Impact of CLAD Phenotype on Survival After Lung Retransplantation: A Multicenter Study
Open accessAbstract
Chronic lung allograft dysfunction (CLAD) remains a major problem after lung transplantation with no definitive treatment except redo lung transplantation (re-LTx) in selected candidates. However, CLAD is not a homogeneous entity and different phenotypes exist. Therefore, we aimed to evaluate the effect of CLAD phenotypes on survival after re-LTx for CLAD. Patients who underwent re-LTx for respiratory failure secondary to CLAD in four LTx centers between 2003 and 2013 were included in this retrospective analysis. Bronchiolitis obliterans syndrome (BOS) and restrictive CLAD (rCLAD) were distinguished using pulmonary function, radiology and explant lung histopathology. Patient variables pre- and post-re-LTx were collected and analyzed. A total of 143 patients underwent re-LTx for CLAD resulting in 94 BOS (66%) and 49 rCLAD (34%) patients. Unadjusted and adjusted survival after re-LTx for rCLAD was worse compared to BOS (HR = 2.60, 1.59-4.24; p < 0.0001 and HR = 2.61, 1.51-4.51; p = 0.0006, respectively). Patients waiting at home prior to re-LTx experienced better survival compared to hospitalized patients (HR 0.40; 0.23-0.72; p = 0.0022). Patients with rCLAD redeveloped CLAD earlier and were more likely to redevelop rCLAD. Survival after re-LTx for rCLAD is worse compared to BOS. Consequently, re-LTx for rCLAD should be critically discussed, particularly when additional peri-operative risk factors are present.
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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 [13]
The Results section (Survival after re-LTx; page unavailable) reports that lower primary graft dysfunction (PGD) grades 48 hours after retransplantation were associated with better survival. It includes recipient age as an adjustment variable but does not report a survival benefit for younger recipients, and the passages found do not link a longer interval between primary transplantation and retransplantation to survival. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOur observed CLAD-free survival at 3 and 5 years following ReTx was comparable to prior reports.
“Our observed CLAD-free survival at 3 and 5 years following ReTx was comparable to prior reports.8, 13”
From Lung retransplantation during the Lung Allocation Score era: Outcomes from a large single center (2026) · cites this paper as [13]
The Results (Second transplant characteristics; page unavailable) report CLAD-free survival after retransplantation and find it shorter for rCLAD than for BOS. The cited copy does not give 3- or 5-year CLAD-free survival estimates or compare those estimates with prior reports. Its Discussion compares overall survival, which is a different outcome. (LLM, conf=0.78)
Experimental — accuracy not yet measuredThere was no significant difference in the survival rate, but the survival rate was lower in patients who underwent lung re-transplantation.
“although there was no significant difference in the survival rate, the survival rate was lower in patients who underwent lung re-transplantation [33,34].”
From Indications for Lung Transplantation and Patient Selection (2022) · cites this paper as [33]
The Discussion (page unavailable) reports median survival of 5.3 years after retransplantation for BOS versus 6.1 years in registry data for primary transplantation, describing them as comparable; it reports much worse survival of 1.7 years for retransplantation with rCLAD. That supports a lower descriptive survival figure, but the paper does not report a significance test comparing retransplantation overall with primary transplantation, so it does not establish the claimed nonsignificant difference. (LLM, conf=0.84)
Experimental — accuracy not yet measuredA history of previous thoracic surgery, pleural disease, and pleural procedures may make the operation difficult and time-consuming and may cause massive bleeding, potentially increasing the incidence of mortality or graft dysfunction.
“A history of previous thoracic surgery, pleural disease, and pleural procedures may make the operation difficult and time-consuming and may cause massive bleeding, potentially increasing the incidence of mortality or graft dysfunction.”
From Indications for Lung Transplantation and Patient Selection (2022) · cites this paper as [33]
The Discussion (page unavailable) says pleural fibrosis in patients with restrictive CLAD may pose a surgical challenge during lung retransplantation. The Results (page unavailable) report longer operations, more blood transfusions, higher primary graft dysfunction scores, and worse survival in that group. The paper does not establish that a history of thoracic surgery or pleural procedures causes massive bleeding or the stated outcomes. (LLM, conf=0.86)
Experimental — accuracy not yet measuredA history of previous thoracic surgery, pleural disease, and pleural procedures is not a contraindication to lung transplantation.
“However, these are not contraindications to lung transplantation”
From Indications for Lung Transplantation and Patient Selection (2022) · cites this paper as [33]
The Methods (Patient selection; page unavailable) include patients who underwent lung retransplantation, showing that a prior transplant operation did not categorically preclude another one. The cited passages do not address pleural disease or pleural procedures as contraindications, so those parts of the claim are unsupported. (LLM, conf=0.78)
Experimental — accuracy not yet measured
About 45% of transplant patients had undergone treatment for chest conditions.
“about 45% of transplant patients had undergone treatment for chest conditions”
From Indications for Lung Transplantation and Patient Selection (2022) · cites this paper as [33]
The Results (Second transplant characteristics; page unavailable) say that 62 patients—about 44% of those with admission data—were admitted to a ward or ICU while awaiting retransplantation. Admission is not the same as having undergone treatment for chest conditions. The Patient selection section identifies patients undergoing retransplantation for chronic lung allograft dysfunction, but our copy does not report the claimed treatment history for about 45% of patients. (LLM, conf=0.75)
Experimental — accuracy not yet measured
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Cited by
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Worth a Double Take? An In-Depth Review of Lung Retransplantation
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- Authors
- Verleden, S. E., Todd, J. L., Sato, M., Palmer, S. M., Martinu, T., Pavlisko, E. N., Vos, R., Neyrinck, A., Van Raemdonck, D., Saito, T., Oishi, H., Keshavjee, S., Greer, M., Warnecke, G., Gottlieb, J., & Haverich, A.
- Affiliations
- KU Leuven (BE)
- Duke Medical Center (US)
- University Health Network (CA)
- Medizinische Hochschule Hannover (DE)
- Corresponding author
- Verleden, S.E.
- ORCID
- Venue
- American Journal of Transplantation
- Publisher
- Elsevier BV
- Published
- 2015-08
- Volume
- 15
- Issue
- 8
- Pages
- 2223-2230
- ISSN
- 1600-6135 (ISSN-L)
- PMC
- PMC4943073
- OpenAlex
- W1540147815
- Cited by
- 123
- References
- 3
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 7 · 2023: 12 · 2022: 7 · 2021: 18 · 2020: 12 · 2019: 16 · 2018: 21 · 2017: 10 · 2016: 9
- FWCI
- 13.44
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- American Journal of Transplantation (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Lirias (submittedVersion, other-oa)
- Funders
- Fonds Wetenschappelijk Onderzoek (12G8715N)
- Clinical trials in organ transplantation (UO1-AI113315)
- 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
- chronic lung allograft dysfunction, lung retransplantation, bronchiolitis obliterans syndrome, post-transplant survival, respiratory failure
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Phenotype, Survival Rate, Lung Transplantation, Primary Graft Dysfunction, Young Adult
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