Long-term Outcome of Lung Retransplantation for Chronic Lung Allograft Dysfunction After En-bloc Heart and Lung Transplantation

OBJECTIVES: Chronic lung allograft dysfunction (CLAD) is a major factor limiting long-term survival after heart-lung transplantation (HLTx). Whether lung retransplantation (LRTx) offers the same long-term results in HLTx recipients as in double-lung transplantation (DLTx) recipients remains unknown. The aim of this study was to compare outcomes of LRTx after HLTx and DLTx. METHODS: We retrospectively reviewed charts of patients retransplanted at our institution in 2006-2023. Outcomes after LRTx, overall survival, and bronchiolitis obliterans syndrome (BOS)-free survival were compared between HLTx and DLTx groups. RESULTS: LRTx was performed in 60 patients, including 20 after HLTx and 40 after DLTx. Median post-retransplant follow-up was 3.54 years [1.37-6.79]. Median time to retransplantation was significantly shorter in LRTx group (HLTx: 5.47 [4.55-7.02] years vs DLTx: 2.77 [1.55-5.46] years; P = .03). Overall in-hospital mortality was 5% (n = 3) with no significant difference between the groups. The 2 groups were similar for primary graft dysfunction (PGD) Grade 2 or 3 at 72 hours (HLTx: 17%; DLTx: 39%; P = .133), 1- and 5-year overall survival (HLTx: 70% and 54%; DLTx: 87% and 43%; P = .249) and 1- and 5-year BOS-free survival rates (HLTx: 70% and 40%; DLTx: 72% and 33%; P = .402). With LRTx after HLTx, 10-year freedom from cardiac allograft vasculopathy (CAV) since the first transplant was 72%. CONCLUSIONS: Overall survival and BOS-free survival benefits of LRTx were similar after DLTx or HLTx. LRTx in HLTx group did not lead to an increased risk of CAV. LRTx seems a good option for carefully selected patients with end-stage CLAD after HLTx to improve survival and quality of life.