Lung transplantation is an effective treatment modality for respiratory failure. Chronic lung infections, including infections caused by nontuberculous mycobacteria (NTM) and Aspergillus, are difficult to control, and uncontrolled infections are relative contraindications for lung transplantation. However, few reports have documented the incidence and outcome of these infections in lung transplant recipients.

To quantify the incidence and outcomes of colonization and disease caused by NTM and aspergillosis in recipients before and after lung transplantation, we review our cohort study in Japan, consisting of 240 consecutive cadaveric lung transplant recipients between 2000 and 2014 and compare the data to that of documented reports.

Isolation of NTM or Aspergillus species from lung transplant recipients is uncommon. Adequate pre-transplant control and post-transplant management of NTM and Aspergillus infections allows for safe lung transplantation.

Some patients with infectious lung diseases, including bronchiectasis, diffuse panbronchiolitis and cystic fibrosis, deteriorate despite long-term therapy with macrolide antibiotics, eventually requiring lung transplantation. We describe our experiences of lung transplantation for infectious lung diseases. Most of the patients with infectious lung diseases had airway colonization by Pseudomonas aeruginosa before lung transplantation. For the management of the patients with infectious lung diseases, control of rhinosinusitis with sinus surgery or continuous nasal care could be important in preventing fatal infection, the development of chronic lung allograft dysfunction, and the recurrence of diffuse panbronchiolitis after lung transplantation. The overall survival rates of the patients with infectious lung diseases were comparable to those of the patients with non-infectious lung diseases at our institution (5-year survival rate, 80.9% vs. 77.7%; 15-year survival rate, 60.7% vs. 57.5%) (p=0.44). Lung transplantation for the patients with progressive infectious lung diseases yielded favorable outcomes in the long term, quite comparable to the outcomes of lung transplantation for those with non-infectious lung diseases.

Despite significant advances in treatment, cytomegalovirus (CMV) infection remains a major cause of morbidity after lung transplantation. Recently, there have been major developments in the management of CMV infection, which include the practical use of diagnostic methods such as the antigenemia assay that facilitate the early detection of CMV viremia and an oral CMV drug, valganciclovir. These advances have greatly changed post-transplant anti-CMV strategies and offer new insights. Herein, we report the updated worldwide practice on CMV prophylaxis and preemptive therapy after lung transplantation. We also provide some data on postoperative CMV infection and disease in our institution.

The lung is an organ that tends to cause infectious problems even in healthy people because it is directly surfaced to the outside environment containing variety of infectious organisms. The most frequent cause of death within a year after lung transplantation is fatal infectious complications, which shifts to chronic allograft rejection or chronic lung allograft dysfunction (CLAD) thereafter. There is no doubt that minimization of the immunosuppression dose within the acceptable therapeutic range is the best strategy to avoid infectious complications; however, an adequate dose of an immunosuppressant is mandatory to protect lung allografts from acute or chronic rejection. Carefully balanced therapy of immunosuppression and infection control is extremely important for a patient’s long term survival after lung transplantation. In this article, our protocol for prevention of infection and treatment at onset is introduced and discussed with the presentation of typical cases.

Lung transplantation (LTX) is one of the most important therapeutic options for end-stage respiratory failure, but perioperative management is difficult. There are several postoperative complications. Among them, infection remains one of the leading causes of morbidity and mortality after LTX. Early recognition and treatment of pathogens improve the outcomes. In this section, we review infectious diseases after LTX.

In consideration of the establishment of a regional organ donation system respecting the patient’s intent, the Donor Action Program (DAP) was set up in our hospital in October 2016. In DAP, in-house coordinators (IHCs) in charge of the donor’s family were assigned to do a proposal for organ donation and grief care. Compared with the results for the past five years, potential donor referral was increased by 11.2 times, and a proposal for organ donation by 9.6 times. Moreover, the rate of approval for organ donation was 60%, when organ donation was proposed by IHCs, while it was 16.7% by the physician. In view of organ donation, an approval for organ donation is no more than one of the options at the patient’s final moments. It is essential for organ donation to arrange IHCs in charge of the donor’s family to support understanding of medical care and choice with no regrets for the donor’s family as a third party who snuggles up to them.

【Objective】 To investigate the clinical characteristics of Campylobacter infection in pediatric patients with liver disease.

【Design】 Case series.

【Methods】 Pediatric patients (<18 years) with detection of Campylobacter sp. from blood or stool culture were retrospectively extracted from a microbiology database. Clinical information including age, sex, and underlying conditions was obtained from the medical records. The detailed clinical course of patients with liver disease was reviewed.

【Results】 We identified 74 patients with Campylobacter sp. infection. Among these, four patients were either awaiting or had undergone liver transplantation. Case 1 was a 10-year-old girl with biliary atresia awaiting liver transplantation. Three days after eating raw chicken liver, she developed fever and abdominal pain and Campylobacter jejuni was identified from blood and stool. Case 2 was a 14-year-old boy, status post liver transplantation for congenital absence of the portal vein, who developed fever 4 days after eating raw quail’s egg. Campylobacter sp. was detected from the blood. Case 3 was a 7-year-old boy, status post liver transplantation for hepatoblastoma, who developed fever and diarrhea. He ate undercooked chicken and beef two days prior to onset. Campylobacter sp. was detected from the stool. Case 4 was a 14-year-old girl, status post liver transplantation for biliary atresia. Fever developed three days after eating chicken liver and Campylobacter sp. was detected from the stool.

【Conclusion】 Patient education on diet is important for pediatric liver transplant recipients to reduce the risk of foodborne infection.

【Objective】 The purpose of this study was to explore and clarify the content of interaction between potential living kidney donors and the transplant coordinator supporting the decision-making about transplantation.

【Design & Methods】 A qualitative research methodology was used in this study. Following ethical approval, data was collected by participant observation and tape-recordings during the first consultations between the transplant coordinator and 5 potential living kidney donors. The data was analyzed qualitatively and inductively.

【Results】 The following two core categories were observed:

1) The assessment used to better understand the backgrounds of the potential living kidney donors.

2) The interaction between the transplant coordinator and the potential living kidney donors to promote the best understanding about kidney transplantation.

The first part of the consultation between the transplant coordinator and 5 potential living kidney donors was highly important in order to establish a confidential relationship between the coordinator and the potential donors. A confidential relationship is helpful to further understand the inherent feeling of the potential donors about kidney donation. The second part of the consultation was dedicated to supporting the decision-making in the act of kidney donation. The level and quality of the communication moved potential donors to consider the justice and rationality of kidney donation, whilst also providing the opportunity to reconsider the decision of kidney donation.

【Conclusion】 It was suggested that the transplant coordinator needs to develop advanced communication skills. Moreover, to enhance the autonomy of the decision-making of potential living kidney donors, a transplant coordinator with plenty of relevant experience and expert knowledge is required.

The patient was a 38-year-old woman who was diagnosed with primary biliary cholangitis at the age of 33. As her liver function gradually worsened, she was registered as a recipient candidate of deceased donor liver transplantation (DDLT). Three months after registration, split liver grafts from a male deceased donor were transplanted to her and a child recipient. The liver graft was divided into a left lateral segment graft for the child recipient and a right extended liber lobe graft for her. Before liver splitting, we examined the cholangiography of the whole liver graft. The results of the cholangiography clearly demonstrated an anatomical feature about branching of the right posterior sector. On the basis of this result, we divided the liver on the back table (ex-situ). After liver splitting by the clamp crushing method, the liver graft was transferred and transplanted to the recipients without any biliary complications. Intraoperative cholangiography during graft harvesting is suggested to be useful for the safety and efficiency of donor operation.