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Heart transplantation in Japan: a critical appraisal for the results and future prospects
1Cardiovascular and Transplant Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan. skitamur@hsp.ncvc.go.jp
Insights
Japanese heart transplant survival rates show promise, with better early and 10-year outcomes compared to international data. Key factors influencing survival include recipient age and heart condition, with cardiac allograft vasculopathy appearing later in Japanese patients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Statistics
Background:
- End-stage heart failure necessitates advanced treatment options.
- Heart transplantation is a critical intervention for eligible patients.
- International data provides benchmarks for transplant outcomes.
Purpose of the Study:
- To evaluate early and long-term survival rates of heart transplantation in Japan.
- To identify risk factors affecting survival in Japanese heart transplant recipients.
- To compare Japanese outcomes with international data from the ISHLT Registry.
Main Methods:
- Retrospective analysis of 113 heart transplant patients in Japan up to September 30, 2011.
- Comparison of survival data with the International Society of Heart and Lung Transplantation (ISHLT) Registry.
- Identification of pre-transplant and donor-related factors influencing patient survival.
Main Results:
- Japanese heart transplant recipients demonstrated favorable early and 10-year survival rates compared to ISHLT data.
- Use of left ventricular assist devices (LVADs) and marginal donor hearts were associated with increased risk.
- Younger recipients and fewer cases of ischemic cardiomyopathy were linked to better survival.
- No deaths or retransplantations due to cardiac allograft vasculopathy (CAV) were observed within the 10-year follow-up period.
Conclusions:
- Japanese heart transplantation outcomes appear superior, with a potential for delayed onset of cardiac allograft vasculopathy (CAV).
- Recipient and donor factors significantly influence survival post-transplantation.
- Evolving LVAD technology necessitates re-evaluation of selection criteria for mechanical support versus transplantation in advanced heart failure.
Abstract:
As of September 30, 2011, a total of 113 patients with end-stage heart failure underwent heart transplantation in Japan, and the early and late (10 years) survival rates appear better than those reported in 2011 by the Registry of the International Society of Heart and Lung Transplantation (ISHLT). Among the risk factors determining survival, use of both left ventricular assist devices (LVADs) during the pretransplant care and marginal donor hearts increased the risk while factors favoring survival included younger adult recipients and fewer patients with ischemic cardiomyopathy; factors noted in Japanese patients in comparison with those registered in the ISHLT report. Although only a few patients have reached 10 years follow-up, so far none has died or required retransplantation due to cardiac allograft vasculopathy (CAV). CAV may develop later in Japanese heart transplant patients than in those of mixed inter-ethnic transplants. Recently, survival rates with newer LVADs have dramatically improved and therefore, selection criteria for the permanent or destination use of an LVAD or for heart transplantation require further evaluation, depending upon the various factors in candidates with profound heart failure.
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