DOCSLIB.ORG

The Impact of the Lung Allocation Score on Short-Term Transplantation Outcomes: a Multicenter Study

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Impact of the Lung Allocation Score on Short-Term Transplantation Outcomes: a Multicenter Study Cardiothoracic Transplantation Kozower et al The impact of the lung allocation score on short-term transplantation outcomes: A multicenter study Benjamin D. Kozower, MD,a Bryan F. Meyers, MD,b Michael A. Smith, MD,c Nilto C. De Oliveira, MD,d Stephen D. Cassivi, MD,e Tracey J. Guthrie, RN,b Honkung Wang, PhD,f Beverly J. Ryan, ACNP,a K. Robert Shen, MD,a Thomas M. Daniel, MD,a and David R. Jones, MDa Objective: The lung allocation score restructured the distribution of scarce donor lungs for transplantation. The algorithm ranks waiting list patients according to medical urgency and expected benefit after transplantation. The purpose of this study was to evaluate the impact of the lung allocation score on short-term outcomes after lung transplantation. Methods: A multicenter retrospective cohort study was performed with data from 5 academic medical centers. Results of patients undergoing transplantation on the basis of the lung allocation score (May 4, 2005 to May 3, 2006) were compared with those of patients receiving transplants the preceding year before the lung allocation score was implemented (May 4, 2004, to May 3, 2005). Results: The study reports on 341 patients (170 before the lung allocation score and 171 after). Waiting time decreased from 680.9 Ϯ 528.3 days to 445.6 Ϯ Dr Kozower 516.9 days (P Ͻ .001). Recipient diagnoses changed with an increase in idiopathic pulmonary fibrosis and a decrease in emphysema and cystic fibrosis (P ϭ .002). Postoperatively, primary graft dysfunction increased from 14.1% (24/170) to 22.9% (39/171) (P ϭ .04) and intensive care unit length of stay increased from 5.7 Ϯ 6.7 days to 7.8 Ϯ 9.6 days (P ϭ .04). Hospital mortality and 1-year survival were the same between groups (5.3% vs 5.3% and 90% vs 89%, respectively; P Ͼ .6) From the Department of Surgery, Univer- sity of Virginia Health System, Charlottes- ville, Vaa; Department of Surgery, Wash- Conclusions: This multicenter retrospective review of short-term outcomes supports ington University School of Medicine, St the fact that the lung allocation score is achieving its objectives. The lung allocation Louis, Mob; Department of Cardiothoracic Surgery, University of Southern California, score reduced waiting time and altered the distribution of lung diseases for which Los Angeles, Calif c; Department of Sur- transplantation was done on the basis of medical necessity. After transplantation, gery, University of Wisconsin, Madison, recipients have significantly higher rates of primary graft dysfunction and intensive Wisd; Department of Surgery, Mayo Clinic, Rochester, Minne; and Department of Pub- care unit lengths of stay. However, hospital mortality and 1-year survival have not lic Health Sciences, University of Virginia been adversely affected. Health System, Charlottesville, Va.f Read at the Eighty-seventh Annual Meeting TX of The American Association for Thoracic Surgery, Washington, DC, May 5–9, 2007. Received for publication May 3, 2007; re- he lung allocation score (LAS) was implemented in May 2005 by the Organ visions received Aug 13, 2007; accepted for 1 publication Aug 15, 2007. Procurement and Transplantation Network (OPTN).The LAS dramatically changed lung allocation from a system based purely on waiting time to an Address for reprints: Benjamin D. Kozo- T wer, MD, University of Virginia Health algorithm based on survival probability on the waiting list and after transplantation. System, General Thoracic Surgery, PO Box The impetus for change was the scarcity of suitable donor lungs and the increasing 800679, Charlottesville, VA 22908-0679 2-4 (E-mail: [email protected]). number of deaths for patients on the waiting list. The OPTN began allocating lungs in 1990 on the basis of blood type and the J Thorac Cardiovasc Surg 2008;135:166-71 amount of time candidates had spent on the5 In waiting1995, list.a minor change 0022-5223/$34.00 was made to this system when 90 days of waiting time were added for patients with Copyright © 2008 by The American Asso- ciation for Thoracic Surgery idiopathic pulmonary fibrosis to offset the increased risk of mortality on the waiting doi:10.1016/j.jtcvs.2007.08.044 list. In 1998, the Department of Health and Human Services published the Final Rule.6 This required the OPTN to emphasize the broader sharing of organs, reduce 166 The Journal of Thoracic and Cardiovascular Surgery ● January 2008 Kozower et al Cardiothoracic Transplantation variables available close to the time of transplant. Primary graft Abbreviations and Acronyms dysfunction was defined according to the International Society of ICU ϭ intensive care unit Heart and Lung Transplantation definition: arterial oxygen tension/ LAS ϭ lung allocation score inspired oxygen fraction less than 300 and a chest radiograph with OPTN ϭ Organ Procurement and Transplantation a characteristic diffuse bilateral infiltrate.8 The human studies Network committees at each institution granted approval for this research. Waiting List Estimates Data from the waiting lists at the five institutions were gathered for the use of waiting time as an allocation criterion, and create the same two groups. To calculate the percentage of patients dying an allocation system based on objective medical criteria and on the waiting list, we estimated the size of the waiting list for both measures of medical urgency. groups. Because the waiting lists are dynamic, this is not a straight- The LAS was developed by multivariate modeling and forward process. We identified the actual number of patients on the was approved by the OPTN in 2004. The three main objec- waiting lists at 4 interval time points for both cohorts (May 15, tives were as follows: (1) reduce the number of deaths on August 15, November 15, and February 15). These numbers were the lung transplant waiting list, (2) increase transplant ben- averaged (total number divided by 4) to estimate the size (denom- efit for lung recipients, and (3) ensure the efficient and inator) of the waiting list. The numerator was the actual number of patients who died on the waiting lists. equitable allocation of lungs to active transplant candi- dates.7 The LAS assigns a score to all candidates over the Statistical Analysis age of 12 years ranging from 0 to 100. It is a weighted Categorical variables were compared by the ␹2 test. Continuous combination of predicted risk of death during the following variables were compared with the Student t test or Kruskal–Wallis year on the waiting list and the predicted likelihood of test where appropriate. Estimates of the cumulative death rate at 1 survival during the first year after transplantation. year were calculated by the Kaplan–Meier method, and the sur- The purpose of this study was to evaluate the impact of vival differences between the pre-LAS and LAS groups were the LAS system on the waiting list and short-term outcomes assessed by the log–rank test. Short-term results were controlled after lung transplantation. Many lung transplant surgeons for diagnosis by the Mantel–Haenszel test. All data analysis was have the impression that the LAS has increased the com- performed with SAS 9.1.3 software (SAS Institute, Inc, Cary, NC). plexity of the cases and their complication rates. Our hy- pothesis was that the LAS would decrease waiting time for Results recipients but would also increase morbidity and mortality Patient Characteristics after transplantation. There were 170 patients in the pre-LAS group and 171 in the LAS group. The numbers of patients per group from Patients and Methods each institution were as follows: Washington University 59 Transplant Recipients and 52, University of Southern California 37 and 38, Uni- A multicenter retrospective cohort study was performed with data versity of Virginia 31 and 35, University of Wisconsin 34 from five academic medical centers: University of Virginia, Wash- and 33, and Mayo Clinic 9 and 13. The baseline character- ington University, University of Southern California, University of istics are listed in Table 1. The pre-LAS group had fewer Wisconsin, and the Mayo Clinic. The two cohorts were patients retransplants and a lower calculated LAS (P Ͻ .05). The undergoing transplantation the year preceding the introduction of the LAS (May 4, 2004, to May 3, 2005) (pre-LAS group) and recipient diagnoses changed significantly with the initiation patients undergoing transplantation the year after the LAS was of the LAS (Table 2). There were an increase in the number implemented (May 4, 2005, to May 3, 2006) (LAS group). In an of patients with idiopathic pulmonary fibrosis and a de- effort to compare the severity of illness between the groups, the crease in patients with chronic obstructive pulmonary dis- TX LAS was calculated for the pre-LAS group using the appropriate ease and cystic fibrosis (P ϭ .002). TABLE 1. Baseline characteristics P value (171 ؍ LAS (n (170 ؍ Pre-LAS (n Age (y) 49.2 Ϯ 14.0 51.2 Ϯ 13.0 .16 Gender (female) 80 (47.1%) 80 (46.8%) .96 Procedure (bilateral lung transplant) 111 (65.3%) 106 (62.0%) .2 Retransplantation 3 (1.8%) 10 (5.8%) .05 Ischemic time (first lung in minutes) 285.2 Ϯ 97.9 271.0 Ϯ 99.4 .20 LAS 35.4 Ϯ 8.2 42.5 Ϯ 15.2 Ͻ.001 LAS, Lung allocation score. The Journal of Thoracic and Cardiovascular Surgery ● Volume 135, Number 1 167 Cardiothoracic Transplantation Kozower et al TABLE 2. Recipient diagnosis P value (171 ؍ LAS (n (170 ؍ Pre-LAS (n Etiology of end-stage lung disease COPD 78 (45.9%) 58 (33.9%) Cystic fibrosis 39 (22.9%) 22 (12.9%) Idiopathic pulmonary fibrosis 25 (14.7%) 42 (24.6%) .002 Pulmonary hypertension 7 (4.1%) 4 (2.3%) Other 21 (12.4%) 45 (26.3%) LAS, Lung allocation score; COPD, chronic obstructive pulmonary disease.
Load more

Recommended publications
  • Surgical Advances in Heart and Lung Transplantation
    Anesthesiology Clin N Am 22 (2004) 789–807 Surgical advances in heart and lung transplantation Eric E. Roselli, MD*, Nicholas G. Smedira, MD Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Desk F25, 9500 Euclid Avenue, Cleveland, OH 44195, USA The first heart transplants were performed in dogs by Alexis Carrel and Charles Guthrie in 1905, but it was not until the 1950s that attempts at human orthotopic heart transplant were reported. Several obstacles, including a clear definition of brain death, adequate organ preservation, control of rejection, and an easily reproducible method of implantation, slowed progress. Eventually, the first successful human to human orthotopic heart transplant was performed by Christian Barnard in South Africa in 1967 [1]. Poor healing of bronchial anastomoses hindered early progress in lung transplantation, first reported in 1963 [2]. The first successful transplant of heart and both lungs was accomplished at Stanford University School of Medicine (Stanford, CA) in 1981 [3]. The introduction of cyclosporine to immunosuppres- sion protocols, with lower doses of steroids, led to the first successful isolated lung transplant, performed at Toronto General Hospital in 1983 [4]. Since these early successes at thoracic transplantation, great progress has been made in the care of patients with end-stage heart and lung disease. Although only minor changes have occurred in surgical technique for heart and lung transplantation, the greatest changes have been in liberalizing donor criteria to expand the donor pool. This article focuses on more recent surgical advances in donor selection and management, procurement and implantation, and the impact these advances have had on patient outcome.
    [Show full text]
  • Clinical Policy: Lung Transplantation Reference Number: CP.MP.57 Coding Implications Last Review Date: 05/20 Revision Log
    Clinical Policy: Lung Transplantation Reference Number: CP.MP.57 Coding Implications Last Review Date: 05/20 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description Medical necessity criteria for the review of lung transplantation requests. Policy/Criteria I. It is the policy of health plans affiliated with Centene Corporation® that lung transplant for members with chronic, end-stage lung disease who have failed maximal medical therapy is medically necessary when all of the following criteria are met: A. High (> 50%) risk of death from lung disease within 2 years if lung transplantation is not performed. B. High (> 80%) likelihood of surviving at least 90 days after lung transplantation. C. High (> 80%) likelihood of 5-year post-transplant survival from a general medical perspective provided that there is adequate graft function. D. Does not have ANY of the following absolute contraindications: 1. Malignancy, except for non-melanoma localized skin cancer that has been treated appropriately, low grade prostate cancer, a malignancy that has been completely resected, or a treated malignancy determined to have a small likelihood of recurrence and acceptable future risks; 2. Untreatable significant dysfunction of another major organ system unless combined organ transplantation can be performed; 3. Uncorrected atherosclerotic disease with suspected or confirmed end-organ ischemia or dysfunction and/or coronary artery disease not amenable to revascularization; 4. Acute medical instability, including, but not limited to, acute sepsis, acute viral respiratory infection, myocardial infarction, and liver failure; 5. Uncorrectable bleeding diathesis; 6. Chronic infection with highly virulent and/or resistant microbes that are poorly controlled pre-transplant; 7.
    [Show full text]
  • Lung Transplantation with the OCS (Organ Care System)
    Lung Transplantation with the OCSTM (Organ Care System) Lung System Bringing Breathing Lung Preservation to Transplant Patients A Guide for You and Your Family DRAFT ABOUT THIS BOOKLET This booklet was created for patients like you who have been diagnosed with end-stage lung failure and are candidates for a lung transplant. It contains information that will help you and your family learn about options available to you for a transplant. This booklet includes information on your lungs, how they function, and respiratory failure. In addition, you will learn about a new way to preserve lungs before transplantation, called breathing lung preservation. Your doctor is the best person to explain your treatment options and their risks and to help you decide which option is right for you. The booklet explains: • Breathing lung preservation with the OCS™ Lung System • How the OCS™ Lung System works • Who is eligible for the OCS™ Lung System • Lung transplant complications • How the lungs function • What is respiratory failure and the treatment options • What to expect during your treatment • Summary of clinical data for the OCS™ Lung System • Contact Information Please read this booklet carefully and share it with your family and caregivers. For your convenience, a glossary is provided in the front of this booklet. Terms in the text in bold italics are explained in the glossary. If you have questions about the OCS™ Lung System that are not answered in this booklet, please ask your physician. This booklet is intended for general information only. It is not intended to tell you everything you need to know about a lung transplant.
    [Show full text]
  • Ethical Implications of Multi-Organ Transplants OPTN/UNOS Ethics Committee
    Public Comment Proposal Ethical Implications of Multi-Organ Transplants OPTN/UNOS Ethics Committee Prepared by: Abigail Fox, MPA UNOS Policy & Community Relations Department Contents Executive Summary 1 Is the sponsoring Committee requesting specific feedback or input about the resource? 1 What problem will this resource address? 1 Why should you support this resource? 1 How was this resource developed? 1 How well does this resource address the problem statement? 3 Which populations are impacted by this resource? 3 How does this resource impact the OPTN Strategic Plan? 4 How will the OPTN implement this resource? 5 How will members implement this resource? 5 Will this resource require members to submit additional data? 5 How will members be evaluated for compliance with this resource? 5 White Paper 6 OPTN/UNOS Public Comment Proposal Ethical Implications of Multi-Organ Transplants Affected Policies: N/A Sponsoring Committee: Ethics Committee Public Comment Period: January 22, 2019 – March 22, 2019 Executive Summary The allocation policies for multi-organ transplant (MOT) have the potential to create inequity in the organ distribution process, either in the rate of transplantation or in the time to transplantation. Such potential inconsistencies may affect the patients who are awaiting MOT as well as those who are awaiting single organ transplantation (SOT) because both groups depend upon available organs from the same limited donor pool. Prioritization of MOT candidates and the allocation rules for each combination have not been standardized across the different organs. As a result, the current allocation system has generated confusion in the transplant community about the rationale for differences in MOT allocation plans between different organ combinations.
    [Show full text]
  • Performance Changes Following the Revision of Organ Allocation System of Lung Transplant
    J Korean Med Sci. 2021 Mar 29;36(12):e79 https://doi.org/10.3346/jkms.2021.36.e79 eISSN 1598-6357·pISSN 1011-8934 Original Article Performance Changes Following the Cell Therapy & Organ Transplantation Revision of Organ Allocation System of Lung Transplant: Analysis of Korean Network for Organ Sharing Data Hye Ju Yeo ,1,2 Do Hyung Kim ,3 Yun Seong Kim ,1 Doosoo Jeon ,1 and Woo Hyun Cho 1,2 1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea Received: Aug 4, 2020 2Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Accepted: Jan 13, 2021 Yangsan Hospital, Yangsan, Korea 3Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Address for Correspondence: Korea Woo Hyun Cho, MD Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine and Research Institute for ABSTRACT Convergence of Biomedical Science and Technology, Pusan National University Background: There is currently a lack of data on the impact of the recent revision of the Yangsan Hospital, 20 Geumo-ro, Mulgeum- eup, Yangsan 50612, Republic of Korea. domestic lung allocation system on transplant performance. E-mail: [email protected] Methods: We conducted a retrospective analysis of transplant candidates and transplant patients registered in Korean Network for Organ Sharing between July 2015 and July 2019. Study © 2021 The Korean Academy of Medical periods were classified according to the introduction of the revised lung allocation system as Sciences. This is an Open Access article distributed follows: period 1 from July 2015 to June 2017 and period 2 from August 2017 to July 2019.
    [Show full text]
  • Vascularized Composite Allografts (Lc Cendales, Section Editor)
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Springer - Publisher Connector Curr Transpl Rep (2014) 1:173–182 DOI 10.1007/s40472-014-0025-6 VASCULARIZED COMPOSITE ALLOGRAFTS (LC CENDALES, SECTION EDITOR) Vascularized Composite Allografts: Procurement, Allocation, and Implementation Axel Rahmel Published online: 3 July 2014 # The Author(s) 2014. This article is published with open access at Springerlink.com Abstract Vascularized composite allotransplantation is a allotransplantation. In 2005, the first face transplantation was continuously evolving area of modern transplant medicine. performed in Lyon [5]; since then the number of face trans- Recently, vascularized composite allografts (VCAs) have plants has increased [6]. This special category of transplants is been formally classified as ‘organs’.Inthisreview,keyas- localized at the border between tissue and organ transplanta- pects of VCA procurement are discussed, with a special focus tion. The term composite tissue allotransplantation (CTA) on interaction with the procurement of classical solid organs. used in the past reflects that it was often considered as a In addition, options for a matching and allocation system that special type of tissue transplantation [7]. Several reports ensures VCA donor organs are allocated to the best-suited looking in-depth at limb and face transplantation made it clear recipients are looked at. Finally, the different steps needed to that vascularized composite allotransplantation is in central promote VCA transplantation in society in general and in the aspects more similar to organ than to tissue transplantation medical community in particular are highlighted. [7–12]. After careful evaluation involving the transplant com- munity and the general public, the United States Department of Health and Human Services recently published its decision Keywords Transplantation .
    [Show full text]
  • Chronic Lung Allograft Dysfunction Post Lung Transplantation: a Review of Computed Tomography Quantitative Methods for Detection and Follow-Up
    Journal of Clinical Medicine Review Chronic Lung Allograft Dysfunction Post Lung Transplantation: A Review of Computed Tomography Quantitative Methods for Detection and Follow-Up Trieu-Nghi Hoang-Thi 1,2,3 , Guillaume Chassagnon 1, Thong Hua-Huy 3, Veronique Boussaud 4, Anh-Tuan Dinh-Xuan 3 and Marie-Pierre Revel 1,* 1 AP-HP.Centre, Hôpital Cochin, Department of Radiology, Université de Paris, 75014 Paris, France; [email protected] (T.-N.H.-T.); [email protected] (G.C.) 2 Department of Diagnostic Imaging, Vinmec Central Park Hospital, Ho Chi Minh City 70000, Vietnam 3 AP-HP.Centre, Hôpital Cochin, Department of Respiratory Physiology, Université de Paris, 75014 Paris, France; [email protected] (T.H.-H.); [email protected] (A.-T.D.-X.) 4 AP-HP.Centre, Hôpital Cochin, Department of Pneumology, Université de Paris, 75014 Paris, France; [email protected] * Correspondence: [email protected]; Tel.: +33-1-5841-2471 Abstract: Chronic lung allograft dysfunction (CLAD) remains the leading cause of morbidity and mortality after lung transplantation. The term encompasses both obstructive and restrictive pheno- types, as well as mixed and undefined phenotypes. Imaging, in addition to pulmonary function tests, plays a major role in identifying the CLAD phenotype and is essential for follow-up after Citation: Hoang-Thi, T.-N.; lung transplantation. Quantitative imaging allows for the performing of reader-independent precise Chassagnon, G.; Hua-Huy, T.; Boussaud, V.; Dinh-Xuan, A.-T.; evaluation of CT examinations. In this review article, we will discuss the role of quantitative imaging Revel, M.-P.
    [Show full text]
  • Pulmonary Transplantation Council
    INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION (ISHLT) LUNG TRANSPLANTATION CORE COMPETENCY CURRICULUM (ISHLT LTX CCC) SECOND EDITION June 2017 THE EDUCATIONAL WORKFORCE OF THE ISHLT PULMONARY TRANSPLANTATION COUNCIL L. LEARD, G. DELLEGREN, and D. DILLING Acknowledgements to First Edition Authors: T. ASTOR, G. BERRY, K. CHAN, D. MASON, D. LEVINE, C. WIGFIELD CONTACT: EMAIL: [email protected] TEL: 708-327-2488 FAX: 708-327-2382 1 (V 2.0 June 15, 2017) ISHLT PULMONARY TRANSPLANTATION COUNCIL EDUCATION WORKFORCE CHAIR LORRIANA LEARD, MD UNIVERSITY OF CALIFORNIA SAN FRANCISCO MEDICAL CENTER SAN FRANCISCO, CALIFORNIA, USA [email protected] CO-CHAIRS GORAN DELLEGREN, MD, PHD SAHLGRENSKA UNIVERSITY HOSPITAL GOTEBORG, SWEDEN [email protected] DANIEL DILLING, MD LOYOLA UNIVERSITY MEDICAL CENTER MAYWOOD, ILLINOIS, USA [email protected] ACKNOWLEDGEMENT OF PRIOR CURRICULTUM CONTENT AUTHORS: KEVIN M. CHAN, MD UNIVERSITY OF MICHIGAN HEALTH SYSTEM 1500 EAST MEDICAL CENTER 3916 TAUBMAN CENTER, BOX 0360 ANN ARBOR, MI 48109 734-936-5047 734-936-7048 (FAX) [email protected] DEBORAH J. LEVINE, MD UT HEALTH CENTER @ SAN ANTONIO 7703 FLOYD CURL DR. DEPT. OF SURGERY, MC 7841 SAN ANTONIO, TX 78229 210-567-5616 210-567-2877 (FAX) [email protected] DAVID P. MASON, MD CLEVELAND CLINIC FOUNDATION THORACIC & CV SURGERY, J4-1 9500 EUCLID AVE. CLEVELAND, OH 44195 216-444-4053 216-445-6876 (FAX) 2 [email protected] GERRY J. BERRY MD STANFORD UNIVERSITY MEDICAL CENTER DEPT. ANATOMIC PATHOLOGY 300 PASTEUR DRIVE SUIT H 2110 STANFORD, CA 94305 650- 723- 7211 650-725-7409 (FAX) [email protected] TODD L. ASTOR, MD PULMONARY AND CRITICAL CARE UNIT MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT STREET, BULFINCH 148 BOSTON, MA 02114 617-623-9704 [email protected] 3 ISHLT LTX CCC: LIST OF CONTENTS I.
    [Show full text]
  • A Guide to Calculating the Lung Allocation Score
    A Guide to Calculating the Lung Allocation Score U.S. lung allocation policy prioritizes lung transplant candidates for lung offers by assigning them a lung allocation score. What is the Lung Allocation Score? The lung allocation score (LAS) is used to prioritize waiting list candidates based on a combination of waitlist urgency and post-transplant survival. In this context, waitlist urgency is defined as what is expected to happen to a candidate, given his or her characteristics, in the next year if he or she doesn’t receive a transplant. Post-transplant survival is defined as what is expected to happen to a candidate, given his or her characteristics, in the first year after a transplant if he or she does receive the transplant. What is involved in the LAS calculation? The LAS involves the following steps: 1. Calculate the waiting list survival probability during the next year 2. Calculate the waitlist urgency measure 3. Calculate the post-transplant survival probability during the first post-transplant year 4. Calculate the post-transplant survival measure 5. Calculate the raw allocation score 6. Normalize the raw allocation score to obtain the LAS. A detailed explanation for each of the steps follows. How is the LAS actually calculated? We’ve computed the LAS for a hypothetical candidate to help you understand the process. The following description of the calculation of the LAS in this document assumes that all characteristics are known. With the exception of a few characteristics (e.g., age and diagnosis), the LAS can also be computed when characteristics are missing.
    [Show full text]
  • Historical Perspectives of Lung Transplantation: Connecting the Dots
    4531 Review Article Historical perspectives of lung transplantation: connecting the dots Tanmay S. Panchabhai1, Udit Chaddha2, Kenneth R. McCurry3, Ross M. Bremner1, Atul C. Mehta4 1Norton Thoracic Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA; 2Department of Pulmonary and Critical Care Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA; 3Department of Cardiothoracic Surgery, Sydell and Arnold Miller Family Heart and Vascular Institute; 4Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA Contributions: (I) Conception and design: TS Panchabhai, AC Mehta; (II) Administrative support: TS Panchabhai, RM Bremner, AC Mehta; (III) Provision of study materials or patients: TS Panchabhai, U Chaddha; (IV) Collection and assembly of data: TS Panchabhai, U Chaddha, AC Mehta; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Atul C. Mehta, MD, FCCP. Professor of Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; Staff Physician, Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA. Email: [email protected]. Abstract: Lung transplantation is now a treatment option for many patients with end-stage lung disease. Now 55 years since the first human lung transplant, this is a good time to reflect upon the history of lung transplantation, to recognize major milestones in the field, and to learn from others’ unsuccessful transplant experiences. James Hardy was instrumental in developing experimental thoracic transplantation, performing the first human lung transplant in 1963. George Magovern and Adolph Yates carried out the second human lung transplant a few days later.
    [Show full text]
  • Islet Interleukin-1Β Immunoreactivity Is an Early Feature of Cystic Fibrosis That May Contribute to Β-Cell Failure
    Diabetes Care 1 Islet Interleukin-1b Rebecca L. Hull,1 Ronald L. Gibson,2 Sharon McNamara,2 Gail H. Deutsch,3 Immunoreactivity Is an Early Corinne L. Fligner,3 Charles W. Frevert,1,4 Bonnie W. Ramsey,2 and Srinath Sanda5,6 Feature of Cystic Fibrosis That May Contribute to b-Cell Failure https://doi.org/10.2337/dc17-1387 OBJECTIVE Cystic fibrosis–related diabetes (CFRD) is a common complication of cystic fibrosis (CF), increasing patient morbidity and mortality. Poor understanding of CFRD path- ogenesis limits the development of targeted therapies to treat and/or prevent the disease. The aim of this study was to evaluate islet pathology, specifically, inflam- mation, amyloid deposition, and endocrine cell composition in subjects with CF with diabetes and with CF without diabetes. RESEARCH DESIGN AND METHODS A retrospective analysis of archived pancreas tissue collected at autopsy was con- ducted using pancreas tissue from subjects with CF and diabetes (CFRD) (n = 18) and PATHOPHYSIOLOGY/COMPLICATIONS CF without diabetes (CF-no DM) (n = 17). Two cohorts of control non-CF subjects were identified, each matched to CFRD and CF-no DM subjects for age, sex, and BMI (non-CF older, n = 20, and non-CF younger, n = 20), respectively. Immunohistochem- istry was performed to assess IL-1b and islet hormone (insulin, glucagon, somato- statin, and pancreatic polypeptide) immunoreactivity; histochemistry was performed 1Department of Medicine, University of Wash- to quantify amyloid deposition. ington, Seattle, WA 2Department of Pediatrics, University of Wash- RESULTS ington, Seattle, WA 3Department of Pathology, University of Wash- Islet IL-1b immunoreactivity was substantially increased in both CFRD and CF-no DM ington, Seattle, WA subjects compared with non-CF subjects and was common in young subjects with CF 4Department of Comparative Medicine, Univer- (£10 years of age).
    [Show full text]
  • Airway Versus Transbronchial Biopsy and BAL in Lung Transplant Recipients: Different but Complementary
    Eur Respir J 1997; 10: 2876–2880 Copyright ERS Journals Ltd 1997 DOI: 10.1183/09031936.97.10122876 European Respiratory Journal Printed in UK - all rights reserved ISSN 0903 - 1936 Airway versus transbronchial biopsy and BAL in lung transplant recipients: different but complementary C. Ward, G.I. Snell, B. Orsida, L. Zheng, T.J. Williams, E.H. Walters Airway versus transbronchial biopsy and BAL in lung transplant recipients: different Dept of Respiratory Medicine, Alfred but complementary. C. Ward, G.I. Snell, B. Orsida, L. Zheng, T.J. Williams, E.H. Walters. Hospital and Monash University Medical ©ERS Journals Ltd 1997. School, Melbourne, Australia. ABSTRACT: Lung transplantation is now an established therapeutic intervention Correspondence: E.H Walters for end-stage cardiopulmonary disease in humans. Chronic rejection, in the form Dept of Respiratory Medicine of bronchiolitis obliterans syndrome (BOS), remains the commonest cause of mor- Alfred Hospital bidity and mortality in those surviving more than 3 months. The pathology of BOS Prahran involves airway changes. We have evaluated the potential for endobronchial biop- Melbourne sies (EBB) to complement existing sampling methods used in allograft monitoring Victoria 3181 and have compared the results of EBB findings with those of bronchoalveolar Australia lavage (BAL) and transbronchial biopsy (TBB) in 18 clinically stable patients. Keywords: Bronchoalveolar lavage We found that all the EBB had inflammatory cells present but that only five endobronchial biopsy TBB specimens had evidence of inflammation, with airway material being present lung transplant in 78% of the TBB. Paired BAL and EBB yielded different results, with no cor- transbronchial biopsy relations between total macrophages, lymphocytes, CD4+ cells or CD8+ cells.
    [Show full text]