Elective cardiac retransplantation: a viable option that can be repeated.

Objective: Our hypothesis is that cardiac retransplantation is a viable option for selected recipients. Furthermore, in some patients multiple retransplantations are reasonable.

Methods: We studied 23 patients who had all received an elective second, third, or fourth cardiac transplant over a 25-year period. Comparisons were made with 792 primary transplantations. Subsequent retransplantations (third and fourth time) were elective and included in the evaluation.

Results: Twenty-three patients electively received a second, 4 a third, and 1 a fourth transplant for coronary vasculopathy or chronic graft failure. Sixteen (70%) patients were men, and 7 (30%) were women. Median survival in years for primary cardiac recipients was 10.7 years; for a second transplantation, median survival from the date of retransplantation was 9.3 years. Average age at the time of first transplantation was 47.8 years, and it was 44.3 years at the time of second transplantation. No significant difference was noted in Kaplan-Meier survival curves between patients undergoing primary transplantation and elective retransplantation. Survival at 1 year for patients undergoing a first transplantation was 88.8%, and it was 81.8% for patients undergoing retransplantation. Patient survival at 10 years was nearly identical for patients undergoing first-time transplantation and those undergoing retransplantation (58%). All 5 third- and fourth-time transplant recipients survived.

Conclusions: Cardiac retransplantation is a reasonable option for elective recipients with coronary vasculopathy or chronic graft failure. Survival for groups undergoing primary transplantation and retransplantation is similar. Careful selection of this small group of cardiac recipients (3% of the total) might be the key to success.