Heart Retransplantation.

Retransplantation of the heart is not a widely performed procedure, and few centers have large series. The most common indication for heart retransplantation is transplant graft coronary artery disease, followed by acute rejection and primary graft dysfunction. The outcome after heart retransplantation is not as good as with primary transplantation; the one year actuarial survival rate is lower and there are more perioperative complications. The number of episodes of infection and rejection, however, is not increased. The outcome of heart retransplantation for transplant graft coronary artery disease is better than that of retransplantation for rejection or primary graft failure. However, it is still inferior to that of primary heart transplantation. Because of this and the critical shortage of donor hearts, it is suggested that heart retransplantation should be limited to carefully selected patients.