Retransplantation in 7,290 primary transplant patients

A 10-year multi-institutional study

Branislav Radovancevic, David C. McGiffin, Jon A. Kobashigawa, Guillermo B. Cintron, G. Martin Mullen, Douglas E. Pitts, Jacqueline O'Donnell, Cindi Thomas, Robert C. Bourge, David C. Naftel

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Abstract

Background: Cardiac retransplantation is a controversial procedure due to the disparity between donor heart demand and supply. Methods: Of 7,290 patients undergoing primary cardiac transplantation between January 1990 and December 1999 at 42 institutions contributing to the Cardiac Transplant Research Database (CTRD), 106 patients later underwent a second and 1 patient a third cardiac transplant procedure. Results: The actuarial freedom from retransplantation was 99.2% and 96.8% at 1 and 10 years, respectively. Reasons for retransplantation included early graft failure (n = 34), acute cardiac rejection (n = 15), coronary allograft vasculopathy (CAV, n = 39), non-specific graft failure (n = 7), and miscellaneous (n = 10). The only risk factor associated with retransplantation was younger age, reflecting the policy of preferential retransplantation of younger patients. Survival after retransplantation was inferior to that after primary transplantation (56% and 38% at 1 and 5 years, respectively). Risk factors associated with death after retransplantation included retransplantation for acute rejection (p = 0.0005), retransplantation for early graft failure (p = 0.03), and use of a female donor (p = 0.005). Survival after retransplantation for acute rejection was poorest (32% and 8% at 1 and 5 years, respectively) followed by retransplantation for early graft failure (50% and 39% at 1 and 5 years, respectively). Survival after retransplantation for CAV has steadily improved with successive eras. Conclusions: The results of retransplantation for acute rejection and early graft failure are poor enough to suggest that this option is not advisable. However, retransplantation for CAV is currently associated with satisfactory survival and should continue to be offered to selected patients.

Original languageEnglish
Pages (from-to)862-868
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume22
Issue number8
DOIs
StatePublished - Aug 1 2003

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antineoplaston A10
Transplants
Survival
Tissue Donors
Graft Rejection
Heart Transplantation
Allografts
Transplantation
Databases
Research

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

Radovancevic, B., McGiffin, D. C., Kobashigawa, J. A., Cintron, G. B., Mullen, G. M., Pitts, D. E., ... Naftel, D. C. (2003). Retransplantation in 7,290 primary transplant patients: A 10-year multi-institutional study. Journal of Heart and Lung Transplantation, 22(8), 862-868. https://doi.org/10.1016/S1053-2498(02)00803-3

Retransplantation in 7,290 primary transplant patients : A 10-year multi-institutional study. / Radovancevic, Branislav; McGiffin, David C.; Kobashigawa, Jon A.; Cintron, Guillermo B.; Mullen, G. Martin; Pitts, Douglas E.; O'Donnell, Jacqueline; Thomas, Cindi; Bourge, Robert C.; Naftel, David C.

In: Journal of Heart and Lung Transplantation, Vol. 22, No. 8, 01.08.2003, p. 862-868.

Research output: Contribution to journalArticle

Radovancevic, B, McGiffin, DC, Kobashigawa, JA, Cintron, GB, Mullen, GM, Pitts, DE, O'Donnell, J, Thomas, C, Bourge, RC & Naftel, DC 2003, 'Retransplantation in 7,290 primary transplant patients: A 10-year multi-institutional study', Journal of Heart and Lung Transplantation, vol. 22, no. 8, pp. 862-868. https://doi.org/10.1016/S1053-2498(02)00803-3
Radovancevic, Branislav ; McGiffin, David C. ; Kobashigawa, Jon A. ; Cintron, Guillermo B. ; Mullen, G. Martin ; Pitts, Douglas E. ; O'Donnell, Jacqueline ; Thomas, Cindi ; Bourge, Robert C. ; Naftel, David C. / Retransplantation in 7,290 primary transplant patients : A 10-year multi-institutional study. In: Journal of Heart and Lung Transplantation. 2003 ; Vol. 22, No. 8. pp. 862-868.
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abstract = "Background: Cardiac retransplantation is a controversial procedure due to the disparity between donor heart demand and supply. Methods: Of 7,290 patients undergoing primary cardiac transplantation between January 1990 and December 1999 at 42 institutions contributing to the Cardiac Transplant Research Database (CTRD), 106 patients later underwent a second and 1 patient a third cardiac transplant procedure. Results: The actuarial freedom from retransplantation was 99.2{\%} and 96.8{\%} at 1 and 10 years, respectively. Reasons for retransplantation included early graft failure (n = 34), acute cardiac rejection (n = 15), coronary allograft vasculopathy (CAV, n = 39), non-specific graft failure (n = 7), and miscellaneous (n = 10). The only risk factor associated with retransplantation was younger age, reflecting the policy of preferential retransplantation of younger patients. Survival after retransplantation was inferior to that after primary transplantation (56{\%} and 38{\%} at 1 and 5 years, respectively). Risk factors associated with death after retransplantation included retransplantation for acute rejection (p = 0.0005), retransplantation for early graft failure (p = 0.03), and use of a female donor (p = 0.005). Survival after retransplantation for acute rejection was poorest (32{\%} and 8{\%} at 1 and 5 years, respectively) followed by retransplantation for early graft failure (50{\%} and 39{\%} at 1 and 5 years, respectively). Survival after retransplantation for CAV has steadily improved with successive eras. Conclusions: The results of retransplantation for acute rejection and early graft failure are poor enough to suggest that this option is not advisable. However, retransplantation for CAV is currently associated with satisfactory survival and should continue to be offered to selected patients.",
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AU - Radovancevic, Branislav

AU - McGiffin, David C.

AU - Kobashigawa, Jon A.

AU - Cintron, Guillermo B.

AU - Mullen, G. Martin

AU - Pitts, Douglas E.

AU - O'Donnell, Jacqueline

AU - Thomas, Cindi

AU - Bourge, Robert C.

AU - Naftel, David C.

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