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Long-term survival after cardiac retransplantation: a twenty-year single-center experience
1Divisions of Cardiothoracic Surgery and Cardiology, Columbia Presbyterian Medical Center, Columbia University, New York, NY, USA.
Insights
Cardiac retransplantation offers survival comparable to primary transplantation, particularly for transplant-related coronary artery disease. Careful patient selection is key to optimizing outcomes and donor organ use.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Cardiac transplantation is a life-saving procedure for end-stage heart disease.
- Retransplantation is considered when the initial graft fails.
- Understanding factors influencing retransplantation outcomes is crucial for patient management.
Purpose of the Study:
- To identify risk factors for survival after cardiac retransplantation.
- To compare survival rates between primary cardiac transplantation and retransplantation.
Main Methods:
- Retrospective analysis of 952 cardiac transplant patients (1977-1997).
- 43 patients underwent cardiac retransplantation due to graft failure or complications.
- Kaplan-Meier and multivariable analyses were used to assess survival and risk factors.
Main Results:
- No significant difference in 1-, 2-, or 5-year survival between primary and retransplantation (76%, 71%, 60% vs. 66%, 66%, 51%).
- Shorter interval between transplants and ischemic cardiomyopathy were risk factors for death post-retransplantation.
- Revised selection criteria since 1993 significantly improved survival rates (45% to 94%).
Conclusions:
- Cardiac retransplantation outcomes are comparable to primary transplantation, especially in cases of transplant-related coronary artery disease.
- Preoperative patient characteristics and variables aid in the rational selection for retransplantation.
- Optimizing donor organ utilization through careful selection enhances long-term results.
Objective:
To identify risk factors for survival after cardiac retransplantation and compare the survival after retransplantation with that after primary cardiac transplantation.
Methods:
A retrospective analysis of 952 patients undergoing cardiac transplantation for the treatment of end-stage heart disease at a single center between 1977 and October 1997. Of these, 43 patients (4.5%) underwent cardiac retransplantation for cardiac failure resulting from transplant-related coronary artery disease, rejection, and early graft failure.
Results:
No significant difference in actuarial patient survival was found by Kaplan-Meier analysis at 1, 2, and 5 years between patients undergoing primary transplantation and those undergoing retransplantation 76%, 71%, and 60% versus 66%, 66%, and 51%, respectively (P =.2). Multivariable analysis identified a shorter interval between transplants and an initial diagnosis of ischemic cardiomyopathy as significant risk factors for death after retransplantation (P =.04 and.03, respectively). Since 1993, when our criteria for patient selection for retransplantation were revised on the basis of earlier experience to exclude patients with allograft dysfunction as a result of primary graft failure and those with intractable acute rejection occurring less than 6 months after transplantation, the survival has been significantly better (<1993 = 45%, 45%, and 33% versus >/=1993 = 94%, 94%, and 94% at 1, 2, and 4 years, respectively, P =.003).
Conclusion:
The long-term outcome of cardiac retransplantation is comparable with that of primary transplantation, especially in patients with transplant-related coronary artery disease. Patient characteristics and other preoperative variables should assist in the rational application of retransplantation to ensure optimal use of donor organs.