POINTS TO NOTE FROM INDICATIONS FOR HEART-TRANSPLANTATION TO POST-HEART TRANSPLANT CARE - FROM THE CARE OF PATIENTS WITH REFRACTORY HEART-FAILURE AND OVERSEAS HEART-TRANSPLANTATION

To examine important points surrounding the indications for heart tran splantation (HTX) to care after HTX, we reviewed 22 patients with refr actory heart failure aged less than 60 years who had been observed for the past 6 years. Sixteen patients had dilated cardiomyopathy; 1, dil ated hypertrophic cardiomyopathy; 3, restrictive cardiomyopathy; and 2 , ischemic cardiomyopathy; there were 15 males and 7 females, and 6 of the 22 patients were children. The 22 patients were divided into two groups according to their response to tailored medical therapy. Group 1 (n = 6) consisted of those whose cardiac function improved to New Yo rk Heart Association (NYHA) status 2 from NYHA status 3 or 4. Group 2 (n = 16) still exhibited refractory heart failure. Seven of these 16 p atients went on to have successful HTX. Survival in groups 1 and 2 com bined was significantly lower than actuarial survival post-HTX cited i n the registry of the International Society for Heart and Lung Transpl antation, and group 2 had an even lower survival than the total groups 1 and 2 survival. Survival in children was much lower than that in ad ults. Seven of the 16 patients in group 2 showed a genetic link, but t here was no genetic link in group 1 patients. One patient in group 2 h ad a panel reactive antibody (PRA) value of 46% and died while awaitin g HTX. Post-HTX care in terms of immunosuppressant therapy, was modifi ed for each patient. It is particularly necessary to consider the time a patient will wait on the list for candidates for HTX who are childr en, have a genetic link, or are positive for PRA. A genetic approach i s helpful to determine indications for HTX. Sensitive monitoring of po st-HTX immunosuppression is needed.