An acute change in lung allocation score and survival after lung transplantation: a cohort study.
An acute change in lung allocation score and survival after lung transplantation: a cohort study.
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DOI：
10.7326/0003-4819-158-9-201305070-00004
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发表时间：
2013-05-07
影响因子：
39.2
通讯作者：
Palmer SM
中科院分区：
文献类型：
--
作者：
Tsuang WM;Vock DM;Copeland CAF;Lederer DJ;Palmer SM
肺移植是晚期肺部疾病患者的有效治疗方法。在美国，肺的分配是基于肺分配评分（LAS），这是一种衡量移植紧迫性和实用性的综合指标。临床恶化导致LAS增加;然而，LAS的轨迹是否具有预后意义尚不确定。确定肺移植前LAS急性升高是否与移植后生存率降低相关。对2005年5月4日（LAS实施）至2010年12月31日期间在器官共享联合网络登记处登记至少30天的成人肺移植受者进行的回顾性队列研究。LAS的急性增加定义为在移植前30天和移植时间之间LAS变化（LASΔ）大于5个单位。多变量考克斯比例风险模型用于检查LASΔ >5与移植后移植物存活率之间的关系。全美国的肺移植中心。5749例肺移植受者。肺移植后生存时间。702名（12.2%）患者的LASΔ >5。在调整了移植时的LAS和其他临床协变量后，这些患者的移植后生存率显著更差（风险比，1.31 [95%CI，1.11 - 1.54]; P = 0.001]）。LASΔ >5的影响与移植时的LAS、基础诊断、中心容量或供体特征无关。分析基于中心报告的数据。移植前LAS的急性增加与移植时调整LAS后的移植后存活率相关。进一步强调LAS的系列评估可以改善移植后的并发症。
Lung transplantation is an effective treatment for patients with advanced lung disease. In the United States, lungs are allocated on the basis of the lung allocation score (LAS), a composite measure of transplantation urgency and utility. Clinical deteriorations result in increases to the LAS; however, whether the trajectory of the LAS has prognostic significance is uncertain. To determine whether an acute increase in the LAS before lung transplantation is associated with reduced posttransplant survival. Retrospective cohort study of adult lung transplant recipients listed for at least 30 days between 4 May 2005 (LAS implementation) and 31 December 2010 in the United Network for Organ Sharing registry. An acute increase in the LAS was defined as an LAS change (LASΔ) greater than 5 units between the 30 days before and the time of transplantation. Multivariable Cox proportional hazards models were used to examine the relationship between an LASΔ >5 and posttransplant graft survival. All U.S. lung transplantation centers. 5749 lung transplant recipients. Survival time after lung transplantation. 702 (12.2%) patients experienced an LASΔ >5. These patients had significantly worse posttransplant survival (hazard ratio, 1.31 [95% CI, 1.11 to 1.54]; P = 0.001]) after adjustment for the LAS at transplantation and other clinical covariates. The effect of an LASΔ >5 was independent of the LAS at transplantation, underlying diagnosis, center volume, or donor characteristics. Analysis was based on center-reported data. An acute increase in LAS before transplantation is associated with posttransplant survival after adjustment for LAS at transplantation. Further emphasis on serial assessment of the LAS could improve prognostication after transplantation.
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