本邦肺移植症例登録報告—2025—

抄録

【Objective】 This paper presents the 21st official registry report on lung transplantation in Japan, conducted by the Japanese Society of Lung and Heart-Lung Transplantation since 2005.

【Design and Methods】 This report analyzes data from all lung transplant cases performed in Japan up to the end of 2024, including cadaveric lung transplantation, living-donor lung transplantation, and heart-lung transplantation. The data cover recipient numbers, underlying diseases, transplant procedures, postoperative survival rates, functional status, working status, and causes of death. Survival rates were calculated using the Kaplan-Meier method.

【Results】 In 2024, the number of newly registered candidates for lung transplantation surpassed 300 for the first time, reaching a record high of 304. Similarly, the number of lung transplants performed reached an all-time high of 148 cases. Among them, cadaveric lung transplants accounted for the majority, while the proportion of living-donor lung transplants continued to decline, representing only 12.2% (18 cases) in 2024. By the end of 2024, the cumulative number of lung transplants performed in Japan reached 1,315, comprising 505 single cadaveric lung transplants, 496 bilateral cadaveric lung transplants, 311 living-donor lung transplants, and 3 heart-lung transplants. As of that time, lung transplantation had been performed at 11 institutions nationwide. Regarding indications, idiopathic interstitial pneumonia (IIP) remained the most common indication for cadaveric single lung transplantation, while pulmonary hypertension continued to dominate in cadaveric bilateral cases. For living-donor lung transplantation, lung dysfunction after hematopoietic stem cell transplantation was the leading cause, and their proportion has been increasing year by year. The 5- and 10-year survival rates were 72.23% and 59.92%, respectively, for cadaveric lung transplantation, clearly exceeding international benchmarks for deceased donor lung transplantation reported by the International Thoracic Organ Transplant Registry (Europe: 57.3% and 38.8%; North America: 52.5% and 28.5%). The survival rates for living-donor lung transplantation were similarly favorable, with 5- and 10-year survival of 72.20% and 59.44%, respectively. All three recipients of heart-lung transplantation remain alive, with a 5-year survival rate of 100%. Assessment of postoperative functional status using the mMRC scale showed that 73.6% of cadaveric and 62.7% of living-donor lung transplant recipients achieved grade 0 or 1. Employment or active social participation was reported in 75.7% of cadaveric and 79.5% of living-donor recipients. Among 1,315 recipients, 272 deaths occurred in cadaveric lung transplant recipients and 119 in living-donor recipients. Infections were the most frequent cause of death in both groups (32.7% and 34.5%, respectively). Chronic lung allograft dysfunction (CLAD), malignancies, and post-transplant lymphoproliferative disorder (PTLD) have become increasingly prevalent causes of late mortality. In contrast, early deaths from primary graft dysfunction have decreased significantly, now accounting for only 5.5% (cadaveric) and 3.4% (living-donor) of all deaths.

【Conclusion】 The outcomes of lung transplantation in Japan remain favorable, with postoperative survival and functional outcomes continuing to exceed international benchmarks. Following a temporary decline in transplant numbers due to the COVID-19 pandemic in 2020, the program has steadily recovered and expanded, culminating in a record 148 transplants in 2024. The Japanese Society of Lung and Heart-Lung Transplantation will continue to compile and report annual registry data to ensure accurate monitoring and information sharing across institutions.