title: Risk factors associated with lung retransplantation: evaluation of a nationwide registry over a quarter century.
abstract: BACKGROUND
  The relative paucity of donors heightens the debate and scrutiny surrounding retransplantation. To date, risk factors associated with retransplantation are poorly characterized in the literature. We sought to identify those risk factors that may independently serve to predict lung retransplantation.
  
  
  METHODS
  We performed a retrospective evaluation of the United Network for Organ Sharing data over 25 years from 1987 to 2012. Competing risk analysis was used to evaluate the cohort for cumulative incidence of retransplantation. Recipient-related, donor-related, and transplant-related characteristics were assessed using Cox regression to identify risk factors associated with lung retransplantation.
  
  
  RESULTS
  We identified 23,180 adult lung transplant recipients, of which 791 (3.4%) had also undergone retransplantation. Factors associated with lung retransplantation at 1 year included recipient age (hazard ratio [HR], 0.97; p=0.005), admission to the intensive care unit (HR, 2.89; p=0.002), donor age (HR, 1.02; p=0.004), and bilateral lung transplantation (HR, 0.41; p<0.001). Moreover, predictors of 5-year risk of retransplantation included recipient age (HR, 0.95; p<0.001), intensive care unit hospitalization (HR, 1.87; p=0.005), and bilateral lung transplant (HR, 0.46; p<0.001), as well as recipient body mass index of 25 to 29 kg/m2 (HR, 1.29; p=0.04) and a diagnosis of chronic obstructive pulmonary disease (HR, 0.68; p=0.008).
  
  
  CONCLUSIONS
  We identified factors associated with retransplantation that may afford a better prediction of graft failure and need for retransplantation. These may further serve to better guide donor selection and assist in the development and validation of a risk-scoring model to further guide preoperative counseling.
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: jhayanga@me.com.
authors.forename: Jeremiah A
authors.initials: JA
authors.lastname: Hayanga
authors.affiliation: Department of Epidemiology and Biostatistics, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Jingyan
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Epidemiology and Biostatistics, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Aboagye
authors.affiliation: Department of Epidemiology and Biostatistics, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Berko
authors.affiliation: Department of Pharmacology, University of Michigan Medical Center, Ann Arbor, Michigan.
authors.forename: Cong-Zhen
authors.initials: CZ
authors.lastname: Qiao
authors.affiliation: Department of Epidemiology and Biostatistics, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Kaiser
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Norihisa
authors.initials: N
authors.lastname: Shigemura
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jonathan
authors.initials: J
authors.lastname: D'Cunha
mesh_terms: D000328:Adult; D000367:Age Factors; D046148:Donor Selection / Q000379:methods*; D005260:Female; D005544:Forecasting; D006801:Humans; D008171:Lung Diseases / Q000401:mortality / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods*; D014481:United States / Q000453:epidemiology