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Retransplant

65%

49%

47%

44%

In light of data indicating that selection of the appropriate retransplant population may significantly impact retransplant outcome, various groups have attempted to identify prognostic indicators. The interval between the first and second grafts has consistently been shown to be of great importance. Patients receiving their second graft more than two years after their first graft have survival rates approaching those of primary transplants, while only 40-50% of those patients that are retransplanted within six months of their first graft live to one year. More recent analysis of the ISHLT data has also demonstrated that recipient age impacts retransplant survival as well, although prior data analysis had indicated that recipient age was not of prognostic importance. A recent multivariate analysis of the 514 cardiac retransplants performed from 1987-1998 listed in the registry revealed that older recipient age adversely affected survival both at one month and one year post-retransplantation. The ISHLT data also indicates that preoperative mechanical ventilation and lack of experience of the transplant center also adversely influence retransplant survival. Therefore, if one were to construct the "ideal" retransplant candidate from recent ISHLT registry data, it would be a 40 year old patient retransplanted for transplant-associated coronary artery disease more than two years after his inital graft. The results of cardiac retransplantation are similar in the pediatric population, with graft coronary artery disease being the primary factor limiting long-term survival. (Table E6.3)

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