Original ArticlesHeart Retransplantation: A 23-Year Single-Center Clinical Experience
Section snippets
Patients
Between January 1973 and April 1996, 1,063 patients underwent cardiac transplantation for end-stage cardiac disease in our hospital: 1,001 orthotopic and 62 heterotopic (Fig. 1). In this cohort, 24 (2.2%) were retransplanted (22 first time, 2 second time). There were 22 male and 2 female patients, ranging in age from 13 to 56 years (mean age ± standard deviation, 36 ± 14 years). Donors were brain-dead patients who suffered head trauma or cerebrovascular injury. At the beginning of our
Results
The original diagnoses of end-stage cardiac disease (Table 1) in the 22 patients (20 male and 2 female patients for a total of 24 retransplantations) who underwent retransplantation were idiopathic cardiomyopathy in 9 (41%), ischemic heart disease in 8 (36%), valvular disease in 2 (9%), and other diagnoses in 3 (14%). The indications for retransplantation (Table 2) were primary graft failure in 4 (17%), refractory acute rejection in 7 (29%), coronary graft disease in 11 (46%), and others in 2
Comment
Five-year survival in patients who underwent transplantation between 1991 and 1996 in our institution is 63.4% and therefore closely matches survival reported in the ISHLT registry [7]. We would stress that survival depicted in the control group in Fig. 3 reflects survival of patients representative of the whole program since its beginning in 1973 and not survival of patients receiving transplants in the more recent years, as depicted in Fig. 2. Survival in the control group is somewhat
Acknowledgements
We are indebted to Aileen Caufield and Thierry Berney for their dedication in preparing the manuscript and to Monique Thallier, who helped us in collecting the data.
References (22)
- et al.
Clinical experience with cardiac retransplantation
J Thorac Cardiovasc Surg
(1993) - et al.
Cardiac retransplantation in the cyclosporin era
Ann Thorac Surg
(1989) - et al.
Myocardial protection by blood cardioplegia and warm reperfusion in heart transplantation
Ann Thorac Surg
(1992) - et al.
Doppler echocardiography for the diagnosis of acute cardiac allograft rejection
J Am Coll Cardiol
(1988) - et al.
Predictors of survival after repeat heart transplantation
J Heart Lung Transplant
(1992) - et al.
Emergency and elective cardiac transplantation
Eur J Cardiothorac Surg
(1993) - et al.
Heart retransplantationthe 25-year experience at a single institution
J Heart Lung Transplant
(1995) - et al.
Cardiac retransplantation. Indications and outcome
Arch Mal Coeur
(1996) - et al.
The Registry of the International Society for Heart and Lung Transplantationthirteenth official report—1996
J Heart Lung Transplant
(1996) - et al.
Studies on orthotopic transplantation of the canine heart
Surg Forum
(1960)
Heart and heart-lung transplantationtechnique and safeguards
Heart Transplant
Cited by (60)
Preoperative risk factors predict survival following cardiac retransplantation: Analysis of the United Network for Organ Sharing database
2014, Journal of Thoracic and Cardiovascular SurgeryWho gets a second heart? A current picture of cardiac retransplantation
2014, Transplantation ProceedingsCitation Excerpt :Even if morbidity and mortality did not differ between HRT patients and control group after risk adjustment, the authors stated that HRT as a salvage strategy for recipients with PGF must be critically reviewed mainly in consideration of the shortage of heart donors. In case of PGF, with its related hemodynamic instability and end-organ dysfunction, HRT used as a salvage procedure explains its ominous outcome in this subgroup of patients, both in recent and in earlier experiences [4,7]. In our series, HRT for PGF resulted in 100% mortality.
Analysis of 2000 heart transplant, procedures at La Pitie Hospital
2012, Bulletin de l'Academie Nationale de MedecineIdentifying recipients at high risk for graft failure after heart retransplantation
2012, Annals of Thoracic SurgeryElective cardiac retransplantation: A viable option that can be repeated
2011, Journal of Thoracic and Cardiovascular SurgeryHigher Rate of Comorbidities After Cardiac Retransplantation Contributes to Decreased Survival
2009, Journal of Heart and Lung TransplantationCitation Excerpt :According to the Scientific Registry of Transplant Recipients (SRTR), the percentage of retransplantations among all heart transplants is constantly increasing.10 However, the outcome post-retransplantation remains inferior that seen in de novo transplantation,3–10 which has led some investigators to conclude that primary transplant candidates should receive priority because of their increased benefit from the procedure.11 Goerler et al12 showed a significantly higher mortality rate of 56% in the early retransplantation period (≤30 days after de novo transplant) compared with a late (≥30 days after de novo transplant) mortality rate of 17%.