Recurrence of XXXX and determinants of outcome in 139 pulmonary retransplant recipients.

@entity1 @entity6910 @entity5924 @entity810 @entity4154
An international series of pulmonary retransplantation was updated to identify the predictors of outcome and the prevalence and recurrence rate of @entity5924 after operation. The study cohort included 139 @entity1 who underwent retransplantation in 34 institutions in North America and Europe between 1985 and 1994. Eighty @entity1 underwent retransplantation because of @entity5924 , 34 because of @entity810 , 13 because of intractable airway complications, 8 because of acute rejection, and 4 because of other indications. Survivors were followed up for a median of 630 days, with 48 @entity1 alive at 1 year, 30 at 2 years, and 16 at 3 years after retransplantation. Actuarial survival was 65% +/- 4% at 1 month, 54% +/- 4% at 3 months, 45% +/- 4% at 1 year, 38% +/- 5% at 2 years, and 36% +/- 5% at 3 years; nonetheless, of 90-day postoperative survivors, 65% +/- 6% were alive 3 years after retransplantation. Life-table and univariate Cox analysis revealed that more recent year of retransplantation (p = 0.009), identical match of @entity6910 (p = 0.01), absence of a donor-recipient cytomegalovirus mismatch (p = 0.04), and being ambulatory immediately before retransplantation (p = 0.04) were associated with survival. By multivariate Cox analysis, being ambulatory before retransplantation was the most significant predictor of survival (p = 0.008), followed by reoperation in Europe (p = 0.044). Complete pulmonary function tests were done yearly in every survivor of retransplantation and @entity4154 stages were assigned. Eleven percent of @entity1 were in stage 3 at 1 year, 20% at 2 years, and 25% at 3 years after retransplantation. Values of forced expiratory volume in 1 second decreased from 1.89 +/- 0.13 L early after retransplantation to 1.80 +/- 0.15 L at 1 year and 1.54 +/- 0.16 L at 2 years (p = 0.006, year 2 versus baseline postoperative value). Most of this decrease occurred in @entity1 who underwent retransplantation because of @entity5924 , whereas the pulmonary function of @entity1 who underwent retransplantation because of other conditions did not significantly change. We conclude that survival after pulmonary retransplantation is improving. Optimal results can be obtained in @entity1 who are ambulatory before retransplantation. Compared with recent data after primary lung transplantation, @entity4154 does not appear to recur in an accelerated manner after retransplantation. As long as early mortality as a result of infection can be minimized, pulmonary retransplantation appears to offer a reasonable option in highly selected @entity1 .
