• Medicina clinica · Jan 2021

    Lung retransplant. Experience of a referral centre.

    • José A Cerón Navarro, Sebastián Peñafiel Guzman, Diana Baquero Velandia, Carlos Ordoñez Ochoa, Sergio Tacoronte Pérez, Carlos Jordá Aragón, Alilis Fontana Bellorín, Alejandra Libreros Niño, Jose Padilla A, Alfonso Morcillo A, and Gabriel Sales Badía.
    • Servicio de Cirugía Torácica y Unidad de Trasplante Pulmonar, Hospital Universitario y Politécnico La Fe, Valencia, España. Electronic address: ceronjs@yahoo.es.
    • Med Clin (Barc). 2021 Jan 8; 156 (1): 1-6.

    BackgroundLung retransplantation (LR) is a valid choice with a significant risk of perioperative morbidity and mortality in selected patients with graft dysfunction after lung transplantation. Our goal is to analyse our experience in LR in terms of survival and lung function.MethodsRetrospective study of patients undergoing LR (1990-2019).Variablesrecipients and procedure, early mortality, survival and lung function in patients with CLAD. Quantitative variables (mean±SD); qualitative (%). Student's t test or χ2 was used. Survival was estimated using Kaplan-Meier, compared with Log Rank. A p < 0.05 was established as significant.ResultsOf 784 transplanted patients, 25 patients (mean age 38.41-16.3 years, 12 men and 13 women) were LR; (CLAD (n = 19), pulmonary infarction (n = 2), airway complications (n = 2), graft dysfunction (n = 1), hyperacute rejection (n = 1), mean time to retransplantation: 5.41 ± 3.87 years in CLAD and 21.2 ± 21.4 days in non-CLAD. The 90-day mortality was 52% and 36.8% in the second period (p = 0.007), being higher in patients who required preoperative ECMO (80 vs. 20%, p = 0.04). The 1- and 5-year survival was 53.9% and 37.7%, respectively (p = 0.016). Survival of the CLAD group was greater (p = 0.08). Pre LR ECMO decreased survival (p = 0.032). After LR, FEV1 improved an average of 0.98 ± 0.13L (25.6 ± 18.8%) (p = 0.001).ConclusionsLR is a high mortality procedure that requires careful selection of patients with better results in patients with CLAD. The lung function of patients with CLAD improved significantly.Copyright © 2020 Elsevier España, S.L.U. All rights reserved.

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