Thorac Cardiovasc Surg 2008; 56(6): 323-327
DOI: 10.1055/s-2008-1038662
Review

© Georg Thieme Verlag KG Stuttgart · New York

Cardiac Retransplantation in Adults: An Evidence-Based Systematic Review

Y. S. Tjang1 , G. Tenderich1 , L. Hornik1 , R. Körfer1
  • 1Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, Germany
Further Information

Publication History

received August 6, 2007

Publication Date:
14 August 2008 (online)

Abstract

Background: It remains a matter of dispute whether cardiac retransplantation should be performed. We aimed to systematically review the available evidence regarding cardiac retransplantation in adults.

Material and Methods: In PubMed, we searched for original reports on cardiac retransplantation in adults. The evidence level of individual studies was assessed.

Results: Twenty-two studies met our selection criteria. The cumulative incidence was 3 % (range: 1 % to 15 %). The incidence rate was 164/10 000 person-years (range: 145 to 318/10 000 person-years). The main indications for retransplantation were cardiac allograft vasculopathy (55 %), acute rejection (19 %), and primary graft failure (17 %). The early mortality rate was 16 % (range: 5 % to 38 %). Refractory acute rejection and primary graft failure, female donor, shorter transplant interval, initial diagnosis of ischemic cardiomyopathy, need for mechanical circulatory support, a center volume of less than 9 transplantations/year, older recipient age, requirement of pretransplant ventilator and intensive care, and ischemic time were associated with poorer outcomes, while cardiac allograft vasculopathy as the cause of allograft failure, employment, and later transplant period were associated with improved survival.

Conclusion: This systematic review shows that the results of cardiac retransplantation in adults are inconclusive. Retransplantation for cardiac allograft vasculopathy is associated with satisfactory outcomes.

References

  • 1 Collins E G, Mozdzierz G J. Cardiac retransplantation: determining limits.  Heart Lung. 1993;  22 206-212
  • 2 Evans R W, Manninen D L, Dong F B, McLynne D A. Is retransplantation cost effective?.  Transplant Proc. 1993;  25 1694-1696
  • 3 Luquire R, Houston S. Ethical concerns regarding cardiac retransplantation.  Nurs Econ. 1992;  10 413-417
  • 4 Ubel P A, Arnold R M, Caplan A L. Rationing failure. The ethical lessons of the retransplantation of scarce vital organs.  JAMA. 1993;  270 2469-2474
  • 5 Mentzer S J, Reilly Jr J J, Caplan A L, Sugarbaker D J. Ethical considerations in lung retransplantation.  J Heart Lung Transplant. 1994;  13 56-58
  • 6 Schlechta B, Kocher A A, Ehrlich M. et al . Heart retransplantation: institutional results of a series of 31 cases.  Transplant Proc. 2001;  33 2759-2761
  • 7 Griffin L. Retransplantation of multiple organs: how many organs should one individual receive?.  Prog Transplant. 2002;  12 92-96
  • 8 Novick R J. Heart and lung retransplantation: should it be done?.  J Heart Lung Transplant. 1998;  17 635-642
  • 9 Chou N K, Chi N H, Chen Y S. et al . Heart retransplantation for heart allograft failure in Chinese heart transplant recipients: NTUH experience.  Transplant Proc. 2006;  38 2147-2148
  • 10 De Boer J, Cohen B, Thorogood J, D'Amaro J, Persijn G G. Results of acute heart retransplantation in Eurotransplant.  Transpl Int. 1992;  5 (Suppl 1) S219-S220
  • 11 Dein J R, Oyer P E, Stinson E B, Starnes V A, Shumway N E. Cardiac retransplantation in the cyclosporine era.  Ann Thorac Surg. 1989;  48 350-355
  • 12 Ensley R D, Hunt S, Taylor D O. et al . Predictors of survival after repeat heart transplantation. The Registry of the International Society for Heart and Lung Transplantation, and contributing investigators.  J Heart Lung Transplant. 1992;  11 S142-S158
  • 13 John R, Chen J M, Weinberg A. et al . Long-term survival after cardiac retransplantation: a twenty-year single-center experience.  J Thorac Cardiovasc Surg. 1999;  117 543-555
  • 14 Karwande S V, Ensley R D, Renlund D G. et al . Cardiac retransplantation: a viable option? The Registry of the International Society for Heart and Lung Transplantation.  Ann Thorac Surg. 1992;  54 840-844
  • 15 Magee J C, Barr M L, Basadonna G P. et al . Repeat organ transplantation in the United States, 1996 – 2005.  Am J Transplant. 2007;  7 1424-1433
  • 16 Martinelli L, Rinaldi M, Goggi C. et al . Emergency and elective cardiac retransplantation.  Eur J Cardiothorac Surg. 1993;  7 587-590
  • 17 Michler R E, McLaughlin M J, Chen J M. et al . Clinical experience with cardiac retransplantation.  J Thorac Cardiovasc Surg. 1993;  106 622-629
  • 18 Mullins P, Scott J, Chauhan A. et al . Acute heart retransplantation.  Lancet. 1991;  337 1552-1553
  • 19 Novitzky D, Cooper D K, Lanza R P, Barnard C N. Further cardiac transplant procedures in patients with heterotopic heart transplants.  Ann Thorac Surg. 1985;  39 149-154
  • 20 Persijn G G, Cohen B, de Meester J. High-urgent repeat heart transplantation.  Transplant Proc. 1995;  27 1282-1283
  • 21 Radovancevic B, McGiffin D C, Kobashigawa J A. et al . Retransplantation in 7290 primary transplant patients: a 10-year multi-institutional study.  J Heart Lung Transplant. 2003;  22 862-868
  • 22 Rahman J E, Walinsky P L, Baumgartner W A. Retransplantation of the heart. Baumgartner WA, Reitz B, Kasper E, Theodore J Heart and Lung Transplantation. 2nd ed. Philadelphia; WB Saunders Company 2002: 489-494
  • 23 Schnetzler B, Pavie A, Dorent R. et al . Heart retransplantation: a 23-year single-center clinical experience.  Ann Thorac Surg. 1998;  65 978-983
  • 24 Shuhaiber J H, Kim J B, Hur K. et al . Comparison of survival in primary and repeat heart transplantation from 1987 through 2004 in the United States.  Ann Thorac Surg. 2007;  83 2135-2141
  • 25 Smith J A, Ribakove G H, Hunt S A. et al . Heart retransplantation: the 25-year experience at a single institution.  J Heart Lung Transplant. 1995;  14 832-839
  • 26 Srivastava R, Keck B M, Bennett L E, Hosenpud J D. The results of cardiac retransplantation: an analysis of the Joint International Society for Heart and Lung Transplantation/United Network for Organ Sharing Thoracic Registry.  Transplantation. 2000;  70 606-612
  • 27 Tjang Y S, Tenderich G, Hornik L, Wlost S, Bairaktaris A, Korfer R. Long-term experiences on cardiac retransplantation in adults.  Eur J Cardiothorac Surg. 2007;  32 923-925
  • 28 Topkara V K, Dang N C, John R. et al . A decade experience of cardiac retransplantation in adult recipients.  J Heart Lung Transplant. 2005;  24 1745-1750
  • 29 Watson D C, Reitz B A, Oyer P E, Stinson E B, Shumway N E. Sequential orthotopic heart transplantation in man.  Transplantation. 1980;  30 401-403
  • 30 De Decker K, Jorens P G, Van Schil P. Cardiac complications after noncardiac thoracic surgery: an evidence-based current review.  Ann Thorac Surg. 2003;  75 1340-1348
  • 31 Chin C, Naftel D, Pahl E. et al . Cardiac re-transplantation in pediatrics: a multi-institutional study.  J Heart Lung Transplant. 2006;  25 1420-1424
  • 32 Dearani J A, Razzouk A J, Gundry S R. et al . Pediatric cardiac retransplantation: intermediate-term results.  Ann Thorac Surg. 2001;  71 66-70
  • 33 Kanter K R, Vincent R N, Berg A M, Mahle W T, Forbess J M, Kirshbom P M. Cardiac retransplantation in children.  Ann Thorac Surg. 2004;  78 644-649
  • 34 Mahle W T, Vincent R N, Kanter K R. Cardiac retransplantation in childhood: analysis of data from the United Network for Organ Sharing.  J Thorac Cardiovasc Surg. 2005;  130 542-546
  • 35 Michler R E, Edwards N M, Hsu D. et al . Pediatric retransplantation.  J Heart Lung Transplant. 1993;  12 S319-S327
  • 36 Razzouk A J, Chinnock R E, Dearani J A, Gundry S R, Bailey L L. Cardiac retransplantation for graft vasculopathy in children: should we continue to do it?.  Arch Surg. 1998;  133 881-885
  • 37 Richmond M E, Addonizio L J, Hsu D T. et al . Cardiac retransplantation in high risk pediatric patients.  Pediatr Transplant. 2007;  11 615-623
  • 38 Johnson M R, Aaronson K D, Canter C E. et al . Heart retransplantation.  Am J Transplant. 2007;  7 2075-2081
  • 39 Taylor D O, Edwards L B, Boucek M M. et al . Registry of the International Society for Heart and Lung Transplantation: twenty-fourth official adult heart transplant report – 2007.  J Heart Lung Transplant. 2007;  26 769-781
  • 40 Miller L W, Schlant R C, Kobashigawa J, Kubo S, Renlund D G. 24th Bethesda conference: Cardiac transplantation. Task Force 5: Complications.  J Am Coll Cardiol. 1993;  22 41-54

Dr. MD, MBA, MPH, MSc, DSc, FICS Yanto Sandy Tjang

Heart and Diabetes Center North Rhine Westphalia
Thoracic and Cardiovascular Surgery

Georgstrasse 11

32545 Bad Oeynhausen

Germany

Phone: + 49 5 73 18 69 69 21

Email: ystjang@hotmail.com