BACKGROUND: Cardiac retransplantation is increasing in frequency. Recent data have shown that retransplantation outcomes are now comparable with primary transplantation. The use of mechanical circulatory support (MCS) as a bridge to retransplantation has similar post-retransplant outcomes to those without MCS, but the success of bridging patients to retransplant with MCS has not been well studied. METHODS: From January 2000 to February 2014 at Columbia University Medical Center, 84 patients were listed for retransplantation. Of this cohort, 48 patients underwent retransplantation, 15 were bridged with MCS, 24 died, and 6 clinically improved. A retrospective analysis was performed examining waiting list time, survival to retransplantation, and survival after retransplant. The effect of the United Network of Organ Sharing (UNOS) allocation policy change in 2006 on waiting list time and MCS use was also investigated. RESULTS: Of 48 patients who underwent retransplantation, 11 were bridged with MCS. Overall 1-year survival to retransplantation was 81.3%. There was no significant difference in waiting list survival (p = 0.71) in those with and without MCS. Death from cardiac arrest or multiorgan failure with infection was more frequent in the medically managed group (p = 0.002). After the UNOS 2006 allocation policy change, waiting list time (599 ± 936 days in Era 1 vs 526 ± 498 days in Era 2, p = 0.65) and waiting list survival (p = 0.22) between eras were comparable, but there was a trend toward greater use of MCS (p = 0.13). Survival after retransplant was acceptable. CONCLUSION: The use of MCS as a bridge to cardiac retransplantation is a reasonable strategy.
BACKGROUND: Cardiac retransplantation is increasing in frequency. Recent data have shown that retransplantation outcomes are now comparable with primary transplantation. The use of mechanical circulatory support (MCS) as a bridge to retransplantation has similar post-retransplant outcomes to those without MCS, but the success of bridging patients to retransplant with MCS has not been well studied. METHODS: From January 2000 to February 2014 at Columbia University Medical Center, 84 patients were listed for retransplantation. Of this cohort, 48 patients underwent retransplantation, 15 were bridged with MCS, 24 died, and 6 clinically improved. A retrospective analysis was performed examining waiting list time, survival to retransplantation, and survival after retransplant. The effect of the United Network of Organ Sharing (UNOS) allocation policy change in 2006 on waiting list time and MCS use was also investigated. RESULTS: Of 48 patients who underwent retransplantation, 11 were bridged with MCS. Overall 1-year survival to retransplantation was 81.3%. There was no significant difference in waiting list survival (p = 0.71) in those with and without MCS. Death from cardiac arrest or multiorgan failure with infection was more frequent in the medically managed group (p = 0.002). After the UNOS 2006 allocation policy change, waiting list time (599 ± 936 days in Era 1 vs 526 ± 498 days in Era 2, p = 0.65) and waiting list survival (p = 0.22) between eras were comparable, but there was a trend toward greater use of MCS (p = 0.13). Survival after retransplant was acceptable. CONCLUSION: The use of MCS as a bridge to cardiac retransplantation is a reasonable strategy.
Authors: Josef Stehlik; Leah B Edwards; Anna Y Kucheryavaya; Christian Benden; Jason D Christie; Anne I Dipchand; Fabienne Dobbels; Richard Kirk; Axel O Rahmel; Marshall I Hertz Journal: J Heart Lung Transplant Date: 2012-10 Impact factor: 10.247
Authors: R John; J M Chen; A Weinberg; M C Oz; D Mancini; S Itescu; M E Galantowicz; C R Smith; E A Rose; N M Edwards Journal: J Thorac Cardiovasc Surg Date: 1999-03 Impact factor: 5.209
Authors: Muhammad S Khan; Carlos M Mery; Farhan Zafar; Iki Adachi; Jeffrey S Heinle; Antonio G Cabrera; Charles D Fraser; David L Morales Journal: J Heart Lung Transplant Date: 2012-08-17 Impact factor: 10.247
Authors: J G Copeland; R B Griepp; C P Bieber; M Billingham; J S Schroeder; S Hunt; J Mason; E B Stinson; N E Shumway Journal: J Thorac Cardiovasc Surg Date: 1977-02 Impact factor: 5.209
Authors: Heidi Goerler; Andre Simon; Bernhard Gohrbandt; Christian Hagl; Petra Oppelt; Axel Haverich; Martin Strueber Journal: Eur J Cardiothorac Surg Date: 2008-08-09 Impact factor: 4.191
Authors: Jeffrey H Shuhaiber; Jong Bae Kim; Kwan Hur; Robert D Gibbons; Hassan W Nemeh; Jeffrey P Schwartz; Mamdouh Bakhos Journal: Ann Thorac Surg Date: 2007-06 Impact factor: 4.330
Authors: Branislav Radovancevic; David C McGiffin; Jon A Kobashigawa; Guillermo B Cintron; G Martin Mullen; Douglas E Pitts; Jacqueline O'Donnell; Cindi Thomas; Robert C Bourge; David C Naftel Journal: J Heart Lung Transplant Date: 2003-08 Impact factor: 10.247