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Clin Transplant. 2019 Mar;33(3):e13482. doi: 10.1111/ctr.13482. Epub 2019 Feb 8.

Description and analysis of patients and outcomes following third-time heart transplantation: An analysis of the United Network for Organ Sharing database from 1985 to 2017.

Author information

1
Rush University Medical College, Chicago, Illinois.
2
Department of Cardiovascular and Thoracic Surgery, Rush Medical Center, Chicago, Illinois.
3
Department of Preventative Medicine, Rush University, Chicago, Illinois.
4
Department of Pathology, Rush University, Chicago, Illinois.

Abstract

BACKGROUND:

Following second heart transplantation (HTx), some patients experience graft failure and require third-time heart transplantation. Little data exist to guide decision-making with regard to repeat retransplantation in older patients.

METHODS:

We performed a retrospective cohort analysis of patients receiving a third HTx, as identified in the United Network for Organ Sharing (UNOS) database from 1985 to 2017.

RESULTS:

The study cohort consisted of N = 60 patients, with an average age of 29 with a standard deviation of ±18 years. Overall survival for the cohort at 1, 5, and 10 years is 83%, 64%, and 44%, respectively. The rate of third-time HTxs has steadily increased in all age groups. Patients older than 50 years now account for 18.3% of all third-time HTxs. Although this group demonstrated longer average previous graft survival, after third HTx they demonstrate significantly poorer survival outcomes compared to third-time HTx recipients younger than 21 (P = 0.05). Age over 50, BMI over 30, and diabetes were all found to be independent risk factors for decreased survival following third HTx.

CONCLUSIONS:

We describe trends in patients undergoing third HTx. We highlight subsets of such recipients who exhibit decreased survival.

KEYWORDS:

United Network for Organ Sharing (UNOS); dysfunction; graft survival; heart (allograft) function; registry; registry analysis; retransplantation

PMID:
30659652
DOI:
10.1111/ctr.13482

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