Background
Lung retransplantation is a complex surgical decision that represents the only potential
treatment option for recipients suffering from lung allograft failure. We sought to
describe the modern landscape of lung retransplantation and to compare the relative
importance of selected clinical, donor, and recipient factors on mortality in the
year following lung retransplantation.
Methods
We conducted a retrospective cohort study of first-time adult recipients of deceased
donor lung retransplants reported to the International Society for Heart and Lung
Transplantation (ISHLT) Thoracic Transplant Registry from May 2005 through June 2017.
In addition to describing the characteristics of lung retransplant recipients, we
examined 1 year survival overall, and by initial transplant-retransplant procedure
type, recipient age, retransplant indication, and time-to-lung retransplantation (i.e.,
inter-transplant interval). We used the Somers' Dxy rank correlation statistic for censored data to assess the relative importance of
several potential prognostic risk factors for mortality in the year following lung
retransplantation.
Results
Our cohort included 1,597 lung retransplant recipients. 2005 was the first year with
more than 100 retransplants, and since 2007, 138 to 188 retransplants (approximately
4%-6% of all transplants) were reported annually to the ISHLT Registry. The median
inter-transplant interval was 3.4 years (interquartile range: 1.6-6.2 years). Forty-three
percent of the cohort had an obliterative bronchiolitis retransplant indication, whereas
17% had primary graft failure. One-third (32%) were retransplanted within 2 years
of their primary transplant, and 64% received a double lung transplant both times,
whereas 36% received consecutive single lung transplants. Six-month and 1 year survival
(82% and 76%) were higher for double-double lung retransplant recipients than for
single-single recipients (76% and 69%). The 3 strongest prognostic factors for 1 year
mortality were the inter-transplant interval (decreasing hazard with longer intervals),
donor age (increasing hazard with older age), and need for mechanical ventilation
preceding lung retransplantation.
Conclusions
Retransplants comprise approximately 5% of annual lung transplants worldwide. The
factor most strongly associated with 1 year mortality in this population was the duration
of time since the primary lung transplant, with a persistent reduction in risk as
more time elapses.
KEYWORDS
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Publication history
Published online: July 04, 2022
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JHLT: The Podcast Episode 22: October 2022
For this month’s episode, JHLT The Podcast explores two impactful studies from the October issue of The Journal of Heart and Lung Transplantation. The episode is hosted by Daniel R. Goldstein, MD, Editor-in-Chief of JHLT, who is joined by the JHLT Digital Media Editors. Listen now to hear study authors discuss their work, their studies, and next steps for their research.
We hear from Anne Dipchand, MD (pictured), Professor of Pediatrics and Pediatric Cardiologist at the Hospital for Sick Children in Toronto, Canada, who is senior author on the study, “Eplet matching in pediatric heart transplantation: The SickKids experience.” Dr. Goldstein and David Schibilsky, MD, discuss the study with Dr. Dipchand. This single-center retrospective study measured allograft survival in 77 patients while performing HLA typing, antigen mismatch, and eplet mismatch analysis, with the goal of comparing the molecular level HLA matching with antigen level HL matching in post-heart transplant outcomes in children.
