title: Who gets a second heart? A current picture of cardiac retransplantation.
abstract: BACKGROUND
  Heart retransplantation (HRT) accounts for 2.6% of heart transplantation (HT) indications. We performed a retrospective analysis of our recent HRT experience.
  
  
  METHODS
  From January 2000 to June 2012, 820 HTs were performed; 798 (97.3%) were primary HTs and 21 (2.5%) 2nd HTs. Indications for HRT included: 57% cardiac allograft vasculopathy, 33% nonspecific graft failure, 5% primary graft failure (PGF), and 5% refractory acute rejection. The primary outcome was overall survival. Our results were compared with the most representative publications reporting HRT experiences before January 2000.
  
  
  RESULTS
  Mean age at HRT was 39.9 ± 14.3 years, and there was a predominance of male patients (62%). Overall mortality was 52%; 30-day mortality was 19%. Eight patients (38%) developed PGF after HRT and 3 of them (38%) died within 30 days. Overall actuarial survivals at 1 month and 1, 3, and 5 years were 81.0%, 70.8%, 59.9%, and 53.3%, respectively. No significant risk factors for mortality could be identified.
  
  
  CONCLUSIONS
  We observed improved short- and medium-term survival after HRT. This finding is probably related to changing recipient profiles, with less patients being retransplanted for PGF and more patients undergoing late retransplantation. Higher rates of PGF after HRT reflect our efforts to broaden the allograft pool by using marginal donors.
authors: Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, University "Pierre et Marie Curie", Paris, France; Ph.D. School in Cardiovascular Science, Cardiovascular Surgery Unit, University of Verona Medical School, Verona, Italy. Electronic address: mpozzi1979@gmail.com.
authors: M
authors: M
authors: Pozzi
authors: Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, University "Pierre et Marie Curie", Paris, France.
authors: C
authors: C
authors: d'Alessandro
authors: Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, University "Pierre et Marie Curie", Paris, France.
authors: F
authors: F
authors: Fernandez
authors: Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, University "Pierre et Marie Curie", Paris, France.
authors: A
authors: A
authors: Nguyen
authors: Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, University "Pierre et Marie Curie", Paris, France.
authors: A
authors: A
authors: Pavie
authors: Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, University "Pierre et Marie Curie", Paris, France.
authors: P
authors: P
authors: Leprince
authors: Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, University "Pierre et Marie Curie", Paris, France.
authors: S
authors: S
authors: Varnous
authors: Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, University "Pierre et Marie Curie", Paris, France.
authors: M
authors: M
authors: Kirsch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents