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Comparison of the GAP Model and the Lung Allocation Score in Patients with Idiopathic Pulmonary Fibrosis/Interstitial Lung Disease Undergoing Lung Transplantation

L. Silhan

Published 2016 in Unknown venue

ABSTRACT

Background Idiopathic Pulmonary Fibrosis (IPF) and other advanced Interstitial Lung Diseases (ILD) are often fatal without Lung Transplantation (LT). Several models for predicting mortality risk have been developed including the GAP (gender, age, physiology) model. Similarly, the Lung Allocation Score (LAS) has been shown to predict the risk of mortality within the first year posttransplant. We hypothesized that a disease specific mortality model (GAP) might be superior compared to the predictive power of the LAS model for overall mortality within the first year posttransplant in patients with IPF and ILD. Methods A retrospective analysis of 72 patients with IPF or ILD listed for transplant between March 2005 and September 2013 at a single academic medical center was conducted. Logistic regression models were used to compare the relative contribution and explanatory power of the LAS and GAP for predicting mortality within the first year posttransplant using likelihood ratio chi-square tests (G2) and the area under the Receiver Operator Characteristic (ROC) curve. Results Fifty-eight subjects received lung transplant and fourteen were removed from the waiting list. Forty-two subjects survived past the first posttransplant year of the 58 transplanted subjects, six had unavailable data. Fifty-two IPF/ILD subjects were included for analysis. Fourteen (26.9%) of the 52 died within the first posttransplant year. GAP and LAS were poorly correlated (r2=0.033). Neither GAP nor LAS was predictive of early posttransplant mortality in IPF/ILD (C-statistic range 0.62-0.67). Conclusions Our data demonstrate poor correlation between GAP and LAS, which may be due to the GAP score being dependent on the diffusion capacity variable which is not included in the LAS. In our dataset, neither correlated well with early posttransplant mortality.

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