Survival Outcomes of Redo Lung Transplantation: UNOS Database

Abstract

Purpose Average 5-year survival after lung transplantation (LTx) still ranges in 50-60% of patients. Primary graft dysfunction (PGD) is common in such procedures, and repeat LTx is warranted in many of these patients due to shorter life-expectancy and PGD. We explored national transplant database to answer questions related to repeat lung transplantation in selected patients. Methods A retrospective analysis of the UNOS database, investigating patients who received a single or double redo-LTx from 1987-2018 (n=1495) was performed. Patients with missing survival data were excluded (n=255). Patients were placed into the following age cohorts: (1) patients age ≤60 years at time of redo-LTx (n=1091), (2) patients >60 years at time of redo-LTx (n=149). Within groups, patients were stratified by redo-Tx type: redo-DLT or redo-SLT ([1]: SLT n=323; DLT n=768; [2]: SLT n=118; DLT n=31). Groups were compared for demographics and survival using STATA Inc. P-value Results The >60 age cohort consisted of more males (p 60 p=0.352; ≤60 p=0.709). The Kaplan-Meier analysis revealed worse survival of patients within the >60 age cohort compared to the ≤60 age cohort regarding redo-SLT (p=0.001). Survival was similar among both age cohorts regarding redo-DLT (p=0.402). Survival was significantly affected by both redo-transplant types (p=0.015). A subgroup survival analysis of older patients over age 65 was done to evaluate more elderly patients, showing similarly worse survival outcomes in both redo-SLT (p=0.016) and redo-DLT (p=0.014). Conclusion These results support that patients above age 60 who need redo-LTx have worse survival outcomes. Redo-DLT showed significantly better survival outcomes compared to redo-SLT when considering candidate age, though survival may be similar as age increases.