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 Scopus citations

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 1 1998

ASJC Scopus subject areas

  • Surgery

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    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