Norihide Fukushima

By Norihide Fukushima, Motohiro Kawauchi, Francois Bouchart, Sandra Nehlsen-Cannarella and Leonard L. Bailey

Although surgical techniques have progressively improved in the field of congenital heart disease (CHD), even such as hypoplastic left heart syndrome, pediatric heart transplantation is the most effective surgical option for complex CHD and cardiomyopathy with severe heart failure. However, even now, donor heart availability has been poor in children. Although technologies for ventricular assist device (VAD) have been progressing even in children, VAD cannot grow as the pediatric recipient grows. Therefore, pediatric cardiac xenotransplantation has a great possibility to save and grow children with end-stage heart failure. In this chapter, I would like to introduce the first pediatric baboon-to-human heart transplantation and its basic animal experiments done by Bailey’s group and the following attempts for pediatric cardiac orthotopic xenotransplantation (rhesus monkey-to-baboon and pig-to-primate combination).

Part of the book: Xenotransplantation

By Norihide Fukushima

Sarcopenia has been defined as the age-related reduced skeletal muscle mass, strength, and physical capacity and is frequently associated with serious complications in patients with heart failure (HF). However, when HF progressed to end-stage HF requiring advanced therapies, such as heart transplantation (HTx) and implantation of left ventricular assist device (LVAD), an even higher prevalence of sarcopenia has been reported in younger patients with end-stage HF than elderly patients with less advanced HF. Many literatures have reported that sarcopenia is greatly associated with high rates of morbidity and mortality after HTx and LVAD implantation. Therefore, therapeutic interventions to prevent and reverse sarcopenia, such as cardiac rehabilitation and nutrition supplementation, are important in patients with end-stage HF prior to HTx and LVAD implantation. Although moderate or severe sarcopenia is a contraindication for HTx, the patients who can recover from sarcopenia after LVAD implantation would be considered eligible for HTx. Then, therapeutic options to reverse sarcopenia in patients supported with LVAD are also important to improve patient prognosis after LVAD implantation. In this review, the impacts of sarcopenia on prognosis after LVAD implantation and HTx and vice versa were summarized and therapeutic interventions to reverse sarcopenia before and after LVAD implantation are discussed.

Part of the book: Frailty and Sarcopenia

By Norihide Fukushima

For many years, heart transplantation has been an established procedure for patients with end-stage heart failure using the so-called “Standard Criteria” for an optimal heart donor. However, annually listed patients for heart transplantation greatly increased worldwide, and the use of extended criteria donor hearts has been utilized as many as possible in many countries. In this chapter, firstly, pathophysiology of brain death is explained. Secondly, donor assessment and issues of extended criteria donors are introduced. Then, donor management to maximize the heart graft availability, and the Japanese donor assessment and evaluation system and its outcome are reviewed.

Part of the book: Heart Transplantation

By Norihide Fukushima

The first heart transplantation (HTx) done by Dr. Wada in 1968 misled the general public not to allow to do brain-dead organ transplantation in Japan. It took almost 30 years to issue the Organ Transplantation Act to allow us to perform HTx in Japan. However, this Act required living written consent for brain death and organ donation. Therefore, children younger than 15 years could not donate their organs under brain-dead condition. After 6 years of struggle to revise this Act, the revised Act was issued in 2010 and brain-dead organ donation as well as HTx increased then. But the number in a year has been still extremely less than other developed countries in Japan. Then, we established a special donor management and assessment system to maximize donor organ availability as well as to improve post-transplant outcomes. During these periods, many types of mechanical circulatory supporting (MCS) have been introduced in Japan. Moreover, there have been many developments in immunosuppressive regimens and monitoring to improve outcomes after LVAD implantation and HTx. The chapter will summarize the past, current status, and future aspects of HTx as well as MCS in Japan.

Part of the book: End Stage Therapy and Heart Transplantation