Too High for Transplantation

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Presentation transcript:

Too High for Transplantation Too High for Transplantation? Single-Center Analysis of the Lung Allocation Score Alexis E. Shafii, MD, David P. Mason, MD, Chase R. Brown, BS, Lucy Thuita, MS, Sudish C. Murthy, MD, PhD, Marie M. Budev, DO, MPH, Gösta B. Pettersson, MD, PhD, Eugene H. Blackstone, MD The Annals of Thoracic Surgery Volume 98, Issue 5, Pages 1730-1736 (November 2014) DOI: 10.1016/j.athoracsur.2014.05.083 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Cumulative distribution of lung allocation scores (LAS) at listing and at transplantation. (A) Overall at listing and at transplantation; (B) LAS at listing stratified by diagnosis; and (C) LAS at transplantation stratified by diagnosis. The Annals of Thoracic Surgery 2014 98, 1730-1736DOI: (10.1016/j.athoracsur.2014.05.083) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Lung allocation score (LAS) and mortality on the waitlist. (A) Survival on lung transplant waitlist according to quartiles of LAS. Each symbol represents a death, vertical bars 68% confidence limits equivalent to ±1 standard error, and numbers below horizontal axis all patients remaining at risk. Quartile 1 = 9.9 to 32.4, filled circles; quartile 2 = 32.5 to 36.4, open circles; quartile 3 = 36.5 to 46.6, triangles; and quartile 4 = 46.7 to 95.1, squares. Dashed lines indicate patients still being followed. (B) Early (6-month) risk-adjusted survival after listing and before lung transplantation according to LAS at listing. Solid line is parametric estimate enclosed within dashed 68% confidence band. This is a nomogram of Table 3 (on waitlist model) based on risk-factor values approximating fourth quartile LAS: bilirubin, 0.4 mg/dL; no gastroesophageal reflux disease; partial pressure of carbon dioxide (Pco2), 40 mm Hg; and 6-minute walk, 1,000 feet. The Annals of Thoracic Surgery 2014 98, 1730-1736DOI: (10.1016/j.athoracsur.2014.05.083) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Lung allocation score (LAS) at transplantation and posttransplant mortality. (A) Survival stratified by lung allocation score quartiles. Quartile 1 = 27.4 to 33.6, filled circles; quartile 2 = 33.7 to 38.9, open circles; quartile 3 = 39.0 to 49.5, triangles; and quartile 4 = 49.6 to 95.2, squares. (B) Early (6-month) risk-adjusted survival after transplantation according to pretransplant LAS. Solid line is parametric estimate enclosed within dashed 68% confidence band. This is a nomogram of Table 3 (posttransplant model) with albumin set to 3.5 g/dL; platelet count, 220 × 109/L; donor creatinine, 1 mg/dL; listing LAS, 40; and double lung transplant. The Annals of Thoracic Surgery 2014 98, 1730-1736DOI: (10.1016/j.athoracsur.2014.05.083) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions