Abstract
Chronic lung allograft dysfunction (CLAD) remains one of the major complications after lung transplantation (LTx) with no treatment except reLTx in selected candidates. CLAD is however heterogeneous as there are at least 2 phenotypes (Bronchiolitis Obliterans Syndrome, BOS vs Restrictive Allograft Syndrome, RAS). We wanted to evaluate the differential effect of reLTx on patients with BOS or RAS
All patients who underwent reLTx for CLAD in 4 LTx centers (Duke, Hannover, Leuven, Toronto) between 2003 and 2013 were retrospectively included. BOS and RAS were distinguished using a combination of pulmonary function, radiology and pathology. Patient variables pre and post reLTx were collected and compared.
In a cohort of 133 patients who underwent reLTx, 129 patients could be phenotyped for CLAD, resulting in 85 BOS (65.9%) and 44 RAS (34.1%) patients. There was no difference in gender (p=0.63), age at reLTx (p=0.62), days with first graft (p=0.33) or time to CLAD (p=0.28), while there was a trend for underlying diagnosis (p=0.078). More RAS patients were bridged to reLTx via ECMO (p=0.011). PGD scores 48 hours after reLTx tended to be higher in recipients undergoing ReLTx for RAS (p=0.054). Unadjusted survival after reLTx for RAS was worse compared to BOS (p=0.0004; HR 2.62). Re-development of CLAD was not different (p=0.16). The major causes of death in RAS patients were post-operative complications and redevelopment of CLAD, while CLAD and infection were the most common cause of death in BOS.
In this multi-center cohort, patients with RAS have worse survival after reLTx when compared to those with BOS. This raises the question whether RAS patients are suitable candidates for reLTx.
- © 2014 ERS