PULMONARY RETRANSPLANTATION FOR OBLITERATIVE BRONCHIOLITIS - INTERMEDIATE-TERM RESULTS OF A NORTH AMERICAN-EUROPEAN SERIES

An international series of pulmonary retransplantation was updated to identify the predictors of survival in the intermediate-term after, re operation for obliterative bronchiolitis. The study cohort included 32 patients with end-stage obliterative bronchiolitis who underwent retr ansplantation in 15 North American and European centers between 1988 a nd 1992. Five types of retransplantation procedures were done, includi ng repeat ipsilateral single lung transplantation (7 patients), repeat contralateral single lung transplantation (8 patients), repeat double lung transplantation (3 patients), double lung transplantation after a previous single lung transplantation (3 patients), and single lung t ransplantation after a previous double lung or heart-lung transplantat ion (11 patients). The mean interval between transplants was 564 +/- 5 1 days (range 187 to 1589 days). Postoperative follow-up was 100% comp lete and the average follow-up in surviving patients was 678 +/- 63 da ys. Actuarial survival was 72%, 53%, 50%, 41%, and 33% at 1, 3, 6, 12, and 24 months, respectively. Survival did not differ according to the age, preoperative diagnosis, ambulatory or ventilator status, or cyto megalovirus serologic status of the recipient before reoperation. Life -table and Cox proportional hazards analysis identified the type of re transplantation procedure and the year of reoperation as significant ( p < 0.05) predictors of postoperative survival. Actuarial survival was significantly better in patients without an old, retained contralater al graft after retransplantation and in patients who underwent reopera tion between 1990 and 1992, as opposed to between 1988 and 1989. Infec tion was the most common cause of death at all time intervals after re transplantation, although all deaths beyond 2 years resulted from obli terative bronchiolitis of the second graft. Most surviving patients ar e in a satisfactory clinical condition, with a mean forced expired vol ume in 1 second of 59% +/- 13% of predicted (repeat double lung transp lant recipients) or 41% +/- 6% of predicted (repeat single lung transp lant recipients). We conclude that pulmonary retransplantation for obl iterative bronchiolitis is associated with significantly worse surviva l than after primary lung transplantation. The absence of an old contr alateral graft after retransplantation and reoperation after 1989 are important predictors of survival. Additional data and follow-up are re quired to determine the merit of pulmonary retransplantation for oblit erative bronchiolitis.