Background

Re-operative lung transplantation (LTx) survival has improved over time such that a growing number of patients may present for third-time LTx (L3Tx). To understand the safety of L3Tx, we evaluated perioperative outcomes and three-year survival after L3Tx at a high-volume US LTx center.

Methods

This retrospective study included all patients who underwent bilateral L3Tx at our institution. Using an optimal matching technique, a primary LTx (L1Tx) cohort was matched 1:2 and a second-time LTx (L2Tx) cohort 1:1. Recipient, operative, and donor characteristics, perioperative outcomes, and three-year survival were compared among L1Tx, L2Tx, and L3Tx groups.

Results

11 L3Tx, 11 L2Tx, and 22 L1Tx recipients were included. Among L3Tx recipients, median age at transplant was 37 years and most (73%) had cystic fibrosis. L3Tx was performed median 6.0 and 10.6 years after L2Tx and L1Tx, respectively. Compared to L1Tx and L2Tx recipients, L3Tx recipients had greater intraoperative transfusion requirements, a higher incidence of post-operative complications, and a higher rate of unplanned reoperation. Rates of grade 3 primary graft dysfunction at 72 hours (PGD3), ECMO at 72 hours, reintubation, and in-hospital mortality were similar among groups. There were no differences in three-year patient (log-rank p=0.61) or rejection-free survival (log-rank p=0.34) after L1Tx, L2Tx, and L3Tx.

Conclusions

At our institution, L3Tx was associated with similar perioperative outcomes and three-year patient survival compared to L1Tx and L2Tx. L3Tx represents the only safe treatment option for patients with allograft failure after L2Tx; however, further investigation is needed to understand the long-term survival and durability of L3Tx.

中文翻译：

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第三次肺移植后的短期结果：单一机构的经验

背景

随着时间的推移，再次手术肺移植 (LTx) 的生存率有所提高，因此越来越多的患者可能会进行第三次 LTx (L3Tx)。为了了解 L3Tx 的安全性，我们在美国一家大容量 LTx 中心评估了 L3Tx 的围手术期结果和三年生存率。

方法

这项回顾性研究包括在我们机构接受双侧 L3Tx 的所有患者。使用最佳匹配技术，主要 LTx (L1Tx) 队列按 1:2 匹配，第二次 LTx (L2Tx) 队列按 1:1 匹配。比较了 L1Tx、L2Tx 和 L3Tx 组的受者、手术和供者特征、围手术期结果和三年生存率。

结果

其中包括 11 个 L3Tx、11 个 L2Tx 和 22 个 L1Tx 接收者。在 L3Tx 接受者中，移植时的中位年龄为 37 岁，大多数 (73%) 患有囊性纤维化。L3Tx 的中位时间分别为 L2Tx 和 L1Tx 后 6.0 和 10.6 年。与L1Tx和L2Tx受者相比，L3Tx受者术中输血需求更大，术后并发症发生率更高，非计划再次手术率也更高。各组间 72 小时 3 级原发性移植功能障碍 (PGD3)、72 小时 ECMO、重新插管和院内死亡率相似。L1Tx、L2Tx 和 L3Tx 后，三年患者生存率（对数秩 p=0.61）或无排斥生存率（对数秩 p=0.34）没有差异。

结论

在我们的机构，与 L1Tx 和 L2Tx 相比，L3Tx 与相似的围手术期结果和三年患者生存率相关。L3Tx 是 L2Tx 后同种异体移植失败患者唯一安全的治疗选择；然而，需要进一步研究以了解 L3Tx 的长期生存和耐久性。