Should we perform heart retransplantation in early graft failure?

Transpl Int. 2010 Jan;23(1):47-53. doi: 10.1111/j.1432-2277.2009.00945.x. Epub 2009 Aug 12.


Cardiac retransplantation represents the gold standard treatment for a failing cardiac graft but the decision to offer the patient a second chance is often made difficult by both lack of donors and the ethical issues involved. The aim of this study was to evaluate whether retransplantation is a reasonable option in case of early graft failure. Between November 1985 and June 2008, 922 patients underwent cardiac transplantation at our Institution. Of these, 37 patients (4%) underwent cardiac retransplantation for cardiac failure resulting from early graft failure (n = 11) or late graft failure (acute rejection: n = 2, transplant-related coronary artery disease: n = 24). Survival at 1, 5 and 10 years of patients with retransplantation was 59%, 50% and 40% respectively. An interval between the first and the second transplantation of less than (n = 11, all in early graft failure) or more than (n = 26) 1 month was associated with a 1-year survival of 27% and 73%, and a 5-year survival of 27% and 65% respectively (P = 0.01). The long-term outcome of cardiac retransplantation is comparable with that of primary transplantation only in patients with transplant-related coronary artery disease. Early graft failure is a significant risk factor for survival after cardiac retransplantation and should be considered as an exclusion criteria.

MeSH terms

  • Adult
  • Aged
  • Contraindications
  • Coronary Artery Disease / etiology
  • Coronary Artery Disease / surgery
  • Female
  • Graft Rejection / surgery*
  • Graft Survival
  • Heart Failure / surgery
  • Heart Transplantation / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Patient Selection
  • Reoperation
  • Time Factors
  • Treatment Outcome