The influence of retransplantation on survival for pediatric lung transplant recipients Ryuichi Waseda, MD, PhD, Alberto Benazzo, MD, Konrad Hoetzenecker,

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The influence of retransplantation on survival for pediatric lung transplant recipients Ryuichi Waseda, MD, PhD, Alberto Benazzo, MD, Konrad Hoetzenecker, MD, PhD, Peter Jaksch, MD, Gabriela Muraközy, MD, Saskia Gruber, MD, Georg Roth, MD, Zsolt Szépfalusi, MD, Edith Nachbaur, MD, Walter Klepetko, MD The Journal of Thoracic and Cardiovascular Surgery Volume 156, Issue 5, Pages 2025-2034.e2 (November 2018) DOI: 10.1016/j.jtcvs.2018.05.080 Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Pediatric lung transplantations performed at the Medical University of Vienna. A, Timeline. B, Age distribution (before 2002, left, and after 2003, right). C, Indications for transplant (before 2002, left, and after 2003, right). y.o., Years old; GVHD, graft versus host disease; BMT, bone marrow transplantation; PPH, primary pulmonary hypertension; CF, cystic fibrosis; BO, bronchiolitis obliterans. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 2025-2034.e2DOI: (10.1016/j.jtcvs.2018.05.080) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Kaplan-Meier curves (solid line) with 95% confidence interval (CI) (dotted line) for the overall and organ survival of all 86 patients. Overall survival at 1 year, 5 years, and 10 years was 79.0% (95% CI, 68.7%-86.2%; 64 patients at risk), 67.5% (95% CI, 55.8%-76.8%; 33 patients at risk), and 57.1% (95% CI, 43.1%-68.9%; 13 patients at risk), respectively. Organ survival at 1 year, 5 years, and 10 years was 79.0% (95% CI, 68.7%-86.2%; 64 patients at risk), 60.3% (95% CI, 48.2%-70.4%; 30 patients at risk), and 36.9% (95% CI, 22.9%-50.9%; 6 patients at risk), respectively. B, Kaplan-Meier curves (solid line) with 95% CI (dotted line) for overall survival according to treatment period. The overall survival during the second period was significantly superior to that during the first period (log-rank P < .01). Overall survival in the second period at 1 year, 5 years, and 10 years was 86.0% (95% CI, 74.9%-92.5%; 52 patients at risk), 73.9% (95% CI, 60.0%-83.6%; 23 patients at risk), and 73.9% (95% CI, 60.0%-83.6%; 7 patients at risk), respectively. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 2025-2034.e2DOI: (10.1016/j.jtcvs.2018.05.080) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Overall survival after retransplantation in patients with chronic lung allograft dysfunction (n = 12). The overall survival at 1 year was 91.7% (95% confidence interval, 53.9%-98.8%; 11 patients at risk) and at 5 years was 80.2% (95% confidence interval, 40.3%-87.6%; 6 patients at risk). The Journal of Thoracic and Cardiovascular Surgery 2018 156, 2025-2034.e2DOI: (10.1016/j.jtcvs.2018.05.080) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Kaplan-Meier curves (solid line) with 95% confidence interval (CI) (dotted line) for organ survival according to treatment period. The organ survival during the second period was significantly superior to that during the first period (log-rank P < .01). Organ survival during the second period at 1 year, 5 years, and 10 years was 86.0% (95% CI, 74.9%-92.5%; 52 patients at risk), 69.7% (95% CI, 55.2%-80.3%; 23 patients at risk), and 52.1% (95% CI, 32.6%-68.4%; 4 patients at risk), respectively. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 2025-2034.e2DOI: (10.1016/j.jtcvs.2018.05.080) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Cumulative incidence of graft death according to treatment period. The cumulative incidence during the first period was 9.5% at 1 year (95% confidence interval [CI], 1.5%-26.7%; 13 patients at risk), 28.6% at 5 years (95% CI, 11.0%-49.1%; 7 patients at risk), and 42.9% at 10 years (95% CI, 20.7%-63.4%; 2 patients at risk), respectively. The cumulative incidence during the second period was 3.2% at 1 year (95% CI, 0.6%-9.8%; 54 patients at risk), 11.2% at 5 years (95% CI, 4.4%-21.4%; 25 patients at risk), and 28.8% at 10 years (95% CI, 12.7%-47.2%; 4 patients at risk), respectively. The cumulative incidence of graft death during the second period was superior with marginal significance to that during the first period (Gray's test P = .09). The Journal of Thoracic and Cardiovascular Surgery 2018 156, 2025-2034.e2DOI: (10.1016/j.jtcvs.2018.05.080) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Kaplan-Meier curves (solid line) with 95% confidence interval (CI) (dotted line) for overall survival in comparison between adults and pediatric patients during 2003 to 2015. The overall survival in pediatric cohort was equal to that in adults (log-rank P = .58). The Journal of Thoracic and Cardiovascular Surgery 2018 156, 2025-2034.e2DOI: (10.1016/j.jtcvs.2018.05.080) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E4 Kaplan-Meier curves (solid line) with 95% confidence interval (CI) (dotted line) for overall survival (OS) on conditional 1-year survival according to treatment period. OS during the first period was 83.3% (95% CI, 48.2%-95.6%; 10 patients at risk) at 5 years, and 50% (95% CI, 20.9%-73.6%; 6 patients at risk) at 10 years, respectively. OS during the second period was 85.9% (95% CI, 70.8%-93.5%; 24 patients at risk) at 5 years, and 85.9% (95% CI, 70.8%-93.5%; 7 patients at risk) at 10 years, respectively. OS during the second period remained superior compared with the first period (P = .04). The Journal of Thoracic and Cardiovascular Surgery 2018 156, 2025-2034.e2DOI: (10.1016/j.jtcvs.2018.05.080) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E5 Cumulative incidence of chronic lung allograft dysfunction (CLAD) according to treatment period. No significant difference in incidence of CLAD was observed between time periods (Gray's test P = .21). CI, Confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 2025-2034.e2DOI: (10.1016/j.jtcvs.2018.05.080) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Overall survival in the second period was significantly superior to that in the first period. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 2025-2034.e2DOI: (10.1016/j.jtcvs.2018.05.080) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions