This is report is on organ procurement from deceased donors for organ transplantation in Japan in 2016. After the enforcement of the Act on Organ Transplantation in 1997, 20 years has now passed. Even after the enforcement of the amended Act on Organ Transplantation in July 2010, the number of brain-dead donors vastly increased. But the total numbers of deceased donors for organ transplantation, which were almost the same in 2010, 2011, and 2012, decreased in 2013 and 2014 and slightly increased in 2015 and 2016. In 2016, the total number of deceased donors increased to 96. The numbers of brain-dead and cardiac-arrested donors were only 64 and 32. The organ procurement for transplantation from deceased donors is supported by the efforts of procurement teams.
A large number of 1,648 kidney transplants in Japan, including 1,471 from living donors, 61 from nonheart-beating donors, and 116 from heart-beating donors, were performed in 2016.
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, status of viral antigens and antibodies, pretransplant complications, causes of death of deceased donors, ischemic time, and histocompatibilities, are described. Moreover, immunosuppressants used initial and other treatments are analyzed.
We also report the results of a follow-up survey for recipients and living donors.
As of December 31, 2016, a total of 8,825 liver transplants have been performed in 67 institutions in Japan. There were 378 deceased donor transplants (375 from heart-beating donor and 3 from non-heart-beating donor) and 8,447 living-donor transplants. The annual total of liver transplants in 2016 was 438 (57 deceased donor transplants and 381 living-donor transplants). The most frequent indication was cholestatic disease, followed by neoplastic disease. As for the graft liver in living-donor cases, right lobe graft was the most popular (35%). Patient survivals following transplantation from heart-beating donors (1-year 88.1%, 3-year 84.8%, 5-year 82.3%, 10-year 76.7%, and 15-year 76.7%) were similar to those from living-donors (1-year 84.7%, 3-year 80.6%, 5-year 78.2%, 10-year 72.8%, 15-year 68.5%, 20-year 66.0%, and 25-year 65.2%). Graft survivals were very much the same as patient survivals. Survival data were provided according to age and sex of recipients, indication, age and sex of donors, ABO-compatibility, and other factors.
Since the Organ Transplantation Act was issued in October 1997, a total of 317 heart transplantations (HTx) have been performed in Japan as of December 2016. Of those, 248 were performed after activation of a revised Transplant Act, and 51 were performed in 2016. Most recipients had dilated cardiomyopathy, and the waiting condition of all patients except for one little girl was status 1 at HTx. The mean waiting time as status 1 increased to 1,057 days in 2016, from 873 days in 2014. After the approval to use the implantable continuous flow ventricular assist device (cf-LVAD) for bridge-to-transplant (BTT) since 2011, the use especially of cf-LVAD increased. In 2016, all HTx's were bridged from VAD support (one EXCOR VAD and fifty cf-LVADs). Mean support duration increased to 1065 days in 2015, from 876 days in 2014. Nineteen children underwent an HTx after LVAD implantation (8 in Nipro VAD, 3 in EXCOR VAD, and 3 in cf-VAD). Most of these patients received a modified bicaval method of operation with Celsior for cardiac preservation, and all recipients were administered triple therapy with calcineurin inhibitor (cyclosporin or tacrolimus), mycophenolate mofetil, and steroid as an initial immunosuppressive regimen. Patient survivals at 10 and 15 years was 90.2% and 84.7%, respectively, superior to similar results of the international registry. This surveillance documented that the results of HTx in Japan were excellent despite a severe shortage of donors and long waiting times with LVAD as BTT.
【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 Society's 13th official registry report. 【Design and Methods】The data of cadaveric lung transplantation and living-donor lobar lung transplantation performed by the end of 2016 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 332 cadaveric lung transplantations (174 single, 158 bilateral), 198 living-donor lobar lung transplantation, and 3 heart-lung transplantation procedures were performed by the end of 2016. Five-year and 10-year survival rates of cadaveric lung transplantations were 73.1% and 61.7%, which were superior to those in the International Registry (54% and 32%). Five-year and 10-year survival rates of living-donor lobar transplantations were similar to those of cadaveric lung transplantations, which were 71.9% and 65.4%. The recipients of 3 heart-lung transplantations are alive. The functional status of more than 80% of recipients was restored to an mMRC (modified Medical Research Council dyspnea) scale of grade 0 or 1 after transplantations. Infection has been the leading cause of death after lung transplantation. Primary graft dysfunction accounts for about 20% of the causes of death after cadaveric and living-donor lung transplantations. 【Conclusion】The outcomes 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 since been achieved. The Japanese Society of Lung and Heart-Lung Transplantation will continue to present annual reports of Japanese lung transplantations.
Since April 2000, a total of 311 cases of pancreas transplantation from deceased, nonheart-beating, and living-related donors have been performed in 18 institutions in Japan through the end of 2016. The following donor- and recipient-related factors were analyzed: ages and genders 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. Despite donor-poor conditions, which were mostly marginal in Japan, the outcome of pancreas transplants was considered comparable to those in the United States and Europe.
Islet transplantation is promising to be capable of relieving glucose instability and improving QOL of type 1 diabetic patients who cannot be controlled of severe hypoglycemic unawareness. In Japan, the phase II clinical trial of islet transplantation for type 1 diabetes patients has been started by using ATG induction and TNF-α inhibition protocol. The primary endpoints for this trial are the proportion of subjects with HbA1c<7.4% and who are free of severe hypoglycemic events one year after the first islet cell infusion. This trial would play an important role in establishing islet transplantation in Japan.
Twenty-six intestinal transplants have been performed since 1996 in 5 institutions: 14 deceased donor and 13 living-related donor transplants. The primary causes of intestinal transplants were short-gut syndrome (n=9), intestinal mobility function disorder (n=14), others (n=1) and re- transplantation (n=3). One-year patient survival was 88%, and 10-year patient survival was 62%. These results were excellent in regard to a standard therapeutic option for intestinal failure if patients fail to maintain total parental nutrition.
Hematopoietic stem cell transplantation (HSCT) offers potentially curative treatment for a wide range of otherwise fatal hematologic disorders. The number of HSCTs has continued to increase over the past 20 years, and more than 5,000 allogeneic and autologous HSCTs have been performed annually in recent years. A constant increase of allogeneic HSCTs for older (aged over 50) patients and an increase in the variety of donor/stem cell sources, such as cord blood from unrelated donors, have led to this constant increase of HSCTs in Japan. The transplant survival outcomes also continue to improve, along with assets for improvement that include better supportive care, innovative transplant approaches, and establishment of a transplant outcome registry.
【Introduction】Besides life support, it is essential that the nutritional management of infants with small bowel failure who are dependent on total parenteral nutrition from soon after birth takes into account their growth and development. However, since long-term dependence on TPN causes a range of complications, small bowel transplantation is often indicated. Becuase there are no markers of rejection following small bowel transplantation, monitoring of the balance between daily oral intake and excretory volume is important. 【Purpose】We reviewed the content of dietary guidance provided by dieticians and the dietary education provided by student volunteers （Nuigurumi byoin,） for a patient who underwent living-donor small bowel transplantation at our hospital. 【Case Report】A living-donor small bowel transplantation was performed to treat a hypoganglionosis 9-year-old boy, with the mother as the donor. 【Intervention and Outcome】Preoperative intervention was provided by a dietician, and the Nuigurumi Byoin provided dietary education. They worked together to evaluate and implement an appropriate posttransplantation diet that carefully considered the underlying condition and biased preferences. The patient was able to understand the need for dietary limitations and a balanced diet postoperatively and is currently capable of observing abdominal symptoms and the volume of intestinal fluid excreted after meals and of adjusting his choice of food accordingly. 【Discussion】The provision of dietary education, which includes information on altering food habits based on the state of their health, is meaningful for small bowel transplant patients, who have few opportunities to receive guidance and education on diet from an early age for medical reasons. 【Conclusion】Dietary education by the Nuigurumi Byoin was provided as participatory-style guidance tailored to the individual circumstances of a child who underwent small bowel transplantation. This type of guidance has the potential to exert a lasting effect on a posttransplantation lifestyle.
【Objective】The ratio of marginal donors (MD) is high in the field of pancreas transplantation from brain-dead donors in Japan because of the small number of donors. The aim of this study was to reveal the clinical outcome of pancreas transplantation from MD. 【Design】Retrospective case series. 【Methods】This study included 38 patients who underwent pancreas transplantation from brain-dead donors. The cumulative survival rates of the patients and pancreas grafts were retrospectively evaluated between the MD group and non-MD (NMD) group according to the Pittsburgh criteria and Minnesota criteria. Moreover, the survival rate of the pancreas grafts was retrospectively evaluated between patients with cerebrovascular disease (CVD group) and those without CVD (non-CVD group). Details of the cause of death were also analyzed with special reference to CVD. 【Results】The cumulative survival rate of the pancreas grafts was 88.1% at 1 year, 77.0% at 3 years, and 73.9% at 5 years (n = 38) among patients who underwent pancreas transplantation from brain-dead donors. The survival rates of the patients and pancreas grafts were not significantly different between the MD and NMD groups as defined by the Pittsburgh criteria and Minnesota criteria. Also, no significant difference resulted in the survival rate of the pancreas grafts between the CVD and non-CVD groups. 【Conclusion】Pancreas transplantation from MD is acceptable in terms of both patient survival and graft survival.
【Objective】Little has been reported on the perceptions and experiences of parents who made pediatric living-liver donations to their children and their needs. The purpose of this study was to explore the perceptions of parents who have experienced pediatric living-liver donation to their children. 【Design & Methods】Thirteen parents who made a living-liver donation to their children were interviewed using a semistructured format; eleven were considered for analysis. The contents of the interviews were transcribed verbatim and analyzed qualitatively through inductive classification. 【Results】Three themes emerged from the data to construct the perceptions of parents who have experienced pediatric living-liver donation to their children: 1. Determine to become the donor, being influenced by their children's disease; 2. Recovering with the help of people around them, confronting their children who received the transplant; and 3. Living with their sick children, getting support from people friends, relatives, and attendents. 【Conclusion】The results from the present study regarding the perceptions of parents who made a pediatric living-liver donation to their children suggest recommendations for nursing practice.
【Objective】We investigated the significance of early nutritional administration for one week after living donor liver transplantation (LDLT). 【Methods】We retrospectively analyzed 62 patients who underwent adult LDLT in our center from January 2013 to November 2015. We compared nutritional statuses, immunological functions, and muscle masses between patients who received recommended calories (recommendation group, equal or more than 20k cal/kg ideal body weight, n = 38) and patients who did not receive recommended calories (non-recommendation group, less than 20k cal/kg ideal body weight, n = 24) for 1 week after LDLT. 【Results】Psoas muscle mass index (PMI), prealbumin, branched-chain amino acids, eicosapentaenoic acid (EPA), the ratio of EPA to arachidonic acid (EPA/AA ratio), and total lymphocyte count (TLC) on admission did not differ significantly between the recommendation group and the nonrecommendation group. The EPA, EPA/AA ratio, and TLC at 2 weeks after LDLT were significantly higher in the recommendation group than in the nonrecommendation group (p = 0.014, p = 0.040, p = 0.016, respectively). A percent against standard skeletal muscle mass in the recommendation group was significantly higher than that in the nonrecommendation group (p = 0.020). Postoperative hospital stay was significantly shorter in the recommendation group compared with the nonrecommendation group （p < 0.010）. A significant positive relationship was found between the total calories as well as protein administration for one week after LDLT and a percent against standard skeletal muscle mass (p = 0.008, p = 0.013, respectively). 【Conclusion】Sufficient nutritional administration during the early period after LDLT contributed to an early recovery of nutritional status, immunological function, and muscle mass.
【Objective】Traveling overseas is a common pursuit among kidney transplant recipients (KTRs). The risk of travel-related infections is high in these patients because of immunosuppression. However, few studies have assessed the relevance of preventive measures against travel-related infections in KTRs, and such studies have not been conducted in Japanese KTRs. 【Design】A cross-sectional survey using a self-administered questionnaire. 【Methods】We retrospectively reviewed 128 kidney transplants that were performed at Shizuoka General Hospital from January 1, 1989, and May 31, 2015. We finally included 86 KTRs older than 18 years who received transplantation > 3 months before the survey implementation. We analyzed the status of travel vaccination awareness, source of information for travel vaccination, presence or absence of international travel, contents of travel, details of travel vaccinations, and travel-related infections. 【Results】Fifteen (17.4%) KTRs traveled overseas after transplantation. The majority (72.1%) was not aware of the existence of travel vaccination; only one KTR received the information of travel vaccination from his primary transplant physician. Furthermore, the proportion of health professionals, including a primary transplant physician, was less than television coverage as the information sources for travel vaccination. Among those who traveled to endemic regions of hepatitis A, 83.3% visited no travel medicine specialists and received no travel vaccinations. 【Conclusion】Awareness of travel vaccination was insufficient among Japanese KTRs, and health professionals, including the primary transplant physician, provided insufficient information regarding travel vaccination. Our findings emphasized that primary transplant physicians, cooperatively with medical staffs, should play a role for improved awareness of pretravel health care, including travel vaccinations for Japanese KTRs.
We report an interesting case of pregnancy and delivery after kidney transplantation with augmentation cystoplasty in a 16-year-old girl with a history of myelomeningocele repair at birth. Although clean intermittent catheterization (CIC) had been done for a neurogenic bladder, she developed repeated urinary tract infections (UTI) and had decreased renal function. Due to bladder dysfunction, a progression of renal failure associated with repeated UTI and exacerbation of lower urinary tract disorder was observed, and these conditions were considered indications for augmentation cystoplasty and renal replacement therapy. When the patient was 11 years old, following augmentation cystoplasty with sigmoid segment, we performed urinary tract management, management of predialysis renal failure, and then preemptive living-donor kidney transplantation. She became pregnant 5 years the kidney transplantation and was admitted to our hospital at 5 weeks of pregnancy. At 27 weeks of gestation, she was admitted to the hospital with proteinuria and weight gain, but she had no UTI or hypertension. At 36 weeks of gestation, renal function had rapidly deteriorated and she presented with renal graft hydronephrosis. A Cesarean section was planned in consultation with her gynecologist, and a healthy baby (2,606 g) was delivered safely. After delivery, serum creatinine level remained normal, and mother and baby were both doing well and discharged. In a patient with a history of urinary diversion, we planned to perform augmentation cystoplasty and preemptive kidney transplantation. Subsequently, we showed that cooperation among obstetricians, urologists, and transplant surgeons made safe pregnancy and delivery possible.