LUNG RETRANSPLANTATION - INSTITUTIONAL REPORT ON A SERIES OF 20 PATIENTS

Background and Methods: Between 1986 and 1995, 124 isolated lung and 2 9 combined heart-lung transplantations were performed at our instituti on. Twenty of these procedures were retransplantations. Four different types of reoperations were performed: ipsilateral single lung retrans plantation (n = 3), single lung retransplantation after bilateral or h eart-lung transplantation (n = 7), bilateral retransplantation after b ilateral lung transplantation (n = 5), and bilateral retransplantation after single lung transplantation (n = 5). Nine patients underwent re transplantation while still in the intensive care unit after the prima ry transplantation. Indications for retransplantation in these patient s were primary graft failure in seven and bronchial complications in t wo patients. In 11 patients a late retransplantation (3 to 30 months a fter the first transplantation) was performed. The indication was obli terative bronchiolitis in nine and late bronchial complications in two patients. Overall, 13 patients were ventilator-dependent before retra nsplantation. Results: Overall survival was 52.8% ana 36.2% at 1 and 1 2 months, respectively. For early retransplantation the survival rate at 1 month was only 22.2% with 2 patients alive 5 and 22 months after the retransplantation. For late retransplantation survival at 1 and 12 months was 70.7% and 50.5%, respectively (p = 0.07), and the longest surviving patient was at 47 months after retransplantation at the time this article was written. Patients who were ventilator-dependent befo re retransplantation had a significantly worse outcome (survival at 1 and 12 months: 33.8% and 25.4% versus 85.7% and 57.1% for all others, p = 0.055). Of those surviving to date, all were in New York Heart Ass ociation class I or II. Conclusions: We conclude that late and electiv e lung retransplantation achieves acceptable results when offered to p atients with chronic pulmonary dysfunction but with otherwise stable c onditions. In view of the poor results, early acute retransplantation should be performed much more restrictively.