Cardiac retransplantation: is it justified in times of critical donor organ shortage? Long-term single-center experience
Cardiac retransplantation: is it justified in times of critical donor organ shortage? Long-term single-center experience
复制标题
DOI：
10.1016/j.ejcts.2008.06.044
复制
发表时间：
2008-12-01
影响因子：
3.4
通讯作者：
Strueber, Martin
中科院分区：
文献类型：
--
作者：
Goerler, Heidi;Simon, Andre;Strueber, Martin
目的：在过去的几十年里，心脏移植后的生存率得到了显著提高。越来越多的患者因慢性移植物功能障碍而需要再次心脏移植。关于心脏移植供体的严重短缺，必须仔细考虑提供重复心脏移植的决定。方法：自1983年以来，我们共进行了807例心脏移植手术。再次心脏移植41例，急性移植失败18例，慢性移植失败23例。对数据进行人口统计学、发病率和死亡率风险因素分析。将急性和慢性再次移植组与接受初次移植的患者进行比较。结果如下：初次移植和再次移植之间的平均间隔在急性组为1.9天，在慢性再次移植组为6.7年。平均随访6.9年。初次移植组和再次移植组的基线特征相似。初次心脏移植术后1、3、5和7年的存活率分别为83、78、72和64%，再次心脏移植术后分别为53、50、47和36%（p < 0.001）。急性再次移植后的早期死亡率显著高于晚期再次移植（10/18，55.6% vs 4/23，17.4%，p = 0.011）。主要死亡原因为急性和慢性排斥反应、感染和败血症。结论：与初次移植相比，再次心脏移植的存活率较低。然而，慢性移植物衰竭再次移植后的结果明显好于急性移植物衰竭。因此，我们认为慢性移植物衰竭的再次心脏移植是一种合理的治疗选择。相比之下，急性移植失败的患者似乎不适合再次心脏移植。(C)2008年欧洲胸外科协会。Elsevier B. V.出版，保留所有权利。
Objective: Survival after heart transplantation has improved significantly over the last decades. There are a growing number of patients that require cardiac retransplantation because of chronic allograft dysfunction. With regard to the critical shortage of cardiac allograft donors the decision to offer repeat heart transplantation must be carefully considered. Methods: Since 1983 a total of 807 heart transplantations have been performed at our institution. Among them 41 patients received cardiac retransplantation, 18 patients because of acute graft failure and 23 because of chronic graft failure. Data were analyzed for demographics, morbidity and risk factors for mortality. The acute and chronic retransplant group was compared to those patients undergoing primary transplantation. Results: The mean interval between primary transplantation and retransplantation was 1.9 days in the acute and 6.7 years in the chronic retransplant group. Mean follow-up was 6.9 years. Baseline characteristics were similar in the primary and retransplant group. Actuarial survival rates at 1, 3, 5 and 7 years after primary cardiac transplantation compared to retransplantation were 83, 78, 72 and 64% vs 53, 50, 47 and 36%, respectively (p < 0.001). Early mortality after acute retransplantation was significantly higher compared to late retransplantation (10/18, 55.6% vs 4/23, 17.4%, p = 0.011). Major causes of death were acute and chronic rejection, infection and sepsis. Conclusions: Cardiac retransplantation is associated with lower survival rates compared to primary transplantation. However, results after retransplantation in chronic graft failure are significantly better compared to acute graft failure. Therefore, we consider cardiac retransplantation in chronic graft failure a justified therapeutic option. In contrast, patients with a cute graft failure seem to be inappropriate candidates for cardiac retransplantation. (C) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.