title: Two Decades of Lung Retransplantation: A Single-Center Experience.
abstract: BACKGROUND
  Lung retransplantation (ReTx) comprises an increasing share of lung transplants and recently has shown improved outcomes. The aim of this study was to identify risk factors affecting overall survival after pulmonary ReTx.
  
  
  METHODS
  The United Network for Organ Sharing database was used to identify patients undergoing lung transplantation at our institution from 1995 to 2014. Of the total 542 lung transplants performed, 87 (16.1%) were ReTxs. The primary outcome was overall survival. Multivariate Cox regression models were used to assess the effect of recipient and donor characteristics on survival.
  
  
  RESULTS
  Of the patients who underwent ReTx, median survival was 2 years. Predictors of worse survival include recipient age between 50 and 60 years (relative risk, 4.3; p = 0.02) or older than 60 years (relative risk, 10.2; p < 0.001), and time to ReTx of less than 2 years (relative risk, 3.8; p = 0.01). ReTx for bronchiolitis obliterans syndrome had longer median survival than for restrictive chronic lung allograft dysfunction (2.7 years vs 0.9 years; p = 0.055). Overall survival of ReTx patients after initiation of the lung allocation score was not significantly different (p = 0.21).
  
  
  CONCLUSIONS
  Lung ReTx outcomes are significantly worse than for primary transplantation but may be appropriate in well-selected patients with certain diagnoses. Lung ReTx in patients older than 50 years or within 2 years of primary lung transplantation was associated with decreased survival. Further work is warranted to identify patients who benefit most from ReTx.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hall
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Erol V
authors.initials: EV
authors.lastname: Belli
authors.affiliation: Division of Transplant Nephrology, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Jon A
authors.initials: JA
authors.lastname: Gregg
authors.affiliation: Division of Pulmonary, Critical Care, & Sleep Medicine, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Salgado
authors.affiliation: Division of Pulmonary Transplantation, University of Kentucky Transplant Center, Lexington, Kentucky.
authors.forename: Maher A
authors.initials: MA
authors.lastname: Baz
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: E Denmark
authors.initials: ED
authors.lastname: Staples
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Beaver
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Florida College of Medicine, Gainesville, Florida. Electronic address: tiago.noguchimachuca@surgery.ufl.edu.
authors.forename: Tiago N
authors.initials: TN
authors.lastname: Machuca
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001989:Bronchiolitis Obliterans / Q000601:surgery; D005260:Female; D005541:Forced Expiratory Volume; D006084:Graft Rejection; D006801:Humans; D008168:Lung / Q000503:physiopathology; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014184:Transplantation, Homologous; D055815:Young Adult