Candidate Selection, Determinant Factor for a Good Result in Cardiac Retransplantation: our Experience

Abstract

Introduction: Cardiac retransplantation is the standard treatment for patients with advanced graft vasculopathy. It remains controversial due to the scarcity of donors and poor results when compared with the novo transplant. Despite all the factors studied to ensure a good result, when to make a new transplant, is still a question based on the experience of each institution as their protocols. This lack of clear information in the literature complicates the proper selection of candidates. We present our experience trying to answer some of these questions. Methods: Retrospective study of all cardiac retransplantation performed at our centre was made. Data of recipients and donors, surgical aspects and results of diagnostic tests were collected. The survival of the first and second graft was compared, as well as the survival according to the indication for retransplantation. Statistical analysis was performed using SPSS V21. Results: 14 retransplant (5%) and two third transplants (0.7%) were performed. The most common cause for retransplantation was graft vascular disease (10 cases (72%)). Operative mortality was 14%, with a survival group of 65 ± 61 months (median 62). Second graft survival was similar to the first (median 87 months first graft vs 74 months of the second, p = 0.851). Poor result was achieved when indication for retrasplantation was acute rejection or primary graft failure, with a mortality of 67% (median survival for acute rejection and primary failure group 6 days vs 106 months graft vascular disease; p = 0.000). Conclusion: Cardiac retransplantation is a valid alternative in selected patients with severe dysfunction of the graft secondary to graft vasculopathy.