Retransplantation of the Lung(s)

Lung transplantation remains the only treatment for end-stage pulmonary disease that has progressed despite medical treatment. The number of retransplants increased dramatically after the development of the lung allocation score and has remained a significant number of the total done per year. Due to ethical considerations regarding organ allocation, several studies have attempted to identify the best candidates for retransplantation. The main indication for retransplant is chronic lung allograft dysfunction (CLAD), particularly bronchiolitis obliterans syndrome. Overall and CLAD-free survival has historically been shown to be worse in patients with retransplantation compared to first-time transplants. However, recent studies have revealed that careful selection can achieve comparable outcomes. Patient-related factors such as mechanical ventilation, use of extracorporeal membrane oxygenation, older age, and a low-performance status have been shown to also carry poor outcomes. Appropriate selection and identification of patients at risk of worse outcomes are essential for proper allocation and management of this population.