Can cardiac re-transplantation be performed with an acceptable survival after primary graft failure?

A best evidence topic in cardio thoracic surgery was written according to a structured protocol. The question addressed whether cardiac re-transplantation can be performed with an acceptable survival in patients who suffer primary graft failure? Altogether 458 papers were found using the reported search, of which 18 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. We conclude that while re-transplantation for graft coronary disease has a similar survival to patients undergoing primary transplantation, acute graft failure or rejection should be treated with a mechanical assist device, as acute re-transplantation is associated with an unacceptably high mortality.