Document Detail


Early and late outcomes after cardiac retransplantation.
MedLine Citation:
PMID:  23187039     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cardiac retransplantation remains the most viable option for patients with allograft heart failure; however, careful patient selection is paramount considering limited allograft resources. We analyzed clinical outcomes following retransplantation in an academic, tertiary care institution.
METHODS: Between 1981 and 2011, 593 heart transplantations, including 22 retransplantations were performed at our institution. We analyzed the preoperative demographic characteristics, cause of allograft loss, short- and long-term surgical outcomes and cause of death among patients who had cardiac retransplantations.
RESULTS: Twenty-two patients underwent retransplantation: 10 for graft vascular disease, 7 for acute rejection and 5 for primary graft failure. Mean age at retransplantation was 43 (standard deviation [SD] 15) years; 6 patients were women. Thirteen patients were critically ill preoperatively, requiring inotropes and/or mechanical support. The median interval between primary and retransplantation was 2.2 (range 0-16) years. Thirty-day mortality was 31.8%, and conditional (> 30 d) 1-, 5- and 10-year survival after retransplantation were 93%, 79% and 59%, respectively. A diagnosis of allograft vasculopathy (p = 0.008) and an interval between primary and retransplantation greater than 1 year (p = 0.016) had a significantly favourable impact on 30-day mortality. The median and mean survival after retransplantation were 3.3 and 5 (SD 6, range 0-18) years, respectively; graft vascular disease and multiorgan failure were the most common causes of death.
CONCLUSION: Long-term outcomes for primary and retransplantation are similar if patients survive the 30-day postoperative period. Retransplantation within 1 year of the primary transplantation resulted in a high perioperative mortality and thus may be a contraindication to retransplantation.
Authors:
Aya Saito; Richard J Novick; Bob Kiaii; F Neil McKenzie; Mackenzie Quantz; Peter Pflugfelder; Grant Fisher; Michael W A Chu
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Canadian journal of surgery. Journal canadien de chirurgie     Volume:  56     ISSN:  1488-2310     ISO Abbreviation:  Can J Surg     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-28     Completed Date:  2013-03-17     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  0372715     Medline TA:  Can J Surg     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  21-6     Citation Subset:  IM    
Affiliation:
The Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London Health Sciences Centre, Lawson Health Research Institute, London, Ont., Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Female
Graft Rejection / etiology,  surgery*
Heart Failure / mortality*,  surgery*
Heart Transplantation* / mortality,  standards
Humans
Immunosuppressive Agents / administration & dosage
Kaplan-Meier Estimate
Male
Medical Records
Middle Aged
Ontario
Patient Selection
Perioperative Period
Reoperation / mortality,  standards
Retrospective Studies
Risk Factors
Tertiary Healthcare
Time Factors
Transplantation, Homologous
Treatment Outcome
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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