title: Mechanical circulatory support as a bridge to cardiac retransplantation: a single center experience.
abstract: BACKGROUND
  Cardiac retransplantation is increasing in frequency. Recent data have shown that retransplantation outcomes are now comparable with primary transplantation. The use of mechanical circulatory support (MCS) as a bridge to retransplantation has similar post-retransplant outcomes to those without MCS, but the success of bridging patients to retransplant with MCS has not been well studied.
  
  
  METHODS
  From January 2000 to February 2014 at Columbia University Medical Center, 84 patients were listed for retransplantation. Of this cohort, 48 patients underwent retransplantation, 15 were bridged with MCS, 24 died, and 6 clinically improved. A retrospective analysis was performed examining waiting list time, survival to retransplantation, and survival after retransplant. The effect of the United Network of Organ Sharing (UNOS) allocation policy change in 2006 on waiting list time and MCS use was also investigated.
  
  
  RESULTS
  Of 48 patients who underwent retransplantation, 11 were bridged with MCS. Overall 1-year survival to retransplantation was 81.3%. There was no significant difference in waiting list survival (p = 0.71) in those with and without MCS. Death from cardiac arrest or multiorgan failure with infection was more frequent in the medically managed group (p = 0.002). After the UNOS 2006 allocation policy change, waiting list time (599 ± 936 days in Era 1 vs 526 ± 498 days in Era 2, p = 0.65) and waiting list survival (p = 0.22) between eras were comparable, but there was a trend toward greater use of MCS (p = 0.13). Survival after retransplant was acceptable.
  
  
  CONCLUSIONS
  The use of MCS as a bridge to cardiac retransplantation is a reasonable strategy.
authors.affiliation: Division of Cardiology, Department of Medicine.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Clerkin
authors.affiliation: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Sunu S
authors.initials: SS
authors.lastname: Thomas
authors.affiliation: Division of Cardiology, Department of Medicine.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Haythe
authors.affiliation: Division of Cardiology, Department of Medicine.
authors.forename: P Christian
authors.initials: PC
authors.lastname: Schulze
authors.affiliation: Division of Cardiology, Department of Medicine.
authors.forename: Maryjane
authors.initials: M
authors.lastname: Farr
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Division of Cardiology, Department of Medicine.
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
authors.affiliation: Division of Cardiology, Department of Medicine.
authors.forename: Susan W
authors.initials: SW
authors.lastname: Restaino
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Division of Cardiology, Department of Medicine. Electronic address: dmm31@columbia.edu.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000628:therapy*; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods*; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: UNOS allocation policy; mechanical circulatory support; retransplant; waiting list survival