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Redo lung transplantation: a North American-European experience
R J Novick1, M P Kaye, G A Patterson
1Division of Cardiovascular-Thoracic Surgery, University Hospital, London, Ontario, Canada.
Summary
Redo lung transplantation survival is lower than primary transplants. Donor cytomegalovirus (CMV) negativity and patient ambulation improve outcomes, while disseminated infection indicates poor prognosis.
Area of Science:
- Cardiology
- Pulmonology
- Transplantation Medicine
Background:
- Redo lung transplantation is a complex procedure with limited data on outcomes.
- Identifying factors influencing survival is crucial for patient selection and management.
Purpose of the Study:
- To assess morbidity and mortality rates in redo lung transplantation.
- To identify factors correlating with survival after lung retransplantation.
Main Methods:
- International survey of 20 institutions involving 61 patients undergoing 63 redo lung transplantations.
- Exclusion of redo heart-lung transplantations.
- Analysis of indications, procedures, patient/donor factors, and survival rates.
Main Results:
- Actuarial survival rates at 1, 3, 6, 12, and 24 months were 65%, 49%, 42%, 35%, and 32%, respectively, significantly lower than primary lung transplants.
- Donor cytomegalovirus (CMV)-negative status was associated with significantly improved survival (p < 0.05).
- Polymicrobial infection was the most common cause of death; disseminated infection and multiorgan failure predicted fatal outcomes.
Conclusions:
- Redo lung transplantation may be indicated for selected patients with obliterative bronchiolitis, airway complications, or graft failure.
- Donor CMV status is a key predictor of survival.
- Disseminated infection and multiorgan failure should be contraindications.