1
|
Cerón Navarro JA, Peñafiel Guzman S, Baquero Velandia D, Ordoñez Ochoa C, Tacoronte Pérez S, Jordá Aragón C, Fontana Bellorín A, Libreros Niño A, Padilla A J, Morcillo A A, Sales Badía G. Lung retransplant. Experience of a referral centre. Med Clin (Barc) 2020; 156:1-6. [PMID: 32430205 DOI: 10.1016/j.medcli.2020.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Lung retransplantation (LR) is a valid choice with a significant risk of perioperative morbidity and mortality in selected patients with graft dysfunction after lung transplantation. Our goal is to analyse our experience in LR in terms of survival and lung function. METHODS Retrospective study of patients undergoing LR (1990-2019). VARIABLES recipients and procedure, early mortality, survival and lung function in patients with CLAD. Quantitative variables (mean±SD); qualitative (%). Student's t test or χ2 was used. Survival was estimated using Kaplan-Meier, compared with Log Rank. A p < 0.05 was established as significant. RESULTS Of 784 transplanted patients, 25 patients (mean age 38.41-16.3 years, 12 men and 13 women) were LR; (CLAD (n = 19), pulmonary infarction (n = 2), airway complications (n = 2), graft dysfunction (n = 1), hyperacute rejection (n = 1), mean time to retransplantation: 5.41 ± 3.87 years in CLAD and 21.2 ± 21.4 days in non-CLAD. The 90-day mortality was 52% and 36.8% in the second period (p = 0.007), being higher in patients who required preoperative ECMO (80 vs. 20%, p = 0.04). The 1- and 5-year survival was 53.9% and 37.7%, respectively (p = 0.016). Survival of the CLAD group was greater (p = 0.08). Pre LR ECMO decreased survival (p = 0.032). After LR, FEV1 improved an average of 0.98 ± 0.13L (25.6 ± 18.8%) (p = 0.001). CONCLUSIONS LR is a high mortality procedure that requires careful selection of patients with better results in patients with CLAD. The lung function of patients with CLAD improved significantly.
Collapse
Affiliation(s)
- José A Cerón Navarro
- Servicio de Cirugía Torácica y Unidad de Trasplante Pulmonar, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - Sebastián Peñafiel Guzman
- Servicio de Cirugía Torácica y Unidad de Trasplante Pulmonar, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Diana Baquero Velandia
- Servicio de Cirugía Torácica y Unidad de Trasplante Pulmonar, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Carlos Ordoñez Ochoa
- Servicio de Cirugía Torácica y Unidad de Trasplante Pulmonar, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Sergio Tacoronte Pérez
- Servicio de Cirugía Torácica y Unidad de Trasplante Pulmonar, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Carlos Jordá Aragón
- Servicio de Cirugía Torácica y Unidad de Trasplante Pulmonar, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Alilis Fontana Bellorín
- Servicio de Cirugía Torácica y Unidad de Trasplante Pulmonar, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Alejandra Libreros Niño
- Servicio de Cirugía Torácica y Unidad de Trasplante Pulmonar, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Jose Padilla A
- Fundación Instituto Valenciano de Oncología (Emérito), Valencia, España
| | - Alfonso Morcillo A
- Servicio de Cirugía Torácica y Unidad de Trasplante Pulmonar, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Gabriel Sales Badía
- Servicio de Cirugía Torácica y Unidad de Trasplante Pulmonar, Hospital Universitario y Politécnico La Fe, Valencia, España
| |
Collapse
|
2
|
Safety and Efficacy of Steroid Pulse Therapy for Acute Loss of FEV 1 in Lung Transplant Recipients After Exclusion of Acute Cellular Rejection. Transplant Proc 2020; 52:309-314. [PMID: 31926742 DOI: 10.1016/j.transproceed.2019.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/06/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The standard treatment of acute cellular rejection after lung transplantation (LTx) is a high-dose steroid pulse therapy. In our center, this therapy is also the standard of care for LTx recipients with acute loss of forced expiratory volume in 1 second (FEV1), after excluding specific causes such as acute rejection on biopsy. The aim of this retrospective study was to evaluate the safety and efficacy of steroid pulse therapy. METHODS From 2015 to 2018, 33 consecutive patients (17 male patients, mean age ± SD, 50.5 ± 12.5 years) were included. All patients underwent routine examinations to exclude acute cellular rejection and other specific causes. FEV1 was routinely measured after 5 days, and 1, 3, and 6 months. Positive response to steroid pulse therapy was defined by increase of FEV1 > 10%. RESULTS The mean decrease ± SD from baseline in FEV1 at the start of steroid pulse therapy was 380 ± 630 mL (P = .02). FEV1 changed after 5 days by 170 ± 180 mL (P = .0007), and after 1 month by 140 ± 230 mL (P = .70), 3 months by -60 ± 240 mL (P = .15), and 6 months by -80 ± 290 mL (P = .73). A positive response was observed in 21% of patients after 3 months and 12% after 6 months. High bronchoalveolar lavage (BAL) eosinophil count correlated with a higher FEV1 after steroid pulse therapy. Serious complications were observed in 4 out of 33 patients (12%) with 1 fatal event (pneumonia). CONCLUSIONS Only a minority of patients after LTx with loss of FEV1 after exclusion of acute cellular rejection benefit from steroid pulse therapy. Patients with BAL eosinophilia are more likely to respond. However, severe complications were observed.
Collapse
|
3
|
Biswas Roy S, Panchanathan R, Walia R, Varsch KE, Kang P, Huang J, Hashimi AS, Mohanakumar T, Bremner RM, Smith MA. Lung Retransplantation for Chronic Rejection: A Single-Center Experience. Ann Thorac Surg 2018; 105:221-227. [DOI: 10.1016/j.athoracsur.2017.07.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/18/2017] [Accepted: 07/11/2017] [Indexed: 10/18/2022]
|
4
|
Hall DJ, Belli EV, Gregg JA, Salgado JC, Baz MA, Staples ED, Beaver TM, Machuca TN. Two Decades of Lung Retransplantation: A Single-Center Experience. Ann Thorac Surg 2017; 103:1076-1083. [DOI: 10.1016/j.athoracsur.2016.09.107] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 09/05/2016] [Accepted: 09/29/2016] [Indexed: 11/29/2022]
|
5
|
The Optimal Procedure for Retransplantation After Single Lung Transplantation. Ann Thorac Surg 2017; 104:170-175. [PMID: 28109573 DOI: 10.1016/j.athoracsur.2016.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/28/2016] [Accepted: 10/05/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Retransplantation has emerged as a therapeutic option for patients experiencing respiratory failure after single lung transplantation. However, outcomes associated with the surgical option (ipsilateral, contralateral, or bilateral lung retransplantation) has not been well evaluated. METHODS The Organ Procurement and Transplantation Network database (1994 to 2012) was queried for all lung transplant procedures performed after an initial single lung transplantation. Donor and recipient demographics, before and after transplant characteristics, and outcomes were stratified by retransplant procedural choice and by interval between transplants. Risk factors for mortality were evaluated by Cox proportional hazards regression analysis. RESULTS Of 325 prior single lung transplant recipients, 50 underwent ipsilateral, 175 contralateral, and 100 bilateral lung retransplantation. The number of retransplant procedures performed per year increased from 3 in 1994 to 31 in 2012, with an increasing proportion of contralateral retransplantation and declining proportions of ipsilateral and bilateral retransplantation. Survival was significantly better in the contralateral and bilateral retransplant groups than in the ipsilateral retransplant group at 30 days (94% and 89% versus 80%), 1 year (72% and 67% versus 50%), and 5 years (41% and 42% versus 20%). Ipsilateral retransplantation (hazard ratio 1.48; p = 0.042), mechanical ventilation before retransplant (hazard ratio 2.39; p < 0.001), and retransplantation performed in the first half of the study period (hazard ratio 1.45; p = 0.027) were associated with increased mortality. CONCLUSIONS After an initial single lung transplant, both the incidence of retransplantation and postoperative survival have increased with time. Although ipsilateral lung retransplantation may be the best available alternative in particular circumstances, this analysis suggests that contralateral or bilateral lung retransplantation may be preferable in patients for whom those options are medically sensible.
Collapse
|
6
|
Thomas M, Belli EV, Rawal B, Agnew RC, Landolfo KP. Survival After Lung Retransplantation in the United States in the Current Era (2004 to 2013): Better or Worse? Ann Thorac Surg 2015; 100:452-7. [PMID: 26141777 DOI: 10.1016/j.athoracsur.2015.04.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/01/2015] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND To understand the current patient survival after lung retransplantation (LRTx) in the United States, which has historically been worse compared with primary lung transplantation (LPTx). METHODS The United Network for Organ Sharing (UNOS) registry was retrospectively analyzed to determine survival after adult LRTx performed in 604 (2.48%) of 14,850 patients from 2004 to 2013. After exclusions, 582 LRTx and 13,673 LPTx recipients were selected for analysis. Cox proportional hazards regression models were used to determine the prognosticators of survival after LRTx. Survival after LRTx and LPTx were compared using Kaplan-Meier analysis. RESULTS The median survival after LRTx was 2.6 years compared with 5.6 years after LPTx. One-year, 3-year, and 5-year survival rates were, respectively, 71.1%, 46.3%, and 34.5% for LRTx, and 84.3%, 66.5%, and 53.3% for LPTx (p < 0.001). On multivariate analysis, patients who had LRTx after a greater than 1-year interval survived longer (relative risk [RR] 0.53; 95% confidence interval [CI] 0.34% to 0.88%; p = 0.008). Lower survival was associated with single-lung transplantations (RR 1.49; 95% CI, 1.06% to 2.07%; p = 0.021), transplantations done between 2009 and 2013 (RR 1.40; CI, 1.01% to 1.94%; p = 0.041), multiple (>1) retransplantations (RR 2.55; 95% CI, 1.14% to 5.72%; p = 0.023), and recipients requiring pre-transplantation ventilator support. The only significant donor variable for poor survival was death due to cerebrovascular accidents (RR 1.98; 95% CI, 1.23% to 3.18%; p = 0.004). CONCLUSIONS Patient survival after LRTx in the United States has improved compared with historical data but remains lower than LPTx. Careful recipient selection and preoperative optimization based on the factors identified in our study may help utilize resources better and improve survival after LRTx. Bilateral LRTx should be preferentially performed as much as possible. Poor candidates for LRTx include those requiring retransplantations more than once or within 1 year. Prospective multi-institutional studies are necessary to help better understand the actual role of these factors in LRTx.
Collapse
Affiliation(s)
- Mathew Thomas
- Division of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida.
| | - Erol V Belli
- Division of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Bhupendra Rawal
- Division of Biostatistics and Bioinformatics at Mayo Clinic, Mayo Clinic, Jacksonville, Florida
| | - Richard C Agnew
- Division of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Kevin P Landolfo
- Division of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
7
|
Lindstedt S, Dellgren G, Iversen M, Riise GC, Bjørtuft Ø, Hämmäinen P, Skog I, Fiane A, Wierup P. Pulmonary Retransplantation in the Nordic Countries. Ann Thorac Surg 2015; 99:1781-7. [DOI: 10.1016/j.athoracsur.2015.01.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 12/04/2014] [Accepted: 01/16/2015] [Indexed: 02/08/2023]
|
8
|
Risk Factors Associated With Lung Retransplantation: Evaluation of a Nationwide Registry Over a Quarter Century. Ann Thorac Surg 2014; 98:1742-6; discussion 1746-7. [DOI: 10.1016/j.athoracsur.2014.06.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/30/2014] [Accepted: 06/03/2014] [Indexed: 11/22/2022]
|
9
|
Meyer KC, Raghu G, Verleden GM, Corris PA, Aurora P, Wilson KC, Brozek J, Glanville AR. An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome. Eur Respir J 2014; 44:1479-503. [PMID: 25359357 DOI: 10.1183/09031936.00107514] [Citation(s) in RCA: 385] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Bronchiolitis obliterans syndrome (BOS) is a major complication of lung transplantation that is associated with poor survival. The International Society for Heart and Lung Transplantation, American Thoracic Society, and European Respiratory Society convened a committee of international experts to describe and/or provide recommendations for 1) the definition of BOS, 2) the risk factors for developing BOS, 3) the diagnosis of BOS, and 4) the management and prevention of BOS. A pragmatic evidence synthesis was performed to identify all unique citations related to BOS published from 1980 through to March, 2013. The expert committee discussed the available research evidence upon which the updated definition of BOS, identified risk factors and recommendations are based. The committee followed the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach to develop specific clinical recommendations. The term BOS should be used to describe a delayed allograft dysfunction with persistent decline in forced expiratory volume in 1 s that is not caused by other known and potentially reversible causes of post-transplant loss of lung function. The committee formulated specific recommendations about the use of systemic corticosteroids, cyclosporine, tacrolimus, azithromycin and about re-transplantation in patients with suspected and confirmed BOS. The diagnosis of BOS requires the careful exclusion of other post-transplant complications that can cause delayed lung allograft dysfunction, and several risk factors have been identified that have a significant association with the onset of BOS. Currently available therapies have not been proven to result in significant benefit in the prevention or treatment of BOS. Adequately designed and executed randomised controlled trials that properly measure and report all patient-important outcomes are needed to identify optimal therapies for established BOS and effective strategies for its prevention.
Collapse
Affiliation(s)
- Keith C Meyer
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Ganesh Raghu
- School of Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Paul Aurora
- Great Ormond Street Hospital for Children, London, UK
| | | | - Jan Brozek
- McMaster University, Hamilton, ON, Canada
| | | | | | | |
Collapse
|
10
|
Tonelli AR, Timofte I, Minai OA, Baz M, Akindipe O. Pulmonary hypertension before first and second lung transplantation. Clin Transplant 2012; 26:672-8. [PMID: 22320224 DOI: 10.1111/j.1399-0012.2011.01588.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) is frequently encountered in patients with advanced lung disease before the first and second lung transplantation. We sought to determine whether there is any relationship between pulmonary hemodynamics obtained before first and second lung transplantation. We also assessed whether PH has prognostic implications in lung transplant patients going for second transplantation. METHODS We included consecutive adult (16-yr-old or older) patients who underwent lung re-transplantation, between 1997 and 2009, and had right heart catheterization before their first and second lung transplantation. RESULTS Eighteen patients were included in the study. Age at first transplantation was 50.4 (SD 10.4) yr, and bronchiolitis obliterans syndrome (BOS) in the transplanted lung was the only indication for re-transplantation. PH was observed in 39% of the patients before the first lung transplant and in 56% of the subjects before re-transplantation (p = 0.91). Pre-capillary PH was present in 28% (n = 5) and 33% (n = 6) of the patients before first and second lung transplantation, respectively. None of the hemodynamic variables obtained before the first transplant predicted the development of PH before re-transplantation. PH before re-transplantation did not predict survival or development of BOS after re-transplantation. CONCLUSIONS PH before initial lung transplantation did not predict the development of PH before the second transplantation. In our cohort, PH before second lung transplantation did not predict outcomes after re-transplantation.
Collapse
Affiliation(s)
- Adriano R Tonelli
- Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, OH 44195, USA.
| | | | | | | | | |
Collapse
|
11
|
Abstract
Lung retransplantation comprises a small proportion of lung transplants performed throughout the world, but has become more frequent in recent years. The selection criteria for lung retransplantation are similar to those for initial lung transplant. Survival after lung retransplantation has improved over time, but still lags behind that of initial lung transplantation. These differences in outcome may be attributable to medical comorbidities. Lung retransplantation appears to be ethically justified; however, the optimal approach to lung allocation for retransplantation needs to be defined.
Collapse
|
12
|
Pulmonary retransplantation in paediatric patients: a justified therapeutic option? A single-centre experience. Eur J Cardiothorac Surg 2011; 39:201-5. [DOI: 10.1016/j.ejcts.2010.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 05/09/2010] [Accepted: 05/18/2010] [Indexed: 11/22/2022] Open
|
13
|
Shuhaiber JH, Kim JB, Hur K, Gibbons RD. Survival of primary and repeat lung transplantation in the United States. Ann Thorac Surg 2009; 87:261-6. [PMID: 19101309 DOI: 10.1016/j.athoracsur.2008.10.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 10/10/2008] [Accepted: 10/14/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study was undertaken to compare survival between primary and repeat lung transplant recipients and to identify survival predictors after repeat lung transplantation. METHODS Data for 10,846 primary and 354 repeat lung transplant patients were extracted from the United Network for Organ Sharing registry. Propensity score matching was used to examine balance in the distribution of potential observed confounders and to match the sample in terms of the probability of repeat lung transplantation given pretransplant characteristics alone. Matching based on the propensity score was used to compare survival between the primary and repeat lung transplant groups. A Cox regression model was used to identify risk factors for death in the cohort of patients receiving lung transplant. RESULTS Considerable bias between the primary and repeat lung transplant groups was found in the sample. Patients with high propensity scores tended to carry high-risk profiles. Propensity score matching revealed incomplete overlap of covariate distributions between primary and repeat transplant groups. For those subjects who could be matched for the set of potential confounding variables, no difference in survival time was observed between primary and repeat lung transplant patients. Functional status and serum creatinine level were the two clinically important risk factors for predicting the survival of repeat transplant patients. CONCLUSIONS The current study revealed that direct comparison of the survival of primary and repeat lung transplant patients is biased by nonoverlap in the distribution of potential confounders. Using propensity score matching we adjusted for this bias and found that there was no significant difference in survival between first and second transplants.
Collapse
Affiliation(s)
- Jeffrey H Shuhaiber
- Department of Thoracic and Cardiovascular Surgery, Loyola University Stritch School of Medicine, Chicago, Illinois, USA.
| | | | | | | |
Collapse
|
14
|
Kawut SM, Lederer DJ, Keshavjee S, Wilt JS, Daly T, D'Ovidio F, Sonett JR, Arcasoy SM, Barr ML. Outcomes after Lung Retransplantation in the Modern Era. Am J Respir Crit Care Med 2008; 177:114-20. [PMID: 17901410 DOI: 10.1164/rccm.200707-1132oc] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Characteristics of and survival estimates for recipients of lung retransplantation in the modern era are unknown. OBJECTIVES To compare lung retransplant patients in the modern era with historical retransplant patients, to compare retransplant patients with initial transplant patients in the modern era, and to determine the predictors of the risk of death after lung retransplantation. METHODS We performed a retrospective cohort study of patients who underwent lung retransplantation between January 2001 and May 2006 in the United States (modern retransplant cohort). The characteristics and survival of this cohort were compared with those of patients who underwent first lung retransplantation between January 1990 and December 2000 (historical retransplant cohort) and patients who underwent initial lung transplantation between January 2001 and May 2006 (modern initial transplant cohort). MEASUREMENTS AND MAIN RESULTS Modern retransplant recipients (n = 205) had a lower risk of death compared with that of the historical retransplant cohort (n = 184) (hazard ratio, 0.7; 95% confidence interval, 0.5-0.9; P = 0.006). However, modern retransplant recipients had a higher risk of death than that of patients who underwent initial lung transplantation (n = 5,657) (hazard ratio, 1.3; 95% confidence interval, 1.2-1.5; P = 0.001), which appeared to be explained by a higher prevalence of certain comorbidities. Retransplantation at less than 30 days after the initial transplant procedure was associated with worse survival. CONCLUSIONS Outcomes after lung retransplantation have improved; however, retransplantation continues to pose an increased risk of death compared with the initial transplant procedure. Retransplantation early after the initial transplant poses a particularly high mortality risk.
Collapse
Affiliation(s)
- Steven M Kawut
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Aigner C, Jaksch P, Taghavi S, Lang G, Reza-Hoda MA, Wisser W, Klepetko W. Pulmonary Retransplantation: Is it Worth the Effort? A Long-term Analysis of 46 Cases. J Heart Lung Transplant 2008; 27:60-5. [DOI: 10.1016/j.healun.2007.09.023] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2007] [Revised: 08/16/2007] [Accepted: 09/24/2007] [Indexed: 11/25/2022] Open
|
16
|
Strueber M, Fischer S, Gottlieb J, Simon AR, Goerler H, Gohrbandt B, Welte T, Haverich A. Long-term outcome after pulmonary retransplantation. J Thorac Cardiovasc Surg 2006; 132:407-12. [PMID: 16872970 DOI: 10.1016/j.jtcvs.2005.12.059] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Revised: 12/18/2005] [Accepted: 12/22/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Bronchiolitis obliterans syndrome has become the most limiting factor for long-term outcome after lung transplantation. Redo lung transplantation was performed for end-stage bronchiolitis obliterans syndrome. Long-term outcome was compared with that after primary lung transplantation as well as with other indications for retransplantation. METHODS Of 614 lung transplantation procedures performed at our institution, 54 (8.5%) were redo transplants. These were stratified into different groups according to the indication for redo transplantation, including chronic graft failure/bronchiolitis obliterans syndrome, acute graft failure, and posttransplantation airway complications. Long-term survival was compared with that of the primary lung transplantation cohort, thereby respecting the need for pretransplant mechanical ventilatory support in a subanalysis. In addition, recurrence of bronchiolitis obliterans syndrome after redo lung transplantation was compared with the occurrence of bronchiolitis obliterans after primary transplantation. RESULTS A 1-year survival of 50% was achieved after redo lung transplantation for acute graft failure and airway complications as well as after primary lung transplantation in patients with pretransplant ventilatory support. Retransplantation for bronchiolitis obliterans syndrome revealed superior 1- (78%) and 5-year (62%) survivals, which were not different from those of first-time lung transplant recipients. In addition, we found a similar incidence of bronchiolitis syndrome after retransplantation for BOS compared with its occurrence after primary lung transplantation. CONCLUSION Redo lung transplantation for end-stage bronchiolitis obliterans syndrome leads to acceptable long-term outcome in selected patients. Future analyses of redo lung transplantation data should generally stratify bronchiolitis obliterans syndrome from other indications with higher mortality.
Collapse
Affiliation(s)
- Martin Strueber
- Hannover Thoracic Transplant Program, Division of Thoracic- and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Shargall Y, Guenther G, Ahya VN, Ardehali A, Singhal A, Keshavjee S. Report of the ISHLT Working Group on Primary Lung Graft Dysfunction Part VI: Treatment. J Heart Lung Transplant 2005; 24:1489-500. [PMID: 16210120 DOI: 10.1016/j.healun.2005.03.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Revised: 02/23/2005] [Accepted: 03/14/2005] [Indexed: 10/25/2022] Open
Affiliation(s)
- Yaron Shargall
- Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
18
|
|
19
|
Abstract
Lung transplantation currently stands as the only therapeutic option that carries the potential to restore patients with advanced cystic fibrosis to a more normal state of health. Nonetheless, the procedure carries significant risk and median survival following transplantation is only 5 years. This article discusses the currently achievable outcomes and the common short-comings of transplantation. Strategies to optimize outcomes through appropriate patient selection, use of living donors, and novel research initiatives are discussed.
Collapse
Affiliation(s)
- J B Zuckerman
- Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, USA
| | | |
Collapse
|
20
|
Abstract
BACKGROUND AND METHODS Despite improving results in lung transplantation, a significant number of grafts fail early or late postoperatively. The Pulmonary Retransplant Registry was founded in 1991 to determine the predictors of outcome after retransplantation, so as to facilitate decisions concerning the appropriateness of lung retransplantation in individual patients. In this study, 230 patients underwent retransplantation in 47 centers from 1985 to 1996. Logistic regression methods were used to determine variables associated with, and predictive of, survival and lung function after retransplantation. RESULTS Actuarial survival was 47%+/-3%, 40%+/-3% and 33%+/-4% at 1, 2, and 3 years, respectively. On multivariable analysis, the predictors of survival included ambulatory status or lack of ventilator support preoperatively (P=.005, odds ratio 1.62, 95% confidence interval 1.15-2.27), followed by retransplantation after 1991 (P=.048, odds ratio 1.41, 95% confidence interval 1.003-1.99). Ambulatory, nonventilated patients undergoing retransplantation after 1991 had a 1-year survival rate of 64%+/-5% versus 33%+/-4% for nonambulatory, ventilated recipients. Eighty-one percent, 70%, 62%, and 56% of survivors were free of bronchiolitis obliterans syndrome at 1, 2, 3, and 4 years after retransplantation, respectively. Factors associated with freedom from stage 3 (severe) bronchiolitis obliterans syndrome at 2 years after retransplantation included an interval between transplants greater than 2 years (P=.01), the lack of ventilatory support before retransplantation (P=.03), increasing retransplant experience within each center (5th and higher retransplant patient, P=.04) and total center volume of 5 or more retransplant operations (P=.05). CONCLUSIONS Nonambulatory, ventilated patients should not be considered for retransplantation with the same priority as other candidates. The best intermediate-term functional results occurred in more experienced centers, in nonventilated patients and in patients undergoing retransplantation more than 2 years after their first transplantation. In view of the scarcity of lung donors, patient selection for retransplantation should remain strict.
Collapse
Affiliation(s)
- R J Novick
- Department of Surgery, the London Health Sciences Centre, the Robarts Research Institute and the University of Western Ontario, London, Canada
| | | |
Collapse
|
21
|
Huddleston CB, Mendeloff EN, Cohen AH, Sweet SC, Balzer DT, Mallory GB. Lung retransplantation in children. Ann Thorac Surg 1998; 66:199-203; discussion 203-4. [PMID: 9692464 DOI: 10.1016/s0003-4975(98)00399-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early primary graft failure due to reperfusion injury may occur in up to 10% of all patients undergoing lung transplantation. Late graft failure in the form of bronchiolitis obliterans progressively increases in frequency as posttransplantation follow-up increases. In both situations, the degree of pulmonary dysfunction may worsen and result in the death of the recipient. The only treatment in many instances is retransplantation. The results in adults are reasonably well established. METHODS We reviewed our experience in children. Of the 136 transplant procedures performed to date in children, 14 have been retransplantations. Six patients required retransplantation for early primary graft failure and 8 underwent retransplantation for bronchiolitis obliterans. RESULTS There were three early and three late deaths. The actuarial survival at 2 years is 58%. The retransplant procedures were more complex than the primary transplant operations as evidenced by the longer time on cardiopulmonary bypass (199 +/- 71 versus 150 +/- 41 minutes; p < 0.01) and the greater volume of blood transfused (1,303 +/- 936 versus 570 +/- 300 mL; p < 0.01). Two of the long-term survivors who received transplants for bronchiolitis obliterans have subsequently had development of this same condition and 1 died secondary to this. In four instances living related donors were used for the retransplant procedure. The most striking difference in these procedures compared with those transplantations performed with cadaveric donors was the shorter donor lung ischemic times (99.5 and 123.3 minutes for the two lungs for living related donors and 251 and 293 minutes for the first and second lung for the cadaveric donors; p < 0.01). CONCLUSIONS We believe that lung retransplantation in children is a reasonable therapy to offer in the circumstance of severe graft dysfunction. In the older child, the option of living donor transplantation offers advantages that might offset of the overall higher risk of this procedure.
Collapse
Affiliation(s)
- C B Huddleston
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, USA.
| | | | | | | | | | | |
Collapse
|
22
|
Novick RJ, Stitt LW, Al-Kattan K, Klepetko W, Schäfers HJ, Duchatelle JP, Khaghani A, Hardesty RL, Patterson GA, Yacoub MH. Pulmonary retransplantation: predictors of graft function and survival in 230 patients. Pulmonary Retransplant Registry. Ann Thorac Surg 1998; 65:227-34. [PMID: 9456123 DOI: 10.1016/s0003-4975(97)01191-0] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite improving results in lung transplantation, a significant number of grafts fail early or late postoperatively. The pulmonary retransplant registry was founded in 1991 to determine the predictors of outcome after retransplantation. We hypothesized that ambulatory status of the recipient and center retransplant volume, which had been previously shown to predict survival after retransplantation, would also be associated with improved graft function postoperatively. METHODS Two hundred thirty patients underwent retransplantation in 47 centers from 1985 to 1996. Logistic regression methods were used to determine variables associated with, and predictive of, survival and lung function after retransplantation. RESULTS Kaplan-Meier survival was 47% +/- 3%, 40% +/- 3%, and 33% +/- 4% at 1, 2, and 3 years, respectively. On multivariable analysis, the predictors of survival included ambulatory status or lack of ventilator support preoperatively (p = 0.005; odds ratio, 1.62; 95% confidence interval, 1.15 to 2.27), followed by retransplantation after 1991 (p = 0.048; odds ratio, 1.41; 95% confidence interval, 1.003 to 1.99). Ambulatory, nonventilated patients undergoing retransplantation after 1991 had a 1-year survival of 64% +/- 5% versus 33% +/- 4% for nonambulatory, ventilated recipients. Eighty-one percent, 70%, 62%, and 56% of survivors were free of bronchiolitis obliterans syndrome at 1, 2, 3, and 4 years after retransplantation, respectively. Factors associated with freedom from stage 3 (severe) bronchiolitis obliterans syndrome at 2 years after retransplantation included an interval between transplants greater than 2 years (p = 0.01), the lack of ventilatory support before retransplantation (p = 0.03), increasing retransplant experience within each center (fifth and higher retransplant patient, p = 0.04), and total center volume of five or more retransplant operations (p = 0.05). CONCLUSIONS Nonambulatory, ventilated patients should not be considered for retransplantation with the same priority as other candidates. The best intermediate-term functional results occurred in more experienced centers, in nonventilated patients, and in patients undergoing retransplantation more than 2 years after their first transplant. In view of the scarcity of lung donors, patient selection for retransplantation should remain strict and should be guided by the outcome data reviewed in this article.
Collapse
Affiliation(s)
- R J Novick
- Department of Surgery, London Health Sciences Centre, Robarts Research Institute, and University of Western Ontario, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|