671 Pediatric Heart Re-Transplantation: A 25-Year Single Center Experience

Abstract

Purpose: Studies regarding pediatric heart re-transplantation (Re-Tx) have reported conflicting short-term outcomes, and also there is a paucity of data available on long-term outcomes. In this study, we sought to analyze the long-term outcomes of Re-Tx. Methods and Materials: This was a retrospective analysis of our heart transplant database between November 1985 and August 2010. Patients who underwent Re-Tx were studied for basic demographic characteristics, indications for the first transplantation and the re-transplantation, survival data and hemodynamic data. Results: Among 473 children who underwent primary heart transplantation, 32 patients were re-transplanted. The mean age of Re-Tx was 8.60+4.5 years (46.87% were females; 62.5% were non-white). Indications of Re-Tx were coronary allograft vasculopathy (CAV) (78%), primary graft failure (18%) and acute rejection (3%). Mean time between the transplants was 6.57+4.2 years. Cause of death included coronary allograft vasculopathy (42% of total deaths), infection (26.31%), acute rejection (6%), pulmonary hypertension (6%), posttransplant lymphoproliferative disorder (3%), chronic graft dysfunction (3%). The mortality rate was higher in earlier era (68% compared with 25%). Kaplan-Meier curve comparing mortality following Re-Tx done for CAV with that of the outcome following a first transplantation did not show any statistically significant separation of curves over time. Conclusions: Pediatric Re-Tx at this point seems to be an acceptable option for the coronary allograft vasculopathy. Re-Tx procedures are now safer than the ones done in the earlier era. Long-term survival for Re-Tx done for coronary allograft vasculopathy appears to be similar to that noted with primary heart transplants. (Figure presented) (Table presented).