Clinical Characteristics of Patients with Chronic Lung Allograft Dysfunction Listed for Lung Re-Transplant

Abstract

Purpose: Chronic lung allograft dysfunction(CLAD) is the barrier to improve long term outcome of lung transplantation. This study aims to examine prevalence and characteristics of patients with CLAD who were listed for lung re-transplant. Methods: This is a retrospective observational study. Adult patients (>18 YO) listed for lung re-transplant due to bronchiolitis obliterans syndrome (BOS) or restrictive allograft syndrome(RAS) were identified from SRTR database. Numerical data were reported in mean and standard deviation. Categorical data were reported in count and percent. T-test and Chi-square test were performed to compare 2 groups. Results: 1546 adult CLAD patients were included. 85.51% of these patients have BOS phenotype. Mean age was 42.79. There was no significant difference in age, mPAP, history of smoking, previous malignancy, or pan-resistant infection between BOS and RAS groups. Oxygen requirement at listing time was significantly higher in RAS group (5.64 §6.33 vs 2.93 §3.31, p < 0.01). Proportion of patients who were on ECMO at listing time is significantly higher in RAS group (4.02% vs 0.91%, p<0.01). LAS of RAS group was significantly higher(52.07 §18.71 vs 43.60 § 17.71, p < 0.01). 67.86% of RAS group received re-transplant compared to 59.15% of BOS group (p = 0.014).

Off-pump lung re-transplantation avoiding clamshell thoracotomy is feasible and safe: a single-center experience

“…In these patients, anatomical changes such as traction bronchiectasis, architectural deformation, volume loss, pleural adhesions and hilar retraction can be observed, which increase surgical complexity ( 30 , 31 ). Furthermore, RAS patients have a higher oxygen requirement and lung allocation score than BOS patients, often resulting in a more urgent Tx ( 32 - 35 ). Therefore, we do not recommend adopting the minimally invasive approach during re-LTx on RAS patients for possible needs of an extended surgical approach and intraoperative ECLS.…”