The Pulmonary Retransplant Registry

Why do primary lung or heart-lung grafts fail?

Although survival rates after lung and heart-lung transplantation have improved in recent years, there is a significant attrition rate in the years after transplantation. The average one, two and three year survival rates after primary lung transplantation are approximately 72%, 62% and 52% respectively, although select centers have reported superior survival results. Ten to 15% of lung grafts develop significant dysfunction in the hours and days after transplantation, which may result in acute graft loss or the necessity for prolonged intensive care. Although technical advances have resulted in improved airway healing after lung transplantation, 10% to 12% of lung grafts exhibit a significant airway healing complication, which could be life-threatening. All patients are subject to the risks of acute rejection and infection after lung transplantation, but these processes are usually controllable with alterations in the regimen of anti-rejection drugs or with antibiotics, respectively. The major long-term complication after lung transplantation is the development of obliterative bronchiolitis, due to chronic rejection and/or repeated viral infections of the lung graft. At present, obliterative bronchiolitis affects up to 50% of survivors by 5 years after primary lung transplantation.

Of patients requiring pulmonary retransplantation, 63% have undergone the procedure because of obliterative bronchiolitis, 23% because of acute graft failure, 6% because of an intractable airway healing complication, 4% because of severe acute rejection and 4% because of miscellaneous conditions.

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