日本における心臓移植報告（2023年度）

抄録

Since the Organ Transplantation Act was passed in October 1997, a total of 704 heart transplantations (HTx) have been performed in Japan as of December, 2022. After the Revised Transplant Act came into effect in July 2010, the number of brain-dead organ donation increased and 84 HTx were performed in 2019. In 2020 and 2021, the number of HTx decreased due to the COVID-19 pandemic. However, in 2022, the severity and fatality rate associated with COVID-19 decreased, and the number of HTx increased to 79. The mean waiting time as status 1 continuously increased to 1,877 days in adults. After approval of the use of an implantable continuous-flow ventricular assist device (iVAD) for bridge-to-transplant (BTT) in 2011, BTT cases using iVAD increased. In 2022, 70 of 71 adult cases were supported by iVADs. In 2022, 8 children underwent HTx, 7 of whom were BTT cases using the EXCOR VAD and 1 was treated with intravenous inotropic drugs. 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 15 years was 92.9%, 88.8% and 79.7%, 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 VAD as BTT.