The pathological implications of heart transplantation: experience with 50 cases in a single center.

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.

• Authors: Hatsue Ishibashi-Ueda, Yoshihiko Ikeda, Taka-Aki Matsuyama, Keiko Ohta-Ogo, Takuma Sato, Osamu Seguchi, Masanobu Yanase, Tomoyuki Fujita, Junjiro Kobayashi, Takeshi Nakatani
• Journal: Pathology international (Pathol Int) Vol. 64 Issue 9 Pg. 423-31 (Sep 2014) ISSN: 1440-1827 [Electronic] Australia
• PMID: 25146228 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 Japanese Society of Pathology and Wiley Publishing Asia Pty Ltd.

Chemical References

• Immunosuppressive Agents

Topics

• Adolescent
• Adult
• Aged
• Biopsy
• Cardiomyopathy, Dilated (pathology, surgery)
• Coronary Vessels (pathology)
• Endocardium (pathology)
• Female
• Follow-Up Studies
• Graft Rejection (etiology, pathology)
• Heart Transplantation (adverse effects, mortality)
• Heart-Assist Devices
• Humans
• Immunosuppressive Agents (adverse effects)
• Japan
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multiple Organ Failure (etiology)
• Opportunistic Infections (etiology, pathology)
• Postoperative Complications (mortality)
• Prognosis
• Retrospective Studies
• Survival Rate
• Young Adult