Retransplantation.
With a continuously rising number of lung-transplant procedures performed worldwide, there is an increasing demand for pulmonary retransplantation once recipients develop lung allograft dysfunction. Due to the scarcity of donor organs, it is crucial to identify those recipients who benefit most from a retransplant procedure. Similar to primary lung transplantation, patients in an elective, ambulatory status with chronic lung allograft dysfunction can expect the best outcome. Recently, refinements in the sub-selection of this patient group have been established, and during the past years, survival after elective retransplantation has clearly improved. Additionally, technical advances in bridging devices have led to the possibility to offer the most appropriate bridging method based on the individual gas exchange and hemodynamic situation of the patient. This includes the recently introduced concept of awake bridging. These advances paved the way to improved bridging success and better post-transplant outcome, which led to increasing interest in bridging patients to retransplant procedures as well. Patient selection in pulmonary retransplantation is crucial. Patients with obstructive chronic lung allograft dysfunction in an ambulatory setting are the ideal candidates. Awake bridging strategies for acutely deteriorating patients can provide equal outcomes to elective patients. Nevertheless, avoiding the development of chronic lung allograft dysfunction is the primary goal.