Author: Eric Ramos
Lung re-transplantation is a feasible treatment option for carefully selected patients with chronic lung allograft dysfunction (CLAD), regardless of age, according to a study presented at the 2020 Virtual Meeting of the American Society of Anesthesiologists (ASA).
“We performed a retrospective analysis of our patients who underwent lung re-transplantation between January 2007 and December 2016,” said Rodrigo Lami Pereira, MD, Mayo Clinic, Jacksonville, Florida.
A total of 409 adult lung transplants (median age, 60 years) were performed during the study period, of which 26 (6.3%) were re-transplantations. One patient underwent lung re-transplantation twice and only the first was included in the final analysis. The indication for lung re-transplantation was CLD in 88% of patients.
Graft survival after lung re-transplantation — the primary outcome — was 80% at 1 year, 52% at 3 years, and 43% at 5 years.
“Our graft survival rates are higher than historical outcomes before 2005 and higher than nationally reported data, despite apparently more advanced age,” noted Dr. Pereira. “The median age of our patients was 60 years — this is quite distinct from what has been previously reported for lung re-transplantation recipients. Similar studies had patients with an average age in the high 30’s or mid 40’s, so our population was significantly older, and because they were older, our patients also had comorbidities, which were assessed and were considered mild. So, we don’t think that age or comorbidity profile impact graft survival time significantly.”
Graft failure or death was associated with procedure performed under cardiopulmonary bypass (hazard ratio [HR] = 2.58; 95% confidence interval [CI], 1.02-6.50; P = .045), postoperative increase in creatinine levels of ≥0.3 mg/dL (HR = 3.68; 95% CI, 1.30-10.38; P = .01), and need for renal replacement therapy within 30 days of surgery (HR = 18.74; 95% CI, 3.23-108.09; P< .001).
“Lung re-transplantation procedures are a feasible form of treatment, especially in patients that have chronic lung allograft dysfunction,” said Dr. Pereira. “We think that the age limit for indication for this procedure should take into consideration a patient’s overall health status, not only the [age] number, because our patients did pretty well and they were considered older for this type of surgery.”