Sophia Auner MD , Panja Maria Boehm MD , Caroline Hillebrand MD , Stefan Schwarz MD, PhD , Anna Elisabeth Frick MD, PhD , Zsofia Kovacs MD , Thomas Schweiger MD, PhD , Gabriella Murakoezy MD, PhD , Eva Schaden MD , Andreas Bacher MD , Peter Faybik MD , Edda Tschernko MD , Shahrokh Taghavi MD , Peter Jaksch MD , Clemens Aigner MD , Konrad Hoetzenecker MD, PhD , Alberto Benazzo MD, PhD
{"title":"慢性同种异体肺移植功能障碍表型对肺再移植后预后的影响：回顾性单中心数据分析","authors":"Sophia Auner MD , Panja Maria Boehm MD , Caroline Hillebrand MD , Stefan Schwarz MD, PhD , Anna Elisabeth Frick MD, PhD , Zsofia Kovacs MD , Thomas Schweiger MD, PhD , Gabriella Murakoezy MD, PhD , Eva Schaden MD , Andreas Bacher MD , Peter Faybik MD , Edda Tschernko MD , Shahrokh Taghavi MD , Peter Jaksch MD , Clemens Aigner MD , Konrad Hoetzenecker MD, PhD , Alberto Benazzo MD, PhD","doi":"10.1016/j.xjon.2024.10.034","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Although retransplantation is the main therapeutic option for end-stage chronic lung allograft dysfunction, several transplant centers consider the “restrictive allograft syndrome” phenotype a contraindication. This selection policy is based on a limited body of literature. The aim of this study was to investigate the association of chronic lung allograft dysfunction phenotypes according to new chronic lung allograft dysfunction definitions with outcomes after retransplantation.</div></div><div><h3>Methods</h3><div>This study was a retrospective single-center analysis including patients undergoing lung retransplantation due to chronic lung allograft dysfunction between 2000 and 2021.</div></div><div><h3>Results</h3><div>Seventy patients were included in the analysis, 73% had bronchiolitis obliterans syndrome, 20% had a mixed phenotype, and 7% had restrictive allograft syndrome. The length of surgery was comparable between the groups. No difference was observed in terms of intraoperative use of packed red blood cells (<em>P</em> = .407), fresh-frozen plasma (<em>P</em> = .173), platelets (<em>P</em> = .300), prothrombin complex concentrates (<em>P</em> = .381), and fibrinogen (<em>P</em> = .808). Patients with non–bronchiolitis obliterans syndrome were more often graded with primary graft dysfunction 3 at arrival to the intensive care unit, and this trend remained at 72 hours after transplantation. After 72 hours, 60% of the cohort was extubated or had primary graft dysfunction grade 0. Early postoperative outcome was comparable between the groups. Survival between the groups did not differ with overall survivals at 1, 5, and 10 years of 72%, 53%, and 51% for bronchiolitis obliterans syndrome and 71%, 56%, and 42% for non–bronchiolitis obliterans syndrome, respectively (<em>P</em> = .841).</div></div><div><h3>Conclusions</h3><div>This analysis showed that retransplantation remains a challenging procedure. However, careful patient selection allows excellent outcomes irrespective of chronic lung allograft dysfunction phenotypes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 335-348"},"PeriodicalIF":0.0000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effect of chronic lung allograft dysfunction phenotypes on the outcome after lung retransplantation: A retrospective single-center data analysis\",\"authors\":\"Sophia Auner MD , Panja Maria Boehm MD , Caroline Hillebrand MD , Stefan Schwarz MD, PhD , Anna Elisabeth Frick MD, PhD , Zsofia Kovacs MD , Thomas Schweiger MD, PhD , Gabriella Murakoezy MD, PhD , Eva Schaden MD , Andreas Bacher MD , Peter Faybik MD , Edda Tschernko MD , Shahrokh Taghavi MD , Peter Jaksch MD , Clemens Aigner MD , Konrad Hoetzenecker MD, PhD , Alberto Benazzo MD, PhD\",\"doi\":\"10.1016/j.xjon.2024.10.034\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>Although retransplantation is the main therapeutic option for end-stage chronic lung allograft dysfunction, several transplant centers consider the “restrictive allograft syndrome” phenotype a contraindication. This selection policy is based on a limited body of literature. The aim of this study was to investigate the association of chronic lung allograft dysfunction phenotypes according to new chronic lung allograft dysfunction definitions with outcomes after retransplantation.</div></div><div><h3>Methods</h3><div>This study was a retrospective single-center analysis including patients undergoing lung retransplantation due to chronic lung allograft dysfunction between 2000 and 2021.</div></div><div><h3>Results</h3><div>Seventy patients were included in the analysis, 73% had bronchiolitis obliterans syndrome, 20% had a mixed phenotype, and 7% had restrictive allograft syndrome. The length of surgery was comparable between the groups. No difference was observed in terms of intraoperative use of packed red blood cells (<em>P</em> = .407), fresh-frozen plasma (<em>P</em> = .173), platelets (<em>P</em> = .300), prothrombin complex concentrates (<em>P</em> = .381), and fibrinogen (<em>P</em> = .808). Patients with non–bronchiolitis obliterans syndrome were more often graded with primary graft dysfunction 3 at arrival to the intensive care unit, and this trend remained at 72 hours after transplantation. After 72 hours, 60% of the cohort was extubated or had primary graft dysfunction grade 0. Early postoperative outcome was comparable between the groups. Survival between the groups did not differ with overall survivals at 1, 5, and 10 years of 72%, 53%, and 51% for bronchiolitis obliterans syndrome and 71%, 56%, and 42% for non–bronchiolitis obliterans syndrome, respectively (<em>P</em> = .841).</div></div><div><h3>Conclusions</h3><div>This analysis showed that retransplantation remains a challenging procedure. However, careful patient selection allows excellent outcomes irrespective of chronic lung allograft dysfunction phenotypes.</div></div>\",\"PeriodicalId\":74032,\"journal\":{\"name\":\"JTCVS open\",\"volume\":\"23 \",\"pages\":\"Pages 335-348\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JTCVS open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666273624003796\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JTCVS open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666273624003796","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Effect of chronic lung allograft dysfunction phenotypes on the outcome after lung retransplantation: A retrospective single-center data analysis
Objective
Although retransplantation is the main therapeutic option for end-stage chronic lung allograft dysfunction, several transplant centers consider the “restrictive allograft syndrome” phenotype a contraindication. This selection policy is based on a limited body of literature. The aim of this study was to investigate the association of chronic lung allograft dysfunction phenotypes according to new chronic lung allograft dysfunction definitions with outcomes after retransplantation.
Methods
This study was a retrospective single-center analysis including patients undergoing lung retransplantation due to chronic lung allograft dysfunction between 2000 and 2021.
Results
Seventy patients were included in the analysis, 73% had bronchiolitis obliterans syndrome, 20% had a mixed phenotype, and 7% had restrictive allograft syndrome. The length of surgery was comparable between the groups. No difference was observed in terms of intraoperative use of packed red blood cells (P = .407), fresh-frozen plasma (P = .173), platelets (P = .300), prothrombin complex concentrates (P = .381), and fibrinogen (P = .808). Patients with non–bronchiolitis obliterans syndrome were more often graded with primary graft dysfunction 3 at arrival to the intensive care unit, and this trend remained at 72 hours after transplantation. After 72 hours, 60% of the cohort was extubated or had primary graft dysfunction grade 0. Early postoperative outcome was comparable between the groups. Survival between the groups did not differ with overall survivals at 1, 5, and 10 years of 72%, 53%, and 51% for bronchiolitis obliterans syndrome and 71%, 56%, and 42% for non–bronchiolitis obliterans syndrome, respectively (P = .841).
Conclusions
This analysis showed that retransplantation remains a challenging procedure. However, careful patient selection allows excellent outcomes irrespective of chronic lung allograft dysfunction phenotypes.
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