Heart and Lung Retransplantation

Cardiac transplantation has become an accepted and well-established treatment for end-stage cardiac disease (Baumgartner et al. 1979). Severe myocardial dysfunction which is not treatable by standard medical therapy or conventional surgical intervention can result from end-stage coronary artery disease, valvar heart disease or cardiomyopathies including idiopathic dilated cardiomyopathy, viral cardiomyopathy and postpartum cardiomyopathy. The recent interest in paediatric cardiac transplantation has extended the indications for cardiac transplantation to include complex congenital cardiac anomalies for which conventional procedures are either not possible or have previously provided insufficient palliation. At Stanford University Medical Center an active clinical cardiac transplantation programme has existed since 1968. Over the past 19 years 474 transplants in 432 recipients have been performed. The survival rates in the era of immunosuppression with cyclosporine are 83% at 1 year and 65% at 5 years. As the experience has grown, the need for retransplantation has developed (Copeland et al. 1977), and to date 40 retransplants have been performed in 38 recipients.