RETRANSPLANTATION OF THE LUNG - A SINGLE-CENTER EXPERIENCE

While lung retransplantation remains the only therapeutic option in early or late graft failure, its value is viewed controversially. Of 134 patients undergoing pulmonary transplantation in our institution, 13 patients 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), and chronic graft failure (n = 7). Prior to retransplantation, six patients had been in stable respiratory failure, the remaining eight patients were on mechanical ventilation or extracorporeal membrane oxygenation (n=2). Four patients died, 19, 43, 142, and 683 days following retransplantation due to pneumonia (n=2), early onset of obliterative bronchiolitis (n = 1), and pulmonary embolism (n = 1). There was no correlation between mortality and intubation prior to re-operating, timing of operation, donor cytomegalovirus (CMV) status, or type of operation. Postoperative need for intensive care treatment was prolonged in patients undergoing acute retransplantation (P < 0.05). Actuarial 1- and 2-year survival rates were calculated at 77 and 64%. This was slightly lower than in the overall population following primary isolated lung transplantation (83 and 80%). Actuarial freedom from obliterative bronchiolitis (stage 3) at 1 and 2 years was calculated at 88 and 27% (primary grafts: 88% vs 72%; P< 0.05). Retransplantation is a realistic option in early and late graft failure after lung transplantation. The more rapid development of obliterative bronchiolitis is of great concern and may require modified immunosuppression to improve the long-term outcome of retransplantation.