Heart Retransplantation: Candidacy, Outcomes, and Management

To describe the incidence and epidemiology of heart retransplantation in adults and children and to review the risk factors associated with adverse outcome following retransplantation to help guide recipient selection.

Heart retransplantation is associated with inferior short-term and long-term survival when compared with primary heart transplantation and its use remains controversial although less so in the pediatric heart transplant population.

In the most recent era of heart transplantation, patients retransplanted for CAV, greater than 1 year from their primary transplant, and who are not in critical condition have improved survival compared with other retransplant recipients. Survival with retransplantation can approach that of primary transplantation when patients are appropriately selected. More research is needed regarding the optimal timing for retransplantation and the optimal management for patients after retransplantation.