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Results of heart retransplantation: subanalysis of the Spanish Heart Transplant Registry
Heart retransplantation (ReHT) is controversial in the current era. The aim of this study was to describe and analyze the results of ReHT in Spain. We performed a retrospective cohort analysis from the Spanish Heart Transplant Registry from 1984 to 2018. Data were collected on donors, recipients, su...
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| Published in: | Revista española de cardiología (English ed.) 2022-01, Vol.75 (1), p.60-66 |
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| creator | Salterain-González, Nahikari Rábago Juan-Aracil, Gregorio Gómez-Bueno, Manuel Almenar-Bonet, Luis Crespo-Leiro, María Generosa Arizón del Prado, José María García-Cosío, María Dolores Martínez-Sellés, Manuel Mirabet-Pérez, Sonia Sobrino-Márquez, José Manuel González-Costello, José Pérez-Villa, Félix Díaz-Molina, Beatriz de la Fuente-Galán, Luis Blasco-Peiró, Teresa Garrido-Bravo, Iris P. García-Guereta Silva, Luis Gil-Villanueva, Nuria Gran, Ferrán González-Vilchez, Francisco |
| description | Heart retransplantation (ReHT) is controversial in the current era. The aim of this study was to describe and analyze the results of ReHT in Spain.
We performed a retrospective cohort analysis from the Spanish Heart Transplant Registry from 1984 to 2018. Data were collected on donors, recipients, surgical procedure characteristics, immunosuppression, and survival. The main outcome was posttransplant all-cause mortality or need for ReHT. We studied differences in survival according to indication for ReHT, the time interval between transplants and era of ReHT.
A total of 7592 heart transplants (HT) and 173 (2.3%) ReHT were studied (median age, 52.0 and 55.0 years, respectively). Cardiac allograft vasculopathy was the most frequent indication for ReHT (42.2%) and 59 patients (80.8%) received ReHT >5 years after the initial transplant. Acute rejection and primary graft failure decreased as indications over the study period. Renal dysfunction, hypertension, need for mechanical ventilation or intra-aortic balloon pump and longer cold ischemia time were more frequent in ReHT. Median follow-up for ReHT was 5.8 years. ReHT had worse survival than HT (weighted HR, 1.43; 95%CI, 1.17-1.44; P |
| doi_str_mv | 10.1016/j.rec.2021.06.009 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2551210633</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1885585721001882</els_id><sourcerecordid>2551210633</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2419-77b65932daa589c0cd7851dee6f371f9064db481d1d62bd637989aeef5e42d203</originalsourceid><addsrcrecordid>eNp9kD1PwzAQhi0EoqXwA1hQRpYEf8RODBOqgCJVQipFYrOc-EJdpUmxHaT-e9IWKiamu-F5X909CF0SnBBMxM0ycVAmFFOSYJFgLI_QkOQ5j3nOs-M_-wCdeb_EmLM8S0_RgKWUs5TLIXqfge_q4KO2ihagXYgcBKcbv651E3SwbXMb-a7Qja433u64sIDoda0b6xfRZJeZHxLRDD6sD25zjk4qXXu4-Jkj9Pb4MB9P4unL0_P4fhqXNCUyzrJCcMmo0ZrnssSlyXJODICoWEYqiUVqijQnhhhBCyNYJnOpASoOKTUUsxG63veuXfvZgQ9qZX0JdX8MtJ1XlHNCCRaM9SjZo6VrvXdQqbWzK-02imC1FaqWqheqtkIVFqoX2meufuq7YgXmkPg12AN3ewD6J78sOOVLC00JxvZdQZnW_lP_DXfUhvk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2551210633</pqid></control><display><type>article</type><title>Results of heart retransplantation: subanalysis of the Spanish Heart Transplant Registry</title><source>ScienceDirect Journals</source><creator>Salterain-González, Nahikari ; Rábago Juan-Aracil, Gregorio ; Gómez-Bueno, Manuel ; Almenar-Bonet, Luis ; Crespo-Leiro, María Generosa ; Arizón del Prado, José María ; García-Cosío, María Dolores ; Martínez-Sellés, Manuel ; Mirabet-Pérez, Sonia ; Sobrino-Márquez, José Manuel ; González-Costello, José ; Pérez-Villa, Félix ; Díaz-Molina, Beatriz ; de la Fuente-Galán, Luis ; Blasco-Peiró, Teresa ; Garrido-Bravo, Iris P. ; García-Guereta Silva, Luis ; Gil-Villanueva, Nuria ; Gran, Ferrán ; González-Vilchez, Francisco</creator><creatorcontrib>Salterain-González, Nahikari ; Rábago Juan-Aracil, Gregorio ; Gómez-Bueno, Manuel ; Almenar-Bonet, Luis ; Crespo-Leiro, María Generosa ; Arizón del Prado, José María ; García-Cosío, María Dolores ; Martínez-Sellés, Manuel ; Mirabet-Pérez, Sonia ; Sobrino-Márquez, José Manuel ; González-Costello, José ; Pérez-Villa, Félix ; Díaz-Molina, Beatriz ; de la Fuente-Galán, Luis ; Blasco-Peiró, Teresa ; Garrido-Bravo, Iris P. ; García-Guereta Silva, Luis ; Gil-Villanueva, Nuria ; Gran, Ferrán ; González-Vilchez, Francisco</creatorcontrib><description><![CDATA[Heart retransplantation (ReHT) is controversial in the current era. The aim of this study was to describe and analyze the results of ReHT in Spain.
We performed a retrospective cohort analysis from the Spanish Heart Transplant Registry from 1984 to 2018. Data were collected on donors, recipients, surgical procedure characteristics, immunosuppression, and survival. The main outcome was posttransplant all-cause mortality or need for ReHT. We studied differences in survival according to indication for ReHT, the time interval between transplants and era of ReHT.
A total of 7592 heart transplants (HT) and 173 (2.3%) ReHT were studied (median age, 52.0 and 55.0 years, respectively). Cardiac allograft vasculopathy was the most frequent indication for ReHT (42.2%) and 59 patients (80.8%) received ReHT >5 years after the initial transplant. Acute rejection and primary graft failure decreased as indications over the study period. Renal dysfunction, hypertension, need for mechanical ventilation or intra-aortic balloon pump and longer cold ischemia time were more frequent in ReHT. Median follow-up for ReHT was 5.8 years. ReHT had worse survival than HT (weighted HR, 1.43; 95%CI, 1.17-1.44; P<.001). The indication of acute rejection (HR, 2.49; 95%CI, 1.45-4.27; P<.001) was related to the worst outcome. ReHT beyond 5 years after initial HT portended similar results as primary HT (weighted HR, 1.14; 95%CI, 0.86-1.50; P<.001).
ReHT was associated with higher mortality than HT, especially when indicated for acute rejection. ReHT beyond 5 years had a similar prognosis to primary HT.
El retrasplante cardiaco (ReTC) representa un tema controvertido actualmente. Nuestro objetivo es describir y analizar los resultados del ReTC en España.
Análisis retrospectivo del Registro Español de Trasplante Cardiaco de 1984 a 2018. Se recogieron datos sobre donante, receptor, cirugía, inmunosupresión y supervivencia. La mortalidad por todas las causas o la necesidad de ReTC postrasplante fueron el objetivo principal. Se estudiaron diferencias en supervivencia según indicación, tiempo entre trasplantes y época del ReTC.
Se estudiaron en total 7.592 trasplantes cardiacos (TxC) y 173 (2,3%) ReTC (mediana de edad, 52,0 y 55,0 años respectivamente). La enfermedad vascular del injerto fue la indicación de ReTC más frecuente (42,2%) y 59 pacientes (80,8%) recibieron el ReTC más de 5 años después del trasplante inicial. El rechazo agudo y el fallo primario del injerto disminuyeron como indicaciones durante el periodo estudiado. La insuficiencia renal, la hipertensión, la necesidad de ventilación mecánica o balón intraaórtico y la mayor duración de la isquemia fría fueron más frecuentes en el ReTC. La mediana de seguimiento del ReTC fue 5,8 años. El ReTC tuvo peor supervivencia que el TxC (HR ponderado=1,43; IC95%, 1,17-1,44; p<0,001). El rechazo agudo (HR=2,49; IC95%, 1,45-4,27; p<0,001) se relacionó con el peor resultado. El ReTC más allá de 5 años del trasplante inicial presagia resultados similares a los del TxC primario (HR ponderado=1,14; IC95%, 0,86-1,50; p<0,001).
El ReTC se asoció con mayor mortalidad que el TxC, especialmente por rechazo agudo. El pronóstico del ReTC realizado más de 5 años después es similar al del TxC primario.]]></description><identifier>ISSN: 1885-5857</identifier><identifier>EISSN: 1885-5857</identifier><identifier>DOI: 10.1016/j.rec.2021.06.009</identifier><identifier>PMID: 34253459</identifier><language>eng</language><publisher>Spain: Elsevier España, S.L.U</publisher><subject>Graft Rejection - epidemiology ; Heart retransplantation ; Heart transplant ; Heart Transplantation ; Humans ; Middle Aged ; Registries ; Reoperation ; Retrasplante cardiaco ; Retrospective Studies ; Spain - epidemiology ; Supervivencia ; Survival ; Trasplante cardiaco</subject><ispartof>Revista española de cardiología (English ed.), 2022-01, Vol.75 (1), p.60-66</ispartof><rights>2021 Sociedad Española de Cardiología</rights><rights>Copyright © 2021 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2419-77b65932daa589c0cd7851dee6f371f9064db481d1d62bd637989aeef5e42d203</citedby><cites>FETCH-LOGICAL-c2419-77b65932daa589c0cd7851dee6f371f9064db481d1d62bd637989aeef5e42d203</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34253459$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Salterain-González, Nahikari</creatorcontrib><creatorcontrib>Rábago Juan-Aracil, Gregorio</creatorcontrib><creatorcontrib>Gómez-Bueno, Manuel</creatorcontrib><creatorcontrib>Almenar-Bonet, Luis</creatorcontrib><creatorcontrib>Crespo-Leiro, María Generosa</creatorcontrib><creatorcontrib>Arizón del Prado, José María</creatorcontrib><creatorcontrib>García-Cosío, María Dolores</creatorcontrib><creatorcontrib>Martínez-Sellés, Manuel</creatorcontrib><creatorcontrib>Mirabet-Pérez, Sonia</creatorcontrib><creatorcontrib>Sobrino-Márquez, José Manuel</creatorcontrib><creatorcontrib>González-Costello, José</creatorcontrib><creatorcontrib>Pérez-Villa, Félix</creatorcontrib><creatorcontrib>Díaz-Molina, Beatriz</creatorcontrib><creatorcontrib>de la Fuente-Galán, Luis</creatorcontrib><creatorcontrib>Blasco-Peiró, Teresa</creatorcontrib><creatorcontrib>Garrido-Bravo, Iris P.</creatorcontrib><creatorcontrib>García-Guereta Silva, Luis</creatorcontrib><creatorcontrib>Gil-Villanueva, Nuria</creatorcontrib><creatorcontrib>Gran, Ferrán</creatorcontrib><creatorcontrib>González-Vilchez, Francisco</creatorcontrib><title>Results of heart retransplantation: subanalysis of the Spanish Heart Transplant Registry</title><title>Revista española de cardiología (English ed.)</title><addtitle>Rev Esp Cardiol (Engl Ed)</addtitle><description><![CDATA[Heart retransplantation (ReHT) is controversial in the current era. The aim of this study was to describe and analyze the results of ReHT in Spain.
We performed a retrospective cohort analysis from the Spanish Heart Transplant Registry from 1984 to 2018. Data were collected on donors, recipients, surgical procedure characteristics, immunosuppression, and survival. The main outcome was posttransplant all-cause mortality or need for ReHT. We studied differences in survival according to indication for ReHT, the time interval between transplants and era of ReHT.
A total of 7592 heart transplants (HT) and 173 (2.3%) ReHT were studied (median age, 52.0 and 55.0 years, respectively). Cardiac allograft vasculopathy was the most frequent indication for ReHT (42.2%) and 59 patients (80.8%) received ReHT >5 years after the initial transplant. Acute rejection and primary graft failure decreased as indications over the study period. Renal dysfunction, hypertension, need for mechanical ventilation or intra-aortic balloon pump and longer cold ischemia time were more frequent in ReHT. Median follow-up for ReHT was 5.8 years. ReHT had worse survival than HT (weighted HR, 1.43; 95%CI, 1.17-1.44; P<.001). The indication of acute rejection (HR, 2.49; 95%CI, 1.45-4.27; P<.001) was related to the worst outcome. ReHT beyond 5 years after initial HT portended similar results as primary HT (weighted HR, 1.14; 95%CI, 0.86-1.50; P<.001).
ReHT was associated with higher mortality than HT, especially when indicated for acute rejection. ReHT beyond 5 years had a similar prognosis to primary HT.
El retrasplante cardiaco (ReTC) representa un tema controvertido actualmente. Nuestro objetivo es describir y analizar los resultados del ReTC en España.
Análisis retrospectivo del Registro Español de Trasplante Cardiaco de 1984 a 2018. Se recogieron datos sobre donante, receptor, cirugía, inmunosupresión y supervivencia. La mortalidad por todas las causas o la necesidad de ReTC postrasplante fueron el objetivo principal. Se estudiaron diferencias en supervivencia según indicación, tiempo entre trasplantes y época del ReTC.
Se estudiaron en total 7.592 trasplantes cardiacos (TxC) y 173 (2,3%) ReTC (mediana de edad, 52,0 y 55,0 años respectivamente). La enfermedad vascular del injerto fue la indicación de ReTC más frecuente (42,2%) y 59 pacientes (80,8%) recibieron el ReTC más de 5 años después del trasplante inicial. El rechazo agudo y el fallo primario del injerto disminuyeron como indicaciones durante el periodo estudiado. La insuficiencia renal, la hipertensión, la necesidad de ventilación mecánica o balón intraaórtico y la mayor duración de la isquemia fría fueron más frecuentes en el ReTC. La mediana de seguimiento del ReTC fue 5,8 años. El ReTC tuvo peor supervivencia que el TxC (HR ponderado=1,43; IC95%, 1,17-1,44; p<0,001). El rechazo agudo (HR=2,49; IC95%, 1,45-4,27; p<0,001) se relacionó con el peor resultado. El ReTC más allá de 5 años del trasplante inicial presagia resultados similares a los del TxC primario (HR ponderado=1,14; IC95%, 0,86-1,50; p<0,001).
El ReTC se asoció con mayor mortalidad que el TxC, especialmente por rechazo agudo. El pronóstico del ReTC realizado más de 5 años después es similar al del TxC primario.]]></description><subject>Graft Rejection - epidemiology</subject><subject>Heart retransplantation</subject><subject>Heart transplant</subject><subject>Heart Transplantation</subject><subject>Humans</subject><subject>Middle Aged</subject><subject>Registries</subject><subject>Reoperation</subject><subject>Retrasplante cardiaco</subject><subject>Retrospective Studies</subject><subject>Spain - epidemiology</subject><subject>Supervivencia</subject><subject>Survival</subject><subject>Trasplante cardiaco</subject><issn>1885-5857</issn><issn>1885-5857</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kD1PwzAQhi0EoqXwA1hQRpYEf8RODBOqgCJVQipFYrOc-EJdpUmxHaT-e9IWKiamu-F5X909CF0SnBBMxM0ycVAmFFOSYJFgLI_QkOQ5j3nOs-M_-wCdeb_EmLM8S0_RgKWUs5TLIXqfge_q4KO2ihagXYgcBKcbv651E3SwbXMb-a7Qja433u64sIDoda0b6xfRZJeZHxLRDD6sD25zjk4qXXu4-Jkj9Pb4MB9P4unL0_P4fhqXNCUyzrJCcMmo0ZrnssSlyXJODICoWEYqiUVqijQnhhhBCyNYJnOpASoOKTUUsxG63veuXfvZgQ9qZX0JdX8MtJ1XlHNCCRaM9SjZo6VrvXdQqbWzK-02imC1FaqWqheqtkIVFqoX2meufuq7YgXmkPg12AN3ewD6J78sOOVLC00JxvZdQZnW_lP_DXfUhvk</recordid><startdate>202201</startdate><enddate>202201</enddate><creator>Salterain-González, Nahikari</creator><creator>Rábago Juan-Aracil, Gregorio</creator><creator>Gómez-Bueno, Manuel</creator><creator>Almenar-Bonet, Luis</creator><creator>Crespo-Leiro, María Generosa</creator><creator>Arizón del Prado, José María</creator><creator>García-Cosío, María Dolores</creator><creator>Martínez-Sellés, Manuel</creator><creator>Mirabet-Pérez, Sonia</creator><creator>Sobrino-Márquez, José Manuel</creator><creator>González-Costello, José</creator><creator>Pérez-Villa, Félix</creator><creator>Díaz-Molina, Beatriz</creator><creator>de la Fuente-Galán, Luis</creator><creator>Blasco-Peiró, Teresa</creator><creator>Garrido-Bravo, Iris P.</creator><creator>García-Guereta Silva, Luis</creator><creator>Gil-Villanueva, Nuria</creator><creator>Gran, Ferrán</creator><creator>González-Vilchez, Francisco</creator><general>Elsevier España, S.L.U</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202201</creationdate><title>Results of heart retransplantation: subanalysis of the Spanish Heart Transplant Registry</title><author>Salterain-González, Nahikari ; Rábago Juan-Aracil, Gregorio ; Gómez-Bueno, Manuel ; Almenar-Bonet, Luis ; Crespo-Leiro, María Generosa ; Arizón del Prado, José María ; García-Cosío, María Dolores ; Martínez-Sellés, Manuel ; Mirabet-Pérez, Sonia ; Sobrino-Márquez, José Manuel ; González-Costello, José ; Pérez-Villa, Félix ; Díaz-Molina, Beatriz ; de la Fuente-Galán, Luis ; Blasco-Peiró, Teresa ; Garrido-Bravo, Iris P. ; García-Guereta Silva, Luis ; Gil-Villanueva, Nuria ; Gran, Ferrán ; González-Vilchez, Francisco</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2419-77b65932daa589c0cd7851dee6f371f9064db481d1d62bd637989aeef5e42d203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Graft Rejection - epidemiology</topic><topic>Heart retransplantation</topic><topic>Heart transplant</topic><topic>Heart Transplantation</topic><topic>Humans</topic><topic>Middle Aged</topic><topic>Registries</topic><topic>Reoperation</topic><topic>Retrasplante cardiaco</topic><topic>Retrospective Studies</topic><topic>Spain - epidemiology</topic><topic>Supervivencia</topic><topic>Survival</topic><topic>Trasplante cardiaco</topic><toplevel>online_resources</toplevel><creatorcontrib>Salterain-González, Nahikari</creatorcontrib><creatorcontrib>Rábago Juan-Aracil, Gregorio</creatorcontrib><creatorcontrib>Gómez-Bueno, Manuel</creatorcontrib><creatorcontrib>Almenar-Bonet, Luis</creatorcontrib><creatorcontrib>Crespo-Leiro, María Generosa</creatorcontrib><creatorcontrib>Arizón del Prado, José María</creatorcontrib><creatorcontrib>García-Cosío, María Dolores</creatorcontrib><creatorcontrib>Martínez-Sellés, Manuel</creatorcontrib><creatorcontrib>Mirabet-Pérez, Sonia</creatorcontrib><creatorcontrib>Sobrino-Márquez, José Manuel</creatorcontrib><creatorcontrib>González-Costello, José</creatorcontrib><creatorcontrib>Pérez-Villa, Félix</creatorcontrib><creatorcontrib>Díaz-Molina, Beatriz</creatorcontrib><creatorcontrib>de la Fuente-Galán, Luis</creatorcontrib><creatorcontrib>Blasco-Peiró, Teresa</creatorcontrib><creatorcontrib>Garrido-Bravo, Iris P.</creatorcontrib><creatorcontrib>García-Guereta Silva, Luis</creatorcontrib><creatorcontrib>Gil-Villanueva, Nuria</creatorcontrib><creatorcontrib>Gran, Ferrán</creatorcontrib><creatorcontrib>González-Vilchez, Francisco</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Revista española de cardiología (English ed.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Salterain-González, Nahikari</au><au>Rábago Juan-Aracil, Gregorio</au><au>Gómez-Bueno, Manuel</au><au>Almenar-Bonet, Luis</au><au>Crespo-Leiro, María Generosa</au><au>Arizón del Prado, José María</au><au>García-Cosío, María Dolores</au><au>Martínez-Sellés, Manuel</au><au>Mirabet-Pérez, Sonia</au><au>Sobrino-Márquez, José Manuel</au><au>González-Costello, José</au><au>Pérez-Villa, Félix</au><au>Díaz-Molina, Beatriz</au><au>de la Fuente-Galán, Luis</au><au>Blasco-Peiró, Teresa</au><au>Garrido-Bravo, Iris P.</au><au>García-Guereta Silva, Luis</au><au>Gil-Villanueva, Nuria</au><au>Gran, Ferrán</au><au>González-Vilchez, Francisco</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Results of heart retransplantation: subanalysis of the Spanish Heart Transplant Registry</atitle><jtitle>Revista española de cardiología (English ed.)</jtitle><addtitle>Rev Esp Cardiol (Engl Ed)</addtitle><date>2022-01</date><risdate>2022</risdate><volume>75</volume><issue>1</issue><spage>60</spage><epage>66</epage><pages>60-66</pages><issn>1885-5857</issn><eissn>1885-5857</eissn><abstract><![CDATA[Heart retransplantation (ReHT) is controversial in the current era. The aim of this study was to describe and analyze the results of ReHT in Spain.
We performed a retrospective cohort analysis from the Spanish Heart Transplant Registry from 1984 to 2018. Data were collected on donors, recipients, surgical procedure characteristics, immunosuppression, and survival. The main outcome was posttransplant all-cause mortality or need for ReHT. We studied differences in survival according to indication for ReHT, the time interval between transplants and era of ReHT.
A total of 7592 heart transplants (HT) and 173 (2.3%) ReHT were studied (median age, 52.0 and 55.0 years, respectively). Cardiac allograft vasculopathy was the most frequent indication for ReHT (42.2%) and 59 patients (80.8%) received ReHT >5 years after the initial transplant. Acute rejection and primary graft failure decreased as indications over the study period. Renal dysfunction, hypertension, need for mechanical ventilation or intra-aortic balloon pump and longer cold ischemia time were more frequent in ReHT. Median follow-up for ReHT was 5.8 years. ReHT had worse survival than HT (weighted HR, 1.43; 95%CI, 1.17-1.44; P<.001). The indication of acute rejection (HR, 2.49; 95%CI, 1.45-4.27; P<.001) was related to the worst outcome. ReHT beyond 5 years after initial HT portended similar results as primary HT (weighted HR, 1.14; 95%CI, 0.86-1.50; P<.001).
ReHT was associated with higher mortality than HT, especially when indicated for acute rejection. ReHT beyond 5 years had a similar prognosis to primary HT.
El retrasplante cardiaco (ReTC) representa un tema controvertido actualmente. Nuestro objetivo es describir y analizar los resultados del ReTC en España.
Análisis retrospectivo del Registro Español de Trasplante Cardiaco de 1984 a 2018. Se recogieron datos sobre donante, receptor, cirugía, inmunosupresión y supervivencia. La mortalidad por todas las causas o la necesidad de ReTC postrasplante fueron el objetivo principal. Se estudiaron diferencias en supervivencia según indicación, tiempo entre trasplantes y época del ReTC.
Se estudiaron en total 7.592 trasplantes cardiacos (TxC) y 173 (2,3%) ReTC (mediana de edad, 52,0 y 55,0 años respectivamente). La enfermedad vascular del injerto fue la indicación de ReTC más frecuente (42,2%) y 59 pacientes (80,8%) recibieron el ReTC más de 5 años después del trasplante inicial. El rechazo agudo y el fallo primario del injerto disminuyeron como indicaciones durante el periodo estudiado. La insuficiencia renal, la hipertensión, la necesidad de ventilación mecánica o balón intraaórtico y la mayor duración de la isquemia fría fueron más frecuentes en el ReTC. La mediana de seguimiento del ReTC fue 5,8 años. El ReTC tuvo peor supervivencia que el TxC (HR ponderado=1,43; IC95%, 1,17-1,44; p<0,001). El rechazo agudo (HR=2,49; IC95%, 1,45-4,27; p<0,001) se relacionó con el peor resultado. El ReTC más allá de 5 años del trasplante inicial presagia resultados similares a los del TxC primario (HR ponderado=1,14; IC95%, 0,86-1,50; p<0,001).
El ReTC se asoció con mayor mortalidad que el TxC, especialmente por rechazo agudo. El pronóstico del ReTC realizado más de 5 años después es similar al del TxC primario.]]></abstract><cop>Spain</cop><pub>Elsevier España, S.L.U</pub><pmid>34253459</pmid><doi>10.1016/j.rec.2021.06.009</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1885-5857 |
| ispartof | Revista española de cardiología (English ed.), 2022-01, Vol.75 (1), p.60-66 |
| issn | 1885-5857 1885-5857 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2551210633 |
| source | ScienceDirect Journals |
| subjects | Graft Rejection - epidemiology Heart retransplantation Heart transplant Heart Transplantation Humans Middle Aged Registries Reoperation Retrasplante cardiaco Retrospective Studies Spain - epidemiology Supervivencia Survival Trasplante cardiaco |
| title | Results of heart retransplantation: subanalysis of the Spanish Heart Transplant Registry |
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