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Primary and Repeat Heart Transplantation in the United States: A propensity score matching analysis of 594 re-recipients through 5 -years |
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Back to 86th Annual Meeting Back to Program Outline Objective: Cardiac retransplantation is a controversial procedure due to the disparity between donor heart demand and supply.We sought to determine the difference in population profile and survival outcome of a matched primary and repeat heart transplant population. Methods: A multi-institutional database provided 20,787 first heart transplants and 594 second heart transplants with complete data on all variables. Propensity score matching was used to compare primary heart transplants to repeat heart transplants, in five quintiles adjusted for the effects of employment status infection ,functional status , ABO blood type, life support , medical condition , HLA mismatch, ventilator support after listing. In our analysis of these data, we used propensity score matching based on a logistic regression and the above mentioned covariates. Patients were assigned to one of five quintiles, Q1-Q5, where the first quintile consists of patients most similar to those that had a single transplant , and Q5 consists of patients most similar to those patients that had a second transplant.Within quintiles, primary and repeat transplant patients are matched in probability for all of the above mentioned covariates. Results: Repeat transplant patients were more likely to be female, in UNOS status 1, less likely to be unemployed, less likely to have limitations with daily living, more likely to be on a ventilator if hospitalized, are younger, have a younger donor, and receive hearts with increased ischemic time.There was an increased risk of mortality for patients undergoing a second transplant relative to a first transplant. At 1-month, repeat transplant patients are 76% more likely to die than first transplant patients, adjusted for case-mix. In terms of risk ratios, the increased risk was 133% for Q1, 118% in Q2, 72% in Q3, 55% in Q4, and 34% in Q5 for a second transplant. All results were statistically significant. Through 5-years, repeat transplant patients are 130% more likely to die than first transplant patients, adjusted for case mix. Conclusions: Survival following re-transplantation is significantly reduced relative to survival following primary transplantation. The difference in survival between primary and repeat transplants is smallest in the sickest patients. 
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