MedWire News: Lung Allocation Score (LAS) is associated with pre- but not post-lung transplant survival in chronic obstructive pulmonary disease patients (COPD), US research shows.

“The LAS, devised to prioritize candidates awaiting lung transplantation, is calculated using the predicted duration of survival on the wait list while also considering the recipient’s likelihood of post-transplant survival,” explain David Nunley (Ohio State University College of Medicine, Columbus) and team.

However, they add: “Since its inception there has been controversy regarding whether the LAS would be useful in achieving the goals of correctly identifying those candidates who were more ill and therefore in more immediate need of a transplant while also favoring those with acceptable post-transplant survival.”

To investigate further, the researchers studied survival data on 41 patients with COPD who were on a waiting list for lung transplantation, and another 17 patients with the disease who received a lung transplant.

In total, 36 of the patients on the waiting list survived to receive a transplant and five died before undergoing the procedure.

The researchers found that the mean LAS calculated for those who survived to receive a transplant was significantly lower than the mean score of those who died while on the waiting list, at 32.62 versus 34.45, respectively.

Among the 17 patients who received lung transplants, 13 were still alive after 1 year. There was no significant association between pre-transplant LAS score and 1-year post-transplant survival among this group.

Nunley and team conclude in the journal Lung: “In a sample of lung transplantation candidates with COPD, as expected, a lower LAS is associated with improved survival to transplant. However, even though the LAS is also calculated in part on the probability of surviving at least 1 year following transplant, no association with post-transplant survival was observed.”

They add: “The results of this pilot investigation require confirmation using a prospective design and larger sample size as well as additional evaluation in other populations with end-stage lung disease.”

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