Zhu Y, Shudo Y, Lingala B, et al. - Researchers sought to report on outcomes after heart retransplantation. Among 2,092 receiving primary transplantation at their institution from January 6, 1968, to June 2019, 123 patients (112 adult and 11 pediatric patients) underwent heart retransplantation. Relative to recipients who only underwent primary heart transplantation, retransplantation recipients were more likely to have hypertension, hyperlipidemia, and require dialysis. Cardiac allograft vasculopathy (32/80%), primary graft dysfunction (6/15%), and refractory acute rejection (2/5%) were the indications for heart retransplantation. Matched median survival of 4.6 years was reported after retransplantation compared with 6.5 years after primary heart transplantation. They observed inferior unadjusted long-term survival after heart retransplantation vs primary heart transplantation, and persistence of short-term survival difference after propensity-score matching. Outcomes support considering heart retransplantation for select patients for optimal donor organ usage.