Can cardiac re-transplantation be performed with an acceptable survival after primary graft failure
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《血管的通路杂志》
Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, Newcastle upon Tyne, NE7 7AZ, UK
Abstract
A best evidence topic in cardio thoracic surgery was written according to a structured protocol. The question addressed whether cardiac re-transplantation can be performed with an acceptable survival in patients who suffer primary graft failure Altogether 458 papers were found using the reported search, of which 18 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. We conclude that while re-transplantation for graft coronary disease has a similar survival to patients undergoing primary transplantation, acute graft failure or rejection should be treated with a mechanical assist device, as acute re-transplantation is associated with an unacceptably high mortality.
Key Words: Evidence-based medicine; Re-transplantion; Heart transplantation; Acute graft failure
1. Introduction
A Best Evidence Topic was constructed according to a structured protocol. The protocol is fully described in the ICTVS [1]
2. Clinical scenario
You are performing a heart transplant on a 34-year-old lady who had a diagnosis of dilated cardiomyopathy. The Donor heart was harvested by another unit. The harvesting surgeon stated that the heart was good quality but in his clinical notes that came with the donor heart he reported a short period of ventricular dilatation prior to explantation.
The transplant is proceeding without complication until you reperfuse the heart and prepare to wean the patient off bypass. No activity returns to the heart and even after 2 h of reperfusion the donor heart shows no sign of myocardial contraction or electrical activity.
The patient remains on bypass for a further 6 h, during which time your hospital receives another offer of a heart, which would be entirely suitable for this lady. However, there is also a 56-year-old man on your list for which it would also be suitable.
After much discussion with your colleagues it is decided that an acute re-transplantation would be too high risk and the man should get the heart. Your patient has a Left and Right Impella Recover device in order to allow this first donor heart more time to recover.
Unfortunately on the Intensive Care, the patient's clinical condition quickly deteriorates and she dies 24 h later.
You are still unsure as to the success rate of acute re-transplantation and also whether the long-term survival is as good with acute re-transplantation and therefore you resolve to look up the literature on this subject.
3. Three part question
In patients with [acute heart transplant failure] is [re-transplantation] a valid treatment option in terms of an acceptable [operative and long term mortality]
4. Search strategy
Medline 1966–July 2004 and EMBASE 1980–July 2004 using the OVID interface
[re-transplant$.mp OR retransplant$.mp] AND [heart.mp or cardiac.mp].
5. Search outcome
Four hundred and fifty-eight papers were identified by the above search of which 11 papers were deemed to be relevant. In addition to the ISHLT registry, two relevant case reports and four papers identified by cross-checking reference lists were also identified (Table 1).
6. Comments
Radovancevic et al. [2] searched the Cardiac Transplant Research Database from the USA and Canada from 1990 to 1999, specifically looking at the results of 106 patients undergoing re-transplantation. They found that patients who had suffered early graft failure or acute rejection performed particularly poorly as did any patients re-operated within 6 months of the first transplant with a 1-year survival of less than 50%. They did report that in the last 4 years of the database figures were improving and that coronary allograft vasculopathy patients were now surviving as successfully as primary heart transplant patients. It is not clear from this paper how acutely the 36 patients who had re-transplantation less than 1 month post-op had their second operation.
Shrivastava in 2000 [3] reported results from 514 patients who had undergone re-transplantation. They found only a 50% 1-year survival in patients having re-transplantation within 6 months of their first operation, and only a 65% 1-year survival overall. This was a very ill cohort of patients with 90% on iv inotropes, 27% on a ventricular assist device and 31% ventilated, although there was no subset analysis of patients having a re-transplantation within days of first operation. Of note this study had 1 year follow up data on only 45% of their patients.
Schlechter [4] briefly reported the Vienna experience of 31 cases. They had a 48% 1-year survival and a 37% 5-year survival although they did not report any breakdowns of the clinical status of the patients or the time to re-transplantation.
Schnetzler [5] reported 24 cases of re-transplantation. Four patients had early re-operation, at days 1, 3, 9 and 30 and only the patient having the re-operation at 30 days survived. Overall results showed a 46% 1-year survival
Smith et al. [6] reported the results of 63 patients who underwent re-transplantation. They achieved an overall 55% 1 year survival and a 33% 5 year survival which was significantly poorer than their 81% 1 year survival in primary heart transplant patients.
John et al. [7] reported a dismal survival in patients with acute graft failure with death occurring in all five patients being re-transplanted within 1 month of primary transplant. However, after they instituted new guidelines for re-transplantation, namely excluding patients with acute graft failure, acute rejection within 6 months, end-organ dysfunction or pulmonary hypertension, their 4-year survival was 94%. Also the overall results of the 43 patients undergoing re-transplantation were not significantly different to their cohort of primary transplants.
In 1988 the Eurotransplant organ exchange programme initiated a ‘high urgency’ priority for patients undergoing re-transplantation for acute graft failure. Forty-six patients underwent re-transplantation, 13 of whom had a Left ventricular assist device (LVAD) and five with an IABP. The survival was poor with only a 36% 1-year survival. In addition, patients on an LVAD had a 21% 1-year survival and 17 of all 28 deaths occurred within 1 week of retransplantation. These results were disappointing and the High urgency system for re-transplant was stopped. Papworth surgeons [8] replied in a letter to these reports stating that in four patients re-transplanted by themselves within 11 days of acute failure all died, and only eight patients with coronary occlusive disease have so far survived in their experience.
Loire et al. in France [9] performed 42 re-transplantations in 38 patients. While survival was comparable to primary surgery in patients that suffered graft coronary disease, nine out of 12 patients who suffered acute graft failure died after re-transplantation.
Michler [10] reported 14 patients who underwent re-transplantation. Their 71% 1-year survival was similar to primary transplantation, although all but one were performed more than 30 days after first transplant. They conclude that except for acute graft failure, re-transplantation has a good survival.
Two case reports were found that were similar to our own case scenario (not included in the table). Jurmann [11] reported the case of a patient who had immediate graft failure. An IABP was placed and an RVAD to assist the right ventricle and allow weaning from bypass. This patient was then quickly re-transplanted and is NYHA class I, 13 months after re-transplantation. In a second patient reported by Wahlers [12], the donor heart suffered left ventricular distension on harvesting. Immediate graft failure occurred complicated by aortic valve insufficiency. The Aortic valve was replaced, and an IABP inserted, but CPB could not be weaned. After 11 h on CPB another donor heart became available and was successfully re-transplanted, and the patient was well 3 months post-operatively.
Marelli et al. [18] reported their experience with 47 re-transplantations. Six of the nine patients with acute graft failure died and overall the 5-year survival was 43%, which was significantly poorer than their 75% survival in 1000 primary transplantations.
Ensley [19] performed a risk analysis of 449 patients who underwent re-transplantation from the ISHLT database from 1968 to 1991. They found that patients undergoing re-transplantation had a significantly lower survival with a 48% 1-year survival, compared to 79% for primary transplant. Predictive risk factors for mortality were: re-transplant within 6 months of the first operation; presence of a mechanical assist device and acute graft failure.
In contrast to adults, children seem to do better with re-transplantation, although acute graft failure is still associated with a high mortality. Kanter [13] reported a 95% 1-year survival in 17 children, although one of the two children with acute graft failure died. Dearani [14] reported re-transplantation in 22 patients. They report an 81% 3-year survival, which is the same as for their primary transplants, although two patients on ECMO and one patient on iv inotropes died.
The ISHLT is the largest registry of Heart transplants and has provided a yearly report for many years now, including reports on re-transplantation in the past. Here only the 2004 paper is included. This report [15] provides some very interesting data on re-transplantation. In contrast to previous years, re-transplantation is no longer a risk factor for increased mortality, with the odds ratio for increased risk having dropped from 1.76 in 1995–1998 to 1.08 in 1999–2002. This is thought to be due to more stringent guidelines for re-transplantation, and alternative strategies for acute graft failure including mechanical assist devices. It is also interesting to note that the presence of a mechanical assist device no longer contributes to decreased survival. The registry reports that the incidence of re-transplantation remains at approximately 2% with approximately 140 being performed between 1999 and 2002.
Thus in summary, acute re-transplantation due to graft failure has been a much-tested strategy but is associated with a high mortality. Far more successful is re-transplantation for graft coronary disease many months or years after primary surgery. In view of the decreasing availability of donor hearts and the improving success of mechanical assist devices, the management of acute graft failure or acute rejection should now consist entirely of placement of a mechanical assist device.
The ISHLT reports that this strategy allows safe re-transplantation in patients with graft coronary disease or stable patients with mechanical assist devices.
7. Clinical bottom line
While re-transplantation for graft coronary disease has a similar survival to patients undergoing primary transplantation, acute graft failure or rejection should be treated with a mechanical assist device, as acute re-transplantation is associated with an unacceptably high mortality.
References
Dunning J, Prendergast B, Mackway-Jones K. Towards evidence-based medicine in cardiothoracic surgery: best BETS. Interac Cardiovasc Thorac Surg 2003;2:405–9.
Radovancevic B, McGiffin DC, Kobashigawa JA, Cintron GB, Mullen GM, Pitts DE, O'Donnell J, Thomas C, Bourge RC, Naftel DC. Retransplantation in 7290 primary transplant patients: a 10-year multi-institutional study. J Heart Lung Transplant 2003;22:862–8.
Srivastava R, Keck BM, Bennett LE, Hosenpud JD. The results of cardiac retransplantation: an analysis of the Joint International Society for Heart and Lung Transplantation/United Network for Organ Sharing Thoracic Registry. Transplantation 2000;70:606–12.
Schlechta B, Kocher AA, Ehrlich M, Ankersmit J, Ploner M, Walch K, Nourani F, Czerny M, Wolner E, Grimm M. Heart re-transplantation: institutional results of a series of 31 cases. Transplant Proc 2001;33:2759–61.
Schnetzler B, Pavie A, Dorent R, Camproux AC, Leger P, Delcourt A, Gandjbakhch I. Heart re-transplantation: a 23-year single-center clinical experience. Ann Thorac Surg 1998;65:978–83.
Smith JA, Ribakove GH, Hunt SA, Miller J, Stinson EB, Oyer PE, Robbins RC, Shumway NE, Reitz BA. Heart re-transplantation: the 25-year experience at a single institution. J Heart Lung Transplant 1995;14:832–9.
John R, Chen JM, Weinberg A, Oz MC, Mancini D, Itescu S, Galantowicz ME, Smith CR, Rose EA, Edwards NM. Long-term survival after cardiac re-transplantation: a 20-year single-center experience. J Thorac Cardiovasc Surg 1999;117:543–55.
Mullins P, Scott J, Chauhan A, Graham T, Aravot D, Large S, Schofield P, Wallwork J. Acute heart re-transplantation.[comment]. Lancet 1991;337:1552–3.
Loire R and Boissonnat P. [Cardiac retransplantation (42 cases in 38 patients). Indications and outcome]. [French]. Arch Mal Coeur Vaiss 1996;89:229–34.
Michler RE, McLaughlin MJ, Chen JM, Geimen R, Schenkel F, Smith CR, Barr ML, Rose EA. Clinical experience with cardiac retransplantation. J Thorac Cardiovasc Surg 1993;106:622–9.
Jurmann MJ, Wahlers T, Coppola R, Fieguth HG, Haverich A. Early graft failure after heart transplantation: management by extracorporeal circulatory assist and retransplantation. J Heart Transplant 1989;8:474–8.
Wahlers T, Frimpong-Boateng K, Haverich A, Schafers HJ, Fieguth HG, Coppola R, Jurmann M, Borst HG. Management of immediate graft failure after cardiac transplantation using cardiopulmonary bypass and intraaortic balloon-pumping followed by cardiac retransplantation. Thorac Cardiovasc Surg 1986;34:389–90.
Kanter KR, Vincent RN, Berg AM, Mahle WT, Forbess JM, Kirshbom PM. Cardiac retransplantation in children. Ann Thorac Surg 2004;78:644–9.
Dearani JA, Razzouk AJ, Gundry SR, Chinnock RE, Larsen RL, delRio MJ, Johnston JK, Bailey LL. Pediatric cardiac retransplantation: intermediate-term results. Ann Thorac Surg 2001;71:66–70.
Taylor DO, Edwards LB, Boucek MM, Trulock EP, Keck BM, Hertz MI. The registry of the international Society for Heart and Lung Transplantation: Twenty-first Official Adult Heart Transplant Report—2004. J Heart Lung Transplant 2004;23:796–803.
deBoer J, Cohen B, Thorogood J, Zantvoort FA, D'Amaro J, Persijn GG. Results of acute heart retransplantation. Lancet 1991;337:1158.
de Boer J, Cohen B, Thorogood J, D'Amaro J, Persijn GG. Results of acute heart retransplantation in Eurotransplant. Transpl Int 1992;5:S219–S20.
Marelli D, Laks H, Bresson J, Houston E, Fazio D, Tsai FC, Hamilton M, Moriguchi J, Fonarow GC, Ardehali A, Camara R, Burch C, Alejos JC, George B, Kawata N, Kobashigawa J. Sixteen-year experience with 1000 heart transplants at UCLA. Clin Transplant 2000;pp. 297–310.
Ensley RD, Hunt S, Taylor DO, Renlund DG, Menlove RL, Karwande SV, O'Connell JB, Barr ML, Michler RE, Copeland JG, Miller LW. Predictors of survival after repeat heart transplantation. J Heart Lung Transplant 1992;11:S142–58.(R. Hareendran Bhaskaran N)
Abstract
A best evidence topic in cardio thoracic surgery was written according to a structured protocol. The question addressed whether cardiac re-transplantation can be performed with an acceptable survival in patients who suffer primary graft failure Altogether 458 papers were found using the reported search, of which 18 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. We conclude that while re-transplantation for graft coronary disease has a similar survival to patients undergoing primary transplantation, acute graft failure or rejection should be treated with a mechanical assist device, as acute re-transplantation is associated with an unacceptably high mortality.
Key Words: Evidence-based medicine; Re-transplantion; Heart transplantation; Acute graft failure
1. Introduction
A Best Evidence Topic was constructed according to a structured protocol. The protocol is fully described in the ICTVS [1]
2. Clinical scenario
You are performing a heart transplant on a 34-year-old lady who had a diagnosis of dilated cardiomyopathy. The Donor heart was harvested by another unit. The harvesting surgeon stated that the heart was good quality but in his clinical notes that came with the donor heart he reported a short period of ventricular dilatation prior to explantation.
The transplant is proceeding without complication until you reperfuse the heart and prepare to wean the patient off bypass. No activity returns to the heart and even after 2 h of reperfusion the donor heart shows no sign of myocardial contraction or electrical activity.
The patient remains on bypass for a further 6 h, during which time your hospital receives another offer of a heart, which would be entirely suitable for this lady. However, there is also a 56-year-old man on your list for which it would also be suitable.
After much discussion with your colleagues it is decided that an acute re-transplantation would be too high risk and the man should get the heart. Your patient has a Left and Right Impella Recover device in order to allow this first donor heart more time to recover.
Unfortunately on the Intensive Care, the patient's clinical condition quickly deteriorates and she dies 24 h later.
You are still unsure as to the success rate of acute re-transplantation and also whether the long-term survival is as good with acute re-transplantation and therefore you resolve to look up the literature on this subject.
3. Three part question
In patients with [acute heart transplant failure] is [re-transplantation] a valid treatment option in terms of an acceptable [operative and long term mortality]
4. Search strategy
Medline 1966–July 2004 and EMBASE 1980–July 2004 using the OVID interface
[re-transplant$.mp OR retransplant$.mp] AND [heart.mp or cardiac.mp].
5. Search outcome
Four hundred and fifty-eight papers were identified by the above search of which 11 papers were deemed to be relevant. In addition to the ISHLT registry, two relevant case reports and four papers identified by cross-checking reference lists were also identified (Table 1).
6. Comments
Radovancevic et al. [2] searched the Cardiac Transplant Research Database from the USA and Canada from 1990 to 1999, specifically looking at the results of 106 patients undergoing re-transplantation. They found that patients who had suffered early graft failure or acute rejection performed particularly poorly as did any patients re-operated within 6 months of the first transplant with a 1-year survival of less than 50%. They did report that in the last 4 years of the database figures were improving and that coronary allograft vasculopathy patients were now surviving as successfully as primary heart transplant patients. It is not clear from this paper how acutely the 36 patients who had re-transplantation less than 1 month post-op had their second operation.
Shrivastava in 2000 [3] reported results from 514 patients who had undergone re-transplantation. They found only a 50% 1-year survival in patients having re-transplantation within 6 months of their first operation, and only a 65% 1-year survival overall. This was a very ill cohort of patients with 90% on iv inotropes, 27% on a ventricular assist device and 31% ventilated, although there was no subset analysis of patients having a re-transplantation within days of first operation. Of note this study had 1 year follow up data on only 45% of their patients.
Schlechter [4] briefly reported the Vienna experience of 31 cases. They had a 48% 1-year survival and a 37% 5-year survival although they did not report any breakdowns of the clinical status of the patients or the time to re-transplantation.
Schnetzler [5] reported 24 cases of re-transplantation. Four patients had early re-operation, at days 1, 3, 9 and 30 and only the patient having the re-operation at 30 days survived. Overall results showed a 46% 1-year survival
Smith et al. [6] reported the results of 63 patients who underwent re-transplantation. They achieved an overall 55% 1 year survival and a 33% 5 year survival which was significantly poorer than their 81% 1 year survival in primary heart transplant patients.
John et al. [7] reported a dismal survival in patients with acute graft failure with death occurring in all five patients being re-transplanted within 1 month of primary transplant. However, after they instituted new guidelines for re-transplantation, namely excluding patients with acute graft failure, acute rejection within 6 months, end-organ dysfunction or pulmonary hypertension, their 4-year survival was 94%. Also the overall results of the 43 patients undergoing re-transplantation were not significantly different to their cohort of primary transplants.
In 1988 the Eurotransplant organ exchange programme initiated a ‘high urgency’ priority for patients undergoing re-transplantation for acute graft failure. Forty-six patients underwent re-transplantation, 13 of whom had a Left ventricular assist device (LVAD) and five with an IABP. The survival was poor with only a 36% 1-year survival. In addition, patients on an LVAD had a 21% 1-year survival and 17 of all 28 deaths occurred within 1 week of retransplantation. These results were disappointing and the High urgency system for re-transplant was stopped. Papworth surgeons [8] replied in a letter to these reports stating that in four patients re-transplanted by themselves within 11 days of acute failure all died, and only eight patients with coronary occlusive disease have so far survived in their experience.
Loire et al. in France [9] performed 42 re-transplantations in 38 patients. While survival was comparable to primary surgery in patients that suffered graft coronary disease, nine out of 12 patients who suffered acute graft failure died after re-transplantation.
Michler [10] reported 14 patients who underwent re-transplantation. Their 71% 1-year survival was similar to primary transplantation, although all but one were performed more than 30 days after first transplant. They conclude that except for acute graft failure, re-transplantation has a good survival.
Two case reports were found that were similar to our own case scenario (not included in the table). Jurmann [11] reported the case of a patient who had immediate graft failure. An IABP was placed and an RVAD to assist the right ventricle and allow weaning from bypass. This patient was then quickly re-transplanted and is NYHA class I, 13 months after re-transplantation. In a second patient reported by Wahlers [12], the donor heart suffered left ventricular distension on harvesting. Immediate graft failure occurred complicated by aortic valve insufficiency. The Aortic valve was replaced, and an IABP inserted, but CPB could not be weaned. After 11 h on CPB another donor heart became available and was successfully re-transplanted, and the patient was well 3 months post-operatively.
Marelli et al. [18] reported their experience with 47 re-transplantations. Six of the nine patients with acute graft failure died and overall the 5-year survival was 43%, which was significantly poorer than their 75% survival in 1000 primary transplantations.
Ensley [19] performed a risk analysis of 449 patients who underwent re-transplantation from the ISHLT database from 1968 to 1991. They found that patients undergoing re-transplantation had a significantly lower survival with a 48% 1-year survival, compared to 79% for primary transplant. Predictive risk factors for mortality were: re-transplant within 6 months of the first operation; presence of a mechanical assist device and acute graft failure.
In contrast to adults, children seem to do better with re-transplantation, although acute graft failure is still associated with a high mortality. Kanter [13] reported a 95% 1-year survival in 17 children, although one of the two children with acute graft failure died. Dearani [14] reported re-transplantation in 22 patients. They report an 81% 3-year survival, which is the same as for their primary transplants, although two patients on ECMO and one patient on iv inotropes died.
The ISHLT is the largest registry of Heart transplants and has provided a yearly report for many years now, including reports on re-transplantation in the past. Here only the 2004 paper is included. This report [15] provides some very interesting data on re-transplantation. In contrast to previous years, re-transplantation is no longer a risk factor for increased mortality, with the odds ratio for increased risk having dropped from 1.76 in 1995–1998 to 1.08 in 1999–2002. This is thought to be due to more stringent guidelines for re-transplantation, and alternative strategies for acute graft failure including mechanical assist devices. It is also interesting to note that the presence of a mechanical assist device no longer contributes to decreased survival. The registry reports that the incidence of re-transplantation remains at approximately 2% with approximately 140 being performed between 1999 and 2002.
Thus in summary, acute re-transplantation due to graft failure has been a much-tested strategy but is associated with a high mortality. Far more successful is re-transplantation for graft coronary disease many months or years after primary surgery. In view of the decreasing availability of donor hearts and the improving success of mechanical assist devices, the management of acute graft failure or acute rejection should now consist entirely of placement of a mechanical assist device.
The ISHLT reports that this strategy allows safe re-transplantation in patients with graft coronary disease or stable patients with mechanical assist devices.
7. Clinical bottom line
While re-transplantation for graft coronary disease has a similar survival to patients undergoing primary transplantation, acute graft failure or rejection should be treated with a mechanical assist device, as acute re-transplantation is associated with an unacceptably high mortality.
References
Dunning J, Prendergast B, Mackway-Jones K. Towards evidence-based medicine in cardiothoracic surgery: best BETS. Interac Cardiovasc Thorac Surg 2003;2:405–9.
Radovancevic B, McGiffin DC, Kobashigawa JA, Cintron GB, Mullen GM, Pitts DE, O'Donnell J, Thomas C, Bourge RC, Naftel DC. Retransplantation in 7290 primary transplant patients: a 10-year multi-institutional study. J Heart Lung Transplant 2003;22:862–8.
Srivastava R, Keck BM, Bennett LE, Hosenpud JD. The results of cardiac retransplantation: an analysis of the Joint International Society for Heart and Lung Transplantation/United Network for Organ Sharing Thoracic Registry. Transplantation 2000;70:606–12.
Schlechta B, Kocher AA, Ehrlich M, Ankersmit J, Ploner M, Walch K, Nourani F, Czerny M, Wolner E, Grimm M. Heart re-transplantation: institutional results of a series of 31 cases. Transplant Proc 2001;33:2759–61.
Schnetzler B, Pavie A, Dorent R, Camproux AC, Leger P, Delcourt A, Gandjbakhch I. Heart re-transplantation: a 23-year single-center clinical experience. Ann Thorac Surg 1998;65:978–83.
Smith JA, Ribakove GH, Hunt SA, Miller J, Stinson EB, Oyer PE, Robbins RC, Shumway NE, Reitz BA. Heart re-transplantation: the 25-year experience at a single institution. J Heart Lung Transplant 1995;14:832–9.
John R, Chen JM, Weinberg A, Oz MC, Mancini D, Itescu S, Galantowicz ME, Smith CR, Rose EA, Edwards NM. Long-term survival after cardiac re-transplantation: a 20-year single-center experience. J Thorac Cardiovasc Surg 1999;117:543–55.
Mullins P, Scott J, Chauhan A, Graham T, Aravot D, Large S, Schofield P, Wallwork J. Acute heart re-transplantation.[comment]. Lancet 1991;337:1552–3.
Loire R and Boissonnat P. [Cardiac retransplantation (42 cases in 38 patients). Indications and outcome]. [French]. Arch Mal Coeur Vaiss 1996;89:229–34.
Michler RE, McLaughlin MJ, Chen JM, Geimen R, Schenkel F, Smith CR, Barr ML, Rose EA. Clinical experience with cardiac retransplantation. J Thorac Cardiovasc Surg 1993;106:622–9.
Jurmann MJ, Wahlers T, Coppola R, Fieguth HG, Haverich A. Early graft failure after heart transplantation: management by extracorporeal circulatory assist and retransplantation. J Heart Transplant 1989;8:474–8.
Wahlers T, Frimpong-Boateng K, Haverich A, Schafers HJ, Fieguth HG, Coppola R, Jurmann M, Borst HG. Management of immediate graft failure after cardiac transplantation using cardiopulmonary bypass and intraaortic balloon-pumping followed by cardiac retransplantation. Thorac Cardiovasc Surg 1986;34:389–90.
Kanter KR, Vincent RN, Berg AM, Mahle WT, Forbess JM, Kirshbom PM. Cardiac retransplantation in children. Ann Thorac Surg 2004;78:644–9.
Dearani JA, Razzouk AJ, Gundry SR, Chinnock RE, Larsen RL, delRio MJ, Johnston JK, Bailey LL. Pediatric cardiac retransplantation: intermediate-term results. Ann Thorac Surg 2001;71:66–70.
Taylor DO, Edwards LB, Boucek MM, Trulock EP, Keck BM, Hertz MI. The registry of the international Society for Heart and Lung Transplantation: Twenty-first Official Adult Heart Transplant Report—2004. J Heart Lung Transplant 2004;23:796–803.
deBoer J, Cohen B, Thorogood J, Zantvoort FA, D'Amaro J, Persijn GG. Results of acute heart retransplantation. Lancet 1991;337:1158.
de Boer J, Cohen B, Thorogood J, D'Amaro J, Persijn GG. Results of acute heart retransplantation in Eurotransplant. Transpl Int 1992;5:S219–S20.
Marelli D, Laks H, Bresson J, Houston E, Fazio D, Tsai FC, Hamilton M, Moriguchi J, Fonarow GC, Ardehali A, Camara R, Burch C, Alejos JC, George B, Kawata N, Kobashigawa J. Sixteen-year experience with 1000 heart transplants at UCLA. Clin Transplant 2000;pp. 297–310.
Ensley RD, Hunt S, Taylor DO, Renlund DG, Menlove RL, Karwande SV, O'Connell JB, Barr ML, Michler RE, Copeland JG, Miller LW. Predictors of survival after repeat heart transplantation. J Heart Lung Transplant 1992;11:S142–58.(R. Hareendran Bhaskaran N)