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410 WHEN TO LIST FOR REDO HEART TRANSPLANT IN PATIENTS WITH SEVERE CARDIAC ALLOGRAFT VASCULOPATHY.

It is not known when to consider retransplantation for patients with severe cardiac allograft vasculopathy (CAV). It has been reported that patients with severe 3 vessel disease have high mortality in the ensuing years after diagnosis. We evaluated 356 patients between January 1994 and December 2003 for the initial diagnosis of CAV at annual coronary angiography and followed these patients for 5-year clinical outcomes of survival. The patients were divided into those that developed early CAV (less than 2 years) and those that developed late CAV (greater than 2 years from heart transplant). There were 26 patients with early CAV. 18 of these patients were found to have initial diagnosis of 1-, 2-, 3-vessel CAV without left ventricular dysfunction (LVdys) and 8 patients were found to have initial diagnosis of 1-, 2-, 3-vessel coronary disease with LVdys (LVEF ≤40%). Of these 18 patients, 5-year survival was significantly lower compared to patients without any CAV (n = 265 patients) (61.1% vs 86.4%, p < .001). For the 8 early CAV patients with initial diagnosis of 1-, 2-, or 3-vessel CAV with LVdys, 5-year survival was significantly lower than patients without any CAV (62.5% vs 86.4%, p < .001). There were 107 patients with late CAV. 87 of these patients were found to have initial diagnosis of 1-, 2-, 3-vessel CAV without LVdys and 20 patients were found to have initial diagnosis of 1-, 2-, 3-vessel CAV with LVdys. Of these 87 patients, 5-year survival was comparable to patients without any CAV (n = 356 patients) (89.7% vs 91.8%, p = ns) with mortality spread evenly over 1, 2, and 3-vessel CAV patients. For the 20 late CAV patients with initial diagnosis of 1-,2-, or 3-vessel CAV with LVdys, 5-year survival was significantly lower than patients without any CAV (60.0% vs 91.8%, p < .001). Conclusion Patients with early (less than 2 years post transplant) 3-vessel CAV with and without LVEF < 40% and late CAV with LVEF < 40% should be considered for retransplantation due to significant increased mortality in the ensuing years.