Pulmonary retransplantation.
METHODS
Despite improving results in lung transplantation, a significant number of grafts fail early or late postoperatively. The Pulmonary Retransplant Registry was founded in 1991 to determine the predictors of outcome after retransplantation, so as to facilitate decisions concerning the appropriateness of lung retransplantation in individual patients. In this study, 230 patients underwent retransplantation in 47 centers from 1985 to 1996. Logistic regression methods were used to determine variables associated with, and predictive of, survival and lung function after retransplantation.


RESULTS
Actuarial survival was 47%+/-3%, 40%+/-3% and 33%+/-4% at 1, 2, and 3 years, respectively. On multivariable analysis, the predictors of survival included ambulatory status or lack of ventilator support preoperatively (P=.005, odds ratio 1.62, 95% confidence interval 1.15-2.27), followed by retransplantation after 1991 (P=.048, odds ratio 1.41, 95% confidence interval 1.003-1.99). Ambulatory, nonventilated patients undergoing retransplantation after 1991 had a 1-year survival rate of 64%+/-5% versus 33%+/-4% for nonambulatory, ventilated recipients. Eighty-one percent, 70%, 62%, and 56% of survivors were free of bronchiolitis obliterans syndrome at 1, 2, 3, and 4 years after retransplantation, respectively. Factors associated with freedom from stage 3 (severe) bronchiolitis obliterans syndrome at 2 years after retransplantation included an interval between transplants greater than 2 years (P=.01), the lack of ventilatory support before retransplantation (P=.03), increasing retransplant experience within each center (5th and higher retransplant patient, P=.04) and total center volume of 5 or more retransplant operations (P=.05).


CONCLUSIONS
Nonambulatory, ventilated patients should not be considered for retransplantation with the same priority as other candidates. The best intermediate-term functional results occurred in more experienced centers, in nonventilated patients and in patients undergoing retransplantation more than 2 years after their first transplantation. In view of the scarcity of lung donors, patient selection for retransplantation should remain strict.
Novick
R J
RJ
Department of Surgery, the London Health Sciences Centre, the Robarts Research Institute and the University of Western Ontario, London, Canada.
Stitt
L
L
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D001315:Australia; D001989:Bronchiolitis Obliterans / Q000401:mortality / Q000601:surgery*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D005060:Europe; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D016040:Lung Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D015999:Multivariate Analysis; D012086:Reoperation / Q000706:statistics & numerical data*; D012129:Respiratory Function Tests; D016019:Survival Analysis; D014481:United States