OPTN

Proposal to Revise the Lung Allocation Score (LAS) System

andSalient Activities of the Thoracic

Organ Transplantation Committee

OPTN

Current LAS Policy

Prioritizes candidates who are at least 12 years of age for allocation of deceased donor lung offers

Categorizes candidates into diagnosis groups: A, B, C, and D

OPTN

Why Modify the Current LAS Policy?

Does not reflect the current waiting list population

Has not been revised thoroughly since its implementation in 2005

OPTN

Goals in Modifying LAS System Address the disease severity of candidates

by modifying the covariates in the system’s statistical models

Updating the covariates’ coefficients Update the baseline survival rates to reflect

the current waiting list and transplant population

Including the LAS equation, baseline survival rates, and other rules that contribute to a candidate’s LAS in policy

OPTN

Analytical Modeling

SRTR performed analyses to update the LAS system

SRTR validated its analyses that resulted in the revised LAS system

0%

20%

40%

60%

80%

100%

0%

20%

40%

60%

80%

100%Percent Survival Percent Survival

Days on Waitlist 0 180 365 0 180 365

Days since Transplant

Waitlist Urgency Measure

Shaded area under curve = Expected number of days lived without a transplant during an additional year on the waitlist

Post-Transplant Survival Measure

Shaded area under curve = Expected number of days lived

during the first year post-transplant

SRTR

OPTN

Revised LAS Policy Would…

Likely Provide benefit to some candidates in Group B (pulmonary hypertension) by:• Increasing their Lung Allocation Scores• Improving their allocation rankings• Better addressing the increase in waiting

list mortality associated with acute worsening of candidates with pulmonary hypertension

OPTN

Change in LAS (Revised LAS – Current LAS) by Diagnosis Group for Candidates

on the Waitlist on January 1, 2010℠

OPTN

Revised LAS Policy Would…

Likely increase the allocation rankings for candidates in all diagnosis groups who have:• Poor functional statuses;• Low cardiac indices;• High creatinine values;• High central venous pressures; and• Need for ventilation support

OPTN

Inclusion of the LAS System’s Components that Are Rules but Are Not

in Policy Today

Equation to calculate the LAS Baseline survival rates Coefficient for each covariate in the model Complete listing of diseases in each group Identification of values that will be

substituted for covariate data that are missing or expired

OPTN

Data Collection Required by Policy Modification

Entry of data for the following three new covariates for LAS calculation purposes: • Bilirubin (new to Waitlist℠)• Cardiac index (already in Waitlist )℠• Central venous pressure (already in

Waitlist ) ℠

OPTN

Policy Proposal

See pages 66 to 110 in the public comment document for the policy modifications:

Proposal #5:http://optn.transplant.hrsa.gov/policiesAndBylaws/publicComment/proposals.asp

OPTN

Questions?

OPTN

Salient Activities of the Thoracic Organ Transplantation Committee

Mark Barr, MD – ChairSteve Webber, MD – Vice-Chair

Regional MeetingsMarch – June, 2012

OPTN

Committee’s Activities Revising the pediatric heart policy for

medical currency Revising the adult heart policy for medical

currency Continuing efforts to modify the joint heart-

lung policy Working with the OPO committee to develop

appropriate guidance for allocation of lungs supported using ex vivo lung perfusion

OPTN

Questions?

OPTN

Extra Slides (Revised LAS Proposal)

OPTN

Scatter Plot of Current and Revised LASs by Diagnosis Group for Candidates on the

Waitlist on January 1, 2010℠

OPTN

Current and Revised Model LAS, by Age Group (Diagnosis Group A Candidates)

OPTN

Current and Revised Model LAS, by Age Group (Diagnosis Group B)

OPTN

Current and Revised Model LAS, by Age Group (Diagnosis Group C)

OPTN

Current and Revised Model LAS, by Age Group (Diagnosis Group D)