HEART RE-TRANSPLANTATION: A SINGLE CENTER EXPERIENCE

Background and Aim: Heart re-transplantation (re-HTx) represents a rare surgical option, due both to the shortage of donors and the complexity of re-HTx candidates. The aim of this study was to analyze the results of re-HTx. Methods: Out of 757 HTx performed in our Center, 34 were re-HTx. The re-HTx data, collected prospectively, were retrospectively analyzed. The primary endpoint was overall mortality, while secondary endpoints were postoperative complications. Results: The mean age of re-HTx recipients was 49±12 years. 22 patients (65%) were male. The most frequent comorbidities were: chronic renal failure (53%), dyslipidemia (26%), atrial fibrillation (24%), hypertension (18%), diabetes mellitus (15%). In 4 cases (12%) the re-HTx occurred within 2 weeks from the first HTx after severe graft failure, while in the remaining 30 patients (88%) the re-HTx occurred after 16±7 years, and the most frequent cause was coronary allograft vasculopathy. In 7 cases a combined kideny transplant was performed. Grafts were preserved with ice (74%), normothermic perfusion (18%), and controlled hypothermia (9%). The average age of the donors was 40±15 years. Overall 30-day mortality was 12% (n=4). The 5- and 10-year survival was 62% and 58%, respectively. Postoperative use of IABP and ECMO was 9% and 6%, respectively. Grade>2 cell-mediated rejection occurred in 39% of patients, and infections were treated in 52%. Thirty-three percent of patients required ventilatory support >72 hours and 21% required hemodialysis. Conclusions: Re-HTx represents a valid treatment for patients with limited therapeutic options. However, shortage of organ availability requires careful patient selection combined with thorough perioperative management.