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Clinical experience with cardiac retransplantation
R E Michler1, M J McLaughlin, J M Chen
1Division of Cardiothoracic Surgery, Columbia-Presbyterian Medical Center, Columbia University College of Physicians & Surgeons, New York, NY.
The Journal of Thoracic and Cardiovascular Surgery
|October 1, 1993
Summary
Cardiac retransplantation shows promising survival rates comparable to primary heart transplants. Early graft failure does not impact long-term outcomes, suggesting retransplantation is a viable option for select patients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Cardiac retransplantation is an option for end-stage heart failure, yet data on its outcomes and selection criteria remain limited.
- Over 560 cardiac retransplantations have been performed globally, but few studies have analyzed this patient population.
- This study evaluates the risks and outcomes associated with cardiac retransplantation.
Purpose of the Study:
- To assess the outcomes of cardiac retransplantation.
- To compare survival rates between primary heart transplant recipients and those undergoing retransplantation.
- To identify factors influencing the success of cardiac retransplantation.
Main Methods:
- Retrospective review of cardiac retransplantation cases at Columbia-Presbyterian Medical Center between February 1977 and March 1991.
- Analysis of 14 retransplantation procedures among 408 patients who received primary transplants during the cyclosporine era.
- Comparison of survival, rejection rates, and mortality between primary transplant and retransplant cohorts.
Main Results:
- Actuarial survival rates at 1 and 2 years were similar for primary transplant recipients (75.1%, 71.3%) and retransplant patients (71.4%, 59.5%).
- No significant differences were observed in rejection rates or early mortality (<30 days) between the two groups.
- Indications for retransplantation included transplant coronary artery disease (8 cases), rejection (5 cases), and graft failure (1 case).
Conclusions:
- Cardiac retransplantation offers a good prognosis, particularly when indicated more than 30 days after the initial transplant.
- Survival outcomes and rejection rates for retransplantation are comparable to primary heart transplantation.
- Further research is needed to refine selection criteria for cardiac retransplantation.