PMID- 15686717
OWN - NLM
STAT- MEDLINE
DCOM- 20050707
LR  - 20131121
IS  - 0041-1345 (Print)
IS  - 0041-1345 (Linking)
VI  - 36
IP  - 10
DP  - 2004 Dec
TI  - Discrepancy between severity of lung impairment and seniority on the lung 
      transplantation list.
PG  - 3156-60
AB  - BACKGROUND: Organ allocation for lung transplantation, based mainly on accrued 
      time on a waiting list, may not be an equitable system of organ allocation. To 
      provide an objective view of the current practice concerning lung allocation, and 
      timing for transplantation, we examined illness severity and list seniority in 
      patients on a lung transplantation waiting list. METHODS: Adult patients awaiting 
      lung transplantation underwent testing for mean pulmonary artery pressure (mPpa), 
      maximum oxygen consumption (VO2 max), 6-minute walk distance (6MWD), forced 
      expiratory volume in 1 second, mean partial pressure of carbon dioxide, partial 
      pressure of oxygen/fractional concentration of inspired oxygen, and diffusing 
      capacity of the lung for carbon monoxide. Relationships between physiological 
      variables and waiting list rankings were then determined. RESULTS: Thirty-four 
      patients were tested and there was no correlation between time spent waiting on 
      the list and mPpa (r=0.01; P=.94), VO2 max percentage predicted (r=0.07; P=.71), 
      or 6MWD (r=0.15; P=.42). Many patients with functional impairments as indicated 
      by low maximum VO2 or by short 6MWD are scheduled to receive their transplant 
      after patients with levels that indicate a lower degree of risk. When compared 
      with a hypothetical reranking based on mean Ppa, 24 of the 34 patients (71%) on 
      our current waiting list were found to be 5 positions higher or lower than this 
      new risk-based ranking. Sixteen patients (47%) were 10 or more positions away 
      from their hypothetical severity-based ranking, and 9 (26%) were at least 15 
      positions out of place. Sixteen of the 34 patients were ranked lower than they 
      would be based on a severity of illness using the pulmonary artery pressure 
      alone, 17 were ranked higher than "should be" based on pulmonary artery mean, and 
      only 1 patient (ranked in position 15) was appropriately positioned based on 
      seniority and severity of disease based on PA mean. CONCLUSION: Rank order for 
      lung transplantation has no relationship with illness severity, and the 
      discrepancy between disease severity and seniority on the lung waiting list may 
      compromise overall outcomes in the lung transplantation population.
FAU - Travaline, J M
AU  - Travaline JM
AD  - Department of Medicine, Division of Pulmonary and Critical Care Medicine, Temple 
      University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
FAU - Cordova, F C
AU  - Cordova FC
FAU - Furukawa, S
AU  - Furukawa S
FAU - Criner, G J
AU  - Criner GJ
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Transplant Proc
JT  - Transplantation proceedings
JID - 0243532
RN  - 142M471B3J (Carbon Dioxide)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Carbon Dioxide/blood
MH  - Emphysema/surgery
MH  - Female
MH  - Forced Expiratory Volume
MH  - Humans
MH  - Lung Diseases/*physiopathology/*surgery
MH  - Lung Transplantation/*statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Oxygen Consumption
MH  - Pulmonary Artery/physiopathology
MH  - Respiratory Physiological Phenomena
MH  - Time Factors
MH  - *Waiting Lists
MH  - Walking/physiology
EDAT- 2005/02/03 09:00
MHDA- 2005/07/08 09:00
CRDT- 2005/02/03 09:00
PHST- 2005/02/03 09:00 [pubmed]
PHST- 2005/07/08 09:00 [medline]
PHST- 2005/02/03 09:00 [entrez]
AID - S0041-1345(04)01299-0 [pii]
AID - 10.1016/j.transproceed.2004.11.009 [doi]
PST - ppublish
SO  - Transplant Proc. 2004 Dec;36(10):3156-60. doi: 
      10.1016/j.transproceed.2004.11.009.