Lung Retransplantation

Abstract

Even though lung retransplantation accounts for a relatively small percentage of all lung transplants, it is increasingly accepted as a therapeutic option for well selected patients. Ipsilateral, contralateral or bilateral procedures can be conducted to replace the failed lung allograft(s) and/or the native lung which was retained at the initial transplant. The outcome of lung retransplantation has been poor when it was done for acute complications that occurred within one year after initial transplant (e.g. primary graft dysfunction, acute rejection and bronchial dehiscence) and restrictive chronic lung allograft dysfunction. Poor results have also been associated with older recipient age, the need for extracorporeal membrane oxygenation and other medical comorbidities. However, the outcomes of lung retransplantation have been improving continuously over the last decades due to a combination of technical and conceptual advances in lung transplantation and changes to donor lung allocation policy. Survival after lung retransplants undertaken for bronchiolitis obliterans syndrome and airway stenosis is now almost equivalent to that after primary lung transplantation.