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Adding clinical variables improves accuracy of lung allocation score

June 25, 2019

Tuesday, June 25, 2019, Cleveland: Implemented back in 2005, the lung allocation score is used to prioritize patients awaiting lung transplants in the United States. Sicker transplant candidates have a higher calculated score and are placed at the top of the list. But a recent study led by Maryam Valapour, M.D., MPP, director of Lung Transplant Outcomes in Cleveland Clinic's Respiratory Institute, found including new clinical variables helped to better identify the sickest cystic fibrosis and chronic obstructive pulmonary disease (COPD) patients awaiting transplants.

The paper was published June 14 in the American Journal of Respiratory and Critical Care Medicine.

Dr. Valapour, who is also the senior investigator for lung transplant for the U.S. Scientific Registry of Transplant Recipients (SRTR), worked on behalf of the U.S. Department of Health and Human Services. The Cystic Fibrosis Foundation (CFF) and Cleveland Clinic physicians Carli Lehr, M.D., MS and Elliott Dasenbrook, M.D., MHS, also collaborated on the study.

"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," Dr. Valapour said.

The study merged patient data from the SRTR and the 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.

People with cystic fibrosis differ from the average patient awaiting a lung transplant in several ways. "They are younger, often have more infections and multiple organs that are affected by their disease," Dr. Lehr said. "While many of these problems progress during a patients' life, they are not adequately factored into the lung allocation score."

This study marked the first time researchers could review a cystic fibrosis patient's entire clinical history. That's because the CFF registry captures all clinical data for almost all cystic fibrosis patients in this country 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.

Results of the data merge not only showed improved accuracy of the lung allocation score for cystic fibrosis candidates, but the re-evaluation of the pulmonary function testing also helped patients with COPD.

"We believe the database we used more accurately identifies candidates likely to benefit the most from a transplant," Dr. Valapour said.

Today, more than 30,000 people are living with cystic fibrosis in the United States. Described as a progressive, genetic disease, cystic fibrosis causes persistent lung infections and limits the ability to breathe over time. The average life span for people with cystic fibrosis is about 37 years. Because almost all individuals with cystic fibrosis die of respiratory failure, lung transplant is a vital therapeutic option for patients with advanced lung disease.
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About Cleveland Clinic

Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation's best hospitals in its annual "America's Best Hospitals" survey. Among Cleveland Clinic's 51,000 employees are more than 3,500 full-time salaried physicians and researchers and 14,000 nurses, representing 140 medical specialties and subspecialties. Cleveland Clinic's health system includes a 165-acre main campus near downtown Cleveland, 10 regional hospitals, more than 150 northern Ohio outpatient locations - including 18 full-service family health centers and three health and wellness centers - and locations in Weston, Fla.; Las Vegas, Nev.; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2016, there were 7.1 million outpatient visits, 161,674 hospital admissions and 207,610 surgical cases throughout Cleveland Clinic's health system. Patients came for treatment from every state and 185 countries. Visit us at clevelandclinic.org. Follow us at twitter.com/ClevelandClinic. News and resources available at newsroom.clevelandclinic.org.

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