Effect of including important clinical variables on accuracy of the lung allocation score for cystic fibrosis and chronic obstructive pulmonary disease

Carli J. Lehr, Melissa Skeans, Elliott Dasenbrook, Aliza Fink, Gabriela Fernandez, Albert Faro, Maryam Valapour

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Rationale: Clinical variables associated with shortened survival in patients with advanced-stage cystic fibrosis (CF) are not included in the lung allocation score (LAS). Objectives: To identify variables associated with wait-list and post-transplant mortality for CF lung transplant candidates using a novel database and to analyze the impact of including new CF-specific variables in the LAS system. Methods: A deterministic matching algorithm identified patients from the Scientific Registry of Transplant Recipients and the Cystic Fibrosis Foundation Patient Registry. LAS wait-list and post-transplant survival models were recalculated using CF-specific variables. This multicenter, retrospective, population-based study of all lung transplant wait-list candidates aged 12 years or older from January 1, 2011, to December 31, 2014, included 9,043 patients on the lung transplant waiting list and 6,110 lung transplant recipients between 2011 and 2014, comprising 1,020 and 677 with CF, respectively. Measurements and Main Results: Measured outcomes were changes in LAS and lung allocation rank. For CF candidates, any Burkholderia sp. (hazard ratio [HR], 2.8; 95% confidence interval [CI], 1.2–6.6), 29–42 days hospitalized (HR 2.8; CI 1.3–5.9), massive hemoptysis (HR 2.1; CI 1.1–3.9), and relative drop in FEV1 >30% over 12 months (HR 1.7; CI 1.0–2.8) increased wait-list mortality risk; pulmonary exacerbation time 15–28 days (1.8; 1.1–2.9) increased post-transplant mortality risk. A relative drop in FEV1 >10% in chronic obstructive pulmonary disease (COPD) candidates was associated with increased wait-list mortality risk (HR 2.6; CI 1.2–5.4). Variability in LAS score and rank increased in patients with CF. Priority for transplant increased for COPD candidates. Access did not change for other diagnosis groups. Conclusions: Adding CF-specific variables improved discrimination among wait-listed CF candidates and benefited COPD candidates.

Original languageEnglish (US)
Pages (from-to)1013-1021
Number of pages9
JournalAmerican journal of respiratory and critical care medicine
Issue number8
StatePublished - Oct 15 2019
Externally publishedYes

Bibliographical note

Funding Information:
The authors thank SRTR colleague Nan Booth, M.S.W., M.P.H., E.L.S., for manuscript editing. The authors also thank the Cystic Fibrosis Foundation for the use of CF Foundation Patient Registry data to conduct this study. In addition, the authors thank the patients, care providers, and clinical coordinators at CF centers throughout the United States for their contributions to the CF Foundation Patient Registry.

Publisher Copyright:
Copyright © 2019 by the American Thoracic Society


  • Cystic fibrosis
  • Lung allocation
  • Lung transplant


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