高齢者の心臓移植

Heart Transplantation for Older Patients

本邦の限られたドナー数と補助人工心臓治療が拡大する中で，移植待機期間の長期化がすすんでいる．心臓移植という機会を逃さないために，適切なドナー評価は不可欠である．また，移植待機期間の長期化に伴い，レシピエントも高齢化している．当院では，2005年2月からこれまでに42例の心臓移植を施行し，早期死亡例はなく，移植後5年以降の累積生存率は94％である．われわれは，年齢という因子に焦点を当てて検討し，当院の治療戦略を再考する．

The number of older donors is increasing in the limited number of donors in Japan. The number of older donors is increasing, and recipients are also ageing as the waiting period for transplantation becomes longer. The age of 60 years is one of the most important criteria for heart transplantation in Japan. Forty-two heart transplantations performed in our institution, and 12 cases were from donors aged over 60 years and seven recipients were older than 60 years at the time of transplantation. In four cases, both donor and recipient were over 60 years of age. All of these patients were discharged home after transplantation. As the number of older donors and recipients is expected to increase in the future, the number of marginal cases based on the status of not only the donor but also the recipient is expected to increase. The evaluation of coronary lesions and the identification of comorbid diseases, including malignant diseases, will become more important. A positive and careful overall decision at the time of transplantation is essential.