Lung retransplantation during the Lung Allocation Score era: Outcomes from a large single center.

Background: Lung retransplantation (ReTx) is the only definitive treatment for advanced chronic lung allograft dysfunction (CLAD). ReTx outcomes are historically inferior to those of primary transplant. Identification of clinically significant risk factors could guide candidate selection and resource allocation to optimize outcomes. Methods: We conducted a single-center, retrospective cohort study of all lung transplants performed at Columbia University Medical Center (CUMC) from 2005 to 2023. The primary outcomes of survival and freedom from CLAD after ReTx were analyzed using Cox regression models. Results: We identified 51 lung retransplant recipients and compared them with 1149 primary lung transplant recipients. ReTx accounted for 3.9% of all transplants, and almost all were for CLAD-BOS.One-, three-, five-, and ten-year survival after ReTx was 96%, 72%, 55%, and 28%, respectively (median = 5.61 [3.30-8.51] years). Characteristics associated with worse survival following ReTx included age ≥ 55 (adjusted HR 2.6; 95% CI, 1.39-5.02) and early-onset CLAD following ReTx (HR 4.86; 95% CI, 1.94-12.2). Pretransplant mechanical ventilation or ECMO support, type of surgical procedure, and the interval between primary and re-transplantation were not significantly associated with survival. Overall, our center's outcomes after lung ReTx were more favorable than those previously reported, likely due to more restrictive candidate selection. These findings highlight the importance of careful patient selection. Multicenter prospective studies are needed to further refine risk stratification and optimize ReTx outcomes.