Outcomes after Lung Retransplantation in the Modern Era

• DOI: 10.1164/rccm.200707-1132oc
• Publication Date: 2007-09-28T15:48:47Z
• Authors: Steven M. Kawut; David J. Lederer; Shaf Keshavjee; Jessie S. Wilt; Theresa Daly; Frank D'Ovidio; Joshua R. Sonett; Selim M. Arcasoy; Mark L. Barr
• Keywords: Adult; Graft Rejection; Male; Reoperation; Tissue and Organ Procurement; Waiting Lists; Kaplan-Meier Estimate; Middle Aged; Respiration, Artificial; United States; 3. Good health; Cohort Studies; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Risk Factors; Cause of Death; Humans; Female; Bronchiolitis Obliterans; Lung Transplantation; Proportional Hazards Models; Retrospective Studies

Characteristics of and survival estimates for recipients of lung retransplantation in the modern era are unknown.To compare lung retransplant patients in the modern era with historical retransplant patients, to compare retransplant patients with initial transplant patients in the modern era, and to determine the predictors of the risk of death after lung retransplantation.We performed a retrospective cohort study of patients who underwent lung retransplantation between January 2001 and May 2006 in the United States (modern retransplant cohort). The characteristics and survival of this cohort were compared with those of patients who underwent first lung retransplantation between January 1990 and December 2000 (historical retransplant cohort) and patients who underwent initial lung transplantation between January 2001 and May 2006 (modern initial transplant cohort).Modern retransplant recipients (n = 205) had a lower risk of death compared with that of the historical retransplant cohort (n = 184) (hazard ratio, 0.7; 95% confidence interval, 0.5-0.9; P = 0.006). However, modern retransplant recipients had a higher risk of death than that of patients who underwent initial lung transplantation (n = 5,657) (hazard ratio, 1.3; 95% confidence interval, 1.2-1.5; P = 0.001), which appeared to be explained by a higher prevalence of certain comorbidities. Retransplantation at less than 30 days after the initial transplant procedure was associated with worse survival.Outcomes after lung retransplantation have improved; however, retransplantation continues to pose an increased risk of death compared with the initial transplant procedure. Retransplantation early after the initial transplant poses a particularly high mortality risk.