Outcomes after lung retransplantation in the modern era.
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.
Kawut
Steven M
SM
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. sk2097@columbia.edu
Lederer
David J
DJ
Keshavjee
Shaf
S
Wilt
Jessie S
JS
Daly
Theresa
T
D'Ovidio
Frank
F
Sonett
Joshua R
JR
Arcasoy
Selim M
SM
Barr
Mark L
ML
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