LAUSR

Introduction Heart transplantation in Japan is rather late start compared to western countries, because a definition of cerebral death by low took time. Up to present, over a hundred heart transplantations have been performed at our center for almost 20 years. MaterialsandMethods We performed histopathological analyses of the 100 explanted hearts for the investigation of the underlying diseases of explanted hearts. We also reviewed follow-up endomyocardial biopsy results of implanted hearts. Results The average age of recipients was 39+/-13.6 years (4 to 64 years). Male recipients were 79 (79%). The primary diseases before transplant were idiopathic dilated cardiomyopathy in 63 patients (63%), hypertrophic cardiomyopathy in 15 (15%), restrictive cardiomyopathy in 1, arrhythmogenic right ventricular cardiomyopathy in 2. The secondary cardiomyopathies were classified as ischemic cardiomyopathy in 7, Becker type muscular dystrophy in 6, cardiac sarcoidosis in 2, congenital heart disease in 1, post-myocarditis cardiomyopathy in 3. Before transplantation, 95 patients (95%) had left ventricular assist devices. Primary graft dysfunction occurred in 7 recipients in the early postoperative period. No severe cardiovascular failure due to allograft rejection occurred. Moderate acute cellular rejection (ACR 2R) occurred in 8 patients (8%) and no ACR 3R, and antibody-mediated rejection occurred in 8% of 4 (pAMR1) and 4 (pAMR2). The post-transplant survival rate was 97.6% at 1 year and 93.1% at 10 years. There were 3 graft lost. One recipient was lost to sepsis from myelodysplastic syndrome At 4th year, one died of multiple organ failure and peritonitis 8 months after transplant. Another patient died of recurrent PTLD. All these 3 causes of death were confirmed by autopsy. Discussion The number of heart transplants performed in Japan is very small because of lack of donors. Therefore, almost heart transplantation candidates are implanted of ventricular assistant devises for chronic heart failure. Acute heart failures such as acute myocardial infarct and fulminant myocarditis are infrequent indications for urgent transplantation. However, the outstanding 10-year survival rate after transplantation is due to donor evaluation, candidate selection and excellent post-transplant care.