Mechanical Circulatory Support as a Bridge to Cardiac Retransplantation: A single center experience

Kevin J. Clerkin, Sunu S. Thomas, Jennifer Haythe, P. Christian Schulze, Maryjane Farr, Hiroo Takayama, Ulrich P. Jorde, Susan W. Restaino, Yoshifumi Naka, Donna M. Mancini

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background Cardiac retransplantation is increasing in frequency. Recent data have shown that retransplantation outcomes are now comparable with primary transplantation. The use of mechanical circulatory support (MCS) as a bridge to retransplantation has similar post-retransplant outcomes to those without MCS, but the success of bridging patients to retransplant with MCS has not been well studied. Methods From January 2000 to February 2014 at Columbia University Medical Center, 84 patients were listed for retransplantation. Of this cohort, 48 patients underwent retransplantation, 15 were bridged with MCS, 24 died, and 6 clinically improved. A retrospective analysis was performed examining waiting list time, survival to retransplantation, and survival after retransplant. The effect of the United Network of Organ Sharing (UNOS) allocation policy change in 2006 on waiting list time and MCS use was also investigated. Results Of 48 patients who underwent retransplantation, 11 were bridged with MCS. Overall 1-year survival to retransplantation was 81.3%. There was no significant difference in waiting list survival (p = 0.71) in those with and without MCS. Death from cardiac arrest or multiorgan failure with infection was more frequent in the medically managed group (p = 0.002). After the UNOS 2006 allocation policy change, waiting list time (599 ± 936 days in Era 1 vs 526 ± 498 days in Era 2, p = 0.65) and waiting list survival (p = 0.22) between eras were comparable, but there was a trend toward greater use of MCS (p = 0.13). Survival after retransplant was acceptable. Conclusion The use of MCS as a bridge to cardiac retransplantation is a reasonable strategy.

Original languageEnglish (US)
Pages (from-to)161-166
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume34
Issue number2
DOIs
StatePublished - Feb 1 2015

Keywords

  • UNOS allocation policy
  • mechanical circulatory support
  • retransplant waiting list survival

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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