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Heart

Lung

Liver

Primary graft dysfunction

Early graft dysfunction

Primary nonfunction

Intractable acute rejection

Intractable airway healing

Rejection

Coronary graft diseases Obliterative bronchiolitis Technical Complications

Coronary graft diseases Obliterative bronchiolitis Technical Complications tients are hemodynamically stable and retransplantation is usually performed in a semi-elective fashion. Candidates for retransplantation secondary to acute or chronic allograft rejection refractory to immunosuppressive therapy are usually hemodynamically unstable, often requiring intensive care nursing and inotropic support. The same absolute contraindications exist for retransplantation as for transplantation including: elevated pulmonary vascular resistance, active infection, and a positive donor-specific lymphocyte crossmatch. Relative contraindications include advanced age and psychosocial instability.

Since the first report of cardiac retransplantation in 1977, data has been collected by the registry of the International Society for Heart and Lung Transplantation (ISHLT). It indicates that approximately 4% of all reported transplants are retransplants. 3 While early data from the ISHLT registry demonstrated a much poorer survival rate among retransplanted patients than those receiving their first transplants (48 vs 78%, respectively), more recent data from the registry has shown improved outcomes. One year survival among retransplant patients as a whole has improved to 65%, while the one year survival rate among primary transplant recipients has remained at approximately 80%4. Some individual centers have even published retransplant survival rates that equal those of their primary transplant population when very stringent selection criteria are applied to the retransplant recipients.5 Not only has retransplant survival improved, but the long-term survivors of cardiac retransplantation fare as well as those receiving a primary transplant from the standpoint of cardiac function and quality of life. (Table E6.2)

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