While lung retransplantation remains the only therapeutic option in ea
rly 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 transplant
ation (n=5). Indications for retransplantation were acute graft failur
e (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 eig
ht patients were on mechanical ventilation or extracorporeal membrane
oxygenation (n=2). Four patients died, 19, 43, 142, and 683 days follo
wing retransplantation due to pneumonia (n=2), early onset of oblitera
tive 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 o
peration. Postoperative need for intensive care treatment was prolonge
d 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 isolat
ed lung transplantation (83 and 80%). Actuarial freedom from obliterat
ive 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 real
istic option in early and late graft failure after lung transplantatio
n. The more rapid development of obliterative bronchiolitis is of grea
t concern and may require modified immunosuppression to improve the lo
ng-term outcome of retransplantation.