Clinical lung and heart/lung transplantationPulmonary Retransplantation: Is it Worth the Effort? A Long-term Analysis of 46 Cases
Section snippets
Methods
We retrospectively analyzed all 46 patients undergoing pulmonary retransplantation from among 567 consecutive primary lung or heart–lung transplantations performed in our department from August 1995 to August 2006. We stratified patients according to indication for retransplantation and analyzed the outcome. Indications for primary lung transplantation were chronic obstructive pulmonary disease (COPD; n = 15), pulmonary fibrosis (n = 12), cystic fibrosis (CF; n = 10), primary pulmonary
Results
Forty-six patients underwent pulmonary retransplantation (10 double-lung, 30 single-lung, 5 lobar and 1 split-lung transplantation). The types of primary transplantation and retransplantation are summarized in Table 1. Indications for retransplantation were PGD (n = 23), BOS (n = 19) and AWP (n = 4, which included 1 patient with cicatriceal stenosis at the right anastomosis and 3 patients with more peripheral obstructions of the airway without possibility for stenting) (Table 2). The
Discussion
Pulmonary retransplantation remains a highly controversial procedure, mainly due to ethical concerns over fair distribution of scarce donor organs. Although the ethical questions can never be answered by medical data alone, we tried to identify which patients would benefit most from retransplantation to establish a refined approach toward this topic. Aside from the many ethical questions it is impossible to fully address all legal, financial and logistic issues related to this field. We have
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