Трансплантационные технологии и исследования

Bridging with Mechanical Circulatory Support for Cardiac Retransplantation: Analysis of the United Organ Sharing Network Database

Abstract

Erol V Belli, Phillip J Habib, Bhupendra Rawal and Kevin Landolfo

Background: Cardiac retransplantation (ReTx) remains an infrequent event, and bridging patients with mechanical circulatory support provides another option while patients await suitable donors.

Methods: The United Network for Organ Sharing database was retrospectively reviewed to identify patients undergoing ReTX between 1995-2012. Of the total 28,464 transplants performed during that period, 850 were retransplants and 29 (3.4%) had VAD support prior to retransplant with available data. The primary outcome investigated was overall survival and patients were stratified based on presence of VAD and time between transplant and retransplant (PRVTXDIF). Comparison was undertaken between four groups (G1: ReTX without VAD and PRVTXDIF > 30days, G2: ReTX with VAD and PRVTXDIF <=30days, G3: ReTX with VAD and PRVTXDIF >30 days, G4: ReTX without VAD and PRVTXDIF <=30 days).These were tested with univariate logistical regression and multivariate Cox regression models. Results: In multivariable analysis, the relative risk of death for patients in G3 vs G1 was not statistically significant (RR=0.37, 95% CI=(0.1, 1.5), P=0.16); and the relative risk of death was 1.7 times higher in G2 compared to that in G4, which was not statistically significant (RR=1.7, 95% CI=(0.8, 4.0), P=0.20) . Donor’s age (RR: 1.1, P=0.038) and ischemic time greater than 4 hours (RR: 1.6, P=0.001) were significant predictors of survival. Conclusion: Cardiac retransplantation may be undertaken safely when patients are maintained on mechanical support and further out from primary transplant.