仅有一小部分心脏移植患者能够行再次心脏移植(3-4%)，我们研究其结果。再次心脏移植不良结果的危险因素包括移植后早期(<6个月)再移植、因急性排斥反应或早期移植物失功再移植、早期再移植。再移植排斥反应和感染的发生率和首次移植相似。对于成人和儿童心脏再移植不良结果的危险因素类似。但是由于心脏移植较短的半寿期，儿童时期行心脏移植的患者可能需要再次移植。根据工作组的意见和这些数据提示心脏再移植的指征：（i）严重的以缺血和心衰为症状的慢性移植心脏血管病或无症状的中重度左室功能不全；（ii）无活动性排斥反应的慢性移植物功能不全。因急性排斥导致移植物功能衰竭且血流动力学不稳定的患者尤其是移植后<6个月的患者不适合移植。另外，严格需制定首次移植受者资格指南。

Retransplants comprise only a small minority (3-4%) of heart transplants, however outcome following retransplantation is compromised. Risk factors for a poor outcome following retransplantation include retransplantation early (<6 months) after primary transplant, retransplantation for acute rejection or early allograft failure, and retransplantation in an earlier era. The incidence of rejection and infection is similar following primary transplant and retransplantation. The compromised outcomes and risk factors for a poor outcome are similar in adult and pediatric heart retransplantation. However, due to the short half-life of the transplanted heart, it is an expectation that patients transplanted in childhood may require retransplantation. Based on the data available and the opinion of the working group, indications for heart retransplantation are (i) chronic severe cardiac allograft vasculopathy with symptoms of ischemia or heart failure (should be considered) or asymptomatic moderate or severe left ventricular dysfunction (may be considered) or (ii) chronic graft dysfunction with symptoms of progressive heart failure in the absence of active rejection. Patients with graft failure due to acute rejection with hemodynamic compromise, especially <6 months post-transplant, are inappropriate candidates for retransplantation. In addition, guidelines established for primary transplant candidacy should be strictly followed.

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