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Eur J Cardiothorac Surg 2009;35:920. doi:10.1016/j.ejcts.2009.01.034
Copyright © 2009, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Letters to the Editor

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

Rebecca A. Leach*, Ceri Evans

Cardiff University, Wales, United Kingdom

Received 9 December 2008; accepted 24 January 2009.

* Corresponding author. Address: 11 Rock Terrace, Ynysybwl, Pontypridd, Mid Glamorgan, South Wales, CF37 3NU, United Kingdom. (Email: leachra{at}cardiff.ac.uk).

Key Words: Cardiac • Re-transplantation • Organ donation

We read with interest the paper by Goerler et al. entitled ‘Cardiac retransplantation: is it justified in times of critical donor organ shortage? Long term single-center experience [1].’ As medical students, and future surgeons, we are conscious of the effect an ageing population and improved survival rates will have on re-transplantation in the future. The Welsh Assembly Government recently refused legislation implementing a policy of presumed consent for organ donation, and this has sparked our interest regarding how donor organs should be allocated.

The conclusion that cardiac re-transplantation in chronic graft failure as a justified therapeutic option is based on the survival results of the 23 patients undergoing the procedure at the centre, compared with the 723 primary transplantations. It is difficult to compare these results with those of the International Society for Heart and Lung Transplantation [2], who classify late re-transplants as those occurring more than one year post primary transplant, in contrast to Hannover's (greater than 30 days), with survival figures for re-transplantation of 85% and 68% respectively. The International Society reports survival rates equivalent for the primary and re-transplant procedures, whereas at Hannover there is a marked difference (83% compared with 68% survival at one year). It may be the inclusion of earlier cases (i.e. pre 1990s) in the Hannover results that causes the difference with the International Society. However, it may also be necessary to look at the success of individual centres and their assessment of patient factors in deciding whether to allocate a limited resource to a primary or re-transplant case. As the paper suggests, allocation should be made on the basis of clinical need and the likely survival time of the patient, but perhaps some more definitive evidence-based guidelines would ensure a more consistent and successful service. With an ageing population, in the future we may see more and more patients needing re-transplantations, reinforcing the need for good, evidence-based guidelines.

The fact remains that cardiac re-transplantation is the only definitive therapy for cardiac allograft vasculopathy. In times of donor organ shortage and increasing need, we await with anticipation developments in artificial hearts, stem cell therapy and xenotransplantation, which may be just around the corner. As future surgeons, we hope to see the ascent of these new and exciting technologies.

References

  1. Goerler H, Simon A, Gohrbandt B, Hagl C, Oppelt P, Haverich A, Strueber M. Cardiac retransplantation: is it justified in times of critical donor organ shortage? Long-term single-center experience. Eur J Cardiothorac Surg 2008;34:1185-1190.[Abstract/Free Full Text]
  2. Taylor DO, Edwards LB, Boucek MM, Trulock EP, Waltz DA, Keck BM, Hertz MI, International Society for Heart and Lung Transplantation Registry of the International Society for Heart and Lung Transplantation: twenty-fourth official adult heart transplantation report. J Heart Lung Transplant 2007;26:769-781.[CrossRef][Medline]



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Home page
 Eur. J. Cardiothorac. Surg.Home page
H. Goerler and M. Strueber
Reply to Leach and Evans
Eur. J. Cardiothorac. Surg., May 1, 2009; 35(5): 920 - 921.
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