FEATURED PAPERSOutcomes in patients undergoing cardiac retransplantation: A propensity matched cohort analysis of the UNOS Registry
Graphical Abstract
Section snippets
Study design and population
This was a retrospective cohort study of adult and pediatric patients enrolled in the United Network for Organ Sharing (UNOS) database between January 1996 and November 2017. Patient inclusion and exclusions are outlined in Supplementary Figure S1 (available online at www.jhltonline.org/). Patients who did not have follow-up status recorded in the database and those in whom a listing diagnosis was not recorded were excluded. Patients undergoing combined heart-lung transplantation were also
Results
In total, 62,112 patients were identified in the UNOS heart transplant database, of which 2,202 (3.5%) underwent late cardiac retransplantation at a median of 9.4 years (IQR 5.7–14.0 years) after initial transplant. An additional 349 (0.6%) patients underwent early/acute retransplant at a median of 154 days (IQR 4–322 days). Time to retransplantation for both groups are outlined in Figure 1. Median follow-up was 5.0 years (IQR 1.7–9.6 years), with slightly shorter follow-up in patients
Discussion
In this analysis of the UNOS heart transplant database, late retransplantation was not associated with an increased risk of all-cause mortality in the adult population after adjusting for donor and recipient characteristics previously identified as independently associated with mortality by the SRTR. In contrast, retransplantation within 1 year or for acute rejection was associated with increased all-cause mortality. These results suggest that the nuances of timing and acuity of
Conclusions
After matching for important donor and recipient characteristics, late retransplantation was not associated with increased all-cause mortality or need for retransplantation in the adult population. In contrast, retransplantation within 1 year or for acute rejection was associated with increased all-cause mortality. Our results highlight the importance of assessing indication acuity and comorbid conditions when assessing retransplant candidacy.
Disclosure statement
This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. Dr Miller receives funding support from the Arthur J.E. Child Fellowship grant.
Supplementary data
Supplementary data associated with this article can be found in the online version at www.jhltonline.org/.
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