DÄ internationalArchive31-32/2017Imitation is the Sincerest Form of Flattery

Gottlieb et al. reported encouraging results after three years’ use of the Lung Allocation Score (LAS) in Germany (1). I congratulate the German lung transplant community for embracing a radically different organ allocation system to provide some objectivity to lung allocation when numbers are inadequate to meet the need. For six years, I chaired the subcommittee that, with help from many people, developed the LAS for the US Organ Procurement and Transplant Network (OPTN). Until recently, LAS was the only US organ allocation system that considered post-transplant survival. I am excited that Eurotransplant uses the LAS to distribute donor lungs (2). Gottlieb reports that in Germany, the LAS was associated with more lung transplants performed (without concomitant increase in donors), a significant reduction in waitlist deaths, with no increase in post-transplant mortality, and improved distribution of recipient diagnoses. This is similar to the impact in the US (3). LAS adoption appears to have been less contentious in Germany than in the US Now Germany has enough data to make its LAS a German entity, instead of relying on old US waitlist and transplant data like us (4). Our Subcommittee intended to use new data to re-analyze risks of waitlist death and post-transplant survival every six months, and modify variable coefficients that factored into LAS calculation. Variables could be eliminated or added as the population of waitlisted patients changed, to keep the model current. Sadly, the OPTN took years to make substantive changes. The Deutsche Stiftung Organtransplantation may be more nimble.

DOI: 10.3238/arztebl.2017.0543a

Acknowledgement

I gratefully acknowledge the help of Prof. Frank Detterbeck, MD, Thoracic Surgery at Yale University, and Margaret Cloud.

Thomas M. Egan, M.D., M.Sc.

University of North Carolina at Chapel Hill

thomas_egan@med.unc.edu

1.
Gottlieb J, Smits J, Schramm R, et al.: Lung transplantation in Germany since the introduction of the Lung Allocation Score—
a retrospective analysis. Dtsch Arztebl Int 2017; 114: 179–85 VOLLTEXT
2.
Eurotransplant: Introduction of the LAS in the Netherlands. 2014. www.eurotransplant.org/cms/index.php?page=newsitems&oid=458&action=viewitem&id=4505 (last accessed on 23 May 2017).
3.
Egan TM, Edwards LB: Effect of the lung allocation score on lung transplantation in the United States. J Heart Lung Transplant 2016; 35: 433–9 CrossRef MEDLINE
4.
Egan TM, Murray S, Bustami RT: Development of the new lung allocation system in the United States. Am J Transplant 2006; 6: 1212–27 CrossRef MEDLINE
1. Gottlieb J, Smits J, Schramm R, et al.: Lung transplantation in Germany since the introduction of the Lung Allocation Score—
a retrospective analysis. Dtsch Arztebl Int 2017; 114: 179–85 VOLLTEXT
2.Eurotransplant: Introduction of the LAS in the Netherlands. 2014. www.eurotransplant.org/cms/index.php?page=newsitems&oid=458&action=viewitem&id=4505 (last accessed on 23 May 2017).
3. Egan TM, Edwards LB: Effect of the lung allocation score on lung transplantation in the United States. J Heart Lung Transplant 2016; 35: 433–9 CrossRef MEDLINE
4. Egan TM, Murray S, Bustami RT: Development of the new lung allocation system in the United States. Am J Transplant 2006; 6: 1212–27 CrossRef MEDLINE

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