title: Differential outcomes with early and late repeat transplantation in the era of the lung allocation score.
abstract: BACKGROUND
  Rates of repeat lung transplantation have increased since implementation of the lung allocation score (LAS). The purpose of this study is to compare survival between repeat (ReTx) and primary (LTx) lung transplant recipients in the LAS era.
  
  
  METHODS
  We extracted data from 9,270 LTx and 456 ReTx recipients since LAS implementation, from the United Network for Organ Sharing registry. Propensity scoring was used to match ReTx and LTx recipients. Kaplan-Meier analysis compared survival between LTx and ReTx groups, with and without stratification based on time between first and second transplant. Multivariable Cox models estimated predictors of survival in lung recipients.
  
  
  RESULTS
  Comparing all ReTx to LTx demonstrates a survival advantage for LTx that is diminished with propensity score matching (p = 0.174). Considering LTx against ReTx greater than 90 days after the initial procedure, there are similar survival results (p < 0.067). In contrast, ReTx within 90 days was associated with a survival disadvantage that persisted despite matching (p = 0.011). In ReTx populations, factors conferring worse outcomes include intensive care unit admission, unilateral transplantation, poor functional status, and primary graft dysfunction as the indication for retransplantation (p < 0.05).
  
  
  CONCLUSIONS
  Late lung retransplantation appears to be as beneficial as primary transplantation in propensity-matched patients. However, survival is severely diminished in those retransplanted less than 90 days after primary transplantation. The utility of early retransplantation needs to be carefully weighed in light of risks.
authors.affiliation: School of Medicine, Duke University Medical Center, Durham, North Carolina. Electronic address: asishana.osho@gmail.com.
authors.forename: Asishana A
authors.initials: AA
authors.lastname: Osho
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Castleberry
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Laurie D
authors.initials: LD
authors.lastname: Snyder
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Palmer
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Asvin M
authors.initials: AM
authors.lastname: Ganapathi
authors.affiliation: School of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Hirji
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Shu S
authors.initials: SS
authors.lastname: Lin
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: R Duane
authors.initials: RD
authors.lastname: Davis
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D055031:Primary Graft Dysfunction / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists; D055815:Young Adult