Updated Cohort for Calculation of the Lung Allocation Score (LAS) will be implemented on September 30

Audience:  (Please share this notice with anyone in your organization who would benefit from it.)

• 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

• Candidates’ Lung Allocation Scores (LAS) will be changing according to revised calculation approved by the OPTN Board of Directors in December 2020.
• The values used to calculate a candidate’s LAS will be updated to use data from a more recent cohort of lung candidates and recipients. The update will improve the prediction of candidates’ expected survival on the waitlist and post-transplant to improve equity in lung allocation.
• Several variables will be removed from the Waitlist^SM mortality calculation and the post-transplant mortality calculation. These variables will no longer expire, but will continue to be available for reporting on the Waitlist.
• Additional changes to lung data fields approved by the OPTN executive committee in July 2021 will take effect when the revised LAS is implemented.

• The following variables will be removed from the waitlist mortality measure calculation:
  • Lung diagnosis:
    • Obliterative bronchiolitis (non-retransplant) or constrictive bronchiolitis
    • Lymphangioleimyomatosis
    • 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 will be removed from the post-transplant survival measure calculation:
  • Lung diagnosis:
    • Lymphangioleimyomatosis
    • Eisenmenger’s syndrome
    • Pulmonary fibrosis, other specify cause
    • Functional status
    • Serum creatinine increase greater than or equal to 150%
• Each remaining variable will be updated to reflect coefficient changes based on the new cohort.
• Other key changes to waitlist include:
  • Collecting separate dates for candidate height and weight, to better align with current clinical practice.
    • BMI expiration will be based only on the date the candidate’s weight was measured.
  • The lung diagnosis “Secondary pulmonary fibrosis (specify cause)” will be removed from the diagnosis list.
    • Candidates on the waitlist with this diagnosis will automatically be converted to a primary lung diagnosis of “pulmonary fibrosis, other specify cause” upon implementation.
  • Candidates with a lung diagnosis of “COVID-19: pulmonary fibrosis” will have the same waitlist mortality 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 will increase from 26.3 to 26.33 L/min.

• Transplant centers should review the lung diagnosis options for their candidates currently 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/or 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 will be 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.

If you have questions relating to data or matching applications, contact UNOS Customer Service at [email protected], or call 800-978-4334 from 8 a.m. to 7 p.m. ET.

For policy-related questions, contact [email protected].

The Organ Center is available 24 hours a day at 800-292-9537.