J.Jpn. Surg. Soc.. 121(2): 158-163, 2020

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Feature topic

HEART TRANSPLANTATION: CURRENT STATUS AND TOPICS

Twenty years have passed since the first heart transplantation (HTx) in Japan was performed in 1999 under the Brain Death Law. After the revision of the law in 2010, the annual number of HTx has now increased to more than 50. The long-term patient prognosis is excellent, with an approximately 90％ survival rate at 10 years post-HTx. However, the waiting period to receive a donor heart has lengthened, reaching 1,310 days in 2018, due to a lack of organ donations. Continuous-flow ventricular assist devices (VADs) enable such long-term HTx waiting lists. Until recently, it was common for pediatric heart failure patients to seek HTx surgery abroad, but the revision of the law and approval of pediatric VADs have led to an abrupt increase in pediatric HTx since 2017. The importance and negative impact of anti-HLA antibody, particularly donor-specific antibody (DSA), are increasingly recognized. Continuous monitoring of DSA before and after HTx may improve long-term outcomes.

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