Goerler Heidi, Simon Andre, Gohrbandt Bernhard, Hagl Christian, Oppelt Petra, Haverich Axel, Strueber Martin
Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Eur J Cardiothorac Surg. 2008 Dec;34(6):1185-90. doi: 10.1016/j.ejcts.2008.06.044. Epub 2008 Aug 9.
Survival after heart transplantation has improved significantly over the last decades. There are a growing number of patients that require cardiac retransplantation because of chronic allograft dysfunction. With regard to the critical shortage of cardiac allograft donors the decision to offer repeat heart transplantation must be carefully considered.
Since 1983 a total of 807 heart transplantations have been performed at our institution. Among them 41 patients received cardiac retransplantation, 18 patients because of acute graft failure and 23 because of chronic graft failure. Data were analyzed for demographics, morbidity and risk factors for mortality. The acute and chronic retransplant group was compared to those patients undergoing primary transplantation.
The mean interval between primary transplantation and retransplantation was 1.9 days in the acute and 6.7 years in the chronic retransplant group. Mean follow-up was 6.9 years. Baseline characteristics were similar in the primary and retransplant group. Actuarial survival rates at 1, 3, 5 and 7 years after primary cardiac transplantation compared to retransplantation were 83, 78, 72 and 64% vs 53, 50, 47 and 36%, respectively (p<0.001). Early mortality after acute retransplantation was significantly higher compared to late retransplantation (10/18, 55.6% vs 4/23, 17.4%, p=0.011). Major causes of death were acute and chronic rejection, infection and sepsis.
Cardiac retransplantation is associated with lower survival rates compared to primary transplantation. However, results after retransplantation in chronic graft failure are significantly better compared to acute graft failure. Therefore, we consider cardiac retransplantation in chronic graft failure a justified therapeutic option. In contrast, patients with acute graft failure seem to be inappropriate candidates for cardiac retransplantation.
在过去几十年中，心脏移植后的生存率有了显著提高。由于慢性移植物功能障碍，需要进行心脏再次移植的患者数量日益增多。鉴于心脏移植物供体严重短缺，必须谨慎考虑提供再次心脏移植的决定。
自1983年以来，我们机构共进行了807例心脏移植手术。其中41例患者接受了心脏再次移植，18例因急性移植物衰竭，23例因慢性移植物衰竭。对人口统计学、发病率和死亡风险因素的数据进行了分析。将急性和慢性再次移植组与初次移植患者进行了比较。
急性再次移植组初次移植与再次移植的平均间隔时间为1.9天，慢性再次移植组为6.7年。平均随访时间为6.9年。初次移植组和再次移植组的基线特征相似。初次心脏移植后1年、3年、5年和7年的精算生存率分别为83%、78%、72%和64%，而再次移植后的生存率分别为53%、50%、47%和36%（p<0.001）。急性再次移植后的早期死亡率显著高于晚期再次移植（10/18，55.6%对4/23，17.4%，p=0.011）。主要死亡原因是急性和慢性排斥反应、感染和败血症。
与初次移植相比，心脏再次移植的生存率较低。然而，慢性移植物衰竭再次移植后的结果明显优于急性移植物衰竭。因此，我们认为慢性移植物衰竭的心脏再次移植是一种合理的治疗选择。相比之下，急性移植物衰竭患者似乎不适合进行心脏再次移植。
