In selected cases with either acute or chronic graft failure after lung or heart-lung transplantation, retransplantation remains the only therapeutic option. Since December 1987, we have performed a total of 110 single lung, bilateral lung, and combined heart-lung transplantations in 102 patients including five early and four late retransplantations in eight patients. Early retransplantation was indicated for severe reperfusion injury after single lung transplantation (n = 2) or heart-lung transplantation (n = 1), for persistent pulmonary hypertension caused by an unrecognized aortopulmonary window (n = 1), for central airway necrosis, and for contralateral pulmonary artery bleeding after bilateral lung transplantation (n = 1). Two of these patients after single lung transplantation were bridged with extracorporeal membrane oxygenation for 9 and 11 days until single lung retransplantation. Three patients underwent late single lung retransplantation 14, 24, and 26 months after single lung transplantation (n = 2) or heart-lung transplantation (n = 1) for chronic rejection, and an additional patient was treated successfully by bilateral lung retransplantation for obliterative bronchiolitis and central airway stenosis 26 months after bilateral lung transplantation. Two patients died 19 and 140 days, respectively, after acute retransplantation because of early graft failure and progressive rejection, respectively, while the other patients were discharged from the hospital. Mortality was 22.2% in the retransplantation group versus 15.1% (11 of 73 patients) undergoing primary single lung transplantation or bilateral lung transplantation (not significant). Patient survival after retransplantation ranged between 159 and 993 days (median, 453 days). Duration of postoperative ventilation was markedly prolonged in patients who underwent retransplantation.(ABSTRACT TRUNCATED AT 250 WORDS)