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Published on: June 23, 2022
Can cardiac re-transplantation be performed with an acceptable survival after primary graft failure?
R Hareendran Bhaskaran Nair1, Thassee Pillay, Asif Hasan
1Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, Newcastle upon Tyne, NE7 7AZ, UK.
Insights
Cardiac re-transplantation survival is acceptable for graft coronary disease but not for acute graft failure. Acute graft failure or rejection necessitates mechanical assist devices due to high mortality risks with re-transplantation.
Area of Science:
- Cardiology
- Thoracic Surgery
- Transplantation Medicine
Background:
- Primary graft failure following cardiac transplantation presents a critical clinical challenge.
- Re-transplantation is a potential therapeutic option for patients with failing grafts.
Purpose of the Study:
- To evaluate the survival outcomes of cardiac re-transplantation in patients experiencing primary graft failure.
- To compare re-transplantation survival rates based on the cause of graft failure (coronary disease vs. acute failure/rejection).
Main Methods:
- Systematic review of existing literature based on a structured protocol.
- Identification and analysis of 18 papers providing the best evidence from an initial search of 458 studies.
- Tabulation of study characteristics, outcomes, and weaknesses.
Main Results:
- Cardiac re-transplantation for graft coronary disease demonstrates survival rates comparable to primary cardiac transplantation.
- Acute re-transplantation for acute graft failure or rejection is associated with unacceptably high mortality.
Conclusions:
- Mechanical assist devices are recommended for managing acute graft failure or rejection post-cardiac transplantation.
- Cardiac re-transplantation is a viable option for graft coronary disease but carries significant risks for acute graft failure.
Abstract:
A best evidence topic in cardio thoracic surgery was written according to a structured protocol. The question addressed whether cardiac re-transplantation can be performed with an acceptable survival in patients who suffer primary graft failure? Altogether 458 papers were found using the reported search, of which 18 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. We conclude that while re-transplantation for graft coronary disease has a similar survival to patients undergoing primary transplantation, acute graft failure or rejection should be treated with a mechanical assist device, as acute re-transplantation is associated with an unacceptably high mortality.
