Heart retransplantation: medical and surgical issues.

In order to look at heart retransplantation in its right perspective, a number of preliminary pieces of information must be kept in mind. First, the actual scope of the problem is limited. From the largest two international heart transplant registries [1,2] and the organ procurement registries [3], we know that retransplantations currently account for 1.5-2.5% of the 4600-4800 heart transplantations performed annually worldwide, i.e. the total retransplant volume is 70-120 procedures per year. There has been no increase in the proportion of heart retransplantation over the past 10 years (Table 1). Second, the available experience is scattered. A majority of heart transplant centers have at some time performed heart retransplantation, although in any given year only 20-25% of centers report such activity. The number of retransplantations per center is mostly very limited so that worldwide there are probably fewer than 10 centers with a total heart retransplantation experience of τ20 patients (Table 2). Third, the global survival rate after retransplantation continues to be inferior to that after a first transplant, even if a slight improvement has been noted over the last years (Table 3). Finally, death rate on the waiting list decreased from 14.5% in 1988 to 12.8% in 1992 and 10.2% in 1996 [1]. [ABSTRACT FROM AUTHOR]