Pulmonary arterial hypertension patients face unique challenges in lung transplantation. Unlike patients with other lung diseases, they often have relatively normal lung function tests but are in critical condition due to heart failure. This means they receive low priority scores in the standard Lung Allocation Score (LAS) system, which was designed primarily for patients with lung tissue diseases.
To address this problem, the Eurotransplant region introduced an exceptional LAS (eLAS) system where independent judges can grant higher priority to pulmonary arterial hypertension patients showing signs of right heart failure. This study analyzed 241 pulmonary arterial hypertension transplant patients and found:
Key findings:
- Pulmonary arterial hypertension patients granted eLAS were transplanted quickly (17 days) with acceptable survival rates (79% survived 90 days)
- However, nearly half of eLAS requests were rejected because patients didn’t yet meet the strict criteria
- Patients whose eLAS was declined but were eventually transplanted had much worse outcomes (only 63% survived 90 days versus 81% in the approved eLAS group)
- Pulmonary arterial hypertension patients have the highest waitlist death rate and lowest chance of transplantation within one year
The problem: The current system only allows eLAS applications when pulmonary arterial hypertension patients are already in advanced heart failure. By that point, they may be too sick for good transplant outcomes. Earlier intervention—before severe heart failure develops—could save more lives.
Conclusion: The allocation system needs refinement to give pulmonary arterial hypertension patients fairer access to life-saving transplantation while they’re still healthy enough to benefit from it.
Read more at this link on Transplant International
Citation
Schwarz S, Vogelaar S, Knoop C, Dzubur F, Warnecke G, Bogyo L, Stupnik T, Seghers L, Evrard P, Schramm R, Gieszer B, Gummert J, Harlander M, Benazzo A, Jaksch P, Hoetzenecker K. The Impact of an Exceptional Lung Allocation Score on Organ Access of Failing Pulmonary Arterial Hypertension Patients – A Eurotransplant Experience. Transpl Int. 2025 Oct 28;38:15013. doi: 10.3389/ti.2025.15013. PMID: 41229568; PMCID: PMC12602372.