Surgeons at the Cedars-Sinai Medical Center in Los Angeles have reported that they have successfully removed a transplanted heart from a patient who had died and retransplanted it in another recipient.
"To my knowledge, this is the first time this has been done with a transplanted heart," said Dr. Lawrence S. C. Czer, medical director of the center's heart transplant program. "Even with other organs, repeat transplantation is very rare."
The second patient was a 45-year-old man with non-compaction syndrome, a rare cardiac condition in which the heart assumes a sponge-like appearance. The disease is progressive, and the man's heart became more and more disabled despite the best medical therapy.
According to Czer, the patient first went on the waiting list for a heart transplant in 2002 but he improved and came off the list for several years. About a year ago, his condition worsened and again he was placed on the list.
Finding a suitable donor heart was complicated by the fact that the patient was a "very large man." As Czer noted, "You can transplant a large heart into a smaller recipient, but not a small heart into a larger recipient."
Two months ago, the patient received a call from the transplant coordinator saying that a heart had become available. As it turned out, this organ had already been transplanted into one recipient who had died a week after the procedure from unrelated causes.
There are a number of potential issues that arise with retransplantation. For one thing, the risk of rejection is heightened because the organ has now been exposed to tissue and antibodies from two different individuals.
In addition, the operation is more complex since the cardiac vessels have already been grafted previously. Furthermore, having two periods without blood flow while the heart is removed prior to each transplantation may damage the heart muscle further.
Czer said that the short time the heart spent in the first recipient may have been critical to the success of the retransplantation. With longer periods, there may have been more significant immune issues.
The new recipient is now several weeks out from the transplantation and thus far seems to be doing well with no sign of rejection or other complications.