title: Cardiac retransplantation is an efficacious therapy for primary cardiac allograft failure.
abstract: BACKGROUND
  Although orthotopic heart transplantation has been an effective treatment for end-stage heart failure, the incidence of allograft failure has increased, necessitating treatment options. Cardiac retransplantation remains the only viable long-term solution for end-stage cardiac allograft failure. Given the limited number of available donor hearts, the long term results of this treatment option need to be evaluated.
  
  
  METHODS
  709 heart transplants were performed over a 20 year period at our institution. Repeat cardiac transplantation was performed in 15 patients (2.1%). A retrospective analysis was performed to determine the efficacy of cardiac retransplantation. Variables investigated included: 1 yr and 5 yr survival, length of hospitalization, post-operative complications, allograft failure, recipient and donor demographics, renal function, allograft ischemic time, UNOS listing status, blood group, allograft rejection, and hemodynamic function.
  
  
  RESULTS
  Etiology of primary graft failure included transplant arteriopathy (n = 10), acute rejection (n = 3), hyperacute rejection (n = 1), and a post-transplant diagnosis of metastatic melanoma in the donor (n = 1). Mean age at retransplantation was 45.5 +/- 9.7 years. 1 and 5 year survival for retransplantation were 86.6% and 71.4% respectively, as compared to 90.9% and 79.1% for primary transplantation. Mean ejection fraction was 67.3 +/- 12.2% at a mean follow-up of 32.6 +/- 18.5 mos post-retransplant; follow-up biopsy demonstrated either ISHLT grade 1A or 0 rejection (77.5 +/- 95.7 mos post-transplant).
  
  
  CONCLUSIONS
  Cardiac retransplantation is an efficacious treatment strategy for cardiac allograft failure.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. pavan.atluri@uphs.upenn.edu
authors.forename: Pavan
authors.initials: P
authors.lastname: Atluri
authors.forename: William
authors.initials: W
authors.lastname: Hiesinger
authors.forename: Robert C
authors.initials: RC
authors.lastname: Gorman
authors.forename: Alberto
authors.initials: A
authors.lastname: Pochettino
authors.forename: Mariell
authors.initials: M
authors.lastname: Jessup
authors.forename: Michael A
authors.initials: MA
authors.lastname: Acker
authors.forename: Rohinton J
authors.initials: RJ
authors.lastname: Morris
authors.forename: Y Joseph
authors.initials: YJ
authors.lastname: Woo
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome