Schnetzler B, Pavie A, Dorent R, Camproux A C, Leger P, Delcourt A, Gandjbakhch I
Department of Cardiac Surgery, La Pitié Salpétrière Hospital, Paris, France.
Ann Thorac Surg. 1998 Apr;65(4):978-83. doi: 10.1016/s0003-4975(98)00058-7.
The main causes of allograft failure after cardiac transplantation are primary graft dysfunction, intractable acute rejection, and coronary graft disease. Despite the important progress in the last several years in graft preservation, surgical techniques, immunosuppression, and treatment of coronary graft disease, retransplantation in selected cases is the only way to achieve long-term recipient survival.
We compare here in a case-control study 24 retransplantations with 47 first transplants in patients matched for date of transplantation.
Between 1973 and 1996, 1,063 patients underwent cardiac transplantation in our institution. In this cohort, 22 patients had a total of 24 retransplantations (2 second-time retransplantations). The causes of retransplantations were primary graft failure (n=4), acute rejection (n=7), coronary graft disease (n=11), and miscellaneous (n=2). Survival at 1 and 5 years of patients with retransplantations is 45.5% and 31.2%, and survival of control patients is 59.4% and 38.8% (p=0.07). An interval between first transplantation and retransplantation shorter (n=11) or longer (n=13) than 1 year is associated with a 1-year survival of 27.3% and 61.5% and a 4-year survival of 27.3% and 46%, respectively (not significant). Intervals shorter than 1 year between first transplantation and retransplantation were exclusively secondary to primary graft failure or intractable acute rejection.
In the face of lack of donor grafts, these and other data indicate that retransplantation should be considered cautiously, especially when the interval between the first transplantation and retransplantation is short.
心脏移植后同种异体移植物失败的主要原因是原发性移植物功能障碍、难治性急性排斥反应和冠状动脉移植物疾病。尽管在过去几年中，移植物保存、手术技术、免疫抑制和冠状动脉移植物疾病的治疗取得了重要进展，但在某些特定情况下，再次移植是实现受体长期存活的唯一途径。
在一项病例对照研究中，我们比较了24例再次移植患者与47例首次移植患者，这些患者的移植日期相匹配。
1973年至1996年期间，我院共有1063例患者接受了心脏移植。在该队列中，22例患者共进行了24次再次移植（2例为第二次再次移植）。再次移植的原因包括原发性移植物衰竭（n = 4）、急性排斥反应（n = 7）、冠状动脉移植物疾病（n = 11）和其他原因（n = 2）。再次移植患者1年和5年的生存率分别为45.5%和31.2%，对照患者的生存率为59.4%和38.8%（p = 0.07）。首次移植与再次移植之间的间隔短于1年（n = 11）或长于1年（n = 13）的患者，其1年生存率分别为27.3%和61.5%，4年生存率分别为27.3%和46%（无显著性差异）。首次移植与再次移植之间间隔短于1年的情况均继发于原发性移植物衰竭或难治性急性排斥反应。
鉴于供体移植物的短缺，这些数据及其他数据表明，应谨慎考虑再次移植，尤其是在首次移植与再次移植之间间隔较短时。
