心臓移植における内科医の役割 [in Japanese] The role of transplant cardiologist in heart transplantation [in Japanese]
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Heart transplantation (HTx) was originally developed by cardiac surgeons, but it has been popularized by many transplant cardiologists world wide since the 1980s. In Japan, however, only a few cardiologists have been involved. But cardiologists and physicians in other fields can now be involved in many ways both before and after HTx. Before HTx, intensive care, including essential medication management, cardiac resynchronization therapy, adaptive servoventilation, and ventricular assist device implantation should be considered for HTx candidates. During the waiting period of approximately 1000 days before HTx, patients should be maintained in stable condition. In the acute phase after HTx, many approaches are needed to diagnose and treat rejection and infection and to manage the adverse effects of immunosuppression. During the chronic stage after HTx, major complications such as cardiac allograft vasculopathy, malignancy, and renal dysfunction should be detected and treated as early as possible, sometimes with modifications in immunosuppressant regimens. The relationship between patients and medical providers should consist of mutual trust and dependence. Narrative-based and evidence-based medicines are both very useful, especially in the chronic stage after HTx, to prevent nonadherence. Various specialists should be involved in the use of these medicines.
- Japanese Journal of Transplantation
Japanese Journal of Transplantation 50(2-3), 112-117, 2015
The Japan Society for Transplantation