Effect of chronic lung allograft dysfunction phenotypes on the outcome after lung retransplantation: A retrospective single-center data analysis.

Objective: Although retransplantation is the main therapeutic option for end-stage chronic lung allograft dysfunction, several transplant centers consider the "restrictive allograft syndrome" phenotype a contraindication. This selection policy is based on a limited body of literature. The aim of this study was to investigate the association of chronic lung allograft dysfunction phenotypes according to new chronic lung allograft dysfunction definitions with outcomes after retransplantation.

Methods: This study was a retrospective single-center analysis including patients undergoing lung retransplantation due to chronic lung allograft dysfunction between 2000 and 2021.

Results: Seventy patients were included in the analysis, 73% had bronchiolitis obliterans syndrome, 20% had a mixed phenotype, and 7% had restrictive allograft syndrome. The length of surgery was comparable between the groups. No difference was observed in terms of intraoperative use of packed red blood cells ( = .407), fresh-frozen plasma ( = .173), platelets ( = .300), prothrombin complex concentrates ( = .381), and fibrinogen ( = .808). Patients with non-bronchiolitis obliterans syndrome were more often graded with primary graft dysfunction 3 at arrival to the intensive care unit, and this trend remained at 72 hours after transplantation. After 72 hours, 60% of the cohort was extubated or had primary graft dysfunction grade 0. Early postoperative outcome was comparable between the groups. Survival between the groups did not differ with overall survivals at 1, 5, and 10 years of 72%, 53%, and 51% for bronchiolitis obliterans syndrome and 71%, 56%, and 42% for non-bronchiolitis obliterans syndrome, respectively ( = .841).

Conclusions: This analysis showed that retransplantation remains a challenging procedure. However, careful patient selection allows excellent outcomes irrespective of chronic lung allograft dysfunction phenotypes.