We have calculated the removal ratio in the pre-serum and post-serum during the hemodialysis of H. D. patients using a high speed gel-chromatography on twelve different diarlyzers.
The total removal ratio i n G 2000 S. W. cuprophane membrane shows results that are quite efficient, most especially in U F -2, On the other hand, G 3000 S. W. PAN membrane shows the best removal ratio. There is a difference between G 2000 S. W. and G 3000 S. W. in that the latter can only detect M. W. below 20000 whereas the former can detect M. W. both above and below 20000.
So we are able to suspect the various results depend on the thickness of the membrane.

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For those who are studying or working in the field of Nephrology, the clinical evaluation of the hemodialysis membrane is very important and nessessary for the chronic homodialysis patients.
At the present time, there is no method yet that can estimate the effectiveness of the dialysis membrane, except the blood-biochemical analysis, for example, BUN, Creatinine and electrolyte determination.
In our studies, we have analyzed the ultrafiltrate by high speed liquid chromatography, which is capable of analyzing various materials within a very short period of time (60 minutes) without endangering the ability of separation and used ion exchange solvent, porous polymer CDR-10 (Mitsubishi bio-chemical industry products).
We also observed the change in hemodialysis efficency, the gradual decrease dialysisstarting time and-ending time.
In view of this investingations, we conclude that to have effective hemodialysis it should be done frequently and at short intervals.

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A hemodialysis is one of mass transfer phenomena. The solute concentration in blood may be calculated from that in dialysate, because all the solute removed must be transferred into the dialysate. We introduced some equations, with which the solute concentration in blood at the preand post-dialysis can be calculated from two dialysate concentrations. This calculation shows a good agreement with in vitro experiments within 10%, and with clinical data within about 30%. This method would be used in clinical therapy.

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This report was written about the basic study of the removal efficiency of many dialyzers. Shimadzu LC-1 LC-2 systems and TSK-G2000W (LS-170) gel were used.
Reprotein method; 1.0ml of H. D. sera diluted with saline (1:1) was ultrafiltrated with CF-50A. It needed 10 minutes filtration in 1000G.
Mobile phase; Buffers, approximate pH 6.4, showed best separation of peaks. In addition, mol concentration frcm 0.075 to 0.085 was best in phosphate buffer.
Peak contents; The middle molecule substances will be in ‘a’ peaks (Fig. 5).

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At present we have many kinds of sterilization methods of dialyzers, but some problems still remain in those methods concerning manufacturing prosses of dislyzers or influences of sterilizers on the patient.
Now, therefore, we would report clinical uses of hollowfiber dialyzers “KF-11” sterilized by autoclave after filling up normal saline in them.
These dialyzers are sterilized in autclave at the condition of 121°C for 20 minutes after filling up normal saline.
We have evaluated clinically for long term of more than six months and compared “KF-11” with the same shape dialyzers sterilized by ethylene oxide gas concerning clearance, UFR, residual blood volume and removal rate of metabolic materials.

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In this study, dimensionless numbers (X, G/C₀·D and K/D) were introduced in analyzing the artificial kidney system (A. K. S.).
Using these numbers, the transfer phenomena of three kinds of solute in A. K. S. were examined by compartment model. Those solutes were BUN, creatinine and U. A.
This resulted in a more genelized formulation which has been virtually independent of patients, dielyzer and other parameters.
That formulation can estimate solute concentration at any time and dialysis time at any conc. ratio between pre- and post-conc. by nomograms.
If validated, those nomograms has improtant implications for routine dialyzer therapy.

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Three types of polymer-metalloporphyrin complexes, i. e., 1) metal complexes coordinately bound to polymer ligands, 2) metal complexes covalently bound to polymer matrices, and 3) metal complexes immobilized into ABA-type block-copolymers, were synthsized. The first one was not so successful due to complex formation and complex dissociation equilibria. The latter two yielded stable polymer-metal complexes, and especially the last one could be applied to aqueous systems as oxygen-carrying materials.

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Artificial oxygen carriers were attempted to construct using the iron- or cobalt-porphyrin complexes bound to synthetic polymers. When the cobalt chelate coordinated to a polymerligand, it absorbed oxygen molecule reversibly. Irreversible oxidation via dimerization was prevented for the covalently bonded polymer ironporphyrins. The ironporphyrin was skilfully oxygenated even in homogeneous aqueous solution by combining it to a hydrophobic domain of a water-soluble block copolymer.

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We reported previously that 8ml/kg B. W./min of oxygen (O₂) delivery was required for a dog in cardiopulmonary bypass (CPB) with artificial blood i. e, perfluorochemical (PFC) emulsion. Although O₂ required by tissue can be supplied by artificial blood, the real blood is still necessary after CPB, because artificial blood disappears rapidly from blood vessels and has no coagulability. Seventy-five % of autologous blood which may provide 10g/dl of hemoglobin (Hb) concentration after CPB will be enough to maintain hemodynamics and coagulability in good condition. The purpose of this paper is to establish a method to remove 75% of blood and to study whether 8ml/kg/min of oxygen can be still delivered by PFC during CPB at the perfusion rate of 120ml/kg/min after 75% of blood was removed at the beginning of CPB.
Six adult mongrel dogs weighing 9 to 12kg were anesthetized and canulated into the aorta, SVC, and IVC. Hartmann's solution was infused rapidly (120ml/kg/min) into the aorta, and venous blood was simultaneously washed out from SVC and IVC. It was studied how much volume of venous blood should be washed out to remove various amounts of autologous blood. After preserving 75% of blood in this way, dogs were placed on CPB with 35w/v% PFC emulsion primed in bubble oxygenator. Hb and PFC concentration, pH, and PO₂ of the perfusate were measured. Arterial O₂ content was calculated.
Result: Seventy-five % of blood was obtained by washing out venous blood approximately 2/13 of body weight of a dog. Hb concentration of the perfusate decreased to 10% of pre-CPB value in average. Concentration of PFC were more than 25w/v% in all cases. As the arterial O₂ content could be kept over 6.7 vol.%, more than 8ml/kg/min of oxygen could be delivered at the perfusion rate of 120ml/kg/min.

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Marlex mesh has been used as a prosthesis in seven patients for the repair of thoracic wall or pericardium defects resulting from surgery. Mediastinal shift and paradoxical movement of the chest wall after operation was minimal. The post operative course was generally good. But in one case of pneumonectomy for lung cancer developed empyema after five months of operation which was thought due to marlex mesh remaining in the thoracic dead space. Also in the other case of pneumonectomy marlex mesh was not adhesive to the chest wall.

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The majority of currently available material test might have a definite limitation in evaluating the true antithrombogenicity of test materials, because in these preparation, the continuous contact of inserted test material with the inner surface may initiate early thrombus formation on the transitional area between the test material and the intima of cardiovascular bed.
Therefore, we developed new in vivo material test - atnial floating ring test - to evaluate real antithrombogenicity of test material itself. In our newly deviced test, the test material ring was introduced into the canine atrium which was stayed floating inside without continuous contact to the atrial wall.
The test material Silastic 3140 RTV was assayed using our atrial floating ring test, and the result was that by our atrial floating ring test, this material has higher antthrombogenicity than that obtain from vena cava ring test previously done in our laboratory.
In conclusion, our atrial floating ring test was thought to be superior to the currently available material test.

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This is part of comprehensive study on immobilization of urokinase (UK) [1, 2, 4]. In this study, UK was immobilized on two kinds of nylon tube surface: nylon-6 and nylon-11, using our newly devised technique and the antithrombogenicity of the materials was studied with clinical application.
The UK-immobilized materials were clinically applied in 70 cases as surgical drains or as intravascular catheters. Silicone coated tubes were used in 35 cases as controls.
Patency of the tubes was defined as follows: (+); patent for the duration of the clinical use, (±); patent for 48 hours or more and (-); obstructed within 48 hours after surgery.
Among 70 of the UK-immobilized materials, 67 were (+), only three were (±). As for controls, only one showed (+), 8 were (±) and 26 were (-).
Our newly devised UK-immobilized nylon tube proved to be an adequate antithrombogenic material.

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This report was investigated to establish the more effective disinfection method for nylon immobilized urokinase.
For this purpose, we chose the three types of disinfection ((1) 0.5% chlorhexidine alcohol·5min, (2) boiling 100°C·20min, (3) γ-rays 100×10⁴ rad) and designed the three types of nylon immobilized urokinase ( (a) disinfected lastly…… N/PEI/G: NP/UK, (b) again immobilized urokinase after the disinfection of completed material which had been immobilized urokinase…… N/PEI/G: NP/UK+UK, (c) first immobilized urokinase after the disinfection of incompleted material which was not immobilized urokinase yet……N/PEI/G: NP+UK).
From these experiments, the available disinfection methods were (1) and (3). We can especially commend the combination method of (3) and (c). On binding form, we suppose that the covalent binding such as peptide linking and the stable ionic binding are main form.

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We previously described that collagen-coated synthetic polymer composite was adequately applicable as a support of immobilization of enzymes, and that urokinase-bearing composite showed good fibrinolytic activity. Now the immobilized urokinase was characterized enzymatically as compared with the native enzyme. Apparent affinity for the substrate was slightly decreased, but intrinsic kinetic properties were not significantly affected. No decrease in esterase activity was observed both on repeated use and on long-term storage, and fibrinolytic activity was stable on heat and disinfection. When applied to rabbit blood vessel, the in vivo retainment of the activity depended largely on adsorption of plasma protein and blood cells.

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This report represented the clinical cases who were used the medical materials immobilized urokinase in surgical therapy and operation.
It has been demonstrated by our experiments that these materials had the antithrombotic action in vitro and in vivo. Disinfection was carried out in the method of ethyleneoxide gas or gamma rays.
The clinical cases were mentioned below:
1. patients who underwent the intravascular hyperalimentation (10 cases): nylon tube or perplene tube which is inserted into caval vein is prepared by urokinase to link it on the surface.
2. patients who underwent the vascular operation (9 cases): nylon suture material which sews the vessel wall is prepared by urokinase.
3. patients who underwent the Handley's method for drainage in lymphedema: dacron thread or nylon thread which is implanted into subcutaneous tissue is prepared by urokinase.
At present, we have had the good results, as shown in Figure 3, 5 and 7.

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Immobilization of some enzymes for medical use on surface of plastic tube or film has been studied by means of radiation polymerization at low temperatures. Glucose oxidase and glucose peroxidase could be immobilized inside polyvinyl chloride tube using glass-forming monomers as carrier. Double coating technique was used in this process to give the adhesiveness between polyvinyl chloride and coated membrane including enzymes. Urokinase was immobilized effectively on polyethylene film. In this case polyethylene film was preliminarily grafted by irradiation with other monomers to improve the affinity with monomer and polymer membrane. The film comprising urokinase showed anti-thrombogenecity to some degree.

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Acetabulu s of dogs were replaced with artificial sockets and periodic changes on the femoral heads of dogs were observed roentgenologically, pathohistologically and scanning electron microscopically as one of the series of experiments for total hip prosthesis.
Materials as artificial acetabulum were stainless steel, titanium, HDP (high density polyethyren) and ceramics.
One month after surgery, all these cases showed slight degeneration of the articular cartilage of the femoral head. Most remarkable changes were seen in the case of HDP acetabulum.
More advanced degeneration of cartilage were observed three months after surgery. Furthermore, HDP acetabulum itself deformed.
Defects of articular cartilage on the femoral heads were seen in every cases six months after surgery.

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We discussed the possibility of clinical application for the ceramic total hip prosthesis by biological and biomechanical experiments.
As a biological problem successive histopathological findings were observed in the femur and knee joint of a rabbit affected by tiny blocks and powder of poly-crystal ceramics.
In the biomechanical experiment, four types of test pieces made of ceramics and metal test pieces were inserted into the femurs of rabbits. Then, the strength of fixation between a bone and test piece was examined with a tensile testing unit. Through these experiments we found that ceramic showed significant biocompatibility with bone and had the firmer fixation with it. Therefore, we designed a ceramic total hip prosthesis for use in dogs and implanted this prosthesis in dogs. These animals were autopsied after varying intervals and studied histopathologically and electromicroscopically.
As the result we designed the JIKEI ceramiccoated total hip prosthesis for clinical use.

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Femoral heads in seven dogs were replaced with metal (titanium) and high density polyethylene (HDP). Clinical and roentgenographic evaluations and histopathological, scan electron microscopic and metal microscopic examinations were done in every dogs at intervals from 3 months to 3 years after surgery.
As a conclusion, HDP femoral head was inadequate for use as the artificial femoral head, because degeneration of cartilage or wear and deformity of HDP femoral head were occured 3 months after surgery and such destruction changes developed until 3 years after surgery.
On the other hand, titanium femoral head as metal was less harmful for acetabular cartilage even if 3 years after surgery, if it was not so larger. Then an application of metal femoral head for clinical use is recommended.

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Various types of polymeric materials were implanted subcutaneously in rats and the thickness of the fibrous tissue capsule formed around the implant was measured. Six tumors developed in 13 cases who survived for more than 18 months. Thickening of the capsule and suppression of metabolic activity in it may play an important role in the production of tumors. We assumed if the capsule thickness exceeds 0.2-0.25mm during 3-12 months tumor will occur after a certain latent period. Tumorigenesis by polymers in rats should be considered generally from the view point of aging and life span of the animal.

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Twenty three polymeric materials were implanted siibcutaneously in dogs for 26 or 36 months. Tissue response induced by various polymeric materials was mostly correlated with the elution of leachables from materials and degradation of polymers. Chronic inflammatory reaction was noted in 4 cases. In most cases the materials were surrounded by the thin fibrous tissue capsules (less than 0.15mm) in which there was some difference in cellularity among the materials. We proposed a picture of tissue response which will be desirable for implant materials.

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By injecting the microspheres (MS) coated with polymers to be examined, the new method to analyze histologically the tissue or cellular reaction to materials was developed.
MS of about 30 microns in diameter were made from such polymers as poly (p-hydroxy-methyl styrene), poly (2-hydroxyethyl methacrylate) and poly (methyl methacrylate). These MS's suspensions in saline were injected with syringe into any target tissues of rats. The bioreactions were histologically investigated with the course of time. The tissue reactions against the three polymers were mild, but the degree of reaction varied from site to site. The bioreaction occurred most strongly in the subcutaneous tissue and most slightly in the spleen. Then MS were coated with such polyion complexes (PIC) as poly (vinyl phenethyl triethyl ammonium) cationpoly (styrene sulfonate) anion and coated with copolymers of 2-hydroxyethyl methacrylate and styrene which have a hydrophilichydrophobic microphase separated structure, and then MS were injected into rats. The bioreaction was mild against most samples but was strong against the degenerated ones with boiled water and cationic PIC. Effect of charge was remarkable. For the purpose of analyzing the interaction, MS injection method is advantageous compared with the conventional in vivo test of biomaterials because of the following reasons: 1) simply injectable with the least surgical invasion, 2) implantabte into any site, 3) maximum contact area with minimum space occupation, 4) minimum mechanical stress, 5) minimum amount of materials required and 6) usable to select diameter.

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We found that the new material; Polyvinylalcohl Silica Composite; is useful as a biomaterial.
In this material, the more the content of Silica, the less the degree of swelling and solubity. We also studied the tissue affinity of the material by the culture of fibroblasts and by the_Jhistnlogical response to the subcutaneously implanted materials.in the rabbits.
The results are summarized as follows; (1) The growth rate of fibroblasts increases with increasing the content of Silica.
(2)Silica-rich-composite has high tissue affinity.

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Four types of Nylon, 3 polybutylene terephthalates, 5 polypropylenes, 4 segmented polyesters, 3 polyolefinic thermoplastic elastomers and polyacetal copolymer were tested and compared with medical grade Silastic and Tygon by repeated extraction test, hemolysis test and tissue culture test. Cell morphology was also studied by scanning electron microscopy in tissue culture test. Eight of 20 materials tested seemed to be less suited for biomedical material. The materials based on polybutylene terephthalate and polypropylene gave the promising results as a potential biomedical material.

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Collagen-spun fibers were buried in the tissues of various organs (e. g., esophagus, lung, heart, aorta, stomach, intestine, liver, kidney, pancreas, urinary bladder, uterus, and tendon) of dogs in order to clarify whether they were available as materials for artificial organs. They were examined for reaction and absorption in the tissues at given intervals.
As a result, these fibers were absorbed and induced a bioreaction in such manner as specific to the respective organ and to the site of implantation.
It was concluded that collagen-spun fibers caused only a mild reaction as foreign matter at the site of implantation and had a high affinity to every organ and tissue.

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In this paper we report the biochemical studies about healing process of synthetic vascular grafts, Woven Dacron (De Bakey) and Woven Teflon (Edwards) in the canine subcutaneous tissue, that is, about mucopolysaccharides changes of the connective tissue surrounding the graft and proceeding the lumen-ward through the interstices from 3 weeks to 6 months post implantation. Uronic acid and hexosamine in the connective tissue in the whole period after implantation were more than 9 and 7umole/g dry wt. respectively. In electrophoretic analysis, the major components of MPS were hyaluronic acid and dermatan sulfate with lesser amounts of chondroitin sulfate and negligible heparan sulfate. Hyaluronic acid content ranged from 26 to 37% of the total MPS, which means sustaining of the heavy tissue reaction.
Furthermore, the histologic study by means of H-E staining revealed that heavy tissue reaction continued in the interstices of the vascular prosthesis for 6 months' observation, while the mild or no tissue reaction could be seen in the graft surface by 6 months after implantation.
These date suggest that the complete healing of these grafts should require still longer period than generally estimated, and we postulate that the heavy tissue reaction paticularly in the interstices of the graft could be sustained for more than years.

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The purpose of these experiments was to evaluate the biocompatibility of materials for potential use as long-term percutaneous leads. Six different leads were designed in our laboratory: 1) No flange, 2) polyester felt, 3) Proplast, 4) epoxy, 5) polyester felt with RFGD and 6) Proplast with RFGD. These 6 leads were implanted subcutaneously along the dorsum of 5 sheep, 2 of which were terminated at 2 months and 3 of them terminated at 6 months after surgery. In the 2-month group all 12 percutaneous leads were infection-free at autopsy. Polyester felt with and without RFGD showed the least microscopic skin reactions. In the 6-month group 7 of 18 percutaneous leads had infection at the implant-skin juncture. The no-flange and polyester felt percutaneous leads showed no infection, in this group. In both groups Proplast percutaneous leads were poorer than polyester felt. From the bacteriological experimentation, flanges were useful as a barrier to prevent migration of infection along the drive lines. In the clinical observation of the drive lines in calves with a TAH, the incidence of infection in the polyester felt group was greatly reduced.

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Blood compatibility of the surface of the intravascular catheters made of teflon, polyethylene, polyvinylchloride, silicone rubber, and new heparinized hydrophilic polymer H-RSD has been studied by scarming electron microscopy. Catheters studied by SEM have been used in patients as the indwelling catheters in the central veinfor the purpose of hyperalimentation for the period of 3 to 85 days. Immediately after removal from the patient, inner surface of the tip of these catheters were observed by SEM. Thick thrombus formation and adhesion of a large amount of platelets were seen on the inner surface of the catheters made of teflon, polyethylene, and polyvinylchloride. Thrombus formation was seen in 70% of the silicone catheters, Platelet adhered to the surface were less, but had false feet. Thrombus formation in H-RSD catheters were observed in 14% But the platelet adhesion has been least and metamorphosis of the platelets on the surface of the H-RSD catheters were minimum. It is concluded that the newly developed H-RSD has better blood compatibilty compared to the conventional intravascular catheter.

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Durability and fatigue behavior of heparinized elastomer (H-USD) in water was studied both in static and dynamic conditions.
In accordance with addition of suitable hardener for epoxide, durability of H-USD in water was remarkably developed.
Results of static and dynamic stress relaxation tests showed that H-USD or polyurethane coated with H-USD had excellent elasticity and was available for blood pump or circuit.

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In artificial organ connected with blood vessel for long term, the connecting method and the selection of material is very important problem. In our artificial heart study, the cannulae has been inserted to right and left atrium, pulmonary artery and d. aorta and ligated with suture. However, It became necessary to change thee connected method with prolongation of animal's surviving time, because the ligated suture gradually cut into vessel wall and began to loose their fastening force for the acnnulae. As a connecting method, use of artificial blood vessel is thought to be one of the best method. But, it is generally said that thrombus formation will be accelerated at the boundary between foreign materials, especially between smooth surface and rough surface.
In this study, the thrombus formation at the boundary between PVC paste or Avcothane as the smooth surface and expanded polytetrafluoroethylene as the rough surface was investigated. EPTFE is easily connected with PVC paste or Avcothane by dipping method. Artificial heart cannula composed from these materials was sutured at pulmonary artery and d. aorta, and artificial heart was pumped during from few days to three months. At the boundary line, pseud-intima and smooth surface could co-existed stably.
It became clear that the composite of smooth surface and rough surface can be utilized for various artificial organs by appropriate selection of materials.

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The artificial biomedical materials on which antithrombin III and heparin were co-immobilized (I-AT III·HEP) had the significant anticoagulative activity. We observed the prolongation of plasma recalcification time and the activities of anti-thrombin and anti-activated factor X by I-AT III HEP in vitro. I-AT III·HEP showed the higher rate of neutralization of activated factor X than that of thrombin. By the reaction of the protease enzymes with I-AT III·HEP, the more quantity of activated factor X was neutralized than thrombin neutralized. The biomedical materials on which antithrombin III was immobilized in the presence of excess of acetylated heparin (I-AT III) could neutralize activated factor X and thrombin. However, the degree of anti-coagulative activity by I-AT III was slight, compared with I-AT III·HEP. Heparin immobilized on biomedical materials (I-HEP) was able to be combined to thrombin tightly and combine to activated factor X by affinity, but enzymes were not able to be neutralized directly. Co-immobilization of antithrombin III and heparin was applied to silicone which contained hydroxyl groups and it showed good anti-coagulative activity.

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The synthetic polymer surface which has a microphase separated structure often shows good blood compatibility, though the reason why was still uncertain. The interaction of platelet with the films of the block copolymer composed of 2-hydroxyethyl methacrylate and styrene was studied by the column beads method in order to clarify the mechanism of the interfacial interaction of blood with a microphase separated structure. The results showed that adhesion and deformation of platelets on the surface of the block copolymers containing 0.347 and 0.608 mole fraction of HEMA were less than those of the PSt, PHEMA and HEMA-St random copolymer. The effect of the microdomains of the block copolymer on the antithrombogenecity was discussed.

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As previously reported, our newly synthesized polyion complex, P (p-QEAS) -PSSS, had promising blood-compatibility¹.
In order to develop blood-compatible adsorbent for direct haemoperfusion, beads type activated charcoal was coated with P (p-QEAS) -PSSS. After coating with P (p-QEAS) -PSSS, release of carbon fines from the charcoal was markedly decreased. Adhesion of platelets was also suppressed especially when polyanion-rich P (p-QEAS) -PSSS was used as coating material.
With the use of high-speed liquid chromatography, adsorption of multi-solutes from serum by the uncoated and the coated charcoals was able to estimate. It was found that the coated charcoal had the same solute-adsorbing ability as the uncoated charcoal.

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Small-sized artificial kidney is desirable for dialysis patients in order for them to unburden the load and to live as well as healthy people.
In this respect we pursued high performance of dialysis membrane and have developed high permeability Bemberg hollow fiber with 5μm in thickness. Also, we are developing a portable dialysis equipment of 6.5kg in weight, and wearable artificial kidney for simplified use.
In the future we can expect the appearance of an implantable artificial kidney by promoting and extending our research work.

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Three kinds of new techniques for purification of blood were investigated. Combination therapy of dialysis and direct hemoperfusion in series was applied to refractory uremic neuropathy which had not been improved with increase of squaremeter -hour and frequency per week. H emofiltration by post dilution technique was applied to patients whose hypertension, hypotension. hyperlipidemia and/or hyperphosphotemia had not been improved with standard dialysis. Continuous ambulatory peritoneal dialysis(C. A. P. U) was tried in one case. Combination therapy of dialysis and direct hemoperfus ion showed remarkable improvemment in three cases, in patients' own complain and MNCV. In hemof iltation group, disappearance of disequilibrinm syndrome was only one identified symptom so far as the present study was concerned. There were no significant differences between dialysis and hemofiltration in hypertension, hypotension and hyperlipidemia. C. A. P. D. proved to be one of the reliable tools for treatment of uremia.

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There were 22, 579 aliving patinets under chronic dialysis treated in about 950 dialysis centers at the end of 1977. 17, 311 patients out of 22, 579 were treated in daytime, 4, 887 patients of all were treated in the evening or at night, 116 patients were treated at home and 259 patients were treated with peritoneal dialysis.
Patients number per one million population was 199.4. This number is the largest number in the world. In Japan, the national health insurance system has been well developed, so that all charges of dialysis treatment is covered by the insurance.
From October 1972, the above mentioned health insurance system made significant increase of chronic dialysis patients. According to the statistical data which were researched by Jinko Toseki Kenkyu Kai (Japanese Society of Dialysis Therapy), they suggest us that the final total number of chronic dialysis patients in Japan will reach to approximatly 90, 000.
Survival ratios of chronic hemodialysis patients are as follows; 1 year survival ratio 84.81, 2 years 77.9%, 3 years 73.9%, 4 years 73.3% and 5 years 53.1%. These data were researched from 20, 239 patients treated from January 1972 to December 1976.
Percentage of full time rehabilitation of those patients were 29.9 and partial rehabilition, including 4 to 2 days per week work were 30.8.
About 200 billion yen ( about one billion US$) of total financial charges for this treatment were spent in one year. This large amount of medical charges becomes big economical problems as well as social problems.

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Home dialysis (HD) was commenced in 1968, and in August 1978, 58 patients are controlled by us.
HD is strengthened this year as one of new programs in Shinseikai Foundation. The followings are the principles in the program: 1) HD is a medical act and the responsibility is placed on the medical staves; 2) doctors and nurses of HD must be qualified as the specialists and given better treatment; 3) the financial burden of patients should be minimal; 4) HD should be performed by a public-service corporation and the accounts must be announced.
HD was evaluated financially and was compared to the report of Frankfurt Kuratorium in West Germany in which the patients' increase rates were considered the same. The calculation disclosed that the cost per dialysis, i. e. 48, 876 yen, would decrease to 40, 000 yen in 1984. Also, it was cleared that the cost in Japan is almost the same as in West Germany.

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Sixty hundred for 23000 patients with hemodialysis are eagerly desiring cadaveric renal transplantation in this country. A new network system for cadaver kidney transplantation that covers over all Japan was organized; Sakura national hospital opened a centralized resistry to collect potential recipients data providing a computer system and selection programs. Thirtyseven cadaver kidney transplantation were success fully performed at 6 hospitals during the first few years under this organisation for pool size 950.

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The development and the progress of successful clinical renal transplantation in Japan depends upon the effective application of the kidney supply system and the recipient selection system. Especially, a successful renal transplant program must develop its own donor source.
Therefore, on the basis of experiences in Tokyo Women's Medical College, this report revealed the present status and some problems in the registration and selection of the recipients, the obtaining cadaver kidneys, and the transportation system of the kidneys. Conclusively, more important for the future will be the community's own efforts to obtain more kidneys and to apply the renal transplantation program.

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