Background

Lung retransplantation is a complex surgical decision that represents the only potential treatment option for recipients suffering from lung allograft failure. We sought to describe the modern landscape of lung retransplantation and to compare the relative importance of selected clinical, donor, and recipient factors on mortality in the year following lung retransplantation.

Methods

We conducted a retrospective cohort study of first-time adult recipients of deceased donor lung retransplants reported to the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Transplant Registry from May 2005 through June 2017. In addition to describing the characteristics of lung retransplant recipients, we examined 1 year survival overall, and by initial transplant-retransplant procedure type, recipient age, retransplant indication, and time-to-lung retransplantation (i.e., inter-transplant interval). We used the Somers' D_xy rank correlation statistic for censored data to assess the relative importance of several potential prognostic risk factors for mortality in the year following lung retransplantation.

Results

Our cohort included 1,597 lung retransplant recipients. 2005 was the first year with more than 100 retransplants, and since 2007, 138 to 188 retransplants (approximately 4%-6% of all transplants) were reported annually to the ISHLT Registry. The median inter-transplant interval was 3.4 years (interquartile range: 1.6-6.2 years). Forty-three percent of the cohort had an obliterative bronchiolitis retransplant indication, whereas 17% had primary graft failure. One-third (32%) were retransplanted within 2 years of their primary transplant, and 64% received a double lung transplant both times, whereas 36% received consecutive single lung transplants. Six-month and 1 year survival (82% and 76%) were higher for double-double lung retransplant recipients than for single-single recipients (76% and 69%). The 3 strongest prognostic factors for 1 year mortality were the inter-transplant interval (decreasing hazard with longer intervals), donor age (increasing hazard with older age), and need for mechanical ventilation preceding lung retransplantation.

Conclusions

Retransplants comprise approximately 5% of annual lung transplants worldwide. The factor most strongly associated with 1 year mortality in this population was the duration of time since the primary lung transplant, with a persistent reduction in risk as more time elapses.

中文翻译：

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肺再移植的流行病学、危险因素和结果：国际心肺移植学会胸部移植登记处的分析

背景

肺再移植是一项复杂的手术决定，是患有同种异体肺移植失败的受者唯一潜在的治疗选择。我们试图描述肺再移植的现代情况，并比较选定的临床、供体和受体因素对肺再移植后一年内死亡率的相对重要性。

方法

我们对 2005 年 5 月至 2017 年 6 月期间向国际心肺移植协会 (ISHLT) 胸腔移植登记处报告的已故供体肺再移植的首次成人接受者进行了一项回顾性队列研究。除了描述肺再移植受者的特征之外，我们检查了总体 1 年生存率，并通过初始移植-再移植手术类型、受者年龄、再移植指征和肺再移植时间（即移植间间隔）进行了检查。我们使用 Somers 的 D _xy等级相关统计数据来评估肺再移植后一年内死亡的几个潜在预后风险因素的相对重要性。

结果

我们的队列包括 1,597 名肺再移植受者。2005 年是第一年超过 100 例再移植，自 2007 年以来，每年向 ISHLT 登记处报告 138 至 188 例再移植（约占所有移植的 4%-6%）。中位移植间隔为 3.4 年（四分位数间距：1.6-6.2 年）。该队列中 43% 的人有闭塞性细支气管炎再移植指征，而 17% 的人有原发性移植失败。三分之一 (32%) 在初次移植后 2 年内接受了再次移植，64% 两次接受双肺移植，而 36% 接受连续单肺移植。双肺再移植受者的 6 个月和 1 年生存率（82% 和 76%）高于单肺再移植受者（76% 和 69%）。1 年死亡率的 3 个最强预后因素是移植间隔（间隔越长，风险越低）、供体年龄（年龄越大，风险越高）以及肺再移植前是否需要机械通气。

结论

再移植约占全球每年肺移植的 5%。与该人群一年死亡率最密切相关的因素是初次肺移植后的持续时间，随着时间的推移，风险持续降低。