2019 年 54 巻 2-3 号 p. 97-104
Since the Organ Transplantation Law was passed in October 1997, a total of 428 heart transplantations (HTx) have been performed in Japan as of December, 2018. Of those, 359 HTx were performed after activation of a revised Transplant Act, and 55 were performed in 2018. Most recipients had dilated cardiomyopathy; and the waiting condition of all patients was status 1 at HTx. The mean waiting time as status 1 continuously increased to 1310 days in 2018 from 873 days in 2014. After approval of the use of the implantable continuous flow ventricular assist device (cf-LVAD) for bridge-to-transplant (BTT) in 2011, BTTs, especially those using the cf-LVAD increased. In 2017, all adult patients were BTT cases, and 50 (100%) of them were supported by several types of cf-LVADs. Mean support duration also continuously increased to 1356 days in 2018 from 876 days in 2014. Thirty-three children underwent HTx and 26 (79%) of them were BTT cases (8 in Nipro VAD, 7 in EXCOR VAD, 6 in Jarvik and 3 in other cf-VADs). 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 89.5% and 85.8%, respectively, which is superior to that of the international registry. This review documented that the results of HTx in Japan were excellent despite a severe shortage of donors and long waiting times with LVAD as BTT.
