[Heart transplantation in Japan: critical appraisal of results]

As of September 30, 2011, a total of 113 patients with end-stage heart failure had undergone heart transplantation in Japan, and the early and late (10-year) survival rates appeared better than those reported by the registry of the International Society of Heart and Lung Transplantation. Among the risk factors negatively affecting survival, utilization of both left ventricular assist devices (LVADs) and marginal donor hearts were higher among Japanese patients, and among the factors favoring survival, younger adult recipients and fewer cases of ischemic cardiomyopathy were noted in Japanese patients. Although only a few patients have reached a survival period longer than 10 years, none has required retransplantation or died due to cardiac allograft vasculopathy (CAV). CAV may develop later in Japanese heart transplant patients than in those with mixed ethnic transplants. In addition, the survival rate with newer LVADs has improved dramatically recently, and therefore selection criteria for the use of an LVAD or heart transplantation require further investigation depending upon the characteristics of candidates with profound heart failure.