PULMONARY RETRANSPLANTATION - DOES THE INDICATION FOR OPERATION INFLUENCE POSTOPERATIVE LUNG-FUNCTION

Objectives: An international series of pulmonary retransplantation was updated to determine the factors associated with pulmonary function, bronchiolitis obliterans syndrome stage, and survival after operation, Methods: One hundred sixty patients underwent retransplantation in 35 centers from 1985 to 1995, Logistic regression methods were used to d etermine variables associated with 3-month and 2-year survival after r etransplantation, Values of forced expiratory volume in 1 second were contrasted between groups by unpaired, two-tailed t tests, Results: Th e median follow-up in surviving recipients was 780 days, Actuarial sur vival was 45% +/- 4%, 41% +/- 4%, and 33% +/- 4% at 1, 2, and 3 years, respectively, On multivariable analysis, the only predictor of 3-mont h survival was preoperative ambulatory status (p = 0.005), whereas cen ter experience with at least five pulmonary retransplantations was the sole predictor of 2-year survival (p = 0.04). The prevalence of stage 3 (severe) bronchiolitis obliterans syndrome was 12% at 1 year, 15% a t 2 years, and 33% at 3 years after retransplantation, Retransplant re cipients with stage 3 bronchiolitis obliterans syndrome at 1 year had a significantly worse actuarial survival than those with stages 0 to 2 (p < 0.01), By 3 years after retransplantation, the forced expiratory volume in 1 second was significantly lower in patients who underwent reoperation because of obliterative bronchiolitis than in patients who underwent retransplantation because of acute graft failure or an airw ay complication (p = 0.02), Only 31% of patients who underwent retrans plantation because of obliterative bronchiolitis were free of bronchio litis obliterans syndrome at 3 years versus 83% of patients who underw ent retransplantation because of other indications (p = 0.02), Conclus ions: Preoperative ambulatory status predicts early survival and cente r volume predicts intermediate-term outcome after retransplantation, I mproved management strategies are necessary to prevent the development of progressive graft dysfunction after retransplantation for oblitera tive bronchiolitis.