title: Should heart transplant recipients with early graft failure be considered for retransplantation?
abstract: BACKGROUND
  The purpose of this study was to determine if orthotopic heart transplantation performed within 90 days of an initial heart transplant (re-Tx) should be a contraindication to retransplantation based on inferior outcomes when compared with primary orthotopic heart transplantation recipients (control).
  
  
  METHODS
  De-identified data were obtained from the United Network for Organ Sharing. The study population included all adult heart transplant recipients greater than 18 years old from 1995 to 2008 (n=26,804). Multivariable regression was performed in order to assess the simultaneous effect of multiple risk factors on posttransplant graft failure (PTGF) at 90 days. Secondary outcomes of interest included infection, stroke, and dialysis during the transplant hospitalization as well as primary nonfunction of the graft at 90 days.
  
  
  RESULTS
  Among the study cohort, there were 90 (0.34%) re-Tx patients. Median survival in this group was 1.6 years compared with 10.5 years for controls. Unadjusted PTGF, infection, dialysis, and primary nonfunction were significantly higher (p<0.001) in the re-Tx group. After risk adjustment, however, PTGF (p=0.545), infection (p=0.696), dialysis (p=0.664), stroke (p=0.115), and primary nonfunction (p=0.531), did not differ significantly between the 2 groups.
  
  
  CONCLUSIONS
  When controlling for pretransplant recipient characteristics, retransplantation within 90 days of a previous transplant is not associated with increased morbidity or mortality. However, unadjusted overall survival was significantly worse in the re-Tx group. This suggests that although retransplantation at 90 days alone is not a risk factor for inferior outcomes, given the significant comorbidities of these patients, the indications for retransplantation within 90 days are rare and must be critically examined.
authors.affiliation: University of Chicago Medical Center, Center for Health & the Social Sciences, The University of Chicago, Chicago, IL 60637, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Iribarne
authors.forename: Kimberly N
authors.initials: KN
authors.lastname: Hong
authors.forename: Rachel
authors.initials: R
authors.lastname: Easterwood
authors.forename: Jonathan
authors.initials: J
authors.lastname: Yang
authors.forename: Valluvam
authors.initials: V
authors.lastname: Jeevanandam
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Russo
mesh_terms: D000328:Adult; D003657:Decision Making; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000601:surgery*; D006085:Graft Survival; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology