High Lung Allocation Scores Do Not Preclude Improvement in Health-Related Quality of Life after Lung Transplantation

Abstract

Purpose High lung allocation listing scores (LAS) are associated with higher mortality after lung transplantation (LTx). Whether high LAS is associated with attenuated improvements in health-related quality of life (HRQL) is unknown. Methods In a single-center prospective cohort study from 2010-2017, we assessed HRQL before and through 6-months after LTx. HRQL was assessed by the Medical Outcomes Study Short Form Physical and Mental Component Summary scales (SF12-PCS, -MCS), the Airway Questionnaire 20-Revised (AQ20R), and the Euroqol 5D (EQ5D) (Table shows measure ranges and minimally clinically important differences). We compared high LAS to low LAS using two grouping approaches. In the first, high LAS was defined as >50. In the second, the cohort was grouped into quintiles by LAS; the highest quintile (LAS >85) was compared to quintiles 1-4. We compared change in HRQL between LAS groupings from before through 6-months after LTx by linear mixed effects models adjusting for age, sex, diagnosis, pre-transplant forced vital capacity , and 6-minute walk distance. Results Two-hundred fifty subjects underwentLTx. In approach one, the high LAS group (>50) generally had worse pre-LTx HRQL (Table, part 1). Generally, the improvements in HRQL after LTx were similar between the high and low LAS groups (Table, part 2). Exceptions included the SF12-MCS and EQ5D in approach 1 and EQ5D in approach 2 in which the high LAS groups experienced greater improvements (approach 1: SF12-MCS difference 2.94 points, 95% CI: 0.36, 5.51; EQ5D difference 0.11 points, 95% CI 0.06, 0.16; approach 2: EQ5D difference 0.16 points, 95% CI 0.10, 0.22). Conclusion LTx recipients with high LAS have similar or greater improvements in HRQL after LTx compared to recipients with low LAS. Despite their increased risk of mortality, patients with high LAS can be reassured that the improvements in HRQL provided by LTx are large and similar to those with lower scores.