Should we perform heart retransplantation in early graft failure?
Cardiac retransplantation represents the gold standard treatment for a failing cardiac graft but the decision to offer the patient a second chance is often made difficult by both lack of donors and the ethical issues involved. The aim of this study was to evaluate whether retransplantation is a reasonable option in case of early graft failure. Between November 1985 and June 2008, 922 patients underwent cardiac transplantation at our Institution. Of these, 37 patients (4%) underwent cardiac retransplantation for cardiac failure resulting from early graft failure (n = 11) or late graft failure (acute rejection: n = 2, transplant-related coronary artery disease: n = 24). Survival at 1, 5 and 10 years of patients with retransplantation was 59%, 50% and 40% respectively. An interval between the first and the second transplantation of less than (n = 11, all in early graft failure) or more than (n = 26) 1 month was associated with a 1-year survival of 27% and 73%, and a 5-year survival of 27% and 65% respectively (P = 0.01). The long-term outcome of cardiac retransplantation is comparable with that of primary transplantation only in patients with transplant-related coronary artery disease. Early graft failure is a significant risk factor for survival after cardiac retransplantation and should be considered as an exclusion criteria.
Vistarini
Nicola
N
Department of Cardiac Surgery and Thoracic Transplantation, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. nvistar@tin.it
Pellegrini
Carlo
C
Aiello
Marco
M
Alloni
Alessia
A
Monterosso
Cristian
C
Cattadori
Barbara
B
Tinelli
Carmine
C
D'Armini
Andrea M
AM
Vigano
Mario
M
D000328:Adult; D000368:Aged; D000075202:Contraindications; D003324:Coronary Artery Disease / Q000209:etiology / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000601:surgery*; D006085:Graft Survival; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome