2018 年 53 巻 2-3 号 p. 125-132
Since the Organ Transplantation Law was passed in October 1997, a total of 373 heart transplantations (HTx) have been performed in Japan as of December, 2017. Of those, 304 HTx were performed after activation of a revised Transplant Act, and 56 were performed in 2017. Most recipients had dilated cardiomyopathy; and the waiting condition of all adult patients was status 1 at HTx. The mean waiting time as status 1 continuously increased to 1174 days in 2017 from 873 days in 2014. After approval of the use of an implantable continuous flow ventricular assist device (cf-LVAD) for bridge-to-transplant (BTT) in 2011, BTT, especially using cf-LVAD increased. In 2017, all patients were BTT cases, and 51 (91%) of them were supported by several types of cf-LVADs. Mean support duration also continuously increased to 1211 days in 2017 from 876 days in 2014. Twenthy-six children underwent HTx and 21 (81%) of them were BTT cases (8 in Nipro VAD, 5 in EXCOR VAD, 5 in Jarvik and 3 in other cf-VAD). Most of patients received a modified bicaval method of operation with Celsior for cardiac preservation, and all recipients were administered triple therapy with calcineurin inhibitor (cyclosporine or tacrolimus), mycophenolate mofetil, and steroid as an initial immunosuppressive regimen. Patient survival at 10 and 15 years was 88.2% and 83.4%, respectively, which is superior to that 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.
