著者

日本心臓移植研究会

出版者

一般社団法人 日本移植学会

雑誌

移植 (ISSN:05787947)

巻号頁・発行日

vol.56, no.3, pp.235-244, 2021 (Released:2021-12-25)

参考文献数

4

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Since the Organ Transplantation Law was passed in October 1997, a total of 566 heart transplantations (HTx) had been performed in Japan as of December, 2020. Of those, 597 HTx were performed after activation of a revised Transplant Act, and 84 were performed in 2019, but the number fell to 54 due to the COVID-19 pandemic. Most recipients had dilated cardiomyopathy; and the waiting condition of all patients was status 1 at HTx. The mean waiting time as status 1 continually increased to 1,625 days in 2020 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) since 2011, BTT, especially using the cf-LVAD increased. In 2020, 46 of 49 adult cases were supported by several types of cf-LVADs. Fifty-five children underwent HTx and 42 (76%) of them were BTT cases (8 in Nipro VAD, 17 in EXCOR VAD, 9 in Jarvik 2000 and 8 in other cf-VADs). Most patients received a modified bicaval method of operation with Celsior for cardiac preservation, and all recipients were administered triple therapy with a calcineurin inhibitor (cyclosporine or tacrolimus), mycophenolate mofetil, and a steroid as an initial immunosuppressive regimen. Patient survival at 5, 10 and 20 years was 90.5%, 79.5% and 75.5%, 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.