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An Immunological Model for Heterotopic Heart and Cardiac Muscle Cell Transplantation in Rats
Published on: May 8, 2020
The pathological implications of heart transplantation: experience with 50 cases in a single center
Hatsue Ishibashi-Ueda1, Yoshihiko Ikeda, Taka-Aki Matsuyama
1Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Insights
Japanese heart transplantation shows excellent long-term outcomes. Careful donor selection and post-transplant care minimize rejection, leading to a 10-year survival rate of over 93% in 50 patients.
Area of Science:
- Cardiology
- Transplantation Immunology
- Pathology
Background:
- Heart transplantation in Japan began in 1999.
- A total of 50 heart transplants were performed at the center.
- The study focuses on histopathological analyses of explanted hearts and biopsy specimens.
Purpose of the Study:
- To evaluate the outcomes of heart transplantation in Japan.
- To analyze the causes of graft loss and patient mortality.
- To identify factors contributing to successful long-term survival.
Main Methods:
- Histopathological analysis of 50 explanted hearts and post-transplant biopsies.
- Review of recipient demographics, primary heart diseases, and pre-transplant interventions (e.g., left ventricular assist devices).
- Assessment of rejection episodes (acute cellular and antibody-mediated) and other complications.
Main Results:
- The median recipient age was 39 years, with idiopathic dilated cardiomyopathy being the most common primary disease (66%).
- A high rate of pre-transplant left ventricular assist device use (94%).
- Excellent survival rates: 97.6% at 1 year and 93.1% at 10 years. Low incidence of severe rejection (moderate acute cellular in 12%, antibody-mediated in 6%). Mortality causes included sepsis, multiple organ failure, and post-transplant lymphoproliferative disorders (PTLD).
Conclusions:
- Despite a low volume of heart transplants in Japan, outstanding long-term survival rates are achievable.
- Effective donor evaluation and meticulous post-transplant care are crucial for minimizing rejection.
- Pathological evaluation plays a significant role in understanding and improving transplant outcomes.
Abstract:
Heart transplantation started in Japan in 1999. Since then, 50 transplants have been performed at our center. We performed histopathological analyses of the 50 explanted hearts and the post-transplant biopsy specimens. The median age of recipients was 39 years. The primary diseases before transplant were idiopathic dilated cardiomyopathy in 33 patients (66%), hypertrophic cardiomyopathy in seven (14%), restrictive cardiomyopathy in one, arrhythmogenic right ventricular cardiomyopathy in one, and secondary cardiomyopathy in eight (16%). Before transplantation, 47 patients (94%) had left ventricular assist devices. No severe cardiovascular failure due to allograft rejection occurred. The post-transplant survival rate was 97.6% at 1 year and 93.1% at 10 years. One recipient was lost to sepsis from myelodysplastic syndrome in the fourth year, one died of multiple organ failure and peritonitis 8 months after transplant. Another patient died of recurrent post-transplant lymphoproliferative disorders (PTLD). Mild cardiac dysfunction occurred in seven recipients in the early postoperative period. Moderate acute cellular rejection occurred in six patients (12%), and antibody-mediated rejection occurred in three (6%). The number of heart transplants performed in Japan is very small. However, the outstanding 10-year survival rate is due to donor evaluation and post-transplant care resulting in low grade rejection. Pathological evaluation has also greatly contributed to the results.
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