The Outcome of Redo Heart Transplant Patients

PURPOSE Redo heart transplantation remains the only treatment for cardiac graft failure. Past research has shown that redo heart transplantation appears to have acceptable outcomes in selected patients. However, it has been shown that redo heart transplant patients have a higher tendency towards developing circulating antibodies post- redo transplant and could be at risk for worse outcome. We sought to assess the outcome of redo heart-transplant patients at our large single center. METHODS Between 2010 and 2018 we assessed 871 patients undergoing heart transplantation. We divided these patients into those who underwent their first transplant (T1: n=837) and those who underwent their second or third transplant (T2/3: n=34). Endpoints included 1 and 5 year survival, freedom from the development of cardiac allograft vasculopathy (CAV) (as defined by stenosis ≥30% by angiography), non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), any treated rejection (ATR), acute cellular rejection (ACR), antibody-mediated rejection (AMR). RESULTS There was no difference between the two groups in terms of 1 or 5 -Year survival, freedom from CAV, NF-MACE or any rejection. However, there was a numerical trend towards worse 1-Year Freedom from NF-MACE in the redo transplant group. CONCLUSION Redo heart transplantation in our single-center appears to have acceptable outcomes compared to those undergoing their first transplant. Further study with larger numbers is warranted.