Outcomes and Long-term Survival After Pulmonary Retransplantation: A Single-Center Experience
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Background The median survival after lung retransplantation (ReLTx) reported to the International Society of Heart and Lung Transplantation is restricted to 2.5 years. We report the results after ReLTx from our center. Methods A retrospective data collection was performed for the 635 patients who underwent lung transplantation between 1991 and 2017 at our center. Recipient variables were compared between patients undergoing only primary lung transplantation (PLTx) and those undergoing PLTx and later ReLTx. Time to death was compared using the Kaplan-Meier method. The risk of ReLTx was analyzed in Cox regression models. Any interaction between type of transplantation, single/double, and PLTx/ReLTx was investigated. Results ReLTx was performed in 49 patients. Survival after ReLTx at 30 days and 1, 2, and 5 years was 90%, 76%, 71%, and 55%, respectively, and the corresponding survival after PLTx was 94%, 82%, 76%, and 61%, respectively. A hazard ratio of 1.73 for ReLTx was shown (95% confidence interval [CI], 1.14 to 2.63; P = .011). After adjustments for sex, age, diabetes, renal function, preoperative ventilator, and extracorporeal membrane oxygenation, the hazard ratio was 1.43 (95% CI, 0.90 to 2.26; P = .13). ReLTx was performed in 8 patients (16%) within the first year after PLTx. The 1-year survival for this group was 50% compared with 81% (P = .18) for patients who underwent ReLTx later than 1 year after the PLTx. One-year survival after double ReLTx was 60% (95% CI, 25% to 83%) compared with 79% (95% CI, 63% to 89%) for single ReLTx. Conclusions ReLTx is a reasonable option for a selected group of patients. Ideally, a number of well-established risk factors are avoided and the ReLTx is performed more than 1 year after the PLTx.
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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 [3]
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 [3]
Recipient age ≥55 years at the time of ReTx was significantly associated with decreased survival (adjusted HR 2.6; 95% CI, 1.39-5.02).
“Recipient age ≥55 years at the time of ReTx was significantly associated with decreased survival (adjusted HR 2.6; 95% CI, 1.39–5.02)”
From Lung retransplantation during the Lung Allocation Score era: Outcomes from a large single center (2026) · cites this paper as [3]
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 [3]
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 [3]
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References 15 · Cited by 33
- Authors
- Wallinder, A., Danielsson, C., Magnusson, J., Riise, G. C., & Dellgren, G.
- Affiliations
- Sahlgrenska University Hospital (SE)
- Corresponding author
- Wallinder, Andreas
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 2019-10
- Volume
- 108
- Issue
- 4
- Pages
- 1037-1044
- ISSN
- 0003-4975 (ISSN-L)
- OpenAlex
- W2945730536
- Cited by
- 33
- References
- 15
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 5 · 2023: 7 · 2022: 5 · 2021: 3 · 2020: 3 · 2019: 2
- FWCI
- 3.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Swedish Foundation for International Cooperation in Research and Higher Education
- Topics
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Keywords
- lung retransplantation, lung transplantation, long-term survival, post-transplant mortality
- MeSH terms
- Adolescent, Adult, Aged, Child, Female, Follow-Up Studies, Graft Rejection, Humans, Lung Diseases, Male, Middle Aged, Reoperation, Retrospective Studies, Sweden, Time Factors, Survival Rate, Lung Transplantation, Young Adult, Transplant Recipients
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