A Decade Experience of Cardiac Retransplantation in Adult Recipients Veli K. Topkara, MD, Nicholas C. Dang, MD, Ranjit John, MD, Faisal H. Cheema, MD, Raffaele Barbato, Marco Cavallo, Judy F. Liu, BA, Lorraine M. Liang, BA, Elyse A. Liberman, BA, Michael Argenziano, MD, Mehmet C. Oz, MD, Yoshifumi Naka, MD, PhD Background: Cardiac retransplantation is considered to be the best therapeutic option for a failing cardiac allograft. However, poor outcomes with retransplantation have previously been reported, a factor that raises important ethical, logistic and financial issues given the limited organ donor supply. Methods: Seven hundred sixty-six adult patients underwent cardiac transplantation for end-stage heart failure at our institution from 1992 to 2002. Of these, 41 (5.4%) were retransplants. Variables examined included recipient and donor demographics, indications for retransplant, comorbidities, cytomeg- alovirus (CMV) serology status, left ventricular assist device use before transplant, donor ischemic time, rate of early mortality (within 30 days), and post-transplantation survival rate. Results: Indications for cardiac retransplant were transplant-related coronary artery disease in 37, acute rejection in 3, and other causes in 1. The mean interval between transplantation and retransplan- tation was 5.9  3.4 years. Baseline characteristics such as recipient age, gender, CMV serology status, and donor age were similar in the primary transplant and retransplant groups. Early mortality after transplantation was comparable between the 2 groups, but post-transplant survival was significantly lower in retransplant patients compared with primary transplants with 1-, 3-, 5-, and 7-year actuarial survival rates of 72.2%, 66.3%, 47.5%, and 40.7% vs. 85.1%, 79.2%, 72.9%, and 66.8%, respectively (p  0.001). Conclusions: Cardiac retransplantation offers short-term outcomes similar to primary transplantation but lower long-term survival rates. Non-retransplant surgical options should also be considered in these patients. Careful patient selection and risk-assessment is necessary to govern appropriate allocation of limited donor organs. J Heart Lung Transplant 2005;24:1745–50. Copyright © 2005 by the International Society for Heart and Lung Transplantation. Despite improvements in selection criteria, donor or- gan preservation, immunosuppressive therapy, and medical treatment, patients with end-stage heart disease who undergo cardiac transplantation still suffer from early and late graft failure. Common causes of allograft myocardial dysfunction include transplant-related coro- nary artery disease (TRCAD), primary graft failure, and acute rejection. 1–6 Several therapeutic interventions have been proposed to overcome graft failure, such as aggressive immunosuppressive therapy, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting (CABG), but cardiac retransplantation is still regarded as the gold standard in terms of attaining favorable long-term outcomes. 7–15 Previous studies from other centers have reported lower post-transplantation survival rates in retransplan- tation patients compared with primary transplantation patients, 16 –19 though a recent review of the transplan- tation population at our institution showed comparable post-transplantation survival for these 2 groups. 20 The universal shortage of available donor organs and a preponderance of reports showing poor clinical out- comes for retransplantation patients raise important ethical and financial concerns. In an effort to summarize our transplantation experience and address these con- cerns, we retrospectively analyzed the adult transplan- tation population at Columbia-Presbyterian Medical Center over the course of 10 years. METHODS Patient Population Seven hundred sixty-six adult patients underwent car- diac transplantation for end-stage heart failure between 1992 and 2002 at our institution. Our previous clinical experience with cardiac retransplantation patients led From the Department of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York. Submitted November 20, 2004; revised February 7, 2005; accepted February 17, 2005. Reprint requests: Yoshifumi Naka, MD, PhD, Columbia University, New York–Presbyterian Hospital, 177 Fort Washington Avenue, Mil- stein Building 7GN– 435, New York, NY, 10032. Telephone: 212-305- 0828; Fax: 212-305-2439. E-mail: yn33@columbia.edu Copyright © 2005 by the International Society for Heart and Lung Transplantation. 1053-2498/05/$–see front matter. doi:10.1016/ j.healun.2005.02.015 1745