Do Long Term Outcomes Justify Third Time Redo Lung Transplantation?

Abstract

Purpose Graft failure remains a significant obstacle to long-term survival in lung transplantation (LT), however, the reported outcomes of reoperative LT are inferior to primary LT, and there is controversy of how best to manage a scarcity of donor allografts for candidates likely to derive maximum benefit. The outcomes of third-time LT have not been described in detail. Methods Review of UNOS database was performed. 3rd time recipients of LT were identified and compared to first-time and second-time LT recipients. Survival was estimated with Kaplan Meier method and compared using log-rank test. Influence of 2nd and 3rd LT was performed using univariate and multivariate analyses. Results 28 recipients of 3rd LT were compared to 1,252 2nd LT and 32,703 primary recipients. Patients of 3rd LT were younger (38.1 ± 16.0 years vs 44.4 ± 16.8 for 2nd LT, 52.6 ± 14.6 for primary LT), and have shorter wait list times (37.0 days [95% CI 9.0-67.5] vs 45.5 days [13.0-57.5] for 2nd LT and 112.0 [30.0- 329.0] for primary LT. Median survival was 60 months for primary LT, 32 months for 2nd LT, and 19 months for 3rd LT (log-rank p Conclusion Reoperative LT has significantly lower long-term survival compared to primary LT, and survival after 3rd LT appears to be worse than 2rd LT. Further work is needed to define which candidates are likely to benefit most from reoperative LT.