EMERGENCY AND ELECTIVE CARDIAC RETRANSPLANTATION

Among 265 patients transplanted at our Institution, 7 underwent cardia c retransplantation. There were five emergency retransplantations, the indication being graft failure in one case and acute rejection in fou r cases. Two patients, retransplanted because of acute rejection, had a positive panel reactivity antibody and a negative donor crossmatch. In the rejection cases immunosuppression was enhanced by perioperative plasmapheresis and a postoperative 1-month course of cyclophosphamide . In two cases emergency retransplantations were successfully performe d despite a highly positive prospective crossmatch. Two patients under went elective retransplantations for chronic rejection 12 and 41 month s, respectively, after the primary transplants. The overall early and late survival rates are 71 % and 57%, respectively, with a mean follow -up of 48.5 months. The early and late mortality for elective retransp lantation is zero. Our experience confirms both the high operative ris k for emergency retransplantation and the excellent results for electi ve retransplantation. The use of plasmapheresis and cyclophosphamide a llowed us to undertake retransplantation successfully in 2 cases with positive donor crossmatch. Both hyperimmunized patients in our series were retransplanted because of irreversible acute rejection despite a negative crossmatch with the primary donor. The meaning of negative cr ossmatch in patients with preformed cytotoxic antibodies is therefore questionable.