Original Articles
Heart Retransplantation: A 23-Year Single-Center Clinical Experience

https://doi.org/10.1016/S0003-4975(98)00058-7Get rights and content

Abstract

Background. The main causes of allograft failure after cardiac transplantation are primary graft dysfunction, intractable acute rejection, and coronary graft disease. Despite the important progress in the last several years in graft preservation, surgical techniques, immunosuppression, and treatment of coronary graft disease, retransplantation in selected cases is the only way to achieve long-term recipient survival.

Methods. We compare here in a case-control study 24 retransplantations with 47 first transplants in patients matched for date of transplantation.

Results. Between 1973 and 1996, 1,063 patients underwent cardiac transplantation in our institution. In this cohort, 22 patients had a total of 24 retransplantations (2 second-time retransplantations). The causes of retransplantations were primary graft failure (n = 4), acute rejection (n = 7), coronary graft disease (n = 11), and miscellaneous (n = 2). Survival at 1 and 5 years of patients with retransplantations is 45.5% and 31.2%, and survival of control patients is 59.4% and 38.8% (p = 0.07). An interval between first transplantation and retransplantation shorter (n = 11) or longer (n = 13) than 1 year is associated with a 1-year survival of 27.3% and 61.5% and a 4-year survival of 27.3% and 46%, respectively (not significant). Intervals shorter than 1 year between first transplantation and retransplantation were exclusively secondary to primary graft failure or intractable acute rejection.

Conclusions. In the face of lack of donor grafts, these and other data indicate that retransplantation should be considered cautiously, especially when the interval between the first transplantation and retransplantation is short.

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)

  • C Cabrol et al.

    Heart and heart-lung transplantationtechnique and safeguards

    Heart Transplant

    (1984)
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