Functional status is highly predictive of outcomes after redo lung transplantation: an analysis of 390 cases in the modern era

Background: The aim of this study was to evaluate whether functional status is a predictor of outcomes after redo lung transplantation (LTx).

Methods: Adults undergoing redo LTx after implementation of the Lung Allocation Score (May 2005 to December 2010) were identified in the United Network for Organ Sharing database. Patients were stratified into three groups based on functional status as measured before redo LTx by the Karnofsky scale: (1) no assistance required, (2) some assistance required, and (3) total assistance required. Outcomes after redo LTx were compared based on these preoperative functional cohorts.

Results: A total of 390 redo LTx were identified: 44 (11%) required no functional assistance, 176 (45%) required some assistance, and 170 (44%) required total assistance preoperatively. Overall survival at 1 year after redo LTx was significantly reduced in the total assistance group (56% versus 82% no assistance, versus 82% some assistance; p < 0.001). After risk adjustment, recipients requiring total assistance preoperatively were at significant risk for 1-year mortality (odds ratio 3.72, p = 0.02). Overall, the preoperative functional assessment outperformed the Lung Allocation Score in predicting 1-year survival after redo LTx (c-index: 0.68 versus 0.58). Transplant survivors who required total assistance before redo LTx were also at increased risk of requiring total assistance after redo LTx (26% versus 0% no assistance, versus 3% some assistance; p < 0.001).

Conclusions: These data suggest that performing redo LTx in patients requiring total functional assistance is associated with significant risk of early mortality and continued functional limitation, findings that may have important implications in organ allocation.