Rucker A Justin, Nellis Joseph R, Klapper Jacob A, Hartwig Matthew G
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
J Thorac Dis. 2021 Nov;13(11):6587-6593. doi: 10.21037/jtd-2021-25.
Chronic lung allograft dysfunction remains the leading cause of long-term morbidity and mortality for lung transplant recipients. Lung retransplantation currently represents the only therapeutic option for patients for refractory allograft dysfunction. However, debate remains regarding both the efficacy and ethicality of lung retransplantation in light of the shortage of lung allografts. The aim of this review is to discuss the available literature on lung retransplantation in the current era. Through this we hope to provide insight into ideal patient selection, donor organ selection, surgical approaches, and future considerations within the field in order to improve outcomes and best address organ utilization while a waitlist continues to exist. Lung retransplantation in select patients can offer comparable survival outcomes to primary lung transplantation. However, several risk factors including retransplantation with the first year of primary transplantation, older age, poor functional status, and ICU level requirements prior to transplantation are associated with worsened outcomes. Donor organ selection considerations are comparable to those in primary lung transplantation. However, surgical approach is often impacted by dense pleural and mediastinal adhesions in the recipient which increase the complexity of the hilar dissection. The postoperative course is often more complex for patients undergoing retransplantation compared to those undergoing primary lung transplant as well. However, pending more data on long term outcomes in lung retransplantation and the potential impact of retransplant recipients on waitlist mortality, lung retransplantation should remain in use primarily for the treatment of chronic graft dysfunction in carefully selected patients.
慢性肺移植功能障碍仍然是肺移植受者长期发病和死亡的主要原因。肺再次移植目前是难治性移植功能障碍患者的唯一治疗选择。然而，鉴于肺移植供体短缺，肺再次移植的疗效和伦理问题仍存在争议。本综述的目的是讨论当前时代肺再次移植的现有文献。通过本文，我们希望深入了解理想的患者选择、供体器官选择、手术方法以及该领域未来的考虑因素，以便在等待名单持续存在的情况下改善治疗效果并最佳地解决器官利用问题。特定患者的肺再次移植可提供与初次肺移植相当的生存结果。然而，包括在初次移植后第一年内进行再次移植、年龄较大、功能状态较差以及移植前对重症监护病房水平的要求等几个风险因素与较差的结果相关。供体器官选择的考虑因素与初次肺移植相似。然而，手术方法通常会受到受者致密胸膜和纵隔粘连的影响，这增加了肺门解剖的复杂性。与初次肺移植患者相比，再次移植患者的术后病程通常也更复杂。然而，在获得更多关于肺再次移植长期结果的数据以及再次移植受者对等待名单死亡率的潜在影响之前，肺再次移植应主要用于精心挑选的患者的慢性移植物功能障碍的治疗。
