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Redo lung transplantation for acute and chronic lung allograft failure: long-term follow-up in a single center

^a Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI, United States
^b Section of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI, United States

Received 13 May 2008; received in revised form 17 July 2008; accepted 21 July 2008.

^_* Corresponding author. Address: Division of Cardiovascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, H4/348 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3236, United States. Tel.: +1 608 263 6311; fax: +1 608 263 0547. (Email: oliveira{at}surgery.wisc.edu).

Objective: This study was undertaken to evaluate outcomes of redo lung transplantation (LT) for acute and chronic graft failure. Methods: Between 1988 and 2007, 388 LT procedures were performed on 369 patients. From those, 17 (4.6%) patients had redo LT once and 2 patients had redo LT twice. Patient survival and recurrence of bronchiolitis obliterans syndrome (BOS) after redo LT were reviewed. Results: The overall survival rates of the 17 redo LT recipients at 1, 2 and 5 years were 59 ± 23%, 59 ± 23% and 42 ± 25%, respectively. For the chronic graft failure group (n = 12), survival rates at 1, 2 and 5 years were 67 ± 26%, 67 ± 26% and 44 ± 30%, respectively. These survival rates were significantly lower than the survival rates observed in our experience after primary LT (n = 352, 1-, 2- and 5-year survival rates of 88 ± 4%, 80 ± 4% and 65 ± 5%, respectively. For the acute graft failure group (n = 5), the 1-year survival rate was 40%; two patients remain free from BOS. Two patients had a second redo LT, one died from multi-organ failure on postoperative day 86 and the other died from pulmonary aspergillosis on postoperative day 214. Conclusions: Redo LT is a valid therapeutic option for selected patients with BOS and might be an option for highly selected patients with acute lung graft failure. Outcomes from a second redo LT are poor, and a second lung retransplantation must be used very cautiously, if at all.

Key Words: Rejection • Reoperation • Transplantation • Retransplantation • Lung