Cardiac re-transplantation in pediatrics: a multi-institutional study.
BACKGROUND
Cardiac re-transplantation (re-Tx) among pediatric recipients remains controversial. The purpose of this study is to use the Pediatric Heart Transplant Study (PHTS) database to investigate the incidence of re-Tx and analyze the risk factors and outcomes after transplantation among children.


METHODS
The PHTS database was reviewed for all subjects <or=18 years of age at the time of primary transplant and re-Tx from January 1, 1993 through December 31, 2004. Multivariate analyses in the hazard-function domain were used to identify risk factors for re-Tx and for mortality after re-Tx.


RESULTS
Risk factors for re-Tx include ventilator support, African-American ethnicity and elevated creatinine. Patient survival was inferior to that after primary transplantation (PTx) with 1-, 3- and 5-year survival probability after re-Tx of 80%, 69% and 60%, respectively (p = 0.04). Patients re-transplanted for graft coronary artery disease fared better than those re-transplanted for early graft failure. A shorter time period between PTx and re-Tx was a significant risk factor for survival according to univariate analysis. However, risk factors for death after re-Tx by multivariate analysis included only early graft failure and rejection during PTx.


CONCLUSIONS
Survival after pediatric re-Tx is inferior to that after PTx. Re-transplantation for graft failure and rejection are associated with high relative risks for death. Given the limitations of donor availability, re-Tx for early graft failure and rejection appear contraindicated but appears acceptable for those who have survived >or=1 year after their PTx, especially those with graft coronary artery disease.
Chin
Clifford
C
Department of Pediatric Cardiology, Stanford University, Palo Alto, California, USA. clifford@leland.stanford.edu
Naftel
David
D
Pahl
Elfriede
E
Shankel
Tamara
T
Clark
Mary Lynne
ML
Gamberg
Pat
P
Kirklin
James
J
Webber
Steve
S
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003324:Coronary Artery Disease / Q000209:etiology* / Q000601:surgery*; D016208:Databases, Factual; D006084:Graft Rejection / Q000209:etiology* / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007223:Infant; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012086:Reoperation; D012306:Risk; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors