Long Term Clinical Outcome of Pulmonary Re-Transplantation for Chronic Lung Allograft Problems

re-LuTX has shifted towards chronic lung allograft dysfunction (CLAD) and airway problems (AWP). However, as donor organs are scarce, the outcome of these patients has to be analyzed to critically evaluate this therapeutic option. Methods: We retrospectively investigated the outcome of all 52 patients with chronic lung allograft problems (CLAD) or airway complications (AWP) which underwent re-LuTX at our center in the last decade (2003-2013). Patients were stratified into two groups according to their indication for re-LuTX (CLAD; AWP). Pre-surgical condition, short-term outcomes and survival rates were analyzed for comparison. Results: From Jan. 2013 to Nov. 2013, 52 patients (mean age 39 ±15 years; 24 women and 28 men) underwent re-LuTX for CLAD or AWP at our institution (41 bilateral LuTX; 11 unilateral LuTX). 46 (88.5%) patients underwent re-LuTX because of CLAD and 6 (11.5%) because of AWP (stenosis: n= 5; undersized graft n= 1). Patients with AWP underwent more often an unilateral re-LuTX (CLAD vs. AWP: 6 ( 13%) vs. 5 (83%); p< 0.001). Median time from first LuTX to re-LuTX was 1719 ±1541 days in patients with CLAD and 160 ±251 days in patients with AWP (p= 0.004). 11 patients (CLAD: n= 10 (22%); AWP: n= 1 (17%); p= 0.43) were intubated prior to re-LuTX and 4 (8.7%) CLAD patients had pre-operative ECMO support (p= 0.45). After re-LuTX, 6 (13%) CLAD patients remained on ECMO and 10 patients (CLAD: n= 9 17%; AWP: n= 1 (17%); p= 0.96) died without ever being dismissed from hospital. Median intubation times after re-LTX were 3 ±14 (CLAD) and 1 ±17 (AWP) days (p= 0.79). Median times on ICU were 8 (CLAD) and 2 (AWP) days (p= 0.43). Median durations of hospitalization were 28 ±22 (CLAD) and 26 ±19 (AWP) days (p= 0.9). 30-day, 3-year and 5-year survival rates were: 91%; 61%; 57% in the CLAD group and 100%; 67%; 50% in the AWP group (Log Rank: p= 0.977). Conclusion: In our experience, re-transplantation for CLAD as well as for airway problems yields excellent shortand long-term results almost comparable to primary LuTX. However, accurate patient selection is crucial as the recipients outcome is highly dependent on the clinical condition prior to re-LuTX.