2022 年 57 巻 3 号 p. 239-247
Since the Organ Transplantation Act was passed in October 1997, a total of 625 heart transplantations (HTx) have been performed in Japan as of December, 2021. Of those, 556 HTx were performed after activation of a revised Transplant Act, and 84 were performed in 2019, which fell to 56 due to the COVID-19 pandemic in 2021. 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 1,815 days in 2021 from 892 days in 2014 in adults. 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 2021, 51 of 56 adult cases were supported by several types of cf-LVADs. Sixty children underwent HTx and 46 (77%) of them were BTT cases (8 in Nipro VAD, 20 in EXCOR VAD, 9 in Jarvik 2000 and 9 in other cf-VADs). Most patients underwent 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 a steroid as an initial immunosuppressive regimen. Patient survival at 5, 10 and 20 years was 93.3%, 89.4% and 77.5%, 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.
