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Should We Continue to Do It?

Anees J. Razzouk, MD; Richard E. Chinnock, MD; Joseph A. Dearani, MD; Steven R. Gundry, MD; Leonard L. Bailey, MD

Arch Surg. 1998;133:881-885.

Background  Cardiac transplantation (CTx) has been established as an effective therapy for a variety of inoperable cardiac conditions in infants and children. However, graft vasculopathy (GV) has emerged as the main limiting factor to long-term survival of CTx recipients. The only treatment of severe GV is cardiac retransplantation (re-Tx). Controversy exists regarding the use of scarce donor organs for cardiac re-Tx.

Objective  To compare the outcome of cardiac re-Tx for GV with that of primary CTx in children.

Design  A 12-year retrospective cohort review.

Setting  A university-affiliated children's hospital.

Patients  All infants and children who underwent CTx (group 1, n=322) had complete follow-up of 1389.7 patient-years. Graft vasculopathy was confirmed in 32 recipients (1.1-8.2 years after undergoing CTx). Thirteen patients died suddenly, 3 died waiting for cardiac re-Tx (1-17 days after relisting), 4 are pending cardiac re-Tx, and 12 (group 2) underwent cardiac re-Tx.

Intervention  Cardiac re-Tx at a mean (±SD) interval from the first CTx of 6.3±1.8 years (range, 2.2-9.4 years). Two patients required additional aortic arch aneurysm repair with cardiac re-Tx.

Results  When group 1 was compared with group 2, there was no significant difference in operative mortality (9.0% vs 8.3%; P=.9), rejection rate (0.98 vs 0.86; P =.1), and hospital stay (23.0±18.8 days vs 20.5±11.6 days; P =.65). Actuarial survival for groups 1 and 2 at 1 and 4 years was 84.3% vs 83.3% (P=.59) and 74.4% vs 83.3% (P=.85), respectively.

Conclusions  The surgical outcome and intermediate survival of cardiac re-Tx for GV and primary CTx are similar. Children with severe cardiac GV are at risk of sudden death and can benefit from early cardiac re-Tx.

From the Division of Cardiothoracic Surgery, Departments of Surgery (Drs Razzouk, Dearani, Gundry, and Bailey) and Pediatrics (Dr Chinnock), Loma Linda University Medical Center and Children's Hospital, Loma Linda, Calif.

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