Cardiac retransplantation: A viable option?

Karwande, Shreekanth V.; Ensley, Rebecca; Renlund, Dale G.; Gay, William A.; Richenbacher, Wayne E.; Doty, Donald B.; Hammond, M. Elizabeth H.; Marks, John D.

doi:10.1016/0003-4975(92)90634-g

Cited by 47 publications

(29 citation statements)

References 4 publications

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“…In fact, if we compare the outcome of patients undergoing primary transplantations and patients retransplanted in LGF (or with an interval between the two procedures of more than 1 month), the difference in actuarial survival was not statistically significant ( P = 0.15). These findings are similar to those reported by other centers [12,14,15,17] and by the ISHLT registry report [3], even though, in their experience, a worse survival rate was seen when the interval between the first transplantation and the retransplantation was less than 6‐to‐12 months. Several factors may be related to the worse survival rate in recipients with a short interval between transplantations: heavy immunosuppression, hemodynamic instability, intensive pharmacologic or mechanical support, lack of time to recover from the first operation.…”

Section: Discussionsupporting

confidence: 91%

“…Although different surgical and medical options have been proposed to overcome end-stage heart failure, such as coronary artery bypass graft (CABG) surgery, partial left ventriculoplasty, coronary angioplasty, laser myocardial therapy, mechanical assistance and new pharmacologic regimens [5][6][7][8][9][10], heart retransplantation remains the only therapy which can achieve the long-term survival of these patients. Since the first case, performed by Copeland and colleagues in 1977 [11], several centers have reported their results on cardiac retransplantation [4,[12][13][14][15][16][17]. From our experience, the overall survival of cardiac retransplantation was significantly lower compared with that of primary transplantation (P < 0.001).…”

Section: Discussionmentioning

confidence: 75%

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Should we perform heart retransplantation in early graft failure?

Vistarini

Pellegrini

Aiello

et al. 2010

Transplant International

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Summary Cardiac retransplantation represents the gold standard treatment for a failing cardiac graft but the decision to offer the patient a second chance is often made difficult by both lack of donors and the ethical issues involved. The aim of this study was to evaluate whether retransplantation is a reasonable option in case of early graft failure. Between November 1985 and June 2008, 922 patients underwent cardiac transplantation at our Institution. Of these, 37 patients (4%) underwent cardiac retransplantation for cardiac failure resulting from early graft failure (n = 11) or late graft failure (acute rejection: n = 2, transplant‐related coronary artery disease: n = 24). Survival at 1, 5 and 10 years of patients with retransplantation was 59%, 50% and 40% respectively. An interval between the first and the second transplantation of less than (n = 11, all in early graft failure) or more than (n = 26) 1 month was associated with a 1‐year survival of 27% and 73%, and a 5‐year survival of 27% and 65% respectively (P = 0.01). The long‐term outcome of cardiac retransplantation is comparable with that of primary transplantation only in patients with transplant‐related coronary artery disease. Early graft failure is a significant risk factor for survival after cardiac retransplantation and should be considered as an exclusion criteria.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 75%

Should we perform heart retransplantation in early graft failure?

Vistarini

Pellegrini

Aiello

et al. 2010

Transplant International

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“…10 Since that time, more than 800 cardiac re-Tx procedures, mostly in adults, have been performed worldwide, with mixed results. The actuarial survival among all recipients of cardiac re-Tx was clearly lower than in patients who received only 1 allograft in the 25-year Stanford series 11 (1-year survival, 55% ± 8% vs 81% ± 2%), the 23-year Utah series 12 (1-year survival, 75% vs 88%), and patients listed in the registry of the International Society for Heart and Lung Transplantation 13 (1-year survival, 58% vs 79%). The results of cardiac re-Tx, however, have improved considerably since the introduction of cyclosporine in the early 1980s.…”

Section: Discussionmentioning

confidence: 81%

Cardiac Retransplantation for Graft Vasculopathy in Children

Razzouk

Chinnock

Dearani³

et al. 1998

Arch Surg

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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.

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“…По данным ряда авторов [27,29,31,38,48], важ-ное значение для получения оптимальных результа-тов играет срок, прошедший между ТС и РеТС.…”

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“…В табл. 2 отражены материалы исследований отдельных центров, изучавших вопросы ретранс-плантации сердца у взрослых пациентов [26,29,30,48,49].…”

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Heart Retransplantation

Саитгареев

Захаревич

Гольц

et al. 2016

RJTAO

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1 ФГБУ «ФНЦ трансплантологии и искусственных органов им. академика В.И. Шумакова» Минздрава России, Москва, Российская Федерация 2 Кафедра трансплантологии и искусственных органов ГБОУ ВПО «Первый МГМУ им. Сеченова» Минздрава России, Москва, Российская Федерация Популяция пациентов с трансплантированным сердцем непрерывно увеличивается. Как следствие, возрастает количество пациентов, нуждающихся в ретрансплантации сердца (РеТС). В данном обзоре литературы представлен анализ результатов опубликованных исследований, посвященных изучению и безопасности РеТС и факторов риска нежелательных событий в периоперационном и отдаленном перио-дах. Результаты опубликованных исследований свидетельствуют о том, что РеТC, являющаяся основным радикальным методом лечения дисфункции сердечного трансплантата, несколько уступает первичной трансплантации сердца (ТС), однако может иметь благоприятный отдаленный прогноз, если будет вы-полняться по показаниям у отдельных групп пациентов. The number of patients with transplanted heart is continuously increasing; therefore, the number of patients requiring heart retransplantation grows. Analysis of the results of published studies focused on safety of cardiac retransplantation and risk factors for adverse events in perioperative, early and late postoperative periods is presented in our review. The results of published studies suggest that heart retransplantation is the main radical treatment option for cardiac allograft dysfunction, but the results of heart retransplantation are slightly worse than those of primary cardiac transplantation. On the other hand, the favorable long-term prognosis after heart retransplantation should be expected in carefully selected recipients.

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Cardiac retransplantation: A viable option?

Cited by 47 publications

References 4 publications

Should we perform heart retransplantation in early graft failure?

Should we perform heart retransplantation in early graft failure?

Cardiac Retransplantation for Graft Vasculopathy in Children

Heart Retransplantation

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