A decade experience of cardiac retransplantation in adult recipients.
BACKGROUND
Cardiac retransplantation is considered to be the best therapeutic option for a failing cardiac allograft. However, poor outcomes with retransplantation have previously been reported, a factor that raises important ethical, logistic and financial issues given the limited organ donor supply.


METHODS
Seven hundred sixty-six adult patients underwent cardiac transplantation for end-stage heart failure at our institution from 1992 to 2002. Of these, 41 (5.4%) were retransplants. Variables examined included recipient and donor demographics, indications for retransplant, comorbidities, cytomegalovirus (CMV) serology status, left ventricular assist device use before transplant, donor ischemic time, rate of early mortality (within 30 days), and post-transplantation survival rate.


RESULTS
Indications for cardiac retransplant were transplant-related coronary artery disease in 37, acute rejection in 3, and other causes in 1. The mean interval between transplantation and retransplantation was 5.9 +/- 3.4 years. Baseline characteristics such as recipient age, gender, CMV serology status, and donor age were similar in the primary transplant and retransplant groups. Early mortality after transplantation was comparable between the 2 groups, but post-transplant survival was significantly lower in retransplant patients compared with primary transplants with 1-, 3-, 5-, and 7-year actuarial survival rates of 72.2%, 66.3%, 47.5%, and 40.7% vs. 85.1%, 79.2%, 72.9%, and 66.8%, respectively (p < 0.001).


CONCLUSIONS
Cardiac retransplantation offers short-term outcomes similar to primary transplantation but lower long-term survival rates. Non-retransplant surgical options should also be considered in these patients. Careful patient selection and risk-assessment is necessary to govern appropriate allocation of limited donor organs.
Topkara
Veli K
VK
Department of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Dang
Nicholas C
NC
John
Ranjit
R
Cheema
Faisal H
FH
Barbato
Raffaele
R
Cavallo
Marco
M
Liu
Judy F
JF
Liang
Lorraine M
LM
Liberman
Elyse A
EA
Argenziano
Michael
M
Oz
Mehmet C
MC
Naka
Yoshifumi
Y
D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000601:surgery; D016027:Heart Transplantation / Q000009:adverse effects; D006353:Heart-Assist Devices; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012086:Reoperation; D012307:Risk Factors; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents