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Solid Organ Transplantation in Infants and Children pp 741–755Cite as

Retransplantation of the Pediatric Heart Recipient

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Part of the book series: Organ and Tissue Transplantation ((OTT))

Abstract

While graft survival has continued to improve after pediatric heart transplantation, graft failure still occurs at median of 15 years post-transplant. When graft failure occurs, retransplantation is an option to improve quality and length of life. It, however, has unique challenges compared to primary transplantation. Patients awaiting retransplantation have longer wait list times and double the wait list mortality. Operative mortality is higher, and immediate peritransplant morbidities (rejection, renal dysfunction, and infection) are more frequent compared to primary transplantation. Long-term outcomes are also worse, with median graft survival of 8.7 years versus 15 years, although survival after retransplantation is dependent to a large extent on the indication for retransplant and the inter-transplant interval. Patients undergoing retransplantation for coronary vasculopathy (CAV) with more than 5 years after primary transplant have good survival; however, patients undergoing retransplantation within the first year after primary transplantation have the worse outcomes. After retransplantation, the recipient is more likely to suffer from rejection, renal dysfunction, late-onset malignancy, and CAV. Despite these complexities, retransplantation remains a viable option in selected patients and can improve their length and quality of life.

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Authors and Affiliations

  1. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Richard Kirk & Ryan J. Butts

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  1. Richard Kirk
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  2. Ryan J. Butts
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Correspondence to Richard Kirk .

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Editors and Affiliations

  1. Department of Surgery, Jefferson Medical College, Wilmington, Delaware, USA

    Stephen P. Dunn

  2. Division of Gastroenterology, Seattle Children’s Hospital, Seattle, Washington, USA

    Simon Horslen

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  1. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Ryan R. Davies

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Kirk, R., Butts, R.J. (2018). Retransplantation of the Pediatric Heart Recipient. In: Dunn, S., Horslen, S. (eds) Solid Organ Transplantation in Infants and Children. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-07284-5_62

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  • DOI: https://doi.org/10.1007/978-3-319-07284-5_62

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-07283-8

  • Online ISBN: 978-3-319-07284-5

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