Lung retransplantation for chronic lung allograft dysfunction

Lung transplantation (LTx) is currently the best therapeutic option for patients with end stage lung disease. Technical progress in graft procurement and implantation, perioperative care, or individual management and better immunosuppression therapy monitoring of patients after transplantation, resulted in a significant improvement in recipients’ survival. Together with the increase in the survival rate of patients after transplantation, the number of retransplantations has increased. Currently, lung retransplantations (ReLTx) account for approximately 5% of all lung transplantations [1]. Chronic lung allograft dysfunction (CLAD) is a major complication of LTx, leading to a substantial decrease in the survival rate of recipients and a significant deterioration of their quality of life [2]. Two major subtypes of CLAD have been described: bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). Chronic rejection usually takes the form of BOS. This brief case description documents a left lung retransplantation due to CLAD-BOS with subsequent right-sided pneumonectomy as a result of the failure of the previous graft.
We present a case of a 43-year-old man with respiratory failure in the course of chronic dysfunction of lungs. The patient had been diagnosed with many chronic conditions, such us post-transplantation renal insufficiency, post-transplantation diabetes (PTD), exocrine pancreatic insufficiency, and osteopenia. In 2014, 4 years prior to the described events, the patient underwent lung transplantation due to the advancement and progression of cystic fibrosis. He was operated on in a different European lung transplantation center. The early and late post-transplantation periods were complicated by chronic infection with Pseudomonas aeruginosa and Pneumocystis jiroveci in 2015 and 2016. From March 2016, there was a gradual deterioration of breathing. The biopsy revealed chronic graft rejection with the BOS 1 subtype (forced expiratory volume in 1 second (FEV1) 80%); therefore, steroid therapy was administered. Six months later, the patient’s condition deteriorated, with a significant impairment of FEV1, requiring antithymocyte globulin ATG and further extracorporeal photopheresis treatment. In 2017 the patient developed oxygen-dependent respiratory failure with a rapidly decreasing FEV1 from 60% to 40%. As a consequence, the patient was successfully qualified for lung retransplantation. In October 2018, the patient...


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