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Lung allocation score for candidates age 12 and older

Lung allocation score for candidates age 12 and older
Step 1: The transplant center enters the factors in part 1 below on the UNet website. A Cox proportional hazards model is used to derive an estimate of the number of days a recipient would be expected to live during the first year post-transplant. This is the post-transplant survival measure.
Step 2: The transplant center enters the factors in part 2 below on the UNet website. A Cox proportional hazards model is used to derive an estimate of the expected number of days a candidate would live without a transplant during an additional year on the waitlist. This is the waitlist survival measure.
Step 3: Using the values derived in steps 1 and 2, the transplant benefit measure is calculated:
  • Transplant benefit = post-transplant survival (days) − waitlist survival (days).
Step 4: The raw allocation score = transplant benefit (days) − waitlist survival (days).
Step 5: The lung allocation score is derived by normalizing the raw allocation score to a range of 0 to 100. The higher the score, the higher the priority.
Part 1 – Post-transplant survival measure:
  1. Age
  1. Serum creatinine
  1. Cardiac Index at rest
  1. Continuous mechanical ventilation
  1. Diagnosis*
  1. Supplemental O2 required at rest
  1. 6-minute walk distance
Part 2 – Waiting list urgency measure:
  1. Age
  1. Serum bilirubin
  1. Body mass index (BMI)
  1. Continuous mechanical ventilation
  1. Serum creatinine
  1. Diagnosis*
  1. Functional status
  1. Supplemental O2 required at rest
  1. pCO2Δ
  1. Pulmonary artery systolic pressure
  1. 6-minute walk distance
* Diagnosis groups:
  • Group A: Chronic obstructive pulmonary disease (COPD), alpha-1-antitrypsin, emphysema, lymphangioleiomyomatosis, bronchiectasis, sarcoidosis with a mean pulmonary artery pressure (MPAP) ≤30 mmHg.
  • Group B: Pulmonary hypertension (idiopathic pulmonary arterial hypertension [IPAH], Eisenmenger syndrome, etc).
  • Group C: Cystic fibrosis, immunodeficiency disorders (eg, hypogammaglobulinemia).
  • Group D: Idiopathic pulmonary fibrosis (IPF), other causes of pulmonary fibrosis, other idiopathic interstitial pneumonias, connective tissue disease-associated interstitial lung disease, hypersensitivity pneumonitis, sarcoidosis with MPAP >30 mmHg, bronchiolitis, lung retransplant, and other rare disorders.

The post-transplant survival measure also separately factors in the following specific diagnoses: bronchiectasis, obliterative bronchiolitis, constrictive bronchiolitis, sarcoidosis ± MPAP >30.

The waiting list urgency measure also separately factors in the following specific diagnoses: bronchiectasis, other causes of pulmonary fibrosis (including COVID-19), and sarcoidosis ± MPAP >30.

¶ Functional status is a binary assessment of whether the patient requires assistance with activities of daily living.

Δ pCO2 may be taken from arterial, capillary or venous measurement. If venous, 6 mmHg will be subtracted to produce an equivalent arterial value. There is also an adjustment for an increase of greater than 15% over less than 6 months.
Adapted from: Organ Procurement and Transplantation Network (OPTN) Policies. Available at: https://optn.transplant.hrsa.gov/media/eavh5bf3/optn_policies.pdf (Accessed July 12, 2022). More information about the LAS calculator can be found at: https://optn.transplant.hrsa.gov/data/allocation-calculators/las-calculator/ (Accessed July 12, 2022).
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