Comparison of survival in primary and repeat heart transplantation from 1987 through 2004 in the United States.
BACKGROUND
The purpose of this study was to identify predictors for survival after primary and repeat heart transplantations, and to compare their survival.


METHODS
The United Network for Organ Sharing database provided 20,787 primary heart transplants and 594 repeat heart transplants (for those patients who had previously undergone a primary heart transplant). Cox regression models were used to separately determine predictors of survival in primary and retransplant patients and to compare their survival distributions. Propensity score matching was then used to compare the survival between primary and retransplant patients adjusted for potential confounders.


RESULTS
Similar predictors of survival were found for primary and retransplant patients. The overall increased risk of death was 71% higher for retransplant versus primary transplant patients. Propensity score analysis showed that, in patients with characteristics most similar to primary transplant patients, the increased risk of death was 133%; however, for patients with characteristics most like retransplant patients, the increased risk of death was only 34%.


CONCLUSIONS
Survival after retransplantation is significantly reduced relative to survival after primary transplantation. The difference in survival between primary and repeat transplants is smallest among recipients who fit the profile of the typical repeat transplant patient. In general, these are younger patients with better functional status prior to listing, who received an organ from a younger donor.
Shuhaiber
Jeffrey H
JH
Department of Thoracic and Cardiovascular Surgery, Loyola University Stritch School of Medicine, Chicago IL 60607, USA. jeffrey01@mac.com
Kim
Jong Bae
JB
Hur
Kwan
K
Gibbons
Robert D
RD
Nemeh
Hassan W
HW
Schwartz
Jeffrey P
JP
Bakhos
Mamdouh
M
D015986:Confounding Factors, Epidemiologic; D019992:Databases as Topic; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D012086:Reoperation / Q000401:mortality; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology