Outcomes after heart retransplantation: A 50-year single-center experience

Yuanjia Zhu; Yasuhiro Shudo; Bharathi Lingala; Michael Baiocchi; Philip E Oyer; Y Joseph Woo

doi:10.1016/j.jtcvs.2020.06.121

Outcomes after heart retransplantation: A 50-year single-center experience

J Thorac Cardiovasc Surg. 2022 Feb;163(2):712-720.e6. doi: 10.1016/j.jtcvs.2020.06.121. Epub 2020 Jul 16.

Authors

Yuanjia Zhu¹, Yasuhiro Shudo¹, Bharathi Lingala¹, Michael Baiocchi², Philip E Oyer¹, Y Joseph Woo³

Affiliations

¹ Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif.
² Department of Epidemiology and Population Health, Stanford University, Stanford, Calif.
³ Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif. Electronic address: [email protected].

PMID: 32798029
DOI: 10.1016/j.jtcvs.2020.06.121

Abstract

Objectives: To evaluate outcomes after heart retransplantation.

Methods: From January 6, 1968, to June 2019, 123 patients (112 adult and 11 pediatric patients) underwent heart retransplantation, and 2092 received primary transplantation at our institution. Propensity-score matching was used to account for baseline differences between the retransplantation and the primary transplantation-only groups. Kaplan-Meier survival analyses were performed. The primary end point was all-cause mortality, and secondary end points were postoperative complications.

Results: Retransplantation recipient age was 39.6 ± 16.4 years, and donor age was 26.4 ± 11.2 years. Ninety-two recipients (74.8%) were male. Compared with recipients who only underwent primary heart transplantation, retransplantation recipients were more likely to have hypertension (44/73.3% vs 774/53.3%, P = .0022), hyperlipidemia (40/66.7% vs 447/30.7%, P < .0001), and require dialysis (7/11.7% vs 42/2.9%, P = .0025). The indications for heart retransplantation were cardiac allograft vasculopathy (32/80%), primary graft dysfunction (6/15%), and refractory acute rejection (2/5%). After matching, postoperative outcomes such as hospital length of stay, severe primary graft dysfunction requiring intra-aortic balloon pump or extracorporeal membrane oxygenation, cerebral vascular accident, respiratory failure, renal failure requiring dialysis, and infection were similar between the 2 groups. Matched median survival after retransplantation was 4.6 years compared with 6.5 years after primary heart transplantation (log-rank P = .36, stratified log-rank P = .0063).

Conclusions: In this single-center cohort, the unadjusted long-term survival after heart retransplantation was inferior to that after primary heart transplantation, and short-term survival difference persisted after propensity-score matching. Heart retransplantation should be considered for select patients for optimal donor organ usage.

Keywords: heart retransplantation; heart transplantation; long-term; outcomes; survival.

Publication types

Comparative Study
Observational Study
Video-Audio Media

MeSH terms

Adolescent
Adult
California
Coronary Artery Disease / etiology
Coronary Artery Disease / mortality
Coronary Artery Disease / physiopathology
Coronary Artery Disease / surgery*
Female
Graft Rejection / etiology
Graft Rejection / mortality
Graft Rejection / physiopathology
Graft Rejection / surgery*
Heart Failure / mortality
Heart Failure / physiopathology
Heart Failure / surgery*
Heart Transplantation* / adverse effects
Heart Transplantation* / mortality
Humans
Male
Middle Aged
Primary Graft Dysfunction / etiology
Primary Graft Dysfunction / mortality
Primary Graft Dysfunction / physiopathology
Primary Graft Dysfunction / surgery*
Recovery of Function
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Young Adult