
The Pulmonary Retransplant Registry
The Pulmonary Retransplant Registry has had several previous publications:
Novick RJ, Schäfers HJ, Stitt L, Andréassian B, Duchatelle JP, Klepetko W, Hardesty RL, Frost A, Patterson GA. Recurrence of obliterative bronchiolitis and determinants of outcome in 139 pulmonary retransplant recipients. J Thorac Cardiovasc Surg 1995;110:140214. Novick RJ, Schäfers HJ, Stitt L, Andréassian B, Klepetko W, Hardesty RL, Frost A, Patterson GA. Seventytwo pulmonary retransplantations for obliterative bronchiolitis: predictors of survival. Ann Thorac Surg 1995;60:1116. Novick RJ, Andréassian B, Schäfers HJ, Haverich A, Patterson GA, Kaye MP, Menkis AH, McKenzie FN. Pulmonary retransplantation for obliterative bronchiolitis: Intermediateterm results of a North American  European series. J Thorac Cardiovasc Surg 1994;107:75563. Novick RJ, Kaye M, Patterson G, Andréassian B, Klepetko W, Menkis AH, McKenzie FN. Redo lung transplantation: a North American  European experience. J Heart Lung Transplant 1993;12:516.
Predictors of Graft Function and Survival in 230 Patients
Reprinted with permission from the Society of Thoracic Surgeons (The Annals of Thoracic Surgery 1998, 65, 227234) Richard J. Novick, MD, Larry W. Stitt, MSc, Khaled AlKattan, MD, Walter Klepetko, MD, HansJoachim Schäfers, MD, JeanPierre Duchatelle, MD, Asghar Khaghani, MD, Robert L. Hardesty, MD, G. Alexander Patterson, MD, and Magdi H. Yacoub, MD, for the Pulmonary Retransplant Registry.
From the 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; Harefield, England; Vienna, Austria; Hannover and Homburg, Germany; Paris, France; Pittsburgh, Pennsylvania; St. Louis, Missouri; and 47 participating centers in the Pulmonary Retransplant Registry. Abstract 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. KaplanMeier 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 1year survival of 64% ± 5% versus 33% ± 4% for nonambulatory, ventilated recipients. Eightyone 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 intermediateterm 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.
Figure 1
Table 1
Figure 1. Actuarial survival of patients undergoing retransplantation because of obliterative bronchiolitis versus those undergoing retransplantation because of other indications (logrank p value = 0.07)
Figure 2. Actuarial survival according to the interval between transplantation procedures (logrank p value = 0.002)
Figure 3. Actuarial survival according to the requirement for ventilator support before retransplantation (logrank p value = 0.002)
Figure 4. Actuarial survival according to the recipient's ambulatory staus and requirement for ventilator support preoperatively (logrank p value = 0.003)
Figure 5. Actuarial survival according to the year of retransplantation and the recipient's requirement for ventilator support preoperatively (logrank p value = 0.001)
Figure 6. Prevalence of stages 0, 1, 2, and 3 bronchiolitis obliterans syndrome (BOS) at 1, 2, and 5 years after retransplantation.
Figure 7. Forced expiratory volume in 1 second (FEV_{1}) values in 3year survivors who underwent retransplantation because of obliterative bronchiolitis (OB) versus nonOB conditions.
Table I.
^{a} Odds ratio >1.0 indicate increased survival, whereas ratios <1.0 indicate decreased survival after retransplantation.
Table 2.
Odds ratio has 95% confidence limits.
Table 3.
Table 4.
^{a} Odds ratios >1.0 indicate an increased probability and ratios <1.0 a decreased probability of BOS stage 0 or stages 02.
