Life expectancy for lung-transplant patients, especially those with cystic fibrosis (CF), is leading increasingly to more retransplantations.
Retrospective monocentric cohort study.
Foch University Hospital, Suresnes, France.
CF patients having had a primary double-lung transplantation (pLgTx) or a retransplantation (reLgTx) from 2012 to 2021.
Measurements and Main Results
The authors compared the main intraoperative and early postoperative features between pLgTx (n = 258) and reLgTx (n = 24). Demographic characteristics were similar. No patients with retransplantations had a preoperative bridge with extracorporeal membrane oxygenation (ECMO); however, 23 patients had it in the pLgTx group (p = 0.24). Patients with retransplants had longer second graft ischemic time (p = 0.02), larger intraoperative bleeding volume (p = 0.001) and blood transfusion (p = 0.009 for packed red blood cells), increased blood lactate concentrations (p = 0.002), and higher norepinephrine dose at end-surgery (p = 0.001). Extracorporeal membrane oxygenation was used during surgery in 94 patients in the pLgTx group and 12 patients in the reLgTx group (p = 0.39). Extracorporeal membrane oxygenation could not be weaned after surgery in 55 patients in the pLgTx group and 4 in the reLgTx group (p = 0.54). Despite worse preoperative renal function in the reLgTx group (p < 0.001), there was no difference concerning renal replacement therapy in the intensive care unit between groups (p = 0.08). There were no differences between groups concerning the main complications, including primary graft dysfunction. Although the difference was not statistically different (p = 0.17), mortality was 3 times higher in the reLgTx group.
Intraoperative period of retransplantation was more convoluted but had a similar ECMO profile to primary transplantation. In addition, the early postoperative period was similar.
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- Sustained effectiveness of elexacaftor-tezacaftor-ivacaftor in lung transplant candidates with cystic fibrosis.J Cyst Fibros. 2022; 21: 489-496
- Chronic lung allograft dysfunction: Definition and update of restrictive allograft syndrome- a consensus report from the Pulmonary Council of the ISHLT.J Heart Lung Transplant. 2019; 38: 483-492
- Chronic lung allograft dysfunction: Definition, diagnostic criteria, and approaches to treatment-a consensus report from the Pulmonary Council of the ISHLT.J Heart Lung Transplant. 2019; 38: 493-503
- The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult lung and heart-lung transplantation report-2019; focus theme: Donor and recipient size match.J Heart Lung Transplant. 2019; 38: 1042-1055
- Lung transplantation for cystic fibrosis.J Heart Lung Transplant. 2020; 39: 553-560
- Outcomes following lung re-transplantation in patients with cystic fibrosis.J Cyst Fibros. 2022; 21: 482-488
- The American Association for Thoracic Surgery (AATS) 2022 Expert Consensus Document: The use of mechanical circulatory support in lung transplantation.J Thorac Cardiovasc Surg. 2023; 165: 301-326
- Lung retransplantation for chronic rejection: A single-center experience.Ann Thorac Surg. 2018; 105: 221-227
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies.Int J Surg. 2014; 12: 1495-1499
- Anesthesia Foch lung transplantation protocol. 2020; (Available at) (Accessed January 30)
- Is extracorporeal membrane oxygenation withdrawal a safe option after double-lung transplantation?.Ann Thorac Surg. 2020; 110: 1167-1174
- Report of the ISHLT Working Group on Primary Lung Graft Dysfunction, part I: Definition and grading-a 2016 Consensus Group statement of the International Society for Heart and Lung Transplantation.J Heart Lung Transplant. 2017; 36: 1097-1103
- Controversies in acute kidney injury: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference.Kidney Int. 2020; 98: 294-309
- Operating room extubation: A predictive factor for 1-year survival after double-lung transplantation.J Heart Lung Transplant. 2021; 40: 334-342
- Feasibility and utility of a lung donor score: Correlation with early post-transplant outcomes.Ann Thorac Surg. 2007; 83: 257-263
- Usefulness of the preoperative prognostic nutritional index score as a predictor of the outcomes of lung transplantation: A single-institution experience.Clin Nutr. 2019; 38: 2423-2429
- Technique and outcomes of less invasive lung retransplantation.Transplantation. 2018; 102: 530-537
- Lung transplantation disparities based on diagnosis for patients bridging to transplant on extracorporeal membrane oxygenation.J Heart Lung Transplant. 2021; 40: 1641-1648
- Extracorporeal life support as a bridge to pulmonary retransplantation: Prognostic factors for survival in a multicentre cohort analysis.Eur J Cardiothorac Surg. 2022; 61: 405-412
- Extracorporeal membrane oxygenation and retransplantation in lung transplantation: An analysis of the UNOS registry.Lung. 2014; 192: 571-576
- A virtual crossmatch-based strategy for perioperative desensitisation in lung transplant recipients with pre-formed donor-specific antibodies: 3-year outcome.Eur Respir J. 2021; 582004090
- Intraoperative extracorporeal membrane oxygenation for lung transplantation in cystic fibrosis patients: Predictors and impact on outcome.J Cyst Fibros. 2020; 19: 659-665
- Extracorporeal membrane oxygenation in the perioperative care of the lung transplant patient.Semin Cardiothorac Vasc Anesth. 2020; 24: 45-53
- Bilateral lung transplantation on intraoperative extracorporeal membrane oxygenator: An observational study.J Thorac Cardiovasc Surg. 2020; 160 (e321): 320-327
- Evaluation of tissue ischemia/reperfusion injury in lung recipients supported by intraoperative extracorporeal membrane oxygenation: A single-center pilot study.Cells. 2022; 11: 3681
- Rotational thromboelastometry reduces blood loss and blood product usage after lung transplantation.J Heart Lung Transplant. 2021; 40: 631-641
- Blood lactate during double-lung transplantation: A predictor of grade-3 primary graft dysfunction.J Cardiothorac Vasc Anesth. 2022; 36: 794-804
- Retransplantation outcomes at a large lung transplantation program.Transplant Direct. 2018; 4: e404
- Comprehensive outcomes after lung retransplantation: A single-center review.Clin Transplant. 2018; 32: e13281
Published online: February 22, 2023
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This work was supported by the Clinical Research Department of Hôpital Foch, which was not involved in the conduct of the study or development of the submission.
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