Outcomes after lung redo- transplantation: a 13-year single-center experience

SESSION TITLE: Outcomes and Opportunities: Lung Transplantation SESSION TYPE: Original Investigations PRESENTED ON: 10/10/2023 01:45 pm - 02:45 pm PURPOSE: In recent years, the number of cases of re-do lung transplantation (redo-LTx) has significantly increased worldwide, especially in major centers. This can be attributed to the improved survival rates seen in primary lung transplantation (LTx). Despite this, redo-LTx remains a complex surgical intervention, which poses several postoperative complications and a higher risk of associated morbidity and mortality than primary LTx. To address these issues, we evaluated the clinical and demographic characteristics of patients who underwent redo-LTx at our transplant center and their short- and long-term outcomes. With the continued organ shortage, these findings can help guide transplant physicians in making more informed decisions about the most effective approach to redo-LTx. METHODS: After IRB approval, we conducted a retrospective review of adults who underwent redo-LTx between 2010 and 2022 at the Norton Thoracic Institute, Phoenix, AZ. Patient data was retrieved from the hospital's electronic medical record system. Demographic and clinical characteristics of included patients were used in the analysis. Kaplan-Meier graphs were used to characterize and predict the 30-day and up to 13-year overall survival. Cox proportional modeling was used to determine the variables associated with mortality. All-cause mortality was the primary endpoint, and postoperative complications were the secondary endpoints. RESULTS: From 2010 to 2022, a total of 58 patients underwent redo-LTx and were followed up until February 2023. Most of these patients received bilateral lung redo-LTx due to chronic graft rejection, specifically restrictive chronic lung allograft dysfunction (CLAD) and bronchiolitis obliterans syndrome. The median age of the predominantly female patients was 52 years (IQR 35-61 years). Patients with lower Karnofsky performance scores (KPS) (median 60%; IQR 30%-70%), higher lung allocation scores (LAS) (median 46; IQR 40.1-60.1), shorter 6-minute walk test distances (median 863; IQR 553.5-1125), and longer median ischemic times (5 hours; IQR 4.5-6.3) prior to redo-LTx were more likely to experience increased mortality. During surgery, 22 of 58 patients (38%) required cardiopulmonary bypass or ECMO support, and 56 of 58 patients (98%) received transfusions. The mortality rates at 6 months, 1 year, 2 years, and beyond 2 years were 6% (2), 24% (8), 12% (4) and 42% (14), respectively. Over the 13-year study period, 33 of 59 (55.2%) redo-LTx patients died, with 39% of deaths occurring within 2 years of the intervention. Infections, sepsis, and respiratory failure were the primary causes of death within the first 1-6 months, while CLAD remained the primary cause of death in the long-term. CONCLUSIONS: As a higher volume LTx center catering to higher risk recipients, we observed that a lower functional status (KPS score), higher LAS score, longer time ischemic times, and poor 6-minute walk test results prior to re-transplantation are strong predictors of poor outcomes after re-do LTx. CLINICAL IMPLICATIONS: Redo-LTx candidates should be cautiously evaluated since carefully selected candidates can have favorable outcomes. Our next step is to compare LTx-related outcomes and long-term mortality among patients who underwent redo-LTx with a propensity score-matched control group of primary LTx recipients. DISCLOSURES: No relevant relationships by Ashwini Arjuna No relevant relationships by Andres Latorre-Rodriguez No relevant relationships by Hesham Mohamed No relevant relationships by Ariba Moin No relevant relationships by Adam Taylor Speaker/Speaker's Bureau relationship with Astellas Please note: 2016 to present Added 12/04/2022 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Boehringer INgelheim Please note: 2016-present Added 12/04/2022 by Rajat Walia, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Takeda Please note: 2018-present Added 12/04/2022 by Rajat Walia, source=Web Response, value=Honoraria Principal Investigator relationship with Grifols Please note: 2015- present Added 12/04/2022 by Rajat Walia, source=Web Response, value=Grant/Research Support Advisory Committee Member relationship with Transmedics Please note: 2021 Added 12/04/2022 by Rajat Walia, source=Web Response, value=Consulting fee Advisory Committee Member relationship with CareDx Please note: 2020-present Added 12/04/2022 by Rajat Walia, source=Web Response, value=Consulting fee