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Pediatric cardiac retransplantation: intermediate-term results
J A Dearani1, A J Razzouk, S R Gundry
1Loma Linda University Medical Center and Children's Hospital, California. jdearani@mayo.edu
Insights
Pediatric cardiac retransplantation (re-CTx) offers a viable option for failing grafts. Intermediate-term survival after re-CTx is comparable to primary cardiac transplants, indicating acceptable outcomes.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Transplantation Medicine
Background:
- Pediatric cardiac retransplantation (re-CTx) is a complex procedure for failing grafts.
- It remains the optimal treatment for select pediatric recipients.
Purpose of the Study:
- To determine the incidence of re-CTx in a pediatric population.
- To evaluate the outcomes and survival rates of pediatric re-CTx.
Main Methods:
- Retrospective analysis of 347 pediatric cardiac transplant recipients from 1985-1999.
- 22 children underwent re-CTx, with data collected on indications, timing, and outcomes.
Main Results:
- Allograft vasculopathy was the primary indication for re-CTx (n=16).
- Operative mortality was 13.6%, with survival at 3 years at 81.9% +/- 8.9%.
- Intermediate-term survival was similar to primary cardiac transplantation (77.3% +/- 2.6%).
Conclusions:
- Elective pediatric re-CTx can be performed with acceptable operative mortality.
- Intermediate-term survival post-re-CTx is comparable to primary cardiac transplantation in children.
Background:
Cardiac retransplantation (re-CTx) in children is a controversial therapy, yet it remains the best treatment option to recipients with failing grafts. Our objective was to determine the incidence of re-CTx in a large pediatric population of recipients and evaluate the outcome of such therapy.
Methods:
Between November 1985 and November 1999, 347 children underwent cardiac transplantation at the Loma Linda University Medical Center. Of these, 32 children were listed for re-CTx. Ten patients died while waiting, and 22 recipients underwent re-CTx. Median age at re-CTx was 7.1 years (range, 52 days to 20.1 years).
Results:
Indications for re-CTx were allograft vasculopathy (n = 16), primary graft failure (n = 5), and acute rejection (n = 1). Two patients with primary graft failure underwent retransplantation within 24 hours of the first transplantation procedure while on extracorporeal membrane oxygenation support. Median time interval to re-CTx for the others was 7.2 years (range, 32 days to 9.4 years). Operative mortality for all cardiac re-CTx procedures was 13.6%. Causes of hospital mortality were pulmonary hypertension with graft failure (n = 2) and multiorgan failure (n = 1). Median hospital stay after re-CTx was 14.1 days (range, 6 to 45 days). There was one late death from severe rejection. Actuarial survival at 3 years for re-CTx was 81.9% +/- 8.9% compared with 77.3% +/- 2.6% for primary cardiac transplantation recipients (p = 0.70).
Conclusions:
Elective re-CTx can be performed with acceptable mortality. Although the number of patients undergoing retransplantation in this report is small and their long-term outcome is unknown, the intermediate-term survival after re-CTx is similar to that of children undergoing primary cardiac transplantation.
