Performance status at the time of lung retransplant predicts long‐term function

Background Lung retransplantation is offered to select patients with chronic allograft dysfunction. Given the increased risk of morbidity and mortality conferred by retransplantation, post‐transplant function should be considered in the decision of who and when to list. The aim of this study is to identify predictors of post‐operative disability in patients undergoing lung retransplantation. Methods Data were collected from the UNOS national dataset and included all patients who underwent lung retransplant from May 2005–March 2023. Pre‐ and post‐operative function was reported by the Karnofsky Performance Status (KPS) and patients were stratified based on their needs. Cumulative link mixed effects models identified associations between pre‐transplant variables and post‐transplant function. Results A total of 1275 lung retransplant patients were included. After adjusting for between‐group differences, pre‐operative functional status was predictive of post‐transplant function; patients requiring Total Assistance ( n = 740) were 74% more likely than No/Some Assistance patients (n = 535) to require more assistance in follow‐up (OR 1.74, 95% CI 1.13–2.68, p = .012). Estimated one year survival of Total Assistance patients is lower than No/Some Assistance Recipients (72% vs. 82%, CI 69%–75%; 79%–86%) but similar to overall re‐transplant survival (76%, CI 74%–79%). Conclusion Both survival and regain of function in patients requiring Total Assistance prior to retransplant may be higher than previously reported. Pre‐operative functional status is predictive of post‐operative function and should weigh in the selection, timing and post‐operative care of patients considered for lung retransplantation.