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Early result of heart transplantation in Japan: Osaka University experience
Norihide Fukushima1, Yuji Miyamoto, Shigeaki Ohtake
1Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. nori@surg1.med.osaka-u.ac.jp
Insights
Japanese heart transplantation since 1997 shows promising results, with no deaths in 17 cases. Left ventricular assist devices (LVADs) are crucial for managing donor shortages and improving patient outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Law
Background:
- The organ transplantation law in Japan was enacted in 1997.
- Heart transplantation is a critical treatment for end-stage heart failure.
- Donor organ scarcity remains a significant challenge globally and in Japan.
Purpose of the Study:
- To evaluate the outcomes of heart transplantation in Japan since the 1997 law.
- To assess the role of left ventricular assist devices (LVADs) in Japanese heart transplantation.
- To analyze patient demographics, diagnoses, and post-transplant complications.
Main Methods:
- Retrospective analysis of 17 heart transplantations performed in Japan between 1997 and the study period.
- Data collection included recipient diagnoses, age, use of LVADs, waiting times, and follow-up duration.
- Assessment of rejection episodes and post-operative complications.
Main Results:
- A total of 17 heart transplants were performed, with 7 at Osaka University Hospital.
- Recipient diagnoses included dilated cardiomyopathy, hypertrophic cardiomyopathy, and post-myocarditis cardiomyopathy.
- No early or late deaths were observed during 1-4.8 years of follow-up.
- Five patients were supported with LVADs prior to transplantation.
- Rejection episodes occurred in 3 patients, with one requiring plasmapheresis.
- One patient experienced neurological sequelae after ventricular tachycardia.
- All patients were discharged and returned to daily life.
Conclusions:
- Heart transplantation in Japan since 1997 has yielded satisfactory outcomes.
- LVADs play a vital role in bridging patients to transplantation amidst donor shortages.
- Despite challenges, the resumption of heart transplantation demonstrates positive patient recovery and quality of life.
Abstract:
Since the new organ transplantation law was established in 1997, 17 heart transplantations have been performed in Japan, 7 of which were carried out at Osaka University Hospital. Recipient diagnosis was dilated cardiomyopathy in 2, dilated phase of hypertrophic cardiomyopathy in 4, and post-myocarditis cardiomyopathy in 1. Ages ranged from 8 to 49 years with a mean of 35.3 years. Five patients were bridged with a left ventricular assist device. The waiting period was 182-977 days (mean, 643 days). There was no early or late death during follow-up of 1-4.8 years. Under a standard triple-drug regimen using mycophenolate, there were 3 rejection episodes greater than grade 3 in 2 patients, and humoral rejection requiring plasmapheresis in one. A young boy whose donor was a hemodynamically compromised adult developed neurological sequelae after resuscitation following ventricular tachycardia. All patients were discharged and went back to work or their regular daily life. Although the donor shortage is still severe in Japan, the resumption of heart transplantation has been satisfactory, and left ventricular assist devices have played a crucial role.
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