Long-term survival after cardiac retransplantation: a twenty-year single-center experience.
OBJECTIVE
To identify risk factors for survival after cardiac retransplantation and compare the survival after retransplantation with that after primary cardiac transplantation.


METHODS
A retrospective analysis of 952 patients undergoing cardiac transplantation for the treatment of end-stage heart disease at a single center between 1977 and October 1997. Of these, 43 patients (4.5%) underwent cardiac retransplantation for cardiac failure resulting from transplant-related coronary artery disease, rejection, and early graft failure.


RESULTS
No significant difference in actuarial patient survival was found by Kaplan-Meier analysis at 1, 2, and 5 years between patients undergoing primary transplantation and those undergoing retransplantation 76%, 71%, and 60% versus 66%, 66%, and 51%, respectively (P =.2). Multivariable analysis identified a shorter interval between transplants and an initial diagnosis of ischemic cardiomyopathy as significant risk factors for death after retransplantation (P =.04 and.03, respectively). Since 1993, when our criteria for patient selection for retransplantation were revised on the basis of earlier experience to exclude patients with allograft dysfunction as a result of primary graft failure and those with intractable acute rejection occurring less than 6 months after transplantation, the survival has been significantly better (<1993 = 45%, 45%, and 33% versus >/=1993 = 94%, 94%, and 94% at 1, 2, and 4 years, respectively, P =.003).


CONCLUSIONS
The long-term outcome of cardiac retransplantation is comparable with that of primary transplantation, especially in patients with transplant-related coronary artery disease. Patient characteristics and other preoperative variables should assist in the rational application of retransplantation to ensure optimal use of donor organs.
John
R
R
Divisions of Cardiothoracic Surgery and Cardiology, Columbia Presbyterian Medical Center, Columbia University, New York, NY, USA.
Chen
J M
JM
Weinberg
A
A
Oz
M C
MC
Mancini
D
D
Itescu
S
S
Galantowicz
M E
ME
Smith
C R
CR
Rose
E A
EA
Edwards
N M
NM
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003327:Coronary Disease / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate