Should we retransplant lung?
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.
KeywordsGraft Failure Chronic Rejection Obliterative Bronchiolitis Bronchiolitis Obliterans Syndrome Heart Lung Transplant
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