Long-term experiences on cardiac retransplantation in adults.
BACKGROUND
It remains disputed whether cardiac retransplantation should be performed. This study aimed to evaluate our long-term experiences on cardiac retransplantation in adults.


METHODS
Between March 1989 and December 2004, 2% (28/1290) of cardiac retransplantations were performed.


RESULTS
The reasons for cardiac retransplantation were cardiac allograft vasculopathy (n=13; 47%), primary graft failure (n=11; 39%), and refractory acute rejection (n=4; 14%). The 30-day mortality risk was 29% (acute rejection: 50%; primary graft failure: 36%; cardiac allograft vasculopathy: 15%, p=0.324), compared to 8.5% for primary cardiac transplantation (p<0.001). The causes of early death were acute rejection (n=3; 37%), multiorgan failure (n=3; 37%), primary graft failure (n=1; 13%), and right ventricular failure (n=1; 13%). The late mortality rate was 96/1000 patient-years. The causes of late death were acute rejection (n=4; 50%), cardiac allograft vasculopathy (n=2; 25%), multiorgan failure (n=1; 13%), and infection (n=1; 13%). The 1-, 5-, 10-, and 15-year survival was respectively 78, 68, 54, and 38% (primary cardiac transplantation), and 46, 41, 32, and 32% (cardiac retransplantation) (p=0.003). The short-term survival for cardiac retransplantation due to cardiac allograft vasculopathy was likely better than primary graft failure and refractory acute rejection (p=0.09).


CONCLUSIONS
The overall outcomes of cardiac retransplantation are significantly inferior to primary cardiac transplantation. Cardiac retransplantation should be only performed for selected patients.
Tjang
Yanto Sandy
YS
Department of Thoracic & Cardiovascular Surgery, Heart & Diabetes Center North Rhine Westphalia/University Hospital of Bochum, Bad Oeynhausen, Germany. ystjang@hotmail.com
Tenderich
Gero
G
Hornik
Lech
L
Wlost
Stefan
S
Bairaktaris
Andreas
A
Körfer
Reiner
R
D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D006084:Graft Rejection / Q000601:surgery; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D012086:Reoperation; D016019:Survival Analysis; D014019:Tissue Donors; D016896:Treatment Outcome