Heart retransplantation: a 23-year single-center clinical experience.
BACKGROUND
The main causes of allograft failure after cardiac transplantation are primary graft dysfunction, intractable acute rejection, and coronary graft disease. Despite the important progress in the last several years in graft preservation, surgical techniques, immunosuppression, and treatment of coronary graft disease, retransplantation in selected cases is the only way to achieve long-term recipient survival.


METHODS
We compare here in a case-control study 24 retransplantations with 47 first transplants in patients matched for date of transplantation.


RESULTS
Between 1973 and 1996, 1,063 patients underwent cardiac transplantation in our institution. In this cohort, 22 patients had a total of 24 retransplantations (2 second-time retransplantations). The causes of retransplantations were primary graft failure (n=4), acute rejection (n=7), coronary graft disease (n=11), and miscellaneous (n=2). Survival at 1 and 5 years of patients with retransplantations is 45.5% and 31.2%, and survival of control patients is 59.4% and 38.8% (p=0.07). An interval between first transplantation and retransplantation shorter (n=11) or longer (n=13) than 1 year is associated with a 1-year survival of 27.3% and 61.5% and a 4-year survival of 27.3% and 46%, respectively (not significant). Intervals shorter than 1 year between first transplantation and retransplantation were exclusively secondary to primary graft failure or intractable acute rejection.


CONCLUSIONS
In the face of lack of donor grafts, these and other data indicate that retransplantation should be considered cautiously, especially when the interval between the first transplantation and retransplantation is short.
Schnetzler
B
B
Department of Cardiac Surgery, La Pitié Salpétrière Hospital, Paris, France.
Pavie
A
A
Dorent
R
R
Camproux
A C
AC
Leger
P
P
Delcourt
A
A
Gandjbakhch
I
I
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D009202:Cardiomyopathies / Q000601:surgery; D016022:Case-Control Studies; D015331:Cohort Studies; D003327:Coronary Disease / Q000209:etiology; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery; D009926:Organ Preservation; D018579:Patient Selection; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents