title: Long-term survival after cardiac retransplantation: a single-center experience.
abstract: Cardiac retransplantation is controversial therapy because of a chronic shortage of donor hearts. We retrospectively reviewed short- and long-term outcomes after cardiac retransplantation. Between February 1989 and December 2004, 28 cases of cardiac retransplantation were performed. Indications for retransplantation were primary graft failure (PGF) in 11 patients (39.3%), intractable acute cardiac rejection (IACR) in 4 (14.3%), and coronary allograft vasculopathy (CAV) in 13 (46.4%). The patients had been supported with prolonged cardiopulmonary bypass (CPB) (n = 3), IABP (n = 1), intravenous inotropic support (n = 7), ECMO (n = 3), and VAD (n = 4). Ten patients had no inotropic support. Eight patients died within 30 days postoperatively. The causes of early death were acute rejection (n = 3 ; 37%), MOF (n = 3 ; 37%), PGF (n = 1 ; 13%), and right ventricular failure (n = 1 ; 13%). The causes of late death in 8 other patients were acute rejection (n = 4 ; 50%), CAV (n = 2 ; 25%), MOF (n = 1 ; 13%), and infection (n = 1 ; 13%). The 1-, 5-, 10-, and 15-year survivals were 78.5, 68.4, 54.5, and 38.3%, respectively, for primary cardiac transplantation, and 46.4, 40.6, 32.5, and 32.5% for cardiac retransplantation (P = 0.003). Acute cardiac rejection was the most common cause of death (43.8%). Thirty-day and 1-year survivals of IACR, PGF, and CAV were 50.0/0, 63.6/45.5, and 84.6/68.4%, respectively. Long-term survival after retransplantation was acceptable for patients with CAV and PGF, however, we should select patients carefully if the indication for retransplantation is IACR because of the poor outcome.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart Center North-Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany.
authors.forename: Masataka
authors.initials: M
authors.lastname: Yoda
authors.forename: Gero
authors.initials: G
authors.lastname: Tenderich
authors.forename: Armin
authors.initials: A
authors.lastname: Zittermann
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schulte-Eistrup
authors.forename: Reiner
authors.initials: R
authors.lastname: Körfer
authors.forename: Kazutomo
authors.initials: K
authors.lastname: Minami
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome