Heart retransplantation: A 23-year single-center clinical experience

Background. The main causes of allograft failure after cardiac transplantation are primary graft dysfunction, intractable acute rejection, and coronary graft disease. Despite the important progress in the last several years in graft presentation, surgical techniques, immunosuppression, and treatment of coronary graft disease, retransplantation in selected cases is the only way to achieve long-term recipient survival. Methods. We compare here in a case-control study 24 retransplantations with 47 first transplants in patients matched for date of transplantation. Results. Between 1973 and 1996, 1,063 patients underwent cardiac transplantation in our institution. Tn this cohort, 22 patients had a total of 24 retransplantations (2 second-time retransplantations). The causes of retransplantations were primary graft failure (n = 4), acute rejection (n = 7), coronary graft disease (n = 11), and miscellaneous (n = 2). Survival at 1 and 5 years of patients with retransplantations is 45.5% and 31.2%, and survival of control patients is 59.4% and 38.8% (p = 0.07). An interval between first transplantation and retransplantation shorter (n = 11) or longer (n = 13) than 1 year is associated with a 1-year survival of 27.3% and 61.5% and a 4-year survival of 27.3% and 46%, respectively (not significant). Intervals shorter than 1 year between first transplantation and retransplantation were exclusively secondary to primary graft failure or intractable acute rejection. Conclusions. In the face of lack of donor grafts, these and other data indicate that retransplantation should be considered cautiously, especially when the interval between the first transplantation and retransplantation is short. (C) 1998 by The Society of Thoracic Surgeons.