Adding Clinical Variables Improves Accuracy of Lung Allocation Score

June 26, 2019

Adding new clinical variables to the lung allocation score can help to better identify the sickest patients with cystic fibrosis and chronic obstructive pulmonary disease (COPD) awaiting transplants, according to a study published in the American Journal of Respiratory and Critical Care Medicine.

“Clinical variables associated with shortened survival in patients with advanced-stage cystic fibrosis are not included in the lung allocation score,” explained Maryam Valapour, MD, The Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, and colleagues.

The study merged patient data from the US Scientific Registry of Transplant Recipients (SRTR) and the Cystic Fibrosis Foundation (CFF) Patient Registry from January 2011 to December 2014. It included 9,043 patients on the lung transplant waiting list and 6,100 lung transplant recipients. Once merged, cystic fibrosis-specific variables were added into the lung allocation score calculation.

For patients with cystic fibrosis, variables that were associated with increased waitlist mortality risk were infection with Burkholderia cepacia, days hospitalised, massive haemoptysis, and relative drop in forced expiratory volume in 1 second (FEV1) ≥ 30% over 12 months. Pulmonary exacerbation time (15-28 days) increased post-transplant mortality risk.

Among patients with COPD, a decrease in FEV1 of ≥10% was associated with increased waitlist mortality risk.

“Lung transplant is a life-saving procedure for patients with end-stage lung disease and these patients have no alternative treatment available to them if an organ doesn’t become available in time,” said Dr. Valapour. “We believe the database we used more accurately identifies candidates likely to benefit the most from a transplant.”

She noted that their study marks the first time researchers could review the entire clinical history of a patient with cystic fibrosis because the CFF registry captures all clinical data for almost all patients with cystic fibrosis in the United States from birth onwards, while the SRTR includes clinical data on all patients starting from when they are placed on the waiting list to transplant and beyond.

Reference: https://www.atsjournals.org/doi/abs/10.1164/rccm.201902-0252OC

SOURCE: Cleveland Clinic