title: The Optimal Procedure for Retransplantation After Single Lung Transplantation.
abstract: BACKGROUND
  Retransplantation has emerged as a therapeutic option for patients experiencing respiratory failure after single lung transplantation. However, outcomes associated with the surgical option (ipsilateral, contralateral, or bilateral lung retransplantation) has not been well evaluated.
  
  
  METHODS
  The Organ Procurement and Transplantation Network database (1994 to 2012) was queried for all lung transplant procedures performed after an initial single lung transplantation. Donor and recipient demographics, before and after transplant characteristics, and outcomes were stratified by retransplant procedural choice and by interval between transplants. Risk factors for mortality were evaluated by Cox proportional hazards regression analysis.
  
  
  RESULTS
  Of 325 prior single lung transplant recipients, 50 underwent ipsilateral, 175 contralateral, and 100 bilateral lung retransplantation. The number of retransplant procedures performed per year increased from 3 in 1994 to 31 in 2012, with an increasing proportion of contralateral retransplantation and declining proportions of ipsilateral and bilateral retransplantation. Survival was significantly better in the contralateral and bilateral retransplant groups than in the ipsilateral retransplant group at 30 days (94% and 89% versus 80%), 1 year (72% and 67% versus 50%), and 5 years (41% and 42% versus 20%). Ipsilateral retransplantation (hazard ratio 1.48; p = 0.042), mechanical ventilation before retransplant (hazard ratio 2.39; p < 0.001), and retransplantation performed in the first half of the study period (hazard ratio 1.45; p = 0.027) were associated with increased mortality.
  
  
  CONCLUSIONS
  After an initial single lung transplant, both the incidence of retransplantation and postoperative survival have increased with time. Although ipsilateral lung retransplantation may be the best available alternative in particular circumstances, this analysis suggests that contralateral or bilateral lung retransplantation may be preferable in patients for whom those options are medically sensible.
authors.affiliation: Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Zachary N
authors.initials: ZN
authors.lastname: Kon
authors.affiliation: Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Bittle
authors.affiliation: Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: cpasrija@smail.umaryland.edu.
authors.forename: Chetan
authors.initials: C
authors.lastname: Pasrija
authors.affiliation: Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Pablo G
authors.initials: PG
authors.lastname: Sanchez
authors.affiliation: Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Bartley P
authors.initials: BP
authors.lastname: Griffith
authors.affiliation: Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland; Department of Surgery, VA Maryland Health Care System, Baltimore, Maryland.
authors.forename: Richard N
authors.initials: RN
authors.lastname: Pierson
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000150:complications* / Q000601:surgery; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D012086:Reoperation / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome