Two Decades of Lung Retransplantation: A Single-Center Experience
Abstract
Background Lung retransplantation (ReTx) comprises an increasing share of lung transplants and recently has shown improved outcomes. The aim of this study was to identify risk factors affecting overall survival after pulmonary ReTx. Methods The United Network for Organ Sharing database was used to identify patients undergoing lung transplantation at our institution from 1995 to 2014. Of the total 542 lung transplants performed, 87 (16.1%) were ReTxs. The primary outcome was overall survival. Multivariate Cox regression models were used to assess the effect of recipient and donor characteristics on survival. Results Of the patients who underwent ReTx, median survival was 2 years. Predictors of worse survival include recipient age between 50 and 60 years (relative risk, 4.3; p = 0.02) or older than 60 years (relative risk, 10.2; p < 0.001), and time to ReTx of less than 2 years (relative risk, 3.8; p = 0.01). ReTx for bronchiolitis obliterans syndrome had longer median survival than for restrictive chronic lung allograft dysfunction (2.7 years vs 0.9 years; p = 0.055). Overall survival of ReTx patients after initiation of the lung allocation score was not significantly different (p = 0.21). Conclusions Lung ReTx outcomes are significantly worse than for primary transplantation but may be appropriate in well-selected patients with certain diagnoses. Lung ReTx in patients older than 50 years or within 2 years of primary lung transplantation was associated with decreased survival. Further work is warranted to identify patients who benefit most from ReTx.
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ReTx is associated with significantly lower survival than primary lung transplant, with 1-year survival ranging between 47% and 76%, and 5-year survival ranging between 21% and 55%.
“Existing literature shows that ReTx is associated with significantly lower survival than primary lung transplant with 1-year survival ranging between 47% and 76%, and 5-year survival ranging between 21% and 55%.3, 4, 5, 6”
From Lung retransplantation during the Lung Allocation Score era: Outcomes from a large single center (2026) · cites this paper as [6]
ReTx accounted for only 3.9% of our total volume, which was lower than the 4-16% reported in previous single-center studies and the 4-6% reported in the ISHLT registry between 2005 and 2017.
“Despite performing over 1000 lung transplants during the 18-year study period, ReTx accounted for only 3.9% of our total volume, which was lower than the 4–16% reported in previous single-center studies across the U.S., North America, and Europe,3, 6, 7, 8, 9 and the 4–6% reported in the ISHLT registry between 2005 and 2017.5”
From Lung retransplantation during the Lung Allocation Score era: Outcomes from a large single center (2026) · cites this paper as [6]
The lack of association between MV/ECMO, interval, surgical procedure and survival may be due to the characteristics of our cohort, which had substantially longer interval between transplants and consisted mostly of bilateral transplant procedures for both primary and retransplantation.
“However, the lack of association may be due to the characteristics of our cohort which had substantially longer interval between transplants and consisted mostly of bilateral transplant procedures for both primary and retransplantation, both of which characteristics were reported to be associated with improved survival.3, 5, 6, 8, 10, 11, 12”
From Lung retransplantation during the Lung Allocation Score era: Outcomes from a large single center (2026) · cites this paper as [6]
Younger age, lower acute graft dysfunction, and longer interval between primary and ReTx have all been previously linked to ReTx survival differences.
“These factors had all been previously linked to ReTx survival differences.3, 4, 5, 6, 7, 8, 10, 11, 12, 13”
From Lung retransplantation during the Lung Allocation Score era: Outcomes from a large single center (2026) · cites this paper as [6]
Cites
Outcomes after Lung Retransplantation in the Modern Era
Kawut, S. M., Lederer, D. J., Keshavjee, S., Wilt, J. S., Daly, T., D'Ovidio, F., Sonett, J. R., Arcasoy, S. M., & Barr, M. L. (2008) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200707-1132oc · Cited by 119 · see citing works
Long-term outcome after pulmonary retransplantation
Strueber, M., Fischer, S., Gottlieb, J., Simon, A. R., Goerler, H., Gohrbandt, B., Welte, T., & Haverich, A. (2006) · The Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2005.12.059 · Cited by 97 · see citing works
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. (2014) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2014.06.036 · Cited by 42 · see citing works
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Lung retransplantation in the modern era
Rucker, A. J., Nellis, J. R., Klapper, J. A., & Hartwig, M. G. (2021) · Journal of Thoracic Disease · doi:10.21037/jtd-2021-25 · Cited by 23 · see citing works
Thoracic retransplantation: does time to retransplantation matter?
Ganapathi, A. M., Heh, V., Rosenheck, J. P., Keller, B. C., Mokadam, N. A., Lampert, B. C., Whitson, B. A., & Henn, M. C. (2023) · The Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2022.05.003 · Cited by 8 · see citing works
Michel, E., Galen Hartwig, M., & Sommer, W. (2022) · Thoracic Surgery Clinics · doi:10.1016/j.thorsurg.2021.12.001 · Cited by 6 · see citing works
Lung retransplantation during the Lung Allocation Score era: Outcomes from a large single center
Laothamatas, K., Salvatori, C., Grewal, H. S., Sonnick, M., Vasilescu, E.-R., Shah, L., Robbins, H., DiMango, A., Magda, G., Stanifer, B. P., et al. (2026) · JHLT open · doi:10.1016/j.jhlto.2026.100501 · Cited by 4 · see citing works
- Authors
- Hall, D. J., Belli, E. V., Gregg, J. A., Salgado, J. C., Baz, M. A., Staples, E. D., Beaver, T. M., & Machuca, T. N.
- Affiliations
- University of Florida Health (US)
- University of Kentucky (US)
- Corresponding author
- Machuca, Tiago N.
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 103
- Issue
- 4
- Pages
- 1076-1083
- ISSN
- 0003-4975 (ISSN-L)
- OpenAlex
- W2561495972
- Cited by
- 43
- References
- 4
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2023: 6 · 2022: 4 · 2021: 4 · 2020: 7 · 2019: 3 · 2018: 11 · 2017: 1
- FWCI
- 5.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- 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 retransplantation, lung transplantation, overall survival, risk factors, recipient age, bronchiolitis obliterans syndrome, lung allocation score, donor characteristics
- MeSH terms
- Adolescent, Adult, Age Factors, Bronchiolitis Obliterans, Female, Forced Expiratory Volume, Graft Rejection, Humans, Lung, Male, Middle Aged, Reoperation, Retrospective Studies, Risk Factors, Transplantation, Homologous, Survival Analysis, Lung Transplantation, Young Adult
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