Retransplantation Outcomes at a Large Lung Transplantation Program

Background With the increase of primary lung transplantation across major centers worldwide, over the last several years the need of lung retransplant (ReTX) is likely to increase. Therefore, characterization of ReTX patients is prudent and necessary. Our study aimed to investigate and characterize the covariates and outcomes associated with lung ReTX survival in a single large U.S. transplant center. Methods Demographic, clinical diagnoses, and comorbidities were analyzed. Kaplan-Meier statistics were used to calculate and predict survival for 30 days and up to 3 years. Cox proportional modeling was used to determine the variables associated with mortality. Results Of included 684 lung transplants performed at the Houston Methodist Hospital between January 2009 and December 2015, 49 were lung ReTX. Median age of primary lung transplant (non-ReTX) and ReTx recipients was 62 and 49 years, respectively. Chronic graft rejection in the form of restrictive chronic lung allograft dysfunction and bronchiolitis obliterans syndrome was the main indications for ReTX. Compared with non-ReTX patients, ReTX patients had higher median lung allocation score (46.2 vs 37.0, respectively) and higher mortality after 6 months posttransplant. ReTX, older age, female sex, hospitalization 15 days or longer, estimated glomerular filtration rate less than 60, 6-minute walk distance less than 400 ft, and donor/recipient height ratio less than 1 were significantly associated with decreased 1-year patient and graft survival. Chronic graft rejection was still the major cause of death in the long-term follow-up recipients. Conclusions Our findings suggested that lung ReTX recipients have poor long-term survival outcomes. Lung ReTX should only be offered to carefully selected patients. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 25 October, 2018. Received 23 April 2018. Revision requested 17 May 2018. Accepted 21 September 2018. D.R., T.K., E.A.G., D.N., N.S., A.G., E.S., M.L., S.S., B.B. participated in the research design. E.A.G., D.N. participated in data analysis. D.R., T.K., E.A.G., D.N. participated in result interpretation. D.R., E.A.G., D.N. participated in writing of the article. D.R., T.K., A.G., I.A., E.A.G., D.N. reviewed and edited article. The authors declare no funding or conflicts of interest. Correspondence: Dewei Ren, MD, Houston Methodist Hospital, 6565 Fannin St. Houston, TX 77030. (dxren@houstonmethodist.org). © 2018 The Authors. Published by Wolters Kluwer Health, Inc.