Retransplantation: is the trouble worth the effort?

  • Roger W. Evans
  • Daniel J. Kitzmann
Part of the Transplantation and Clinical Immunology book series (TRAC, volume 29)


The merits of retransplantation have often been debated [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. Opponents are of the opinion that patients who have not had a previous transplant should be given a fair opportunity to receive one. Proponents of retransplantation argue that organs should be allocated based on medical urgency. They believe that patients awaiting their first graft stand a reasonable chance of receiving a donor organ at a later date. A retransplant candidate often has a diminished probability of survival.


Donor Organ Scientific Registry Heart Lung Transplant Live Donor Kidney Cadaveric Kidney 
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  1. 1.
    Stratta RJ, Oh CS, Sollinger HW, Pirsch JD, Kalayoglu M, Beizer FO. Kidney retransplantation in the cyclosporine era. Transplantation 1988; 45: 40–45.PubMedCrossRefGoogle Scholar
  2. 2.
    Dein JR, Oyer PE, Stinson EB, Starnes VA, Shumway NE. Cardiac retransplantation in the cyclosporine era. Ann. Thorac. Surg. 1989; 48: 350–355.PubMedCrossRefGoogle Scholar
  3. 3.
    Salmela K, Kyllonen L, Eklund B, Isoniemi H, Hockerstedt K, Ahonen J. The value of repeated renal transplantation. Transplantation 1990; 50: 984–986.PubMedCrossRefGoogle Scholar
  4. 4.
    Gordon RD, Hartner CM, Casavilla A et al. The liver transplant waiting list-a single-center analysis. Transplantation 1991; 51: 128–134.PubMedCrossRefGoogle Scholar
  5. 5.
    Mora NP, Klintmalm GB, Cofer JB et al. Results after liver retransplantation in a group of 50 regrafted patients: two different concepts of elective versus emergency retransplantation. Transplant. Int. 1991; 4: 231–234.CrossRefGoogle Scholar
  6. 6.
    Candinas D, Keusch G, Conrad B, Schlumpf R, Decurtins M, Largiader F. A 20-year follow-up of cadaveric kidney allotransplantation. Transplant Proc. 1992; 24: 2711–2713.PubMedGoogle Scholar
  7. 7.
    Ensley RD, Hunt S, Taylor DO et al. Predictors of survival after repeat heart transplantation. The Registry of the International Society for Heart and Lung Transplantation, and Contributing Investigators. J. Heart Lung Transplant. 1992; 11: S142–S158.PubMedGoogle Scholar
  8. 8.
    Karwande SV, Ensley RD, Renlund DG et al. Cardiac retransplantation: a viable option? The Registry of the International Society for Heart and Lung Transplantation. Ann. Thorac. Surg. 1992; 54: 840–844.PubMedCrossRefGoogle Scholar
  9. 9.
    Retransplantation termed unfair, cost-ineffective. UNOS Update 1992; 8: 4.Google Scholar
  10. 10.
    Evans RW. A cost-outcome analysis of retransplantation: the need for accountability. Transplant. Rev. 1993; 7: 163–175.CrossRefGoogle Scholar
  11. 11.
    Evans RW. Is retransplantation cost-effective? Transplant. Proc. 1993; 25: 1694–1696.PubMedGoogle Scholar
  12. 12.
    Michler RE, Edwards NM, Hsu D et al. Pediatric retransplantation. J. Heart Lung Transplant. 1993; 12: S319–S327.PubMedGoogle Scholar
  13. 13.
    Michler RE, McLaughlin MJ, Chen JM et al. Clinical experience with cardiac retransplantation. J. Thorac. Cardiovasc. Surg. 1993; 106: 622–631.PubMedGoogle Scholar
  14. 14.
    Mentzer SJ, Reilly JJ, Caplan AL, Sugarbaker DJ. Ethical considerations in lung retransplanta-tion. J. Heart Lung Transplant. 1994; 13: 56–58.PubMedGoogle Scholar
  15. 15.
    Smith JR, Ribakove GH, Hunt SA et al. Heart retransplantation: the 25-year experience at a single institution. J. Heart Lung Transplant. 1995; 14: 832–839.PubMedGoogle Scholar
  16. 16.
    Evans RW, Manninen DL, Dong FB. An economic analysis of liver transplantation: costs, insurance coverage, and reimbursement. Gastroenterol Clin. North Am. 1993; 22: 451–473.PubMedGoogle Scholar
  17. 17.
    Evans RW. Organ transplantation and the inevitable debate as to what constitutes a basic health care benefit. In: Terasaki PI, Cecka JM (eds.), Clinical Transplants, 1993. Los Angeles, CA: UCLA Tissue Typing Laboratory, 1994: 359–391.Google Scholar
  18. 18.
    Evans RW. Liver transplantation in a managed care environment. Liver Transplant. Surg. 1995; 1: 61–75.CrossRefGoogle Scholar
  19. 19.
    Evans RW. Organ transplantation in an era of economic constraint: liver transplantation as a case study. Semin. Anesthesiol. 1995; 14: 127–135.Google Scholar
  20. 20.
    Evans RW. Socioeconomic aspects of heart transplantation. Curr. Opin. Cardiol. 1995; 10: 169–179.PubMedCrossRefGoogle Scholar
  21. 21.
    Evans RW. Effect of liver transplantation on local, regional, and national health care. In: Busuttil RW, Klintmalm GB (eds.), Transplantation of the Liver. Philadelphia,PA: W.B. Saunders, 1996: 869–879.Google Scholar
  22. 22.
    Evans RW, Kitzmann DJ. Contracting for services: liver transplantation in the era of mismanaged care. Clinics in Liver Disease 1997; 1: (in press).Google Scholar
  23. 23.
    Evans RW, Kitzmann D. The ‘arithmetic’ of donor liver allocation. In: Terasaki PI, Cecka JM (eds.), Clinical Transplants, 1996. Los Angeles,CA: UCLA Tissue Typing Laboratory, 1997.Google Scholar
  24. 24.
    Hauboldt RH. Cost Implications of Human Organ Transplantations, An Update: 1993. Brookfield, WI: Milliman and Robertson, Inc., 1993.Google Scholar
  25. 25.
    Hauboldt RH. Cost Implications of Human Organ and Tissue Transplantation, An Update: 1996. Brookfield,WI: Milliman & Robertson, 1996.Google Scholar
  26. 26.
    Relman AS. Assessment and accountability; the third revolution in medical care. N. Engl. J. Med. 1988; 319: 1220–1222.PubMedCrossRefGoogle Scholar
  27. 27.
    Lohr KN. Outcome measurement; concepts and questions. Inquiry 1988; 25: 37–50.PubMedGoogle Scholar
  28. 28.
    Epstein AM. The outcomes movement — will it get us where we want to go? N. Engl. J. Med. 1990; 323: 266–270.PubMedCrossRefGoogle Scholar
  29. 29.
    Geigle R, Jones SB. Outcomes measurement: a report from the front. Inquiry 1990; 27: 7–13.PubMedGoogle Scholar
  30. 30.
    Hopkins A, Costain D. Measuring the Outcomes of Medical Care. London, England: Royal College of Physicians of London, 1990.Google Scholar
  31. 31.
    Clinton JJ. Outcomes research — a way to improve medical practice. JAMA 1991; 266: 2057.PubMedCrossRefGoogle Scholar
  32. 32.
    Delamothe T. Outcomes into Clinical Practice. London: BMJ Publishing, 1994.Google Scholar
  33. 33.
    Guadagnoli E, McNeil BJ. Outcomes research: hope for the future or the latest rage? Inquiry 1994; 31: 14–24.PubMedGoogle Scholar
  34. 34.
    Dauphinee WD. Assessing clinical performance: where do we stand and what might we expect? JAMA 1995; 274: 741–743.PubMedCrossRefGoogle Scholar
  35. 35.
    Hayward J. Promoting clinical effectiveness. Br. Med. J. 1996; 312: 1491–1492.Google Scholar
  36. 36.
    Evans RW. A critical perspective on the tools to support clinical decision making (editorial). Transfusion 1996; 36: 671–673.PubMedCrossRefGoogle Scholar
  37. 37.
    Annual Report of the U.S. Scientific Registry for Transplant Recipients and the Organ Procurement and Transplantation Network — Transplant Data. Richmond, VA: UNOS and the U.S. Department of Health and Human Services, 1996.Google Scholar
  38. 38.
    Evans RW, Manninen DL, Dong FB. The National Cooperative Transplantation Study: Final Report. Seattle, WA: Battelle-Seattle Research Center, 1991.Google Scholar
  39. 39.
    Evans RW. Executive Summary: The National Cooperative Transplantation Study. Report BHARC-100-91-020. Seattle, WA: Battelle-Seattle Research Center, 1991.Google Scholar
  40. 40.
    Division of Organ Transplantation, United Network for Organ Sharing. 1994 Report of Center-Specific Graft and Patient Survival Rates: Liver Data. Rockville, MD: Health Resources and Services Administration, 1994.Google Scholar
  41. 41.
    Evans RW. Health care technology and the inevitability of resource allocation and rationing decisions, Part I. JAMA 1983; 249: 2047–2053.PubMedCrossRefGoogle Scholar
  42. 42.
    Evans RW. Health care technology and the inevitability of resource allocation and rationing decisions, Part II. JAMA 1983; 249: 2208–2219.PubMedCrossRefGoogle Scholar
  43. 43.
    Evans RW. Advanced medical technology and elderly people. In: Binstock RH, Post SG (eds.), Too Old for Health Care? Controversies in Medicine, Law, Economics, and Ethics. Baltimore, MD: The Johns Hopkins University Press, 1991: 44–74.Google Scholar
  44. 44.
    Evans RW. Rationale for rationing. Health Management Quarterly 1992; 14: 14–17.PubMedGoogle Scholar
  45. 45.
    Smith R. Rationing in Action. London: BMJ Publishing Group. 1993Google Scholar
  46. 46.
    Bowling A, Jacobson B, Southgate L. Health service priorities: exploration in consultation of the public and health professionals on priority setting in an inner London health district. Soc. Sci. Med. 1993; 37: 851–857.PubMedCrossRefGoogle Scholar
  47. 47.
    Heginbotham C. Health care priority setting: a survey of doctors, managers, and the general public. In: Smith R (ed.), Rationing In Action. London: BMJ Publishing Group, 1993: 141–156.Google Scholar
  48. 48.
    Ham C. Health care rationing. Br. Med. J. 1995; 310: 1483–1484.Google Scholar
  49. 49.
    Smith R. Being creative about rationing. Br. Med. J. 1996; 312: 391–392.Google Scholar
  50. 50.
    Bowling A. Health care rationing: the public’s debate. Br. Med. J. 1996; 312: 670–674.Google Scholar
  51. 51.
    Maynard A. Rationing health care. Br. Med. J. 1996; 313: 1499.Google Scholar
  52. 52.
    Klein R. Defining a package of healthcare services the NHS is responsible for: the case against. Br. Med. J. 1997; 314: 506–509.Google Scholar
  53. 53.
    New B. Defining a package of healthcare services the NHS is responsible for: the case for. Br. Med. J. 1997; 314: 503–505.Google Scholar
  54. 54.
    Kmietowciz Z. Rationing is now accepted as inevitable by all sides. Br. Med. J. 1997; 314: 461.Google Scholar
  55. 55.
    Harrison S. Central government should have a greater role in rationing decisions: the case against. Br. Med. J. 1997; 314: 970–973.Google Scholar
  56. 56.
    Lenaghan J. Central government should have a greater role in rationing decisions: the case for. Br. Med. J. 1997; 314: 967–970.Google Scholar
  57. 57.
    Doyal L. Rationing within the NHS should be explicit: the case for. Br. Med. J. 1997; 314: 1114–1118.Google Scholar
  58. 58.
    Coast J. Rationing within the NHS should be explicit: the case against. Br. Med. J. 1997; 314: 1118–1122.Google Scholar
  59. 59.
    Iglehart JK. The American health care system: managed care. N. Engl. J. Med. 1992; 327: 742–747.PubMedCrossRefGoogle Scholar
  60. 60.
    Iglehart JK. Physicians and the growth of managed care. N. Engl. J. Med. 1994; 331: 1167–1171.PubMedCrossRefGoogle Scholar
  61. 61.
    Iglehart JK. The struggle between managed care and fee-for-service practice. N. Engl. J. Med. 1994; 331: 63–67.PubMedCrossRefGoogle Scholar
  62. 62.
    Jolt H, Leibovici MM. Managed Care: Principles and Practice. Philadelphia, PA: Hanley & Belfus, 1995.Google Scholar
  63. 63.
    Kassirer JP. Is managed care here to stay? N. Engl. J. Med. 1997; 336: 1013–1014.PubMedCrossRefGoogle Scholar
  64. 64.
    Jensen GA, Morrisey MA, Gaffney S, Liston DK. The new dominance of managed care: insurance trends in the 1990s. Health Aff. 1997; 16: 125–136.CrossRefGoogle Scholar
  65. 65.
    Chernew M, Fendrick AM, Hirth RA. Managed care and medical technology: implications for cost growth. Health Aff. 1997; 16: 196–206.CrossRefGoogle Scholar
  66. 66.
    Herzlinger RE. Market-driven health care: who wins, who loses in the transformation of America’s largest service industry. Reading: Addison-Wesley, 1997.Google Scholar
  67. 67.
    Wilkerson JD, Devers KJ, Given R. Competitive Managed Care: The Emerging Health Care System. San Francisco: Jossey-Boss, 1997Google Scholar
  68. 68.
    Reiser SJ. Medicine and public health: pursuing a common destiny. JAMA 1996; 276: 1429–1430.PubMedCrossRefGoogle Scholar
  69. 69.
    Hearn W. Time for medicine, public health to join forces. Am. Med. News. 1996; 39: 3.Google Scholar
  70. 70.
    Stapleton S. Linking medicine, public health. Am. Med. News 1997; 40: 3.Google Scholar

Copyright information

© Kluwer Academic Publishers 1997

Authors and Affiliations

  • Roger W. Evans
  • Daniel J. Kitzmann

There are no affiliations available

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