小児心臓移植の予後は年代とともに改善傾向にあり，国際的には最近の5年生存率は約70％，日本人小児では90％を超えている．しかし，この短期的な予後改善は移植後急性期の生存率改善によるところが大きく，移植後の中長期的な罹病率や死亡率は必ずしも改善していない．したがって小児心臓移植後の遠隔期をいかに管理するかが重要な課題である．心臓移植後の長期的な管理において，免疫抑制療法と拒絶の管理を中心に，主たる移植後合併症である感染症，移植心冠動脈病変，腎機能障害，悪性腫瘍の監視と管理が重要である．加えて，小児においては，移植後の身体発育，精神運動発達，心理社会的機能の発達も重要であり，これらの評価と服薬アドヒアランスの問題を含めた移行期の管理が必要である．今後，多職種による総合的な移植後管理により，小児心臓移植後遠隔期の予後がさらに改善されることが望まれる．
Survival after pediatric heart transplantation has been improving ever since the procedure was first performed. The international survival data showed that the actual 5-year survival rate was approximately 70％. This improvement was observed mostly in the period immediately following heart transplantation, but intermediate and late mortality have not improved. Therefore, how to manage pediatric recipients in the long term after heart transplantation is important issue. Not only management of immunosuppressive therapy and rejection but also detection and treatment of major post-transplant complications, including infection, coronary allograft vasculopathy, renal dysfunction and malignancy are essential. In addition, other important issues are to assess somatic growth and intellectual and psychosocial development in children after heart transplantation. Transitional care, including management of nonadherence in adolescents after transplantation, is also important. Total post-transplantation care by a multidisciplinary team may improve long-term outcome after pediatric heart transplantation.
Key words: pediatric heart transplantation; post-transplant follow-up; recipient care; long-term outcome
© 2017 特定非営利活動法人日本小児循環器学会© 2017 Japanese Society of Pediatric Cardiology and Cardiac Surgery
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