Published ahead of print on September 27, 2007, doi:10.1164/rccm.200707-1132OC Am. J. Respir. Crit. Care Med., Volume 177, Number 1, January 2008, 114-120 A more recent version of this article appeared on January 1, 2008
Submitted on July 30, 2007 Outcomes After Lung Retransplantation in the Modern EraSteven M Kawut1*,1 Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA; Department of Epidemiology, Columbia University, Joseph L. Mailman School of Public Health, New York, NY, USA, 2 Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA, 3 University of Toronto, Division of Thoracic Surgery, Toronto, Ontario, Canada, 4 Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, NY, USA, 5 Department of Cardiothoracic Surgery, University of Southern California, Los Angeles, CA, USA * To whom correspondence should be addressed. E-mail: sk2097{at}columbia.edu.
Rationale: Characteristics of and survival estimates for recipients of lung retransplantation in the modern era are unknown. Objectives: To compare lung retransplant patients in the modern era to historical retransplant patients. To compare retransplant patients to 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 to 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). Measurements and Main Results: Modern retransplant recipients (N = 205) had a lower risk of death compared to 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 = 5657) (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 < 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 to the initial transplant procedure. Retransplantation early after the initial transplant poses a particularly high mortality risk. Key words: Lung transplantation; Cohort study; Retransplantation: Solid organ
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