Emergency and elective cardiac retransplantation

Area of Science:

• Cardiology
• Transplantation Immunology

Background:

• Cardiac retransplantation is a complex procedure with varying outcomes.
• Graft failure and acute or chronic rejection are primary indications for retransplantation.

Purpose of the Study:

• To evaluate the outcomes of cardiac retransplantation in a single institution.
• To compare the results of emergency versus elective retransplantation.
• To assess the impact of immunosuppressive strategies and crossmatch status on survival.

Main Methods:

• Retrospective analysis of 7 cardiac retransplantations over a period.
• Categorization of retransplantations into emergency (graft failure, acute rejection) and elective (chronic rejection) groups.
• Review of immunosuppression protocols, including plasmapheresis and cyclophosphamide, and crossmatch results.

Main Results:

• Overall early and late survival rates were 71% and 57%, respectively, with a mean follow-up of 48.5 months.
• Emergency retransplantation had a higher operative risk, while elective retransplantation demonstrated zero early and late mortality.
• Successful retransplantation was achieved in two cases with positive donor crossmatch using enhanced immunosuppression.
• The predictive value of a negative crossmatch in highly sensitized patients was questioned.

Conclusions:

• Elective cardiac retransplantation offers excellent survival outcomes.
• Emergency retransplantation is associated with significant operative risks.
• Enhanced immunosuppression and plasmapheresis can facilitate successful retransplantation in select cases with positive crossmatch.
• Careful patient selection and timing are crucial for optimizing cardiac retransplantation results.