Cardiac Retransplantation: A Viable Option

Methods: We conducted a retrospective study of 26 patients who had all received either a second, third or fourth cardiac transplantation over a 25 year period. 4 patients were emergently retransplanted for acute graft failure and have been removed from the study. Two of those four patients died and two lived long term. Comparisons were performed between 818 primary transplants and the group of 22 elective retransplant patients for the following variables: actuarial survival curves for first and second time cardiac transplantation, one year survival, age at time of transplant, ischemic time, years of survival, and sex of the patients. The subsequent retransplants (third and fourth time) were also evaluated.

Results: We have performed over 840 cardiac transplants. 22 patients electively received a second, 4 a third, and 1 a fourth cardiac transplant for coronary vasculopathy or chronic graft failure. Sixteen patients were men (72%) and 6 were women (27%). Mean survival in years for a first time cardiac transplant patient from our institution is 11.5 years; for a second time transplant from the date of retransplantation is 9.5 years. Average age at time of first transplant is 47.8 years; 44.3 years at time of second transplant. No significant difference was noted in actuarial survival curves. Graft survival at one year for first transplant was 88.6% and 82% for retransplant patients; p value =0.16. Patient survival at 10 years was nearly identical for first time and retransplant patients(58%). (see actuarial survival functions). The longest survivor was a patient that received three transplants and lived 24 years after the initial transplant. The recipient of 4 transplants is currently surviving at 23 years post initial transplant.

Conclusion: Based on our results, cardiac retransplantation up to 4 times is a reasonable option for elective recipients with coronary vasculopathy or chronic graft failure. There is no difference in survival between primary and retransplant patients. The retransplant group is younger than the primary group. Careful selection of this small group of cardiac recipients (3% of the total) may be the key to success.