Retransplantation outcomes at a large lung transplantation program

Dewei Ren, Thomas S. Kaleekal, Edward A. Graviss, Duc T. Nguyen, Neeraj Sinha, Amad Goodarzi, Isioma Agboli, Erik E. Suarez, Matthias Loebe, Scott A. Scheinin, Brian A. Bruckner

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background. With the increase of primary lung transplantation across major centers worldwide, over the last several years the need of lung retransplant (ReTX) is likely to increase. Therefore, characterization of ReTX patients is prudent and necessary. Our study aimed to investigate and characterize the covariates and outcomes associated with lung ReTX survival in a single large U.S. transplant center. Methods. Demographic, clinical diagnoses, and comorbidities were analyzed. Kaplan-Meier statistics were used to calculate and predict survival for 30 days and up to 3 years. Cox proportional modeling was used to determine the variables associated with mortality. Results. Of included 684 lung transplants performed at the Houston Methodist Hospital between January 2009 and December 2015, 49 were lung ReTX. Median age of primary lung transplant (non-ReTX) and ReTx recipients was 62 and 49 years, respectively. Chronic graft rejection in the form of restrictive chronic lung allograft dysfunction and bronchiolitis obliterans syndrome was the main indications for ReTX. Compared with non-ReTX patients, ReTX patients had higher median lung allocation score (46.2 vs 37.0, respectively) and higher mortality after 6 months posttransplant. ReTX, older age, female sex, hospitalization 15 days or longer, estimated glomerular filtration rate less than 60, 6-minute walk distance less than 400 ft, and donor/recipient height ratio less than 1 were significantly associated with decreased 1-year patient and graft survival. Chronic graft rejection was still the major cause of death in the long-term follow-up recipients. Conclusions. Our findings suggested that lung ReTX recipients have poor long-term survival outcomes. Lung ReTX should only be offered to carefully selected patients.

Original languageEnglish (US)
Article numbere404
JournalTransplantation Direct
Volume4
Issue number11
DOIs
StatePublished - Nov 1 2018

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Lung Transplantation
Lung
Graft Rejection
Transplants
Survival
Bronchiolitis Obliterans
Mortality
Graft Survival
Glomerular Filtration Rate
Allografts
Comorbidity
Cause of Death
Hospitalization
Demography
Tissue Donors

ASJC Scopus subject areas

  • Transplantation

Cite this

Ren, D., Kaleekal, T. S., Graviss, E. A., Nguyen, D. T., Sinha, N., Goodarzi, A., ... Bruckner, B. A. (2018). Retransplantation outcomes at a large lung transplantation program. Transplantation Direct, 4(11), [e404]. https://doi.org/10.1097/TXD.0000000000000844

Retransplantation outcomes at a large lung transplantation program. / Ren, Dewei; Kaleekal, Thomas S.; Graviss, Edward A.; Nguyen, Duc T.; Sinha, Neeraj; Goodarzi, Amad; Agboli, Isioma; Suarez, Erik E.; Loebe, Matthias; Scheinin, Scott A.; Bruckner, Brian A.

In: Transplantation Direct, Vol. 4, No. 11, e404, 01.11.2018.

Research output: Contribution to journalArticle

Ren, D, Kaleekal, TS, Graviss, EA, Nguyen, DT, Sinha, N, Goodarzi, A, Agboli, I, Suarez, EE, Loebe, M, Scheinin, SA & Bruckner, BA 2018, 'Retransplantation outcomes at a large lung transplantation program', Transplantation Direct, vol. 4, no. 11, e404. https://doi.org/10.1097/TXD.0000000000000844
Ren D, Kaleekal TS, Graviss EA, Nguyen DT, Sinha N, Goodarzi A et al. Retransplantation outcomes at a large lung transplantation program. Transplantation Direct. 2018 Nov 1;4(11). e404. https://doi.org/10.1097/TXD.0000000000000844
Ren, Dewei ; Kaleekal, Thomas S. ; Graviss, Edward A. ; Nguyen, Duc T. ; Sinha, Neeraj ; Goodarzi, Amad ; Agboli, Isioma ; Suarez, Erik E. ; Loebe, Matthias ; Scheinin, Scott A. ; Bruckner, Brian A. / Retransplantation outcomes at a large lung transplantation program. In: Transplantation Direct. 2018 ; Vol. 4, No. 11.
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AU - Ren, Dewei

AU - Kaleekal, Thomas S.

AU - Graviss, Edward A.

AU - Nguyen, Duc T.

AU - Sinha, Neeraj

AU - Goodarzi, Amad

AU - Agboli, Isioma

AU - Suarez, Erik E.

AU - Loebe, Matthias

AU - Scheinin, Scott A.

AU - Bruckner, Brian A.

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N2 - Background. With the increase of primary lung transplantation across major centers worldwide, over the last several years the need of lung retransplant (ReTX) is likely to increase. Therefore, characterization of ReTX patients is prudent and necessary. Our study aimed to investigate and characterize the covariates and outcomes associated with lung ReTX survival in a single large U.S. transplant center. Methods. Demographic, clinical diagnoses, and comorbidities were analyzed. Kaplan-Meier statistics were used to calculate and predict survival for 30 days and up to 3 years. Cox proportional modeling was used to determine the variables associated with mortality. Results. Of included 684 lung transplants performed at the Houston Methodist Hospital between January 2009 and December 2015, 49 were lung ReTX. Median age of primary lung transplant (non-ReTX) and ReTx recipients was 62 and 49 years, respectively. Chronic graft rejection in the form of restrictive chronic lung allograft dysfunction and bronchiolitis obliterans syndrome was the main indications for ReTX. Compared with non-ReTX patients, ReTX patients had higher median lung allocation score (46.2 vs 37.0, respectively) and higher mortality after 6 months posttransplant. ReTX, older age, female sex, hospitalization 15 days or longer, estimated glomerular filtration rate less than 60, 6-minute walk distance less than 400 ft, and donor/recipient height ratio less than 1 were significantly associated with decreased 1-year patient and graft survival. Chronic graft rejection was still the major cause of death in the long-term follow-up recipients. Conclusions. Our findings suggested that lung ReTX recipients have poor long-term survival outcomes. Lung ReTX should only be offered to carefully selected patients.

AB - Background. With the increase of primary lung transplantation across major centers worldwide, over the last several years the need of lung retransplant (ReTX) is likely to increase. Therefore, characterization of ReTX patients is prudent and necessary. Our study aimed to investigate and characterize the covariates and outcomes associated with lung ReTX survival in a single large U.S. transplant center. Methods. Demographic, clinical diagnoses, and comorbidities were analyzed. Kaplan-Meier statistics were used to calculate and predict survival for 30 days and up to 3 years. Cox proportional modeling was used to determine the variables associated with mortality. Results. Of included 684 lung transplants performed at the Houston Methodist Hospital between January 2009 and December 2015, 49 were lung ReTX. Median age of primary lung transplant (non-ReTX) and ReTx recipients was 62 and 49 years, respectively. Chronic graft rejection in the form of restrictive chronic lung allograft dysfunction and bronchiolitis obliterans syndrome was the main indications for ReTX. Compared with non-ReTX patients, ReTX patients had higher median lung allocation score (46.2 vs 37.0, respectively) and higher mortality after 6 months posttransplant. ReTX, older age, female sex, hospitalization 15 days or longer, estimated glomerular filtration rate less than 60, 6-minute walk distance less than 400 ft, and donor/recipient height ratio less than 1 were significantly associated with decreased 1-year patient and graft survival. Chronic graft rejection was still the major cause of death in the long-term follow-up recipients. Conclusions. Our findings suggested that lung ReTX recipients have poor long-term survival outcomes. Lung ReTX should only be offered to carefully selected patients.

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