Impact of Lung Allocation Score on Transplantation Activity and Outcomes – Initial German Experience

Abstract

Purpose The Lung Allocation Score (LAS), first introduced in the United States in 2005, was developed with the aim of allocating organs based on predicted transplant benefit. Analysis of its impact in the US revealed reduced waiting times, increased numbers of procedures and decreased mortality amongst listed patients. Transplant survival appeared unchanged. On December 10th 2011, Germany became the first European country to adopt LAS for organ allocation, abandoning the previous urgency system. The current study compares the effects of LAS on transplant activity, wait list mortality and outcomes directly before and after its introduction. Methods and Materials Retrospective analysis of all 506 patients undergoing lung transplantation between 14.03.2011 and 05.09.2012 was performed comparing a 9 month period before and after the introduction of LAS. Results Of these patients, 252 were transplanted prior to the introduction of LAS and 254 thereafter (p=0.68). Despite an increase in waiting list registrations, a net reduction in the number of active patients on the waiting list of 20% was observed. A significant reduction in median time to transplantation amongst transplant recipients was observed under LAS (108 vs. 208 days, p=0.001). Age of transplant recipients and the composition of underlying diagnoses did not change significantly since LAS introduction. No change in waiting list mortality were observed, remaining at 19% in both periods. A trend towards increased prevalence of ventilatory or ECMO support prior to transplantation post-LAS introduction were noted (15 vs. 26 pts. p=0.077). Conclusions Early experience with LAS in Germany corroborates previous reports from the United States. Increased numbers of procedures and improved waiting times, without any detrimental effects on early survival are apparent. Regular and objective reassessment of patients after listing acts as an early warning system, leading to earlier transplantation in unstable patients.