Cardiac transplantation under new legislation for organ transplantation inJapan - Report of two cases

During the past 2 years since new legislation for organ transplantation fro m brain-dead donors came into effect in Japan, 3 cardiac transplants have b een carried out, 2 of which were performed at the National Cardiovascular C enter (NCVC). The recipient cases were 46- and 25-year-old male patients wh o suffered from end-stage dilated cardiomyopathy and had been listed for ca rdiac transplantation in the Japan Organ Transplantation Network as status I candidates. The first patient was supported by the use of a paracorporeal air-driven left ventricular assist device of the NCVC type, and had a mode rate degree of renal and hepatic dysfunction at the time of transplantation . Donor hearts were transported from distant hospitals (Tokyo and Miyagi pr efecture) and the transportation time was 1 h 33 min and 2h 4min, respectiv ely. The operation was performed by the standard technique (Lower-Shumway) in the first patient and by the bicaval anastomosis technique in the second patient. Reperfusion of the transplanted heart was performed retrogradely through the coronary sinus utilizing leukocyte-depleted blood with a gradua l increase in temperature. Total ischemic time was 3 h 34 min and 3 h 35 mi n, respectively. Weaning from the cardiopulmonary bypass was easy and uneve ntful in each patient. Immunosuppressive therapy was conducted with OKT-3 i nduction in the first patient because of the coexisting renal dysfunction a nd with a triple immunosuppressive regimen for both patients. Routine endom yocardial biopsy showed acute rejection of less than grade Ib, and the pati ents were discharged on the 65th and 46th postoperative day, respectively. At present, both patients are in the NYHA class I state and are ready to re turn to work. The uneventful recovery seen in these patients shows the adva nces made in transplant medicine, including the progress and improvement of immunosuppressive therapy, surgical techniques, myocardial protection, and detection and treatment of infection. Further efforts are required to full y establish the cardiac transplantation program in Japan.