EMERGENCY AND ELECTIVE CARDIAC RETRANSPLANTATION

被引：8

作者：

MARTINELLI, L

RINALDI, M

GOGGI, C

PEDERZOLLI, C

DARMINI, A

PEDERZOLLI, N

VIGANO, M

机构：

[1] University of Pavia, Pavia

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1993年 / 7卷 / 11期

关键词：

HEART TRANSPLANTATION; RETRANSPLANTATION; ACUTE REJECTION; CHRONIC REJECTION; HUMORAL REJECTION;

D O I：

10.1016/1010-7940(93)90244-6

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Among 265 patients transplanted at our Institution, 7 underwent cardiac retransplantation. There were five emergency retransplantations, the indication being graft failure in one case and acute rejection in four cases. Two patients, retransplanted because of acute rejection, had a positive panel reactivity antibody and a negative donor crossmatch. In the rejection cases immunosuppression was enhanced by perioperative plasmapheresis and a postoperative 1-month course of cyclophosphamide. In two cases emergency retransplantations were successfully performed despite a highly positive prospective crossmatch. Two patients underwent elective retransplantations for chronic rejection 12 and 41 months, respectively, after the primary transplants. The overall early and late survival rates are 71 % and 57%, respectively, with a mean follow-up of 48.5 months. The early and late mortality for elective retransplantation is zero. Our experience confirms both the high operative risk for emergency retransplantation and the excellent results for elective retransplantation. The use of plasmapheresis and cyclophosphamide allowed us to undertake retransplantation successfully in 2 cases with positive donor crossmatch. Both hyperimmunized patients in our series were retransplanted because of irreversible acute rejection despite a negative crossmatch with the primary donor. The meaning of negative crossmatch in patients with preformed cytotoxic antibodies is therefore questionable.

引用

页码：587 / 590

页数：4

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