Outcome of Lung Re-Transplant in Chronic Lung Allograft Dysfunction

Abstract

<h3>Purpose</h3> Lung transplant patients eventually develop CLAD and require re-transplant. This study aims to examine the outcome of lung re-transplant in CLAD patients and compare between bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). <h3>Methods</h3> This is a retrospective observational study. Adult patients (>18 yo) with diagnosis of BOS or RAS underwent lung re-transplant were identified from SRTR database. The primary outcome is graft failure. Numerical data were reported in mean and standard deviation. Categorical data were reported in count and percent. T-test and Chi-square were performed to compare between 2 groups. Kaplan-Meier (K-M) survival curves were performed to compare survival of RAS and BOS. <h3>Results</h3> 934 patients underwent lung re-transplant were included. 782 patients have BOS. There was no significant difference in age, mPAP or history of smoking between BOS and RAS. LAS was significantly higher in RAS (60.03±19.39 vs 54.19±17.6). Time on waitlist is significantly longer in BOS (165±286 vs 83±147). Time from first transplant is significantly longer in BOS (1876±1432 vs 1616±1221). There was no difference in airway dehiscence rate, primary graft dysfunction at 72 hrs or length of stay. Rate of intubation at 72 hrs is significantly higher in RAS (34.48% vs 56.18%). Post op ECMO rate is higher in RAS (8.55% vs 3.45%). Hemodialysis rate is higher in RAS (18.37% vs 11.57%). Rate of acute rejection treatment in first year is significantly higher in BOS (29.51% vs 18.89%). Time to graft failure is significant higher in BOS (1258±1334 vs 834±834). K-M survival curves of RAS and BOS stratified by 5-year predicted graft survival was performed. BOS had higher 5 year graft survival although this was not statistically significant (p = 0.21). <h3>Conclusion</h3> Patients with RAS have worse clinical condition prior to re-transplant. They also have higher rate of post op ECMO and require longer ventilator support. Patients with BOS have higher 5 year survival of graft than RAS (not significant).