Predictive Utility of Lung Allocation Score for Retransplantation Outcomes

Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation

“…(1) The outcomes after retransplants are inferior compared to first lung transplants, particularly if the re-transplant is done within the first year after the original transplant or for patients with restrictive allograft syndrome (RAS). (1,139,140,(145)(146)(147)(148)(149) Several studies, however, have found acceptable results for carefully selected recipients. (140,146,150,151) In the pre-transplant evaluation of such patients, particular emphasis should be focused on understanding the possible reasons for the graft failure, such as alloimmunization, poor adherence, GER, or repeated infections.…”

“…(1,139,140,(145)(146)(147)(148)(149) Several studies, however, have found acceptable results for carefully selected recipients. (140,146,150,151) In the pre-transplant evaluation of such patients, particular emphasis should be focused on understanding the possible reasons for the graft failure, such as alloimmunization, poor adherence, GER, or repeated infections. (86,152)…”

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.…”

“…2 While retransplantation constitutes only a small fraction (about 5%) of annual transplant volume, the number of these cases has doubled since implementation of the Lung Allocation Score (LAS) in 2005. 3 Recipients who opt for retransplant experience higher morbidity and mortality compared to their initial transplant procedure. 4 Given the known ethical and technical challenges of retransplantation 5,6 methods to better define candidates for retransplantation must be continuously reviewed.…”

“…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 .…”