Long-term Outcome of Lung Retransplantation for Chronic Lung Allograft Dysfunction After En-bloc Heart and Lung...

Chronic lung allograft dysfunction (CLAD) is a major factor limiting long-term survival after heart-lung transplantation (HLTx). Whether lung retransplantation (LRTx) offers the same long-term results in HLTx recipients as in double-lung transplantation (DLTx) recipients remains unknown. The aim of this study was to compare outcomes of LRTx after HLTx and DLTx.

We retrospectively reviewed charts of patients retransplanted at our institution in 2006-2023. Outcomes after LRTx, overall survival, and bronchiolitis obliterans syndrome (BOS)-free survival were compared between HLTx and DLTx groups.

LRTx was performed in 60 patients, including 20 after HLTx and 40 after DLTx. Median post-retransplant follow-up was 3.54 years [1.37-6.79]. Median time to retransplantation was significantly shorter in LRTx group (HLTx: 5.47 [4.55-7.02] years vs DLTx: 2.77 [1.55-5.46] years; P = .03). Overall in-hospital mortality was 5% (n = 3) with no significant difference between the groups. The 2 groups were similar for primary graft dysfunction (PGD) Grade 2 or 3 at 72 hours (HLTx: 17%; DLTx: 39%; P = .133), 1- and 5-year overall survival (HLTx: 70% and 54%; DLTx: 87% and 43%; P = .249) and 1- and 5-year BOS-free survival rates (HLTx: 70% and 40%; DLTx: 72% and 33%; P = .402). With LRTx after HLTx, 10-year freedom from cardiac allograft vasculopathy (CAV) since the first transplant was 72%.

Overall survival and BOS-free survival benefits of LRTx were similar after DLTx or HLTx. LRTx in HLTx group did not lead to an increased risk of CAV. LRTx seems a good option for carefully selected patients with end-stage CLAD after HLTx to improve survival and quality of life.