Current Therapeutic Strategies for Children Referred to Heart Transplantation in Japan: A Single Center Experience.

Abstract

Although the Transplantation Act was revised, there has been still small number of pediatric heart transplantation (HTx) in Japan. In this study, the outcomes of pediatric HTx candidates were retrospectively reviewed. Patients: 71 children defined as a HTx candidate between 1997 and 2013, were reviewed. Thirty eight were boys. Age at referral for HTx was 6.8 ± 5.8 (0 to 17) years. Underlying disease was dilated cardiomyopathy in 48, restrictive cardiomyopathy in 15, hypertrophic cardiomyopahty in 1 and congenital heart disease in 4. 44 were registered on HTx list (Japan in 21, Japan and abroad 2, and USA in 21). During waiting for HTx, 17 required left ventricular assist device (LVAS) (Berlin Heart 3, centrifugal pump 2, Nipro LVAS 7, EVAHeart 1, HeartWare 1, DuraHeart 2 and HeartMate IP 1). Results: 8 underwent HTx in Japan (adult donor 5, child donor 3). 6 were implanted with LVAS and their waiting period was 917 (182 to 1764) days. One did of renal failure 11 years after HTx but other six were alive. 24 patients underwent oversea HTx. Their waiting period for HTx was 51 (16 to 135) days. 7 died during waiting for HTx in Japan and 13 died during preparing to go abroad. 2 HTx recipients died before returning to Japan. All other 30 HTx recipients are alive for 1 months to 13 years after HTx (a mean 6.1 years). Conclusion: Although outcome after HTx was satisfactory, many children died or required LVAS before HTx. Although the Transplant Act was revised, only six HTx had been performed from a pediatric donor in Japan. We greatly appreciate to foreign donors and HTx centers and really hope to establish pediatric HTx program from pediatric donors soon.