title: 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.affiliation: Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Hatsue
authors.initials: H
authors.lastname: Ishibashi-Ueda
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Ikeda
authors.forename: Taka-Aki
authors.initials: TA
authors.lastname: Matsuyama
authors.forename: Keiko
authors.initials: K
authors.lastname: Ohta-Ogo
authors.forename: Takuma
authors.initials: T
authors.lastname: Sato
authors.forename: Osamu
authors.initials: O
authors.lastname: Seguchi
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yanase
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujita
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakatani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000473:pathology* / Q000601:surgery; D003331:Coronary Vessels / Q000473:pathology; D004699:Endocardium / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology* / Q000473:pathology; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006353:Heart-Assist Devices; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D009894:Opportunistic Infections / Q000209:etiology* / Q000473:pathology; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: acute rejection; cardiomyopathy; endomyocardial biopsy; heart transplantation