2017 年 52 巻 2-3 号 p. 148-154
Since the Organ Transplantation Act was issued in October 1997, a total of 317 heart transplantations (HTx) have been performed in Japan as of December 2016. Of those, 248 were performed after activation of a revised Transplant Act, and 51 were performed in 2016. Most recipients had dilated cardiomyopathy, and the waiting condition of all patients except for one little girl was status 1 at HTx. The mean waiting time as status 1 increased to 1,057 days in 2016, from 873 days in 2014. After the approval to use the implantable continuous flow ventricular assist device (cf-LVAD) for bridge-to-transplant (BTT) since 2011, the use especially of cf-LVAD increased. In 2016, all HTx's were bridged from VAD support (one EXCOR VAD and fifty cf-LVADs). Mean support duration increased to 1065 days in 2015, from 876 days in 2014. Nineteen children underwent an HTx after LVAD implantation (8 in Nipro VAD, 3 in EXCOR VAD, and 3 in cf-VAD). Most of these patients received a modified bicaval method of operation with Celsior for cardiac preservation, and all recipients were administered triple therapy with calcineurin inhibitor (cyclosporin or tacrolimus), mycophenolate mofetil, and steroid as an initial immunosuppressive regimen. Patient survivals at 10 and 15 years was 90.2% and 84.7%, respectively, superior to similar results of the international registry. This surveillance documented that the results of HTx in Japan were excellent despite a severe shortage of donors and long waiting times with LVAD as BTT.
