Time since primary transplant and poor functional status predict survival after redo lung transplant

Abstract

Background: In previous studies, lower functional status measured by Karnofsky Performance Status (KPS) correlated with worse survival after redo lung transplant. We hypothesize that combining reduced functional status and time from primary lung transplant will correlate with the etiology of lung allograft failure after primary lung transplant and more accurately predict survival after redo lung transplant.Methods: This retrospective study was approved by University of Minnesota Institutional Review Board. From the Scientific Registry of Transplant Recipients (SRTR) database, 739 patients underwent redo lung transplant (01/01/2005-8/30/2019). Pre-lung transplant characteristics, KPS, time between primary and redo lung transplant, outcomes, overall survival were evaluated. Paired comparisons were used to compare pre-transplant variables. A Cox regression model was fit to examine re-transplant survival. Due to nonproportional hazards, time between transplants was split into <1-year vs. 1+ years and analyzed with timedependent coefficients, with follow-up time considered in three segments (0-6, 6-24, 24+ months).Results: After KPS grouping (10-40%, 50-70%, 80-100%), KPS 10-40% were less likely to be discharged after primary transplant and more likely required mechanical ventilation or extracorporeal membrane oxygenation (ECMO) bridging (P<0.001). Redo lung transplant survival was worse in the KPS 10-40% group who more likely underwent lung transplant <1 year after primary lung transplant. Mortality was significantly higher for patients who underwent redo lung transplant within one year of primary transplant when KPS was 10-40% (P<0.001). These patients were more likely to require redo lung transplant due to primary graft failure or acute cellular rejection.Conclusions: Functional status and time from primary lung transplant are strong predictors of outcome after redo lung transplant. We categorized redo lung transplant recipients in two distinct groups. One group has early allograft failure and poor functional status with a very poor prognosis after redo lung transplant. The other group has chronic allograft failure and overall better functional status with relatively better survival after redo lung transplant. Salvage redo lung transplant for primary allograft failure or acute rejection is associated with low one year survival.

Performance status at the time of lung retransplant predicts long‐term function

“…Recipient factors such as preoperative mechanical ventilation, mechanical circulatory support, LAS, and time from primary transplant are all known predictors of poor survival after retransplant. [7][8][9][10] In addition, there is a known association between poor functional status and adverse outcomes after lung transplantation, including inhospital and 1-year mortality, transplant encounter length of stay, and likelihood of finding paid employment after the operation. [11][12][13][14] The Karnofsky Performance Status (KPS), initially developed to quantify the functional status of cancer patients after an intervention, is a functional metric collected pre-transplant, at time of match, and posttransplant follow-up.…”

“…Recipient factors such as preoperative mechanical ventilation, mechanical circulatory support, LAS, and time from primary transplant are all known predictors of poor survival after retransplant 7–10 . In addition, there is a known association between poor functional status and adverse outcomes after lung transplantation, including in‐hospital and 1‐year mortality, transplant encounter length of stay, and likelihood of finding paid employment after the operation 11–14 .…”

Time is ticking: the role of time after primary transplant and functional impairment on survival after redo lung transplant

“…Multiple studies have shown its predictive value for outcomes after both primary and redo LTx ( 1 , 2 ). Aggarwal and colleagues ( 3 ) addressed a potential utility for preoperative functional status when analyzed against patients’ time between primary and redo LTx. Namely, when redo LTx recipients are categorized by both variables, it reveals two distinct “phenotypes” of patients with dichotomous clinical and prognostic outcomes.…”