第84回東京女子医科大学学会総会 シンポジウム
心臓移植の贈り物
キーワード:
heart transplantation,
ventricular assist device,
cardiac allograft vasculopathy,
narrative-based medicine,
the transplant life
2019 年 89 巻 2 号 p. 50-56
詳細
2019 年 89 巻 2 号 p. 50-56
There have been over 6,000 human heart transplants since the first transplant approximately 50 years ago. In Japan, 50-60 transplants have been performed annually since enforcement of the revised Organ Transplant Law; however, 600-700 people await transplantation, and even Status 1 patients wait over 1,000 days.
Post-transplant management is divided into two categories. One, related to transplantation itself, includes open heart surgery, denervation/re-innervation, donor heart ischemia, and issues resulting from recipient heart failure. The other consists of manageable factors such as rejection control, risk of infection or tumor under immunosuppression, adverse effects of immunosuppressants, and frequent cardiac catheterization procedures.
After transplantation, patients receive combined treatment with a calcineurin inhibitor (e.g., tacrolimus or cyclosporine), mycophenolate mofetil, and a steroid. Antibody-mediated rejection and its relationship to cardiac allograft vasculopathy have received significant attention. Immunosuppressants contribute to infection with pathogens such as cytomegalovirus, Epstein-Barr virus, and hepatitis virus within 30 days after transplantation.
Cardiac allograft vasculopathy is characterized by diffuse coronary stenosis of mainly small- and medium-sized arteries. It is diagnosed by intravascular ultrasound observation of intimal hyperplasia, a lesion caused by immunologic and non-immunologic mechanisms and treated with mTOR (mammalian target of rapamycin) inhibitors.
Compliance with post-transplantation maintenance therapies and behaviors enables good long-term health.
Heart transplantation is part of an ideal health care system, complemented by evidence- and narrative-based medicine.
