Should we perform heart retransplantation in early graft failure?

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

doi:10.1111/j.1432-2277.2009.00945.x

Cited by 10 publications

(11 citation statements)

References 22 publications

(30 reference statements)

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“…The analysis from our series revealed that retransplantation for graft vascular disease significantly improved 30-day mortality and late survival compared with retransplantation for other conditions. These findings are supported by others, who report similarly good outcomes in patients who had retransplantation for graft vascular disease; 10,11,18,19 however, patients with acute graft rejection or primary graft failure had significantly inferior outcomes. 10,11,18,20 We therefore conclude that allograft failure for acute graft rejection or primary graft failure should be medically managed and the patients possibly excluded from consideration for retransplantation.…”

Section: Discussionsupporting

confidence: 79%

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Early and late outcomes after cardiac retransplantation

Saito¹,

Novick²,

Kiaii³

et al. 2013

Can J Surg

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Background: Cardiac retransplantation remains the most viable option for patients with allograft heart failure; however, careful patient selection is paramount considering limited allograft resources. We analyzed clinical outcomes following retransplantation in an academic, tertiary care institution. Methods:Between 1981 and 2011, 593 heart transplantations, including 22 retransplantations were performed at our institution. We analyzed the preoperative demographic characteristics, cause of allograft loss, short-and long-term surgical outcomes and cause of death among patients who had cardiac retransplantations.Results: Twenty-two patients underwent retransplantation: 10 for graft vascular disease, 7 for acute rejection and 5 for primary graft failure. Mean age at retransplantation was 43 (standard deviation [SD] 15) years; 6 patients were women. Thirteen patients were critically ill preoperatively, requiring inotropes and/or mechanical support. The median interval between primary and retransplantation was 2.2 (range 0-16) years. Thirty-day mortality was 31.8%, and conditional (> 30 d) 1-, 5-and 10-year survival after retransplantation were 93%, 79% and 59%, respectively. A diagnosis of allograft vasculopathy (p = 0.008) and an interval between primary and retransplantation greater than 1 year (p = 0.016) had a significantly favourable impact on 30-day mortality. The median and mean survival after retransplantation were 3.3 and 5 (SD 6, range 0-18) years, respectively; graft vascular disease and multiorgan failure were the most common causes of death. Conclusion:Long-term outcomes for primary and retransplantation are similar if patients survive the 30-day postoperative period. Retransplantation within 1 year of the primary transplantation resulted in a high perioperative mortality and thus may be a contraindication to retransplantation. Contexte :Une nouvelle transplantation cardiaque demeure l'option la plus viable pour les patients qui présentent une insuffisance de leur coeur transplanté. Il est toutefois crucial de bien sélectionner les patients, compte tenu du nombre limité d'organes disponibles. Nous avons analysé les résultats cliniques des secondes transplantations cardiaques dans un établissement universitaire de soins tertiaires. Méthodes :Entre 1981 et 2011, on a procédé dans notre établissement à 593 transplantations cardiaques, dont 22 secondes transplantations. Nous avons analysé les carac téristiques démographiques préopératoires, la cause de la perte du coeur transplanté, les résultats chirurgicaux à court et à long terme et la cause de mortalité chez les patients soumis à une seconde transplantation.

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Section: Discussionsupporting

confidence: 79%

“…This has also been reported in other studies where shorter intervals between operations significantly increased adverse outcomes. 11,18 Because of this, most authors generally advise against retransplantation less than 1 month after primary transplantation because of clearly inferior outcomes.…”

Section: Discussionmentioning

confidence: 99%

Early and late outcomes after cardiac retransplantation

Saito¹,

Novick²,

Kiaii³

et al. 2013

Can J Surg

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“…[1][2][3] This remarkable achievement of modern medicine was made possible with substantial improvements in the field of immunosuppression, infection prophylaxis and surgical techniques. 1,[4][5][6][7][8][9][10][11] Today, heart transplantation is no longer considered an experimental operation, but rather a standard treatment; nevertheless the context has changed substantially in recent years owing to donor shortage.…”

Section: Discussionmentioning

confidence: 99%

Changes in patient characteristics following cardiac transplantation: the Montreal Heart Institute experience

Vistarini

Nguyen

White³

et al. 2017

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Background: Heart transplantation is no longer considered an experimental operation, but rather a standard treatment; nevertheless the context has changed substantially in recent years owing to donor shortage. The aim of this study was to review the heart transplant experience focusing on very long-term survival (≥ 20 years) and to compare the initial results with the current era.Methods: From April 1983 through April 1995, 156 consecutive patients underwent heart transplantation. Patients who survived 20 years or longer (group 1) were compared with patients who died within 20 years after surgery (group 2). To compare patient characteristics with the current era, we evaluated our recent 5-year experience (group 3; patients who underwent transplantation between 2010 and 2015), focusing on differences in terms of donor and recipient characteristics.Results: Group 1 (n = 46, 30%) included younger patients (38 ± 11 v. 48 ± 8 yr, p = 0.001), a higher proportion of female recipients (28% v. 8%, p = 0.001) and a lower prevalence of ischemic heart disease (42% v. 65%, p = 0.001) than group 2 (n = 110, 70%). Patients in group 3 (n = 54) were older (52 ± 12 v. 38 ± 11 yr, p = 0.001), sicker (rate of hospital admission at transplantation 48% v. 20%, p = 0.001) and transplanted with organs from older donors (42 ± 15 v. 29 ± 11 yr, p = 0.001) than those in group 1. Conclusion:Very long-term survival ( ≥ 20 yr) was observed in 30% of patients transplanted during the first decade of our experience. This outcome will be difficult to duplicate in the current era considering our present population of older and sicker patients transplanted with organs from older donors.

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“…There have been studied factors related to the receptor (such as age, the reason for the CRT or some comorbidities), technical aspects such as the ischemic time or even the technique used, and characteristics of the donor [5][6][7][8][9][10][11][12][13][14][15], none of them guaranteeing long-term success. The experience gained in each centre, the specific protocol of each group and individual assessment are so far the only variables that appear to influence the outcome in the CRT.…”

Section: Journal Of Clinical and Experimental Research In Cardiologymentioning

confidence: 99%

Candidate Selection, Determinant Factor for a Good Result in Cardiac Retransplantation: our Experience

Salterain¹,

Esteban‐Fernández

Delgado³

et al. 2015

Journal of Clinical and Experimental Research in Cardiology

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Introduction: Cardiac retransplantation is the standard treatment for patients with advanced graft vasculopathy. It remains controversial due to the scarcity of donors and poor results when compared with the novo transplant. Despite all the factors studied to ensure a good result, when to make a new transplant, is still a question based on the experience of each institution as their protocols. This lack of clear information in the literature complicates the proper selection of candidates. We present our experience trying to answer some of these questions. Methods: Retrospective study of all cardiac retransplantation performed at our centre was made. Data of recipients and donors, surgical aspects and results of diagnostic tests were collected. The survival of the first and second graft was compared, as well as the survival according to the indication for retransplantation. Statistical analysis was performed using SPSS V21. Results: 14 retransplant (5%) and two third transplants (0.7%) were performed. The most common cause for retransplantation was graft vascular disease (10 cases (72%)). Operative mortality was 14%, with a survival group of 65 ± 61 months (median 62). Second graft survival was similar to the first (median 87 months first graft vs 74 months of the second, p = 0.851). Poor result was achieved when indication for retrasplantation was acute rejection or primary graft failure, with a mortality of 67% (median survival for acute rejection and primary failure group 6 days vs 106 months graft vascular disease; p = 0.000). Conclusion: Cardiac retransplantation is a valid alternative in selected patients with severe dysfunction of the graft secondary to graft vasculopathy.

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Should we perform heart retransplantation in early graft failure?

Cited by 10 publications

References 22 publications

Early and late outcomes after cardiac retransplantation

Early and late outcomes after cardiac retransplantation

Changes in patient characteristics following cardiac transplantation: the Montreal Heart Institute experience

Candidate Selection, Determinant Factor for a Good Result in Cardiac Retransplantation: our Experience

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