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Lung Retransplantation for Bronchiolitis Obliterans Syndrome^*

Long-term Follow-up in a Series of 15 Recipients

^* From the Service de Pneumologie et Réanimation Respiratoire (Drs. Brugière, Thabut, Mal, Dauriat, Marceau, and Lesèche), and Service de Chirurgie Thoracique (Dr. Castier), Hôpital Beaujon, Clichy, France.

Correspondence to: Olivier Brugière, MD, Service de Pneumologie et Réanimation Respiratoire, Hôpital Beaujon, 100 bd du Gén. Leclerc, 92000 Clichy, France

Background: Although lung retransplantation is the only definitive therapeutic option in lung recipients with bronchiolitis obliterans syndrome (BOS), its value remains a considerable source of controversy. We report our experience of retransplantation for BOS performed in our center since 1988.

Methods: Between 1988 and 2002, 15 lung retransplantations for BOS were performed. Patient survival, causes of death, long-term functional status, and BOS recurrence rate were reviewed.

Results: The retransplantation procedure was single-lung transplantation (SLT) in all cases (ipsilateral SLT, n = 4; contralateral SLT, n = 9; SLT after previous double-lung transplantation, n = 2). The median time between primary lung transplantation and retransplantation was 31 months (range, 12 to 39 months). The median follow-up duration of the 10 patients surviving beyond 6 months was 49.5 months (range, 16.5 to 105 months), and 5 patients were followed up for > 5 years. Actuarial survival rates at 1 year, 2 years, and 5 years after retransplantation were 60%, 53%, and 45%, respectively. Ten patients died during long-term follow-up, 6 of them from infection (60%). The retained graft was the initial site of the fatal infection in four of these six patients (66%). Two other patients with a retained graft experienced disabling chronic purulent expectoration arising from the old graft. In the 10 patients surviving beyond 6 months, mean best FEV₁ was 58 ± 13% of predicted (± SD), and actuarial freedom from BOS (stage 1, 2, or 3) at 1 year, 3 years, and 5 years was 90%, 72%, and 66%, respectively.

Conclusion: Lung retransplantation offered a viable therapeutic option for selected lung recipients with BOS. Given the morbidity and mortality related to the retained graft, we now favor replacement of the primary graft when retransplantation is considered.

Key Words: bronchiolitis obliterans syndrome • lung retransplantation • lung transplantation

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