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Outcomes after Lung Retransplantation in the Modern Era

¹ Department of Medicine, College of Physicians and Surgeons, and ² Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York; ³ Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada; ⁴ Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York; and ⁵ Department of Cardiothoracic Surgery, University of Southern California, Los Angeles, California

Correspondence and requests for reprints should be addressed to Steven Kawut, M.D., M.S., Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, PH 8E, Room 101, 622 West 168th Street, New York, NY 10032. E-mail: sk2097{at}columbia.edu

Rationale: Characteristics of and survival estimates for recipients of lung retransplantation in the modern era are unknown.

Objectives: 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.

Methods: 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).

Measurements and Main Results: 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.

Conclusions: 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.

Key Words: lung transplantation • cohort study • retransplantation • solid organ

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Lung retransplantation is a treatment for lung allograft failure; however, outcomes have traditionally been poor, and this procedure is historically uncommon. What This Study Adds to the Field The number of retransplantation procedures performed as well as survival after retransplantation have increased in the modern era.