Various combinations of living and deceased donors for lung retransplantation—a single institutional retrospective study

TL;DR

This study examines lung retransplantation using combinations of living and deceased donors, finding it technically challenging but feasible with acceptable outcomes.

Contribution

The study provides insights into lung retransplantation techniques and outcomes in a setting with limited deceased donor availability.

Findings

Hospital death occurred in 25% of retransplantation cases.

The 1-, 3-, and 5-year survival rates after retransplantation were 75%.

Primary lung transplantation had higher survival rates than retransplantation.

Abstract

Lung retransplantation has been performed as a treatment option mainly for chronic lung allograft dysfunction; however, the outcomes of lung retransplantation have been reported to be worse than those of primary lung transplantation. Because of the scarcity of deceased donors in our country, our lung transplant experience includes both living and deceased donors. Therefore, we have experienced lung retransplantation cases with various combinations of living and deceased donors. The aim of this study was to explore technical pitfalls and outcomes of lung retransplantation in this unique environment.

We performed 311 lung transplantation procedures between April 2002 and October 2022. Eight lung retransplantation cases (2.6%) were analysed retrospectively.

At lung retransplantation, the age of the recipient patients ranged from 11 to 61 years (median, 33 years). The combinations of donor sources (primary lung transplantation/lung retransplantation) were as follows: 2 living/living, 2 deceased/living, 3 living/deceased and 1 deceased/deceased. Seven of 8 patients received lung retransplantation for chronic lung allograft dysfunction. Hospital death occurred in 2 patients (25.0%). The 1-, 3- and 5-year survival rates after lung retransplantation (n = 8) were 75.0%, 75.0% and 75.0%, respectively, while those after primary lung transplantation (n = 303) were 92.8%, 83.4% and 76.4%, respectively (P = 0.162).

Lung retransplantation with various combinations of living and deceased donors is a technically difficult but feasible procedure with acceptable outcomes.

According to the registry report of the International Society for Heart and Lung Transplantation, the post-transplant survival curve has not improved since chronic lung allograft dysfunction (CLAD) remains a hindrance to survival [1].

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