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Third time’s the charm? Outcomes after third-time lung transplantation

Year: 2026

Type: article

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.

Source: JHLT Open

DOI: 10.1016/j.jhlto.2026.100683