Heart re-transplantation in Eurotransplant

Abstract

Internationally 3% of the donor hearts are distributed to re-transplant patients. In Eurotransplant, only patients with a primary graft dysfunction (PGD) within 1 week after heart transplantation (HTX) are indicated for high urgency listing. The aim of this study is to provide evidence for the discussion on whether these patients should still be allocated with priority. All consecutive HTX performed in the period 1981-2015 were included. Multivariate Cox' model was built including: donor and recipient age and gender, ischaemia time, recipient diagnose, urgency status and era. The study population included 18 490 HTX, of these 463 (2.6%) were repeat transplants. The major indications for re-HTX were cardiac allograft vasculopathy (CAV) (50%), PGD (26%) and acute rejection (21%). In a multivariate model, compared with first HTX hazards ratio and 95% confidence interval for repeat HTX were 2.27 (1.83-2.82) for PGD, 2.24 (1.76-2.85) for acute rejection and 1.22 (1.00-1.48) for CAV (P < 0.0001). Outcome after cardiac re-HTX strongly depends on the indication for re-HTX with acceptable outcomes for CAV. In contrast, just 47.5% of all hearts transplanted in patients who were re-transplanted for PGD still functioned at 1-month post-transplant. Alternative options like VA-ECMO should be first offered before opting for acute re-transplantation.

Heart transplantation: focus on donor recovery strategies, left ventricular assist devices, and novel therapies

“…Cardiac re-transplantation remains a rare indication and requires careful patient selection to optimize outcomes. 2,106,107 Clinical outcomes of Re-HT compared with a first transplant are worse, especially within 1-year. 106,108 A systematic review and meta-analysis that included 7791 patients with a first HT and 345 with a Re-HT (mean of 5 years after the first HT), observed worse survival after Re-HT vs. those after the first HT at 1 and 10 years, respectively.…”

Características y resultados del retransplante cardíaco en España: Análisis del Registro Nacional de Trasplante Cardíaco

“…Existen múltiples factores que explicarían esta diferencia en las tendencias objetivadas, tales como la disponibilidad y sistema de distribución de órganos propias de cada país así como la experiencia adquirida en el ReTC por parte de los grupos trasplantadores. La posibilidad de que a medida que los resultados en TC vayan mejorando, el número de posibles candidatos para ReTC pueda aumentar en el futuro parece real y que el retrasplante siga asociándose en la literatura con una mayor mortalidad al ser comparada con el TC nos obliga a estudiar en profundidad este grupo de pacientes (4,73).…”

“…realizado en 2014 por el Registro de la Sociedad Internacional de Trasplante de Corazón y Pulmón (ISHLT) o el de 2018 del Eurotrasplant(4,5). Según…”