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J Thorac Cardiovasc Surg 1996;112:1504-1514
© 1996 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

PULMONARY RETRANSPLANTATION: DOES THE INDICATION FOR OPERATION INFLUENCE POSTOPERATIVE LUNG FUNCTION?

Supported by grants from the Ontario Thoracic Society, the Multi-Organ Transplant Service, London Health Sciences Center, and Sandoz Canada, Inc.

Received for publication May 6, 1996 revisions requested June 26, 1996; revisions received July 22, 1996 accepted for publication July 26, 1996. Address for reprints: Richard J. Novick, MD, P.O. Box 5339, London Health Sciences Centre, London, Ontario, Canada N6A 5A5.

Abstract

Objectives: An international series of pulmonary retransplantation was updated to determine the factors associated with pulmonary function, bronchiolitis obliterans syndrome stage, and survival after operation.
Methods: One hundred sixty patients underwent retransplantation in 35 centers from 1985 to 1995. Logistic regression methods were used to determine variables associated with 3-month and 2-year survival after retransplantation. Values of forced expiratory volume in 1 second were contrasted between groups by unpaired, two-tailed t tests.
Results: The median follow-up in surviving recipients was 780 days. Actuarial survival was 45% ± 4%, 41% ± 4%, and 33% ± 4% at 1, 2, and 3 years, respectively. On multivariable analysis, the only predictor of 3-month survival was preoperative ambulatory status (p = 0.005), whereas center experience with at least five pulmonary retransplantations was the sole predictor of 2-year survival (p = 0.04). The prevalence of stage 3 (severe) bronchiolitis obliterans syndrome was 12% at 1 year, 15% at 2 years, and 33% at 3 years after retransplantation. Retransplant recipients with stage 3 bronchiolitis obliterans syndrome at 1 year had a significantly worse actuarial survival than those with stages 0 to 2 (p < 0.01). By 3 years after retransplantation, the forced expiratory volume in 1 second was significantly lower in patients who underwent reoperation because of obliterative bronchiolitis than in patients who underwent retransplantation because of acute graft failure or an airway complication (p = 0.02). Only 31% of patients who underwent retransplantation because of obliterative bronchiolitis were free of bronchiolitis obliterans syndrome at 3 years versus 83% of patients who underwent retransplantation because of other indications (p = 0.02).
Conclusions: Preoperative ambulatory status predicts early survival and center volume predicts intermediate-term outcome after retransplantation. Improved management strategies are necessary to prevent the development of progressive graft dysfunction after retransplantation for obliterative bronchiolitis. (J THORAC CARDIOVASC SURG 1996;112:1504-14)

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