Chronic Lung Allograft Dysfunction (CLAD) remains a problem following lung transplantation

Chronic Lung Allograft Dysfunction (CLAD) remains a problem following lung transplantation without definitive treatment except redo lung transplantation (re-LTx) in preferred candidates. were analyzed and collected. A complete of 143 sufferers underwent re-LTx for CLAD leading to 94 BOS (66%) and 49 rCLAD (34%) individuals. Unadjusted and modified survival after re-LTx for rCLAD was worse compared to BOS (HR=2.60 1.59 p<0.0001 and HR=2.61 1.51 p=0.0006 respectively). Individuals waiting at home prior to re-LTx experienced better survival compared to hospitalized individuals (HR 0.40; 0.23-0.72; p=0.0022). Individuals with rCLAD re-developed CLAD earlier and were more likely to re-develop rCLAD. Survival after re-LTx for rCLAD is definitely worse compared to BOS. As a result re-LTx for rCLAD should be critically discussed particularly when additional peri-operative risk factors are present. Intro Chronic lung allograft dysfunction (CLAD) remains the major hurdle Rabbit Polyclonal to Actin-pan. to long-term survival after lung transplantation (LTx). R406 (freebase) Definitive treatment is limited as most therapies only stabilize pulmonary function. The only option bringing alleviation for well-selected individuals is definitely redo LTx (re-LTx). Due to the scarcity of organs this option is rarely applied with only 970 re-LTx (2.6% of all transplant procedures) worldwide between 1995 and 2012. Only 568 (1.5% of all transplant procedures) were performed as treatment for end-stage CLAD (1). Earlier studies shown a survival benefit in individuals undergoing re-LTx for BOS compared to main graft dysfunction R406 (freebase) (PGD) (2). In general survival after re-LTx for BOS is definitely believed to be related to that after main transplantation (2) although one statement showed a slight survival disadvantage (3). UNOS data (4) showed that survival after re-LTx in the modern era (2001-2006) implied better survival compared to the early transplantation era R406 (freebase) (1990-2000). Moreover renal failure and bridge to re-LTx with mechanical ventilation appeared to influence survival after re-LTx for BOS while other comorbidities like diabetes and hypertension did not influence survival (4). However with the increasing knowledge that BOS does not fit the entire spectrum of CLAD (5) these data require re-evaluation to account for the differential phenotypes of CLAD. In particular the recent introduction of a restrictive phenotype of CLAD (rCLAD) which was first described as restrictive allograft syndrome (RAS) (6) can be an important confounding factor. In contrast to BOS patients (obstructive pulmonary function air-trapping on chest CT scan and constrictive bronchiolitis on pathology) rCLAD patients have pulmonary function changes consistent with a restrictive ventilatory defect defined as either a persistent decline in total lung capacity (TLC) (6) loss of R406 (freebase) forced vital capacity (FVC) (7) or normal or elevated FEV1/FVC ratio (8) in association with CLAD. In each of these prior reports the observation of restrictive physiology correlates with persistent infiltrates on CT scan alveolar fibrosis on pathology and most importantly a worse survival after CLAD diagnosis (median 7-18 months) (6-8). Therefore re-LTx could be indicated in rCLAD individuals given their poor prognosis particularly. As a result we aimed to research overall success after re-LTx using data of 4 well-established transplant centers with unique interest for the phenotype of CLAD (BOS vs. rCLAD). Additionally we wished to determine specific risk elements associated with results after re-LTx for CLAD but also BOS and rCLAD individually. MATERIAL AND Strategies Individual selection All individuals going through re-LTx for chronic respiratory failing supplementary to end-stage CLAD between 2003 and 2013 in 4 founded large-volume Tx centers (Duke College or university INFIRMARY Durham USA; Hannover Medical College Hannover Germany; Toronto INFIRMARY Toronto Canada and College or university Private hospitals Leuven Leuven Belgium) had been included. We excluded individuals going through re-LTx for factors apart from CLAD due to the low total numbers of methods and a probably different behavior (shape 1). The day of the next consecutive re-LTx (=3th LTx) was regarded as date of death for the re-LTx procedure. One pediatric patient was excluded due to logistical difficulties in obtaining reliable data (figure 1). Figure 1 Flowchart describing the number of patients that were excluded.