Observational studyThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation2022
Assessing the accuracy of the lung allocation score.
Observational study in The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Inconsistent values and algorithmic fairness: a review of organ allocation priority systems in the United States.BMC medical ethics · 2024Pooled it
- A Narrative Review on ECMO as a Bridge to Transplantation: Optimising Outcomes in Heart and Lung Failure.Cureus · 2026Review
- National Organ Procurement and Transplant Network Heart Allocation Policy: 6 Years Later.Circulation. Heart failure · 2025Review
- Predicting post-lung transplant survival in systemic sclerosis using CT-derived features from preoperative chest CT scans.European radiology · 2025Article
- Development of a Machine Learning-Powered Optimized Lung Allocation System for Maximum Benefits in Lung Transplantation: A Korean National Data.Journal of Korean medical science · 2025Article
- Application of artificial intelligence and machine learning in lung transplantation: a comprehensive review.Frontiers in digital health · 2025Review
- Disparities in lung transplantation in children.Pediatric pulmonology · 2024Review
- Pushing the Survival Bar Higher: Two Decades of Innovation in Lung Transplantation.Journal of clinical medicine · 2024Review
- Impact of Extracorporeal Membrane Oxygenation Bridging Duration on Lung Transplant Outcomes.The Annals of thoracic surgery · 2024Observational
- Miscalibration of lung allocation models leads to inaccurate waitlist mortality predictions.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2023Article
- Article
- Is it too soon to abandon all hope of useful post-transplant predictions in thoracic transplantation? Reply to: Expecting the unexpected, and prioritizing the predictable.The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2022Article
- The lung allocation score and other available models lack predictive accuracy for post-lung transplant survival.The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2022Article
- Expecting the unexpected, and prioritizing the predictable.The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2022Article
- Trends over Time in Practice and Outcomes of Lung Transplantation in Recipients With Human Immunodeficiency Virus.Transplant infectious disease : an official journal of the Transplantation SocietyArticle
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Authors and funding
5 authors.
Funding
Abstract
backgroundThe United States (US) Lung Allocation Score (LAS) relies on the performance of 2 survival models that estimate waitlist and post-transplant survival. These models were developed using data from 2005 to 2008, and it is unknown if they remain accurate.
methodsWe performed an observational cohort study of US lung transplantation candidates and recipients greater than 12 years of age between February 19, 2015 and February 19, 2019. We evaluated the LAS waitlist and post-transplant models with the concordance probability estimate and by comparing predicted vs observed 1-year restricted mean survival times by risk decile. We then compared a nonparametric estimate of the observed LAS with the predicted LAS for each percentile of recipients.
resultsThe waitlist model ranked candidates (N = 11,539) in the correct risk order 72% of the time (95% CI 71%-73%), and underestimated candidate one-year survival by 136 days for the highest risk decile (p < 0.001). The post-transplant model ranked recipients (N = 9,377) in the correct risk order 57% of the time (95% CI 55-58%), and underestimated recipient one-year survival by 70 days for the highest risk decile (p < 0.001). Overall, the LAS at transplant explained only 56% of the variation in observed outcomes, and was increasingly inaccurate at higher predicted values.
conclusionsThe waitlist and the post-transplant models that constitute the LAS are inaccurate, limiting the ability of the system to rank candidates on the waitlist in the correct order. The LAS should therefore be updated and the underlying models should be modernized.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.