Early and late outcomes after cardiac retransplantation

Abstract

Background: Cardiac retransplantation remains the most viable option for patients with allograft heart failure; however, careful patient selection is paramount considering limited allograft resources. We analyzed clinical outcomes following retransplantation in an academic, tertiary care institution. Methods:Between 1981 and 2011, 593 heart transplantations, including 22 retransplantations were performed at our institution. We analyzed the preoperative demographic characteristics, cause of allograft loss, short-and long-term surgical outcomes and cause of death among patients who had cardiac retransplantations.Results: Twenty-two patients underwent retransplantation: 10 for graft vascular disease, 7 for acute rejection and 5 for primary graft failure. Mean age at retransplantation was 43 (standard deviation [SD] 15) years; 6 patients were women. Thirteen patients were critically ill preoperatively, requiring inotropes and/or mechanical support. The median interval between primary and retransplantation was 2.2 (range 0-16) years. Thirty-day mortality was 31.8%, and conditional (> 30 d) 1-, 5-and 10-year survival after retransplantation were 93%, 79% and 59%, respectively. A diagnosis of allograft vasculopathy (p = 0.008) and an interval between primary and retransplantation greater than 1 year (p = 0.016) had a significantly favourable impact on 30-day mortality. The median and mean survival after retransplantation were 3.3 and 5 (SD 6, range 0-18) years, respectively; graft vascular disease and multiorgan failure were the most common causes of death. Conclusion:Long-term outcomes for primary and retransplantation are similar if patients survive the 30-day postoperative period. Retransplantation within 1 year of the primary transplantation resulted in a high perioperative mortality and thus may be a contraindication to retransplantation. Contexte :Une nouvelle transplantation cardiaque demeure l'option la plus viable pour les patients qui présentent une insuffisance de leur coeur transplanté. Il est toutefois crucial de bien sélectionner les patients, compte tenu du nombre limité d'organes disponibles. Nous avons analysé les résultats cliniques des secondes transplantations cardiaques dans un établissement universitaire de soins tertiaires. Méthodes :Entre 1981 et 2011, on a procédé dans notre établissement à 593 transplantations cardiaques, dont 22 secondes transplantations. Nous avons analysé les carac téristiques démographiques préopératoires, la cause de la perte du coeur transplanté, les résultats chirurgicaux à court et à long terme et la cause de mortalité chez les patients soumis à une seconde transplantation.

Changes in patient characteristics following cardiac transplantation: the Montreal Heart Institute experience

“…[12][13][14][15] In this regard, our long-term results compare favourably with the published literature and with other Canadian centres, 16,17 with a 35% survival rate at 20 years. Moreover, acute rejection episodes were significantly reduced in group 3 patients, who were administered long-term tacrolimus and MMF immunosuppression.…”

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

“…The cause of graft failure is probably the major determinant which could determine the prognosis of these patients. As has been reported in other studies [5][6][7][8][9][10][11][12][13][14], in our centre too, those retrasplanted because of AR and PGF presented a much lower survival when compared to that obtained in patients reoperated due to GVD. For this reason, since 1996 is our criterion not to retransplant AR or PGF patients, using in these mechanical devices for hemodynamic stabilization.…”

“…There have been studied factors related to the receptor (such as age, the reason for the CRT or some comorbidities), technical aspects such as the ischemic time or even the technique used, and characteristics of the donor [5][6][7][8][9][10][11][12][13][14][15], none of them guaranteeing long-term success. The experience gained in each centre, the specific protocol of each group and individual assessment are so far the only variables that appear to influence the outcome in the CRT.…”

“…To ensure a good short term result is not enough, to obtain a result comparable to that with the de novo HT is almost impossible and the fact of accepting less optimal donors for these patients or the urgent indication for redo procedures in unstable patients had probably contributed to the worse results after the first CRT [4]. This has been a matter of study for multiple groups, where they tried to identify factors involved in the survival that would establish a unified criterion for the correct indication of CRT [5][6][7][8][9][10][11][12][13][14].…”

Heart Retransplantation

“…Тем не менее ряд ав-торов считает, что отдаленные результаты ретранс-плантации сердца могут быть улучшены [27][28][29][30][31][32][33][34][35][36][37].…”