title: Outcomes after lung retransplantation in the modern era.
abstract: BACKGROUND
  Characteristics of and survival estimates for recipients of lung retransplantation in the modern era are unknown.
  
  
  OBJECTIVE
  To compare lung retransplant patients in the modern era with historical retransplant patients, to compare retransplant patients with initial transplant patients in the modern era, and to determine the predictors of the risk of death after lung retransplantation.
  
  
  METHODS
  We performed a retrospective cohort study of patients who underwent lung retransplantation between January 2001 and May 2006 in the United States (modern retransplant cohort). The characteristics and survival of this cohort were compared with those of patients who underwent first lung retransplantation between January 1990 and December 2000 (historical retransplant cohort) and patients who underwent initial lung transplantation between January 2001 and May 2006 (modern initial transplant cohort).
  
  
  RESULTS
  Modern retransplant recipients (n = 205) had a lower risk of death compared with that of the historical retransplant cohort (n = 184) (hazard ratio, 0.7; 95% confidence interval, 0.5-0.9; P = 0.006). However, modern retransplant recipients had a higher risk of death than that of patients who underwent initial lung transplantation (n = 5,657) (hazard ratio, 1.3; 95% confidence interval, 1.2-1.5; P = 0.001), which appeared to be explained by a higher prevalence of certain comorbidities. Retransplantation at less than 30 days after the initial transplant procedure was associated with worse survival.
  
  
  CONCLUSIONS
  Outcomes after lung retransplantation have improved; however, retransplantation continues to pose an increased risk of death compared with the initial transplant procedure. Retransplantation early after the initial transplant poses a particularly high mortality risk.
authors: Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. sk2097@columbia.edu
authors: Steven M
authors: SM
authors: Kawut
authors: David J
authors: DJ
authors: Lederer
authors: Shaf
authors: S
authors: Keshavjee
authors: Jessie S
authors: JS
authors: Wilt
authors: Theresa
authors: T
authors: Daly
authors: Frank
authors: F
authors: D'Ovidio
authors: Joshua R
authors: JR
authors: Sonett
authors: Selim M
authors: SM
authors: Arcasoy
authors: Mark L
authors: ML
authors: Barr
mesh_terms: D000328:Adult; D001989:Bronchiolitis Obliterans / Q000401:mortality / Q000601:surgery*; D002423:Cause of Death / Q000639:trends; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000401:mortality / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D016016:Proportional Hazards Models; D012086:Reoperation; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D009927:Tissue and Organ Procurement / Q000639:trends; D014481:United States; D014850:Waiting Lists