The number of Japanese kidney transplant surgery and the number of transplant visiting outpatient will increase. For maintaining and further improving the current good results of Japan’s renal transplantation, multi-occupational collaboration is indispensable. Particularly, it is necessary to strengthen cooperation among multi-occupation types, centering on recipient transplant coordinator. In addition, it is important to actively incorporate administrative dietitians and clinical psychotherapists who are not adequately entered into transplant medical care into the follow-up regime.

Post-transplant lymphoproliferative disorder (PTLD) is a serious complication of kidney transplantation；however, few studies have been performed in Asian populations in this regard. In this context, we review our multi-institutional experience with PTLD following kidney transplantation between 1986 and 2016. Patients were divided into early- and late-onset groups based on the development of PTLD, time from transplantation to the discovery of the condition (＜1 vs. ≥1 year). Among 2,020 kidney-transplant recipients, PTLD developed in 16 patients (0.79％)； 3 patients showed an early-onset (18.8％), but with no further development since 2000. In the late-onset group (n＝13, 81.3％), the median development time from transplantation was 108.7 months, and in 4 patients, development was observed even after ≥10 years from transplantation. The 10-year overall survival rate from the time of transplantation was significantly lower in patients with PTLD vs. without PTLD (n＝2,004) (74.5％ vs. 95.4％, p ＜ 0.0001). In summary, PTLD significantly affects mortality in transplant recipients. Long-term follow-up is needed because late-onset PTLD can develop even＞10 years after transplantation.

【Objectives】Recently, older donors have been increasing in kidney transplantation because of the shortage of donors in Japan. On the other hand, survival of kidney graft from older donors is inferior to that of graft from younger donors. We evaluated the relationship between donor age and graft function after living-donor kidney transplantation.【Methods】In a retrospective cohort study, we analyzed 48 living donors and their recipients who underwent kidney transplantation between November 2011 and May 2016. We compared graft survival and laboratory data between control group (donor age younger than 70 years) and old donor group (donor age older than 71). Additionally, we determined donor kidney volume based on 3DCT.【Results】There was no difference in recipient age and in total ischemic times between control group and old donor group. Survival of kidney graft was lower in old donor group than in control group (p＜0.05). Donor kidney volume was smaller among old donor group than control group (152±27mL vs 129±26mL, p＜0.05). Pre-transplant kidney volume/recipient body surface area (Vol/BSA) ratio was significantly correlated with serum creatinine level at 3 months post-transplantation (r＝0.52, p＜0.01).【Conclusions】Donor age and pre-transplant kidney volume seem to be important predictors of kidney transplantation outcome.

【Purpose】Educational activities on organ donation are important for promoting organ transplantation. Our university held an annual elective seminar on organ donation for pharmacy students. We conducted a questionnaire-based survey to investigate the effect of the seminar upon awareness of organ donation among pharmacy students.【Methods】The seminar, which involved a series of lectures and small group discussions on multiple themes about organ transplantation, was held for third-grade pharmacy students. The participating students completed questionnaires before and after the seminar.【Results】The lectures taught the students about organ donation. The awareness of organ donation was significantly improved after the seminar (p＜0.0001). Furthermore, the pharmacy students expressed extremely high interest in organ donation following the lecture.【Discussion】Educating pharmacy students on organ donation was thought to positively contribute to the promotion of organ donation. Thus, various educational institutions should hold lectures on organ donation. This may help to increase the rate of organ transplantation.

【Back ground】Salt restriction is important in recipients of kidney transplant. Excessive salt intake is a risk factor for hypertension and weight gain, and also associated with poor prognosis in patients receiving a kidney graft. We tried to estimate the salt intake in renal-transplant recipients to elucidate the actual condition and the affecting factors of salt intake.【Method】We studied the estimated salt intake during one year after kidney transplantation in 60 patients who received a renal graft between 2008 and 2015 at Nagasaki University Hospital (Male：Female＝35：25, age 45.9±13.9, living：cadaveric＝51：9). Estimation of the amount of salt intake was performed by urine at any time with Tanaka’s equation.【Results】The mean estimated salt intake was 9.0±1.9g/day. The amount of salt intake was significantly higher in patients with hypertension (p＝0.034), body mass index≧24 (p＝0.048) at the time of transplantation, and non-preemptive kidney transplantation cases (p＝0.039). Patients who showed a weight gain≧10% of body weight in a year after transplantation also showed a tendency toward a much larger intake of salt (p＜0.01).【Conclusion】Estimation of salt intake based on urine analysis is relatively easy in routine clinical practice. It would be beneficial to share the results of estimated salt intake with patients to create awareness about the need for strict salt restriction, especially in high-risk cases.

【Objectives】The aim of this study was to evaluate the use of serum N-glycan profiles for antibody mediated rejection (AMBR) prediction in living donor kidney transplant (LKTx).【Methods】Between 2007 and 2016, we retrospectively examined serum N-glycans associated with ABMR in 197 LKTx recipients of whom 16 recipients with ABMR with or without T cell mediated rejection (TCMR), 40 recipients with TCMR, and 141 recipients without any adverse events. Serum N-glycans were purified by glycoblotting method and quantified by mass spectrometry using serum samples on postoperative day 1 (POD1). Discriminant analysis for prediction of ABMR was performed by inputting ABMR event as explanatory variable, 36 kind of N-glycan concentration, recipient gender and age as objective variables. N-glycan score was calculated by ABMR predictive formula by using function of objective variables that obtained by discriminant analysis. ABMR predictive performance of N-glycan score assessed by receiveroperator characteristic curve (ROC) and Kaplan-Meier curves.【Results】The AUC for N-glycan score was 0.8916 much superior than DSA status (0.7619). Positive predictive value and negative predictive value of N-glycan score was 81.25％ and 86.74％, respectively. Kaplan-Meier curves analysis also showed that recipients with N-glycan score positive (＞0.8770) was significantly shorter non-ABMR survival than that of recipient with N-glycan score negative group.【Conclusions】Although, the limitations of our study included its small sample size, retrospective nature, the serum N-glycan score status may contribute for ABMR prediction.