Third time's the charm? Outcomes after third-time lung transplantation.
- 1Creighton University School of Medicine, Phoenix, AZ.
- 2Department of General Surgery, Brooke Army Medical Center, Fort Sam Houston, TX.
- 3Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
Abstract
Objectives
With the increased success of redo lung transplantation (LTx), third-time LTx (3LTx) has emerged as a potential option for select patients with recurrent graft failure. We investigated outcomes after 3LTx compared to those of first-time (1LTx) and second-time (2LTx) lung transplantation.Methods
The United Network for Organ Sharing Standard Transplant Analysis and Research file was retrospectively analyzed for patients listed for 1LTx, 2LTx, and 3LTx between May 4, 2005, and March 28, 2025. Patient demographics, pretransplant characteristics, and postoperative outcomes were compared across groups.Results
A total of 40,419 patients were identified: 39,223 (97.0%) underwent 1LTx, 1161 (2.87%) underwent 2LTx, and 35 (0.09%) underwent 3LTx. Compared to the 2LTx cohort, 3LTx patients were younger (35 vs 46 years, p<0.001) and more likely to have been initially transplanted for cystic fibrosis (57% vs 35%, p=0.007). Postoperative complication rates were comparable; however, acute dialysis rates were higher in the 3LTx cohort (43% vs 18%, p<0.001). Median survival was comparable between the groups (2LTx: 3.58 years vs 3LTx: 2.90 years, p=0.295). In a multivariable analysis using 1LTx as the reference group, 3LTx was associated with an increased risk of death (aHR: 2.24, 95% CI: 1.12-4.49, p=0.023). Compared to 2LTx, 3LTx showed a nonsignificant trend toward higher mortality (aHR: 1.29, 95% CI: 0.64-2.60, p=0.48).Conclusions
Outcomes following 3LTx were largely comparable to those of 2LTx, despite increased renal complications. These findings suggest that 3LTx is a possible therapeutic option for carefully selected patients.
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BibTeX
@article{rybachok2026third,
title = {{Third time's the charm? Outcomes after third-time lung transplantation.}},
author = {Artur Rybachok and Mark Shacker and Lucas Wang and Michael T Olson and Andrew Keogan and Sreeja Biwas Roy and Ashwini Arjuna and Rajat Walia and Nathan Zwintscher and Samad Hashimi and Lara W Schaheen and Ross M Bremner and Jasmine L Huang and Michael A Smith},
journal = {JHLT open},
year = {2026},
month = sep,
doi = {10.1016/j.jhlto.2026.100683},
url = {https://europepmc.org/article/MED/42909266},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Third time's the charm? Outcomes after third-time lung transplantation.
AU - Artur Rybachok
AU - Mark Shacker
AU - Lucas Wang
AU - Michael T Olson
AU - Andrew Keogan
AU - Sreeja Biwas Roy
AU - Ashwini Arjuna
AU - Rajat Walia
AU - Nathan Zwintscher
AU - Samad Hashimi
AU - Lara W Schaheen
AU - Ross M Bremner
AU - Jasmine L Huang
AU - Michael A Smith
PY - 2026
DA - 2026/09/24
JO - JHLT open
DO - 10.1016/j.jhlto.2026.100683
UR - https://europepmc.org/article/MED/42909266
AB - Objectives With the increased success of redo lung transplantation (LTx), third-time LTx (3LTx) has emerged as a potential option for select patients with recurrent graft failure. We investigated outcomes after 3LTx compared to those of first-time (1LTx) and second-time (2LTx) lung transplantation.Methods The United Network for Organ Sharing Standard Transplant Analysis and Research file was retrospectively analyzed for patients listed for 1LTx, 2LTx, and 3LTx between May 4, 2005, and March 28, 2025. Patient demographics, pretransplant characteristics, and postoperative outcomes were compared across groups.Results A total of 40,419 patients were identified: 39,223 (97.0%) underwent 1LTx, 1161 (2.87%) underwent 2LTx, and 35 (0.09%) underwent 3LTx. Compared to the 2LTx cohort, 3LTx patients were younger (35 vs 46 years, p<0.001) and more likely to have been initially transplanted for cystic fibrosis (57% vs 35%, p=0.007). Postoperative complication rates were comparable; however, acute dialysis rates were higher in the 3LTx cohort (43% vs 18%, p<0.001). Median survival was comparable between the groups (2LTx: 3.58 years vs 3LTx: 2.90 years, p=0.295). In a multivariable analysis using 1LTx as the reference group, 3LTx was associated with an increased risk of death (aHR: 2.24, 95% CI: 1.12-4.49, p=0.023). Compared to 2LTx, 3LTx showed a nonsignificant trend toward higher mortality (aHR: 1.29, 95% CI: 0.64-2.60, p=0.48).Conclusions Outcomes following 3LTx were largely comparable to those of 2LTx, despite increased renal complications. These findings suggest that 3LTx is a possible therapeutic option for carefully selected patients.
SN - 2950-1334
ER -