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J Thorac Cardiovasc Surg 1999;117:543-555
© 1999 Mosby, Inc.

CARDIOTHORACIC TRANSPLANTATION

Long-Term Survival After Cardiac Retransplantation: A Twenty-Year Single-Center Experience

From the Divisions of Cardiothoracic Surgery^a and Cardiology,^b Columbia Presbyterian Medical Center, Columbia University, New York, NY.

Read at the Seventy-eighth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 3-6, 1998.

Received for publication May 19, 1998. Revisions requested Aug 19, 1998. Revisions received Oct 3, 1998. Accepted for publication Oct 30, 1998. Address for reprints: Niloo M. Edwards, MD, Division of Cardiothoracic Surgery, Columbia Presbyterian Medical Center, Milstein Hospital Building 7-435, 177 Fort Washington Ave, New York, NY 10032.

Objective: To identify risk factors for survival after cardiac retransplantation and compare the survival after retransplantation with that after primary cardiac transplantation.
Methods: A retrospective analysis of 952 patients undergoing cardiac transplantation for the treatment of end-stage heart disease at a single center between 1977 and October 1997. Of these, 43 patients (4.5%) underwent cardiac retransplantation for cardiac failure resulting from transplant-related coronary artery disease, rejection, and early graft failure.
Results: No significant difference in actuarial patient survival was found by Kaplan-Meier analysis at 1, 2, and 5 years between patients undergoing primary transplantation and those undergoing retransplantation—76%, 71%, and 60% versus 66%, 66%, and 51%, respectively (P = .2). Multivariable analysis identified a shorter interval between transplants and an initial diagnosis of ischemic cardiomyopathy as significant risk factors for death after retransplantation (P = .04 and .03, respectively). Since 1993, when our criteria for patient selection for retransplantation were revised on the basis of earlier experience to exclude patients with allograft dysfunction as a result of primary graft failure and those with intractable acute rejection occurring less than 6 months after transplantation, the survival has been significantly better (<1993 = 45%, 45%, and 33% versus 1993 = 94%, 94%, and 94% at 1, 2, and 4 years, respectively, P = .003).
Conclusion: The long-term outcome of cardiac retransplantation is comparable with that of primary transplantation, especially in patients with transplant-related coronary artery disease. Patient characteristics and other preoperative variables should assist in the rational application of retransplantation to ensure optimal use of donor organs.

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