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Salterain-González N, Rábago Juan-Aracil G, Gómez-Bueno M, Almenar-Bonet L, Crespo-Leiro MG, Arizón Del Prado JM, García-Cosío MD, Martínez-Sellés M, Mirabet-Pérez S, Sobrino-Márquez JM, González-Costello J, Pérez-Villa F, Díaz-Molina B, de la Fuente-Galán L, Blasco-Peiró T, Garrido-Bravo IP, García-Guereta Silva L, Gil-Villanueva N, Gran F, González-Vilchez F. Results of heart retransplantation: subanalysis of the Spanish Heart Transplant Registry. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:60-66. [PMID: 34253459 DOI: 10.1016/j.rec.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Heart retransplantation (ReHT) is controversial in the current era. The aim of this study was to describe and analyze the results of ReHT in Spain. METHODS We performed a retrospective cohort analysis from the Spanish Heart Transplant Registry from 1984 to 2018. Data were collected on donors, recipients, surgical procedure characteristics, immunosuppression, and survival. The main outcome was posttransplant all-cause mortality or need for ReHT. We studied differences in survival according to indication for ReHT, the time interval between transplants and era of ReHT. RESULTS A total of 7592 heart transplants (HT) and 173 (2.3%) ReHT were studied (median age, 52.0 and 55.0 years, respectively). Cardiac allograft vasculopathy was the most frequent indication for ReHT (42.2%) and 59 patients (80.8%) received ReHT >5 years after the initial transplant. Acute rejection and primary graft failure decreased as indications over the study period. Renal dysfunction, hypertension, need for mechanical ventilation or intra-aortic balloon pump and longer cold ischemia time were more frequent in ReHT. Median follow-up for ReHT was 5.8 years. ReHT had worse survival than HT (weighted HR, 1.43; 95%CI, 1.17-1.44; P<.001). The indication of acute rejection (HR, 2.49; 95%CI, 1.45-4.27; P<.001) was related to the worst outcome. ReHT beyond 5 years after initial HT portended similar results as primary HT (weighted HR, 1.14; 95%CI, 0.86-1.50; P<.001). CONCLUSIONS ReHT was associated with higher mortality than HT, especially when indicated for acute rejection. ReHT beyond 5 years had a similar prognosis to primary HT.
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Affiliation(s)
| | | | - Manuel Gómez-Bueno
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Luis Almenar-Bonet
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Universitat de València, Valencia, Spain
| | - María Generosa Crespo-Leiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | | | - María Dolores García-Cosío
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain; Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Sonia Mirabet-Pérez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Insuficiencia Cardiaca y Programa de Trasplante Cardiaco, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - José González-Costello
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Félix Pérez-Villa
- Unidad de Insuficiencia Cardiaca, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Beatriz Díaz-Molina
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardico, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Luis de la Fuente-Galán
- Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Teresa Blasco-Peiró
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Iris P Garrido-Bravo
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Nuria Gil-Villanueva
- Unidad de Insuficiencia Cardiaca y Trasplante, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain
| | - Ferrán Gran
- Servicio Cardiología pediátrica, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Francisco González-Vilchez
- Unidad de Insuficiencia Cardiaca y Transplante, Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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Vistarini N, Nguyen A, White M, Racine N, Perrault LP, Ducharme A, Bouchard D, Demers P, Pellerin M, Lamarche Y, El-Hamamsy I, Giraldeau G, Pelletier G, Carrier M. Changes in patient characteristics following cardiac transplantation: the Montreal Heart Institute experience. Can J Surg 2017; 60:305-310. [PMID: 28805187 DOI: 10.1503/cjs.005716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Heart transplantation is no longer considered an experimental operation, but rather a standard treatment; nevertheless the context has changed substantially in recent years owing to donor shortage. The aim of this study was to review the heart transplant experience focusing on very long-term survival (≥ 20 years) and to compare the initial results with the current era. METHODS From April 1983 through April 1995, 156 consecutive patients underwent heart transplantation. Patients who survived 20 years or longer (group 1) were compared with patients who died within 20 years after surgery (group 2). To compare patient characteristics with the current era, we evaluated our recent 5-year experience (group 3; patients who underwent transplantation between 2010 and 2015), focusing on differences in terms of donor and recipient characteristics. RESULTS Group 1 (n = 46, 30%) included younger patients (38 ± 11 v. 48 ± 8 yr, p = 0.001), a higher proportion of female recipients (28% v. 8%, p = 0.001) and a lower prevalence of ischemic heart disease (42% v. 65%, p = 0.001) than group 2 (n = 110, 70%). Patients in group 3 (n = 54) were older (52 ± 12 v. 38 ± 11 yr, p = 0.001), sicker (rate of hospital admission at transplantation 48% v. 20%, p = 0.001) and transplanted with organs from older donors (42 ± 15 v. 29 ± 11 yr, p = 0.001) than those in group 1. CONCLUSION Very long-term survival ( ≥ 20 yr) was observed in 30% of patients transplanted during the first decade of our experience. This outcome will be difficult to duplicate in the current era considering our present population of older and sicker patients transplanted with organs from older donors.
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Affiliation(s)
- Nicola Vistarini
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Anthony Nguyen
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Michel White
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Normand Racine
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Louis P Perrault
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Anique Ducharme
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Denis Bouchard
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Philippe Demers
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Michel Pellerin
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Yoan Lamarche
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Ismaïl El-Hamamsy
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Geneviève Giraldeau
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Guy Pelletier
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
| | - Michel Carrier
- From the Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Que. (Vistarini, Nguyen, Perrault, Bouchard, Demers, Pellerin, Lamarche, El-Hamamsy, Carrier); and the Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Que. (White, Racine, Ducharme, Giraldeau, Pelletier)
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Belli E, Leoni Moreno JC, Hosenpud J, Rawal B, Landolfo K. Preoperative risk factors predict survival following cardiac retransplantation: analysis of the United Network for Organ Sharing database. J Thorac Cardiovasc Surg 2014; 147:1972-7, 1977.e1. [PMID: 24636155 DOI: 10.1016/j.jtcvs.2014.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/20/2014] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of our study was to identify preoperative risk factors affecting overall survival after cardiac retransplantation (ReTX) in a contemporary era. METHODS The United Network for Organ Sharing database was used to identify patients undergoing ReTX between 1995 and 2012. Of the total 28,464 primary transplants performed, 987 (3.5%) were retransplants. The primary outcome investigated was overall survival. The influence of preoperative donor and recipient characteristics on survival were then tested with univariate logistic regression and multivariate Cox regression models. RESULTS Of 987 patients who underwent ReTX, median survival was 9 years. Estimated survival at 1, 3, 5, 10, and 15 years following retransplant was 80% (95% confidence interval [CI], 78%-83%), 70% (95% CI, 67%-73%), 64% (95% CI, 61%-67%), 47% (95% CI, 43%-51%), and 30% (95% CI, 25%-37%), respectively. Clinical predictors of survival using multivariable analysis included donor age (relative risk [RR], 1.14; P = .004), ischemic time > 4 hours (RR, 1.48; P = .004); preoperative support with extracorporeal membrane oxygenator (RR, 3.91; P < .001), and the time between previous and current transplant (P = .004). Patients with ReTX have 1.27 times higher relative risk of death compared with patients undergoing primary transplant only (RR, 1.27; 95% CI, 1.13-1.42; P < .001). CONCLUSIONS Patients who undergo cardiac ReTX can expect to have a 1-year survival less than a patient undergoing primary transplant with an acceptable median overall survival. Both donor and recipient preoperative factors contribute to overall survival following cardiac ReTx. Donor characteristics include age of the donor and ischemic time. Recipient factors include the need for extracorporeal membrane oxygenator and the number of days between the first and second transplant. Optimal survival following cardiac ReTX can best be predicted by choosing patients who are farther out from their initial transplant, not dependent upon preoperative extracorporeal support, and by choosing donor hearts younger in age and those likely to have shorter ischemic times.
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Affiliation(s)
- Erol Belli
- Department of Surgery, Mayo Clinic Florida, Jacksonville, Fla
| | | | - Jeffrey Hosenpud
- Department of Cardiology, Mayo Clinic Florida, Jacksonville, Fla
| | - Bhupendra Rawal
- Department of Biostatistics and Bioinformatics, Mayo Clinic Florida, Jacksonville, Fla
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Fla
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5
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Saito A, Novick RJ, Kiaii B, McKenzie FN, Quantz M, Pflugfelder P, Fisher G, Chu MW. Early and late outcomes after cardiac retransplantation. Can J Surg 2013; 56:21-6. [PMID: 23187039 PMCID: PMC3569470 DOI: 10.1503/cjs.012511] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2011] [Indexed: 11/01/2022] Open
Abstract
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.
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Affiliation(s)
- Aya Saito
- Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London Health Sciences Centre, Lawson Health Research Institute, London, Ont
- Department of Cardiothoracic Surgery, University ofTokyo, Tokyo, Japan
| | - Richard J. Novick
- Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London Health Sciences Centre, Lawson Health Research Institute, London, Ont
| | - Bob Kiaii
- Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London Health Sciences Centre, Lawson Health Research Institute, London, Ont
| | - F. Neil McKenzie
- Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London Health Sciences Centre, Lawson Health Research Institute, London, Ont
| | - Mackenzie Quantz
- Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London Health Sciences Centre, Lawson Health Research Institute, London, Ont
| | - Peter Pflugfelder
- Division of Cardiology, Department of Medicine, University of Western Ontario and London Health Sciences Centre, London, Ont
| | - Grant Fisher
- Multi-Organ Transplant Program, London Health Sciences Centre, London, Ont
| | - Michael W.A. Chu
- Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London Health Sciences Centre, Lawson Health Research Institute, London, Ont
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