Cardiac retransplantation for graft vasculopathy in children: Should we continue to do it?

Anees J. Razzouk, Richard E. Chinnock, Joseph A. Dearani, Steven R. Gundry, Leonard L. Bailey

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: Cardiac transplantation (CTx) has been established as an effective therapy for a variety of inoperable cardiac conditions in infants and children. However, graft vasculopathy (GV) has emerged as the main limiting factor to long-term survival of CTx recipients. The only treatment of severe GV is cardiac retransplantation (re-Tx). Controversy exists regarding the use of scarce donor organs for cardiac re-Tx. Objective: To compare the outcome of cardiac re-Tx for GV with that of primary CTx in children. Design: A 12-year retrospective cohort review. Setting: A university-affiliated children's hospital. Patients: All infants and children who underwent CTx (group 1, n = 322) had complete follow-up of 1389.7 patient-years. Graft vasculopathy was confirmed in 32 recipients (1.1-8.2 years after undergoing CTx). Thirteen patients died suddenly, 3 died waiting for cardiac re-Tx (1-17 days after relisting), 4 are pending cardiac re-Tx, and 12 (group 2) underwent cardiac re-Tx. Intervention: Cardiac re-Tx at a mean (± SD) interval from the first CTx of 6.3 ± 1.8 years (range, 2.2-9.4 years). Two patients required additional aortic arch aneurysm repair with cardiac re-Tx. Results: When group 1 was compared with group 2, there was no significant difference in operative mortality (9.0% vs 8.3%; P = .9), rejection rate (0.98 vs 0.86; P = .1), and hospital stay (23.0 ± 18.8 days vs 20.5 ± 11.6 days; P = .65). Actuarial survival for groups 1 and 2 at 1 and 4 years was 84.3% vs 83.3% (P= .59) and 74.4% vs 83.3% (P = .85), respectively. Conclusions: The surgical outcome and intermediate survival of cardiac re-Tx for GV and primary CTx are similar. Children with severe cardiac GV are at risk of sudden death and can benefit from early cardiac re- Tx.

Original languageEnglish (US)
Pages (from-to)881-885
Number of pages5
JournalArchives of Surgery
Volume133
Issue number8
DOIs
StatePublished - Aug 1998
Externally publishedYes

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Transplants
Survival
compound A 12
Aortic Aneurysm
Heart Transplantation
Sudden Death
Thoracic Aorta
Length of Stay
Tissue Donors
Mortality
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Razzouk, A. J., Chinnock, R. E., Dearani, J. A., Gundry, S. R., & Bailey, L. L. (1998). Cardiac retransplantation for graft vasculopathy in children: Should we continue to do it? Archives of Surgery, 133(8), 881-885. https://doi.org/10.1001/archsurg.133.8.881

Cardiac retransplantation for graft vasculopathy in children : Should we continue to do it? / Razzouk, Anees J.; Chinnock, Richard E.; Dearani, Joseph A.; Gundry, Steven R.; Bailey, Leonard L.

In: Archives of Surgery, Vol. 133, No. 8, 08.1998, p. 881-885.

Research output: Contribution to journalArticle

Razzouk, AJ, Chinnock, RE, Dearani, JA, Gundry, SR & Bailey, LL 1998, 'Cardiac retransplantation for graft vasculopathy in children: Should we continue to do it?', Archives of Surgery, vol. 133, no. 8, pp. 881-885. https://doi.org/10.1001/archsurg.133.8.881
Razzouk, Anees J. ; Chinnock, Richard E. ; Dearani, Joseph A. ; Gundry, Steven R. ; Bailey, Leonard L. / Cardiac retransplantation for graft vasculopathy in children : Should we continue to do it?. In: Archives of Surgery. 1998 ; Vol. 133, No. 8. pp. 881-885.
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abstract = "Background: Cardiac transplantation (CTx) has been established as an effective therapy for a variety of inoperable cardiac conditions in infants and children. However, graft vasculopathy (GV) has emerged as the main limiting factor to long-term survival of CTx recipients. The only treatment of severe GV is cardiac retransplantation (re-Tx). Controversy exists regarding the use of scarce donor organs for cardiac re-Tx. Objective: To compare the outcome of cardiac re-Tx for GV with that of primary CTx in children. Design: A 12-year retrospective cohort review. Setting: A university-affiliated children's hospital. Patients: All infants and children who underwent CTx (group 1, n = 322) had complete follow-up of 1389.7 patient-years. Graft vasculopathy was confirmed in 32 recipients (1.1-8.2 years after undergoing CTx). Thirteen patients died suddenly, 3 died waiting for cardiac re-Tx (1-17 days after relisting), 4 are pending cardiac re-Tx, and 12 (group 2) underwent cardiac re-Tx. Intervention: Cardiac re-Tx at a mean (± SD) interval from the first CTx of 6.3 ± 1.8 years (range, 2.2-9.4 years). Two patients required additional aortic arch aneurysm repair with cardiac re-Tx. Results: When group 1 was compared with group 2, there was no significant difference in operative mortality (9.0{\%} vs 8.3{\%}; P = .9), rejection rate (0.98 vs 0.86; P = .1), and hospital stay (23.0 ± 18.8 days vs 20.5 ± 11.6 days; P = .65). Actuarial survival for groups 1 and 2 at 1 and 4 years was 84.3{\%} vs 83.3{\%} (P= .59) and 74.4{\%} vs 83.3{\%} (P = .85), respectively. Conclusions: The surgical outcome and intermediate survival of cardiac re-Tx for GV and primary CTx are similar. Children with severe cardiac GV are at risk of sudden death and can benefit from early cardiac re- Tx.",
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AU - Bailey, Leonard L.

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N2 - Background: Cardiac transplantation (CTx) has been established as an effective therapy for a variety of inoperable cardiac conditions in infants and children. However, graft vasculopathy (GV) has emerged as the main limiting factor to long-term survival of CTx recipients. The only treatment of severe GV is cardiac retransplantation (re-Tx). Controversy exists regarding the use of scarce donor organs for cardiac re-Tx. Objective: To compare the outcome of cardiac re-Tx for GV with that of primary CTx in children. Design: A 12-year retrospective cohort review. Setting: A university-affiliated children's hospital. Patients: All infants and children who underwent CTx (group 1, n = 322) had complete follow-up of 1389.7 patient-years. Graft vasculopathy was confirmed in 32 recipients (1.1-8.2 years after undergoing CTx). Thirteen patients died suddenly, 3 died waiting for cardiac re-Tx (1-17 days after relisting), 4 are pending cardiac re-Tx, and 12 (group 2) underwent cardiac re-Tx. Intervention: Cardiac re-Tx at a mean (± SD) interval from the first CTx of 6.3 ± 1.8 years (range, 2.2-9.4 years). Two patients required additional aortic arch aneurysm repair with cardiac re-Tx. Results: When group 1 was compared with group 2, there was no significant difference in operative mortality (9.0% vs 8.3%; P = .9), rejection rate (0.98 vs 0.86; P = .1), and hospital stay (23.0 ± 18.8 days vs 20.5 ± 11.6 days; P = .65). Actuarial survival for groups 1 and 2 at 1 and 4 years was 84.3% vs 83.3% (P= .59) and 74.4% vs 83.3% (P = .85), respectively. Conclusions: The surgical outcome and intermediate survival of cardiac re-Tx for GV and primary CTx are similar. Children with severe cardiac GV are at risk of sudden death and can benefit from early cardiac re- Tx.

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