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Cardiac Retransplantation is an Efficacious Therapy for Primary Cardiac Allograft Failure

P. Atluri, W. Hiesinger, R. C. Gorman, A. Pochettino, M. Jessup, M. A. Acker, R. J. Morris, Y. J. Woo. University of Pennsylvania, Philadelphia, PA,

Cardiac Retransplantation is an Efficacious Therapy for Primary Cardiac Allograft Failure
Objective: Orthotopic heart transplantation has been an effective treatment for end-stage heart failure. The incidence of allograft failure has increased, necessitating treatment options. Cardiac retransplantation remains the only viable long-term solution for end-stage cardiac allograft failure. Given the limited number of available donor hearts, the long term results of this treatment option need to be clarified.
Methods: 621 heart transplants were performed over an 18 year period at our institution. Repeat cardiac transplantation was performed in 14 patients (2.5%). A retrospective analysis was performed to determine the efficacy of cardiac retransplantation. Variables investigated included: 1yr and 5 yr survival, length of hospitalization, post-operative complications, allograft failure, recipient and donor demographics, renal function, allograft ischemic time, UNOS listing status, blood group, allograft rejection, and hemodynamic function.
Results: Etiology of primary graft failure included transplant arteriopathy (n=9), humoral rejection (n=3), hyperacute rejection (n=1), and a post-transplant diagnosis of metastatic melanoma in the donor (n=1). Mean age at retransplantation was 46.0±9.8years. 1 and 5 year survival for retransplantation were 84.6% and 60.0% respectively, as compared to 86.8% (p=NS) and 79.1% (p=NS) for primary transplantation. Mean ejection fraction was 67.1±11.4% at a mean follow-up of 68.8±80.7mos post-retransplant; follow-up biopsy demonstrated either ISHLT grade 1A or 0 rejection (77.5±95.7mos post-transplant). [Table]
Conclusion: Cardiac retransplantation is an efficacious treatment strategy for cardiac allograft failure with results comparable to primary heart transplantation.
Retransplant Variables
Gender (male)77.8%
Race (caucasian)89.5%
Initial Allograft Survival (mos)40.7±12.7
Donor Age (yrs)45.8±12.4
Donor Gender (male)66.7%
Recipient Body Mass Index (kg/m2)27.9±3.7
Chronic Renal Insufficiency (Cr>1.5)64.3%
Pre-Operative Creatinine2.54±1.50
Discharge Creatinine1.46±0.52
Cold Ischemic Time (min)171.4±38.5
Cardiopulmonary Bypass Time (min)148.2±28.6
Allograft anastomosis (bicaval vs. biatrial)42.86% bicaval
Time to Extubation (hrs)11.6±6.8
Length of ICU stay (days)4.6±2.3
24 Hour Chest-Tube Output (ml)918±682
Packed Red Blood Cell Transfusion (units)6.0±4.3
Hospital Stay (days)16±7

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