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than if the same graft were used to transplant a patient in better health.

Once on the list, primary transplant and retransplant candidates are treated identically. Practically, however, it should be noted that patients awaiting retransplantation generally represent a sicker group of patients. For example, only about 22% of patients awaiting primary liver transplantation are the highest UNOS status whereas more than 80% of patients awaiting retransplant are the highest status. Thus, on average, patients who undergo retransplantation wait less time on the list than patients waiting for their first transplant.

Current data shows that survival for heart, lung, and liver retransplantation is poorer than that demonstrated for primary transplants. If retransplantation were as likely to produce the same results as primary transplantation, would these questions then be unnecessary and would retransplant candidates then rightly deserve their equal place on the waiting list alongside primary transplant candidates? Although the adult population is more frequently studied, the pediatric population suffers from many of the same constraints. However, it is inherently more difficult to refuse a child repeat transplantations and most transplant teams have accepted the decreased survival statistics to continue the practice of pediatric retransplantation of vital organs. Some studies have shown that among candidates for retransplantation, there are easily identifiable parameters which, when followed, can accurately predict outcome, suggesting that safe modifications to our current system are possible. We review such attempts for heart, lung, and liver retransplantation.

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