2020 Volume 55 Issue 3 Pages 261-269
Since the Organ Transplantation Law was passed in October 1997, a total of 512 heart transplantations (HTx) had been performed in Japan as of December, 2019. Of those, 443 HTx were performed after activation of a revised Transplant Act, and 84 were performed in 2019. 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 1502 days in 2018 from 892 days in 2014 in adults. After approval of the use of the implantable continuous flow ventricular assist device (cf-LVAD) for bridge-to-transplant (BTT) in 2011, BTT, especially using cf-LVAD, increased. In 2019, 63 of 67 adult cases were supported by several types of cf-LVADs. Mean support duration also continuously increased to 1531 days in 2019 from 876 days in 2014. Fifty children underwent HTx and 38 (76%) of them were BTT cases (8 in Nipro VAD, 13 in EXCOR VAD, 9 in Jarvik 2000 and 8 in other cf-VADs). Most of the 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 89.4% and 79.1%, respectively, which is superior to that of the international registry. This survey documented that the results of HTx in Japan were excellent despite a severe shortage of donors and long waiting times with LVAD as BTT.
