Purpose: Increasing number of lung re-transplantation (LRT) after chronic rejection are being performed worldwide. Patients who undergo LRT are unique by way of higher likelihood of being sensitized and are reported to have worse 1 year outcomes. We sought to determine if these patients have more frequent or severe acute cellular rejection (ACR) episodes or airway complications after LRT.

Methods: We reveiwed the chart of patients who underwent LRT for chronic rejection at Cleveland Clinic in last 10 years. We recorded information regarding first transplant indications, type of first and re-transplantation, and course after re-transplantation. All patients underwent surveillance bronchoscopy (SB) at 3 wk, 6 wk, 3 m, 6 m, 9 m and 12 m as per the institutional protocol. We focused on the incidence and severity of ACR episodes, short term (such as necrosis or dehiscence at the anastomotic site) and long term (such as airway stenosis) airway complications.

Results: During the last 10 years a total of 17 patients underwent LRT (mean age 45±18 years, range12-64 years, M:F 8:9). Commonest diagnostic groups was COPD (n=8) followed by cystic fibrosis (n=5). Majority of the patients had initial bilateral transplantation (n=10) and almost each of these patient underwent bilateral LRT (9/10). Seven underwent single LRT. Mean period between the first and re-transplantation was 66±34 months (range 25-160 m). Two patients died due to early post-operative complications (1 had stroke and another fulminant sepsis). Significant number of patients needed re-operation for bleeding (n=4, 23.5%). Among those discharged, average length of hospital stay was 50 days (range 10-147 days). Another two patients died within the first year (one year survival: 76%) and cause of death in both was infection.

On SB during the first year, only 4 patients (23.5%) had LRSG grade A2 or higher rejection whereas 5 patients (29.4%) had no ACR episodes. Five patients were noted to have airway necrosis and 3 (17.6%) developed airway stenosis. One required placement of airway stents. None of the patients developed any of the ominous complication such as dehiscence.

Conclusions: LRT patients have significant peri-operative morbidity and mortality. However, the post-transplant course thereafter seems to mirror those with first transplantation. Patients with LRT do not appear to have more frequent / severe ACR episodes or increased airway complications.

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