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Clinical judgment versus lung allocation score in predicting lung transplant waitlist mortality
Alim Hirji1, Hedi Zhao2, Maria B Ospina1
1University of Alberta, Edmonton, AB, Canada.
Clinical Transplantation
|April 10, 2020
Summary
The Lung Allocation Score (LAS) better predicts waitlist mortality than the subjective Status system in lung transplant candidates. Combining LAS and clinical judgment may offer the best prediction for transplant waitlist survival.
Area of Science:
- Transplant Surgery
- Cardiology
- Pulmonology
Background:
- Canadian lung transplant centers use a subjective
- Status
- ranking for waitlist prioritization.
Purpose of the Study:
- Compare the predictive accuracy of the Lung Allocation Score (LAS) versus clinical judgment (
- Status
- ) for waitlist mortality.
Main Methods:
- Retrospective cohort study of 1122 adult lung transplant candidates (2007-2012).
- Compared LAS and Status using Cox proportional hazards models and C-statistics to predict waitlist mortality.
Main Results:
- Higher LAS was associated with increased waitlist mortality risk (HR 1.06 per unit LAS).
- LAS demonstrated superior prediction of waitlist mortality compared to Status (C-statistic 0.689 vs 0.674).
- Status 2 patients with LAS ≥ 37 faced the highest mortality risk (HR 8.94).
Conclusions:
- The objective Lung Allocation Score (LAS) is a better predictor of waitlist mortality than the subjective Status system.
- A combination of LAS and clinical judgment may provide the most accurate prediction of waitlist mortality in lung transplant candidates.
