Lung retransplantation during the Lung Allocation Score era: Outcomes from a large single center

We identified 51 lung retransplant recipients and compared them with 1149 primary lung transplant recipients. ReTx accounted for 3.9% of all transplants, and almost all were for CLAD-BOS.One-, three-, five-, and ten-year survival after ReTx was 96%, 72%, 55%, and 28%, respectively (median = 5.61 [3.30-8.51] years). Characteristics associated with worse survival following ReTx included age ≥ 55 (adjusted HR 2.6; 95% CI, 1.39-5.02) and early-onset CLAD following ReTx (HR 4.86; 95% CI, 1.94-12.2). Pretransplant mechanical ventilation or ECMO support, type of surgical procedure, and the interval between primary and re-transplantation were not significantly associated with survival. Overall, our center's outcomes after lung ReTx were more favorable than those previously reported, likely due to more restrictive candidate selection. These findings highlight the importance of careful patient selection. Multicenter prospective studies are needed to further refine risk stratification and optimize ReTx outcomes.