O. Follis1, M. Kashem1,2, H. Kehara1,2, R. Yanagida1,2, K. Krishan1,2, E. Leotta1,2, N. Shigemura1,2, Y. Toyoda1,2 1Lewis Katz School of Medicine, Philadelphia, PA, USA 2Temple University Hospital, Cardiothoracic Surgery, Philadelphia, PA, USA
Introduction:
The prevalence of lung allograft rejection after transplant within the first year is approximately 30%. The only viable option for chronic lung allograft rejection after exhausting all medical treatment is lung retransplantation (Re-Ltx), which makes up a small fraction of total annual lung transplants (Ltx). Little research exists comparing mortality rates in single vs double Re-Ltx. We investigated whether single or double Re-Ltx along with laterality of lung transplantation yielded better survival outcomes.
Methods:
We retrospectively reviewed 1,110 Ltx performed at our medical center from February 2012 – June 2023. All cases that did not include Re-Ltx were excluded resulting in 33 Re-Ltx. Of these 33 cases, one patient was excluded due to combined heart lung transplant, resulting in 32 Re-Ltx patients. The 32 patients were further subdivided into single or double Re-Ltx and laterality was noted as ipsilateral and contralateral Ltx. Kaplan Meier survival analysis, multi-variate cox regression including hazard ratio and confidence interval of 95% were performed using JMP Pro 17. A p-value<0.05 was considered as statistically significant.
Results:
Of the 32 patients, 13 were female: White-28, Hispanic-2, African American-2; mean age 57 ± 13; mean BMI 25 ± 4 kg/m2; mean height 66 ± 4 inches. Intraoperatively 2 patients received VV ECMO, 6 patients VA ECMO, 19 off –pump, and 5 patients underwent cardiopulmonary bypass for surgical procedures. 24 patients received a single Re-Ltx and 8 received a double Re-Ltx. Kaplan Meier survival curve at 3-year post Re-Ltx revealed no significant difference between single vs double Re-Ltx (p = 0.661). When multivariable cox was performed, similar results were shown. Among patients who received a single Re-Ltx there were: 9 contralateral, 2 ipsilateral and 12 single lung from previously done double Ltx. Total deaths among the single Re-Ltx were: 2 ipsilateral, 4 contralateral, 6 single from previously done double Ltx. There were 3 deaths among the double Re-Ltx. Kaplan Meier curve at 3-year analysis post Re-Ltx revealed no significant difference between laterality of Re-Ltx (p=0.941) and verified by multi-variable cox regression.
Conclusion:
In a single center study, single Re-Ltx from previously done double Ltx showed no survival difference within 3 years of retransplantation. More patients died who received a single Re-Ltx from previously done double Ltx (n=6) than those who received a double Re-Ltx (n=3). Still, single ipsilateral or contralateral re-lung transplantation in previously done double lung transplantation may be beneficial in a selected patient. Further multicenter study involving lung retransplantation patients is warranted.
