(794) - Lung Retransplantation for Early Graft Failure: Trends and Results in 112 Patients Over a 24-Year Period

Abstract

In this study, we review trends and results of lung retransplantation for early graft failure (EGF) in the United States. Adult patients undergoing lung transplantation between 1987-2010 were identified in the United Network for Organ Sharing database. Patients undergoing redo lung transplantation for EGF (defined as within 90-days of original transplant) were compared to primary lung transplant patients (PLTx) and those undergoing redo lung transplantation for late graft failure (LGF). Trends were identified using three eras (1987-1994, 1995-2004, and 2005-2010). Postoperative complications were also compared between cohorts. Of 20,658 lung transplant recipients in the 24-year study period, 719(3%) were redo transplants (112 EGF, 607 LGF). The mean interval between initial transplant and redo transplant was 18.5±19.2 days for the EGF group and 1502.5±1201.7 days for the LGF group. The EGF cohort had significantly worse overall 1-year survival (49% versus 81% PLTx versus 68% LGF; p<0.001). Although 1-year survival significantly improved over time for the other cohorts (PLTx: 75% to 84%, p<0.001; LGF: 45% to 73%, p<0.001), this was not observed in the EGF patients (48% to 48%, p=0.88). Postoperative rates of renal failure requiring dialysis (31% versus 5% PLTx versus 11% LGF, p<0.001), stroke (5% versus 2% PLTx versus 1% LGF, p=0.05), reoperation (57% versus 19% PLTx versus 24% LGF, p<0.001), and infection (74% versus 44% PLTx versus 57% LGF, p<0.001) were higher in the EGF group. Median days of hospitalization were also longer in EGF (46 versus 24 in PLTx versus 31 in LGF, p<0.001). Redo lung transplant for EGF is associated with significantly high mortality and morbidity risk. Although overall outcomes in lung transplant recipients have improved over the last quarter century, this has not applied to the EGF subset. Judicious patient selection in this challenging cohort remains prudent in the modern era.