Differential Outcomes With Early and Late Repeat Transplantation in the Era of the Lung Allocation Score
Open accessAbstract
Background Rates of repeat lung transplantation have increased since implementation of the lung allocation score (LAS). The purpose of this study is to compare survival between repeat (ReTx) and primary (LTx) lung transplant recipients in the LAS era.Methods We extracted data from 9,270 LTx and 456 ReTx recipients since LAS implementation, from the United Network for Organ Sharing registry. Propensity scoring was used to match ReTx and LTx recipients. Kaplan-Meier analysis compared survival between LTx and ReTx groups, with and without stratification based on time between first and second transplant. Multivariable Cox models estimated predictors of survival in lung recipients.Results Comparing all ReTx to LTx demonstrates a survival advantage for LTx that is diminished with propensity score matching (p = 0.174). Considering LTx against ReTx greater than 90 days after the initial procedure, there are similar survival results (p < 0.067). In contrast, ReTx within 90 days was associated with a survival disadvantage that persisted despite matching (p = 0.011). In ReTx populations, factors conferring worse outcomes include intensive care unit admission, unilateral transplantation, poor functional status, and primary graft dysfunction as the indication for retransplantation (p < 0.05).Conclusions Late lung retransplantation appears to be as beneficial as primary transplantation in propensity-matched patients. However, survival is severely diminished in those retransplanted less than 90 days after primary transplantation. The utility of early retransplantation needs to be carefully weighed in light of risks.
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Previous literature has suggested that early re-transplant recipients have worse outcomes than those requiring a re-transplant farther out from the initial transplant.
“Previous literature has suggested that early re-transplant recipients have worse outcomes than those requiring a re-transplant farther out from the initial transplant.19”
From Cystic fibrosis survival outcomes following second lung transplant: The north American experience (2023) · cites this paper as [19]
Osho et al. found worse survival in those who underwent re-transplant within 90 days of the initial transplant.
“Osho et al. found worse survival in those who underwent re-transplant within 90 days of the initial transplant.”
From Cystic fibrosis survival outcomes following second lung transplant: The north American experience (2023) · cites this paper as [19]
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- Authors
- Osho, A. A., Castleberry, A. W., Snyder, L. D., Palmer, S. M., Ganapathi, A. M., Hirji, S. A., Lin, S. S., Davis, R. D., & Hartwig, M. G.
- Affiliations
- Duke University (US)
- Duke Medical Center (US)
- Corresponding author
- Osho, Asishana A.
- ORCID
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 2014-12
- Volume
- 98
- Issue
- 6
- Pages
- 1914-1921
- ISSN
- 0003-4975 (ISSN-L)
- PMC
- PMC5201423
- OpenAlex
- W1966142500
- Cited by
- 42
- References
- 27
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 4 · 2022: 4 · 2021: 4 · 2020: 5 · 2019: 2 · 2018: 6 · 2017: 5 · 2016: 3 · 2015: 2
- FWCI
- 3.30
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Duke University Medical Center
- National Institutes of Health Cardiothoracic Surgical Trials Network (U01-HL088953)
- Topics
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Organ Donation and Transplantation
- Keywords
- lung allocation score, primary graft dysfunction, intensive care unit admission, functional status, transplant outcomes
- MeSH terms
- Adult, Female, Follow-Up Studies, Graft Survival, Humans, Male, Middle Aged, Tissue and Organ Procurement, Prognosis, Registries, Reoperation, Retrospective Studies, Time Factors, United States, Waiting Lists, Survival Rate, Proportional Hazards Models, Lung Transplantation, Treatment Outcome, Patient Selection, Kaplan-Meier Estimate, Primary Graft Dysfunction, Young Adult, Propensity Score
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