Purpose Retransplantation has been considered for heart transplant patients with severe systolic dysfunction mainly due to underlying cardiac allograft vasculopathy (CAV) or severe rejection. However, some patients develop heart failure symptoms (shortness of breath, low cardiac output, fatigue, etc.) with preserved systolic function (defined as left ventricular ejection fraction (LVEF) ≥ 40%). Similar to restrictive cardiomyopathic patients, these patients have symptoms refractory to medical therapy, which severely reduces their quality of life, necessitating retransplantation. This study describes these patients and their candidacy for retransplantation.
Methods Between January 1994 and December 2004, 31 heart transplant patients underwent retransplantation. Twenty-four of the 31 patients were found to have severe heart failure with preserved systolic function. These transplant patients were all on triple immunosuppresion: cyclosporine (n = 15) or tacrolimus (n = 9) in combination with azathioprine (n = 7) or mycophenolate mofetil (n = 11) or sirolimus (n = 1) plus or minus corticosteroids.
Results These 24 patients with preserved systolic function all had significant symptoms of shortness of breath, fatigue, and decreased exercise tolerance. Echocardiography showed 8 patients with left ventricular hypertrophy. Nineteen patients (5 had no rejection episodes) had an average of 1.4 rejection episodes, and 20 patients developed epicardial CAV. For these 24 patients, 5-year survival after retransplantation was 66.7%, which is comparable to survival of the 7 retransplant patients with severe systolic dysfunction.
Conclusions Retransplantation in patients with severe heart failure symptoms but preserved systolic function (similar to restrictive cardiomyopathic patients) appears acceptable. These patients have comparable survival to patients retransplanted due to systolic dysfunction and therefore should be considered candidates for retransplantation.
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