title: Early and late outcomes after cardiac retransplantation.
abstract: BACKGROUND
  Cardiac retransplantation remains the most viable option for patients with allograft heart failure; however, careful patient selection is paramount considering limited allograft resources. We analyzed clinical outcomes following retransplantation in an academic, tertiary care institution.
  
  
  METHODS
  Between 1981 and 2011, 593 heart transplantations, including 22 retransplantations were performed at our institution. We analyzed the preoperative demographic characteristics, cause of allograft loss, short- and long-term surgical outcomes and cause of death among patients who had cardiac retransplantations.
  
  
  RESULTS
  Twenty-two patients underwent retransplantation: 10 for graft vascular disease, 7 for acute rejection and 5 for primary graft failure. Mean age at retransplantation was 43 (standard deviation [SD] 15) years; 6 patients were women. Thirteen patients were critically ill preoperatively, requiring inotropes and/or mechanical support. The median interval between primary and retransplantation was 2.2 (range 0-16) years. Thirty-day mortality was 31.8%, and conditional (> 30 d) 1-, 5- and 10-year survival after retransplantation were 93%, 79% and 59%, respectively. A diagnosis of allograft vasculopathy (p = 0.008) and an interval between primary and retransplantation greater than 1 year (p = 0.016) had a significantly favourable impact on 30-day mortality. The median and mean survival after retransplantation were 3.3 and 5 (SD 6, range 0-18) years, respectively; graft vascular disease and multiorgan failure were the most common causes of death.
  
  
  CONCLUSIONS
  Long-term outcomes for primary and retransplantation are similar if patients survive the 30-day postoperative period. Retransplantation within 1 year of the primary transplantation resulted in a high perioperative mortality and thus may be a contraindication to retransplantation.
authors.affiliation: The Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London Health Sciences Centre, Lawson Health Research Institute, London, Ont., Canada.
authors.forename: Aya
authors.initials: A
authors.lastname: Saito
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Novick
authors.forename: Bob
authors.initials: B
authors.lastname: Kiaii
authors.forename: F Neil
authors.initials: FN
authors.lastname: McKenzie
authors.forename: Mackenzie
authors.initials: M
authors.lastname: Quantz
authors.forename: Peter
authors.initials: P
authors.lastname: Pflugfelder
authors.forename: Grant
authors.initials: G
authors.lastname: Fisher
authors.forename: Michael W A
authors.initials: MW
authors.lastname: Chu
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000601:surgery*; D006333:Heart Failure / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality / Q000592:standards; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009864:Ontario; D018579:Patient Selection; D059035:Perioperative Period; D012086:Reoperation / Q000401:mortality / Q000592:standards; D012189:Retrospective Studies; D012307:Risk Factors; D063128:Tertiary Health Care; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents