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Updated: Jul 5, 2026
A Porcine Heterotopic Heart Transplantation Protocol for Delivery of Therapeutics to a Cardiac Allograft
Published on: February 14, 2022
Cardiac retransplantation is an efficacious therapy for primary cardiac allograft failure
Pavan Atluri1, William Hiesinger, Robert C Gorman
1Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. pavan.atluri@uphs.upenn.edu
Insights
Cardiac retransplantation offers a viable solution for heart allograft failure, demonstrating significant long-term survival rates. This procedure is an effective treatment for patients with end-stage heart failure, despite challenges with donor heart availability.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Orthotopic heart transplantation is effective for end-stage heart failure.
- Increasing allograft failure necessitates alternative treatments.
- Cardiac retransplantation is the sole long-term option for graft failure.
Purpose of the Study:
- To evaluate the efficacy of cardiac retransplantation.
- To assess long-term outcomes and survival rates.
- To analyze factors influencing retransplantation success.
Main Methods:
- Retrospective analysis of 709 heart transplants over 20 years.
- 15 patients (2.1%) underwent repeat cardiac transplantation.
- Investigated survival, complications, demographics, and graft function.
Main Results:
- Primary graft failure causes: transplant arteriopathy (10), acute rejection (3), hyperacute rejection (1), donor melanoma (1).
- 1- and 5-year survival for retransplantation: 86.6% and 71.4%.
- Post-retransplant ejection fraction averaged 67.3%; 77.5% showed minimal rejection.
Conclusions:
- Cardiac retransplantation is an effective treatment for cardiac allograft failure.
- Retransplantation offers significant survival benefits.
- The procedure demonstrates favorable long-term graft function.
Background:
Although orthotopic heart transplantation has been an effective treatment for end-stage heart failure, the incidence of allograft failure has increased, necessitating treatment options. Cardiac retransplantation remains the only viable long-term solution for end-stage cardiac allograft failure. Given the limited number of available donor hearts, the long term results of this treatment option need to be evaluated.
Methods:
709 heart transplants were performed over a 20 year period at our institution. Repeat cardiac transplantation was performed in 15 patients (2.1%). A retrospective analysis was performed to determine the efficacy of cardiac retransplantation. Variables investigated included: 1 yr and 5 yr survival, length of hospitalization, post-operative complications, allograft failure, recipient and donor demographics, renal function, allograft ischemic time, UNOS listing status, blood group, allograft rejection, and hemodynamic function.
Results:
Etiology of primary graft failure included transplant arteriopathy (n = 10), acute rejection (n = 3), hyperacute rejection (n = 1), and a post-transplant diagnosis of metastatic melanoma in the donor (n = 1). Mean age at retransplantation was 45.5 +/- 9.7 years. 1 and 5 year survival for retransplantation were 86.6% and 71.4% respectively, as compared to 90.9% and 79.1% for primary transplantation. Mean ejection fraction was 67.3 +/- 12.2% at a mean follow-up of 32.6 +/- 18.5 mos post-retransplant; follow-up biopsy demonstrated either ISHLT grade 1A or 0 rejection (77.5 +/- 95.7 mos post-transplant).
Conclusion:
Cardiac retransplantation is an efficacious treatment strategy for cardiac allograft failure.
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