CLINICAL-EXPERIENCE WITH CARDIAC RETRANSPLANTATION

Although more than 560 patients worldwide have undergone cardiac retra nsplantation, few studies of this population have been reported. To ev aluate the risk of cardiac retransplantation and to better establish s election criteria, we reviewed the records of all patients who underwe nt retransplantation at the Columbia-Presbyterian Medical Center. Of 4 31 patients who underwent transplantation between February 1977 and Ma rch 1991, 408 underwent the procedure in the era of cyclosporine-based immunosuppression. Thirteen of these 408 patients underwent retranspl antation (including one patient who received a third graft). Indicatio ns for the 14 retransplantations included transplant coronary artery d isease (n = 8), rejection (n = 5), and intraoperative graft failure (n = 1). Immunosuppression and follow-up protocols used in this cohort w ere similar to those in the primary transplantation population. No sig nificant differences were found in either actuarial survival between p rimary transplant recipients (75.1% +/- 2.2% at 1 year and 71.3% +/- 2 .4% at 2 ears) and patients who underwent retransplantation (71.4% +/- 12.1% at 1 year and 59.5% +/- 14.8% at 2 years) or in linearized rate s of rejection and actuarial freedom from rejection between the two gr oups. No differences between these groups were found with regard to ag e, sex, race, origin of end-stage heart disease, or early (<30 day) mo rtality. The origin of primary graft failure did not correlate with su rvival outcome in the retransplantation cohort. Follow-up time for pat ients having primary transplantation ranged from 0 to 8 years (mean 24 months) with a cumulative patient follow-up of 830 patient-years; fol low-up time for patients who underwent retransplantation ranged from 0 to 3 years (mean 8.1 months) with a cumulative patient follow-up of 9 .5 patient-years. Approximately 50% of patients in both groups had at least one rejection episode by 3 months. Within the limited time perio d studied after retransplantation, only one patient had transplant cor onary artery disease, approximately 27 months after her first retransp lantation procedure for acute rejection. These results indicate that t he prognosis for patients undergoing cardiac retransplantation is good for patients for whom the indication for retransplantation is identif ied more than 30 days after initial transplantation.