Lung Transplantation in Patients with High Lung Allocation Scores in the US: Evidence for the Need to Evaluate Score Specific Outcomes
Lung Transplantation in Patients with High Lung Allocation Scores in the US: Evidence for the Need to Evaluate Score Specific Outcomes
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DOI：
10.1155/2015/836751
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发表时间：
2015-01-01
影响因子：
2.5
通讯作者：
D'Cunha, Jonathan
中科院分区：
文献类型：
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作者：
Hayanga, Jeremiah A.;Lira, Alena;D'Cunha, Jonathan
Objective.肺分配评分（LAS）导致肺移植（LT）的选择过程中指导的临床敏锐度。我们试图评价劳工会计制度与结果之间的关系。方法.我们分析了2005年至2012年期间与接受者有关的移植物科学登记处（SRTR）数据。我们根据LAS将其分为四分位数，并比较生存率和死亡率的预测因素。结果我们确定了10，304例连续患者，每个LAS四分位数（四分位数1（26.3-35.5），四分位数2（35.6-39.3），四分位数3（39.4-48.6）和四分位数4（48.7-95.7））中包含2，576例。30天后的存活率（96.9% vs 96.8% vs 96.0% vs 94.8%），90天（94.6% vs 93.7% vs 93.3% vs 90.9%），1年（87.2% vs 85.0% vs 84.8% vs 80.9%）和5年（55.4% vs 54.5% vs 52.5% vs 48.8%）在较低组中较高。最高LAS组的5年死亡率显著更高（HR 1.13，p = 0.030，HR 1.17，p = 0.01和HR 1.17，p = 0.02），分别与四分位数2、3和4相比。结论总体而言，LAS较高的受者的结局比LAS较低的受者更差。这些数据应该在移植前咨询期间提供更多个性化的循证讨论。
Objective. The lung allocation score (LAS) resulted in a lung transplantation (LT) selection process guided by clinical acuity. We sought to evaluate the relationship between LAS and outcomes. Methods. We analyzed Scientific Registry of Transplant Recipient (SRTR) data pertaining to recipients between 2005 and 2012. We stratified them into quartiles based on LAS and compared survival and predictors of mortality. Results. We identified 10,304 consecutive patients, comprising 2,576 in each LAS quartile (quartile 1 (26.3-35.5), quartile 2 (35.6-39.3), quartile 3 (39.4-48.6), and quartile 4 (48.7-95.7)). Survival after 30 days (96.9% versus 96.8% versus 96.0% versus 94.8%), 90 days (94.6% versus 93.7% versus 93.3% versus 90.9%), 1 year (87.2% versus 85.0% versus 84.8% versus 80.9%), and 5 years (55.4% versus 54.5% versus 52.5% versus 48.8%) was higher in the lower groups. There was a significantly higher 5-year mortality in the highest LAS group (HR 1.13, p = 0.030, HR 1.17, p = 0.01, andHR 1.17, p = 0.02) comparing quartiles 2, 3, and 4, respectively, to quartile 1. Conclusion. Overall, outcomes in recipients with higher LAS are worse than those in patients with lower LAS. These data should inform more individualized evidence-based discussion during pretransplant counseling.