Redo lung transplantation for acute and chronic lung allograft failure: long-term follow-up in a single center

Objective: This study was undertaken to evaluate outcomes of redo lung transplantation (LT) for acute and chronic graft failure. Methods: Between 1988 and 2007, 388 LT procedures were performed on 369 patients. From those, 17 (4.6%) patients had redo LT once and 2 patients had redo LT twice. Patient survival and recurrence of bronchiolitis obliterans syndrome (BOS) after redo LT were reviewed. Results: The overall survival rates of the 17 redo LT recipients at 1, 2 and 5 years were 59 ± 23%, 59 ± 23% and 42 ± 25%, respectively. For the chronic graft failure group (n = 12), survival rates at 1, 2 and 5 years were 67 ± 26%, 67 ± 26% and 44 ± 30%, respectively. These survival rates were significantly lower than the survival rates observed in our experience after primary LT (n = 352, 1-, 2- and 5-year survival rates of 88 ± 4%, 80 ± 4% and 65 ± 5%, respectively. For the acute graft failure group (n = 5), the 1-year survival rate was 40%; two patients remain free from BOS. Two patients had a second redo LT, one died from multi-organ failure on postoperative day 86 and the other died from pulmonary aspergillosis on postoperative day 214. Conclusions: Redo LT is a valid therapeutic option for selected patients with BOS and might be an option for highly selected patients with acute lung graft failure. Outcomes from a second redo LT are poor, and a second lung retransplantation must be used very cautiously, if at all.