Changes to the Updated Cohort for Calculation of the Lung Allocation Score (LAS) are now in effect

Audience

• Lung Primary Program Administrators, Primary Data Coordinators, Primary Physicians, Primary Surgeons
• Lung TX Program Administrators/Managers, TX Program Directors, TX Program Medical Directors, Clinical Training Coordinators/Managers, TX Program – Clinical Coordinators, Support Staff-Clinical, Data Coordinators, Regulatory Affairs Coordinators/Managers, Compliance Officers, Quality Directors/Managers, Quality Coordinators, TX Program Surgical Directors, TX Surgeons
• The Board of Directors of the Organ Procurement and Transplantation Network
• Members of the Lung Transplantation Committee

Implementation date

September 30, 2021

At-a-glance

• Candidates’ Lung Allocation Scores (LAS) have changed according to a revised calculation approved by the OPTN Board of Directors in December 2020.
• The values used to calculate a candidate’s LAS have been updated to use data from a more recent cohort of lung candidates and recipients. The update improves the prediction of candidates’ expected survival on the waitlist and post-transplant to improve equity in lung allocation.
• Several variables have been removed from the Waiting List Urgency Measure and the Post-transplant Survival Measure. These variables will no longer expire, but continue to be available for reporting on the Waitlist^SM.
• Additional changes to lung data fields approved by the OPTN Executive Committee in July 2021 are now in effect.

What you need to do

• Please review your candidates’ scores. It is important to keep in mind that nearly every coefficient is changing, some variables are being entirely removed and the baseline daily probability values are changing too. While the changes individually can look small, cumulatively they can have a larger impact.
• Transplant centers should review the lung diagnosis options for their candidates previously listed with a diagnosis of “secondary pulmonary fibrosis (specify cause)” to ensure that the automatic conversion to “pulmonary fibrosis, other specify cause” is correct.
• Transplant centers may need to review and revise their current practices for reporting height and weight evaluation dates to ensure accuracy.
• If you normally convert 100% oxygen to a value in L/min when entering the candidate’s supplemental O2 information, you are now able to enter a more precise value of 26.33 in the L/min field, instead of 26.3.
• Continue to report optional lung data variables, when available, to inform ongoing lung policy improvements.

Additional details

• The following variables have been removed from the Waiting List Urgency Measure:
  • Lung diagnosis:
    • Obliterative bronchiolitis (non-retransplant) or constrictive bronchiolitis
    • Lymphangioleiomyomatosis
    • Eisenmenger’s syndrome
  • Bilirubin increase greater than or equal to 50%
  • Diabetes
  • Forced vital capacity (FVC)
  • Cardiac index (CI)
  • Central venous pressure (CVP)
• The following variables have been removed from the Post-transplant Survival Measure:
  • Lung diagnosis:
    • Lymphangioleiomyomatosis
    • Eisenmenger’s syndrome
    • Pulmonary fibrosis, other specify cause
  • Functional status
  • Serum creatinine increase greater than or equal to 150%
• Each remaining variable has been updated to reflect coefficient changes based on the new cohort.
• Other key changes to Waitlist^SM include:
  • Collecting separate dates for candidate height and weight, to better align with current clinical practice.
    • Body Mass Index (BMI) expiration is based only on the date the candidate’s weight was measured.
  • The lung diagnosis “Secondary pulmonary fibrosis (specify cause)” has been removed from the diagnosis list.
    • Candidates on the waiting list with this diagnosis are automatically converted to a primary lung diagnosis of “pulmonary fibrosis, other specify cause.”
  • Candidates with a lung diagnosis of “COVID-19: pulmonary fibrosis” now have the same Waiting List Urgency Measure covariate applied that is currently applied to candidates with a diagnosis of “pulmonary fibrosis, other specify cause”.
  • Changes to the Supplemental O2 L/min field to reduce decimal precision to just 2 decimal places. Additionally, the maximum reportable value increased from 26.3 to 26.33 L/min.
• Custom Reports will be updated in the next few weeks to reflect these changes.

 

Education and resources

A detailed explanation for the changes can be found in the policy notices for Updated Cohort for Calculation of the LAS and Refine Lung Data Fields