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

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 al...

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Autores principales: Aggarwal, Rishav, Jackson, Scott, Lemke, Nicholas T., Trager, Lena, Shumway, Sara J., Kelly, Rosemary F., Hertz, Marshall, Huddleston, Stephen J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9641320/
https://www.ncbi.nlm.nih.gov/pubmed/36389317
http://dx.doi.org/10.21037/jtd-22-334
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author Aggarwal, Rishav
Jackson, Scott
Lemke, Nicholas T.
Trager, Lena
Shumway, Sara J.
Kelly, Rosemary F.
Hertz, Marshall
Huddleston, Stephen J.
author_facet Aggarwal, Rishav
Jackson, Scott
Lemke, Nicholas T.
Trager, Lena
Shumway, Sara J.
Kelly, Rosemary F.
Hertz, Marshall
Huddleston, Stephen J.
author_sort Aggarwal, Rishav
collection PubMed
description 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 non-proportional hazards, time between transplants was split into <1-year vs. 1+ years and analyzed with time-dependent 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.
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spelling pubmed-96413202022-11-15 Time since primary transplant and poor functional status predict survival after redo lung transplant Aggarwal, Rishav Jackson, Scott Lemke, Nicholas T. Trager, Lena Shumway, Sara J. Kelly, Rosemary F. Hertz, Marshall Huddleston, Stephen J. J Thorac Dis Original Article 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 non-proportional hazards, time between transplants was split into <1-year vs. 1+ years and analyzed with time-dependent 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. AME Publishing Company 2022-10 /pmc/articles/PMC9641320/ /pubmed/36389317 http://dx.doi.org/10.21037/jtd-22-334 Text en 2022 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Aggarwal, Rishav
Jackson, Scott
Lemke, Nicholas T.
Trager, Lena
Shumway, Sara J.
Kelly, Rosemary F.
Hertz, Marshall
Huddleston, Stephen J.
Time since primary transplant and poor functional status predict survival after redo lung transplant
title Time since primary transplant and poor functional status predict survival after redo lung transplant
title_full Time since primary transplant and poor functional status predict survival after redo lung transplant
title_fullStr Time since primary transplant and poor functional status predict survival after redo lung transplant
title_full_unstemmed Time since primary transplant and poor functional status predict survival after redo lung transplant
title_short Time since primary transplant and poor functional status predict survival after redo lung transplant
title_sort time since primary transplant and poor functional status predict survival after redo lung transplant
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9641320/
https://www.ncbi.nlm.nih.gov/pubmed/36389317
http://dx.doi.org/10.21037/jtd-22-334
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