heart transplant

• 心臓移植、心移植

関

cardiac transplant、cardiac transplantation、heart transplantation

WordNet

1. be transplantable; "These delicate plants do not transplant easily"
2. an operation moving an organ from one organism (the donor) to another (the recipient); "he had a kidney transplant"; "the long-term results of cardiac transplantation are now excellent"; "a child had a multiple organ transplant two months ago" (同)transplantation, organ_transplant
3. the act of removing something from one location and introducing it in another location; "the transplant did not flower until the second year"; "too frequent transplanting is not good for families"; "she returned to Alabama because she could not bear transplantation" (同)transplantation, transplanting
4. place the organ of a donor into the body of a recipient (同)graft
5. lift and reset in another soil or situation; "Transplant the young rice plants" (同)transfer
6. a plane figure with rounded sides curving inward at the top and intersecting at the bottom; conventionally used on playing cards and valentines; "he drew a heart and called it a valentine"
7. the courage to carry on; "he kept fighting on pure spunk"; "you havent got the heart for baseball" (同)mettle, nerve, spunk
8. an inclination or tendency of a certain kind; "he had a change of heart" (同)spirit
9. a playing card in the major suit that has one or more red hearts on it; "he led the queen of hearts"; "hearts were trumps"
10. the locus of feelings and intuitions; "in your heart you know it is true"; "her story would melt your bosom" (同)bosom
11. the hollow muscular organ located behind the sternum and between the lungs; its rhythmic contractions move the blood through the body; "he stood still, his heart thumping wildly" (同)pump, ticker
12. a firm rather dry variety meat (usually beef or veal); "a five-pound beef heart will serve six"
13. able to perceive sound
14. an opportunity to state your case and be heard; "they condemned him without a hearing"; "he saw that he had lost his audience" (同)audience
15. (law) a proceeding (usually by a court) where evidence is taken for the purpose of determining an issue of fact and reaching a decision based on that evidence
16. the ability to hear; the auditory faculty; "his hearing was impaired" (同)audition, auditory sense, sense of hearing, auditory modality
17. a session (of a committee or grand jury) in which witnesses are called and testimony is taken; "the investigative committee will hold hearings in Chicago"
18. receive a communication from someone; "We heard nothing from our son for five years"
19. examine or hear (evidence or a case) by judicial process; "The jury had heard all the evidence"; "The case will be tried in California" (同)try
20. perceive (sound) via the auditory sense
21. a form of whist in which players avoid winning tricks containing hearts or the queen of spades (同)Black_Maria

PrepTutorEJDIC

1. 〈植物〉‘を'移植する / (…から他の場所へ)…‘を'移す,〈人〉‘を'移住させる《+名+from+名+to+名》 / (…から…へ)〈組織・器官など〉‘を'移植する《+名+from+名+to+名》 / 移植できる;移住する / 〈C〉移植された物 / 〈U〉移植すること
2. 〈C〉『心臓』;胸 / 〈C〉(感情の中心をなす)『心』,気持ち / 〈U〉愛情,同情 / 〈U〉『勇気』,元気,熱意 / 《the ~》『中心』,内部,(物事の)本質,核心 / 〈C〉ハート形の物;(カードの)ハートの札
3. 〈U〉『聴力』,聴覚〈U〉〈C〉(…を)『聞くこと』,(…の)聞き取り《+『of』+『名』》・〈C〉聞いてもらう機会,聞いてやること・聴取・聴聞会〈C〉(法廷などでの)尋問,審問,;(刑罰の減免を求める)釈明,意見陳述 / 〈U〉聞こえる距離(範囲)
4. 〈音〉‘が'『聞こえる』,‘を'聞く(進行形にできない) / 〈人の言うこと〉‘に'『耳を傾ける』,‘を'注意深く聞く(listen);(裁判官などが)…の申し立てを聞く / 〈うわさ・ニュースなど〉‘を'『耳にしている』,聞いている / 『耳が聞こえる』 / 《しばしば命令形で》耳を傾ける,注意を向ける / 『うわさ』(『消息』)『を聞く』

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/10/15 13:33:14」(JST)

wiki en

[Wiki en表示]

Heart transplantation
Intervention
Diagram illustrating the placement of a donor heart in an orthotopic procedure. Notice how the back of the patient's left atrium and great vessels are left in place.
ICD-9-CM	37.51
MeSH	D016027
MedlinePlus	003003

A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed. As of 2016, the most common procedure is to take a functioning heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient. The patient's own heart is either removed and replaced with the donor heart (orthotopic procedure) or, less commonly, left in place to support the donor heart (heterotopic procedure). Approximately 3500 heart transplants are performed every year in the world, more than half of which occur in the US. Post-operation survival periods average 15 years. Heart transplantation is not considered to be a cure for heart disease, but a life-saving treatment intended to improve the quality of life for recipients.

History

One of the first mentions about the possibility of a heart transplantation was by American medical researcher Simon Flexner, who declared in a reading of his paper on “Tendencies in Pathology” in the University of Chicago in 1907 that it would be possible in the then-future for diseased human organs substitution for healthy ones by surgery — including arteries, stomach, kidneys and heart.

Norman Shumway is widely regarded as the father of heart transplantation although the world's first adult human heart transplant was performed by a South African cardiac surgeon, Christiaan Barnard, utilizing the techniques developed and perfected by Shumway and Richard Lower. Barnard performed the first transplant on Louis Washkansky on December 3, 1967, at the Groote Schuur Hospital in Cape Town, South Africa. Adrian Kantrowitz performed the world's first pediatric heart transplant on December 6, 1967, at Maimonides Hospital in Brooklyn, New York, barely three days after Christiaan Barnard's pioneering operation (which used Shumway and Lower's procedure). Norman Shumway performed the first adult heart transplant in the United States on January 6, 1968, at the Stanford University Hospital.

Worldwide, about 3,500 heart transplants are performed annually. The vast majority of these are performed in the United States (2,000–2,300 annually). Cedars-Sinai Medical Center in Los Angeles, California, currently is the largest heart transplant center in the world, having performed 122 adult transplants in 2014 alone. About 800,000 people have NYHA Class IV heart failure symptoms indicating advanced heart failure. The great disparity between the number of patients needing transplants and the number of procedures being performed spurred research into the transplantation of non-human hearts into humans after 1993. Xenografts from other species and man-made artificial hearts are two less successful alternatives to allografts.

Most published surgical methods of HT necessarily divide the Vagus nerve and thus amputate parasympathetic control of the myocardium.

Contraindications

Some patients are less suitable for a heart transplant, especially if they suffer from other circulatory conditions related to their heart condition. The following conditions in a patient increase the chances of complications;

Absolute contraindications:

• Advanced kidney, lung, or liver disease
• Active cancer if it is likely to impact the survival of the patient
• Life-threatening diseases unrelated to heart failure including acute infection or systemic disease such as systemic lupus erythematosus, sarcoidosis, or amyloidosis
• Vascular disease of the neck and leg arteries.
• High pulmonary vascular resistance - over 5 or 6 Wood units.

Relative contraindications:

• Insulin-dependent diabetes with severe organ dysfunction
• Recent thromboembolism such as stroke
• Severe obesity
• Age over 65 years (some variation between centers) - older patients are usually evaluated on an individual basis.
• Active substance abuse, such as alcohol, recreational drugs or tobacco smoking (which increases the chance of lung disease)

Patients who are in need of a heart transplant but do not qualify, may be candidates for an artificial heart or a left ventricular assist device i.e. LVAD.

Procedures

Orthotopic heart transplant. Recipient P-waves (arrows).

Pre-operative

A typical heart transplantation begins when a suitable donor heart is identified. The heart comes from a recently deceased or brain dead donor, also called a beating heart cadaver. The patient is contacted by a nurse coordinator and instructed to come to the hospital for evaluation and pre-surgical medication. At the same time, the heart is removed from the donor and inspected by a team of surgeons to see if it is in suitable condition. Learning that a potential organ is unsuitable can induce distress in an already fragile patient, who usually requires emotional support before returning home.

The patient must also undergo emotional, psychological, and physical tests to verify mental health and ability to make good use of a new heart. The patient is also given immunosuppressant medication so that the patient's immune system does not reject the new heart.

Operative

Schematic of a transplanted heart with native lungs and the great vessels.

Once the donor heart passes inspection, the patient is taken into the operating room and given a general anaesthetic. Either an orthotopic or a heterotopic procedure follows, depending on the conditions of the patient and the donor heart.

Orthotopic procedure

The orthotopic procedure begins with a median sternotomy, opening the chest and exposing the mediastinum. The pericardium is opened, the great vessels are dissected and the patient is attached to cardiopulmonary bypass. The donor's heart is injected with potassium chloride (KCl). Potassium chloride stops the heart beating before the heart is removed from the donor's body and packed in ice. Ice can usually keep the heart usable for four to six hours depending on preservation and starting condition. The failing heart is removed by transecting the great vessels and a portion of the left atrium. The patient's pulmonary veins are not transected; rather a circular portion of the left atrium containing the pulmonary veins is left in place. The donor heart is trimmed to fit onto the patient's remaining left atrium and the great vessels are sutured in place. The new heart is restarted, the patient is weaned from cardiopulmonary bypass and the chest cavity is closed.

The orthotopic procedure was developed by Shumway and Lower at Stanford-Lane Hospital in San Francisco in 1958.

Heterotopic procedure

In the heterotopic procedure, the patient's own heart is not removed. The new heart is positioned so that the chambers and blood vessels of both hearts can be connected to form what is effectively a 'double heart'. The procedure can give the patient's original heart a chance to recover, and if the donor's heart fails (e.g., through rejection), it can later be removed, leaving the patient's original heart. Heterotopic procedures are used only in cases where the donor heart is not strong enough to function by itself (because either the patient's body is considerably larger than the donor's, the donor's heart is itself weak, or the patient suffers from pulmonary hypertension).

'Living organ' transplant

In February 2006, at the Bad Oeynhausen Clinic for Thorax and Cardiovascular Surgery, Germany, surgeons successfully transplanted a 'beating heart' into a patient. Rather than cooling the heart, the living organ procedure keeps it at body temperature and connects it to a special machine called an Organ Care System that allows it to continue pumping warm, oxygenated blood. This technique can maintain the heart in a suitable condition for much longer than the traditional method.

Non-beating heart transplant

The first successful non-beating heart transplant was achieved in Australia in 2014, performed by cardiothoracic surgeon Kumud Dhital. The transplant was made possible by the development of preservation technology able to preserve a heart, resuscitate it and to assess the function of the heart. The first patient to have this surgery was 57-year-old Michelle Gribilas. Papworth Hospital in England (where the first non-beating heart transplant in Europe was carried out) stated that the technique could increase the number of hearts available for transplant by at least 25%.

Post-operative

Transplanted heart in the thorax of recipient

The patient is taken to the ICU to recover where they are started on immunosuppressants. When they are stable, they may move to a special recovery unit for rehabilitation. The duration of in-hospital, post-transplant care depends on the patient's general health, how well the heart is working, and the patient's ability to look after the new heart. Doctors typically prefer that patients leave the hospital 1–2 weeks after surgery, because of the risk of infection and presuming no complications. After release, the patient returns for regular check-ups and rehabilitation. They may also require emotional support. The frequency of hospital visits decreases as the patient adjusts to the transplant. The patient remains on immunosuppressant medication to avoid the possibility of rejection. Since the vagus nerve is severed during the operation, the new heart beats at around 100 beats per minute unless nerve regrowth occurs.

The patient is regularly monitored to detect rejection. This surveillance can be performed via frequent biopsy or a gene expression blood test known as AlloMap Molecular Expression Testing. Typically, biopsy is performed immediately post-transplant and then AlloMap replaces it once the patient is stable. The transition from biopsy to AlloMap can occur as soon as 55 days after the transplant.

Complications

Post-operative complications include infection, sepsis, organ rejection, as well as the side-effects of the immunosuppressive medication. Since the transplanted heart originates from another organism, the recipient's immune system typically attempts to reject it. The risk of rejection never fully goes away, and the patient will be on immunosuppressive drugs for the rest of his or her life, but these may cause unwanted side effects, such as increased likelihood of infections or development of certain cancers. Recipients can acquire kidney disease from a heart transplant due to side effects of immunosuppressant medications. Many recent advances in reducing complications due to tissue rejection stem from mouse heart transplant procedures. Surgery death rate is 5-10% in 2011.

Prognosis

The prognosis for heart transplant patients following the orthotopic procedure has increased over the past 20 years, and as of June 5, 2009, the survival rates were:

• 1 year: 88.0% (males), 86.2% (females)
• 3 years: 79.3% (males), 77.2% (females)
• 5 years: 73.2% (males), 69.0% (females)

In a study spanning 1999 to 2007, conducted on behalf of the U.S. federal government by Dr. Eric Weiss of the Johns Hopkins University School of Medicine, it was discovered that, compared to men receiving male hearts, "men receiving female hearts had a 15% increase in the risk of adjusted cumulative mortality" over five years. No significant differences were noted with females receiving hearts from male or female donors.

Famous recipients

• Robert Altman (1925-2006), American film director (M*A*S*H, McCabe & Mrs. Miller, Nashville), transplant in 1995 (survival: 11 years)
• Robert P. Casey (1932-2000), American politician (42nd Governor of Pennsylvania), transplant in 1993 (survival: 7 years)
• Dick Cheney (born 1941), American politician (46th Vice President of the United States), transplant in 2012
• Erik Compton (born 1979), Norwegian-American golfer, transplants in 1992 and 2008
• Glen Gondrezick (1955-2009), American basketball player (New York Knicks, Denver Nuggets), transplant in 2008 (survival: <1 year)
• Jonathan Hardy (1940-2012), Australian actor, writer and director (The Devil's Playground, Mad Max, Mr. Reliable, Moulin Rouge!), transplant in 1988 (survival: 24 years)
• Billy T. James (1948-1991), New Zealand comedian (The Billy T James Show), transplant in 1989 (survival: 2 years)
• Eddie Large (born 1941), British comedian (Little and Large), transplant in 2002
• Mussum (1941-1994), Brazilian comedian and actor (Os Trapalhões), transplant in 1994 (survival: <1 year)
• Norton Nascimento (1962-2007), Brazilian actor, transplant in 2003 (survival: 4 years)
• Kelly Perkins (born 1961), American mountain climber, transplant in 1995
• Jerry Richardson (born 1936), American football player (Baltimore Colts) and team owner (Carolina Panthers), transplant in 2009
• Sandro de América (1945-2009), Argentinian singer, transplant in 2008 (survival: <1 year)
• Carroll Shelby (1923-2012), American race car driver and entrepreneur (Carroll Shelby International), transplant in 1990 (survival: 22 years)

Other notable recipients

At the time of his death on August 10, 2009, Tony Huesman was the world's longest living heart transplant recipient, having survived for 30 years, 11 months and 10 days, before dying of cancer. Huesman received a heart in 1978 at the age of 20 after viral pneumonia severely weakened his heart. The operation was performed at Stanford University under Dr. Norman Shumway.

As of February 2016, the record holder for longest living heart recipient was Englishman John McCafferty. He received his heart on 20 October 1982. He died aged 73 on 9 February 2016, 33 years after his operation. The operation was performed at Harefield Hospital in Middlesex under Sir Magdi Yacoub.

Former Vice President of the United States Dick Cheney received a heart transplant on March 24, 2012 Because he was 71 years old at the time of the surgery, it sparked discussions about the upper age of transplant patients.

See also

• Biological pacemaker
• Xenotransplantation

References

External links

• [1] - Heart Transplant in India
• [2] - The real first heart transplant.
• Official Heart Transplant Museum - Heart Of Cape Town
• Photograph of first U.S. heart transplant
• Western Cape government; South Africa (21 February 2005). "Chris Barnard Performs World's First Heart Transplant". Cape Gateway. Retrieved 2007-01-10. 
• Department of Cardiothoracic Surgery. "Patient's Guide to Heart Transplant Surgery". University of Southern California. Retrieved 2007-01-10. 
• Nancy Reid (22 September 2005). "Heart transplant: How is it performed?". Healthwise. Retrieved 2007-01-10. 
• The Adrian Kantrowitz Papers Profiles in Science from the National Library of Medicine for Adrian Kantrowitz, the first to perform a pediatric heart transplant
• Orthotopic heart transplantation: the bicaval technique
• [3]
• [4]

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 成人の心臓移植の適応および禁忌 indications and contraindications for cardiac transplantation in adults
• 2. 心臓移植後の予後 prognosis after cardiac transplantation
• 3. 心臓移植における免疫抑制療法の導入および維持 induction and maintenance of immunosuppressive therapy in cardiac transplantation
• 4. 同所性心臓移植後の移植片機能不全 graft dysfunction after orthotopic cardiac transplantation
• 5. 心臓同種移植血管症の予防および治療 prevention and treatment of cardiac allograft vasculopathy

English Journal

• Successful matrix guided tissue regeneration of decellularized pulmonary heart valve allografts in elderly sheep.

• Theodoridis K1, Tudorache I1, Calistru A1, Cebotari S1, Meyer T1, Sarikouch S2, Bara C2, Brehm R3, Haverich A1, Hilfiker A4.
• Biomaterials.Biomaterials.2015 Jun;52:221-8. doi: 10.1016/j.biomaterials.2015.02.023. Epub 2015 Feb 27.
• In vivo repopulation of decellularized allografts with recipient cells leads to a positive remodeling of the graft matrix in juvenile sheep. In light of the increasing number of heart valve replacements among older patients (>65 years), this study focused on the potential for matrix-guided tissu
• PMID 25818428

• Molecular mechanisms of myocarditis caused by Trypanosoma cruzi.

• Esper L1, Talvani A, Pimentel P, Teixeira MM, Machado FS.
• Current opinion in infectious diseases.Curr Opin Infect Dis.2015 Jun;28(3):246-52. doi: 10.1097/QCO.0000000000000157.
• PURPOSE OF REVIEW: American trypanosomiasis, or Chagas disease, is a lifelong and persistent infection caused by the protozoan Trypanosoma cruzi and is the most significant cause of morbidity and mortality in South and Central America. Owing to immigration and additional risks from blood transfusion
• PMID 25887609

• Cardiac dysfunction in patients with cirrhosis: is the systolic component its main feature?

• Cesari M1, Fasolato S, Rosi S, Angeli P.
• European journal of gastroenterology & hepatology.Eur J Gastroenterol Hepatol.2015 Jun;27(6):660-6. doi: 10.1097/MEG.0000000000000340.
• OBJECTIVE: To investigate the subclinical cardiac morphological and functional modifications in cirrhotic patients according to the stage of liver disease.PATIENTS AND METHODS: One hundred and thirteen cirrhotic patients underwent standard Doppler echocardiography and were compared with healthy indi
• PMID 25923940

Japanese Journal

• 心臓移植患者に対する薬剤師の役割 (総合医学会報告 シンポジウム 国立医療における薬剤師の役割 : 未来を見据えた取り組み)

• 和田 恭一
• 医療 = Japanese journal of National Medical Services : 国立医療学会誌 68(4), 189-193, 2014-04
• NAID 40020104991

• 診療ノート(Ⅳ)腎臓病のエッセンス

• 戸村 成男,トムラ シゲオ,Shigeo Tomura
• 浦和論叢 (50), 99-131, 2014-02
• … CKD may progress，eventually leading to end stage kidney disease（ESKD），which requires dialysis or a kidney transplant to maintain life. … Also，CKD is an increased risk factor for cardiovascular disease（CVD），such as stroke，heart disease and blood vessel disease. …
• NAID 120005472154

• Hydrogen rich water bath を用いた新しい臓器保存法

• 中尾 篤典,野田 健太郎,川村 知裕,小濱 圭祐,山田 太平,小久保 謙一,小林 弘祐,小谷 穣治
• Organ Biology 21(2), 150-158, 2014
• 近年，移植医療において，移植後虚血再灌流障害に対する水素含有保存液の有用性が報告されている．水素含有保存液をつくる方法として，臓器保存液に100％の水素をバブリングし，水素を保存液中に溶け込ませる方法があるが，この方法では保存容器を開放するためコンタミネーションの危険性があり，安定した水素濃度が得られにくく，さらにバブリングでの気泡による機械的な臓器損傷の可能性もある．また，高濃度の水素ガスは常に …
• NAID 130004715797

Related Links

• Heart transplant: MedlinePlus Medical Encyclopedia

A heart transplant may be done to treat: Severe heart damage after a heart attack Severe heart failure, when medicines, other treatments, and surgery no longer help Severe heart defects that were present at birth and can ...

• What Is a Heart Transplant? - NHLBI, NIH

A heart transplant is surgery to remove a person's diseased heart and replace it with a healthy heart from a deceased donor. Most heart transplants are done on patients who have end-stage heart failure. Heart failure is a condition in ...

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★リンクテーブル★

リンク元	「心臓移植」「cardiac transplant」
関連記事	「transplant」「hearing」「hear」「heart」

「心臓移植」

　　[★]

英

cardiac transplantation, heart transplantation, cardiac transplant, heart transplant

関

心移植

「cardiac transplant」

　　[★]

• 心臓移植、心移植

関

cardiac transplantation、heart transplant、heart transplantation

「transplant」

　　[★]

• n.

• 移植片、移植

• v.

• 移植する

関

cell transplant、engraft、engraftment、explant、graft、grafting、implant、implantation、organ graft、organ transplant、tissue graft、tissue transplant、transfer、transplant recipient、transplantation

　 　 　 　 　 　

「hearing」

　　[★]

• n。

• 聴力、聴覚。聞くこと、聴取。聞こえる距離/範囲。聞いてやること、傾聴。聞いてもらうこと、発言の機会。(委員会などの)聴聞会、ヒアリング。(法)審問、尋問。

　 　 　 　 　 　

「hear」

　　[★]

• v.

• 聞く、聞こえる

　 　 　 　

「heart」

　　[★] 心臓