心臓移植とリハビリテーション

抄録

In recent years, the waiting period until a heart transplant has been increasing. Therefore, the need for rehabilitation after heart transplantation to patients who had severe heart failure before transplantation has been widely recognized. Cardiac rehabilitation is a type of comprehensive disease management including exercise therapy, patient education and counseling. Several reports have shown that even if the left ventricular contractility of the transplanted heart is normal, exercise tolerance is hardly improved. This involves such factors as mechanisms of exercise intolerance in chronic heart failure and deconditioning, denervation of transplanted hearts, and immunosuppressants. It is important to perform rehabilitation after transplantation with understanding of the conditions before transplantation, the specificity of the transplanted heart, type of rejection, and immunosuppressive therapy. In practice, starting from the ambulation in the postoperative acute phase, exercise therapy is performed with the aim of acquiring daily activities equivalent to or greater than those before transplantation and improving exercise capacity. Furthermore, patient education by a multi-disciplinary team is required so that self-management centering on complications of medication, dietary guidance, and infection prevention can be performed. Such comprehensive management is expected to improve exercise tolerance, prognosis, and quality of life (QOL).