The Nutritional statuses of patients awaiting heart transplant (HTx) are quite different in individuals. Underweight or malnutrition seems to be related with the poorer prognosis after HTx. On the other hand, markedly obese recipients also have poor prognosis. After HTx, nutritional management is also significant in the control of atherosclerotic risk factors and prevention of allograft coronary vasculopathies, and as a result, the realization of better long-term outcomes.

The concept of sarcopenia has been recently introduced into the field of lung transplantation. In lung transplant recipients as well as patients on the waiting list for lung transplantation, there are many patients who meet the criteria of sarcopenia. Because of the poor outcomes in sarcopenic patients, measures should be taken, such as nutritional support and rehabilitation therapy in order to prevent various potentially lethal complications. We provide some data on patients undergoing lung transplantation as well as those awaiting lung transplantation in our institution.

Patients undergoing liver transplantation (LT) are often associated with secondary sarcopenia owing to malnutrition, liver failure, and surgery. However, the impact of sarcopenia on outcomes after LT was unclear until several years ago. Therefore, we investigated the present status and significance of sarcopenia in patients undergoing LT. Based on the findings of our study, we revised our criteria for LT, considering sarcopenia and body composition, and started aggressive interventions, including perioperative nutrition therapy and rehabilitation for patients undergoing LT. As a result, the 1-year overall survival rate has dramatically improved to 98%. In this review, we introduce our efforts and innovations focusing on the significance of sarcopenia in LT.

Sarcopenia is a phenomenon of aging, while sarcopenia found in kidney transplantation (KT) is a secondary sarcopenia due to chronic kidney disease (CKD). The prevalence of sarcopenia is higher in elderly and cadaveric KT patients. The deficiency of vitamin D and uremic condition are mitigating factors for sarcopenia in KT patients. Exercise and vitamin D administration reveal a certain level of efficacy in the prevention or treatment of sarcopenia in CKD patients. Unfortunately, it has not been clarified whether exercise and vitamin D administration are effective in KT patients with sarcopenia.

Intestinal failure is a condition in which digestion and absorption functions are significantly impaired and homeostasis cannot be maintained. Patients with intestinal failure have many of the factors that cause sarcopenia. It is reasonable to think that intestinal transplantation is part of intestinal rehabilitation and is expected to become one of the approaches to overcome the disadvantages of intestinal failure. The short-term results of intestinal transplantation in the local setting are better than those overseas, and intestinal function is maintained when the transplanted intestine is engrafted. However, graft rejections have occurred, and it is difficult to say that subsequent nutritional status is totally problem-free. Keeping the graft in good condition with rejections controlled is key to improving nutritional status.

【Objective】 Focal segmental glomerulosclerosis (FSGS) often develops rapidly and frequently progresses to renal failure, while the recurrence rate after kidney transplantation is 20-50%. We performed low-density lipoprotein (LDL) apheresis and administered rituximab before kidney transplantation in FSGS patients to prevent recurrence.

【Design】 Retrospective observational study.

【Methods】 Six adult patients with chronic renal failure due to FSGS undergoing living related donor kidney transplantation were investigated retrospectively. LDL apheresis was done 2 times and a low dose of rituximab was administered before transplantation. Postoperative renal function and recurrence of FSGS were assessed.

【Results】 The patients were four men and two women aged 21 to 40 years. The observation period ranged from 6 to 31 months. Blood LDL cholesterol levels were normal before LDL apheresis, and remained normal both after LDL apheresis and after kidney transplantation. Additional LDL apheresis was performed once in one patient with mild proteinuria after transplantation. The renal graft survived in all patients and there was no evidence of recurrent FSGS.

【Conclusion】 Although the observation period was short, FSGS did not recur in any of the 6 patients receiving preoperative LDL apheresis and rituximab. These results suggest that the combination of LDL apheresis and rituximab can be effective for preventing recurrence of FSGS after kidney transplantation.

We present our experience of successful kidney transplantation from a cardiac death donor with period of anuria for 164 hours. The donor was a woman in her thirties who was diagnosed as having incurred brain death due to suicide by hanging herself and had been anuric for 164 hours before cardiac arrest. A 46-year-old man received a deceased kidney transplantation, and the renal graft showed prompt urination on postoperative day (POD) 1. He got off hemodialysis on POD 9. His serum creatinine level was maintained at as low as 1.0 mg/dL 9 months after the surgery. In the face of a serious shortage in the donor pool, this anuric case indicated that acute tubular necrosis in a deceased donor due to a prolonged agonal stage might not be a contraindication for kidney transplantation.

【Introduction】 The substantial improvement of patient survival after organ transplantation leads to frequent occurrence of de novo malignancy during the long-term follow-up period. Among such cases, however, one has rarely been reported for pancreatic cancer. Herein, we report two cases of de novo pancreatic cancer after living donor liver transplantation (LDLT).

【Case 1】 A female in her 60s who underwent LDLT at 55 years of age due to alcoholic liver cirrhosis was diagnosed with asymptomatic diabetes mellitus 4 years postoperatively. A month later, a CT scan revealed pancreatic cancer with multiple liver metastasis; no tumor had been detected by CT performed 3 months earlier as part of an annual systemic work-up. The main lesion and liver metastasis was quite rapidly exacerbated despite aggressive chemotherapies. She passed away 4 months after the diagnosis.

【Case 2】 A 60-year-old male who underwent LDLT for decompensated liver cirrhosis type C at the age of 53 exhibited a rapid deterioration of glycemic control at 13 years post-LDLT. Pancreatic cancer without distant metastasis was detected by CT examination. Distal pancreatectomy was performed one month after the diagnosis. Histopathological examination revealed a pancreatic cancer with serosal and retroperitoneal invasions and adjacent lymph node metastasis. Peritoneal dissemination occurred 2 months after the operation, and the patient died 3 months after the distal pancreatectomy.

【Conclusion】 De novo pancreatic cancer is a rare complication after liver transplantation. However, the lesion evolves quite rapidly and the patient with this disease dies within short time period. An early detection based on a clinical sign such as hyperglycemia rather than annual systemic work-up is mandatory for a better outcome. Heavy smoking and/or drinking history may contribute the occurrence of post-transplant pancreatic cancer.