Lung Retransplantation After Single Lung Transplantation

H. A. Theeuwen¹, J. Rodman¹, B. V. Udelsman¹, G. M. Rosenberg¹, S. C. Wightman², A. W. Kim¹, S. M. Atay¹, T. Harano^1
1Keck School of Medicine, University of Southern California, Los Angeles, California ²Keck School of Medicine, University of Southern California, La Crescenta, California

Purpose: When performing a lung retransplantation after initial single lung transplantation, there are three options: contralateral single lung retransplantation (CLSLRT), ipsilateral single lung retransplantation (ILSLRT), and double lung retransplantation (DLRT). The aim of this study is to investigate the effect of recipient characteristics and retransplant type on the survival outcomes.

Methods: Patients undergoing lung retransplantation after initial single lung transplantation were identified using the United Network for Organ Sharing database between May 2005 and December 2022. Patients were grouped by primary diagnosis of initial lung transplantation as either obstructive lung disease (OLD) or restrictive lung disease (RLD). Donor and recipient demographics, time interval since initial single lung transplantation, indications for lung retransplantation, retransplant type, and post-transplant outcomes were analyzed. The primary outcome was overall survival (OS) after lung retransplantation. Survival outcomes were evaluated using Kaplan-Meier curves, log-rank test, and multivariable Cox regression.

Results: Of the 418 lung retransplant recipients after initial single lung transplantation, the primary diagnosis of initial single transplantation was OLD in 35% (148/418) and RLD in 58% (244/418). Sixteen percent (26/148) of OLD group and 37% (91/148) of RLD group underwent retransplantation within one year (p < 0.001). Among those in OLD group, 74% (109/148) underwent CLSLRT and 26% (39/148) underwent DLRT, and 5-year OS was comparable (CLSLRT 47.5% [95%CI 38.7-58.3%]; DLRT 48.0% [95%CI 34.1-67.6%]; p=0.77) (Figure 1A). Among those with RLD, retransplant types were as follows: 13% (32/244) ILSLT, 53% (129/418) CLSLRT, 34% (83/244) DLRT, and there was no significant difference in 5-year OS between groups (ILSLRT 21.0% [95%CI 9.4-46.6%]; CLSLRT 32.5% [95%CI 25.0-42.4%]; DLRT 30.5% [95%CI 21.2-44.1%]; p=0.46) (Figure 1B). On multivariable COX-regression, the type of re-transplant and diagnosis group were not associated with overall survival, however age and lung allocation score were identified as significant predictors (Table 1).

Conclusion: Overall survivals of lung retransplantation after initial single lung retransplantation were comparable among retransplantation type. When lung retransplantation is considered, it is important to select the retransplant type judiciously while taking organ sharing into consideration.

Identify the source of the funding for this research project: None