Radovancevic Branislav, McGiffin David C, Kobashigawa Jon A, Cintron Guillermo B, Mullen G Martin, Pitts Douglas E, O'Donnell Jacqueline, Thomas Cindi, Bourge Robert C, Naftel David C
Transplant Research, Texas Heart Institute, Houston 77030, USA.
J Heart Lung Transplant. 2003 Aug;22(8):862-8. doi: 10.1016/s1053-2498(02)00803-3.
Cardiac retransplantation is a controversial procedure due to the disparity between donor heart demand and supply.
Of 7,290 patients undergoing primary cardiac transplantation between January 1990 and December 1999 at 42 institutions contributing to the Cardiac Transplant Research Database (CTRD), 106 patients later underwent a second and 1 patient a third cardiac transplant procedure.
The actuarial freedom from retransplantation was 99.2% and 96.8% at 1 and 10 years, respectively. Reasons for retransplantation included early graft failure (n = 34), acute cardiac rejection (n = 15), coronary allograft vasculopathy (CAV, n = 39), non-specific graft failure (n = 7), and miscellaneous (n = 10). The only risk factor associated with retransplantation was younger age, reflecting the policy of preferential retransplantation of younger patients. Survival after retransplantation was inferior to that after primary transplantation (56% and 38% at 1 and 5 years, respectively). Risk factors associated with death after retransplantation included retransplantation for acute rejection (p = 0.0005), retransplantation for early graft failure (p = 0.03), and use of a female donor (p = 0.005). Survival after retransplantation for acute rejection was poorest (32% and 8% at 1 and 5 years, respectively) followed by retransplantation for early graft failure (50% and 39% at 1 and 5 years, respectively). Survival after retransplantation for CAV has steadily improved with successive eras.
The results of retransplantation for acute rejection and early graft failure are poor enough to suggest that this option is not advisable. However, retransplantation for CAV is currently associated with satisfactory survival and should continue to be offered to selected patients.
由于供体心脏供需失衡，心脏再次移植是一个存在争议的手术。
在1990年1月至1999年12月期间，42家机构向心脏移植研究数据库（CTRD）贡献了7290例接受初次心脏移植的患者，其中106例患者后来接受了第二次心脏移植，1例患者接受了第三次心脏移植手术。
再次移植后1年和10年的精算无再次移植生存率分别为99.2%和96.8%。再次移植的原因包括早期移植物功能衰竭（n = 34）、急性心脏排斥反应（n = 15）、冠状动脉移植血管病变（CAV，n = 39）、非特异性移植物功能衰竭（n = 7）和其他原因（n = 10）。与再次移植相关的唯一危险因素是年龄较小，这反映了优先为年轻患者进行再次移植的政策。再次移植后的生存率低于初次移植后的生存率（1年和5年时分别为56%和38%）。与再次移植后死亡相关的危险因素包括因急性排斥反应进行再次移植（p = 0.0005）、因早期移植物功能衰竭进行再次移植（p = 0.03）以及使用女性供体（p = 0.005）。因急性排斥反应进行再次移植后的生存率最差（1年和5年时分别为32%和8%），其次是因早期移植物功能衰竭进行再次移植（1年和5年时分别为50%和39%）。随着时间的推移，因CAV进行再次移植后的生存率稳步提高。
因急性排斥反应和早期移植物功能衰竭进行再次移植的结果很差，表明这种选择不可取。然而，目前因CAV进行再次移植的生存率令人满意，应继续为选定的患者提供。
