| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1998;65:227-234
© 1998 The Society of Thoracic Surgeons
Departments of Surgery and Epidemiology and Biostatistics, the London Health Sciences Centre, the Robarts Research Institute and the University of Western Ontario, London, Ontario, Canada;
Departments of Surgery and Epidemiology and Biostatistics, the London Health Sciences Centre, the Robarts Research Institute and the University of Western Ontario, Harefield, England, United Kingdom;
Departments of Surgery and Epidemiology and Biostatistics, the London Health Sciences Centre, the Robarts Research Institute and the University of Western Ontario, Vienna, Austria;
Departments of Surgery and Epidemiology and Biostatistics, the London Health Sciences Centre, the Robarts Research Institute and the University of Western Ontario, Hannover and Homburg, Germany;
Departments of Surgery and Epidemiology and Biostatistics, the London Health Sciences Centre, the Robarts Research Institute and the University of Western Ontario, Paris, France;
Departments of Surgery and Epidemiology and Biostatistics, the London Health Sciences Centre, the Robarts Research Institute and the University of Western Ontario, Pittsburgh, Pennsylvania, USA;
Departments of Surgery and Epidemiology and Biostatistics, the London Health Sciences Centre, the Robarts Research Institute and the University of Western Ontario, St. Louis, Missouri, and 47 participating centers in the Pulmonary Retransplant Registry, USA
Accepted for publication September 25, 1997.
Dr Novick, Department of Surgery, London Health Sciences Centre, PO Box 5339, London, Ont, Canada N6A 5A5, (e-mail: rjnovick@julian.uwo.ca).
Background. Despite improving results in lung transplantation, a significant number of grafts fail early or late postoperatively. The pulmonary retransplant registry was founded in 1991 to determine the predictors of outcome after retransplantation. We hypothesized that ambulatory status of the recipient and center retransplant volume, which had been previously shown to predict survival after retransplantation, would also be associated with improved graft function postoperatively.
Methods. Two hundred thirty patients underwent retransplantation in 47 centers from 1985 to 1996. Logistic regression methods were used to determine variables associated with, and predictive of, survival and lung function after retransplantation.
Results. Kaplan-Meier survival was 47% ± 3%, 40% ± 3%, and 33% ± 4% at 1, 2, and 3 years, respectively. On multivariable analysis, the predictors of survival included ambulatory status or lack of ventilator support preoperatively (p = 0.005; odds ratio, 1.62; 95% confidence interval, 1.15 to 2.27), followed by retransplantation after 1991 (p = 0.048; odds ratio, 1.41; 95% confidence interval, 1.003 to 1.99). Ambulatory, nonventilated patients undergoing retransplantation after 1991 had a 1-year survival of 64% ± 5% versus 33% ± 4% for nonambulatory, ventilated recipients. Eighty-one percent, 70%, 62%, and 56% of survivors were free of bronchiolitis obliterans syndrome at 1, 2, 3, and 4 years after retransplantation, respectively. Factors associated with freedom from stage 3 (severe) bronchiolitis obliterans syndrome at 2 years after retransplantation included an interval between transplants greater than 2 years (p = 0.01), the lack of ventilatory support before retransplantation (p = 0.03), increasing retransplant experience within each center (fifth and higher retransplant patient, p = 0.04), and total center volume of five or more retransplant operations (p = 0.05).
Conclusions. Nonambulatory, ventilated patients should not be considered for retransplantation with the same priority as other candidates. The best intermediate-term functional results occurred in more experienced centers, in nonventilated patients, and in patients undergoing retransplantation more than 2 years after their first transplant. In view of the scarcity of lung donors, patient selection for retransplantation should remain strict and should be guided by the outcome data reviewed in this article.
This article has been cited by other articles:
|
|
 |
|
  A. Y. Sheikh, M. P. Pelletier, and R. C. Robbins Heart-Lung and Lung Transplantation Card. Surg. Adult, January 1, 2008; 3(2008): 1579 - 1608. [Full Text]
|
|
|
|
 |
|
 S. M. Kawut, D. J. Lederer, S. Keshavjee, J. S. Wilt, T. Daly, F. D'Ovidio, J. R. Sonett, S. M. Arcasoy, and M. L. Barr Outcomes after Lung Retransplantation in the Modern Era Am. J. Respir. Crit. Care Med., January 1, 2008; 177(1): 114 - 120. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Okazaki, A. E. Gelman, J. R. Tietjens, A. Ibricevic, C. G. Kornfeld, H. J. Huang, S. B. Richardson, J. Lai, J. R. Garbow, G. A. Patterson, et al. Maintenance of Airway Epithelium in Acutely Rejected Orthotopic Vascularized Mouse Lung Transplants Am. J. Respir. Cell Mol. Biol., December 1, 2007; 37(6): 625 - 630. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Oto, M. Rowland, A. P. Griffiths, B. J. Levvey, D. S. Esmore, T. J. Williams, and G. I. Snell Third-Time Lung Transplant Using Extended Criteria Lungs Ann. Thorac. Surg., August 1, 2007; 84(2): 642 - 644. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.-F. Cordier Challenges in pulmonary fibrosis {middle dot} 2 : Bronchiolocentric fibrosis Thorax, July 1, 2007; 62(7): 638 - 649. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. C. Chang, K. M. Chan, R. J. Lonigro, C. L. Lau, V. N. Lama, K. R. Flaherty, R. Florn, A. Pickens, S. Murray, F. J. Martinez, et al. Surgical patient outcomes after the increased use of bilateral lung transplantation J. Thorac. Cardiovasc. Surg., February 1, 2007; 133(2): 532 - 540. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Al-Githmi, N. Batawil, N. Shigemura, M. Hsin, T. W. lee, G.-W. He, and A. Yim Bronchiolitis obliterans following lung transplantation Eur. J. Cardiothorac. Surg., December 1, 2006; 30(6): 846 - 851. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Keshavjee Retransplantation of the lung comes of age. J. Thorac. Cardiovasc. Surg., August 1, 2006; 132(2): 226 - 228. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Labott Understanding a Patient's Wishes to Die Clinical Case Studies, June 1, 2006; 5(3): 220 - 230. [Abstract] [PDF]
|
|
|
|
|
|
S. D. Force, D. L. Miller, A. Pelaez, A. M. Ramirez, D. Vega, B. Barden, and E. C. Lawrence Outcomes of Delayed Chest Closure After Bilateral Lung Transplantation Ann. Thorac. Surg., June 1, 2006; 81(6): 2020 - 2025. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. D. Kozower, S. C. Sweet, M. de la Morena, P. Schuler, T. J. Guthrie, G. A. Patterson, S. K. Gandhi, and C. B. Huddleston Living donor lobar grafts improve pediatric lung retransplantation survival J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 1142 - 1147. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. M. Hoffman, B. J. Nelson, M. B. Drangstveit, B. M. Flynn, E. A. Watercott, and J. M. Zirbes Caring for Transplant Recipients in a Nontransplant Setting Crit. Care Nurse, April 1, 2006; 26(2): 53 - 73. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Martinu, D. N. Howell, R. D. Davis, M. P. Steele, and S. M. Palmer Pathologic correlates of bronchiolitis obliterans syndrome in pulmonary retransplant recipients. Chest, April 1, 2006; 129(4): 1016 - 1023. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Kotloff, V. N. Ahya, and S. W. Crawford Pulmonary Complications of Solid Organ and Hematopoietic Stem Cell Transplantation Am. J. Respir. Crit. Care Med., July 1, 2004; 170(1): 22 - 48. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Kotloff Lung Retransplantation: All for One or One for All? Chest, June 1, 2003; 123(6): 1781 - 1782. [Full Text] [PDF]
|
|
|
|
|
|
O. Brugiere, G. Thabut, Y. Castier, H. Mal, G. Dauriat, A. Marceau, and G. Leseche Lung Retransplantation for Bronchiolitis Obliterans Syndrome: Long-term Follow-up in a Series of 15 Recipients Chest, June 1, 2003; 123(6): 1832 - 1837. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Balsam, D. D. Yuh, R. C. Robbins, and B. A. Reitz Heart-Lung and Lung Transplantation Card. Surg. Adult, January 1, 2003; 2(2003): 1461 - 1490. [Full Text]
|
|
|
|
|
|
M. Estenne and M. I. Hertz Bronchiolitis Obliterans after Human Lung Transplantation Am. J. Respir. Crit. Care Med., August 15, 2002; 166(4): 440 - 444. [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Arcasoy and R. M. Kotloff Lung Transplantation N. Engl. J. Med., April 8, 1999; 340(14): 1081 - 1091. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
