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Ann Thorac Surg 1992;54:840-845
© 1992 The Society of Thoracic Surgeons

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Articles

Cardiac retransplantation: A viable option?

Division of Cardiothoracic Surgery, University of Utah School of Medicine, and Utah Transplant Affiliated Hospitals Cardiac Transplant Program, Salt Lake City, Utah, USA

^_* Address reprint requests to Dr Karwande, Division of Cardiothoracic Surgery, University of Utah Medical Center, 50 North Medical Dr, Salt Lake City, UT 84132.

To evaluate cardiac retransplantation as an appropriate utilization of scarce donor organs we analyzed data from the registry of the International Society for Heart and Lung Transplantation (ISHLT) (n = 449) and the Utah Cardiac Transplant Program (n = 20). Actuarial survival among retransplants was lower than in patients who received only one transplant in both the ISHLT registry patients (1 year survival, 48% versus 78%; p = 0.001) and the Utah series (1 year survival, 74% versus 88%; p = 0.06). Uncontrolled rejection, short interval (<6 months) between transplantations, and the need for mechanical circulatory support were identified as risk factors for retransplantation. The incidence of rejection and infection was similar in first and second transplant recipients. Second transplant recipients had a higher level of sensitization, a greater incidence of donor-specific positive crossmatches, and an increased early mortality. Repetition in the second donor of mismatched HLA antigens present in the first donor did not adversely affect survival. If patients who underwent retransplantation within 6 months of their initial transplantation, those receiving transplants for uncontrolled rejection, and those requiring mechanical assistance were eliminated from the study, the short-term and long-term survival after cardiac retransplantation does not differ from that in patients having a single transplant.

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