Objective
Life expectancy for lung-transplant patients, especially those with cystic fibrosis
(CF), is leading increasingly to more retransplantations.
Design
Retrospective monocentric cohort study.
Setting
Foch University Hospital, Suresnes, France.
Participants
CF patients having had a primary double-lung transplantation (pLgTx) or a retransplantation
(reLgTx) from 2012 to 2021.
Interventions
None.
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.
Conclusions
Intraoperative period of retransplantation was more convoluted but had a similar ECMO
profile to primary transplantation. In addition, the early postoperative period was
similar.
Graphical abstract
Graphical Abstract
Key Words
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Article info
Publication history
Published online: February 22, 2023
Publication stage
In Press Corrected ProofFootnotes
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.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
