title: Pulmonary retransplantation for obliterative bronchiolitis. Intermediate-term results of a North American-European series.
abstract: An international series of pulmonary retransplantation was updated to identify the predictors of survival in the intermediate-term after reoperation for obliterative bronchiolitis. The study cohort included 32 patients with end-stage obliterative bronchiolitis who underwent retransplantation in 15 North American and European centers between 1988 and 1992. Five types of retransplantation procedures were done, including repeat ipsilateral single lung transplantation (7 patients), repeat contralateral single lung transplantation (8 patients), repeat double lung transplantation (3 patients), double lung transplantation after a previous single lung transplantation (3 patients), and single lung transplantation after a previous double lung or heart-lung transplantation (11 patients). The mean interval between transplants was 564 +/- 51 days (range 187 to 1589 days). Postoperative follow-up was 100% complete and the average follow-up in surviving patients was 678 +/- 63 days. Actuarial survival was 72%, 53%, 50%, 41%, and 33% at 1, 3, 6, 12, and 24 months, respectively. Survival did not differ according to the age, preoperative diagnosis, ambulatory or ventilator status, or cytomegalovirus serologic status of the recipient before reoperation. Life-table and Cox proportional hazards analysis identified the type of retransplantation procedure and the year of reoperation as significant (p < 0.05) predictors of postoperative survival. Actuarial survival was significantly better in patients without an old, retained contralateral graft after retransplantation and in patients who underwent reoperation between 1990 and 1992, as opposed to between 1988 and 1989. Infection was the most common cause of death at all time intervals after retransplantation, although all deaths beyond 2 years resulted from obliterative bronchiolitis of the second graft. Most surviving patients are in a satisfactory clinical condition, with a mean forced expired volume in 1 second of 59% +/- 13% of predicted (repeat double lung transplant recipients) or 41% +/- 6% of predicted (repeat single lung transplant recipients). We conclude that pulmonary retransplantation for obliterative bronchiolitis is associated with significantly worse survival than after primary lung transplantation. The absence of an old contralateral graft after retransplantation and reoperation after 1989 are important predictors of survival. Additional data and follow-up are required to determine the merit of pulmonary retransplantation for obliterative bronchiolitis.
authors.affiliation: Division of Cardiovascular-Thoracic Surgery, University Hospital, London, Ontario, Canada.
authors.forename: R J
authors.initials: RJ
authors.lastname: Novick
authors.forename: B
authors.initials: B
authors.lastname: Andréassian
authors.forename: H J
authors.initials: HJ
authors.lastname: Schäfers
authors.forename: A
authors.initials: A
authors.lastname: Haverich
authors.forename: G A
authors.initials: GA
authors.lastname: Patterson
authors.forename: M P
authors.initials: MP
authors.lastname: Kaye
authors.forename: A H
authors.initials: AH
authors.lastname: Menkis
authors.forename: F N
authors.initials: FN
authors.lastname: McKenzie
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D001989:Bronchiolitis Obliterans / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality; D008297:Male; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation / Q000401:mortality; D013997:Time Factors; D014481:United States / Q000453:epidemiology