Assessing the accuracy of the lung allocation score.

Background: The United States (US) Lung Allocation Score (LAS) relies on the performance of 2 survival models that estimate waitlist and post-transplant survival. These models were developed using data from 2005 to 2008, and it is unknown if they remain accurate.

Methods: We performed an observational cohort study of US lung transplantation candidates and recipients greater than 12 years of age between February 19, 2015 and February 19, 2019.

Association of Transplant Center With Survival Benefit Among Adults Undergoing Heart Transplant in the United States.

Importance: In the United States, the number of deceased donor hearts available for transplant is limited. As a proxy for medical urgency, the US heart allocation system ranks heart transplant candidates largely according to the supportive therapy prescribed by transplant centers.

Objective: To determine if there is a significant association between transplant center and survival benefit in the US heart allocation system.

Geographic Variation in the Treatment of U.S. Adult Heart Transplant Candidates.

Background: The current U.S. priority ranking for heart candidates is based on treatment intensity, not objective markers of severity of illness.

Trends in the Use of Inotropes to List Adult Heart Transplant Candidates at Status 1A.

Background: The number of adult heart transplant candidates waiting at the most urgent status 1A has increased over time despite the expansion of geographic sharing of hearts in 2006. We aimed to determine whether candidates listed with inotropes contribute to the excess status 1A candidates.

Methods And Results: The initial registrations of all adult heart-only candidates listed from 2000 to 2015 were analyzed using the Scientific Registry of Transplant Recipients data set.

Lung Transplantation: The State of the Airways.

Context: Lung transplantation has become a viable option for definitive treatment of several end-stage lung diseases for which there are no other options available. However, long-term survival continues to be limited by chronic lung allograft dysfunction, which primarily affects the airways.

Objective: To highlight the complications occurring mainly in the airways of the lung transplant recipient from the early to late posttransplant periods.

Impact of the lung allocation score.

The number of donors falls short of the number of patients on the wait list for lung transplantation making it necessary to ration the available donor organs. The ideal allocation system is guided by ethical principles and scientifically accurate at identifying patients who will gain the greatest degree of benefit from receiving the organ, in terms of both pre- and posttransplantation survival. The lung allocation score (LAS) was developed in 2005 to reduce mortality on the wait list, prioritize candidates based on urgency, minimize the role of geography, and maximize transplant benefit.

Decreased incidence of cytomegalovirus infection with sirolimus in a post hoc randomized, multicenter study in lung transplantation.

Background: Cytomegalovirus (CMV) is the most common opportunistic infection in lung transplantation. A recent multicenter, randomized trial (the AIRSAC study) comparing sirolimus to azathioprine in lung transplant recipients showed a decreased incidence of CMV events in the sirolimus cohort. To better characterize this relationship of decreased incidence of CMV events with sirolimus, we examined known risk factors and characteristics of CMV events from the AIRSAC database.

Interobserver variability in grading transbronchial lung biopsy specimens after lung transplantation.

Background: Acute rejection remains a major source of morbidity after lung transplantation. Given the importance of this diagnosis, an international grading system was developed to standardize the diagnosis of acute lung-allograft rejection. The reliability of this grading system has not been adequately assessed by previous studies.

SaLUTaRy: survey of lung transplant rejection.

Background: The International Society for Heart and Lung Transplantation (ISHLT) guidelines on the interpretation of lung rejection in pulmonary allograft biopsy specimens were revised most recently in 2007. The goal of our study was to determine how these revisions, along with nuances in the interpretation and application of the guidelines, affect patient care.

Methods: A Web-based survey was e-mailed to pathologists and pulmonologists identified as being part of the lung transplant team at institutions in the United States with active lung transplant programs as determined from the Organ Procurement and Transplantation Network Web site (http://optn.

Myocardial damage in patients with sarcoidosis and preserved left ventricular systolic function: an observational study.

Aims: Late gadolinium enhanced cardiovascular magnetic resonance (LGE-CMR) is a valuable test to detect myocardial damage in patients with sarcoidosis; however, the clinical significance of LGE in sarcoidosis patients with preserved left ventricular ejection fraction (LVEF) is not defined. We aim to characterize the prevalence of LGE, its associated cardiac findings, and its clinical implications in sarcoidosis patients with preserved LVEF.

Methods And Results: One hundred and fifty-two patients with biopsy proven extra-cardiac sarcoidosis, no known cardiac sarcoidosis, and LVEF ≥ 50% referred for LGE-CMR were included in this observational study.

Lung allocation in the United States.

Lung allocation in the United States has changed significantly with the introduction of the Lung Allocation Score (LAS) system in May 2005. Since then, organ allocation is no longer based on waiting time but on a measure of transplant benefit (the difference between survival with vs without a transplant). The LAS system has met its primary goal of reducing time and mortality on the waiting list.

Differentiated transplant derived airway epithelial cell cytokine secretion is not regulated by cyclosporine.

Background: While lung transplantation is an increasingly utilized therapy for advanced lung diseases, chronic rejection in the form of bronchiolitis obliterans syndrome (BOS) continues to result in significant allograft dysfunction and patient mortality. Despite correlation of clinical events with eventual development of BOS, the causative pathophysiology remains unknown. Airway epithelial cells within the region of inflammation and fibrosis associated with BOS may have a participatory role.

Early readmission is a predictor of overall survival following isolated lung transplantation.

Causes of early readmissions following lung transplantation are not well understood, and the impact is poorly reported. We reviewed 221 consecutive lung transplantations and identified patients readmitted within 90 days. A case control analysis was performed to determine the characteristics that predict readmission and the impact of readmission on survival.

Decreased percentage of CD4+FoxP3+ cells in bronchoalveolar lavage from lung transplant recipients correlates with development of bronchiolitis obliterans syndrome.

Background: Lung transplantation, in patients with end-stage lung disease, is limited by chronic rejection, which occurs with an incidence and severity exceeding most other transplanted organs. Alloimmune responses play an important role in progression to chronic rejection that manifests as bronchiolitis obliterans syndrome (BOS), but no biomarker can currently predict the progression to BOS. Studies in animal models suggest that intragraft T regulatory cells (Tregs) are important in maintaining transplantation tolerance, and FoxP3 is the protoypic Treg marker.

Telomere lengths, pulmonary fibrosis and telomerase (TERT) mutations.

Background: Telomerase is an enzyme that catalyzes the addition of nucleotides on the ends of chromosomes. Rare loss of function mutations in the gene that encodes the protein component of telomerase (TERT) have been described in patients with idiopathic pulmonary fibrosis (IPF). Here we examine the telomere lengths and pulmonary fibrosis phenotype seen in multiple kindreds with heterozygous TERT mutations.

The impact of the lung allocation score.

The lung allocation score (LAS) was developed in an effort to facilitate lung transplantation to more urgent and ill patients, to decrease wait time, and to change the allocation process to a more merit-based system. Four years after the implementation of the LAS, we now evaluate the impact and outcomes of this system. We have found that registrations on the wait list as well as wait time have decreased.

General overview of lung transplantation and review of organ allocation.

Lung transplantation is an established treatment option for patients with a wide variety of end-stage lung diseases. For patients with end-stage lung disease, lung transplant can prolong life substantially; however, the survival statistics for lung transplants still pale compared with other solid organ transplants. Acute cellular rejection (ACR) is common after lung transplantation occurring in up to 90 percent of patients.

Minimization of immunosuppression after lung transplantation: current trends.

This paper reviews efforts that have been made to minimize immunosuppression in lung transplant patients. A brief history of tolerance and its potential application to lung transplantation is also discussed.

Cylex ImmuKnow assay levels are lower in lung transplant recipients with infection.

Background: Current monitoring systems of immunosuppression in solid-organ transplant recipients are typically focused on prevention of clinical toxicities of immunosuppressive drugs. Unfortunately, these strategies are often not tailored to the individual and do not determine the optimal level of immunosuppression for these patients. Recently, the Cylex Immune Cell Function Assay (ImmuKnow; Cylex, Inc.

Organ allocation in lung transplant.

Since the first successful single-lung transplant in 1983 and double-lung transplant in 1986, thousands of patients have benefited from the procedures. Until 1995, allocation of donor lungs was based purely on time on the waiting list. In 1995, a 90-day credit was given to patients with idiopathic pulmonary fibrosis, while still maintaining allocation based on waiting list time.

Clinical pathway after lung transplantation shortens hospital length of stay without affecting outcome.

Transplant programs are under pressure to resolve multiple challenges related to quality, cost, and access in a resource-driven customer-focused health care environment. We reviewed outcomes of patients undergoing isolated lung transplantation using a single postoperative clinical pathway, developed between the specialties of Thoracic Surgery, Pulmonary and Critical Care Medicine, and Nursing. The data were retrospectively reviewed for mortality, length to extubation (LE), hospital length of stay (LOS), and readmissions of 183 consecutive patients.