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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 622-629, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
RE Michler, MJ McLaughlin, JM Chen, R Geimen, F Schenkel, CR Smith, ML Barr and EA Rose
Although more than 560 patients worldwide have undergone cardiac
retransplantation, few studies of this population have been reported. To
evaluate the risk of cardiac retransplantation and to better establish
selection criteria, we reviewed the records of all patients who underwent
retransplantation at the Columbia-Presbyterian Medical Center. Of 431
patients who underwent transplantation between February 1977 and March
1991, 408 underwent the procedure in the era of cyclosporine-based
immunosuppression. Thirteen of these 408 patients underwent
retransplantation (including one patient who received a third graft).
Indications for the 14 retransplantations included transplant coronary
artery disease (n = 8), rejection (n = 5), and intraoperative graft failure
(n = 1). Immunosuppression and follow-up protocols used in this cohort were
similar to those in the primary transplantation population. No significant
differences were found in either actuarial survival between primary
transplant recipients (75.1% +/- 2.2% at 1 year and 71.3% +/- 2.4% at 2
years) and patients who underwent retransplantation (71.4% +/- 12.1% at 1
year and 59.5% +/- 14.8% at 2 years) or in linearized rates of rejection
and actuarial freedom from rejection between the two groups. No differences
between these groups were found with regard to age, sex, race, origin of
end-stage heart disease, or early (< 30 day) mortality. The origin of
primary graft failure did not correlate with survival outcome in the
retransplantation cohort. Follow-up time for patients having primary
transplantation ranged from 0 to 8 years (mean 24 months) with a cumulative
patient follow-up of 830 patient-years; follow-up time for patients who
underwent retransplantation ranged from 0 to 3 years (mean 8.1 months) with
a cumulative patient follow-up of 9.5 patient-years. Approximately 50% of
patients in both groups had at least one rejection episode by 3 months.
Within the limited time period studied after retransplantation, only one
patient had transplant coronary artery disease, approximately 27 months
after her first retransplantation procedure for acute rejection. These
results indicate that the prognosis for patients undergoing cardiac
retransplantation is good for patients for whom the indication for
retransplantation is identified more than 30 days after initial
transplantation.
ARTICLES
Clinical experience with cardiac retransplantation
Division of Cardiothoracic Surgery, Columbia-Presbyterian Medical Center, Columbia University College of Physicians & Surgeons, New York, NY.
This article has been cited by other articles:
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K. R. Kanter, R. N. Vincent, A. M. Berg, W. T. Mahle, J. M. Forbess, and P. M. Kirshbom Cardiac retransplantation in children Ann. Thorac. Surg., August 1, 2004; 78(2): 644 - 649. [Abstract] [Full Text] [PDF]
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J. A. Dearani, A. J. Razzouk, S. R. Gundry, R. E. Chinnock, R. L. Larsen, M. J. del Rio, J. K. Johnston, and L. L. Bailey Pediatric cardiac retransplantation: intermediate-term results Ann. Thorac. Surg., January 1, 2001; 71(1): 66 - 70. [Abstract] [Full Text] [PDF]
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 N. F. Mulla, J. K. Johnston, L. Vander Dussen, W. L. Beeson, R. E. Chinnock, L. L. Bailey, and R. L. Larsen Late rejection is a predictor of transplant coronary artery disease in children J. Am. Coll. Cardiol., January 1, 2001; 37(1): 243 - 250. [Abstract] [Full Text] [PDF]
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 A. J. Razzouk, R. E. Chinnock, J. A. Dearani, S. R. Gundry, and L. L. Bailey Cardiac Retransplantation for Graft Vasculopathy in Children: Should We Continue to Do It? Arch Surg, August 1, 1998; 133(8): 881 - 885. [Abstract] [Full Text] [PDF]
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B. Schnetzler, A. Pavie, R. Dorent, A.-C. Camproux, P. Leger, A. Delcourt, and I. Gandjbakhch Heart Retransplantation: A 23-Year Single-Center Clinical Experience Ann. Thorac. Surg., April 1, 1998; 65(4): 978 - 983. [Abstract] [Full Text] [PDF]
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G. Y. Ott, D. J. Norman, J. D. Hosenpud, R. E. Hershberger, R. M. Ratkovec, and A. Cobanoglu Heart transplantation in patients with previous cardiac operations:Excellent clinical results J. Thorac. Cardiovasc. Surg., January 1, 1994; 107(1): 203 - 209. [Abstract] [Full Text]
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