Section of Heart Failure, Cardiac Transplant, and Mechanical Circulatory Support, and Department of Medicine, Stanford University, Stanford, California, USA; Division of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
Division of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
J Heart Lung Transplant. 2019 Oct;38(10):1067-1074. doi: 10.1016/j.healun.2019.07.001. Epub 2019 Jul 8.
Cardiac retransplantation accounts for approximately 3% of cardiac transplantation and is considered a risk factor for increased mortality. However, factors inherent to retransplantation including previous sternotomy, sensitization, and renal dysfunction may account for the increased mortality. We assessed whether retransplantation was associated with all-cause mortality after adjusting for such patient risk factors.
We conducted a retrospective cohort study of adult and pediatric patients enrolled in the United Network for Organ Sharing database. We identified patients undergoing cardiac retransplantation based on transplant listing diagnosis and history of previous transplant. We used propensity-score matching to identify a matched cohort undergoing initial heart transplantation.
In total, 62,112 heart transplant recipients were identified, with a mean age 46.6 ± 19.1 years. Of these, 2,202 (3.4%) underwent late cardiac retransplantation (>1 year after initial transplant and not for acute rejection). Compared with a matched group of patients undergoing initial heart transplantation, patients undergoing late retransplantation had comparable rates of all-cause mortality at 1 year (13.6% vs 13.8%, p = 0.733). In addition, overall mortality was not significantly different after matching (unadjusted hazard ratio [HR] 1.08, p = 0.084). In contrast, patients undergoing retransplantation within 1 year of initial transplant or for acute rejection remained at increased risk of mortality post-transplant after similar matching (unadjusted HR 1.79, p < 0.001).
After matching for comorbidities, late retransplantation in the adult population was not associated with an increase in all-cause mortality. Our findings highlight the importance of assessing indication acuity and comorbid conditions when considering retransplant candidacy.
心脏再次移植约占心脏移植的 3%，被认为是死亡率增加的一个危险因素。然而，再次移植所固有的因素，包括先前的开胸术、致敏和肾功能不全，可能是导致死亡率增加的原因。我们评估了在调整患者的这些危险因素后，再次移植与全因死亡率之间的关系。
我们对美国器官共享网络数据库中登记的成人和儿科患者进行了回顾性队列研究。我们根据移植列表诊断和以前移植的病史确定接受心脏再次移植的患者。我们使用倾向评分匹配来确定接受初始心脏移植的匹配队列。
共确定了 62112 例心脏移植受者，平均年龄为 46.6±19.1 岁。其中 2202 例（3.4%）接受了晚期心脏再次移植（初始移植后 1 年以上，非急性排斥反应）。与接受初始心脏移植的匹配组相比，晚期再次移植患者在 1 年内的全因死亡率相当（13.6%对 13.8%，p=0.733）。此外，在匹配后总体死亡率没有显著差异（未调整的危险比[HR]1.08，p=0.084）。相比之下，在初始移植后 1 年内或因急性排斥反应而再次移植的患者在匹配后仍存在移植后死亡风险增加（未调整的 HR 1.79，p<0.001）。
在对合并症进行匹配后，成人中晚期再次移植与全因死亡率的增加无关。我们的研究结果强调了在考虑再次移植候选资格时评估适应症严重程度和合并症的重要性。
