Pulmonary retransplantation: does the indication for operation influence postoperative lung function?

Abstract

OBJECTIVE:

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.

• Authors: R J Novick, L Stitt, H J Schäfers, B Andréassian, J P Duchatelle, W Klepetko, R L Hardesty, A Frost, G A Patterson
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 112 Issue 6 Pg. 1504-13; discussion 1513-4 (Dec 1996) ISSN: 0022-5223 [Print] United States
• PMID: 8975842 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Actuarial Analysis
• Adult
• Bronchiolitis Obliterans (physiopathology, surgery)
• Female
• Forced Expiratory Volume
• Graft Rejection
• Humans
• Logistic Models
• Lung Transplantation (standards)
• Male
• Multivariate Analysis
• Recurrence
• Reoperation
• Retrospective Studies
• Survival Analysis
• Treatment Outcome