Should we retransplant lung?

  • James H. Dauber
Part of the Transplantation and Clinical Immunology book series (TRAC, volume 29)


Transplantation of the lung has become an accepted form of therapy for a variety of endstage lung diseases. Despite recent improvements in surgical techniques and immunosuppression, graft failure, particularly in the late post transplant period from chronic rejection, continues to extract an unacceptable toll leading to a strong desire on the part of both the afflicted patient and physician for retransplantation. Given the growing disparity between the size of donor and recipient pools, however, the practice of retransplanting lung is controversial. Information on the survival post retransplantation is limited due to the relatively few numbers that have been performed world wide. Most recent figures indicate that overall survival is only half the rate seen for a first transplant. In selected centers it is better but still not as good as after a first transplant. Leading causes of death after retransplantation are infection and respiratory failure from chronic rejection. Factors associated with a favorable outcome after retransplantation include ambulatory status of the recipient, interval between first and second transplants and retransplantation for conditions other than chronic rejection. Survival also seems to be higher if retransplantation is performed at centers which have done more than five procedures. Functional status following retransplantation may achieve virtually normal levels, but in recipients retransplanted for chronic rejection, recurrence of this complication occurs in nearly two thirds leading to significant declines in both their functional status and survival.


Graft Failure Chronic Rejection Obliterative Bronchiolitis Bronchiolitis Obliterans Syndrome Heart Lung Transplant 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    1996 Annual Report of the U.S. Scientific Registry of Transplant Recipients and the Organ Procurement and Transplantation Network. UNOS and the Division of Transplantation, Bureau of heath Resources Develoment, Heath Resources and Services Administration, U.S Department of Health and Human Services, 1997.Google Scholar
  2. 2.
    Hosenspud JD, Novick RJ, Bennett LD, Keck BM, Fiol B, Daily OP. The Registry of the International Society for heart and lung transplantation: Thirteenth Official Report-1996. J. Heart Lung Transplant. 1996; 15: 655–674.Google Scholar
  3. 3.
    Trulock EP. State of the art: lung transplantation. Am. J. Resp. Crit. Care Med. 1997; 155: 789–818.PubMedGoogle Scholar
  4. 4.
    Dauber, JH, Paradis IL, Dummer JS. Infectious complications in pulmonary allograft recipients. Clin. Chest Med. 1990; 11: 291–308.PubMedGoogle Scholar
  5. 5.
    Higgins R, McNeil K, Dennis C et al. Airway stenoses after lung transplantation: management with expanding stents. J. Heart Lung Transplant. 1994; 13: 774–778.PubMedGoogle Scholar
  6. 6.
    Paradis IL, Yousem SA, Griffith BP. Airway obstruction and bronchiolitis obliterans after lung transplantation. Clin. Chest Med. 1993; 14: 751–763.PubMedGoogle Scholar
  7. 7.
    Cooper JD, Billingham M, Egan T et al. A working formulation for the standardization of nomenclature and for clinical staging of chronic dysfunction in lung allografts. J. Heart Lung Transplant. 1993; 12:713–16.PubMedGoogle Scholar
  8. 8.
    Novick RJ, Stitt L, Schafers H-J et al. Pulmonary retransplantation: does the indication for operation influence postoperative lung function? J. Thorac. Cardiovasc. Surg. 1996; 112: 1504–1514.PubMedCrossRefGoogle Scholar
  9. 9.
    Haverich A, Hirt SW, Wahlers T, Schafers H-J, Zink C, Borst H-G. Functional results after lung retransplantation. J. Heart Lung Transplant. 1994; 13: 48–55.PubMedGoogle Scholar
  10. 10.
    Wekerle T, Kelpetko W, Wisser W et al. Lung retransplantation: institutional report on a series of twenty patients. J. Heart Lung Transplant. 1996; 15: 182–189.PubMedGoogle Scholar
  11. 11.
    Novick RJ, Schafers H-J, Stitt L et al. Seventy-two pulmonary retransplantations for obliterative bronchiolitis: predictors of survival. Ann. Thorac. Surg. 1995; 60: 111–116.PubMedGoogle Scholar
  12. 12.
    A1 Kattan K, Tadjkarimi S, Banner N, Khaghani N, Yacoub M. Pattern of survival and functional results of single lung transplantation for obliterative bronchiolitis (abstract). J. Heart Lung Transplant. 1996; 15: S69.Google Scholar

Copyright information

© Kluwer Academic Publishers 1997

Authors and Affiliations

  • James H. Dauber

There are no affiliations available

Personalised recommendations