After the enforcement in Japan of the amended Act on Organ Transplantation in July 2010, the number of brain-dead donors vastly increased. But the total numbers of the deceased donors for organ transplantation were almost the same after 2009. Brain-dead and cardiac-arrested donors in 2012 totaled 45 and 65. The percentage of brain-dead donors increased after 2010, but the total numbers of deceased donors decreased. According to the increase of brain-dead donors, many institutions took part in the procurement of variety of organs. This is a report on organ procurements from deceased donors for organ transplantations in Japan in 2012.

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A number of 1,610 kidney transplants including 1,417 from living donors, 116 from non-heart-beating donors and 77 from heart-beating donors were performed in 2012.
The data obtained from the Japanese Renal Transplant Registry are shown and analyzed in this annual report. The characteristics of recipients and donors such as relationships, original diseases, duration of dialysis therapy, blood transfusion, the status of viral antigens and antibodies, pretransplant complications, the causes of death of deceased donors, ischemic time and the histocompatibilities are described. In addition, immunosuppressants used initially and other treatments are analyzed.

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An online registry and tracking system for liver transplantation in Japan was introduced on January 1, 2012, and this is the first report using this system. In all, 422 such transplants were performed at 38 institutions in 2012. Forty-one were cadaveric transplants (all from heart-beating donors), and 381 were living-donor transplants. Then most common indication was cholestatic disease, followed by neoplastic disease. As for the graft liver in living-donor transplants, a right lobe graft was used in 45.3% of adult cases, whereas a lateral segment graft was used in 73.6% of pediatric cases. The preoperative data of recipients, operation time, blood loss, and transfusions of recipients and donors, as well as postoperative immunosuppression regimen, are also reported.

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Since the Organ Transplantation Law was passed in October 1997, a total of 170 heart transplantations (HTx) have been performed in Japan as of August 16, 2013. Of those, 111 HTx was performed after activation of modified transplant law. Most recipients had dilated cardiomyopathy; waiting condition of all patients, except for one pediatric patient, was status 1 at HTx. The mean waiting time as status 1 was 855 days. Ninety-one percent of the patients (155) were bridge-to-transplant (BTT) cases by several types of left ventricular assist systems (LVAS), and mean support duration was 861 days. Most received a modified bicaval method of operation with Celsior for cardiac preservation, and all recipients were administered triple therapy with calcineurin inhibitor (cyclosporine or tacrolimus), mycophenolate mofetil, and steroid as initial immunosuppressive regimen. Two patients have been doing well＞14 years after HTx, and ten-year survival rate was 89.2 %, which is superior to that of the international registry. Five pediatric HTx (＜10 years: one, 10-18 years: 4) performed under modified transplant law. In this year, the number of HTxs in Japan exceeded the number of HTxs of Japanese patients in abroad. However, pediatric HTxs of Japanese patients abroad, especially under those who were less than 10 years old, still number many. This surveillance documented that the results of HTxs in Japan were excellent despite a severe shortage of donors and long waiting time for patients with LVAS.

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Objective: To scrutinize the status of lung transplantation in Japan, the Japanese Society of Lung and Heart-Lung Transplantation started to collect and present registry data from 2005. This is the 9th official registry report of Japanese lung transplantation.
Design and Methods: The data of cadaveric lung transplantation and living-donor lobar transplantation performed by the end of 2012 were registered in the database and analyzed with respect to the number of transplants, recipient-survival rates, recipient functional and working statuses, and causes of death after transplantations. Survival rates were calculated by the Kaplan-Meier method.
Results: A total of 157 cadaveric lung transplantations (87single and 70 bilateral), 125 living-donor lobar transplantations and 1 heart-lung transplantation procedures were performed by the end of 2012. Five-year and 10-year survival rates of cadaveric lung transplantations were 73.5% and61.4%, which were superior to those in the International Registry (52.6% and 30.3%). Five-year and 10-year survival rates of living-donor lobar transplantations were excellent at 73.4% and67.6%. The functional status of more than 85% of recipients was restored to Hugh-Jones I or II after transplantations. Infection was the leading cause of death after lung transplantation. Primary graft dysfunction accounted for 27% of the causes of death after cadaveric lung transplantation.
Conclusion: The results of Japanese lung transplantations are so far satisfactory. Efforts must be made, however, to overcome early deaths resulting from primary graft dysfunctions. The modified Japanese transplantation law has been enforced since July 2010, and an increase in the number of cadaveric organ transplantations has been achieved. The Japanese Society of Lung and Heart-Lung Transplantation will continue to present annual reports of Japanese lung transplantations.

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One hundred and seventy four cases of pancreas transplantation from deceased, non-heart beating and living-related donors have been performed in 17 institutions in Japan until the end of 2012 since April, 2000. The following donor-and recipient-related factors were analyzed; i.e., age and gender of donor and recipient, cause of death, histories of diabetes and dialysis, waiting period, total cold ischemic time, operative procedure, immunosuppression and survival rates of patient and graft.
In spite of donor poor conditions which were mostly marginal in Japan, the outcome of pancreas transplants was considered to be comparable to that of the US and Europe.

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Islet transplantation employing donors after cardiac death (DCD) can relieve glucose instability and problems with hypoglycemia while the graft is functioning. However, islets from DCD might be associated with reduced long-term graft survival. We started the phase II clinical trial with type 1 diabetes patients for islet transplantation using both brain-dead donors and DCD to evaluate ATG induction and TNF inhibition protocol. Primary endpoints are the proportion of subjects with HbA1c＜7.4% and who are free of severe hypoglycemic events one years after the first islet cell infusion. This trial would play a critical role in establishing islet transplantation in Japan.

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Twenty-four intestinal transplants were performed since 1996 in 5 institutions. There were 13 deceased donor and 12 living related donor transplants. Primary causes of intestinal transplants were short gut syndrome (n=9), intestinal mobility function disorder (n=12), others (n=1) and re-transplantation (n=3). One-year patient survival was 86%, and 10-year patient survival was 65%. They were excellent results for a standard therapeutic option for intestinal failure if patients fail to maintain total parental nutrition.

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【Objective】Patients who have undergone organ transplantations are considered to be at risk for developing malignancies resulting from prolonged immunosuppression. However, the incidence and the most common sites of such malignancies following living donor liver transplantation (LDLT) remain unclear. We investigated patients who developed de novo malignancies after undergoing LDLTs at our institute.
【Design】Case series.
【Methods and patients】From August 1997 to March 2012, a total of 156 patients underwent LDLT. Among these patients, those with de novo malignancy were analyzed in detail.
【Results】Nine of our 156 patients developed de novo malignancies (5.8%). The median age at LDLTs was 57 years (range: 0-65 years). The de novo malignancies included squamous cell carcinoma (SCC), gastric cancer, pancreatic cancer, lung squamous cell carcinoma, colon cancer, renal cell carcinoma, ameloblastoma, oral cancer and Langerhans histiocytosis. Seven patients were successfully treated with surgical resection. One patient with pancreatic cancer already had liver metastasis at the time of diagnosis and was treated with chemotherapy. However, he died 22 months after the diagnosis of malignancy. One patient with Langerhans histiocytosis was treated with chemotherapy that induced a remission; however, she later died as a result of liver failure.
【Conclusions】SCC, which has frequently been reported as a de novo malignancy in patients who have undergone liver transplantations in Western countries, also developed in this series, as mentioned. However, SCC has so far been only rarely reported in Japan as a malignancy after LDLT, so it is difficult to precisely clarify the ratio of the number of SCCs in all malignancies after LDLT in comparison with the general population. Considering the differences in the patients' race and ethnicity, and also the frequency of the different surgical procedures performed between Europe and Japan, we therefore find that a national registry should be established to clarify the details of de novo malignancies in Japan.

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【Objective】Measles or varicella contracted by immunocompromised hosts is aggravated. In Japan, the outbreak of measles and varicella is ongoing.
Children with chronic renal failure must be immunized before they undergo renal transplantation. However, the antibody titers often decrease later.
The purpose of this study was to investigate the change in antibody titers for measles and varicella after renal transplantation in children.
【Methods】This study included 44 patients who underwent renal transplantation during childhood and are currently visiting our hospital. Antibody titers for measles and varicella were measured in the outpatient department irregularly.
Immunoglobulin G antibodies against measles and varicella were measured using an enzyme-linked immunosorbent assay. An antibody titer under 2.0 enzyme immunoassay units was considered seronegative and one between 4.0 and 2.0 was considered pseudo-seropositive.
【Results】The measles antibody did not correlated with patient age, but significantly did correlate with the transplantation period. In 25% of the patients, the measles antibody titer decreased to a pseudoseropositive or seronegative status.
The varicella antibody titer correlated with meither patient age nor transplantation period. In 12% of the patients, however, the varicella antibody titer decreased to a pseudoseropositive or seronegative status.
【Conclusion】The antibody titers for measles and varicella tended to decrease in children after renal transplantation. In Japan, the outbreak of measles and varicella is ongoing. Therefore precautions, such the vaccinations of children undergoing renal transplantations should be taken.

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Several studies have reported that pancreatic ductal preservation greatly improved the islet yield and function after cold storage. However, these studies were devoid of appropriate controls, such as vascular perfusion, which is routinely performed to preserve organs in the clinical setting. In this study, we created a vascular perfusion model using inbred rats, and investigated the effects of ductal injection on the islet yield and function after cold storage. Rat pancreases after 10 h cold ischemia were classified as follows: without ductal/vascular perfusion; with ductal injection; with vascular perfusion; and with ductal/vascular perfusion. The islet yield, function, viability, release of inflammatory mediators, and pathological changes in the exocrine tissues were assessed in the Hanks' Balanced Salt Solution model. The islet yield was also assessed by introducing University of Wisconsin Solution and Histidine-Tryptophan-Ketoglutarate Solution, which are the standard clinical preservation solutions. In the Hanks' Balanced Salt Solution model, ductal injection and vascular perfusion significantly improved the islet yield compared with the control group. However, ductal injection showed no additional effects on the islet yield, function, viability, and suppression of the release of inflammatory mediators when vascular perfusion was performed. Although ductal injection significantly decreased the apoptosis of exocrine cells, no beneficial effect on vacuolation was observed. In contrast, vascular perfusion significantly suppressed vacuolation in the exocrine tissues. Likewise, in the University of Wisconsin Solution and Histidine-Tryptophan-Ketoglutarate Solution model, ductal injection and vascular perfusion improved the islet yield compared with the control group. Nevertheless, the combination group showed no additional effects. These data suggest that ductal injection has no additional effect on islet yield and function after cold storage in a vascular perfusion model. We propose that ductal injection can be an effective and simple alternative for vascular perfusion prior to pancreas harvest, but it is usually unnecessary, since vascular perfusion is routinely performed.
This article is based on a study first reported in [Nakanishi W, Imura T, Inagaki A, et al. Ductal injection does not increase the islet yield or function after cold storage in a vascular perfusion model. PloS one 2012; 7: e42319.].

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