acute cellular rejection (ACR), antibody-mediated rejection (AMR), and infections remains challenging. 1 Risk factors for poor clinical prognosis or difficulties for their management by healthcare practitioners for patients necessitate alternative immunosuppression strategies. 1 Induction T riple immunosuppressive therapy including calcineurin inhibitors (CNIs), mycophenolate mofetil (MMF), and steroids, has substantially improved outcomes for heart transplant (HTx) recipients. Nevertheless, the management of CNI-related nephrotoxicity, fatal

No abstract

Heart transplantation (HTx) is an established and effective treatment for advanced heart failure [1]. The long-term prognosis after HTx has continuously improved as a consequence of reduced early post-transplant mortality [2]. In Japan, the survival rates at 5, 10, and 15 years after HTx are 92.7%, 89.6%, and 81.8%, better than those in Europe and the USA [3]. However, the incidence of de novo malignancy increases in the late period and is one of the major causes of death after HTx [4]. Malignancy negatively impacts the prognosis after HTx, regardless of the type of malignancy [5]. The risk of de novo malignancy in heart transplant recipients was reported to be 2-4 times higher than that in the general population [5-7]. Additionally, heart transplant recipients have a 4 times higher risk compared to renal transplant recipients due to their intensive immunosuppression therapy [5,6]. There are several

improve pre-and post-HTx outcomes. For those patients waiting for HTx, the Japanese insurance coverage was extended to the continuous flow-type of implantable left ventricular assist device (CF-LVAD) in April 2011; the total number of CF-LVAD implantation patients enrolled in the Japanese registry for Mechanically Assisted Circulatory Support (J-MACS) increased to nearly 1200 at the end of 2019, 5 200 of which were implanted at the NCVC. Before approval of CF-LVAD, most HTx recipients were bridged with the Nipro-Toyobo extracorporeal LVAD (E-LVAD; Nipro Co., Ltd, Osaka, Japan) at the NCVC as well as at other centers. Regarding donor selection, we T he Japanese Organ Transplant Act came into effect in October 1997 and the first heart transplantation (HTx) under this Act was performed at Osaka University Hospital in February 1999 1 and the second and third ones at the National Cerebral and Cardiovascular Center (NCVC). 2 The annual number of HTx procedures increased steadily to ∼10, but rose sharply to 84 in 2019 after a revision of the Act in July 2010, 3,4 and the total HTx exceeded 500 at the end of 2019. One hundred and thirtythree HTxs of them have been performed at the NCVC.During these 2 decades (1999-2019), many therapeutic strategies have been developed in the field of HTx to

No abstract