Heart retransplantation: medical and surgical issues
In order to look at heart retransplantation in its right perspective, a number of preliminary pieces of information must be kept in mind. First, the actual scope of the problem is limited. From the largest two international heart transplant registries [1,2] and the organ procurement registries , we know that retransplantations currently account for 1.5–2.5% of the 4600–4800 heart transplantations performed annually worldwide, i.e. the total retransplant volume is 70–120 procedures per year. There has been no increase in the proportion of heart retransplantation over the past 10 years (Table 1). Second, the available experience is scattered. A majority of heart transplant centers have at some time performed heart retransplantation, although in any given year only 20–25% of centers report such activity. The number of retransplantations per center is mostly very limited so that worldwide there are probably fewer than 10 centers with a total heart retransplantation experience of τ20 patients (Table 2). Third, the global survival rate after retransplantation continues to be inferior to that after a first transplant, even if a slight improvement has been noted over the last years (Table 3). Finally, death rate on the waiting list decreased from 14.5% in 1988 to 12.8% in 1992 and 10.2% in 1996 .
KeywordsDonor Heart Heart Lung Transplant Actuarial Survival Rate Hyperacute Rejection Surgical Issue
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