Under the current situation where the number of surgeons is expected to continue decreasing, the activities of women surgeons are indispensable for transplantation medicine. However, it is difficult for women being pregnant or parenting small children to take part in brain-dead-donor lung transplantation. Other women doctors also feel physical handicaps when carrying heavy equipment for donor surgery. The weight reduction of equipment and local procurement should be mentioned as future issues.

In Japan, the Act on Promotion of Women’s Participation and Advancement in the Workplace was enacted in August, 2015. Thereafter, woman’s participation has been focused on in the field of medicine. However, the number of surgeons, especially in the transplantation field, is few. As a transplant female surgeon, I have been working for more than 15 years. As a rare case, I would like to write about my career history first, and then I would like to comment on how to work as a transplant surgeon for younger generations.

In recent years, the working environment of women in Japan has changed dramatically. According to a report from the Ministry of Internal Affairs and Communications in 2018, 44% of the total working population is women, which has been on an upward trend since 2012. In the medical field, the proportions of female doctors and dentists are both 20%. However, in total, about 80% of women are in the workplace, which has the highest proportion of women among all occupations.

Only 6% of the number of doctors certified by the Japanese Transplant Society is female doctors. In the results of a questionnaire survey to female surgeons and urologists, the economic power of the female doctor was low compared with that of the male doctor, and women doctors don’t have time for their hobbies or fun because of child-rearing and housework. Transplantation care for patients is performed not only by doctors; many female workers such as nurses, coordinators, pharmacists, nutritionists, and case workers play a role. So, we have to create an environment in which women can work with life satisfaction.

The most important factor in preventing the career development of female medical professionals is the employment gaps associated with childbirth and child-rearing. In order to enable continuous work, it is necessary to choose a good environment for themselves. This means knowing for themselves whether there is a diversity of support and work styles in the workplace, and to choose such a workplace. In addition, it is necessary for the employer to actively engage in task shifting and build up an environment for workers’ work-life balance. We, transplant surgeons, reaffirm that our medical system is capable of workshare, and should create a system that allows women to pursue becoming a transplant professional.

【Objective】 During the time before and after pediatric liver transplantation, it is necessary to support not only the medical aspects, but also to understand other concerns in life, providing information in anticipation of daily life situations. Few studies have explored what types of postoperative support are appropriate for either the recipient or the parents. The aim of this study was to clarify the specific support requirements for parents of a pediatric liver transplantation patient, before and after transplantation.

【Methods】 During the study period, 262 liver transplant recipients and their parents at the National Center for Child Health and Development (excluding patients older than 18 years or those living abroad) were asked to respond to an anonymous survey about the patients’ need for support directly before and after surgery.

【Results】 Responses were obtained from 173 of 262 parents (participation rate: 66.0%). Response frequencies for each type of support and concern required before and after transplantation were classified into six items. The type of support needed and the concerns in descending order of importance were: medical issues, psychological support, life-stage events, being understood by others, children’s development, and others. The medical issues and psychological support accounted for 60%. In addition to these responses, various opinions such as those regarding the social security system were submitted.

【Conclusion】 Our results suggest a framework of support needs before and after transplantation, viewed from a broad perspective. Among them, medical issues and psychological support were particularly high in support needs from parents, and the necessity of support during times of transition. Further study is needed to deepen our understanding of the recipients’ needs and to improve the current support system.

【Objective】 To investigate the efficacy and safety of rehabilitation program in patient with end stage liver disease before living-donor liver transplantation.

【Design】 case-series report.

【Methods】 We investigated thirty patients waiting for living-donor liver transplantation who had undergone a rehabilitation program for one week or more, which was conducted by physical therapists and consisted of light to moderate intensity muscle strengthening and aerobic exercise. Before and after the program, we evaluated aerobic exercise capacity and muscle strength (hand grip and knee extensor force). In addition, we analyzed safety in regard to liver function.

【Result】 Knee extensor strength and 6-minute walking distance were significantly improved after a median period of 17 days’ rehabilitation (1.97±0.57 to 2.12±0.69 Nm/kg, p＝0.02 and 463 (389-505) to 493 (434-554) m, p＝0.01 respectively). There was no adverse event during exercise or negative effect on liver function.

【Conclusion】 The pretransplant rehabilitation program effectively and safely improved muscle strength and physical function.

Total pancreatectomy with islet autotransplantation is an ideal surgical procedure used to relieve chronic pain derived from the pancreatitis, while insulin-dependent diabetes is inevitably induced after the surgery. Islet autotransplantation combined with a total pancreatectomy can reduce the risk of severe diabetes by preserving available islet cells. We experienced a case with hereditary pancreatitis, which is a rare inherited condition characterized by recurrent acute pancreatitis and/or chronic pancreatitis. The case was that of a female in her thirties who was introduced to our hospital due to treatment-refractory abdominal pain derived from repeated pancreatitis even after surgical treatments. At the introduction, the pain was uncontrollable even by opioid use, and oral intake was impossible due to increase of the pain after the intake. She was genetically diagnosed with hereditary pancreatitis. For relieving the pancreatitis-derived pain, total remnant pancreatectomy with islet autotransplantation was planned. After the pancreatectomy, islet cells were extracted from the excised remnant pancreas, and injected into the portal vein for liver autotransplantation. The pain was completely relieved for her after the surgery, suggesting improvement of her quality-of-life. A glucose tolerance test and glucagon loading test performed one month after the surgery showed C-peptide secretion as the blood glucose rose. However, the serum c-peptide level and SUIT index had been gradually decreased after the surgery, and she is now treated with insulin. The case suggested that total pancreatectomy with islet autotransplantation is useful for improvement of the patient’s quality of life by controlling the pain in cases with hereditary pancreatitis.