A Cohort Study

Background: Lung transplantation is an effective treatment for patients with advanced lung disease. In the United States, lungs are allocated on the basis of the lung allocation score (LAS), a com-posite measure of transplantation urgency and utility. Clinical de-teriorations result in increases to the LAS; however, whether the trajectory of the LAS has prognostic significance is uncertain. Objective: To determine whether an acute increase in the LAS before lung transplantation is associated with reduced posttrans-plant survival. Design: Retrospective cohort study of adult lung transplant recip-ients listed for at least 30 days between 4 May 2005 (LAS imple-mentation) and 31 December 2010 in the United Network for Organ Sharing registry. An acute increase in the LAS was defined as an LAS change (LAS) greater than 5 units between the 30 days before and the time of transplantation. Multivariable Cox propor-tional hazard models were used to examine the relationship be-tween an LAS 5 and posttransplant graft survival. Setting: All U.S. lung transplantation centers. Patients: 5749 lung transplant recipients