Epidemiology, risk factors, and outcomes of lung retransplantation: An analysis of the International Society for Heart and Lung Transplantation Thoracic Transplant Registry
Open accessAbstract
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' D xy 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.
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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 [5]
The Discussion (page unavailable) says survival after lung retransplantation is somewhat lower than after primary transplantation, but does not establish the claimed significant difference. The Results (page unavailable) report 73.8% one-year survival overall and 76% for one subgroup; our copy does not support the 47% lower bound or the claimed 21%–55% five-year range. (LLM, conf=0.88)
Experimental — accuracy not yet measuredRecipient 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 [5]
The Results (page unavailable) identify recipient age as a prognostic factor in the adjusted 1-year mortality analysis. They do not report an age ≥55 cutoff or the claimed adjusted HR of 2.6 (95% CI, 1.39–5.02); the Methods instead describe age categories of 18–40, 41–64, and 65+ years for survival estimates. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAs primary lung transplant volume continues to increase, ReTx rates are also rising.
“As primary lung transplant volume continues to increase, ReTx rates are also rising,5”
From Lung retransplantation during the Lung Allocation Score era: Outcomes from a large single center (2026) · cites this paper as [5]
The Introduction (page unavailable) reports that lung retransplantation increased markedly during 2005–2012 compared with earlier years. But the Results and Discussion (pages unavailable) report that retransplants accounted for approximately 4–6% of transplants annually since 2005–2007; they do not establish that ReTx rates continue to rise alongside primary transplant volume. (LLM, conf=0.84)
Experimental — accuracy not yet measuredYounger 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 [5]
The Results (page unavailable) link the inter-transplant interval to 1-year mortality and list recipient age among prognostic factors, although an age-adjusted analysis found no association between recipient age and mortality. The paper does not establish that younger recipient age improves survival, nor does it report lower acute graft dysfunction as a survival factor; it analyzes retransplant indication instead. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCompared to the ISHLT registry data, our retransplant recipients had longer interval between primary and ReTx procedures (median interval of 4.9 vs. 3.4 years).
“and had longer interval between primary and ReTx procedures (median interval of 4.9 vs. 3.4 years).5”
From Lung retransplantation during the Lung Allocation Score era: Outcomes from a large single center (2026) · cites this paper as [5]
Compared to the ISHLT registry data, our retransplant recipients had lower rates of ReTx for acute graft dysfunction (4% vs. 17%).
“and had lower rates of ReTx for acute graft dysfunction (4% vs. 17%)”
From Lung retransplantation during the Lung Allocation Score era: Outcomes from a large single center (2026) · cites this paper as [5]
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 [5]
Compared to the ISHLT registry data, our retransplant recipients were younger (median age 37 years vs. 46 years).
“Compared to the ISHLT registry data, our retransplant recipients were also younger (median age 37 years vs. 46 years)”
From Lung retransplantation during the Lung Allocation Score era: Outcomes from a large single center (2026) · cites this paper as [5]
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 [5]
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Cites
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Cited by
Sorted by citations
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
“However, unlike prior studies, 5,8,10–12, 15 we did not find that pre-transplant pre-transplant MV or ECMO use”
Worth a Double Take? An In-Depth Review of Lung Retransplantation
Dawodu, G., Gulati, S., Bugacov, H., Laskey, D., Housman, B., Seethamraju, H., & Scheinin, S. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12237418 · Cited by 4 · see citing works
- Authors
- Harhay, M. O., Cherikh, W. S., Toll, A. E., Christie, J. D., Stehlik, J., Chambers, D., Hayes Jr., D., & Cantu, E.
- Affiliations
- International Society for Heart and Lung Transplantation (US)
- United Network for Organ Sharing (US)
- University of Pennsylvania (US)
- University of Utah (US)
- The University of Queensland (AU)
- Corresponding author
- Harhay, Michael O.
- ORCID
- Venue
- The Journal of Heart and Lung Transplantation
- Publisher
- Elsevier BV
- Published
- 2022-10
- Volume
- 41
- Issue
- 10
- Pages
- 1478-1486
- ISSN
- 1053-2498 (ISSN-L)
- PMC
- PMC9986966
- OpenAlex
- W4284700933
- Cited by
- 31
- References
- 6
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 11 · 2023: 4
- FWCI
- 5.13
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Heart and Lung Transplantation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- International Society for Heart and Lung Transplantation
- Astellas Pharma
- International Society for Heart and Lung Transplants
- 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, one-year mortality, prognostic factors, bronchiolitis obliterans, primary graft failure, donor age, mechanical ventilation, survival outcomes, risk stratification, transplant decision-making
- MeSH terms
- Adult, Graft Survival, Humans, Lung, Registries, Reoperation, Respiratory Insufficiency, Retrospective Studies, Risk Factors, Heart Transplantation, Lung Transplantation
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