Comprehensive outcomes after lung retransplantation: A single‐center review
Abstract
Introduction: Lung retransplantation is an important therapy for a growing population of lung transplant recipients with graft failure, but detailed outcome data are lacking. Methods: We conducted a retrospective cohort study of adult lung retransplant in the Toronto Lung Transplant Program from 2001 to 2013 (n = 38). We analyzed the postoperative course, graft function, renal function, microbiology, donor‐specific antibodies (DSA), quality of life, and survival compared to a control cohort of primary transplant recipients matched for age and era. Results: Indication for retransplant was chronic lung allograft dysfunction in most retransplant recipients (35/38, 92%). The postoperative course was more complex after retransplant than primary (ventilation time, 8 vs 2 days, P < .01; ICU stay 14 vs 4 days, P < 0.01), and peak lung function was lower (FEV 1 2.2L vs 3L, P < .01). Quality of life scores were comparable, as were renal function, microbiology, and donor‐specific antibody formation. Median survival was 1988 days after primary and 1475 days after retransplant (P = .39). Conclusions: Lung retransplantation is associated with a more complex postoperative course and lower peak lung function, but the long‐term medical profile is similar to primary transplant. Lung retransplantation can be beneficial for carefully selected candidates with allograft failure.
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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 [8]
Our 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 [8]
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 [8]
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 [8]
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 [8]
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 [34]
There 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 [34]
A 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 [34]
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.
“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 [34]
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Outcomes after Lung Retransplantation in the Modern Era
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Self-citationLong-term outcome after pulmonary retransplantation
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Leard, L. E., Holm, A. M., Valapour, M., Glanville, A. R., Attawar, S., Aversa, M., Campos, S. V., Christon, L. M., Cypel, M., Dellgren, G., et al. (2021) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2021.07.005 · Cited by 821 · see citing works
“140,146,150,151 In the pre-transplant evaluation of such patients, particular emphasis should be focused on understanding the possible reasons for the graft failure, such as alloimmunization, poor adherence, GER, or repeated infections.”
BackgroundSelf-citationLung 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
Indications for Lung Transplantation and Patient Selection
Son, J., & Shin, C. (2022) · Journal of Chest Surgery · doi:10.5090/jcs.22.057 · Cited by 9 · see citing works
“According to a recent report, about 45% of transplant patients had undergone treatment for chest conditions, and although there was no significant difference in the survival rate, the survival rate was lower in patients who underwent lung re-transplantation [33,34].”
BackgroundThoracic 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
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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
- Halloran, K., Aversa, M., Tinckam, K., Martinu, T., Binnie, M., Chaparro, C., Chow, C., Waddell, T., McRae, K., Pierre, A., de Perrot, M., Yasufuku, K., Cypel, M., Keshavjee, S., & Singer, L. G.
- Affiliations
- University Health Network (CA)
- Toronto Lung Transplant Program Toronto General Hospital University Health Network Toronto ON Canada
- Corresponding author
- Halloran, Kieran
- ORCID
- Venue
- Clinical Transplantation
- Publisher
- Wiley
- Published
- 2018-06
- Volume
- 32
- Issue
- 6
- Pages
- e13281-e13281
- ISSN
- 0902-0063 (ISSN-L)
- 1399-0012
- OpenAlex
- W2799290510
- Cited by
- 42
- References
- 4
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 6 · 2023: 8 · 2022: 8 · 2021: 7 · 2020: 2 · 2019: 4
- FWCI
- 3.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Transplantation (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, chronic lung allograft dysfunction, graft failure, postoperative course, survival, donor-specific antibodies, quality of life, renal function
- MeSH terms
- Adult, Female, Follow-Up Studies, Graft Rejection, Graft Survival, Humans, Lung Diseases, Male, Middle Aged, Postoperative Complications, Prognosis, Quality of Life, Reoperation, Retrospective Studies, Risk Factors, Survival Rate, Lung Transplantation
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