This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (19)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Cardiovascular Interventions, Other  • Cardiovascular System  • Surgery  • Surgical Interventions  • Cardiovascular/ Cardiothoracic Surgery  • Pediatric Surgery  • Transplantation  • Cardiac Transplantation  • Cardiovascular Intervention  • Alert me on articles by topic  Social Bookmarking   What's this?

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.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Cardiac retransplantation: is it justified in times of critical donor organ shortage? Long-term single-center experience
Goerler et al.
Eur. J. Cardiothorac. Surg. 2008;34:1185-1190.
ABSTRACT | FULL TEXT  

Does duration of donor brain injury affect outcome after orthotopic pediatric heart transplantation?
Odim et al.
J. Thorac. Cardiovasc. Surg. 2005;130:187-193.
ABSTRACT | FULL TEXT  

Cardiac retransplantation in children
Kanter et al.
Ann. Thorac. Surg. 2004;78:644-649.
ABSTRACT | FULL TEXT  

Pediatric cardiac retransplantation: intermediate-term results
Dearani et al.
Ann. Thorac. Surg. 2001;71:66-70.
ABSTRACT | FULL TEXT  

Late rejection is a predictor of transplant coronary artery disease in children
Mulla et al.
J Am Coll Cardiol 2001;37:243-250.
ABSTRACT | FULL TEXT  

Pediatric cardiac transplantation
Kirklin
Ann. Thorac. Surg. 2000;69:1627-1628.
FULL TEXT