Requests for Exceptional LAS in Eurotransplant

PurposeFor patients, for whom the calculated LAS is not appropriately reflecting benefit of lung transplantation (LTx), a so-called exceptional LAS (eLAS) value can be requested. The aim of this study was to investigate the outcome after a first eLAS request.MethodsAll patients with an eLAS request in Eurotransplant in the period between December 10, 2011 and July 31, 2019 were included (N=256). Patients were followed for at least one year until LTx or death on the waiting list (DOWL) occurred. Waiting list outflow was analyzed using competing risk method. Differences were tested using log likelihood tests. Multivariate analysis was performed to study factors determining the acceptance of an eLAS request.ResultsOf 256 patients, 97 (38%) eLAS requests were approved and 159 (62%) were declined. Within 1 year after the first request, 78 (80.4%) of the accepted patients underwent a LTx and 14 (14.4%) had died on the waiting list. In the declined group 104 (65.4%) were transplanted and 27 (17%) died on the waiting list. Patients in the approved group were significantly more likely to undergo LTX vs. the declined group (p<0.0001). No statistical difference was observed with relation to DOWL (p=0.64) (Figure) Factors significantly associated with acceptance of the eLAS request were primary diagnosis and the need for IV prostanoids (Table). No association was observed for cardiac index, ECMO, recipient age, year, and country of request.ConclusionApproval of an eLAS request was associated with an increased probability of transplantation whereas decline did not result in an increased risk of death on the waiting list. For patients, for whom the calculated LAS is not appropriately reflecting benefit of lung transplantation (LTx), a so-called exceptional LAS (eLAS) value can be requested. The aim of this study was to investigate the outcome after a first eLAS request. All patients with an eLAS request in Eurotransplant in the period between December 10, 2011 and July 31, 2019 were included (N=256). Patients were followed for at least one year until LTx or death on the waiting list (DOWL) occurred. Waiting list outflow was analyzed using competing risk method. Differences were tested using log likelihood tests. Multivariate analysis was performed to study factors determining the acceptance of an eLAS request. Of 256 patients, 97 (38%) eLAS requests were approved and 159 (62%) were declined. Within 1 year after the first request, 78 (80.4%) of the accepted patients underwent a LTx and 14 (14.4%) had died on the waiting list. In the declined group 104 (65.4%) were transplanted and 27 (17%) died on the waiting list. Patients in the approved group were significantly more likely to undergo LTX vs. the declined group (p<0.0001). No statistical difference was observed with relation to DOWL (p=0.64) (Figure) Factors significantly associated with acceptance of the eLAS request were primary diagnosis and the need for IV prostanoids (Table). No association was observed for cardiac index, ECMO, recipient age, year, and country of request. Approval of an eLAS request was associated with an increased probability of transplantation whereas decline did not result in an increased risk of death on the waiting list.