Retransplantation of the lung*A single center experience

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Abstract
While lung retransplantation remains the only therapeutic option inearly or late graft failure, its value is viewed controversially. Of 134patients undergoing pulmonary transplantation in our institution, 13patients underwent 14 redos following heart-lung transplantation (n = 3),bilateral lung transplantation (n = 5), and unilateral lung transplantation(n = 5). Indications for retransplantation were acute graft failure (n =2), persistent graft dysfunction (n = 3), airway complications (n = 2), andchronic graft failure (n = 7). Prior to retransplantation, six patients hadbeen in stable respiratory failure, the remaining eight patients were onmechanical ventilation or extracorporeal membrane oxygenation (n = 2). Fourpatients died, 19, 43, 142, and 683 days following retransplantation due topneumonia (n = 2), early onset of obliterative bronchiolitis (n = 1), andpulmonary embolism (n = 1). There was no correlation between mortality andintubation prior to re-operating, timing of operation, donorcytomegalovirus (CMV) status, or type of operation. Postoperative need forintensive care treatment was prolonged in patients undergoing acuteretransplantation (P < 0.05). Actuarial 1- and 2-year survival rateswere calculated at 77 and 64%. This was slightly lower than in the overallpopulation following primary isolated lung transplantation (83 and 80%).Actuarial freedom from obliterative bronchiolitis (stage 3) at 1 and 2years was calculated at 88 and 27% (primary grafts: 88% vs 72%; P <0.05). Retransplantation is a realistic option in early and late graftfailure after lung transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

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