Related Experiment Videos
Cardiac retransplantation for graft vasculopathy in children: should we continue to do it?
A J Razzouk1, R E Chinnock, J A Dearani
1Department of Surgery, Loma Linda University Medical Center and Children's Hospital, Calif 92354, USA. arazzouk@som.llu.edu
Insights
Cardiac retransplantation (re-Tx) for graft vasculopathy (GV) in children yields similar outcomes to primary cardiac transplantation (CTx). Early re-Tx can benefit children with severe GV, who are at risk of sudden death.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Transplantation Medicine
Background:
- Cardiac transplantation (CTx) is a vital treatment for pediatric end-stage heart disease.
- Graft vasculopathy (GV) is a major complication limiting long-term survival after pediatric CTx.
- Cardiac retransplantation (re-Tx) is the only option for severe GV, but its utility is debated due to organ scarcity.
Purpose of the Study:
- To compare the outcomes of cardiac retransplantation (re-Tx) for graft vasculopathy (GV) with primary cardiac transplantation (CTx) in pediatric recipients.
- To evaluate the efficacy and safety of re-Tx in children with severe GV.
Main Methods:
- A 12-year retrospective cohort study was conducted at a university-affiliated children's hospital.
- Data from 322 primary CTx recipients (group 1) and 12 re-Tx recipients for GV (group 2) were analyzed.
- Outcomes including operative mortality, rejection rates, hospital stay, and actuarial survival were compared.
Main Results:
- No significant differences were observed in operative mortality (9.0% vs 8.3%), rejection rates (0.98 vs 0.86), or hospital stay (23.0 vs 20.5 days) between primary CTx and re-Tx groups.
- Actuarial survival at 1 year was similar (84.3% vs 83.3%), and at 4 years, survival was comparable (74.4% vs 83.3%).
Conclusions:
- Cardiac retransplantation for graft vasculopathy in children demonstrates similar surgical outcomes and intermediate survival rates to primary cardiac transplantation.
- Children with severe graft vasculopathy face a risk of sudden death and may benefit from timely cardiac retransplantation.
Background:
Cardiac transplantation (CTx) has been established as an effective therapy for a variety of inoperable cardiac conditions in infants and children. However, graft vasculopathy (GV) has emerged as the main limiting factor to long-term survival of CTx recipients. The only treatment of severe GV is cardiac retransplantation (re-Tx). Controversy exists regarding the use of scarce donor organs for cardiac re-Tx.
Objective:
To compare the outcome of cardiac re-Tx for GV with that of primary CTx in children.
Design:
A 12-year retrospective cohort review.
Setting:
A university-affiliated children's hospital.
Patients:
All infants and children who underwent CTx (group 1, n = 322) had complete follow-up of 1389.7 patient-years. Graft vasculopathy was confirmed in 32 recipients (1.1-8.2 years after undergoing CTx). Thirteen patients died suddenly, 3 died waiting for cardiac re-Tx (1-17 days after relisting), 4 are pending cardiac re-Tx, and 12 (group 2) underwent cardiac re-Tx.
Intervention:
Cardiac re-Tx at a mean (+/- SD) interval from the first CTx of 6.3 +/- 1.8 years (range, 2.2-9.4 years). Two patients required additional aortic arch aneurysm repair with cardiac re-Tx.
Results:
When group 1 was compared with group 2, there was no significant difference in operative mortality (9.0% vs 8.3%; P = .9), rejection rate (0.98 vs 0.86; P = .1), and hospital stay (23.0 +/- 18.8 days vs 20.5 +/- 11.6 days; P = .65). Actuarial survival for groups 1 and 2 at 1 and 4 years was 84.3% vs 83.3% (P = .59) and 74.4% vs 83.3% (P = .85), respectively.
Conclusions:
The surgical outcome and intermediate survival of cardiac re-Tx for GV and primary CTx are similar. Children with severe cardiac GV are at risk of sudden death and can benefit from early cardiac re-Tx.