Outcomes of Heart Re-Transplantation: Analysis of the United Network for Organ Sharing (UNOS)

Abstract

Donor and recipient-related factors may limit long-term graft survival and a selected subset of heart transplantation recipients are candidates for re-transplantation (HRT). However, outcomes of HRT are inferior to those of primary HT. HT recipients ≥18 years old that underwent HRT, were identified in the United Network for Organ Sharing (UNOS) registry between 1991 and 2016, with follow-up through March 2018. We conducted inverse-probability weighted estimator (IPWE) survival analysis of long-term survival stratified by type of primary HT or HRT, accounting for donor, recipient and operative characteristics. We identified 51231 HT and 1552 HRT recipients. Patients who underwent HRT were significantly younger (45.4 years vs. 52.1 year for HT) and more likely females (29.9% vs. 24.2% for HT). Cardiac allograft vasculopathy (CAV) was the most frequent etiology for HRT (57.2%) followed by chronic rejection (9.5%) and primary graft failure (8.3%). HRT rates have increased significantly during the study period (Figure). Median survival was 11.2 years for primary HT recipients (95% Confidence intervals [CI], 11.1-11.3), and was significantly higher (Hazard ratio 1.3, 95% CI 1.2-1.5) compared with HRT (8.7 years, 95% CI 7.9-9.5, Figure). A subset of HT recipients with graft dysfunction mainly due to CAV, undergo HRT with long-term survival inferior to that of primary HT.