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Still holding their breath: Mortality on lung transplant wait list remains high for some
Date:8/23/2009

simultaneously examined two outcomesdeath versus transplantfor the nearly 8,000 registrants diagnosed with COPD, IPF, CF or IPAH and compared the "Pre-LAS" period (from May 4, 2002 to May 3, 2005) to the "post-LAS" (from May 4, 2005 to May 3, 2008.)

They were not surprised to find that implementation of LAS was associated with an overall increased likelihood of transplantation and decreased risk of death. However, further analysis revealed that the risk of death for each individual disease except IPAH decreased significantly.

Before the implementation of LAS, the likelihood of transplant was highest for COPD patients and lowest for IPAH patients, even after adjusting for confounding variables including age, blood type and type of transplant. After the LAS, IPAH patients remained the least likely to receive a transplant, despite being at greater risk of death while on the waiting list than either COPD patients or those with IPF.

"The fact that the LAS has led to an overall improvement in the time to transplantation is not particularly surprising," noted Dr. Chen. "But we would hope that those changes would have positively affected all lung transplant candidates, whereas we found distinct differences in the impact according to disease, particular for pulmonary arterial hypertension."

A possible explanation of these findings is the fact that key prognostic indicators in IPAH are not considered under the LAS algorithm. "Hemodynamic variables currently included in LAS, such as pulmonary capillary wedge pressure, provide little information for patients with IPAH," wrote Dr. Chen. "In contrast, mean right arterial pressure and cardiac index, which are known to be strong predictors of mortality for patients with IPAH, are not utilized."

"The LAS has had a positive impact on the majority of wait-listed patients in the U.S.," wrote Kevin Chan, M.D., of the University of Michigan, in an accompanying editorial. "Although the overal
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Contact: Keely Savoie
ksavoie@thoracic.org
212-315-8620
American Thoracic Society
Source:Eurekalert

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