Objectives:We sought to determine if the 2015 revision achieved its intended goals.Methods:Using the Standard Transplant Analysis and Research file, we assessed the impact of the 2015 LAS revision by comparing the pre- and postrevision eras. Registrants were divided into the LAS diagnostic categories: group A–chronic obstructive pulmonary disease; group B–pulmonary arterial hypertension; group C–cystic fibrosis; and group D–interstitial lung disease. Competing risk regressions were used to assess the two mutually exclusive competing risks of waiting list death and transplant. Cumulative incidence plots were created to visually inspect risks.Measurements and Main Results:The LAS at organ matching increased by 14.2 points for registrants with PAH after the 2015 LAS revision, the greatest increase among diagnostic categories (other LAS categories: Δ, −0.9 to +2.8 points). Before the revision, registrants with PAH had the highest risk of death and lowest likelihood of transplant. After the 2015 revision, registrants with PAH still had the highest risk of death, now similar to those with interstitial lung disease, and the lowest rate of transplant, now similar to those with chronic obstructive pulmonary disease.Conclusions:Although the 2015 LAS revision improved access to transplant and reduced the risk of waitlist death for patients with PAH, it did not go far enough. Significant differences in waitlist mortality and likelihood of transplant persist.