451 Cardiac Retransplantation is a Valuable Option for End-Stage Coronary Artery Vasculopathy

Abstract

Retransplantation is done in only 2% to 3% of primary transplant recipient. Most of these patients have advanced coronary vasculopathy at the time of retransplantation. We report our experience with cardiac retransplantation since 1983. We reviewed all cases of patients who underwent heart retransplantation for end-stage coronary artery vasculopathy. From April 1983 to March 2011, we performed 377 cardiac transplantations. Ten (2.6%) were retransplantations. All primary cardiac transplant recipients at our institution served as the control group. Time to event analyses included comparisons of patients undergoing primary transplantation versus patients undergoing retranplantation for patient survival, rejection and infection analyses. There were 7 male and 3 female patients ranging from 14 to 69 years (mean, 37 ± 17 years). Indication for second transplantation was end-stage coronary vasculopathy in all cases. The Kaplan-Meier survival curves comparing our primary transplantation group with the retransplantation group are identical. The 30-day and the one year survival averaged 90 % ± 9 and 88 % ± 8 in retransplantation patients compared with 92 % ± 1 and 85 % ± 2 (p = 0.71) in primary transplant patients. The freedom rates from acute rejection (51 % ± 3 and 39 % ± 17, respectively) and from infection (48 % ± 3 and 39 % ± 17) were similar in both groups (p = 0.65 and p = 0.97) at ten year follow-up. Patients who underwent cardiac retransplantation for endstage coronary artery vasculopathy have similar outcomes when compared to primary heart transplant patients.