Heart re-transplantation in Eurotransplant

被引：5

作者：

Smits, Jacqueline M. ^{[1
]}

De Pauw, Michel ^{[2
]}

Schulz, Uwe ^{[3
]}

Van Cleemput, Johan ^{[4
]}

Raake, Philip ^{[5
]}

Knezevic, Ivan ^{[6
]}

Caliskan, Kadir ^{[7
]}

Sutlic, Zeljko ^{[8
]}

Knosalla, Christoph ^{[9
]}

Schoenrath, Felix ^{[9
]}

Szabolcs, Zoltan ^{[10
]}

Gottlieb, Jens ^{[11
]}

Hagl, Christian ^{[12
]}

Doesch, Andreas ^{[5
]}

Baric, Davor ^{[8
]}

Rudez, Igor ^{[8
]}

Strelniece, Agita ^{[1
]}

De Vries, Erwin ^{[1
]}

Green, Dave ^{[1
]}

Samuel, Undine ^{[1
]}

Milicic, Davor ^{[13
]}

Hartyanszky, Istvan ^{[10
]}

Berchtold-Herz, Michael ^{[14
]}

Schulze, P. Christian ^{[15
]}

Mohr, Friedrich ^{[16
]}

Meiser, Bruno ^{[12
]}

Haverich, Axel ^{[17
]}

Reichenspurner, Hermann ^{[18
]}

Gummert, Jan ^{[3
]}

Laufer, Guenter ^{[19
]}

Zuckermann, Andreas ^{[19
]}

机构：

[1] Eurotransplant Int Fdn, Leiden, Netherlands

[2] Univ Hosp Ghent, Dept Cardiol, Ghent, Belgium

[3] Ruhr Univ Bochum, Univ Hosp, Dept Thorac & Cardiavasc Surg, Bad Oeynhausen, Germany

[4] Univ Hosp Gasthuisberg, Dept Cardiol, Leuven, Belgium

[5] Univ Hosp Heidelberg, Dept Cardiol, Heidelberg, Germany

[6] Univ Med Ctr Ljubljana, Dept Cardiothorac Surg, Ljubljana, Slovenia

[7] Erasmus Univ, Med Ctr, Dept Cardiol, Rotterdam, Netherlands

[8] Univ Hosp, Dept Cardiac Surg, Zagreb, Croatia

[9] German Heart Inst Berlin, German Ctr Cardiovasc Res, Dept Cardiothorac & Vasc Surg, Berlin, Germany

[10] Semmelweis Univ, Dept Cardiovasc Surg, Budapest, Hungary

[11] Hannover Med Sch, Dept Resp Med, Hannover, Germany

[12] Transplant Ctr Munich, Dept Cardiac Surg, Munich, Germany

[13] Univ Hosp Ctr Zagreb, Dept Cardiovasc Dis, Zagreb, Croatia

[14] Univ Heart Ctr Freiburg Bad Krozingen, Dept Cardiovasc Surg, Freiburg, Germany

[15] Univ Hosp Jena, Div Cardiol, Dept Internal Med, Jena, Germany

[16] Leipzig Heart Ctr, Dept Cardiothorac Surg, Leipzig, Germany

[17] Hannover Med Sch, Dept Cardiovasc Surg, Hannover, Germany

[18] Univ Hosp Eppendorf, Dept Cardiovasc Surg, Hamburg, Germany

[19] Univ Hosp Vienna, Dept Cardiac Surg, Vienna, Austria

来源：

TRANSPLANT INTERNATIONAL | 2018年 / 31卷 / 11期

关键词：

complications; heart clinical; outcome; rejection; PRIMARY GRAFT DYSFUNCTION; EXTRACORPOREAL MEMBRANE-OXYGENATION; CARDIAC ALLOGRAFT VASCULOPATHY; INTERNATIONAL SOCIETY; UNITED-STATES; RETRANSPLANTATION; OUTCOMES; CLASSIFICATION; ALLOCATION; REJECTION;

D O I：

10.1111/tri.13289

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Internationally 3% of the donor hearts are distributed to re-transplant patients. In Eurotransplant, only patients with a primary graft dysfunction (PGD) within 1 week after heart transplantation (HTX) are indicated for high urgency listing. The aim of this study is to provide evidence for the discussion on whether these patients should still be allocated with priority. All consecutive HTX performed in the period 1981-2015 were included. Multivariate Cox' model was built including: donor and recipient age and gender, ischaemia time, recipient diagnose, urgency status and era. The study population included 18 490 HTX, of these 463 (2.6%) were repeat transplants. The major indications for re-HTX were cardiac allograft vasculopathy (CAV) (50%), PGD (26%) and acute rejection (21%). In a multivariate model, compared with first HTX hazards ratio and 95% confidence interval for repeat HTX were 2.27 (1.83-2.82) for PGD, 2.24 (1.76-2.85) for acute rejection and 1.22 (1.00-1.48) for CAV (P < 0.0001). Outcome after cardiac re-HTX strongly depends on the indication for re-HTX with acceptable outcomes for CAV. In contrast, just 47.5% of all hearts transplanted in patients who were re-transplanted for PGD still functioned at 1-month post-transplant. Alternative options like VA-ECMO should be first offered before opting for acute re-transplantation.

引用

页码：1223 / 1232

页数：10