Higher Rate of Comorbidities After Cardiac Retransplantation Contributes to Decreased Survival

Tsao, Lana; Uriel, Nir; Leitz, Katherine; Naka, Y.; Mancini, Donna

doi:10.1016/j.healun.2009.06.004

Cited by 31 publications

(30 citation statements)

References 11 publications

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“…These findings are supported by others, who report similarly good outcomes in patients who had retransplantation for graft vascular disease; 10,11,18,19 however, patients with acute graft rejection or primary graft failure had significantly inferior outcomes. 10,11,18,20 We therefore conclude that allograft failure for acute graft rejection or primary graft failure should be medically managed and the patients possibly excluded from consideration for retransplantation.…”

Section: Discussionmentioning

confidence: 93%

Early and late outcomes after cardiac retransplantation

Saito¹,

Novick²,

Kiaii³

et al. 2013

Can J Surg

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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.

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Section: Discussionmentioning

confidence: 93%

Early and late outcomes after cardiac retransplantation

Saito¹,

Novick²,

Kiaii³

et al. 2013

Can J Surg

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“…As seen in Figure 2, the survival curves diverge early in the first year following transplant and then are nearly parallel. This suggests that the differences in survival likely represent perioperative and early postoperative complications such as multi-organ failure, bleeding, and infection, which deserve further exploration (26,27). If the problem of early mortality can be overcome, long-term survival of heart RTx appears to be good.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and survival following heart retransplantation for cardiac allograft failure: a systematic review and meta-analysis

Rizvi

Luc

Choi

et al. 2018

Ann. Cardiothorac. Surg.

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Background: Long-term efficacy of heart retransplantation (RTx) for end-stage cardiac allograft failure remains unclear given the limited worldwide experience and is an important question to elucidate given the shortage of donor organs. The aim of this systematic review was to examine the outcomes of RTx in patients with cardiac allograft failure.Methods: Electronic search was performed to identify all studies in the English literature assessing RTx for cardiac allograft failure. All identified articles were systematically assessed for inclusion and exclusion criteria.Results: Eleven studies were included for analysis, with a total of 7,791 patients. A total of 7,446 patients underwent primary heart transplantation (HTx) whereas 345 patients underwent RTx with average time from primary HTx to RTx interval of 5.03 years (95% CI: 3.13-6.94 years). There were 35.2% of patients Conclusions:Patients who underwent heart RTx had a significant lower survival when compared to those who only underwent primary HTx. There were no significant differences in post-transplantation freedom from rejection. Careful patient selection and perioperative care can make heart RTx a viable option for selected recipients.

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“…Retransplant for CAV continues to be the most frequent reason after 1 year in both adults and children worldwide (22,23). While survival after retransplant in the setting of CAV is favorable, identification of patients that would derive survival benefit compared to continued medical management continues to present a significant challenge (22)(23)(24)(25). This is underscored by the fact that systolic ejection fraction remains preserved in many transplant recipients despite significant CAV.…”

Section: Retransplant For Cardiac Allograft Vasculopathymentioning

confidence: 99%