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Vol.3 - No.3

Should Heart Transplant Recipients With Early Graft Failure Be Considered for Retransplantation?

By : baghaei

Keywords : -

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Objectives

The purpose of this study was to determine if
orthotopic heart transplantation performed within 90 days
of an initial heart transplant (re-Tx) should be a contraindication
to retransplantation based on inferior outcomes when
compared with primary orthotopic heart transplantation recipients
(control).

Methods

De-identified data were obtained from the United
Network for Organ Sharing. The study population included
all adult heart transplant recipients greater than 18 years old
from 1995 to 2008 (n = 26,804). Multivariable regression
was performed in order to assess the simultaneous effect of
multiple risk factors on posttransplant graft failure (PTGF)
at 90 days. Secondary outcomes of interest included infection,
stroke, and dialysis during the transplant hospitalization
as well as primary nonfunction of the graft at 90 days.

Results

Among the study cohort, there were 90 (0.34%)
re-Tx patients. Median survival in this group was 1.6 yearscompared with 10.5 years for controls. Unadjusted PTGF,
infection, dialysis, and primary nonfunction were significantly
higher (p < 0.001) in the re-Tx group. After risk adjustment,
however, PTGF (p = 0.545), infection (p = 0.696),
dialysis (p = 0.664), stroke (p = 0.115), and primary nonfunction
(p = 0.531), did not differ significantly between
the 2 groups

Conclusion

When controlling for pretransplant recipient
characteristics, retransplantation within 90 days of a previous
transplant is not associated with increased morbidity
or mortality. However, unadjusted overall survival was significantly
worse in the re-Tx group. This suggests that although
retransplantation at 90 days alone is not a risk factor
for inferior outcomes, given the significant comorbidities of
these patients, the indications for retransplantation within
90 days are rare and must be critically examined.

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