Clerkin Kevin J, Thomas Sunu S, Haythe Jennifer, Schulze P Christian, Farr Maryjane, Takayama Hiroo, Jorde Ulrich P, Restaino Susan W, Naka Yoshifumi, Mancini Donna M
Division of Cardiology, Department of Medicine.
Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
J Heart Lung Transplant. 2015 Feb;34(2):161-6. doi: 10.1016/j.healun.2014.09.033. Epub 2014 Sep 28.
Cardiac retransplantation is increasing in frequency. Recent data have shown that retransplantation outcomes are now comparable with primary transplantation. The use of mechanical circulatory support (MCS) as a bridge to retransplantation has similar post-retransplant outcomes to those without MCS, but the success of bridging patients to retransplant with MCS has not been well studied.
From January 2000 to February 2014 at Columbia University Medical Center, 84 patients were listed for retransplantation. Of this cohort, 48 patients underwent retransplantation, 15 were bridged with MCS, 24 died, and 6 clinically improved. A retrospective analysis was performed examining waiting list time, survival to retransplantation, and survival after retransplant. The effect of the United Network of Organ Sharing (UNOS) allocation policy change in 2006 on waiting list time and MCS use was also investigated.
Of 48 patients who underwent retransplantation, 11 were bridged with MCS. Overall 1-year survival to retransplantation was 81.3%. There was no significant difference in waiting list survival (p = 0.71) in those with and without MCS. Death from cardiac arrest or multiorgan failure with infection was more frequent in the medically managed group (p = 0.002). After the UNOS 2006 allocation policy change, waiting list time (599 ± 936 days in Era 1 vs 526 ± 498 days in Era 2, p = 0.65) and waiting list survival (p = 0.22) between eras were comparable, but there was a trend toward greater use of MCS (p = 0.13). Survival after retransplant was acceptable.
The use of MCS as a bridge to cardiac retransplantation is a reasonable strategy.
心脏再次移植的频率正在增加。最近的数据表明，再次移植的结果现在与初次移植相当。使用机械循环支持（MCS）作为再次移植的桥梁，其移植后的结果与未使用MCS的情况相似，但使用MCS将患者成功过渡到再次移植的情况尚未得到充分研究。
2000年1月至2014年2月在哥伦比亚大学医学中心，有84例患者被列入再次移植名单。在这个队列中，48例患者接受了再次移植，15例通过MCS过渡，24例死亡，6例临床状况改善。进行了一项回顾性分析，检查等待名单时间、再次移植的生存率以及再次移植后的生存率。还研究了2006年器官共享联合网络（UNOS）分配政策的变化对等待名单时间和MCS使用的影响。
在48例接受再次移植的患者中，11例通过MCS过渡。总体而言，再次移植的1年生存率为81.3%。使用和未使用MCS的患者在等待名单上的生存率无显著差异（p = 0.71）。在药物治疗组中，心脏骤停或感染导致的多器官功能衰竭死亡更为常见（p = 0.002）。在2006年UNOS分配政策改变后，不同时期之间的等待名单时间（第1阶段为599±936天，第2阶段为526±498天，p = 0.65）和等待名单生存率（p = 0.22）相当，但使用MCS有增加的趋势（p = 0.13）。再次移植后的生存率是可以接受的。
使用MCS作为心脏再次移植的桥梁是一种合理的策略。
