The Pulmonary Retransplant Registry

When should redo lung transplantation be considered?

Although significant graft dysfunction early after lung transplantation can often be successfully managed, some of these patients do not respond to intensive care measures and develop intractable respiratory failure, necessitating retransplantation in the days and weeks after the first procedure. Many airway healing complications after lung transplantation can be managed conservatively, with the insertion of a silicone or wire stent via a bronchoscope in cases of airway narrowing. A small proportion of these patients may require a second operation to repair airway disruption. Only a few patients with airway healing complications will not respond to these measures and require retransplantation.

Although modern anti-rejection drug regimens have resulted in improved survival after lung transplantation, the development of obliterative bronchiolitis results in decreasing lung function in up to half of patients within 5 years of transplantation. Progressive respiratory failure due to obliterative bronchiolitis is, at present, the most common indication for pulmonary retransplantation. It is hoped that new anti-rejection drug regimens will result in a lower prevalence of obliterative bronchiolitis in long-term survivors of lung transplantation.

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