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Retransplantation of the Pediatric Heart Recipient

  • Richard Kirk
  • Ryan J. Butts
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)

Abstract

While graft survival has continued to improve after pediatric heart transplantation, graft failure still occurs at median of 15 years post-transplant. When graft failure occurs, retransplantation is an option to improve quality and length of life. It, however, has unique challenges compared to primary transplantation. Patients awaiting retransplantation have longer wait list times and double the wait list mortality. Operative mortality is higher, and immediate peritransplant morbidities (rejection, renal dysfunction, and infection) are more frequent compared to primary transplantation. Long-term outcomes are also worse, with median graft survival of 8.7 years versus 15 years, although survival after retransplantation is dependent to a large extent on the indication for retransplant and the inter-transplant interval. Patients undergoing retransplantation for coronary vasculopathy (CAV) with more than 5 years after primary transplant have good survival; however, patients undergoing retransplantation within the first year after primary transplantation have the worse outcomes. After retransplantation, the recipient is more likely to suffer from rejection, renal dysfunction, late-onset malignancy, and CAV. Despite these complexities, retransplantation remains a viable option in selected patients and can improve their length and quality of life.

Keywords

Pediatric heart retransplantation Graft survival Immunosuppression Outcomes Graft failure 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Texas Southwestern Medical CenterDallasUSA

Section editors and affiliations

  • Ryan R. Davies
    • 1
  1. 1.University of Texas Southwestern Medical CenterDallasUSA

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