Cardiac retransplantation for graft vasculopathy in children: should we continue to do it?
BACKGROUND
Cardiac transplantation (CTx) has been established as an effective therapy for a variety of inoperable cardiac conditions in infants and children. However, graft vasculopathy (GV) has emerged as the main limiting factor to long-term survival of CTx recipients. The only treatment of severe GV is cardiac retransplantation (re-Tx). Controversy exists regarding the use of scarce donor organs for cardiac re-Tx.


OBJECTIVE
To compare the outcome of cardiac re-Tx for GV with that of primary CTx in children.


METHODS
A 12-year retrospective cohort review.


METHODS
A university-affiliated children's hospital.


METHODS
All infants and children who underwent CTx (group 1, n = 322) had complete follow-up of 1389.7 patient-years. Graft vasculopathy was confirmed in 32 recipients (1.1-8.2 years after undergoing CTx). Thirteen patients died suddenly, 3 died waiting for cardiac re-Tx (1-17 days after relisting), 4 are pending cardiac re-Tx, and 12 (group 2) underwent cardiac re-Tx.


METHODS
Cardiac re-Tx at a mean (+/- SD) interval from the first CTx of 6.3 +/- 1.8 years (range, 2.2-9.4 years). Two patients required additional aortic arch aneurysm repair with cardiac re-Tx.


RESULTS
When group 1 was compared with group 2, there was no significant difference in operative mortality (9.0% vs 8.3%; P = .9), rejection rate (0.98 vs 0.86; P = .1), and hospital stay (23.0 +/- 18.8 days vs 20.5 +/- 11.6 days; P = .65). Actuarial survival for groups 1 and 2 at 1 and 4 years was 84.3% vs 83.3% (P = .59) and 74.4% vs 83.3% (P = .85), respectively.


CONCLUSIONS
The surgical outcome and intermediate survival of cardiac re-Tx for GV and primary CTx are similar. Children with severe cardiac GV are at risk of sudden death and can benefit from early cardiac re-Tx.
Department of Surgery, Loma Linda University Medical Center and Children's Hospital, Calif 92354, USA. arazzouk@som.llu.edu
A J
AJ
Razzouk
R E
RE
Chinnock
J A
JA
Dearani
S R
SR
Gundry
L L
LL
Bailey
D002675:Child, Preschool; D003327:Coronary Disease / Q000150:complications* / Q000209:etiology*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D006083:Graft Occlusion, Vascular / Q000150:complications* / Q000209:etiology*; D006084:Graft Rejection / Q000209:etiology*; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome