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J Thorac Cardiovasc Surg 2006;132:226-228
© 2006 The American Association for Thoracic Surgery

Editorial

Retransplantation of the lung comes of age

Toronto Lung Transplant Program, University of Toronto, Toronto, Ontario, Canada.

Received for publication April 3, 2006; accepted for publication April 11, 2006.

^_* Address for reprints: Shaf Keshavjee, MD, Director, Toronto Lung Transplant Program, Professor and Chair, Division of Thoracic Surgery, University of Toronto—Toronto General Hospital, 200 Elizabeth St, 9N-947, Toronto, Ontario M5G 2C4, Canada (Email: Shaf.Keshavjee@uhn.on.ca).

The first 20% of the full text of this article appears below.

Lung transplantation has entered a new era—serious reconsideration of retransplantation. Although lung transplantation represents the only life-saving therapy for patients with end-stage lung disease, it has not yet achieved the long-term graft survival results observed with other solid organs. The aggregate international experience reported in the International Society for Heart and Lung Transplantation (ISHLT) Registry ¹ reveals a 5-year survival for first-time lung transplantation in the range of 50%. In comparison, the 5-year graft survival for kidney transplantation is 70%, for liver 67%, and for heart 71%. ² The primary cause of death after lung transplantation is chronic graft dysfunction or bronchiolitis obliterans, and retransplantation remains the only treatment option for these individuals today. Given the magnitude of late graft failure, it is inevitable that some patients will be back in line, requiring retransplantation.

Retransplantation of the lung has been undertaken by various transplant centers worldwide. It is clear that a retransplant is a higher risk procedure than a first-time transplant and the outcomes have generally not been as good. The Organ Procurement and Transplantation Network reports that retransplantation accounts for about 4% of the current lung transplant activity to date. The 1-year survival in this group is 59% and the 5-year survival is 32% (compared with 79% and 45% for 1- and 5-year survivals, respectively, for primary lung transplants in that registry ² [Table 1]).

View this table: [in this window] [in a new window]   TABLE 1. The Organ Procurement and Transplantation Network graft survivals (Kaplan-Meier) for transplants performed from 1995 to 2002 in the United States 2

Although no single center has a large experience, a number . . . [Full Text of this Article]

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