title: Preoperative risk factors predict survival following cardiac retransplantation: analysis of the United Network for Organ Sharing database.
abstract: BACKGROUND
  The aim of our study was to identify preoperative risk factors affecting overall survival after cardiac retransplantation (ReTX) in a contemporary era.
  
  
  METHODS
  The United Network for Organ Sharing database was used to identify patients undergoing ReTX between 1995 and 2012. Of the total 28,464 primary transplants performed, 987 (3.5%) were retransplants. The primary outcome investigated was overall survival. The influence of preoperative donor and recipient characteristics on survival were then tested with univariate logistic regression and multivariate Cox regression models.
  
  
  RESULTS
  Of 987 patients who underwent ReTX, median survival was 9 years. Estimated survival at 1, 3, 5, 10, and 15 years following retransplant was 80% (95% confidence interval [CI], 78%-83%), 70% (95% CI, 67%-73%), 64% (95% CI, 61%-67%), 47% (95% CI, 43%-51%), and 30% (95% CI, 25%-37%), respectively. Clinical predictors of survival using multivariable analysis included donor age (relative risk [RR], 1.14; P = .004), ischemic time > 4 hours (RR, 1.48; P = .004); preoperative support with extracorporeal membrane oxygenator (RR, 3.91; P < .001), and the time between previous and current transplant (P = .004). Patients with ReTX have 1.27 times higher relative risk of death compared with patients undergoing primary transplant only (RR, 1.27; 95% CI, 1.13-1.42; P < .001).
  
  
  CONCLUSIONS
  Patients who undergo cardiac ReTX can expect to have a 1-year survival less than a patient undergoing primary transplant with an acceptable median overall survival. Both donor and recipient preoperative factors contribute to overall survival following cardiac ReTx. Donor characteristics include age of the donor and ischemic time. Recipient factors include the need for extracorporeal membrane oxygenator and the number of days between the first and second transplant. Optimal survival following cardiac ReTX can best be predicted by choosing patients who are farther out from their initial transplant, not dependent upon preoperative extracorporeal support, and by choosing donor hearts younger in age and those likely to have shorter ischemic times.
authors.affiliation: Department of Surgery, Mayo Clinic Florida, Jacksonville, Fla.
authors.forename: Erol
authors.initials: E
authors.lastname: Belli
authors.affiliation: Department of Cardiology, Mayo Clinic Florida, Jacksonville, Fla.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Leoni Moreno
authors.affiliation: Department of Cardiology, Mayo Clinic Florida, Jacksonville, Fla.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hosenpud
authors.affiliation: Department of Biostatistics and Bioinformatics, Mayo Clinic Florida, Jacksonville, Fla.
authors.forename: Bhupendra
authors.initials: B
authors.lastname: Rawal
authors.affiliation: Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Fla.
authors.forename: Kevin
authors.initials: K
authors.lastname: Landolfo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult