• Victoria Yin, John C S Rodman, Scott M Atay, Sean C Wightman, Graeme M Rosenberg, Brooks V Udelsman, Sivagini Ganesh, Peter Chung, Anthony W Kim, and Takashi Harano.
• Keck School of Medicine of the University of Southern California, Los Angeles, CA.
• J. Thorac. Cardiovasc. Surg. 2024 Sep 30.

ObjectiveThe aim of this study is to compare outcomes of single lung retransplantation (SLRTx) to double lung retransplantation (DLRTx) after an initial double lung transplantation.MethodsThe Organ Procurement and Transplantation Network/United Network for Organ Sharing database between May 2005 and December 2022 was retrospectively analyzed. Multiorgan transplantation, repeated retransplantation, and lung retransplantation when the status of the initial transplantation was unknown were excluded.Results891 patients were included in the analysis: 698 cases (78.3%) were DLRTx and 193 cases (21.7%) were SLRTx. Mean lung allocation score was higher among DLRTx (59.6±20.7 vs 55.1±19.3, p = 0.007). Extracorporeal membrane oxygenation (ECMO) bridge to lung transplantation use was similar between groups (p=0.125), as was waitlist time (p=0.610). Need for mechanical ventilation (54.6% vs 35.8%, p = 0.005) and ECMO (17.9% vs 9.0%, p = 0.069) at 72 hours after transplantation was more frequent in DLRTx group. However, median post-transplant hospital stay (21.5 [IQR 12-35] vs 20 days [IQR 12-35], p=0.119) and in-hospital mortality (10.9% [76/698] vs 12.4% [24/193], p=0.547) were comparable between groups. Long-term survival was significantly better among DLRTx (log-rank test p < 0.001). In the propensity-score weighted multivariable model, DLRTx had 28% lower risk of mortality at any point during follow-up compared to SLRTx (HR: 0.72, 95% confidence interval: 0.57-0.91, p=0.006).ConclusionsLess invasiveness of single lung transplantation in the retransplant setting has minimal short-term benefit and is associated with significantly worse long-term survival. Double lung retransplantation should remain the standard for lung retransplantation after initial double lung transplantation.Copyright © 2024. Published by Elsevier Inc.

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