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Who gets a second heart? A current picture of cardiac retransplantation
M Pozzi1, C d'Alessandro2, F Fernandez2
1Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, University "Pierre et Marie Curie", Paris, France; Ph.D. School in Cardiovascular Science, Cardiovascular Surgery Unit, University of Verona Medical School, Verona, Italy.
Insights
Heart retransplantation (HRT) shows improved survival rates, with fewer patients needing retransplantation for primary graft failure. This analysis of recent HRT outcomes offers valuable insights for heart transplantation (HT) strategies.
Area of Science:
- Cardiology
- Transplantation Medicine
- Surgical Outcomes
Background:
- Heart retransplantation (HRT) represents a small but significant portion of heart transplantation (HT) procedures.
- Recent HRT experience was analyzed to evaluate outcomes and compare them with historical data.
Purpose of the Study:
- To assess the outcomes of recent heart retransplantation (HRT) procedures.
- To compare current HRT results with previous studies published before 2000.
Main Methods:
- Retrospective analysis of 21 HRT cases performed between January 2000 and June 2012.
- Indications for HRT included cardiac allograft vasculopathy, graft failure, primary graft failure (PGF), and acute rejection.
- Overall survival was the primary outcome measure, compared against historical HRT data.
Main Results:
- The mean age of patients undergoing HRT was 39.9 years, with a male predominance (62%).
- Overall mortality was 52%, with 30-day mortality at 19%.
- Actuarial survival rates at 1 month, 1, 3, and 5 years were 81.0%, 70.8%, 59.9%, and 53.3%, respectively. No significant mortality risk factors were identified.
Conclusions:
- Short- and medium-term survival after HRT has improved.
- This improvement is attributed to shifts in recipient profiles, with fewer HRTs for PGF and more for late graft failure.
- Increased PGF rates post-HRT reflect the use of marginal donors to expand the allograft pool.
Background:
Heart retransplantation (HRT) accounts for 2.6% of heart transplantation (HT) indications. We performed a retrospective analysis of our recent HRT experience.
Methods:
From January 2000 to June 2012, 820 HTs were performed; 798 (97.3%) were primary HTs and 21 (2.5%) 2nd HTs. Indications for HRT included: 57% cardiac allograft vasculopathy, 33% nonspecific graft failure, 5% primary graft failure (PGF), and 5% refractory acute rejection. The primary outcome was overall survival. Our results were compared with the most representative publications reporting HRT experiences before January 2000.
Results:
Mean age at HRT was 39.9 ± 14.3 years, and there was a predominance of male patients (62%). Overall mortality was 52%; 30-day mortality was 19%. Eight patients (38%) developed PGF after HRT and 3 of them (38%) died within 30 days. Overall actuarial survivals at 1 month and 1, 3, and 5 years were 81.0%, 70.8%, 59.9%, and 53.3%, respectively. No significant risk factors for mortality could be identified.
Conclusions:
We observed improved short- and medium-term survival after HRT. This finding is probably related to changing recipient profiles, with less patients being retransplanted for PGF and more patients undergoing late retransplantation. Higher rates of PGF after HRT reflect our efforts to broaden the allograft pool by using marginal donors.
