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Early experience of a new national lung allocation scheme in the UK based on clinical urgency

Lookup NU author(s): S Clark

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Abstract

© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.Introduction: A new UK Lung Allocation Scheme (UKLAS) was introduced in 2017, replacing the previous geographic allocation system. Patients are prioritised according to predefined clinical criteria into a three-tier system: the super-urgent lung allocation scheme (SULAS), the urgent lung allocation scheme (ULAS) and the non-urgent lung allocation scheme (NULAS). This study assessed the early impact of this scheme on waiting-list and post-transplant outcomes. Methods: A cohort study of adult lung transplant registrations between March 2015 and November 2016 (era-1) and between May 2017 and January 2019 (era-2). Outcomes from registration were compared between eras and stratified by urgency tier and diagnostic group. Results: During era-1, 461 patients were registered. In era-2, 471 patients were registered (19 (4.0%) SULAS, 82 (17.4%) ULAS and 370 (78.6%) NULAS). SULAS patients were younger (median age 35 vs 50 and 55 for urgent and non-urgent, respectively, p=0.0015) and predominantly suffered from cystic fibrosis (53%) or pulmonary fibrosis (37%). Between eras 1 and 2, the odds of transplantation within 6 months of registration were increased (OR=1.41, 95% CI 1.07 to 1.85, p=0.0142) despite only a 5% increase in transplant activity. Median time-to-transplantation during era-1 was 427 days compared with waiting times in era-2 of 8 days for SULAS, 15 days for ULAS and 585 days for NULAS patients. Waiting-list mortality (15% era-1 vs 13% era-2; p=0.5441) and post-transplant survival at 1 year (81.3% era-1 vs 83.3% era-2; p=0.6065) were similar between eras. Conclusion: The UKLAS scheme prioritises the critically ill and improves transplantation odds. The true impact on waiting-list mortality and post-transplant survival requires further follow-up.

Publication metadata

Author(s): Al-Adhami A, Al-Aloul M, Rushton S, Thompson RD, Carby M, Lordan J, Clark S, Spencer H, Tsui S, Parmar J

Publication type: Article

Publication status: Published

Journal: Thorax

Year: 2023

Volume: 78

Issue: 12

Pages: 1206-1214

Online publication date: 24/07/2023

Acceptance date: 21/06/2023

ISSN (print): 0040-6376

ISSN (electronic): 1468-3296

Publisher: BMJ Publishing Group

URL: https://doi.org/10.1136/thorax-2022-219475

DOI: 10.1136/thorax-2022-219475

PubMed id: 37487710

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