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Should we perform heart retransplantation in early graft failure?

2009; Springer Science+Business Media; Volume: 23; Issue: 1 Linguagem: Inglês

10.1111/j.1432-2277.2009.00945.x

1432-2277

Nicola Vistarini, Carlo Pellegrini, Marco Aiello, Alessia Alloni, Cristian Monterosso, Barbara Cattadori, Carmine Tinelli, Andrea M. D’Armini, Mario Viganò,

Mechanical Circulatory Support Devices

Cardiac retransplantation represents the gold standard treatment for a failing cardiac graft but the decision to offer the patient a second chance is often made difficult by both lack of donors and the ethical issues involved. The aim of this study was to evaluate whether retransplantation is a reasonable option in case of early graft failure. Between November 1985 and June 2008, 922 patients underwent cardiac transplantation at our Institution. Of these, 37 patients (4%) underwent cardiac retransplantation for cardiac failure resulting from early graft failure (n = 11) or late graft failure (acute rejection: n = 2, transplant-related coronary artery disease: n = 24). Survival at 1, 5 and 10 years of patients with retransplantation was 59%, 50% and 40% respectively. An interval between the first and the second transplantation of less than (n = 11, all in early graft failure) or more than (n = 26) 1 month was associated with a 1-year survival of 27% and 73%, and a 5-year survival of 27% and 65% respectively (P = 0.01). The long-term outcome of cardiac retransplantation is comparable with that of primary transplantation only in patients with transplant-related coronary artery disease. Early graft failure is a significant risk factor for survival after cardiac retransplantation and should be considered as an exclusion criteria.