Five-year experience using the Lung Allocation Score: the Munich Lung Transplant Group.

OBJECTIVES: The Lung Allocation Score (LAS) was implemented in Germany on 10 December 2011 after demonstrating favourable outcomes in the USA since its introduction in 2005. There are only limited and short-term data on the effect of the LAS on lung transplantation programmes in Germany. The purpose of this study was to analyse our 5-year single-centre experience with the LAS within the influential area of the Eurotransplant Foundation (ET).

METHODS: After implementation of the LAS until December 2016, 294 patients underwent a single-lung transplantation or a bilateral sequential lung transplantation for end-stage lung disease at our centre. Patients were divided into 4 groups according to their primary diagnosis. The Kaplan-Meier analyses of survival probabilities were performed to compare types of transplant procedures, underlying diagnoses and the LASs at the time of transplantation. Waitlist characteristics, transplant procedures and up to 5-year post-transplant outcomes were analysed.

RESULTS: The proportion of lung transplants performed for interstitial lung disease increased over time from 27% in 2012 to 54% in 2016 (P = 0.056). At the same time, the proportion of patients with chronic obstructive pulmonary disease undergoing lung transplantation declined over the 5-year period, i.e. from 29% in 2011 to 19% in 2016 (P = 0.029). Overall waiting times of transplanted patients were approximately 200 days and did not markedly change over time. There was an increasing proportion of chronic obstructive pulmonary disease patients on the waitlist from 41% in 2011 to 51% in 2016 (P = 0.51). Outcomes were independent of the underlying disease entity or the LAS. Bilateral sequential lung transplantation was associated with a better long-term survival probability when compared with a single-lung transplantation (P < 0.001).

CONCLUSIONS: Our centre-specific 5-year experience confirms previous findings demonstrating that the LAS is a well-established tool for the selection of lung transplant candidates, respecting urgency and prognostic transplant benefit in a disease-specific manner. However, the LAS did not shorten overall waiting times in transplanted patients. Further long-term and multicentre data with respect to differential transplant centre activities have to be gathered for further evaluation.