Cardiac retransplantation: is it justified in times of critical donor organ shortage? Long-term single-center experience.
OBJECTIVE
Survival after heart transplantation has improved significantly over the last decades. There are a growing number of patients that require cardiac retransplantation because of chronic allograft dysfunction. With regard to the critical shortage of cardiac allograft donors the decision to offer repeat heart transplantation must be carefully considered.


METHODS
Since 1983 a total of 807 heart transplantations have been performed at our institution. Among them 41 patients received cardiac retransplantation, 18 patients because of acute graft failure and 23 because of chronic graft failure. Data were analyzed for demographics, morbidity and risk factors for mortality. The acute and chronic retransplant group was compared to those patients undergoing primary transplantation.


RESULTS
The mean interval between primary transplantation and retransplantation was 1.9 days in the acute and 6.7 years in the chronic retransplant group. Mean follow-up was 6.9 years. Baseline characteristics were similar in the primary and retransplant group. Actuarial survival rates at 1, 3, 5 and 7 years after primary cardiac transplantation compared to retransplantation were 83, 78, 72 and 64% vs 53, 50, 47 and 36%, respectively (p<0.001). Early mortality after acute retransplantation was significantly higher compared to late retransplantation (10/18, 55.6% vs 4/23, 17.4%, p=0.011). Major causes of death were acute and chronic rejection, infection and sepsis.


CONCLUSIONS
Cardiac retransplantation is associated with lower survival rates compared to primary transplantation. However, results after retransplantation in chronic graft failure are significantly better compared to acute graft failure. Therefore, we consider cardiac retransplantation in chronic graft failure a justified therapeutic option. In contrast, patients with acute graft failure seem to be inappropriate candidates for cardiac retransplantation.
Goerler
Heidi
H
Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. goerler.adelheid@mh-hannover.de
Simon
Andre
A
Gohrbandt
Bernhard
B
Hagl
Christian
C
Oppelt
Petra
P
Haverich
Axel
A
Strueber
Martin
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000601:surgery; D006324:Heart Arrest, Induced / Q000379:methods; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012044:Regression Analysis; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D012306:Risk; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution; D014184:Transplantation, Homologous; D055815:Young Adult