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Cardiac retransplantation: is it justified in times of critical donor organ shortage? Long-term single-center experience

Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany

Received 29 February 2008; received in revised form 26 June 2008; accepted 30 June 2008.

^_* Corresponding author. Address: Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. Tel.: +49 511 532 2153; fax: +49 511 532 5404. (Email: goerler.adelheid{at}mh-hannover.de).

Objective: Survival after heart transplantation has improved significantly over the last decades. There are a growing number of patients that require cardiac retransplantation because of chronic allograft dysfunction. With regard to the critical shortage of cardiac allograft donors the decision to offer repeat heart transplantation must be carefully considered. Methods: Since 1983 a total of 807 heart transplantations have been performed at our institution. Among them 41 patients received cardiac retransplantation, 18 patients because of acute graft failure and 23 because of chronic graft failure. Data were analyzed for demographics, morbidity and risk factors for mortality. The acute and chronic retransplant group was compared to those patients undergoing primary transplantation. Results: The mean interval between primary transplantation and retransplantation was 1.9 days in the acute and 6.7 years in the chronic retransplant group. Mean follow-up was 6.9 years. Baseline characteristics were similar in the primary and retransplant group. Actuarial survival rates at 1, 3, 5 and 7 years after primary cardiac transplantation compared to retransplantation were 83, 78, 72 and 64% vs 53, 50, 47 and 36%, respectively (p < 0.001). Early mortality after acute retransplantation was significantly higher compared to late retransplantation (10/18, 55.6% vs 4/23, 17.4%, p = 0.011). Major causes of death were acute and chronic rejection, infection and sepsis. Conclusions: Cardiac retransplantation is associated with lower survival rates compared to primary transplantation. However, results after retransplantation in chronic graft failure are significantly better compared to acute graft failure. Therefore, we consider cardiac retransplantation in chronic graft failure a justified therapeutic option. In contrast, patients with acute graft failure seem to be inappropriate candidates for cardiac retransplantation.

Key Words: Heart transplantation • Heart retransplantation • Graft failure • Cardiac allograft vasculopathy

This article has been cited by other articles:

				R. A. Leach and C. Evans Re: Cardiac retransplantation: is it justified in times of critical donor organ shortage? Long-term single-center experience Eur. J. Cardiothorac. Surg., May 1, 2009; 35(5): 920 - 920. [Full Text] [PDF]

				H. Goerler and M. Strueber Reply to Leach and Evans Eur. J. Cardiothorac. Surg., May 1, 2009; 35(5): 920 - 921. [Full Text] [PDF]